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type2diabetestreatments-blog · 7 years

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"Golden Rules" for Living with Type 1 Diabetes

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"Golden Rules" for Living with Type 1 Diabetes

One of the best resources for learning about diabetes and connecting with other PWDs (people with diabetes) locally can be summed up in five letters: TCOYD.

That would be Taking Control of Your Diabetes, the national educational conference series founded by endocrinologist and longtime type 1 Dr. Steven Edelman in San Diego. He's not only a super-knowledgeable clinician and researcher, but a really funny, passionate guy who infuses these day-long seminars with energy and inspiration. Seriously, everything I need to know about diabetes I learned at TCOYD.

For the past dozen years, I've had the privilege of speaking at my local Santa Clara event, that brings in about 1,000 patients for a full day of talks, panels, activities, a product expo and a banquet lunch -- all at the affordable price tag of just $20 per person!

This year, I was honored to be on a very cool opening panel for the Type 1 Track led by another awesome accomplished endo + type 1, Dr. Jeremy Pettus (who shared his smarts on alcohol and diabetes with us here).

Our panel was titled, "Golden Rules for Type 1s: Tips for Living Well with Diabetes," and included Dr. Bruce Buckingham of Stanford, Dr. Christine Ferrara of UCSF, Adam Brown of diaTribe, and Yours Truly from the 'Mine.

I think the audience really appreciated that we weren't trying to act as if we had all the answers, but rather just talking turkey about the realities of the hour-by-hour challenges of T1D. I thought you all might enjoy hearing the answers I prepared for this session, which aren't exactly "golden rules" but my own personal best practices, such as they are...

TCOYD) Do you have an overarching philosophy with your approach to managing your diabetes?

Amy) Do just enough to stay in decent control while STAYING SANE.

Has this philosophy changed over time?

It’s only grown stronger. Not having regular meltdowns over diabetes issues is an ongoing effort.

What would you say is the most important thing that has made a difference in your type 1 life and helped you keep on track? Inner strength/approach? A healthcare provider? Family members? Your job?

The support of my family for sure, and to a large extent exercise -- which makes me feel good physically and psychologically.

I also think it's super important to connect with other PWDs for sanity checks (TCOYD is excellent for that!)

What therapy or equipment has made the biggest difference in your life (CGM, pump, rapid insulin)?

I would say the OmniPod tubeless pump and Dexcom CGM. I love being able to pump with no dangling cannula, and the CGM has been a huge game-changer in just being constantly aware of what's happening in my body. I've also been using Afrezza inhaled insulin for the past year and have found the biggest advantage of that is having less complexity with IOB (insulin on board).

As you know, injected insulin sticks around in your system for four hours, whereas Afrezza is in and out in 1.5 hours. That means way less chance of insulin stacking, going low during exercise, nighttime lows, and more.

How important, or not, has a healthcare provider been in your success?

From my POV, the priority is that your HCP does NOT annoy / judge / misunderstand you / dismiss your concerns. You need to be comfortable and feel respected with that person! I have been fortunate to find such a doctor, although I must admit I don't see her all that often.

When everything goes to shit, what is usually the reason? Travel? Life stress? Change in diet? And what do you do to get back on track?

Travel and lack of sleep are huge for me; they usually go hand-in-hand. For that, I do my best to eat as low-carb as possible and check often, plus correct often.

Laziness / procrastination are also big factors. There are lots of times when my pump is beeping that it's time for a pod change or my CGM is alarming high, and I just don't want to deal with it immediately. I don't want to have to drop what I'm doing. But the results are almost always bad. I chalk this one up to being human.

Finally, my period does wonky things to my BG levels that are hard to predict. For the Ladies reading this: am I right? Hormonal cycles have a strong effect on blood sugar, an issue that's not discussed or explored enough.

How do you deal with exercise? Does it help your BGs or make them worse?

It’s constant trial and error. I have some set Temp Basals that I use regularly for spin class, aerobics, kick boxing, hiking and other workouts, but they’re far from fool-proof. To me, the most important thing is not to have to eat a bunch of empty calories I’m not hungry for -- in other words, to avoid going low at all costs, which often means I end up high after exercise and have to spend several hours at least chasing those highs. Come to think of it, I could use some improvement in this area.

What's your approach to food? Do you eat whatever the hell you want and just bolus for it, or do you avoid certain foods? Do you have any additional dietary restrictions?

I’m also gluten-intolerant, which is a pain in the rear, but it helps keep me very low-carb. I try to eat as low-carb as possible without making myself miserable -- meaning I try to do "just a taste" of the carby foods I desire most (which for me is mainly tortilla chips and granola bars).

Overall, I just eat a lot of protein and veggies, mostly salads. Thank God I actually like kale 🙂

How involved, or not, is your significant other in your diabetes? Do you want them more or less involved? If you could tell them one thing to change, what would that be?

My partner is very supportive, but not at all involved in the daily nitty-gritty. That's usually how I like it.

If I could change one thing, I guess I wish that instead of peering over my shoulder every once in a while to ask something like, "175, wow isn't that kind of high?," he would periodically ask a broader question, like, “Hey, how’s it going with your diabetes?” and then just listen to whatever I feel like sharing -- without necessarily trying to "fix it."

What do you LOVE to eat when you are low?

Raisins! I loved to eat lots of dried fruit before I got diagnosed, and had a hard time giving that up. Now I buy copious amounts of those little red snack boxes of raisins. Did you know the mini-boxes come in chocolate-covered and yogurt-covered varieties now too? Yum!

I stash them in my car, purse, nightstand, kitchen, suitcase, etc.

I stock up so much that one day when I had a bunch of six-packs piled in the backseat of my car, I picked up my daughter and her little friend asked, "Does your mom sell raisins?!"

Tell us a time that you have used type 1 to your advantage?

This is a hard one to admit, but I've definitely used it to get to the front of a buffet line. When I get really hungry, it feels like a low, even if my BG isn't dipping too badly. If you tell people you have type 1 diabetes and need to eat now, they're usually accommodating.

I've also had my doctor write me a letter to avoid jury duty. She actually encouraged me to get out of it if possible, because it really is tough if you get stuck there for weeks on end -- in terms of being able to eat right, exercise, etc. (Before you get judgy, know that many PWDs have gone this route.)

What does "being in control" mean to you? Is it an A1C? No hypos? Time in range?

I would say an A1C of 7.4 or less WITHOUT FREQUENT HYPOS.

My good friend Dr. Richard Jackson of Joslin Diabetes Center always encouraged me to think of "good control" this way -- not as pressure for ever-lower A1Cs, but maintaining a decent level without frequent lows, which shows that you are actually staying "in range" most of the time.

Tell us about your approach to complications. If you have them, how do you deal with them? If you don't, how often do they enter your mind?

I don’t have any yet, knock on wood! But I do think about them often – especially for eyes and feet, which are my “weak spots.” Gotta get those screenings regularly!

Give us a parting piece of advice to others on how to make life with type 1 better?

I’d return to my overarching philosophy: “Do just enough to stay in decent control while STAYING SANE.”

Sanity in this case means allowing yourself slip-ups, and taking time for family, friends and activities you enjoy (and occasional food splurges) WITHOUT FEELINGS OF GUILT.

So Dear Readers, got any "golden rules" of your own to share?

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.

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type2diabetestreatments-blog · 7 years

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Ask D'Mine: Insulin Stones and a Surprise at the Hospital

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Ask D'Mine: Insulin Stones and a Surprise at the Hospital

Happy Saturday! Welcome to another edition of our weekly advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois, where our goal is to always "tell it like it is" — no matter what! We're glad you're here!

Need help navigating life with diabetes? Email us at [email protected]

Megan from Nevada, type 1, asks: Can you tell me how this whole "giving yourself a small dose of Lantus so you can disconnect your pump for a few hours" works? How would you calculate the right amount of Lantus when you haven't been on long-acting insulin for a long time?

Wil@Ask D'Mine answers: You bet I can! It won't work at all. Now, moving on... What? Oh. Sorry. Amy says I need to give you a little more detail than that.

OK, so here's the deal, Megan. You can use Lantus to help you take a pump vacation—for days, weeks, or months — I guess even for years, if you wanted to. But Lantus is ill-suited for taking just a few hours off. Here's why: Lantus is a 24- hour time-release insulin. Well, technically it's insulin that's been manufactured to be more acidic than the body. When you inject it into your pH-neutral body, it "microprecipitates," basically forming little lumps of insulin, like friendly gallstones. The stones then dissolve a little at a time over a day or so, slowly releasing the insulin into your blood.

The bottom line here is that you can't un-inject a Lantus shot, and any shot you take will last 24 hours. So you can't realistically use Lantus to cover for your pump for just a few hours because you'd overdose on insulin once you hooked back up (the Lantus would keep dissolving away, and the pump would be feeding fresh fast-acting insulin in on top of it). I guess you could un-hook, take Lantus, hook back up, and then suspend your pump for the rest of the day... but it hardly seems worth it.

If you just want to be off your pump for a few hours for some hot tub action or whatever, the better choice is to probably (depending on your blood sugar level), look at your basal rates over the time you want to unhook, add up the insulin you will miss, take some of it before, and then add the rest of it back in when you hook up again.

But if you want to take more than just a few hours off, I can help you out with that, too. You've probably forgotten by now, but the initial settings for your basal rate were calculated by your pump trainer by taking 80% of your total daily basal insulin dose, dividing by 24, and plugging that number in as a units-per-hour drip. Of course, since then, you've modified your basal a great deal, adding steps up and steps down to fine-tune the basal delivery to your body's needs. But you can still reverse-engineer the original math to convert from pump back to Lantus.

Start by finding the total daily dose of basal insulin on your pump. For instance, on a Medtronic pump, go to Main Menu > Basal > Basal Review > and right at the top of the screen you will see your 24-hour total. Mine happens to be 22.05 units a day. So if I wanted to metaphorically chuck my pump in the trash, I'd take 22.05 x 1.2 (increasing by 20% to reverse-engineer the original reduction of 80%) = 26.46. I'd round down in this case, as a half-unit of basal insulin is meaningless, and take 26 units of Lantus. If you're more insulin resistant and need more than 40u of basal at a time, the current thinking is to take half of it in the morning and half in the evening so the body doesn't have quite so many "insulin stones" in one place at one time.

(FYI: on the OmniPod, go to Home > My Records > Insulin Delivery, and then use the down arrow to look at the last full day to get your total daily basal—accurate so long as you didn't use any temporary basal rates that day.)

By the way, the onset of action of your first Lantus shot is around five hours. Everyone likes to think of it as "peakless," and that's more or less true, but only after the second shot. The first one takes some time to get to work. After that, the next shot's spool-up time is overlapped by the previous shot's tail. If you take Lantus at the same time every day, you end up with an effectively peakless day-to-day basal insulin coverage. In terms of switching from pump to Lantus, the last drip of basal from the suspended pump will last four hours, so it's dying off as the Lantus spools up. You might see a small bump in your blood sugar level during the switch-over, but it won't be anything dramatic.

Joel from Vermont, type 2, writes: I turned 59 at the end of December, and was admitted to the hospital for an infection in my right index finger. There I found out I am diabetic (644 blood sugar level). Could there be any connection between the two?

Wil@Ask D'Mine answers: No causative connection. In other words, there's no way in hell your finger infection caused your diabetes, and there's no way in hell the diabetes caused the finger infection.

But there might be a more subtle connection between the two.

I'd wager a box of doughnuts that you've had diabetes quite a bit longer than you think you have. It would be a safe wager for me, 'cause type 2 is a sneaky bastard that lurks around in the shadows for a long time before it's discovered. People who have diabetes but don't know it yet, tend to have higher blood sugars. And people who have higher blood sugars tend to heal badly.

Ah-ha!

So... a finger infection sent you to the hospital? It must have been one nasty infection. One that didn't want to heal. One that was gorging itself on all that spare sugar in your blood. One that didn't have to worry too much about your white blood cells (essential for healing) because there were stuck in a traffic jam trying to get to the site of the injury (high blood sugar retards both the action and distribution of white blood cells).

So the only connection is that your already-growing diabetes made it hard for your injured finger to heal. Which led you to the hospital. Which lead you to your diagnosis. Which was a very good thing indeed, and I think you should thank your lucky stars that you injured your finger in the first place. That infected finger lead to the most important day of your life: Diagnosis Day.

Hey, the diabetes was there. It would have been discovered... eventually. But the longer it went undetected, the more havoc it would have had a chance to wreak in on your body.

When it comes to diabetes, an early diagnosis is an early blessing. Now you can focus on learning what you need to keep it in check.

Oh, and the next time you injure your finger — by when you'll surely have your blood sugar levels in a more healthy range — odds are it'll heal just fine.

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

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