Monday, September 1, 2014

Fifteen Things Not to Say to a Person with Type 1 Diabetes

If you're like me, you have probably heard some or all of these things when you tell somebody you have diabetes. While this is more about type 1 diabetes, I'm sure most of them apply to any type of diabetes.

1) "But you don't look sick." That's because I'm not sick.

2) "But you're not fat!" Thanks, I guess, but that has nothing to do with my diabetes.

3) "Juvenile diabetes? Don't you grow out of that?" I'm sure many parents of children with diabetes would fervently wish it to be so, along with us diabetic adults, but no, you don't outgrow diabetes. (This is why I prefer "type 1" to "juvenile" diabetes.)

4) "You STILL have diabetes?" Why wouldn't I? Is there a cure I don't know about?

5) "Big Pharma found a cure for diabetes ages ago, but they're withholding it so that they can make more money selling diabetes supplies." Let me adjust your tinfoil hat for you. People who work for Big Pharma get diabetes. The children and other loved ones of people who work for Big Pharma get diabetes. If there were a cure, don't you think they would want to use it on themselves or their children? Besides, don't you think they would make just as much, if not more money marketing a cure for diabetes?

6) "Diabetes is a self-inflicted disease." Yeah, when I was four years old I told my pancreas to stop producing insulin just for fun.

7) "You just take insulin because you were brainwashed by your doctor/by Big Pharma into thinking you need it." Those have got to be some amazing powers if another person can convince my pancreas to stop producing insulin and make my blood sugar go up and down just with the power of the mind.

8) "You got diabetes because you ate too much sugar when you were a kid." Infants who have never consumed anything other than breast milk have been diagnosed with diabetes. Where did all that sugar come from to cause their diabetes?

9) "That will go away if you lose weight." How is that you know how to cure diabetes when so much money is spent on research every year to find a cure? Let me show you pictures of me when I was a child, just before I was diagnosed with diabetes. I looked like a famine victim. "Skin and bones" doesn't even begin to describe me at the time I was diagnosed.

10) "People with diseases like diabetes are a burden on the health care system and a drain on taxpayers." What would you prefer us to do — die?

11) "I'd DIE if I had to take needles every day!" Guess what. I'll die if I DON'T take needles every day.

12) "Didn't Halle Berry wean herself off insulin? Why don't you do that?" Let's not talk about Halle Berry unless we're discussing her movies or TV show. It's probable she never had type 1 diabetes in the first place.

13) "If we take pop machines out of schools, kids won't get diabetes like you did." My school didn't have a pop machine, and I still got diabetes. Besides, kids are resourceful. Even if you prevent them from getting pop at school, they're going to find it somewhere. I personally think it's better to teach kids healthy eating habits (and for parents to model them) and alternatives to drinking pop, regardless of their likelihood of getting any type of diabetes, than it is to turn something into the "forbidden fruit," which will just make it more attractive.

14) "Can you eat that?" Unless it's poison, then yes, I can. "You shouldn't be eating that!" Unless you are my doctor, I don't think you are qualified to tell me what I should and should not be eating.

15) "Are you going to die?" Yes. Everyone is going to die someday. Will I die of diabetes? I don't know. Let's just say I am trying my best not to, and leave it at that.

Monday, August 18, 2014

Adventures in misplaced pods

One thing I sometimes have trouble with, with my OmniPod is that sometimes I don't place it correctly and then it either comes off or it doesn't work in the first place. One time I put the pod on my arm upside-down, and the cannula didn't get inserted. I should have known there was a reason all the illustrations show the pod being placed in a specific way! Another time I dislodged my pod by towelling off too vigorously after a shower and I wound up with super-high blood sugar until I changed it. Yesterday I had a combination of both. It was mid-afternoon when the pod change alarm came, and I am trying to remember to rotate my pod locations so as to minimize the effects of the adhesive on my skin. I decided to put my pod on my butt, but I remembered that when the pod goes on the butt or the belly it goes sideways instead of up and down. Unfortunately, I was sitting in an awkward position and I didn't put it either straight up and down or straight sideways. It looked wrong, but the cannula inserted itself and my blood sugar was fine at 5.3, so I figured everything was okay. Later I sat down at the kitchen table to eat supper, and I felt and heard my pod go "whack" against the back of the chair as I sat down. I did a quick visual inspection and nothing seemed to be wrong, so I ate my pizza and delivered an extend bolus, all the while scolding myself for forgetting to order the lower-carb thin crust pizza. I then set about unpacking the moving boxes sitting in my living room in the hopes of finding all my cooking utensils so that I could cook myself a proper dinner next time and not order pizza. I did this for about two hours, until I noticed that I was awfully thirsty and that I had downed several glasses of Coke Zero in a relatively short time. I checked the PDM (pod controller/blood glucose monitor) to see if my extend bolus was finished. It was, and I did a blood test. Result: 19.1 mmol/l. Uh-oh. My question was: was this because of my pizza or because I hadn't placed my latest pod correctly? I decided to take a correction bolus and wait an hour or so to see whether my blood sugar came down. Only when I sat down at the table to look up something on my laptop, the pod whacked against the chair again, and this time I could tell that the cannula had come out. Oh, well. A waste of insulin, but at least I'd learned my lesson about proper pod placement. I got out a new pod and realized that I didn't have enough insulin to put my usual 150 units into my new pod, but I figured I had enough to last me overnight and then I'd go get a new vial of insulin in the morning. However, it turned out that I didn't have enough insulin to feed the pod. Good thing the drugstore is open till midnight (it was now around 10:30 p.m.) I called a cab and hurried off to the drugstore. Happily, I had already ordered my insulin refill and it was waiting for me at the counter. I paid for the insulin, sat down and changed the pod. I also checked my blood sugar again. Result: 22.1. Ouch. I took a bolus of 15 units. The pod controller recommended a lower dose, but it believed I still had insulin in my system from the previous bolus that I'd taken before I knew the pod hadn't been placed correctly. I got the bus home and arrived around 11:30. My blood sugar had gone down to 18. Certainly better than 22, I guess, though still a lot higher than I was comfortable with. I felt a bit sick to my stomach, and I was worried that DKA was going to land me in the hospital (I've read that if you have nausea and vomiting when you have ketones, you should go to the hospital) but then I let out a huge belch and realized I'd just had gas from all the Coke Zero I'd been drinking! I curled up in bed with my cat and a good book. Two hours after my bolus of 15 units, my blood sugar was 16. By now it was 1:00 in the morning so I decided to just go to sleep. I didn't sleep well, unfortunately; maybe too much adrenaline was left over from my rush to the drugstore? However, when I got up at 8:00 my blood sugar was a perfect 4.8. I think I will not use that site for a pod placement again. I'll stick to my arms, legs and stomach. I don't want to risk another pod getting dislodged when I sit down in a chair.

Monday, April 14, 2014

Day Three of Podding

My third day of using the OmniPod didn't go so well. This is mainly due to my having trouble working out how the extended bolus works.

When I eat food that is high in fat, it keeps my blood sugar from rising for awhile. The extended bolus is meant to help with that by holding back some or all of the insulin bolus for however long the user specifies. My big problem has been in figuring out how long that is. On Saturday morning I ate a banana muffin with peanut butter, and when I took a bolus for it my blood sugar dropped right away and then increased significantly a couple of hours later.

On both Saturday and Sunday I ate a burger and fries for lunch. On Saturday I programmed my extend bolus for two hours, only to have a high blood sugar by the time the pod gave me the bolus. The next day, Sunday, I programmed it for an hour and a half, and again I had high blood sugar by the time of the bolus.

Because of the high blood sugar, I did something stupid. I had a high fat coffee drink at Starbucks but I gave myself the bolus right away -- at the same time the pod gave me the extended bolus from lunch. This resulted in my blood sugar crashing in the middle of Wal Mart -- not surprising, really. I temporarily suspended insulin delivery and ate some candy that I keep in my bag for emergencies.

The rest of day three was uneventful until a couple of hours before bedtime, when the pod suddenly emitted an alarm. Turns out that the insulin reservoir was low. I probably would have had enough to last the night, but I didn't want to risk either going into ketoacidosis overnight or being rudely awakened by another alarm. I decided to change my pod early.

I was nervous about doing everything on my own, since the first time I applied a pod I'd done it under the watchful eye of Nicola the pump trainer, but I had a handy "quick start" guide that was easy to follow. Changing the pod wasn't as difficult as I had feared.

Today I am going to try to find food that isn't as high in fat if I happen to be downtown at lunch time, but I am going to have to figure out that extended bolus eventually if I want to eat pizza ever again.

Saturday, April 12, 2014

Day 2 as a Pod Person

My first day as a pod person had its ups and downs, or at least my blood sugar did. After my blood sugar had been high all morning, the PDM finally suggested a correction bolus to bring it down.

When I was finally down to a blood sugar in the single digits I ate a chocolate bar. The PDM then suggested a bolus for the chocolate that was a bit more than I thought I needed, but I accepted the bolus. That was a mistake, as I wound up with hypoglycemia at a blood sugar of 2.4.

However, a glass of Coke and another chocolate bar brought it back to normal. I then had to figure out how to keep it up. At first I thought I would reduce my basal rate, but I soon found the "suspend" function, and I suspended all insulin delivery for the next 90 minutes, until I had supper.

I spent most of my evening working on my new house, and I noticed my blood sugar was dropping quite quickly. Time to suspend basal insulin again. Another hour and my blood sugar had increased, so I turned on the basal once more.

I slept like the proverbial log last night, completely unaware of the pod on my arm, even when I was lying on it. The biggest change I noticed was eating without doing an injection. For more than 40 years I have done an injection at breakfast time, and this morning all I had to do was push a couple of buttons on my PDM -- fewer buttons than you would push to send a text message.

Obviously I am still getting used to setting my insulin dose on the PDM. I think my peaks and crashes on day one were due to a combination of miscalculation of carbohydrates and more activity than I was anticipating, along with the learning curve on the pump. I think I'm getting there, though, and soon I will be an expert pod person.

Friday, April 11, 2014

First Day on the Pod

Today is my first day using an OmniPod. I was very excited and found it hard to sleep last night, or maybe I couldn't sleep because my endocrinologist had instructed me to not take my Lantus long-acting insulin last night, so high blood sugar kept me awake all night. At about three in the morning I checked my blood sugar and took two units of fast-acting NovoRapid. Those were gone by the time I got up at seven and had a blood sugar of 15. I met my pump trainer, Nicola, at a local restaurant. She's very nice. She showed me how to activate my PDM (personal device manager) and program in my basal rate and my carbohydrate-to-insulin ratio, which is now 10 to 1. (My endo had originally set it at 12, but Nicola and I decided to take the middle ground between 8 to 1, which I had been using, and 12 to 1, which Dr. Miller said to use, and set it at 10 to 1.) I input all the information, filled the pod, activated it and stuck it on my left arm. When I put on the pod for the first time it felt very similar to an injection, but as I've been doing injections for 40-plus years, that's not a problem. I'm fine with going from four injections a day to one injection every three days. Unfortunately my blood sugar has been high all day. I think it's a combination of the lack of long-acting insulin in my system and probably miscalculating the carbohydrates in my breakfast. (A breakfast wrap with a side of hashbrown potatoes.) It's coming down, but very slowly. I've had to resist the temptation to just grab my insulin pen and inject a bolus to bring down my blood sugar. I skipped lunch because I had breakfast very late and because my blood sugar was so high. For supper I intend to eat something for which I know the carbohydrate count for certain so that I know how much insulin to tell the pod to give me. Maybe I can avoid getting high blood sugar again (or avoid keeping it high.)

Sunday, March 16, 2014

Reviving the Diabeteblog: learning to carb count

I haven't posted in this blog for years, but I've decided to try giving it another go. I am about to acquire an OmniPod insulin pump, and I want a place to record my experiences. I am trying to find a way to change the name of this blog from "Diabeteblog" to "Diary of Pod Person" but I haven't found a way to do so, so far.

Because I am getting an insulin pump I decided it was finally time to learn how to count carbs. I'd tried it once before, but I gave up before I got very far. I generally guess-timated the amount of insulin needed for the food I ate; I was pretty good at judging this for things I ate every day, but not so much for things that I ate only once in a while. I was determined to learn carb-counting once and for all, though, because I would need it for the Omnipod. I started out with breakfast: muffins from the bakery at Save-On-Foods. The package gave me all the information I needed. Each muffin contained 48 grams of carbs. I tried four units of insulin one day, six the next and eight the next. Six turned out to be just the right number.

My next food was cereal. I measured one cup of Cheerios and half a cup of blueberries. The carb count for the cereal was on the box, but I had to look up the blueberries. Since the muffins had worked out at six units for 48 grams of carbs, I decided to take one unit of NovoRapid for every eight grams of carbs. Success!

These days every time I go to a restaurant I ask for nutritional information for the food. I've started asking my boyfriend to take me to Milestones for special occasions because they have a special card that contains the carb count, calorie count, fat grams etc. for all of their dishes. I found that A & W has something similar posted on the wall of their store at the Bay Centre. Starbucks drinks and menu items can be easily found with a Google search on my smart phone, so I know exactly how much insulin I need to take for my tall cinnamon dolcé latte (four units, by the way.)

Some foods are more difficult to judge. I failed badly when I had sushi because I had no idea how many cups of rice came with my meal, nor did I know how much sugar was in the sauce that was added to the rice or how much sauce was used. I have no clue how to measure cooked pasta. I definitely still have much to learn.

I'm noticing differences already, though. I'm not having lows nearly as often because I now don't have to guess how much insulin I need to cover that sandwich or this glass of juice. Also, now that I know the carb counts of the foods I eat most often, I'm making an effort to eat more lower-carbohydrate foods.

I definitely appreciate that the bakery at Save-On Foods labels all their products with carbohydrate counts. I now know how many grams of carbs are in one-eighth of a cake, and when I want some, I will cut the cake in half, then cut it into quarters, and then slice one of the quarters in half so that I have one-eighth of a cake. Before I counted carbs I'd have had a bigger piece.

My OmniPod arrives tomorrow, and then I have to get a pump trainer to teach me how to use it. I hope to chart my progress here. Wish me luck in becoming a pod person!

Sunday, August 7, 2011

Diabetes history

I was diagnosed with juvenile diabetes in 1973. I was five years old. There were no blood glucose meters. There was no A1C test. There were urine tests before every meal, and there was a fasting blood sugar done at the hospital every few months. Injections were done with a syringe, once a day, using Toronto insulin and Lente insulin. (I think I switched to two injections a day when I was 16.) The word "carbohydrate" was never mentioned; instead, we had food exchanges. Half a banana was one fruit exchange. (Half of what size of banana? Well, that was guesswork.) Half a cup of milk was a milk exchange. A certain amount of cereal -- not a lot of choice there, either -- was a starch exchange. The exact measurement was found in a book with some original title like "The Diabetic Diet." It had a blue and yellow cover and was spiral-bound.

There was some "diet" food available. I could drink Tab, Fresca or Bubble Up. There were a few sugarless candies available. That was until the Canadian government decided to ban saccharin. Suddenly there was no diet pop, no sugarless gum, no sugarless candy. I drank Kool-Aid prepared with Sugar Twin, which was cyclamate. There was no Equal or aspartame, no Splenda or sucralose.

I went to summer camp four times, sponsored by the Canadian Diabetes Association. There were three or four other diabetic kids my age in my hometown, and we all had the same doctor, who made an effort to get us together every so often, and we all travelled to camp together. Diabetes camp was really just like any other summer camp, with the exception that we all had diabetes and the counsellors had to carry emergency sugar supplies with them. We went swimming and boating, hiking and camping, made arts and crafts and had dances.

When I was 13, which would have been in 1981, I saw a blood glucose meter for the first time. It was about the size of a hardcover book, took a large amount of blood from your finger, and had a pointer on a dial that showed approximately what range your blood sugar was in. At that point we were still all doing urine tests, and four times a day there would be two campers assigned to do the tests for each group. Take two drops of urine, add ten drops of water, drop in a Clinitest tablet and watch the chemical reaction take place.

By my third time at camp, when I was 15, we were all using blood glucose meters -- Glucoscan or Glucometer. These were sophisticated machines for their time! They were now about the size of a paperback book instead of a hardcover. The lancing device was a nasty little thing called an Autolet. (See a picture of it here.) The drop of blood was still pretty big, and you had to wait 60 seconds (the machine would sound a buzzer) and rinse off the strip with a special bottle of water before putting it in the machine. It then gave you a digital readout. This was a big improvement over urine tests. Aspartame became available around this time too, and we now had sugar-free pop again, including Diet Coke. For the first few years, though, products made with aspartame were more expensive than their sugar-containing counterparts.

When I was in my teens I had to spend some time in the hospital. I got my tonsils out, was admitted for nausea and vomiting because I couldn't keep my blood sugar under control when I couldn't eat, and had dental surgery. Each time I was admitted, I wound up teaching the nursing staff how to use the blood glucose monitor and how to mix two types of insulin in one syringe so that I didn't have to take extra needles.

By the time I was in university I was taking two shots a day -- still Lente and Toronto -- and the blood glucose monitor was now the Glucoscan II (image) and no longer required rinsing. Now it used a slightly smaller drop of blood. It still required a countdown, but now you had to blot the blood on a special pad before inserting into the machine. It was still about as big as a paperback book.

When I finished university in the early 1990s my insulin changed from beef-pork insulin to synthetic "human" insulin, or Humulin. I now took Humulin R and Humulin L, and a newer blood test machine that now read in mmol/l instead of mg/dl and required neither rinsing nor blotting of the strips. (Sadly, I can't remember the name.) Unfortunately, it was around this time that I became unemployed and had to go on welfare. Due to a poorly informed case worker and my being so shy and timid that I didn't dare speak up for myself or contest what I was told, I was left with the impression that my diabetes supplies would not be paid for by the welfare program, and I wound up reusing my syringes, taking as little insulin as I could get away with, and never testing my blood sugar. To make things worse, the company making my blood glucose meter discontinued it, and the strips were soon impossible to find.

Fortunately, in the mid-90s I discovered the diabetes clinic at the Royal Jubilee Hospital, and I also got a better caseworker for the welfare benefits. The diabetes clinic supplied me with my first One Touch blood glucose meter (image), and the caseworker got my medical supplies paid for.

One day around 1995 or so, I went to the pharmacy to pick up my prescriptions as usual, and the pharmacist asked me if I would like to try an insulin pen made by the Novolin company. I was intrigued by this new device. Sadly, there wasn't one for Lente insulin, but I started using it for my Toronto insulin. In 1997 I went on disability, which guaranteed that my medical benefits would stay in place.

It was in 1999 that I changed insulin for the first time since 1973. I switched from Lente to NPH insulin. Now I could use an insulin pen for that insulin too. A few years after that, in the early 21st century, I changed from using Toronto (Regular) insulin to NovoRapid. A few years after that, I went on Lantus insulin. My cat was also diagnosed with diabetes, of the feline variety, and now we both take Lantus -- me once a day, and my cat twice a day. I also went through a few more glucose meters, all from Lifescan -- the Fast Take, the Ultra and the Ultra Smart.

Today I am no longer on welfare or disability. I have a job now. I still use insulin pens, and now I use a One Touch Ultra Smart for my glucose meter, alternating with an Ultra Mini that I carry in my purse for convenience. I've tried almost every diabetes gadget under the sun except for the insulin pump and the continuous glucose monitor, both of which are out of my price range and neither of which is covered by public medical insurance and the medical benefits I get from my job only go up to $500 a year.