When I flipped on CNN the other morning while getting ready for work and saw thousands of drivers stranded in Atlanta due to inclement weather, my very first thought was “if that was me, I’d be screwed.”
Due to all the crazy cold weather this year, many folks have been stranded, grounded, or like in Atlanta, stuck in their cars through the night or worse: forced to walk home in freezing temperatures or risk freezing or starving in their cars overnight. Looking in my empty trunk later that day, I realized that I’m completely unprepared for life on the road. And I do live on the road now – I have several accounts that are three hour drive away from my home, and long stretches of deserted highway in between.
Diabetes-wise, I’m actually totally prepared. My purse is always stocked with extra insulin, test strips, and a syringe in case my pump pod and all the extra ones I have packed with me end up busted. But in terms of the basics like food, water, and warmth, I come up empty – unless you count the tube of fermented glucose tablets I keep stashed in my glove box in case I go through all my other low treats (ew). And I don’t think my low treats really count as “food” if we’re talking about having to spend the whole night or longer trapped somewhere.
The weather plauguing other parts of our country served as a major wake-up call to me. My first stop tonight when I get home will be my local grocery store for several bottles of water and some non-perishable, long-lasting food like Clif Bars. I’m also going to buy an emergency gas can and a warm blanket to keep in the car, just in case.
After all, I drove through no less that 10 cities I’d never heard of in Oregon and Washington yesterday, with miles in between of zero civiliation. It’s time to be prepared for all the non-diabetes things I would need in an emergency!
My thoughts are with all those who are and were stranded in Atlanta and other parts of the country. I wish for everyone to make a safe return home.
Now that I’m back working full time, I was reminded last week what it really means for your blood sugars when you sit in a chair…for 12 hours a day…in meetings. Hint: it ain’t pretty folks.
I lead a generally active life, even in my work. As a sales rep, you’re constantly in and out of the car, popping in to offices and walking around to get in touch with your customers. Even on days when I have long drive I know that eventually I’ll be out and about. But when it comes time for the national group of reps to come together and have our annual meeting, the total paces during the day are often comprised of walking to the meeting rooms from your hotel room and back again 12 hours later after a full day of presentations and meetings. Combine that with the fact that meetings are often full of non-diabetes friendly foods and you have a receipe for running high the better part of the day.
This stark of a drop in activity has always been an issue for me. I start to see a rise in my overall BGs as early as the end of one day like this, and it often continues throught the meeting until I have at least 30 minutes of exercise that seems to break the cycle. In a perfect world, I’d have the time and energy to get up before the meetings and work out, but when you need to be somewhere fully dressed and presentable by 7am and don’t stop until midnight or later, sleep has a higher premium than exercise for me.
As I jump right back in to a busy career, I will be adjusting my diabetes management. Workouts have been pushed to the early mornings again and both days of the weekend. I’ll be spending hours in the car and on the road with this new role, and I’ll be making a concerted effort to go jogging in some new towns in places of Washington state and Oregon that I’ve never heard of until now. And I’ll have to plan ahead with healthy snacks and meals lest I get caught on a deserted stretch of highway where the next restaurant is a McDonald’s in 30 miles. I’ve never been a fast food eater and I won’t start now.
Ultimately, life on the road as a rep simply takes more planning. And I am determined to get this A1c down to below seven, where I was just one year ago before we left for Asia.
Anyone want to go running in Yakima Tuesday night! If you know where that is, you’re already ahead of me
With a blog named “I Run on Insulin,” you’d better believe I’m always happy to test out a new product for people with diabetes that like to get their fitness on. So when a company called “Type Tanks” generously sent me one their workout tops specially built for people with diabetes, I put it on the first chance I got to take it for a test run, complete with all my d-gear.
First impressions upon handling this tank top? Daaaaaang this thing is PREMIUM. This top is made with a moisture-wicking, high quality fabric that I usually only find in the fancy-pants running stores. I guess that’s part of the reason the price point, which is the only negative for me, is so high. At $59 a pop, these tanks are not cheap. However, with all the features they have and the premium materials they’ve used, it feels like a top-of-the-line product and that’s what Nike and Lululemon and others would charge too SO I can’t really complain about the price.
First of all, let’s get to the important stuff: It’s nice looking. You could actually get away with wearing this to the gym and then throwing a sweater over it with some jeans and feel good about it. This is a plus for someone like me often works out on Saturday morning and doesn’t really change much until about 5pm when it’s time for happy hour.
Second, the features of this top are very conducive to helping with all the crap we carry around with us. There are right and left side zip pockets that also contain a little hole to feed insulin pump tubing through. In my case, I put the pod controller in one pocket and my CGM in the other, but very cool to have to option for tubing (or headphone, I suppose).
But where shall I put my trusty GU pack that comes running with me always, you ask? Well, there’s a little pocket sewn in to the sports bra part of the top (in case it’s not apparent by now, they are currently only making women’s shirts). So yeah, you’d have to do that awkward reach-down-your-shirt thing if you needed your GU while running but if I get low 5 miles from home with five more to go, I’m really not concerned about what I look like while fixing it. Stare away.
The pockets in the back are a tremendous advantage for pumpers, especially those that use a tubed pump. However the fact that they are on the back of the shirt is the challenge for CGM. Folks using CGM will want to have it where they can see it, such as on a belt with a clear window to easily click in and see numbers, especially on longer runs. For a shorter run though, I’d be fine to put my CGM in the back zip pocket, because it would vibrate if I went out of range, prompting me to stop and evaluate.
That being said, being an athlete with diabetes means I usually don’t ever have enough pockets for everything, so I welcome a beautiful product like this that allows me to carry things in more places. Maybe you put your pump in one back pocket, keys in the other. Or Shot Blocks for longer runs. The options are endless and as the old adage says “With diabetes, more pockets are better…” or something like that, right?
Overall, I think this is a premium, beautifully designed product for people with diabetes who are athletes and struggle with all the crap we carry. For more information on Type Tanks, check their website here.
I love the fact that by having a blog, I have access to the thoughts and opinions of all of YOU out there. That’s the whole point of a blog, right? It’s a chance to start a discussion, to hear other’s perspectives and…gain access to their electron microsopes?
Yep, you read that right! I am SO excited to have a guest post today by a reader from Germany named Florian Lang (who you can catch blogging about diabetes and cycling and other things across the pond at his blog right here). Florian, lucky for us, works in an engineering lab and has access to this totally insanely detailed microscope. And even luckier is the fact that like most of us who read this blog, he wanted to know everything about his lancets and needles so he took that microscope power to the next level. Please enjoy his guest blog and incredible images today!
How bad is it to not change the lancet, really? Well, see for yourelf!
by Florian Lang
The honour of a guest post. I’m quite willing to use that opportunity to blab on and on about cycling and the weather and how everything was better in the olden days. No? Stick to one topic? Oh if I have to. Please imagine a sulking three year old here – it’s about the right mental image.
Tiny introduction – basically so you know what you are dealing with. I’m a 30-something old man from Germany, who’s had diabetes for 35 years. Over here things are occasionally different. Very much so, as I find out from time to time. For instance we do not get CGM (continuous glucose measurement) devices paid for by our insurance companies, as they are considered “new technology without proven benefits”. We also actively have to document, that a pump would provide an improvement in our diabetes control (with documentation including all blood glucose tests, sports, carbohydrates, injection site changes for six months – I suppose the German reputation for documenting things thoroughly is not entirely unfounded). On the other hand, we do, of course, have health insurance for everyone. And our employers pay half (roughly) of the insurance premium.
I’ve had phases in diabetes – ranging from well controlled (by my parents) when I was very little, to horribly messy in my teenage phase. I’ve been startled about two years ago by a picture taken at the company barbeque that showed a seriously fat man. My diabetes doctor at the time (himself a bit on the wide side) said: You cannot change this. You’d have to completely change your lifestyle and become a vegetarian. I felt let down (and changed doctor) – and decided to just be a bit more sensible.
“Bit more sensible” turned out to involve more sports (which I occasionally blog about), less food (which I _don’t_ blog about – who’d want to read that?!) and better control of my diabetes. Which meant not only going on lots of training courses during my work hours, but also to finally get a pump and read up on resources. Turns out there are a few available on the internet (who’d have thunk it?).
I’ve also been annoyed (frequently) by doctors’ orders. What especially bothered me (for today’s topic, anyway) was the clear rule to use lancets and needles only once. Always throw them out right after you used them. Waste the 0.5 units of insulin required to fill the needle just in case you dropped it into the dirt on the side of the road. But I’m slightly getting ahead of myself there.
Anyway, the topic at hand today is misuse of pen needles and lancets. I’ll go so far as to extend this to syringe needles as well. No information on pump related stuff, of course, as will become obvious in a second.
When Alexis posted about life hacks, she mentioned changing the lancet maybe twice a month (and this is a direct quote, I’ll have you know!). I know people who tell diabetics off for that. In fact, I was specifically told not to reuse things in every single training course I got. The images shown are usually similar to this one:
Taken from a German pharmacies web-site and available in similar shape and format from many, many English and US sources as well.
The usual symptoms mentioned are pain during the injection or the blood-letting. Some of the sources are curiously dubious, mentioning diabetic dogs, laboratory tests on pig skin and synthetic dummies. Now I don’t mean to appear like a contrary old person (I suppose I actually do), but I never trusted those images and numbers.
Admittedly – mainly because I didn’t feel pain and I certainly did not change my syringes, pen needles and lancets anywhere near as often as recommended (Reality check time: When I go out for a meal and a visit to the cinema I need two injections: for the meal and the popcorn. I’m not going to open my pen in the dark of the cinema, unscrew a pointy, sharp metal needle and leave it in the popcorn container).
So, I checked. Conveniently I work with a scanning electron microscopy daily and thus just need to distract my boss with a cup of coffee, while I quickly put several things inside the vacuum chamber that have previously been stuck into me. I mean… into a randomized male patient, age 30-40 with soft sensual skin. Two of those are true!
Now this image (above) is a new pen needle (Novofine 8mm, in case it makes any difference). Unfortunately, the very tip is buried inside the carbon pad that I used to hold this sample. Sorry. However, we can probably safely assume that this tip is pointy and not bent in funny shapes. Because we believe in medical companies having sensible quality control and have had an optimism-inducing beer before writing this post (second German prejudice confirmed, I suppose).
I’ve used that same type (not the same – I didn’t have that much time) of needle several times. I’ll just tell you now, that after 1 and 2 injections it looked exactly the same. Needle shape wise, that is. Some “stuff” ends up stuck to it (we shall call it skin and blood and hope it’s nothing else).
This is the needle after 20 times use (above). Still doesn’t look too bad, does it? Although, I’ll admit, the amount of gunk is not exactly getting better.
Now I admit that that was at the same magnification. And thus fitting my description better than that of the manufacturers. Which was sort of the point. So here is the same image (above), magnified ten times more. Now there is some bending at the tip. Which seems to turn the needle into a grappling-hook-of-skin-ripping (that’s the technical term – look it up!). But the total deformation is still only 5 µm. Considering the total needle diameter of 250 µm that is a deformation of 2%. I think. If my math is right.
The pen needles are by design relatively flimsy, though. They have to be thin-walled, and thin to produce the least amount of PAIN!! Which is in all our interest, so I’m definitely not complaining. Lancets, on the other hand, don’t need to be hollow and can be designed with a bit more stability in mind.
And so they are (above). Solid chunks of steel. With a slight edge to them (two, technically, but we’re not debating their legality in a bar-fight here).
When you ram that thing into your skin – skin breaks (Evidence: look at any diabetics fingertips, although I suppose Wikipedia would stick a  here). The big chunk of metal? Not so much …
This is the same needle after 300 blood tests (above). On a male subject, age 30-40 … with unusually soft skin, I am sure.
And because the pen needle didn’t show much deformation in the small magnification here is the enlarged view:
Still nothing. In fact, it would appear that solid steel is harder than skin. Which isn’t all that surprising. Even the Mohs Hardness scale tells us the same.
Summary? It’s not going to cause much more damage if you don’t exchange your needles. I’m tempted to add “ever” here, but evidence is still missing (a well-deserved  in this case). There are “things” sticking to the needles, though. Probably just cells and blood and gore and such, but the images above allow a case to be made for “ICK!”.
So I still occasionally exchange my needles. And switched to a pump instead of a pen.
Alright folks, it’s time for the big reveal, which will also, as a byproduct, include a bit of a let down BUT one that’s well worth it.
My new job is with Dexcom and I couldn’t be more stoked. I will be managing the Portland to Tacoma territory for them with the sole purpose of getting the best CGM on the planet into the hands of more patients. I’m one week in and already loving all the diabetes interaction this job allows for. Getting to talk about diabetes and the benefits of CGM are a dream come true for me. And also I called on a pediatric endo office yesterday and kind of melted into a pile of mush based on the cuteness and bravery of the kids in there. Wow. I hope I was that cool when I was diagnosed.
After several months of looking for the right fit up here in the Pac Northwest, I’ve finally found the right home for the next step in my career. I followed the company since it’s inception and the fact that they are based in San Diego is a huge bonus for me in that it allows for trips home for meetings and trainings. Most important though is of course the fact that diabetes education and advocacy are my true passions in life, and this allows me to persue that and also have a career at the same time. Stoked!
So what’s the downside? Well, as an employee of Dexcom there are rules and regulations about what I can write about on this blog (and any other social media) in regards to the product. Posts about CGM will still be happen, but expect it to be referred to as just that: CGM with no brand name, as well as fewer (if any) photos of my device. This is a normal company procedure and I’m so happy to make this tradeoff because it means I get to work full-time for what I think is the coolest company out there. Plus, I get to help people with diabetes live better – and that’s a dream come true for me. Well that, and finally being employed again
If you’ve never heard of Tim Ferriss, you’re not alone. But you may have heard of some of his books, with the enticing, too-good-to-be-true titles like “The Four Hour Body” and “The Four Hour Workweek.” The titles are a bit misleading, in that not everything he describes takes four hours, but the basic principal of his work is “life hacks.” A “hack,” as you may have seen floating around an internet meme before is a simply another word for “shortcut.” Tim Ferriss has spent his life finding shortcuts to everything from losing weight to making money to hitting a three pointer every time. What’s interesting about him is that he tries all of these things on himself first, and blogs candidly about his results, including his experiments that don’t work.
Some of them I find totally ridiculous (he claims her can function on about two hours total of sleep, if that sleep is stretched out into the appropriate number of naps, each for calculated lengths….that sounds horrible to me.) But others, like his use of the “slow carb diet” for weight loss makes total sense to me (it’s actually the diet that many of us Type 1s have used for years – low to no carbs, lean meats, lots of veggies, no fruit. He also cuts out most dairy but allows for red wine…my kinda guy!). Overall his methodology is interesting and if you want to learn more about him just use the Google Machine. This post is not actually about Tim Ferriss, but this idea of “hacks.”
All of us with diabetes do things that make living with this disease easier, whether it’s concious or not. For example, the gross fact that I change the lancet like…twice a month…is a shortcut I didn’t intentionaly start out using. It’s just that it’s a pain in the neck to change the lancet and in 21 years with diabetes I’ve never had an infection or increased pain from re-using them. So it’s one thing I don’t do that often because in a way, I don’t find the recomended use of them to be efficient.
Other “diabetes hacks” could include re-upping your CGM sensor when it expires…same goes for infusion sites. These are ways to save a little money, save some time, avoid an annoying chore, or all three. “Diabetes hacks” are just the little shortcuts we take to “work more efficiently” in one way or another.
So my question is, what are YOUR diabetes hacks? What do you skip/manipulate/change SAFELY to make something about this disease easier?
Listen…don’t get me wrong, I’m all for work-related hardware. I got a new phone for my new job that I’ll use only for work and that’s great. The company takes care of the cost of the phone for me which is amazing. But tell me this isn’t getting a little ridiculous?
It’s like a Leaning Tower of Tech! I’m no longer kidding about needing a Bat – Belt. Four devices in total? I’m becoming more droid than human these days!
It’s a strange feeling being a person with diabetes without insurance. Vulnerable. Scary. When I left my last job, I ponied up the exorbitant monthly fee of $600 to remain covered on COBRA. While it was a burden to pay that every month, the alternatives of being uninsured or choosing a lesser plan that wouldn’t allow for my pump and CGM supplies were even less appealing. Jacob and I worked hard to save up enough money to ensure our trip to Asia and our move to Portland wouldn’t cripple us financially, and I feel lucky that we were able to prepare for it.
But when December rolled around and we had been married for a few months, Jacob and I realized it made more sense for me to join his plan if January rolled around and I still didn’t have a job with benefits. So I sent a letter cancelling my benefits, effective December 31st.
But, as usual with life, another curve ball (a great one!) came flying through: I found a new job! It’s for a diabetes company (more on that later) and I’m so excited/honored/flattered/stoked/totally thrilled to have been hired into this role. It’s truly a dream job for me. But since my start date isn’t until the 13th, I’ve had a 13 day gap without insurance.
It’s not technically a huge deal. I have plenty of my supplies to last those two weeks, and my numbers have generally been steady. I have only ever been to the ER once (KNOCK ON WOOD LOUDLY AND VIGOROUSLY) for diabetes, and I’ll do everything I can to make sure I don’t land there sometime between now and Monday. But interestingly, the last thing I’ve been worried about without having insurance is my diabetes. Instead, it’s been literally everything else.
What if we get in a car accident? What if I tear my ACL running? What if I drop a weight on my toe at the gym? What if we get attacked by bears on our way to the Tillamook Cheese Factory? WHAT IF THE CHEESE IS POISONOUS???
Ok, ok, those last few might be a bit gratuitous (although for the record, to get to the town of Tillamook where the factory is, you have drive through a LARGE forest and I am sure there are bears there…) the concerns have been very real for me. Through the years, I’ve always blamed needing a corporate job and benefits on my diabetes but really, it’s a vulnerable position for anyone to be in. The idea that a trip to the gym could eventually bankrupt me if my luck runs out is terrifying, and only further highlighting how scary and unfair it is to be an uninsured American. Diabetes or not. I don’t pretend to know what the answer is but one thing is for sure: it’s scary out here. There has to be a better way.
Are you able to identify this dish?
If not, you’re not alone. I didn’t know what it was until I moved to Portland and a nearby English pub became a local favorite for us to grab a drink and a snack on the way home. They have literally hundreds of beers to choose from and serve a variety of British fare including bangers and mash and the little creation you see above. It’s called a Scottish egg and there’s no way else to describe it except as an egg wrapped in meat and then lightly fried. Yep, it sounds weird but it is absolutely delicious. And guess what? I have no freaking clue what the carb count is on something like this. Um, five?
When we describe what it means to live with diabetes to folks who don’t know, we have to try and keep things simple. We explain it in terms of evening a scale: too much sugar means I need more insulin, too much insulin means I need sugar. I count the carbs and dose for that many and that’s how you “manage diabetes.”
Except that all of us know that half the time at a restaurant, that carb count is a total ballpark. It also doesn’t factor in if you worked out that morning, or are going for a walk after that meal, or if you’ve been low all day, or if you’re having alcohol with that snack, or if you’re sick, or stressed, or tired, or if the moon happens to be aligning with the seventh ring of Saturn and it’s the third Tuesday of February (because that seriously must account for some of this diabetes ridiculousness we all experience, right?).
It’s just simply not that simple with diabetes. If all I had to do was know my blood sugar, carb count a food and bolus the correct insulin for it, I’d have an A1c better than someone with two working pancreases (I know that’s not a thing – I’m using hyperbole but that would be rad because I’d totally ask to borrow one from that person. And by “borrow” I mean “have.”)
The layers of complexity, the nonsense, the sheer guestimation we’re using with this disease much of the time is the stressful part, and it’s so hard to explain that subtlety to someone who doesn’t experience it themselves. Just the other day I was with my husband – who truly lives and breathes this disease with me – and a high BG was making me feel exceptionally sluggish and yucky. I was in the 250mg/dL range due to a large lunch but this one was hitting me hard. Why is this one so bad? is what my husband was wondering. And the answer is that I don’t freaking know…because the wind was blowing south? It’s as good a guess as any, really.
It’s so funny that managing diabetes is so intensely complex when the reason we have it (death of the beta cells – R.I.P islets of Langerhan) is relatively simple. Just another testament to how amazing the human body is I suppose. And, a reminder that it’s miracle that our bodies even work at all!
Ah the new year! A time to re-commit to exercise and diet goals and for all of us with diabetes, getting or keeping that A1c low. And after all the amazing meals between Thanksgiving and New Year’s, I’m finding it a little hard to get back on the bandwagon. There were so many reasons to enjoy so many delicious foods for a while there, but now, alas, it’s time to buckle down and make food choices that can help me continue to strive for an A1c under 7%. Which leads me to this question: Can net carbs really be trusted?
Net carbs are supposedly the amount of carbs that will actually hit your system after subtracting the grams of fiber from a total carb count of a food. Many so-called “diabetes friendly” foods make this claim, but I’ve been burned by it too many times in the past. Most notably in my mind with a brand of pasta called “Dreamfields” which claims to only have about five grams of carbohydrates after deducting the fiber from the total count. This, in summary, did not work for me, and I ended up taking as much insulin as I would have for normal pasta.
But the net carb claim isn’t going away, and some folks even apply it to high-fiber fruits and vegetables. I haven’t had consistent experience with it and in fact, it makes bolusing more complicated because it can often lead to some, but not all of the carbs hitting me, and me not being able to predict how much that will be. Somewhere between the total carb count and the net carb count, I guess.
Are there any of you that follow the net carbs rules in a hard and fast manner that you have found to be effective? Or is this one rule to ditch in 2014?