Listen to Me, Because I Don't

A few weeks ago, a friend who recently acquired a continuous glucose monitor asked me for some tips on how to appropriately use the device. One of the first pieces of advice I gave him was to never make management decisions based the monitor, and to always check to confirm that the monitor was correct. Ah, such good advice based on months of experience. Now, if I only I had actually listened to my own advice a few nights ago...

Love the CGM, but it's
always best to check.

I went to sleep late - 12:30am. I was closely monitoring my glucose levels because they were a little high, and I was expecting an overnight dip because of an intense 1-hour bike ride in the late afternoon and because of the adult beverage I consumed a few hours earlier. I went to sleep and, like clockwork, the pump started singing like Mariah Carey at 2:30am, and it wasn't singing "Sweet, sweet fantasy baby!" Instead, it was indicating that I was low. The sensor was new and I had inserted it after the bike ride earlier in the evening. Prior to going to sleep, I had decided to cleverly change the sensor settings on my pump so that I would be alerted at 80 mg/dl instead of 70 mg/dl because I wanted to catch the low early. I rolled out of bed to treat the low. "Ha, I don't feel low" I thought. I have outsmarted the sensor and am catching the hypo before I have the symptoms! Chalk one up for me. I stumbled to the kitchen, ate 15 carbs of Oikos yogurt. While eating, I noticed that I wasn't shaking or sweating. My heart wasn't beating rapidly. I was slightly disoriented, but that's normal when you wake up suddenly in the middle of the night. Man, this is great! I walked back to my room to go to sleep. After nearly stepping on my cat, who likes to walk under my feet in the dark, I had a thought: what if I'm not low? I decided it would be best to check since I had already taken measures to treat the low. I checked, and my blood glucose was 138. Awesome! I didn't feel low because I wasn't low. I bolused for the carbs I had consumed, calibrated the sensor, and hit the sack. When I woke up, I was sitting at 81 and the sensor had come back into a state near accuracy.

What did I learn from this little episode? Listen to my own advice and actually CHECK before making management decisions. Also, train the cat to stop walking under my feet.

Reaching an Optimal HbA1c

We live in a results-oriented world, and for people with diabetes, the HbA1c test is the standard for determining how well we are managing the disease. For readers who are not familiar with the A1c test, you can think of it as a 4 month blood glucose average. People without diabetes normally have an A1c between 4.6% and 5.6%. The American Diabetes Association recommends that people with diabetes maintain A1c levels of less than 7.0% in order to stave off any long term complications. However, I strive to keep mine lower than 6.5% because I believe that the closer it is to normal, the better!

Santa delivered my latest A1c results on December 24 (a day early). My results? 5.8%. To say the least, I was overjoyed! This result was down half a percent from my previous A1c of 6.3%, which was also a very solid result. After twelve years with diabetes, I know that I am proficient at controlling the disease. This does not mean that every day is perfect (because it's not), but it does mean that I have more good days than bad. More important, I know that I am blessed to have access all of the resources that people with diabetes need to effectively manage disease. This includes an insulin pump, continuous glucose monitor, blood glucose meter and test strips, and an awesome endocrinologist!

We all have our own methods for managing our diabetes. After all, everyone's diabetes is a little bit different. I thought I would share a few that I use that have proven successful for me over the years.

Disclaimer: I am not yet a medical professional and this is not considered to be medical advice. These are merely methods that I employ that you may find useful. Always check with a doctor before making any changes.

1. Check Glucose Levels Early and Often. Many diabetes groups and organizations recommend that people with diabetes check their glucose levels 5 times / day. I do not believe that 5 times / day is nearly enough. In fact, I usually check mine 3 times before noon! The ability to instantly and accurately know our blood glucose levels is what separates us from people who had diabetes between 1920 and 1980. Information is power, and the more you know about what is happening in your body, the better able you will be to make proper management decisions. I check my levels a minimum of 8 times / day.
2. Don't Eat If Your Levels are High. Even if it is time for a meal or snack, I do not eat if my levels are higher than 140 mg/dl. I bolus, drink water, wait an hour, and check again. Like everyone, I have those mornings where my glucose levels are high when I wake up. Instead of eating and spiking them even further, I make my adjustments and wait. Depending on how much time I have, I may go for an early morning walk, which brings me to my next point...
3. Get Physical. I do a minimum of 35 minutes of exercise everyday. My new passion is cycling, but I do lots of things to stay active: walking/running, playing tennis, yard work, push-ups & sit-ups, etc. I use exercise as medicine. If my blood glucose levels are high (>150 mg/dl) two and half hours after a meal, I look at that as a great excuse to go for a 2 or 3-mile run/walk around the neighborhood. Why  give extra insulin when I could, instead, get the same result with a little exercise? Moreover, exercise is good for the cardiovascular system and reduces stress. Find something physical that you love and do it everyday!
4. Know What's Going into Your Body. I measure all of the food I prepare so that I know exactly how many carbs I'm consuming. I don't like surprises and try to leave as little room for error as possible. Yes, you can "eyeball" the carbs, but it's too easy to be off by 15 or 20 grams. Being off can leave you with high glucose levels for a longer period of time, which leads to a higher HbA1c. You can purchase a nice food scale for about $50 at Bed, Bath, and Beyond. I have used a scale for about two years, and it has been a game changer. I even take it with me when I travel places!

I hope that you find these methods helpful! What methods do you use?

On NOT Letting Diabetes Define You

By: Andrea Romie, guest contributor

Hi, my name is Andrea and I have Diabetes.

Wilford Brimley has become well-

known in recent years for his Liberty

Medical commercials

At the tender age of 12, I had a lot of growing to do, both mentally and physically, but I certainly already had a solid personality.  I was a loquacious, perhaps too mature (if you ask my parents), fiercely independent little girl.  However, when I was diagnosed with Type 1 Diabetes, I knew I had something that would change me and shape the rest of my life not for the worst, but in a much different way. Not long after I was diagnosed, I knew I never wanted my disease to define me.  I don’t refer to myself as a Diabetic, rather than someone with Diabetes.  I think there is a certain stigma or stereotype about “Diabetics” and I do not, nor do a lot of other people like me, fit the bill.  It doesn’t help my cause to have old men with white mustaches riding on horses talking about Diabetics and their “Diabeedez” equipment in lame commercials every night on prime time television.  If you don’t know what I’m talking about, take a gander at the YouTube link here.  I don’t feel like one of those Diabetics he’s referring to - ones who start their day off with a brisk walk at 5 a.m., eat dinner every day during the early bird special and reward themselves with a nice piece of sugar-free candy.  First, that stuff sucks and should not be allowed in the candy aisle, and second I never planned on having the same daily schedule for the rest of my life.

I knew very early on that I wanted to be healthy and responsible while living a life that allowed me to be a regular kid.  While I was still on “N” and “R” shots (we all remember those), I did NOT like having to wake up early during a sleepover to eat breakfast and take my insulin and I certainly did NOT like missing out on eating at the Rainforest Café during a class trip in Chicago because it wasn’t scheduled during my set dinner time.  That strictly regimented lifestyle was super annoying and not fun, especially for a pre-teen.  Within a year of my diagnosis, my doctor allowed me to go on Humalog and a long acting insulin which gave me freedom and a chance at being a regular kid again – just one who always had syringes, a blood sugar monitor and glucose tablets on hand.  After remedying that little snafu in Chicago, I figured, “this isn’t so bad, I can deal with this”.  Of course I have my bad days especially when I seem to be low ALL the time or high ALL the time for no reason. Sometimes I hate dealing with it but, in general, I have a “c’est la vie” attitude towards my disease.  I really hope that other kids dealing with their diagnosis can feel the same way – you can be just like everyone else, active, healthy, spontaneous but just a little, well, special.

Ever since my presentation to my 7^th grade class about these new shots I’d be taking, I’ve been extremely open and never ashamed of the fact that I have Diabetes; however, it’s not something that I lead with.  Like “Hi, my name is Andrea and I have Diabetes.”  There are so many other things that come up in conversation before the inability of my pancreas to create insulin.  We all will deal with it in our own way but for me, this is how I see it – Now, at 26, I am a loquacious, averagely mature, fiercely independent woman, wife, daughter, sister, friend, runner, amateur chef, marketing guru and oh, yeah, I have Diabetes.

KC Students Return From Fitness Academy

A terrific story was reported in the Sun Herald today about students from my hometown of Kansas City, Missouri returning from MindStream Academy, a fitness boarding school in South Carolina. The 14 students lost a combined 756 lbs. during their four months at the school! The goal of MindStream Academy is to help teenage students learn and develop skills to ensure long-term health and wellness. The school has a unique curriculum that teaches students how to make prudent decisions about eating and exercise.

The curriculum was practical and hands-on: Students took field trips to a grocery store and fast food restaurant to learn to make good purchasing decisions and studied things like knife skills in the school's kitchen. - The Sun Herald

The state of physical education in U.S. schools is perhaps as bad as it has ever been. As a former middle and high school teacher, I am well aware that students are not taught about nutrition, metabolism, and the importance of exercise. Interestingly, many medical school programs don't even teach doctors the basics of nutrition, so it should come as no surprise that U.S. citizens are poorly informed about how to eat healthy. Even though MindStream Academy is doing great work, I wish families did not have to pay more than $28,000 to teach students something they should already be learning in school and from their doctors! Nevertheless, these students and families should be commended for getting healthier and avoiding chronic conditions like type 2 diabetes, hypertension, metabolic syndrome, and even cancer.

Here is a link to the Sun Herald Article. If you want to see pictures of the students returning to KCI airport, you can click here. If you want to learn more about MindStream Academy, please click this link.

Read more here: http://www.sunherald.com/2012/12/21/4371883/mo-students-lose-756-pounds-at.html#storylink=cpy

Tips to Help You Avoid Cruel Practices by Health Insurance Companies

Let me begin by apologizing for not updating my blog in a while! I can promise that I will be better about updating it more frequently as we move forward.

If you were to ask me about the most frustrating part of living with diabetes, my answer might surprise you. It would not be frequent blood glucose checks, hypoglycemia at inconvenient times, unexpected and unexplainable highs, or even the expense of treating the disease. Instead, my answer would be dealing with some of the crueler practices of health insurance companies.

Earlier today, I received a phone call from Medtronic informing me that my health insurance company did not have a certificate of credible coverage on file and was, therefore, rejecting all claims related to diabetes treatment. My initial thought was “Here we go again,” because this is not the first time that a health insurance company has claimed to somehow lose, misplace, or never receive my certificate. Lucky for me, I was prepared this time. I switched insurance companies last June, and was sure to make phone calls to confirm that all of the necessary documents (application, certificate of credible coverage, etc.) had been received by the new company. After confirming with the new company that all was well, I wrote down the name of the agent and the date of our conversation. In addition, I had my old insurance company mail me a copy my certificate of credible coverage last June, which I filed away just in case something funny happened. You can imagine the surprise of the agent at my new insurance company when I reminded her of our conversation on June 21 confirming that they had received my certificate and that I was currently holding a copy of the certificate and would be more than willing to hand deliver it to her this afternoon if necessary. Somehow, she turned into Houdini and magically found the certificate in the system, so I didn’t have to make the 45-minute drive. 

These things happen to people with diabetes and other chronic conditions all of the time! Because health insurance companies are for-profit, their goal is to avoid paying as many claims as possible, and the easiest way to do this is to simply state that a person has a pre-existing condition with no certificate of credible coverage. Chances are pretty good that if you have a chronic condition, then you have experienced or will experience this at some point. I know how frustrating this can be, so I have provided a few tips for everyone below on how to avoid being swindled by your health insurance company:

1.  Always keep a personal copy of your certificate of credible coverage.
2. Never assume the insurance company has received any documents sent to them by you or another insurance company. Call them in order to confirm and write down the name of the person you talked to as well as the date.
3. Keep all health insurance documents and documentation in a file-folder and consider keeping the folder in a fire proof safe.
4. Make electronic copies of your application for insurance as well as your certificate of credible coverage so that you can easily email these documents if necessary.

I hope that you find these tips helpful. I feel blessed that my experience today had a happy ending, but I would still be fighting it for the next two weeks if I did not have a copy of my certificate!

Running with Diabetes

By: Andrea Romie, guest contributor

Andrea posing after finishing 8th

overall at the Race for a Cure in Plano, 

TX.She finished the 5K in 22:03, a

personal best!

I’ve been running for years – in fact, I started by accident.  You see, I wasn’t gifted with that natural athletic ability to throw, shoot, kick or catch anything with ease. Despite the odds against me, I joined every sports team in middle school to simply maintain my social butterfly status.  So, after being diagnosed with Type 1 Diabetes in the 7^th grade and finally gaining my strength back, I noticed that even though I ran suicides practically the whole basketball practice (due to my innate inability to make a free throw), I kept up with the girls who only had to run one or two.  Feeling that I found my niche, I went out for track my 8^th grade season and haven’t looked back since. 

Besides being the one and only athletic activity that I’m skilled at, running has always been my magic trigger when it comes to diabetes.  When I’m running consistently, I’m less stressed, I maintain a healthy weight and my blood sugars are more manageable.  Since my magic trigger isn’t wine tasting, shopping or international travel, I have to push myself mentally and physically to maintain a regular exercise schedule.  I’ve found that next to anticipating an endocrinologist’s wrath at an upcoming check-up, my best motivation is scheduling a 5K every now and then to inspire me to keep up the good work.  It’s a race that requires endurance, but only a reasonable amount of training to finish at a good pace.

As we all know, heightened activity levels can lead to low blood sugars.  I have been extremely lucky not to have serious issues with lows due to cardio, but I’ve always been cautious.  I spent many years running with glucose tablets in my socks and am very conservative with my carb ratios before a run.  When I was on shots, I would have to back down my nighttime long acting insulin to almost nothing to avoid nighttime lows during my heavy running seasons.  Recently getting on a pump, I’m still working out what basal rates work best for me when a race is coming up vs. periods when I’m resting my legs. 

I have to admit, I was extremely nervous about lows when I first got hooked up to my Omni Pod. Yet, after the first couple days, I found that I needn’t be any more afraid of the Pod compared to the shots I had known for 14 years.  The most important thing for me is listening to my body, checking my blood sugar before a run and having lots of snack on hand during heavy running periods.  I know that I will have good days and some “bad” days, but I have the ability to learn and correct for the future.  For me, running can be rewarding, enjoyable and maybe even your magic trigger. 

Blame it on the Sugar?

Last Spring, the CBS television program 60 Minutes aired a story titled Is Sugar Toxic? Dr. Robert Lustig, a pediatric endocrinologist at the University of California-San Francisco, argues that the consumption of fructose is the cause of increased rates of obesity, type 2 diabetes, heart disease, and metabolic syndrome that have occurred over the last thirty years. In 2009, Lustig gave a lecture called Sugar: The Bitter Truth that has since been viewed by more than 2.6 million people on YouTube in which he gives his reasons for calling fructose poisonous. His lecture, which you can access by clicking here, is quite academic and perhaps a bit esoteric if you have not studied organic chemistry or biochemistry. However, you can find the crux of his argument in the 60 Minutes piece below.

You may be wondering at this point what you are eating that contains fructose. The short answer is that if you have adopted the so-called Western diet, it’s in everything! Table sugar (sucrose) is actually a disaccharide composed of two simple sugars – glucose and fructose. If you put a few scoops of sugar in your iced tea or down a couple cans of soda, you are consuming fructose. Check the labels on most of the processed foods you purchase at the supermarket and see if they contain the ingredient high fructose corn syrup.  Fructose and high fructose corn syrup are found in almost all the foods we eat including cereals, breads, soft drinks, chips, and even peanut butter. Do you put chocolate syrup on ice cream? Double whammy. The real problem is not that we are consuming fructose; rather, it is that we are consuming processed fructose that lacks fiber. To be clear, fructose occurs naturally and you consume it if you eat any type of fruit. However, fruit is replete with high amounts of fiber that protect your body against the harmful of effects of fructose.

Ok, so what’s the big deal? Why is processed fructose that lacks fiber so bad? The answer, according to Lustig and University of California-Davis researcher Dr. Kinder Stanhope, has to do with the liver. When you consume glucose, your liver can convert it into glycogen, which can be used for energy at a later time. Fructose, in contrast, gets turned into fat and some of that fat is in the form of LDL cholesterol. If you are confused by the difference between HDL and LDL cholesterol, an easy mnemonic is to think of the “H” in HDL as standing for “healthy” and the “L” in LDL as standing for “lethal.” LDL cholesterol is associated with increased atherosclerosis (hardening of the arteries) and risk for heart attack. You can read the article published by Dr. Stanhope and her colleagues reporting the findings from their study by clicking here. In short, consuming processed foods that contain high fructose corn syrup is tantamount to eating foods high in saturated fats.

In addition, sugar may actually be addictive. That’s right! What you nonchalantly called a sweet tooth may actually turn out to be a full-blown addiction to sugar. In 2010, Dr. Eric Stice and his colleagues published an article in Behavioral Neurobiology of Eating Disorder that explained how the consumption of sugar causes the reward region of the brain to release dopamine. Whenever dopamine is released, it makes us feel good. The first time you take a bite of chocolate cake, your brain releases dopamine and you feel terrific. However, if you want that same sensation again the next day, you have to eat even more chocolate cake because you build up a tolerance for sugar much like a drug addict. Consuming more chocolate cake means you are consuming more sugar (fructose), which means you are storing more fat and increasing your LDL cholesterol, which means BAM! We have a serious health crisis on our hands. With strong scientific evidence suggesting fructose is toxic and addictive, it’s no surprise that we have seen rates of obesity, type 2 diabetes, heart disease, and metabolic syndrome skyrocket.

What can you eat and drink if fructose is so ubiquitous and yet so harmful? The short answer is that you should avoid processed foods. Eat whole grain bread instead of white or wheat bread. Eat oatmeal or shredded wheat instead of sugary cereals. Put down the glass of apple juice and bite into an apple. Substitute natural peanut butter for classic Jif and Skippy peanut butter. Drink water instead of soda. Making these small but substantive changes will have a long-term positive effect on your health.


So, what do you think? Is sugar to blame for the obesity epidemic and our subsequent health crisis?

Remove Every Obstacle

I love the attitude of Team Type 1, a team of professional cyclists comprised of type 1 riders. They don't just compete, they win. Their victories come not only on the racing circuit, but also through their advocacy by engaging others in the fight against diabetes. The group doesn't see diabetes as an obstacle. Instead, the disease fuels them. You can check out their website by clicking here. Remove every obstacle.

The Story of Olympic Champion Gary Hall Jr.

Since getting underway, most U.S. Olympic swimming fans have been enthralled by Michael Phelps’ pursuit of 19 medals, the stellar performances of Ryan Lochte and Allison Schmitt, and the rise of Missy Franklin. As we enjoy the amazing feats of all of our Olympic athletes, I would like to tell readers about one of my favorite Olympians, Gary Hall Jr., who is a decorated former U.S. Olympic swimmer with type 1 diabetes.

Swimming runs in Gary Hall Jr.’s family. His father, whom he was named after, competed in the 1968, 1972, and 1976 Olympic games, and his uncle Charles Keating III also competed in the 1976 games. Gary Jr., like his father, competed in three Olympic games (1996, 2000, and 2004), and they are the only father-son duo to accomplish this feat!

At the 1996 Olympics in Atlanta, Gary Hall Jr. medaled in four events. He earned gold medals in the 4 x 100m freestyle relay and the 4 x 100m medley relay and silver medals in the 50m and 100m freestyle. After his performance in the 1996 games, his future in the sport appeared to be very bright until he received the diagnosis.

Gary Hall Jr. at 2000 Olympic Games.
Source: CNN/Sports Illustrated

In March 1999, Gary Hall Jr. was diagnosed with type 1 diabetes. Initially, his doctors told him that his days as a competitive swimmer were over. Gary explained in a 2004 interview with Diabetes Health that he went through the usual stages of depression and anger following the diagnosis before finally accepting that he had diabetes. Despite being told by doctors that his career was over, Gary Hall Jr. was determined to keep swimming. He met Dr. Anne Peters Harmel, an endocrinologist from UCLA who encouraged him to continue his training regimen. Her impact on Gary and his swimming career cannot be overstated. While other doctors were telling Gary to give up swimming, she helped him understand that he could manage the disease and continue to pursue his dreams of becoming the best swimmer in the world.

Gary competed in two Olympic games with type 1 diabetes and earned six additional medals. He won two gold medals without diabetes. He won three gold medals with the disease. In 2004, he made the U.S. Olympic swim team at the age of 29 and was the oldest person to make the team in eighty years. Gary started the Gary Hall Jr. Foundation for Diabetes, which provides support for cure-focused research. His story is truly inspirational for all persons with diabetes especially those who love to compete in sports! To hear Gary Hall Jr. tell his story, check out the video on the right side of the blog.