Cure vs. Cure.

CellThere’s been a whole bunch of buzz lately about this project out of Harvard, claiming a breakthrough in stem-cell technology. This could all translate (and by “translate” I mean don’t hold your breath – I’ve heard they’re just five years away from a cure for the last…22 years) to a means by which people with Type 1 diabetes could get new insulin-producing beta cells implanted so they can once again make their own insulin. They would be, in a word, cured.

Meanwhile, also on the east coast, you have the Bionic Pancreas project headed up by Dr. Damiano and Dr. Russell which uses CGM and two pumps (one with insulin, one with glucagon) to automatically regulate blood sugar using devices. Patients using the system would for the most part be on auto-pilot. In the sense of not having to think about diabetes much or at all would also be. They too would be, in a way, cured.

Which brings us to that very important question of: what really constitutes a cure? Is a mechanical, bionic solution enough? If the artificial pancreas system was perfected to the point that you didn’t have to do anything except wear a device, is that considered “cured”? Or, is it only a cure when there’s no need for any sort of intervention because your own body is back to work? And where does prevention fit in to all of this? What if tomorrow they invent a vaccine that prevents Type 1 from ever developing? What would that mean for those of us living with diabetes today?

Where do all of you weigh in on a cure? Is a bionic solution enough or do you believe until we can make our own insulin again that everything else falls short? And, the million dollar question – does this effect which charities (and therefore what research) you are inclined to give to?

Serendipity is…

….your brother-in-law saying he’s cooking Italian and finding out he went this Italian route instead of pasta or pizza.

IMG_2052.JPG

Nope, no carbs here.

Would you rather: Diabetes Edition

Make a ChoiceYou know that game people play at parties called “Would you rather?” It usually involves two not-so-awesome choices and you have to pick the least-worst situation. For example, a question might be: “would you rather spend the day with someone you can’t stand or stand in line at the DMV for the same amount of time?” or something like that….

I realized over the weekend that us folks with diabetes play this game every day without meaning to….here’s just a smattering:

 

 

So…I’m thinking the diabetes version of this wouldn’t go over so well at your average cocktail party…but maybe all of us in the ‘betes blogosphere should get together and actually play this game together…because that would be hilarious! And just know that you’re winning this game every day by the sheer fact that you have to play it, even though you don’t want to :) What other “Would you rathers” have you had today already?

 

 

Product Review: Great Low Carb Bread Company!

IMG_0008.GIF

IMG_0009.JPGOne of the hardest things about working towards my super-low A1c has been cutting carbs almost entirely. For me, restricting carbs is a sure way for me to crank my numbers down. I use the rule of small numbers: small amounts of carbs mean small amounts of insulin which means small mistakes. Making small mistakes means there’s less likelihood for wide swings in my BGs and a free ticket on the Glucoaster (and everyone knows that ride sucks!).

But, no one said that would be easy all the time. I miss things like bread and bagels and pizza, especially on the weekends when we cook at home a lot. There’s nothing better than a lazy Saturday morning with a big pot of coffee and some home-made eggs on toast (two poached eggs on a lonely plate by themselves is…a bit depressing…plus I’ll be hungry literally one hour later).

So when Great Low Carb Bread company said “hey, wanna try some of our products?” I was absolutely game. Great Low Carb bread company wanted to create low-carb bread products that would have a minimal impact on blood sugars. They use high-quality, non-GMO ingredients like almond flour, flax meal, oat fiber, and all-natural stevia. Their ingredients are Kosher, and their products are free of soy and hard-to-digest sugar alcohols, which is good news for my tummy. One thing I noticed and liked about the company right away was that all they make is bread products: bagels, sliced breads, hot dog buns, even pizza crust. They’re not trying to make every product low carb, they’re just doing breads in an amazing array of options (seriously though, check out all their products here – it’s expansive). I love that kind of focus and commitment to quality!

I was lucky enough to be able to try their Everything bagels and their plain sliced bread – and I put them to the test. Their bagels list a total carb count of 16 grams (14 being fiber), while the sliced bread clocks only 8 grams (7 fiber). I toasted, sandwiched, cream-cheesed, grilled cheese, and buttered their products (not all at the same time…that would be weird) to see what they could do and here’s what I found:

The taste was…well to me, it was low-carb. Listen, nothing will ever replace the real thing and that’s exactly the challenge that we face with diabetes. But the taste for both products overall was pleasant – certainly nothing bad about it but a little “plain” might be how I put it. But since we’re most often not snacking on plain bread and bagels, this was ok. Once toasted and dressed, they crunched in all the right places, just like the real deal. And the best part was, the carb counts rang absolutely true for me: one unit of insulin needed for a slice of the bread, two units for the bagels, like clockwork. That is nothing compared to what I have to take for the real thing. I can recall days of taking SIX units for a regular bagel and still ending up in the 300s post-meal. Not cool.

I absolutely loved being able to make a big breakfast for me and my husband on the weekend and not have to leave out the toast or bagels. And come lunch time, it was a relief to be able to make a quick sandwich instead of slicing up everything needed for a salad, which can be so time-consuming sometimes. Only having to bolus four units for a super-satisfying sandwich (and not ending up high anyways) was the best part though.

Overall, I have to say I was quite satisfied with these products as great alternatives to the full-carb versions. It doesn’t taste quite like the real thing, but like I said, the fact that I can still make some of the meals I’ve been missing and not sacrifice my total daily units is huge. If you’d like to try them for yourself, you can get there on their website here, or on Amazon.com (search Great Low Carb Bread Company). Happy Low-Carbing! And special thanks to Great Low Carb Bread Company for generously offering their samples to me!

The Why.

“He’s just not been taking care of himself.”

I’ve heard this at least a thousand times, whether from a friend of a person with diabetes or like a few weeks ago, from a parent of a teenager with T1. They complain about how he just doesn’t care and he’s going to suffer the consequences if he’s not careful and that he’s on a dangerous path and they just don’t know how to help him. And these people are almost always coming from a place of concern. They see a person they love with “bad” numbers and they get worried. This is a normal thing to worry, and these folks mean well (usually).  But what we have to remember about diabetes management is that there are so many barriers to care, and sometimes, they are not what we expect.

I met this teenager that was supposedly “not taking care of himself.” His parents said he would never tell anyone he had diabetes, even though he was quite active and social in school. He’d given up on his pump and was barely testing anymore.  They worried he and his peers were experimenting with alcohol and were terrified of what would happen if things went wrong and no one knew about his diabetes. They felt like they couldn’t reach him and didn’t know what else to do. They were at the end of their rope. Which is how I ended up meeting him solo at his doctor’s office. He’d come to his appointment alone because he and his parents were arguing so badly with him about his diabetes care (or lack thereof) that both sides had enough of each other. He and I sat down to train on his new device together. When I told him I had diabetes too, he finally looked me in the eye for the first time.

“Really?” he said quietly, giving me the once-over, making sure I was a “normal” person. “It sucks,” he added.

I told him that I couldn’t agree more. I told him that it’s a crappy club we’re part of but it’s also not the worst thing to have. At least we get to play sports, travel, go to school, and do everything most other people do. We just have to plan ahead a little more. He told me about all the sports he plays and I told him I’d just run a half marathon, and did karate competitively for five years. We talked about Drake and how the new T.I. song was kinda lame and whether or not Tyga was going to really make it as a rapper.

I asked him what the hardest part about having diabetes was. It was then that he revealed that a few months ago, his pump had failed and set off a long, loud, disruptive beep during a recent sporting event and he didn’t know how to turn it off. It was obnoxious and distracting, and he didn’t know how to silence it. Some kids started making fun of him. He was mortified. Since then, the pump had remained stashed in a drawer, and his desire to be associated with diabetes in any way had fallen to zero. It wasn’t exactly helping him fit it. Bingo. There was the disconnect. Diabetes = embarrassing = not fitting = I’m not doing this diabetes crap anymore.

Barriers to care are social, economic, gender and race-specific. They are big and small reasons, and they are as varied as each person with diabetes themselves. But very rarely is someone “just not taking care of themselves.” No one wants to feel crappy everyday. No one wants to go blind or lose feelings in their limbs eventually. No one wakes up one day and says, “I’d just rather feel awful today and every day after.” It’s quite simply not that simple.

Sometimes, it helps to just ask someone how they are doing, and ask why things feel hard right now. And then just listen. It’s so hard for all of us to do that, diabetes or not. Have I nagged my husband/friend/parent about a habit they know isn’t good for them? You bet. It’s not the easy choice to just listen and support. But when we do, we’re often able to be so much more helpful than when dispense advice or admonishment. It’s that “no judging” thing that really goes a long way. Easier said than done, I know, but it’s worth it to try!

 

Positive ID!

About a year ago this time I was newly married and making the rounds in the world of “changing your name.” There was the Social Security office, the DMV, my credit card, my bank, my gym membership, my Facebook….the list went on and on. Turns out when you’ve been known by a particular name for 30 years, it’s recorded in quite a few places.

One thing I had not bothered to change during my initial sweep of my identity was my medic alert bracelet. I’d had the same one for several years. I’m funny about medic alert bracelets. I know there are tons of companies that make super-cute ones, and sporty ones and ones with pretty beads that don’t look all medical. But I have this fear that if I was really in trouble and unconscious that an EMT would look at my wrist for a medical tag, see a decorated bracelet next to a few other bangles and a watch and not notice that one of those happens to be a medical ID.

So although the stainless steel bracelet I wore for the past few years is…um…not cute to say the least, I felt like it was necessary to truly do the job. I really disliked it when I switched to gold-tone jewelry for a different day or outfit, because then the stainless steel ruined the whole “look” (Side note: HA!! Like I have a “look…” My “look” these days involves: 1. appear like you’ve showered and 2. no {visible} coffee stains…which is why I wear a lot of black…anywho…) For the past year, my bracelet has read “Alexis Pollak-Type 1 Diabetes,” which is my maiden name. I think I finally just tapped out on the whole name change thing by the time I realized it…so there it stayed.

And then the other day a friend posted a link to a medic alert jewelry website and I clicked on it. It was about 11 o’clock at night and for whatever reason I said “seriously, I’ve got to get a new bracelet with my new name on it” and I grabbed my wallet.  And then, my friends, I did some serious late-night shopping, diabetes-style. Oh yeah. I got ‘em all:

photo 2 (2)

 

New stainless steel bracelet, new gold-plated bracelet (so I don’t ruin any more of the aforementioned “looks”!), new earthy-Portlander-rustic leather with a steel plate and medic ID symbol and one stretchy black rubber bracelet that’s perfect for long, sweaty workouts. All now bearing my official, social security sanctioned new(er) last name of Hauptman. photo 1 (1)

Damn it feels good to upgrade. And if we have to deal with this stupid disease, we might as well get the cool accessories to match, right? (Note to self: do not wear all four new bracelets at the same time, no matter how tempted to do so….)

Carbs? What Carbs?

Super normal breakfast, right? Total units taken: 0.5. BG after breakfast: 93mg/dL. Here’s to holding on to 5.9%!

NO CARBS

Normal Pancreas Person Numbers.

Puzzle PiecesJacob and I have always had plans to start a family one day (nope, no people, this is not a “we’re expecting post” by any means…slow your roll!) but we both always knew that involves me having some seriously stellar numbers and in particular, a super-low A1c. Months ago, my endo told me she prefers her patients to go into the family planning stages with an A1c under 6.5%. To that, I said “great, that’s where I want to be normally – regardless of planning for a child or not.” It was already my personal goal to get my numbers at 6.5% or below, and I was able to finally achieve that a few months ago, after popping up into the 8% range after eating all the Pho in Thailand our travels to Southeast Asia.

But then I chatted with a high-risk OB about where she likes to see numbers in her patients with T1 and she said…under 6%. Which, if I remember what the “normal range” is for an A1c is correctly…as in a person without diabetes…it’s between 4 and 6%.

So um, great. You want me over here with the busted pancreas that produces zero insulin to get an A1c that is the same as a person who has functioning beta cells. Holy. Cow. At least, that was my initial reaction. But I’ll be low all the time! And never eating a single carb! That’s IMPOSSIBLE! I thought. And then I realized something that made all the difference.

An A1c of 6% translates roughly to an average BG of 120. 120mg/dL. That’s a number I like to see and that I strive for anyways. That’s a number that’s not that low to m and is in fact, quite nice. Averaging to that number, well that will take some work. That’s correcting a 140 with a quarter-unit of insulin. That’s keeping a hawk-like eye on post-prandial rises on the CGM. That’s some extra effort that takes some tweaking. But a BG of 120 is doable. When I looked at things that way instead of holy sh%$ she seriously thinks I should have a NORMAL PERSON’S A1C?? IS SHE NUTS!? it became way more doable.

So doable in fact that my A1c as of last Friday is 5.9%. Yep, that’s functioning-beta-cell-type-of-numbers.

Look, it wasn’t a cake walk (every pun intended). It was a lot of making time to exercise at 5 in the morning when it’s still dark out and even the dog thinks I have to be crazy to be going outside at that hour. It was a lot of “let’s make you (Jacob) an ear of corn to go with this steak and salad we’re having because I don’t want the carbs and I know this meal isn’t enough for you by itself.” It was correcting the 140s with tiny doses and bringing up lows with just a few glucose tabs instead of a double helping of frosting. But it was doable, and I didn’t go crazy in the process.

Now maintaining that number? Well, we’ll see about that! But as I’ve always said, getting to a goal like this boosts your “diabetes confidence” so much – you did it once and you can do it again. And thinking to myself “shoot for 120mg/dL” felt so much better than “try to have a normal A1c.” So I know I got there, now I just have to stay there…digging deep for the motivation as the holiday season approaches soon! Must…be…strong…near fun-size candy bars for Halloween….

Glucose Tablets: Making a Comeback.

Glucose tablets. We all meet them at some point during our diabetes life time. It’s usually towards the beginning when you’re first diagnosed and your doctor or CDE tells you that they are a simple, fast way to get the required 15 grams of carb down your gullet when you’re low. You might have used them frequently at the beginning of your diagnosis because you didn’t realize yet that Ben and Jerry’s tastes waaaaay better and also contains blood-sugar raising carbs that act quickly. In fact, most things taste better than glucose tablets. Yes, even the so-called gourmet glucose tablets that have become available recently aren’t much better. Even with better flavors, it’s so hard to get that chalky, powdery hunk of glucose chewed up and into your tummy so it can do it’s job. Which is why I actually haven’t used them in years. Tablets

Years ago, I discovered GU energy gel, which is designed for runners but comes in tasty flavors like chocolate mint and peanut butter. I love the little silver GU packets and throw them in my pocket or purse everywhere I go.  I’ve also kept plain chocolate or vanilla frosting in the fridge for years. GU packets are very portable, but at almost a $1 each they’re pricey. And one small can of frosting can fix 50 lows for the same cost. If I find myself out on the road for work and trending down, it’s serendipity to be close to a Starbucks so I can treat myself to a beloved cake-pop. All of these seem like way better ways to treat a low because they taste better and are easier to get down.

But the problem with all of those mentioned methods is the amount of carb they deliver. GU packs have 18 grams of CHO. Cake pops have 22 grams. And frosting can pack 21 grams in a single serving, All of my go-to methods for treating lows are in fact, more than the recommended amount of carb to treat a low. And for someone who is trying to achieve extremely tight control, this can actually cause more problems than its worth. I’ve noticed lately that most of these treats I use for lows can cause me to rebound too much – not crazy high rebounds, but enough to matter for my A1c. 22 grams of carb can take a 65mg/dL to a 150mg/dL pretty quickly. And if I’m only down at say, 75mg/dL and slightly trending down, a cake pop can send me through the roof.

Glucose tablets on the other hand, with only four grams of carb each are allowing me to customize how I treat lows so that I don’t over do it. They let me bring my BGs up to a level that’s safe without cranking them up too quickly or too much. I also like that I can have just one or two tablets for BGs that are simply trending down but not dangerous yet. And all of this may sound obvious, but seriously, I hadn’t bought glucose tablets in years and they’re kind of blowing my mind right now! I am loving being able to “titrate” my low treatments so that I don’t end up on the Glucoaster as often.

Although, there will always be times where I take a solid low as a wonderful opportunity to dig in to that pint ice cream – we do deserve to treat ourselves sometimes when we’re going through all the crap that diabetes makes us deal with. But for all the times when Hagen Daz isn’t  randomly available to me, I’m going old school and poppin’ open a tube of glucose tabs, letting that powder float through the air and downing my little customizable sugar tabs!

Have it your way.

CheeseburgerHave you ever ordered a venti, sugar-free, non-fat mocha…with whip cream? Or maybe you’ve ordered a bacon cheeseburger with fries and..a diet coke. I’ve been guilty of both of these orders in my lifetime and I don’t feel bad about it.  Many people might say “why not just go for the real deal and get the full-fat, full sugar mocha?” Or “what difference does the 130-calorie Coke make with the 1,000 calorie burger and fries?”

The difference is that with diabetes, we know how to make things count. We know where we’re ok to splurge and where we’d rather just save the calories/carbs because it’s just not that important to us. On a cold Portland day, I’ve honestly ordered a plain black coffee with whip cream at my local Starbucks simply because I wanted the “winter drink” experience without annihilating my BGs with a peppermint mocha monstrosity. Bolusing for the whip cream was worth it to me. Bolusing for anything else right there in that moment was not. And I’m totally ok with that.

I think what’s harder is explaining to other people why we make the food choices that we do. We’ve all been dining with friends and decided to indulge in a dessert or something sugary and had a well-meaning acquaintance get that confused look on their face and say “wait…I thought you said eating low carb was easier on your diabetes?” Or you’re out with friends who are used to the fact that you occasionally have dessert or might need to sugar for a low…but you’re not feeling carbs that day. You opt out of the chips-and-salsa-appetizer and cold beers and they wonder if you’re on some special new diet.

And no wonder – diabetes is super-confusing that way. Every day, we’re making choices about what we want to manage or not manage, how it will impact us in the moment and in a few hours, and whether or not something is worth it. On top of that, our goals evolve and change through the years. Someone who is aiming to tighten their control might make different decisions than someone suffering from serious burnout. It just depends on the person and what they’re trying to do with their diabetes management that day (or hour even!). But explaining that to others isn’t easy.

 One of the biggest stereotypes about living with diabetes is that there are hard and fast rules for everything, and that couldn’t be further from the truth. In fact the way we make most diabetes management decisions starts with “it depends.” And I think that’s the biggest education we can give to those around us – that this isn’t always an exact science and that it will continue to evolve for each of us throughout our lives and even day to day.

Plus, you can use it as an opportunity to really show someone what the term “bolus-worthy” actually means…