Comparing the Accuracy of My Blood Glucose Meters


I was first introduced to the One Touch Verio IQ when I began using an Animas insulin pump in May 2016. The sales rep gave me a rave review of this blood glucose meter, telling me that it was one of the most accurate on the market. This meter had also been recommended for calibrating readings on a Dexcom system, which is often considered the golden child of continuous glucose monitoring in the diabetes community.

At the time, I was quite happy with my FreeStyle Insulinx and had no intention of switching. However, the Verio was quite a good looking meter and certainly more modern than any of the other devices I was using. So, I ended up placing it in my travel case and decided that I would use it as my spare.

As wonderful as the encasing, color screen, and rechargeable batteries were, my biggest deal breaker in using this meter was its accuracy. I have consistently found that the One Touch Verio reads at least 0.5 mmol/L (9 mg/dL), if not 1 mmol/L (18 mg/dL) higher than each of my other blood glucose meters.

There have been times where I’ve felt lows coming on, only to check my blood sugar using the Verio and still see a reading within range. From my personal experience, this is not a meter that I can trust.

To be fair, all blood glucose meters will only be accurate to the nearest 1 mmol/L (18 mg/dL) of a laboratory result. Which explains why two simultaneous blood glucose checks will likely produce two different results.

Most blood glucose meters must have a mean absolute relative difference (MARD) within 15 to 20 percent of laboratory results. This standard deems these devices a reliable indicator of blood glucose levels and safe to dose insulin from.

Which blood glucose meter can I trust? I conducted an experiment of sorts at home comparing all of the blood glucose monitoring devices that I currently use. Pictured from left to right, these include FreeStyle Libre, OneTouch Verio IQ, Accu-Chek Guide, and FreeStyle Insulinx. (Note: The FreeStyle Libre is a flash glucose monitoring system that measures interstitial fluid, and produces a reading each time the reader is waved over the sensor worn on the upper arm.)

Given that any moisture or dirt on my hands can impact glucose readings, I washed and dried my hands thoroughly before lancing my finger and repeated this experiment three times.

  Lowest Reading Highest Reading Variance
Experiment 1 FreeStyle Insulinx (7.0 mmol/L) OneTouch Verio IQ (8.2 mmol/L) 1.2 mmol/L
Experiment 2 FreeStyle Insulinx (7.1 mmol/L) OneTouch Verio IQ (8.4 mmol/L) 1.3 mmol/L
Experiment 3 FreeStyle Insulinx (6.2 mmol/L) OneTouch Verio IQ (7.8 mmol/L) 1.6 mmol/L

The FreeStyle Insulinx produced the lowest blood glucose reading in each of my three checks, while the OneTouch Verio IQ produced the highest. Variances between the lowest and highest reading were fairly consistent, ranging from 1.2-1.6 mmol/L.

  Lowest Reading Highest Reading Variance
FreeStyle Libre 7.3 mmol/L 7.4 mmol/L 0.1 mmol/L
OneTouch Verio IQ 7.8 mmol/L 8.4 mmol/L 0.6 mmol/L
Accu-Chek Guide 7.2 mmol/L 7.6 mmol/L 0.4 mmol/L
FreeStyle Insulinx 6.2 mmol/L 7.1 mmol/L 0.9 mmol/L

When comparing the performance of each meter across my three checks, the Accu-Chek Guide reported the lowest variance among the standard blood glucose meters with 0.4 mmol/L. The FreeStyle Insulinx reported the greatest variance, with a 0.9 mmol/L difference between the lowest and highest reading.

I also decided to repeat my experiment a second time with an elevated post-meal blood sugar, as I had my suspicions that the variances might be greater.

Lowest Reading Highest Reading Variance
Experiment 1 FreeStyle Insulinx (10.3 mmol/L) OneTouch Verio IQ (11.5 mmol/L) 1.2 mmol/L
Experiment 2 FreeStyle Insulinx (10.6 mmol/L) OneTouch Verio IQ (12.7 mmol/L) 2.1 mmol/L
Experiment 3 FreeStyle Insulinx (8.7 mmol/L) OneTouch Verio IQ (12.1 mmol/L) 3.4 mmol/L

Once again the FreeStyle Insulinx produced the lowest blood glucose readings across my three checks, while the One Touch Verio produced the highest. Interestingly variances between the lowest and the highest readings ranged significantly higher than my first experiment, from 1.2 mmol/L to 3.4 mmol/L.

Lowest Reading Highest Reading Variance
FreeStyle Libre 11.1 mmol/L 11.3 mmol/L 0.2 mmol/L
Accu-Chek Guide 10.8 mmol/L 11.1 mmol/L 0.3 mmol/L
OneTouch Verio IQ 11.5 mmol/L 12.7 mmol/L 1.2 mmol/L
FreeStyle Insulinx 8.7 mmol/L 10.6 mmol/L 1.9 mmol/L

The Accu-Chek Guide again reported the lowest variance in each of my three tests, while the FreeStyle Insulinx reported the greatest variance. Interestingly, the OneTouch Verio and FreeStyle Insulinx showed significantly larger variances in this second experiment.

I thought it would also be interesting to compare the accuracy of each brand of test strip with laboratory results. This information can also be found on the information packets inside test strip boxes.

Glucose concentrations of less than 5.5 mmol/L (100 mg/dL):

  Within 0.3 mmol/L (5 mg/dL) Within 0.6 mmol/L (10 mg/dL) Within 0.8 mmol/L (15 mg/dL)
Accu-Chek Guide 94.1% 100% 100%
FreeStyle Lite 70.1% 95.5% 99.5%

Glucose concentrations of less than 4.4 mmol/L (75 mg/dL):

  Within 0.3 mmol/L (5 mg/dL) Within 0.6 mmol/L (10 mg/dL) Within 0.8 mmol/L (15 mg/dL)
OneTouch Verio 88.2% 100% 100%

Glucose concentrations greater than or equal to 5.5 mmol/L (100 mg/dL):

Within 5% Within 10% Within 15%
Accu-Chek Guide 71.5% 97.6% 99.8%
FreeStyle Lite 66.9% 91.1% 98.8%

Glucose concentrations greater than or equal to 4.4 mmol/L (75 mg/dL):

  Within 5% Within 10% Within 15% Within 20%
OneTouch Verio 71.1% 94.8% 90.0% 100%

All glucose meters were accurate within 15 or 20 percent of a laboratory result, likely meeting medical device regulations.

All meters showed greater accuracy among the lower glucose level classifications than higher ones. The Accu-Chek Guide also scored significantly better than the other brands at being within 5 and 10 percent laboratory result.

Interestingly, laboratory testing for the OneTouch Verio strips was classified differently from the FreeStyle Lite and FreeStyle Insulinx. The higher glucose level classification started at 4.4 mmol/L (75 mg/dL), compared to 5.5 mmol/L (100 mg/dL) for the other brands. In the higher glucose level classification, the Verio only reached near perfect accuracy at 20% of a laboratory result, compared to 15% for the other brands.

Feeling overwhelmed with all of this data? I think it is best not to get too caught up in the differences. Most meters are only accurate to the nearest 1 mmol/L (18 mg/dL), and two finger pricks will not guarantee you two identical results.

Stick with one meter that you feel comfortable with and that you feel you can trust. Ensure that your hands are clean and dry before lancing your finger and that you obtain a sufficient sample of blood. Finally, you will obtain more insight into your blood glucose data the more frequently you check your blood sugar. As the old saying goes, test early and test often!

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How to Use Average Blood Glucose to Estimate HbA1c


Checking blood glucose

By John Pemberton, Head Coach at Diabetic Muscle and Fitness and Diabetes Specialist Dietitian/Educator 

Do you have this essential diabetes management skill?

Most adults only get their HbA1c checked once a year, sound familiar?

This means you have an idea how things have been going for the previous 90 days, but what about the other 275 days?

The most effective way of keeping on top of your diabetes control is by regularly checking your average blood glucose (BG).

How Often Do You Check Yours?

Do you know how to use the results to predict HbA1c?

This table shows where your HbA1c will be very close to, depending on what level your average BG has been at for 90 days. The table also shows the benefits and consequences of having different levels of control for long periods of time.

What has your average BG been for the:

  • Last 90 days?
  • Last 30 days?
  • Last 14 days?

If you are currently in the red zone – don’t freak out!

This article is your wake up call. It’s time to take action. You can change this around very quickly, that is the beauty of using average BG to guide you.

How Do I Achieve Better Average Blood Glucose Levels?

Make small incremental changes to your daily diabetes habits and regimen. You can evaluate your progress by tracking the change in average BG every two weeks.

Top Diabetes Management Tips Based on 1000s of Hours Spent in Clinical Practice

  • Test BG at least five times per day – this allows you to correct high glucose levels more often.
  • Aim to be in target before bed; this means 8 hours per day of in target levels.
  • Bolus 15-30 minutes before food to prevent high glucose levels after, remember BIFF:
    • Blood test,
    • Insulin dose,
    • Fifteen minutes wait,
    • Food, eat it.
  • Keep to 3-4 meals per day, spread equally with 3-4 hours in-between.
  • This matches with the action of quick acting insulin (Apidra, NovoRpaid, Fiasp, Humalog) perfectly.
  • Frequent snacking makes in target glucose control very difficult.
  • Eat mixed macronutrient meals. Avoid carb only snacks, unless using for exercise management.
  • Review the patterns of your glucose trends every 14 days to identify where you need to change your habits and diabetes regimen.
  • Use a written log; there is a lot to be said for writing it down. Why? You process and identify patterns as you write.
  • Use an online platform where you can upload your meter, pump, and CGM devices:
    • Diasend & Glooko
    • They are both the same platform – they have just merged.

I personally use this platform and love it. I have even made guides and videos of how to set up an account, how to review control, and how to make changes in my day job as a Diabetes Specialist Dietitian. You can access these guides and videos here.

  • Use APPS such as MySugar and Diabetes:M
  • If you are struggling to identify solutions and find it hard to make changes, get professional help.

Your diabetes team or a professional with the requisite skills and qualifications should be able to guide and empower you.

If they just tell you what to do without teaching you how to do it, they are not setting you up for long-term success!

I work on the premise that as long as my average BG is less than 8.0 mmol/L (145mg/dL), I am all good.

If it’s above there, I need to focus on improving my control.

A special note: it’s no good having an average BG of 6.0 mmol/L (110mg/dL) if it means you are hypo all the time.

Research suggests having 3-4 mild hypos a week that you can treat yourself is usual for people with good control. But if more than this you are at risk of becoming hypo unaware. This research is from people on MDI and pumps who adjust their doses based on food intake and activity.

Being hypo unaware will mean you will not be able to drive (in the UK and most places if your physician knows or you call out an ambulance), and you will be at much higher risk of having a severe hypo. This is not a worthwhile trade-off for a HbA1c of 5.0%!

It’s all about balance.

Everyone is different, so set your target according to your circumstances.

As a general rule these are two good markers to aim for:

  1. Average BG less than 8.0 mmol/L (145 mg/dL).
  2. Less than 3-4 mild hypos per week, but no severe hypos and you can detect your hypos.

Checking average BG every 14 days will mean you stay in control and catch issues early! A Wiseman one told me: “If you’re not assessing, you’re guessing!”

Hope that helps!

References

  1. DAFNE Research Database Study

The Artificial Pancreas: What Is It and When’s It Coming?


 

You’ve probably heard about the artificial pancreas, but are you up to speed on what’s happening in this rapidly evolving field?

First of All, What Is It Really?

The artificial pancreas (AP) is a device that mimics the blood sugar function of a healthy pancreas. It has three parts: a sensor for continuous glucose monitoring, a pump to deliver insulin, and a laptop or cell-phone component that directs the pump to deliver insulin as needed.

Most systems will deliver insulin alone, but some will be able to deliver both insulin and glucagon*.

How It’s Different from CGM

Artificial pancreas systems are often called “closed-loop” because they talk to both the sensor and the pump, bridging the gap between the two. The goal is to make a continuous loop without the need for human intervention. In testing so far, AP systems have often resulted in more time in target glucose ranges with less hypoglycemia, and they have also shined in controlling blood sugars overnight. They are not a cure by any means, but they are a huge improvement and will allow for diabetes management to go a little more on autopilot in the near future.

50 Years in the Making

The first precursors of the artificial pancreas date back to the 1970s. In the 50 years since, improvements have been made on all fronts: control algorithms are getting more predictive and less reactive, and pumps and glucose sensors are getting more accurate. Yet many challenges remain, such as the need for faster insulin, more stable glucagon, and systems that can work without user intervention, e.g., during meals and exercise.

The Future Is Almost Here

In June of 2017, Medtronic launched the first commercialized product, Minimed 670G.

The Medtronic device is a “hybrid” system due to the need to manually interact for meals and exercise. Hailed as a major advance towards a fully-automated artificial pancreas system, the 670G will be followed by other closed-loop systems in the coming months and years, with more and more academic group and industry collaborations being announced.

MiniMed 670G

One such effort – the IDCL (International Diabetes Closed Loop) Trial – is another example of the degree of collaboration between academic centers and industry. Led by the University of Virginia in conjunction with centers in Europe, companies like TypeZero Technologies, Tandem Diabetes CareDexcom and Roche Diagnostics are also involved. Other companies like Insulet (Omnipod) and Bigfoot are developing AP systems as well.

If You Just Can’t Wait

Alongside conventional development of AP systems, “Do It Yourself” or DIY movements spearheaded by patient and engineering communities are gaining visibility with a reported 400+ PWD currently using DIY artificial pancreas systems. Initiatives such as DIYPS.org and #wearenotwaiting are providing information on the internet to help people with diabetes build their own AP systems using commercially available CGM and pumps while providing information on how to set up control algorithms.

These systems require a great deal of user learning and commitment. While probably not for everyone and regulatory authorities sending out caveats on the potential risks involved, they can be a way for people to access artificial pancreas technology now before other systems are cleared for use.

At the 2017 Taking Control Of Your Diabetes Conference & Health Fair in San Diego, there was a panel discussion with five people who experimented with DIY systems and shared their thoughts, advice, and personal experiences.  You can watch the seminar and hear what they had to say here.

As a result, we can expect several artificial pancreas options in the coming years, which is amazing news! Systems will differ, but the goal will be the same: to reduce the burden of living with diabetes until a cure is found. We look forward to seeing more and more options in this space, and send kudos to all involved for their perseverance, passion, and commitment!

*Glucagon causes the liver to release stored glucose, raising blood sugar levels. It can be used to treat severe hypoglycemia.

Supercharge Your Insulin Sensitivity Naturally with These 5 Proven Daily Routines


 

Insulin sensitivity refers to the biological response of target tissues such as muscle to the actions of insulin. In other words, insulin sensitivity refers to how well insulin performs its role of transporting and storing fuels in specific cells in the body, particularly glucose.

Insulin sensitivity varies between individuals and is reduced in people with diabetes.

Medication aside, lifestyle plays an important role in helping boost insulin sensitivity and prevent impaired tissue responses (insulin resistance), which, in turn, supports blood glucose disposal and improves diabetes management.

Lifestyle choices do this in a number of ways:

  • Strength training increases muscle mass which serves as a major storage house for glucose.
  • Walking and other forms of low-intensity exercise can reduce blood glucose.
  • Stress management including meditation and a good quality sleep pattern help control excess production of counterregulatory stress hormones, such as cortisol and adrenaline, which increase blood glucose levels.

All of the above help improve the action of diabetes medication and whatever is left of natural insulin production. Obviously, the effects of each lifestyle factor will vary depending on how often they are conducted, their intensity and, of course, inter-individual physiology and genetics.

Treat this article like an accountability checklist.

If you live with diabetes and aren’t following any of the five lifestyle behaviors listed, you might be missing a few tricks for improving health, managing your diabetes, and building that body you always wanted.

Daily Routine #1 – Perform at Least 20-45 Minutes of Anaerobic Exercise Every Single Day

Anaerobic exercise is defined as physical exercise that is intense enough to generate lactate.

You know you have generated lactate when you start feeling a burning sensation in your muscles. High rep squats and sprint intervals get you burning pretty quick. Strength training and high-intensity interval training are prime examples of anaerobic exercise.

The human body responds differently when trained with anaerobic exercise compared to aerobic exercise. The adaptions that occur to the muscle energy systems are of particular interest and benefit to people with diabetes.

Anaerobic training increases insulin sensitivity and stimulates skeletal muscle tissue to absorb glucose from the bloodstream independently of insulin. This is achieved through the stimulation of specific glucose transporters called GLUT-4. The more anaerobic work a muscle fiber has to contend with, the greater number of GLUT-4 rise to the surface of a muscle cell for the purpose of glucose extraction. Once glucose is absorbed from the bloodstream it is stored as muscle glycogen.

Increased insulin sensitivity is just one of the many benefits of anaerobic exercise. There are plenty more, which I will cover another time.

How often and how much anaerobic training should I perform?

Perform anaerobic training at least 3 times per week in the form of:

  • 20-60 minutes of strength training – whole body, body part splits, etc.
  • 10-20 minutes high-intensity interval training – skipping, spinning, battle ropes, sprints etc.

All of these training bouts will improve glucose uptake and improve blood glucose management in people living with diabetes.

Daily Routine #2 – Get and Stay Lean

It is well-established that high levels of body fat result from living in a calorie surplus for a prolonged amount of time. Excess body fat accumulation is not only unsightly, but highly inflammatory and detrimental to the effectiveness of your insulin.

Also proven is the fact that the biological response of target tissues to the actions of insulin (insulin sensitivity) are majorly affected by adiposity, or the amount of body fat one carries. 1

The leaner you are, the better your insulin will work. Period.

5 top tips for getting lean with diabetes:

  • Create a calorie deficit by sensibly increasing your physical activity and reducing food intake in a controlled way.
  • Strength train at least 4-5 times per week.
  • Manage your diabetes.
  • Achieve at least 7 hours sleep each night.
  • Aim to lose between 0.5-1% of your body weight each week.

Daily Routine #3 – Have a Toolbox of De-Stressing Activities

In today’s modern day age, we are increasingly exposed to more chronic stress than ever before: mobile phones, social media, traffic, bills, etc.

Stress stimulates a flight or fight response within the body, a physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival. The body responds to stress by activating the sympathetic branch of the central nervous system. Stress increases muscle tone, constricts blood vessels, and increases the production of counterregulatory stress hormones which increase blood glucose.

In small doses stress is healthy. It can save your life.

However, excessive stress is unhealthy and works against diabetes management.2

The greater and more prolonged the stress, the more insulin is required to balance blood glucose. It is well established that stress can influence whole-body glucose metabolism and promote insulin resistance. 2,3

Any forms of stress management, like meditation, massage, yoga, breathing exercises, or personal development, are worthwhile if they help reduce stress. Reducing your daily stress is a surefire way to improve insulin sensitivity and reduce incidents of high blood glucose.

Even Apple have cottoned on to this with their new “take a minute to breathe” reminder on their Apple Watch.

Daily Routine #4 – Have a Structured Sleeping Plan

Sleep could also be considered a form of stress management, especially for individuals who are highly active and live with diabetes.

I hate to tell you the obvious, but sleep is essential for good health and diabetes management.

Many laboratory and epidemiological studies suggest that sleep loss may play a role in the increased prevalence of insulin resistance and diabetes.4,5,6,7

One of the best pieces of advice is to set a fixed bedtime and wake time. Not only does this provide structure for your day, but it ensures you get enough restorative sleep for health and optimal diabetes management.

Again, the major tech company Apple and their recent focus on health tech apps have included a set wake/bedtime function in their alarm clock.

At Diabetic Muscle and Fitness, we take sleep seriously. We even developed a 3.5+ hour video module on sleep optimization for improving hormone profiles and body composition.

Daily Routine #5 – Perform Aerobic Exercise Daily

Aerobic exercise such as a light jogging or a brisk walk can increase glucose disposal and lower blood glucose levels – independently of insulin.

One of the main reasons aerobic exercise lowers blood glucose levels so well is due to the fact that there is little to no counterregulatory hormone response like that which occurs during high-intensity anaerobic exercise.

Please bear in mind, it is important to monitor insulin intake around aerobic exercise in order to avoid hypoglycemia.

I highly recommend buying an activity monitor like a Fitbit, Apple Watch, or Garmin. These are awesome for building the habit of doing more aerobic exercise throughout your day.

Take Home

Each and every daily routine I’ve shared in this article will improve insulin action and help your body clear glucose easier. Each and every one of these routines is a prerequisite for a great looking body and high levels of mental and physical performance.

Identify which areas you need to work on and get to it!

References

  1. Wilcox G. Insulin and insulin resistance. Clin Biochem Rev. 2005 May; 26(2):19-39.
  2. Li L et al. Acute psychological stress results in the rapid development of insulin resistance. J Endocrinol. 2013 Apr 15;217(2):175-84.
  3. Nolan et al. Insulin Resistance as a Physiological Defense Against Metabolic Stress: Implications for the Management of Subsets of Type 2 Diabetes. Diabetes Mar 2015, 64 (3) 673-686;
  4. Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR. Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry. 2002;59:131–6.
  5. Ayas NT, White DP, Manson JE, et al. A prospective study of sleep duration and coronary heart disease in women. Arch Intern Med. 2003;163:205–9.
  6. Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med. 2002;165:670–6.
  7. Punjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE. Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol. 2004;160:521–30.

Metformin during pregnancy safer than insulin : Study


https://speciality.medicaldialogues.in/metformin-during-pregnancy-safer-than-insulin/

Disordered Eating with Diabetes


eating disorder with diabetes

 

“Are you hungry?” my husband asked me after a particularly difficult hike in the Rocky Mountains last summer that lasted over 12 hours, where all we ate during the day was trail mix and some dried fruit. He was starving.

“I’m fine,” I replied. “My blood sugar is 115.”

He looked at me quizzically, and lovingly reminded me that blood sugar and hunger are not the same thing.

As a person with diabetes, I have had to separate my hunger from my need of food. There have been countless instances when at dinner time my blood sugar was over 400, and I had to wait until insulin brought me down to a safe level before digging in. Conversely, there have been many times (too many to count) where I was not hungry at all, but of course had to eat something because my blood sugar was under 60. I am always cognizant of my blood sugar, but not always of the crucial hunger and fullness cues. This is problematic.

People with diabetes have a tricky relationship with food. Diabetes requires one to be diligent when it comes to tracking what and how much they eat. There is also constant monitoring of food intake (carbohydrates in particular), exercise, and insulin. Additionally, people with type 1 diabetes, whose beta cells have been destroyed by the body’s immune system, secrete none of the hormone called amylin at all. Amylin is a peptide hormone that is co-secreted with insulin, and inhibits glucagon secretion, delays gastric emptying, and acts as a satiety agent. This may be why some people with diabetes struggle to feel full after meals. As a result of all of this constant tracking of food, plus the inability to regulate our hunger cues, people with diabetes may be inherently more prone to issues around disordered eating.

According to the National Institutes of Health, adolescents (ages 12-21) with type 1 diabetes experience elevated rates of disordered eating behaviors in 37.9% of females and in 15.9% of males. For adolescents without diabetes, the rates are 3.8% and 1.5%, respectively. The most common type of disordered eating among people with type 1 diabetes is a little known condition called diabulimia, where people intentionally reduce their insulin intake to lose weight. This is a serious condition that leads to diabetic ketoacidosis (DKA) and even death, if not treated.

One in three teenagers (more often than not a girl) will face disordered eating in her lifetime with type 1 diabetes. We’re bombarded with magazines and ads, fad diets and “quick fixes.” We also have to maintain a healthy HbA1c, measure every portion of food we eat, and make sure we get adequate exercise and take our insulin appropriately. It’s stressful. And how “normal” is it that every 12 year old with diabetes knows the carb counts for not only every sandwich they eat, but all of the snacks they eat at sleepovers, as well as their birthday cake?

Holding all of that healthy knowledge inside is overwhelming, especially in a society that values thinness over all else. It is also powerful that every diabetic holds the keys to their health literally in their hands. If they mismanage their diabetes, they will lose weight (losing weight is also a classic symptom of diabetes, so it stands to reason that diabulimia and the mismanagement of the condition leads to weight loss). People with diabetes face many tough battles, and food is a major source of stress for most people with the condition.

Since many people’s relationship to food is warped, it’s important to note the symptoms of diabulimia if your loved ones are showing any of the following signs, and to seek help if you think they have a problem:

According to the National Eating Disorder Association, signs of diabulimia include:

  • Hemoglobin A1c level of 9.0 or higher on a continuous basis
  • Unexplained weight loss
  • Persistent thirst/frequent urination
  • Preoccupation with body image and a fear that insulin will cause weight gain
  • Blood sugar records that do not match hemoglobin A1c results (falsifying sugar logs)
  • Depression
  • Secrecy about blood sugars, shots, and eating
  • Repeated bladder and yeast infections
  • Low sodium/potassium
  • Increased appetite especially in sugary foods
  • Cancelled doctors’ appointments

If you think that you or someone you know is struggling with disordered eating or diabulimia, contact the diabulimia helpline or call their hotline, open 24 hours a day: (425) 985–3635.

Have you seen drastic dietary or behavioral changes in someone you love that has diabetes? Do you recognize any of the aforementioned symptoms in your own life? If so, please seek the help you need. Your diabetes and your life depend on it.

 

Diabetes Management: A Work in Progress


 snow footprint

 

 

There’s a blizzard outside and today we’re snowed in. In Rochester, NY where I grew up, we rarely had snow days. Being close to Canada and having snow for almost 8 months of the year meant the city was well equipped to meet extreme weather.

But here in New York state, it’s been snowing in snowballs. It’s been too cold to go outside, too cold to go anywhere and did I mention… it’s frigging cold out there! I am not sure what I was thinking leaving behind endless summers ,but it’s been quite a shock to my blood sugar levels. I really thought I had things down but I’ve realized that my diabetes management is still a work in progress.

In spite of the cold, I went into the city this week to meet with Craig Kasper the creator of the Bravest Podcast. Craig also lives with type 1 and created the podcast so he could learn and explore what it is that enables people to live extraordinary lives in spite of their diabetes.

In the interview, we talked about levels of bravery. As our discussion progressed I shared that acceptance continues to be a process. There was that moment of diagnosis, where I felt like I had to swallow a bitter pill, the long years of denial where I kept thinking that controlling my diet and walking up hills would cure me, the moment where I gave myself my first injection through a rain of tears, the day where I knew I needed to change my management strategy by splitting my basal dose and finally yesterday pulling up a ½ unit of bolus insulin into a syringe and taking the plunge.

insulin pen

Living with Latent Autoimmune Diabetes in Adults (LADA) is no picnic. A friend recently commented that it’s easier to calculate your insulin to carb ratio when your beta cells don’t produce any insulin. Living with LADA is like playing roulette. Some days the ball lands on the money and other days I leave the table in despair.

The only way I get through each and every wonky moment is with the varied practices of yoga. I love working with the medium of sound in my practice because sound is so direct and immediately calms and centers me.

Working with sound in yoga is called mantra. The word mantra comes from two words, manas, meaning mind and trayati meaning freedom. A mantra is a sound, which frees the mind by giving the mind a focus so it’s naturally drawn out of its preoccupation with thoughts, ideas, and beliefs.

I know it’s natural to be obsessed with thoughts about the ins and outs of daily management. In working up to that first bolus injection I would sit down to meditate and replay worst case scenarios over and over.

That thought loop went on for days until I caught myself. It’s up to me to stop my need to identify with the thought by asking myself; what kind of investment do I have in that thought? Can a thought make me happy? How can a thought, which has no substance or dimension get the better of me?

It’s like trying to catch a snowflake. Impossible!

And it’s not about stopping the thought either. Try and banish any thought, another impossible task.

Mantra is such a profound way to bring the mind into a one-pointed focus, it can be chanted out loud or internally. Each nuance has a different effect on the mind and body. Chanting audibly affects the pituitary gland, the master gland in the body. It vibrates during chanting which tones and tunes all the other glands in the body. It also affects the vagus nerve which is responsible for increasing immunity

Chanting out loud increases the length of exhalation too. The longer the exhale the calmer the nervous system. Finally, mantra increases our ability to recognize that moment of getting lost in a thought. Thoughts come and go. It’s the thinker of the thoughts that matters.

For today’s practice join me in a simple chanting practice with the sound, om.

URL: https://soundcloud.com/the-flying-yogini/om-chanting-for-health-and-wellbeing

Reactive Hypoglycemia: A Cautionary Tale


reactive hypoglycemia

For many people, losing a lot of weight results in blood glucose (BG) levels at or close to normal, and your doctor may tell you that you’re no longer diabetic. If this happens to you, first of all you should be congratulated for the difficult job of losing weight. That’s wonderful.

But you should also be vigilant to make sure you don’t get reactive hypoglycemia, which means very low BG levels after you’ve eaten a lot of carbohydrates. This can happen even when you’re not diabetic.

I had reactive hypoglycemia about 20 years before I got the diabetes diagnosis. At the time, I was a night owl and hated getting up early in the morning. But occasionally, at the daily newspaper where I worked, I had to do the “wire desk,” which meant arriving at 7:00 a.m. Because I hated it so much, I’d treat myself to a chocolate doughnut. Usually I didn’t eat breakfast at all.

Then at almost exactly 4 hours after the doughnut and black coffee, I’d get the shakes and feel as if I’d die if I didn’t eat something. In fact, I could almost set my watch by this phenomenon. “Oh. The shakes. It must be 11 o’clock.” Then I’d eat a candy bar and feel fine for the rest of the day.

Why does this happen?

Insulin secretion is biphasic. When a non-diabetic eats a carbohydrate food, the pancreas quickly spurts out a pulse of insulin. This pulse doesn’t last very long but it’s enough to keep the carbohydrate that reaches the intestine from going very high. It also suppresses the production and release of glucose from the liver. This is called the phase 1 or first phase insulin response.

Then insulin is secreted continuously as long as carbohydrate comes into the system in proportion to the amount of carbohydrate reaching the intestine. This is the phase 2 or second phase insulin response, and it lasts much longer than the first one.

The food that we eat, including carbohydrate, isn’t dumped into the intestine all at once. Instead, the stomach releases only a certain amount at a time, usually containing about the same number of calories, so the insulin release is pretty steady. Liquids leave the stomach faster than solids.

Unfortunately, those of us with type 2 diabetes tend to lack a first phase insulin response and may have lacked it for a long time before we were diagnosed with diabetes. This means that when we eat carbohydrate, our BGs aren’t knocked down by that first insulin pulse, so they go much higher than they would in a non-diabetic who ate the same amount of carbohydrate. Then the body sees these high numbers and assumes they’re that high despite a first phase insulin response. So the second phase response is extra strong, and with all that extra insulin, we may go low. Some people call this “too much too late.”

Now, no one really knows at what point in our life the first phase insulin response is eliminated, although there is evidence that first-degree relatives of people with diabetes have impaired first-phase insulin responses despite having normal BG levels. We also don’t know if or when the first phase is restored when people normalize BGs enough to be considered non-diabetic again.

I was in a clinical study in which they did an intravenous glucose tolerance test that measured both BG and insulin after a huge dose of glucose. I started with almost no phase 1 response. But after I was on the study drug (salsalate) for a couple of weeks, the phase 1 response was restored to about 70% of normal, which is consistent with the idea that the situation is reversible.

Weight loss alone may or may not restore the phase 1 response, but there’s some evidence that phase 1 is restored after weight-loss surgery.

So if you’ve managed your diabetes so that your BG levels are in normal ranges, you may still lack that phase 1 response and be sensitive enough to large carbohydrate loads that you’ll have reactive hypoglycemia.

That happened to Joseph recently. He had lost a lot of weight after gastric bypass surgery, and his BG levels were usually normal, but he still watched his diet and didn’t go overboard with the starches. Then one day he was at a football game, and it was very cold and his friends had a lot of tasty crackers with them, so he ate some. No, he ate a lot. A few hours later, he felt odd and tested his BG. It was 35. Luckily, he wasn’t alone, and someone gave him some juice and he recovered.

I have no idea how low I was when I worked the wire desk and got the shakes after eating a doughnut with black coffee. But I do know it was very unpleasant. So if you’re diabetic, be vigilant and don’t let this happen to you. Avoid carbohydrate fests, especially on an empty stomach. And if you can’t avoid them, make sure you have available some glucose tablets or other food that will raise BG quickly in case you do go low.

Reactive hypoglycemia is counterintuitive (“How could I be low when I just ate all those carbs?”), but it can be serious. You can outsmart it, though, if you’re prepared.

Why Don’t People Take Diabetes Seriously?


 

When we hear that a loved one or friend has a serious illness it can evoke in us strong emotions of fear, worry, sadness and compassion. “I’m so sorry” and “How can I help?” are commonly offered sentiments in these difficult situations. Hearing the news that someone has diabetes does not often herald the same degree of concern.

Why is this? I believe that the reasons are multifactorial.

Broad Terms Contribute to Confusion

If we consider the word “cancer” people typically have an immediate reaction of alarm. However, cancer is a large umbrella representing over 100 distinct diseases depending on the organ or system affected. Prognoses for cancer are widely variable and many cancers are curable with early diagnosis and treatment.

These important distinctions reflective of cancer’s diverse landscape are often lost on the public’s perception. Thus, people may endure unnecessary anxiety, dread and anguish. Society’s increased understanding of the medical and scientific advances in cancer treatments would alleviate a lot of suffering and fear and replace it with hope and optimism. Even those who can’t be cured are often able to have significantly lengthened periods of disease-free survival and enhanced quality of life due to new treatments.

While the term diabetes is not as deceptively broad as cancer it does represent over seven distinct conditions each with its own pathophysiology. If you consider that diabetes may occur as a result of another disease or condition like cystic fibrosis, hemochromatosis or chronic pancreatitis, just to name a few, there are even more types of diabetes.

Unless you’ve personally known someone with diabetes and seen firsthand either a complication of the disease or its daily, labor-intensive management you may not grasp the seriousness of the diagnosis. Perhaps we’ve heard the word so much that we are desensitized to it. This is unfortunate since diabetes has become one of the fastest growing risks to human health throughout the world.

Since my own child was diagnosed with type one diabetes in 2013 I’ve become very attuned to how diabetes is perceived both in personal encounters and in the media. In our circle of family, friends and teachers, the reactions to my son’s diagnosis were a mix of bewilderment, sadness and nonchalance. Most people simply didn’t know what it was.

The knowledge gap with T1D may partially be attributed to its name. For clarity, I tell people that it was previously called Juvenile Diabetes. That charged term usually captures attention. Putting “juvenile” in front of any word will often do that (e.g., juvenile delinquency, juvenile detention center, etc.)

In my experience people generally assumed that my son would now need some sort of low-level lifestyle tweaks. The word sugar was always coming up. Should we get some sugar-free foods for him? Can he have cake? Wouldn’t some exercise, a “balanced diet” and a Crystal Light or two keep this thing in “control?”

Someone once told me to ditch my son’s insulin and go macrobiotic. Although disturbing, at least one of my son’s classmates understood that diabetes was serious. Lacking a filter he felt compelled to share that he had a relative who had his leg amputated. My husband who is an ICU physician had to reassure my son that these complications are very rare.

Pre-Diabetes

With so many different types of diabetes it’s no wonder that such a knowledge deficit exists. Take prediabetes as a perfect example.

According to the American Diabetes Association, in 2015 an astonishing 84.1 million Americans or more than 1 out of 3 adults had pre-diabetes. A person may leave an annual doctor’s visit with this news and a general recommendation to lose weight and exercise more. He may compare notes with his friends and discover that some of his buddies are in the same boat. With the tendency to feel like there is safety in numbers one might be inclined to either ignore the diagnosis or just try a few lifestyle tweaks like joining a gym or eating brown rice instead or white.

Unlike those with type 1, those with pre-diabetes don’t leave the doctor’s office with an abrupt and permanent new way of life requiring 24/7 insulin. Perhaps this is another factor that contributes to a lack of urgency to reverse pre-diabetes. Some will gamble that they can coast along with no lifestyle changes without converting to type 2 diabetes. They might be right but they need to know the real risks of this strategy.

Pre-diabetes means that something is wrong with a fundamentally important body function: glucose metabolism. Even if an individual does not ultimately receive a type 2 diagnosis he is still at risk for serious complications like retinopathy and neuropathy. So, feeling “fine” with this relatively silent condition is, indeed, a false sense of security.

Inspiration from a Type 2

Before my own child was diagnosed with type one I had a grim, skewed perception that diabetes was either coping with spirit crushing food restrictions or trying to persevere through difficult complications. Two relatives with type 2 succumbed to those complications. I just didn’t understand the other perfectly viable scenario of a healthy life filled with abundance.

One type 2 thriver who has intruigued me so much is the acclaimed English actor, Robin Ellis. In the 1970s he was the heartthrob leading man, Captain Ross Poldark, of the beloved BBC and Masterpiece Theatre series, Poldark.

A remake of it is currently thrilling millions on Masterpiece Theatre.

A huge fan of the original, I was fascinated to discover that Mr. Ellis is an inspiring type 2 diabetic. He has contributed to the diabetes community by being very transparent about his condition and his successful journey adapting to it.

An accomplished chef, Mr. Ellis’s lushly photographed and delectable diabetic-friendly cookbooks are a wonderful resource. Anyone with diabetes perusing these books may begin to feel that there is, indeed, another way to not just live with diabetes, but flourish as a result of it.

His latest, Mediterranean Cooking for Diabetics: Delicious Dishes to Control or Avoid Diabetes, is a go-to book in my cookbook collection. My type one son is a big fan of Mr. Ellis’s lower carb recipes and it makes me feel good to cook his healthy and flavorful dishes for my entire family.

So why do some people with diabetes like Robin Ellis become converts to a new way of living with diabetes? Growing up with a mother with type 1 diabetes who passed away from a heart attack due to her condition, Robin was cognizant of the dangers of diabetes as a result of this terrible loss.

However, I believe his motivation for a lifestyle change was not simply motivated by fear. Living in the French countryside with his supportive wife, Meredith, Mr. Ellis embraced the healthy culinary treasures of this region. He used his diagnosis as a springboard to explore new possibilities in food, exercise and wellbeing.

As the mighty Theodore Roosevelt used to say, “get action.” Take diabetes seriously no matter what type you have. Don’t let denial put your health at risk. You can shift from a place of worrisome vulnerability to one of hopeful optimism and fortitude if you are open to change.

There is a full life of abundance waiting for you.

What Can Exercise Do for People With Type 1 Diabetes?


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In a meta-analysis done to look at exercise training in those with type 1 diabetes, researchers report which benefits were observed.

They sought to “establish the relationship between exercise training and clinical outcomes in people with type 1 diabetes.”

The study authors searched for prospective randomized or controlled trails involving exercise training in people with type 1 diabetes for 12 or more weeks though MEDLINE, Cochrane Controlled Trials Registry, CINAHL, SPORTDidscus, and Science Citation Index.

What Does Exercise Help With if You Have Type 1 Diabetes?

In those who exercised, researchers found that exercise lowered daily insulin needs, BMI (body mass index), peak VO2, resting heart rates, resting systolic blood pressure (the top number), LDL cholesterol, and triglycerides.

Children who exercised, specifically had lowered insulin doses, waist circumference, and triglycerides.

They didn’t find any effects from exercise on A1c levels however, nor fasting blood glucose, body mass, or HDL cholesterol levels.

What About  You?

If you have type 1 diabetes, what does exercise personally help you with? Share in the comments!