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Today (10th Sep, 2009) this blog moved to: http://ladalife.com


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Thanks!

Still Learning

Today (10th Sep, 2009) this blog moved to: http://blog.zansuri.com 
 In 30 years of diabetes, which has progressed, sometimes become better-managed, and has changed over the years, I’ll profess my avid interest in its treatment.

I thought I knew a lot until I started the preparation for going on an insulin pump earlier this year. Since then, I can’t tell you how much more my poor brain has been filled with extra information. Every week it seems I learn something new. Whether it’s about managing the disease, research, reading other people's experiences, it’s still learning.

My averages had been creeping up over the last couple of weeks. I can put it down to a number of things including another kilo on my already overweight frame (I still manage to just scrape in to the ‘overweight’ category with Body Mass Index (BMI)).

We had visitors and were eating out a lot, in places where whatever was on my plate was sometimes difficult to carb-guess. And the kicker was the extra exercise. Like some, I’m not textbook when it comes to exercise. I don’t do enough of it (knee needing replacement) so I go high during exercise - contrary to text book advice - and have to bolus more. More bolus = more insulin = more weight for me. Going high during all the walking we did meant extra insulin.

So, whatever the reason or combination of reasons for my averages going up, I felt I had to break the cycle. Three days last week, I did very-low-carb. This week, I’m doing lower-carb. It’s done the trick. Don't take this as advice - it's just my experience.

Under no circumstances did I want to increase my TDD of insulin, which would put on more weight. What I did, worked nicely for me. I’m back to carb-watch-eating and my numbers are way better. In the process, I also shed a couple of pounds, for which I’m very grateful. The extra weight seems to be super-glued to me, and getting it off is a battle.

In passing, my endo, a few weeks ago, told me not to worry about the extra weight, considering how well I’ve done since I went on an insulin pump. I didn’t think much of it at the time. My thoughts were of fashion and vanity.

In a twist of fate, I subsequently read about some latest studies which suggest that BMIs under 18 and over 30 are associated with a greater risk of death. What was apparently surprising to the researchers was that the overweight category BMI: 25 to 30, was NOT associated with any significant greater risk. And the most surprising was that the underweight category BMI <18, was.

We all thought that calorie restriction was the way to go. Apparently not. From what I’m reading, going into the twilight years with a little extra padding, isn’t all that bad. What is vitally important, is your fitness. If you are normal weight and not fit, you do worse than someone overweight and fit.

If you have the time, watch the video below. It outlines some of the latest research.

Obesity: Ten Things You Thought You Knew

So maybe my endo had seen these same studies.

That still doesn’t let me off the hook as far as off-the-hook fashion goes. And yeah, I’m not all that fit. I hope to change that.

Please Don't Lecture!

Today (10th Sep, 2009) this blog moved to: http://blog.zansuri.com 
 It bugs the hell out of me! Well-meaning (sometimes) and uninformed (nearly always) people telling someone (including me) how to manage their diabetes.

While I haven’t lately had anyone tell me anything that irked me, I see it and hear it all the time.

Please folks, if you don’t have diabetes yourself, unless you’re a medical person (and they are sometimes wrong too),  don’t presume you know anything about how to manage anyone's diabetes!

Just a few tidbits… if you have diabetes, as you know, this list can get a mile long. Here are just a few that come to mind. 

• Because I’m a few pounds overweight (thank you insulin), don’t presume I have Type 2. I don’t.
• Because something worked for someone else, don’t presume it’ll work for me… and above all, stop shoving it down my throat.
• Don’t tell me that if I don’t look after myself, I’ll die. That’s the first thing we learn. Then it’s OUR choice.
• Please stop being the food police!!! I have insulin. Theoretically, I can eat whatever I want as long as I can manage it effectively with insulin. (Doesn't mean I do or I can.)
  
• If I look like I’m not motivated to manage my diabetes effectively, motivate me gently, suggest a counselor who can help, or just plain hold your tongue! You probably have no idea why I’m not motivated.
• Don’t talk to me about low-carb, high-carb, low-fat or whatever other combination of foods you think aren’t good. Studies have shown that both a low-carb/high protein/high fat, or high-carb/low fat diet/low protein (in whatever combination you want) are equally effective for losing weight. If you can manage your diabetes well on high carb, then that's your choice. If you manage on low-carb, that's your choice too. If you manage on a mix of both, fine too. 

I can’t stress this enough, EVERYONE IS DIFFERENT in terms of their management of diabetes and what works for them, and what they're willing to do. If just one thing worked, everyone would be on the same diet, with the same amount of insulin/pills, taken at the same time of day, via the same method. Nice try, but no cigar!

If everyone was motivated the same way, there'd be no issue - everyone would have perfect A1Cs, right? Even then, diabetes doesn't always behave the way it's expected to all the time. Just doesn't happen unless you're a total creature of habit (eating the same thing every day, same exercise, same everything, stable hormones, no illnesses and so on)! Even then everyone gets curve-balls at one time or another!

What I want to stress above all else is that it's people's personal choice about how they manage their diabetes, whether you think it's right or not.

If you find someone who's not motivated, then try gently once or twice, then LEAVE THEM ALONE, and don't judge. Support them in other ways. It's not your place to be judge and jury for anyone else's life.

Even if you think you know better, please don't lecture - more often than not, it's more unproductive than helpful.

Mediterranean Diet Better for Diabetes Than Low-Fat Meals: Study

Mediterranean Diet Better for Diabetes Than Low-Fat Meals: Study

Been saying the same thing it for years!!

Whether you're Type 1 or Type 2 or anything in between, if you can't keep your blood glucose within your target range most of the time, try cutting the carbs!

On lower carbs, diabetes is so much easier to control - on insulin and even more so, without insulin!

If you are on any medications for diabetes, please check with your doctor before embarking on any change of diet.

Recipe - Coconut Pancakes & Waffles (Low Carb)

Here's a recipe from Adam, a reader at Mark's Daily Apple. The recipe looks interesting (haven't tried it yet, but others have), and it's low carb too! If you love coconut, try it! The recipe can also be made into waffles.

Primal Coconut Pancakes and Waffles (link to original, including video, which shows you how)
2 eggs
1/2c or 56g almond meal
1c or 68g shredded coconut, unsweetened, unsulphured
1 can or 400mL/g Coconut Milk
1/2t sea salt
1/2t baking powder
1/2t or 1g cinnamon (to taste)
vanilla, optional (to taste)

Nutritional Info
Servings Per Recipe: 8 (divide by 8 to get nutritional info for 1 pancake)

Amount Per Serving
Calories: 209.4
Total Fat: 19.7 g
Cholesterol: 46.8 mg
Sodium: 141.4 mg
Total Carbs: 6.1 g
Dietary Fiber: 2.2 g
Protein: 3.6 g

Exercise and Fructose

Here's an interesting explanation of why exercise is important and why we're eating too much fructose. It's also somewhat related to why insulin puts on weight - whether that's insulin promoting drugs, the insulin you take for diabetes, or the excess insulin produced in most people with Type 2 Diabetes.

I knew some of the theory, but this explains it in detail.

Considering the process of Type 2 Diabetes starts long before it becomes obvious medically, it might be why two people can have exactly the same diet and the one prone to Type 2 Diabetes will be the only one piling on the weight, long before they are diagnosed. You also have to have the genes for Type 2, otherwise every overweight, obese and morbidly obese person would have diabetes. Not all do, in fact, go look at the statistics.

It's yet another reason I think much of the medical community has it backwards - being overweight DOES NOT cause diabetes. Being overweight is the result of the disease process - you pile on the weight, often well before you are diagnosed.

In Type 1, you don't produce insulin. End of story. But many people find that taking insulin puts on weight.

Below is an excerpt from an interview by Norman Swan, who chairs the Health Report on Australia's ABC. The guest is Dr Robert Lustig, Professor of Pediatric Endocrinology at the University of California, San Francisco.

Dr Lustig, also a researcher, "claims that the reason for the obesity epidemic is more than just the calories we eat and the lack of exercise. It's a substance that food manufacturers are widely using."

They are, of course, talking about high-fructose corn syrup. But the discussion focuses on fructose in general.

The part of the discussion that I've reproduced here, also highlights why exercise is important and why staying away from fructose is also important. Yes, fructose, as in fruit.

As an observation, fruit will make my blood sugar go sky high, even with my usual insulin to carb dose ratio. Clearly, for me, fruit is in a category of its own. I might as well be taking the equivalent in spoons of sugar or honey.

Yes, fruit is yummy, but I find I just can't eat it without all the problems of managing high blood sugars, even if I eat it with a protein. I rarely eat fruit for this reason. Easy in winter but not so easy in summer with cherries, mangoes, nectarines, peaches and apricots - summer fruits that are amongst my favourites.

Now if you think you can eat sugar and not fructose, think again. Sugar is half fructose (or thereabouts).

Can you burn off that Big Mac? Find out why exercise is important for reasons other than burning calories, and why it's really important if you are overweight - even slightly.

Why are the Japanese, who eat so much high carb white rice, not fat? For the answer, read on.

The science is there - we just have to pay attention.

The original transcript can be found here. My apologies if I've infringed any copyright. The material presented here is the property of the ABC, and I reproduce it here for the purposes of my subject matter and with a link to the original.

It might be worth reading the full interview. This is the last part of the interview, but the most relevant to my interest.

The obesity epidemic - July 9, 2007

Continued....

Robert Lustig: Exactly, in fact exercise is the best treatment. The question is why does exercise work in obesity? Because it burns calories? That's ridiculous. Twenty minutes of jogging is one chocolate chip cookie, I mean you can't do it. One Big Mac requires three hours of vigorous exercise to work that off, that's not the reason that exercise is important, exercise is important for three reasons exclusive of the fact that it burns calories.

The first is it increases skeletal muscle insulin sensitivity, in other words it makes your muscle more insulin sensitive, therefore your pancreas can make less, therefore your levels can drop, therefore there's less insulin in your blood to shunt sugar to fat. That's probably the main reason that exercise is important and I'm totally for it.

The second reason that exercise is important is because it's the single best treatment to get your cortisol down. Cortisol is your stress hormone, it's the hormone that goes up when you are mega-stressed, it's the hormone that basically causes visceral fat deposition which is the bad fat and it has been tied to the metabolic syndrome. So by getting your cortisol down you're actually reducing the amount of fat deposited and it also reduces food intake. People think that somehow exercise increases food intake, it does not, it reduces food intake.

And then the third reason that exercise is important, which is somewhat not well known, but I'm trying to evaluate this at the present time, is that it actually helps detoxify the sugar fructose. Fructose actually is a hepato-toxin; now fructose is fruit sugar but we were never designed to take in so much fructose. Our consumption of fructose has gone from less than half a pound per year in 1970 to 56 pounds per year in 2003.

Norman Swan: It's the dominant sugar in these so-called sugar free jams for example that you buy, these sort of natural fruit jams.

Robert Lustig: Right, originally it was used because since it's not regulated by insulin it was thought to be the perfect sugar for diabetics and so it got introduced as that. Then of course high fructose corn syrup came on the market after it was invented in Japan in 1966, and started finding its way into American foods in 1975. In 1980 the soft drink companies started introducing it into soft drinks and you can actually trace the prevalence of childhood obesity, and the rise, to 1980 when this change was made.

Norman Swan: What is it about this, it's got more calories than ordinary sugar weight for weight hasn't it?

Robert Lustig: No, actually it's not the calories that are different it's the fact that the only organ in your body that can take up fructose is your liver. Glucose, the standard sugar, can be taken up by every organ in the body, only 20% of glucose load ends up at your liver. So let's take 120 calories of glucose, that's two slices of white bread as an example, only 24 of those 120 calories will be metabolised by the liver, the rest of it will be metabolised by your muscles, by your brain, by your kidneys, by your heart etc. directly with no interference. Now let's take 120 calories of orange juice. Same 120 calories but now 60 of those calories are going to be fructose because fructose is half of sucrose and sucrose is what's in orange juice. So it's going to be all the fructose, that's 60 calories, plus 20% of the glucose, so that's another 12 out of 60 -- so in other words 72 out of the 120 calories will hit the liver, three times the substrate as when it was just glucose alone.

That bolus of extra substrate to your liver does some very bad things to it.

Norman Swan: Dr Robert Lustig who's Professor of Pediatric Endocrinology at the University of California, San Francisco. And you're listening to a Health Report special here on ABC Radio National on how food manufacturers by adding fructose to our foods, either from corn syrup as in the United States or added sucrose as in Australia, may actually be making the obesity epidemic even worse, starting with damage to our liver cells, the hepatocytes.

Robert Lustig: The first thing it does is it increases the phosphate depletion of the hepatocyte which ultimately causes an increase in uric acid. Uric acid is an inhibitor of nitric oxide, nitric oxide is your naturally occurring blood pressure lowerer. And so fructose is famous for causing hypertension.

Norman Swan: High blood pressure. And what you're saying here is that the liver cell itself gets depleted of this phosphate and then you've got this downstream reaction.

Robert Lustig: That's right. And so when you have excess uric acid you're going to end up with increased blood pressure and we actually have data from the NHANES study in America, the National Health and Nutritional Examination Survey in America which actually shows that the most obese hypertensive kids are making more uric acid and have an increased percentage of their calories coming from fructose.

Norman Swan: Are they getting gout as well?

Robert Lustig: Well not yet. They will.

Norman Swan: So what you're saying in fact is that whilst we are clearly eating too much, we're passively eating too much of the wrong thing, that the food manufacturing industry is putting stuff in which is fuelling the epidemic?

Robert Lustig: Absolutely, we're being poisoned to death, that's a very strong statement but I think we can back it up with very clear scientific evidence.

Norman Swan: There's clear scientific evidence on this fructose pathway in the liver?

Robert Lustig: There's clear scientific evidence on the fructose doing three things that are particularly bad in the liver. The first is this uric acid pathway that I just mentioned, the second is that fructose initiates what's known as de novo lipogenesis.

Norman Swan: Which is fat production.

Robert Lustig: Excess fat production and so VLDL, very low density lipoproteins end up being manufactured when you consume this large bolus of fructose in a way that glucose does not, and so that leads to dyslipidaemia.

Norman Swan: And that's the bad form of cholesterol.

Robert Lustig: That's correct. And then the last thing that fructose does in the liver is it initiates an enzyme called Junk one, and Junk one has been shown by investigators at Harvard Medical School basically is the inflammation pathway and when you initiate Junk one what happens is that your insulin receptor in your liver stops working. It's phosphorylated in a way that basically inactivates it, serum phosphorylation it's called and when your insulin receptor doesn't work in your liver that means your insulin levels all over your body have to rise. And when that happens basically you're going to interfere with normal brain metabolism of the insulin signal which is part of this leptin phenomenon I mentioned before. It's also going to increase the amount of insulin at the adipocyte storing more energy. And you put all of this together and basically you've got a feed forward system of increased insulin, increased liver fat, liver deposition of fat, increased inflammation -- you end up with non-alcoholic fatty liver disease. You end up with your inability to see your leptin and so you consume more fructose and you've now got a viscious cycle out of control.

In fact fructose, because of the way it's metabolised, is actually damaging your liver the same way alcohol is. In fact it's the exact same pathway, in fact fructose is alcohol without the buzz.

Norman Swan: So this is the obesity related fatty liver disease that people talk about?

Robert Lustig: Exactly.

Norman Swan: Some people say, I've heard obesity experts say, well it's surprising that will all the ready availability of food that we're not fatter. In other words that we are actually controlling our appetite pretty well given that we've probably been evolutionary designed to eat anything that goes, and there's anything that goes all around us, so why aren't we actually fatter? It's not so much why is there an obesity epidemic, why isn't is worse, is what people say and therefore you don't need to postulate fructose, it's just the fact that we've evolved in the Savannah to eat in times of plenty.

Robert Lustig: I've heard those same concerns you know, why, if we have so many calories why aren't we fatter. Well there are a few reasons why that might be. I do want to mention that the American food industry produces 3,900 calories per capita per day. We can only eat 1,800 calories per capita per day. In other words the American food industry makes double the amount of food that we can actually use. Who eats the rest? We do, through this mechanism, they actually know that by putting fructose into the foods that we eat, for instance pretzels -- why do you need fructose in pretzels, why do we need fructose in hamburger buns?

Norman Swan: Are you postulating here a fructose conspiracy, the way the tobacco industry had a nicotine conspiracy?

Robert Lustig: Well I can't call it a conspiracy per se. I certainly know, and they certainly know that they sell more of it when they add the fructose to it. That's why it's in there, otherwise why would it be in there? Do they know that this is actually harmful? That's what I don't know. There's no smoking gun, ultimately we found the smoking gun for smoking, you know we found the documents. I'm not prepared to say that about the food companies. I do not know that they know that they are hurting us. However, they definitely know they sell more, and it temporarily coincides with the advent of fructose being added to our diet.

Norman Swan: And of course you could argue that it's going up because they are responding to the market and they've got sugar-free, fat-free etc. etc.

Robert Lustig: Well in fact fat-free doesn't help, if anything as the fat content of our foods has gone down, and it has gone down, it's gone from 40% to 30%, in fact our obesity prevalence has gone way up. So that's not the answer.

Norman Swan: This is because they're adding carbohydrates and sugars to it to replace the fat.

Robert Lustig: Absolutely, in fact fat does not raise your insulin but certainly sugar does. And fructose has been bandied about...because after all it doesn't raise your insulin directly because there's no fructose receptor on your beta cell in your pancreas. So people say well it doesn't raise your insulin, but in fact it does because it's a chronic effect not an acute effect. This has nothing to do with one fructose meal, this has to do with a year's worth of fructose meals, or a lifetime's worth of fructose meals, because as you become insulin resistant, which fructose clearly does and has been shown by many investigators not just me -- that interferes with that leptin signal which causes you to eat more.

Norman Swan: Insulin-resistance increases your insulin levels because your pancreas pumps out more to get the insulin working.

Robert Lustig: Exactly, especially since your liver is not responding to it because of that effect on the serum phosphorylation of the insulin receptor. So that's going to cause you to make a whole lot more insulin, that's going to interfere with your leptin, that's going to make you eat more so the whole thing just keeps going out of control.

Norman Swan: One way of proving this would be to put you on a fructose free diet, has anybody done that?

Robert Lustig: Well no one's done it yet. In fact we're trying to do that, in fact we're actually going to be working with the Atkins Foundation here in America to actually do a fructose withdrawal experiment to try to actually answer that question directly.

Norman Swan: Well given that you're not going to come to harm by reducing the fructose in your diet -- somebody who's listening to this -- what's the ingredient on the packet, or the jar, or the back of the tin that tells you there's fructose in there because it won't always say fructose will it?

Robert Lustig: Well high fructose corn syrup, it should say that, now in Australia for instance the sodas don't have high fructose corn syrup they have sucrose. Well sucrose is half fructose. You know a lot has been made over this high fructose corn syrup being particularly evil. In fact high fructose corn syrup is either 42% or 55% fructose, the rest is glucose. Well sucrose is 50% fructose the rest is glucose. In fact high fructose corn syrup and sucrose are equally problematic.

Norman Swan: Basically table sugar.

Robert Lustig: Table sugar -- that's right. We were not designed to eat all of this sugar, we're supposed to be eating our carbohydrate, particularly our fructose, with high fibre. Well the fact is we have 100 pound bags of sugar that go into the cakes, and the donuts.

Norman Swan: So we don't need to get obsessed on fruit sugars, it's sugar itself, sucrose.

Robert Lustig: Absolutely, it's sugar in general. So people say oh does that mean I can't eat fruit? No, let's take an orange -- an orange has 20 calories, 10 of which are fructose and has high fibre. A glass of orange juice has 120 calories, it takes 6 oranges to make that glass of orange juice and there's no fibre. You tell me which is better for you, so by all means eat the fruit, just don't drink the juice. Juice is part of the problem and there's plenty of data, not just mine. Miles Faith had an article in Pediatrics, December 2006 showing that in toddlers, in inner city Harlem in New York, in toddlers the number of juice servings correlated with the degree of BMI increase.

Norman Swan: Where does this fit, I mean people at the University of Sydney who've pioneered the glycaemic index, the idea that you get some foods which actually boost your blood sugar very quickly and some which are slow. They kind of argue that it doesn't actually matter terribly much what kind of sugar it is, it just depends on how fast your insulin is going to go up. Where does what you're saying fit into the glycaemic index story?

Robert Lustig: In fact glycaemic index is half the story, the other half of the story is the fibre. Here's the way it works -- carrots, let's talk about carrots for a minute. Carrots are very high glycaemic index, what is the definition of glycaemic index? It's how high your blood sugar goes if you eat 50 grams of carbohydrate in that food, that's what glycaemic index is. So if you eat 50 grams of carbohydrate in carrots your blood sugar goes up very high and so that would be a high glycaemic index food. Fructose is a low glycaemic index food because fructose does not stimulate insulin, it's all of these calories but it doesn't stimulate insulin. So in fact a soda has a glycaemic index of 53 which is low. So you'd say oh wait a second, carrots are bad for you and a soda is good for you? Because glycaemic index is not the whole story, in fact what you really want to talk about is a related concept called glycaemic load.

Glycaemic load is glycaemic index times the amount of food you'd actually have to eat to get the 50 grams of carbohydrate, so in carrots you'd have to eat the entire truck in order to get that. Well you can't do that, you wouldn't do that, so in fact carrots, even though they are high glycaemic index are actually low glycaemic load. Carrots are fine, there's nothing wrong with carrots. On the other hand fructose, I mean a soda, there's a lot wrong with it but you wouldn't see it in just looking at glycaemic index.

Norman Swan: So glycaemic index plus common sense?

Robert Lustig: Well it's glycaemic index plus fibre. Fibre turns any food into a low glycaemic load food. In fact we are supposed to eat our carbohydrate with fibre, that's the key. Processed wheat is white, when you go out into the field it's brown but by the time it gets to your bakery it's white. What happened? Well the bran was stripped off, well the bran is the good part, the bran is what we're supposed to be eating.

Norman Swan: I've often wondered, I've heard of some processed stuff and the evil of the food industry etc. but explain to me a conundrum -- why Asians are thin, or have been traditionally thin and for centuries they've eaten processed rice, they've eaten white rice, they don't like brown rice and I don't blame them.

Robert Lustig: Not a problem, I can explain it very simply. If you look at the Atkins diet, the Atkins diet was no-carb, high-fat, no-carb and it worked. We look at the Japanese diet, high-carb, no-fat, it also worked. When you put them together you get something called McDonalds and clearly that doesn't work. So the question is what is it about the Japanese diet, even though they eat all of this white rice, that still allows this phenomenon to be OK? And the answer is very simple -- it's called fructose, because fructose is really not a carbohydrate. If you look at the metabolism, the liver metabolism of fructose it is just like a fat, it doesn't stimulate insulin, just like fat. It causes all this de novo lipogenesis.

Norman Swan: Fat production

Robert Lustig: Fat production within the liver, it causes deposition of fat within the liver, it's actually like alcohol and alcohol is like a fat. So here's a carbohydrate that's acting like a fat. So outside of the Japanese diet, when you eat a low fat diet what are you eating? Snackwell -- and what did they do? They added sugar because otherwise it would be unpalatable. So in fact a low fat diet's not really a low fat diet, a low fat diet containing fructose is really a high fat diet and that explains what's going on. So a Japanese diet yes, they're eating a lot of white rice but they are also eating a lot of fibre in all of their vegetables and they are not consuming any fructose. There is no fructose in the Japanese diet whatsoever, but there is now, and childhood obesity has doubled in Japan in the last ten years whereas adult obesity hasn't moved.

Norman Swan: And the reasons?

Robert Lustig: Because the adults are eating like they used to and the children are eating like we do in America.

Norman Swan: So do you check your home garage floor for brake fluid every morning, I mean you can't be the most popular person with the food industry?

Robert Lustig: Well I'm not, I am not, very much so. The Corn Refiners Association and the Juice Products Association have been on my tail, but the fact of the matter is the science is clear, the science is there and the science has to drive the policy.

Norman Swan: So what about the regulators?

Robert Lustig: Well we're trying to work with them, we are trying to do something about it. They are not moving very fast. In fact you may be aware of the International Obesity Task Force that met at the Sydney meeting in October and they came out with something which they called the Sydney principles. The Sydney principles involved marketing and advertising to children and trying to get rid of that, and they basically said that you have to do something about this and it has to be statutory in nature, it has to be regulated, it has to be a law. In fact in Europe 52 health ministers from the World Health Organisation from all the different European countries got together in Istanbul in August and agreed that marketing to children had to stop. Well in fact that is not happening in America.

Norman Swan: Nor is it in Australia.

Robert Lustig: Well probably not, but I just met with the commissioner of the Federal Communications Commission, Miss Deborah Taylor Tait, and she mentioned that she expected that the food companies would police themselves, that regulation would not be necessary. In fact I said, excuse me but I disagree. In fact in 1978 the US Federal Trade Commission had an entire congressional hearings on marketing and advertising to children and the food companies actually lobbied congress to actually have that killed. And they knew why, they knew what they were doing then, and they are going to do it again because it's not in their best interest. They couldn't increase their profits by 5% a year if they didn't advertise and market to children.

Norman Swan: Dr Robert Lustig is Professor of Pediatric Endocrinology at the University of California, San Francisco.

If you have time, sit back and watch a video by Dr Lustig (1:29 hrs) called Sugar: The Bitter Truth, here on YouTube.

Weighty Issues

While I'm generally a lower-carber (not totally low carb, but breakfast and lunch, definitely), insulin has given me an extra 14kg since 2006. That's not an insignificant amount of weight.

Could I eat less? For breakfast and lunch, definitely not. I eat like a bird. Should I cut down the 2 eggs to 1 egg for breakfast with a glass of water? Maybe I could.

For dinner - it's a regular dinner (say 2 lamb chops, or 1 smallish steak) with salad and sometimes a small amount of carbs - eg a small potato or half a cup of rice, or half an ear of corn.

After dinner... now herein lies a problem, but not every night.

On what I'm eating, I should be losing weight. Instead, my body has decided to find calories where I'm sure there aren't any.

Exercise is a huge problem for me. A geek-girl from way back, I much prefer to do almost anything else, including sitting at my computer. With a knee waiting for a replacement, and pain in other places from Lupus, exercise is a mild form of torture for me.

If there was a heated pool anywhere within a half hour's drive from me, I'd be in it. There isn't. I'm hopeful that in summer, I can go to the local pool (not heated) and get some exercise in. Other than that, I'm pretty stumped.

I'm also one of those whose blood glucose goes high during and after exercise. Then 4-6 hours later I'm having to watch for lows. Totally contrary to what the literature says - most say that you'll go low during exercise. I do know of others like me. I'm still experimenting with all this... maybe a small carb snack and a raised bolus during exercise will tell my liver in no uncertain terms not to dump all that glucose.

Then again, that small carb snack and the extra insulin will probably cancel out any exercise I might do. Damned if I do, and damned if I don't.

Weight used to fall off me. I'd just think the word 'diet' and it would start falling off. Age, menopause, stress, diabetes and worst of all, insulin, has totally done me in. Heaving around all those extra kilos (including the extra 6 I started with), is not at all fun.

I can't even lift 14 kg of anything but I've got to drag it around with me 24/7. Not fair!!!

I've put on 4kg since starting on an insulin pump last June 1st. Outrageous!!! My TDD (total daily dose) is about 3/4 of what it was on injections. I should have lost weight, right?. A few measly kilos at the very least. Not to be.

I know I'm not the only one struggling with this, but I do NOT want to go down the road of reducing my insulin, as tempting as that might be. With a great A1C on the pump, but not in the years before, I don't want or need any more complications from diabetes.

Interesting - Tweaks for Insulin Pumps

Some new thinking about tweaking the settings on your insulin pump was reported by Kelly Close, a guest blogger on Diabetes Mine.
Read it via the link below...

New Tricks for Tweaking Dosing Formulas for Your Insulin Pump
I'm giving it serious thought.

Highs and More Highs

I've just had 4-5 days of blood glucose highs for no obvious reason. This happened through 3 site changes (clutching at straws for the reason), a new bottle of insulin, several calls and emails to my DE to confirm my actions were right, and generally through days of total chaos, not understanding what was going on.

I've had this many times on injections but only for a day or two. And back then I blamed it on absorption at the injection site, or not bolusing for carbs properly. In hindsight I think that was totally wrong.

A gazillion corrections as suggested by the pump, and a basal increase of 50% over many hours, barely did anything, and within 2 hours of corrections I was back where I started.

Speculation included getting sick, being stressed (I wasn't) and more. None of it was true.

So what was the problem? Take any guess you like because I wouldn't have a clue.

Yesterday my numbers started coming down and today I'm back to normal - no site change, nothing. I have not done or eaten anything different either. If anything I had less carbs once I realized what was happening. I didn't want to deal with carbs that weren't going to be corrected on top of my no-food BGLs being high.

Go figure!

Looking at other blogs and tweets, I know this happens to people... but what I'm reading more about is wild swings, from high to low to high - totally unexplained. That wasn't the case for me - I just went high and stayed high with the insulin doing almost nothing.

It's more than frustrating!

Lucky I'm a night owl. Night before last, I switched my basal to +30% for sleep. Lucky I stayed up a bit longer because at 4am I started to drop into my normal zone. I definitely would have had a hypo had I gone to sleep when I'd planned to.

When I checked, quite by chance, I was 4 mmol/L (72 mg/dl) with no hypo symptoms and basal at +30%. So off went the temp basal, and I headed for some glucose, and some longer-acting carbs, because that +30% basal would have still been working for a few hours. That's my worst fear - a hypo at night (a nypo).

So last night, when I knew this high-phase was over, I went to bed on 6.2 mmol/L (111 mg/dl) and woke up with exactly the same BGL. Sweet! (Pun intended!)

So today, I'm completely back to normal. Stranger than strange!

Test Your Blood Sugar - July 14th, 4:00 ET (USA Time)

Diabetes Hands Foundation I 2802 Tenth St, Berkeley, CA 94710 I Ph: 650.283.4862 I EIN: 26·2274537

FOR IMMEDIATE RELEASE

14,000 People With Diabetes
Test Their Blood Sugar at the Same Time

BERKELEY, CA: July 8, 2009 – July 14, at 4:00 pm ET, 14,000 people worldwide will test their blood sugar simultaneously and share their results online through TuDiabetes.com (www.tudiabetes.com), a social network for people touched by Diabetes which originated in March 2007, as well as through its sister Spanish language social network, EsTuDiabetes.com (www.estudiabetes.com).

The idea for the test-in came from Kelly Rawlings, someone who has lived with type 1 diabetes for 35 years. Kelly is one of the nearly 10,000 members at TuDiabetes.com, which has been called the “Myspace on Insulin” and a “Facebook for Diabetes.”

“People with diabetes have to test their blood sugar as part of their daily routine: it’s like drinking water or brushing your teeth,” said Manny Hernandez, co-founder of TuDiabetes.com and a person with diabetes himself. “When Kelly mentioned having a collective test-in, I thought it would be a great way for thousands of us to connect and raise awareness about diabetes.”

Currently, more than 250 million people are afflicted with diabetes. In the month of July, TuDiabetes will pass 10,000 registered members, and EsTuDiabetes.com, the sister social network about diabetes in Spanish, passed 4,000 registered members touched by diabetes from Mexico, Spain, Venezuela, Argentina, the US and other countries. In both communities, initiatives to raise diabetes awareness are the primary focus, making the combined 14,000-member milestone yet another opportunity to shed light on this chronic condition.

Participating in this initiative to raise diabetes awareness is easy:

• If you are a member of TuDiabetes or EsTuDiabetes, click on the home page banner and share your reading.
• If you have a Twitter account, post your reading on Twitter (use the #14KPWD hashtag) and link back to: http://14kPWD.org.
• If you prefer, update your status on Facebook or your preferred social network, linking back to: http://14kPWD.org.

“We hope to see most readings posted at 4 pm ET on July 14. If you are a few minutes late, however, or are able to post your blood sugar reading earlier or later that day, it’s OK,” said Hernandez. “What really matters is that you test your blood sugar regularly. If you don’t have diabetes, just tell someone who does to test and share on July 14.”

Update from eMails

Having no time at the moment to compose a full blog-post, I thought I'd put snippets taken from my recent emails to others.

Taken from an email to H:

How often are you changing your cartridge? I so can't do 'every 3 days'. Doesn't work for me - so unless I have a problem, I'm doing Tuesdays and Fridays. Definitely using less insulin on the pump - before I was doing between 50u and 65u (40 of which was Levemir) - depending on what I was eating. Now I'm doing in the mid 30s - pretty amazing, considering I'm also eating a tad more carbs. You're only supposed to do around 25% less.

My ratio is still 65%basal to 25%bolus.

Are you/do you need to bolus for protein? I'm finding I do... actually I've known that for a long time, but my stupid DE (and believe me, I think hard before I call someone stupid) says I don't need to. It's typical advice for T2 that she gives me. If it was up to her, I could drink 4 glasses of tomato juice (around 24 carb) and not bolus because it's "free' food, but for a slice of bread at the same carbs, of course I need insulin. LOL NO food is free when eaten in any quantity, as far as I'm concerned.

Sometime, when I get around to it, I have to have another c-peptide, a Celiac test (strongly suspicious) and another GAD Antibody - you know... the one you're supposed to repeat in 6 weeks, but for me it's been 6 months! I didn't want a reason not to be classed as T1, in case the 2nd test was somehow negative. Now, it can be as negative as it wants.

From an email to S:

I only have 2 words for the pump: LOVE IT!!!!

Mind you... just spent since Friday battling high sugars, with no clue as to why. I hardly ate at all. Today it's much better, actually back to normal, again with no logical explanation. I had problems like this on MDI too, but first time on the pump.

Never had such consistently good BGLs! But we knew all that. It's not hard work at all. Only thing I find frustrating is sometimes getting the carbs wrong on a plate of food that's presented to me. Apparently everyone has that more or less. Been sticking to between 80 and 110gr carbs a day, which works better for me than anything else I've experimented with.

Had one site failure so far and one pump occlusion another time. Both easy fixed and I didn't panic, just followed what I thought. The occlusion happened when I tried a site on my lower belly - where I'd been injecting. Back to above the navel for now.

So yes... best thing I ever did!

Infusion Set - Site Failure

It was late afternoon, I was sitting in a cafe in town with my lovely husband, with a latte in front of me. My meter sat on my knee under the table staring back at me with a number that didn't make sense. Ok, I gave it the benefit of the doubt and bolused for the number and the milk in the latte. Thought that'd be the end of it. An hour later, when I got home, that darn number was still the same. It shouldn't have been.

I was sure I'd had a site failure.

A 'site' is where the cannula goes under the skin with whatever infusion sets are used with the insulin pump. In my case, with the Animas 2020, I use the Inset II (pictured) - today, a pink one.

So off I went to grab another infusion set. Inserted it a couple of inches over and hooked up with the old line. Meanwhile, my BGLs had been going up and up. Once hooked up, and because I wasn't all that high, I bolused again. Success! Within 45 minutes my BGLs were starting to come down. Yessss!

I then pulled out the old infusion set and sure enough, a bent cannula. I thought I'd done everything right with the insertion of that infusions set, but something still went wrong.

It happens.

Pump Occlusion

Monday this week, my pump alarmed with a pump occlusion. At the time, I couldn't figure out why - it was nothing obvious then.

It was clearly a while (no idea how long) before the pump alarmed me, and I was extremely surprised to see that my BGL went up so quickly.

I changed the site with a completely new inset, then took a new cartridge and filled it with insulin. On rewinding the pump, it all went a bit strange. I hadn't rewound properly and I had to call support for some assistance. A few minutes later, no problem, but I ended up with a cartridge with only 100u of insulin instead of 200u. No problem, I thought, I'd change it again in a couple of days, which I did yesterday afternoon. Somehow I'd napped through the 20u-left alarm. Lucky I woke when I did, I guess.

These things happen on a pump. In retrospect, I'd used my lower belly where I'd been injecting insulin for the past few years. And I'd occasionally had trouble with with absorption because of hard, fatty deposits that some people are prone to with insulin injections. I'm pretty sure I stuck my site into one of those places that were half-healed, but not quite.

Pump occlusions do happen, but insulin pumps alarm as soon as they detect it, so you can take action as soon as possible.

Otherwise everything is going really well. I've never had such good, steady BGLs - and this was one of the major reasons for me to go on a pump. Absolutely no regrets!

Pump Notes

This post is a tad overdue. I've been on the Animas 2020 insulin pump for just over a week.

With only one very explainable hypo early Saturday morning (lots of activity on Friday plus a party), I've been going great. Two site changes on my own so far - one last Friday and one yesterday. Both went well, although I was a little worried about the one yesterday, but it turned out ok.

There's no doubt that my blood sugar levels are really great, especially compared to this time 6 months ago on MDI. I'm astounded at the freedom this pump gives me.

Yes you need to test lots, but on MDI you should be doing the same if you want good BGLs. For the rest, it's so easy!

I uploaded a food database and it went fine. In Australia, the food database doesn't come installed.

I'm downloading pump data every few days because my DE needs to see what still has to be tweaked. We've already upped my basal by .1 an hour, and for some times during the day, maybe it's a tad too much. I'm just waiting for a call from me DE to see what can be tweaked from a full week of data.

Hooked up and flying! (Animas 2020)

Pump-start day yesterday!!! All went very smoothly. Out to dinner last night. BGLs really great, but some tweaking of basals probably in store next week. Even got the software to work on Vista (the Australian version isn't supposed to). Downloaded the pump data. Site change & refill today with the rep and handed in the reports from the downloaded data - less than 24 hours worth (LOL). Off to breakfast in town. So easy to bolus! Learning to trust what the pump tells me to do.

Am so loving this pump!! I made exactly the right choice for me.

Some hints before anyone goes on the pump.

• Do lots of homework.
• Download the manual and familiarise yourself with the functions.
• Do the online pump-school on the Animas site.
• Read "Pumping Insulin" by John Walsh, and then once you're hooked up, use it to understand more.
• Play with the virtual pump on the Animas site.
• Make a list of your favourite foods with carbs so you can upload them to your pump later.
• Read pumping blogs and posts on Tu Diabetes and other sites.
• And ask questions!

The more you learn beforehand, the easier pump-start day will be. No two people's requirements will be the same, but reading about others' experiences was invaluable for me!

I have the most awesome Animas trainer on the planet (sorry, I want to claim this one). Not only does she wear the Animas 2020 herself, but is a fountain of knowledge and helpful information, given in a language catered to whatever level you're at. She's very kind and encouraging, and has a wicked sense of humour - definitely things I appreciate in any trainer. I can't praise her and my DE highly enough for making this transition easy and painless in so many ways.

I'm definitely hooked up and flying!

12 Hours To Go!

Only about 12 hours to go before I get hooked up to the Animas 2020 insulin pump. It's been a long wait - more than 2 months! Despite all the preparation and learning, I've still got a ways to go. I'm in for an awesome training session. But the real hard work begins after I'm hooked up.

I have no idea what my body is going to do on an insulin pump. Will I have better control? Will there be highs and lows? Will I be able to tweak my basals and figure out whether I need 2 or 10 different basals in 24 hours? It's going to be a lot of work over the next few weeks, but something I'm more than prepared to do.

We have an 11am start, even though I am worried I won't wake easily to get there on time. My getting to sleep problem is still hanging around. Que sera sera. I really can't worry about all that tonight. I can survive on very little sleep. My only problem is waking up. So, I've got 2 alarms, my mobile phone and a phone-a-friend - someone's going to call me to make sure I'm up. Of course, there's always my husband who tries to wake me but is rarely successful. He's generally sweet and gentle, and that's the way he tries to wake me. As gorgeous as he is, I need something a little more loud.

So, I've got all my supplies ready. Only the insulin is still in the fridge. I'm about to make some food to take. Although there's a fast-food shop of sorts on the hospital grounds, if I remember correctly, everything revolves around bread, which is too high carb for me. I'd rather have a normal lunch with me. Cheaper too.

So here we go. This is the last blog before I next report, attached to a pump.

7 Days to Go!

Just a week to go for my pump-start. It's been a hectic week with horrendous storms from South-East Queensland to the Mid North Coast of NSW. Trees down everywhere, flooding, power outages and more. My fridge died with one of the power outages, so rather than throwing more money at it, I decided to buy a new one. Reasonably happy with what I got although what I really wanted was $1000 more! Maybe next time.

I have finally worked out that I need to bolus for protein. Why has no one told me this before? Typical lack of education.

I've also worked out that at dinner, it's far better for me to take 50% of the bolus with dinner, and the other 50% 1 to 1.5 hours later. Worked a charm tonight. I'd been playing around with percentages in a split bolus and finally nailed it tonight. Different meals may need a different approach but what I ate tonight is fairly typical for me. So at least I have that problem solved. This will be a breeze on a pump with the possibility of extended boluses.

Some really interesting information over at dsolve. Am still reading and learning.

12 Days to Go!

A relatively short 12 days will fly by, I know. I had a meeting with the diabetes educator last Monday and all is going well.

Next week we work out, via a formula, what my basal insulin will be for the pump. Then the following Monday, it's pump-start day!

The protocol requires my starting basal insulin to be approved by my wonderful endo, who is 1 hour away. Faxes are still very useful, although not for me.

Failing any major catastrophes, it's all systems go.

Someone else I know from two other internet forums started on his pump today. Here's Henry's blog.

I'm constantly amazed at what is to be learned in the field of managing diabetes. I'm more than convinced we don't have nearly enough education about it. It's definitely not just a matter of matching insulin to carbs. It's so much more. So many are of the opinion (including me) that almost everything you eat can have an effect on your blood glucose. This is definitely true for me. Only 2 eggs in the morning, with nothing else, and my BGL will go up. I've proven this for years now. For me, a protein only meal still needs some insulin.

More learning about the incricacies of diabetes and more hoping that the pump-start day will be here really soon!

17 Days to Go

Closer and closer - 17 days to be almost exact. I'm not counting that hard, but every time I start a blog entry, I need to add the days.

I'm still learning in preparation for my insulin pump start but also lamenting the fact that Continuous Glucose Monitoring Systems (CGMS) are so lacking in Australia. I had high hopes for the Freestyle Navigator and the Dexcom 7+, but they're nowhere to be seen and don't look like they'll land here anytime soon. Pity.

CGMS, like insulin pumps, really do help in diabetes management. What you can't see, even if you test 10 times a day, is accurate trends. Is your blood glucose going up or down? What's it doing when you're asleep? At what point after food do you spike? Answers make for even tighter control.

I'm insanely jealous of those forum posters who write about their experiences with CGMS. The only CGMS available in Australia at this time, is from Medtronic. They're expensive, the sensor only lasts a 3 days (unlike those mentioned above) and the cost is beyond my current budget.

Great video about Type 2 Diabetes

Great video about Type 2 Diabetes HERE.

2 weeks, 5 days to go!

As the title says pump-start day is looming ever closer. Learning more and more every day by web surfing. I'm reading studies, forums, and generally paying close attention to others and their experiences on an insulin pump. Thought I knew a lot, but am constantly surprised at what I didn't know about the finer art of diabetes management. But I'm definitely onto the nitty gritty of it all.

[Posted from my iPhone]

23 Days To Go

Just 23 days to go before the pump-start. Still seems a long way off, but closer and closer.

After my loopy hypo yesterday, today I relaxed a little with the tight control I'm trying to have at the moment. Not all that good for me, but I feel a whole lot better. Back to the grind tomorrow with lots of testing and eating lower carb foods. I find it works best for me. Porridge is now officially out for me for breakfast. Too many carbs for me to control properly. Insulin to carb ratio is still a little unpredictable, even after all this time, but doing the lower carb thing just seems to work for me.

Am loving the cooler weather we're having. Had the window and door surrounds in the living areas painted today while they're still replacing our roof after the hail from last October. I've just realized that at no stage today could I smell paint, and I was in the same room! I must go look at what paint was used. A super fastidious German trained master painter did the job. It's the second time I've used this guy and his work is immaculate!

Made one of my favourite dinners tonight - schnitzel, Israeli salad, red cabbage and risi bisi (rice with peas) - not that I had much rice. My daughter popped in for dinner and I know she loves rice. Jack was also around at that time, so he ate with us as well.

I'm not much of a drinker, but we did open a bottle of Shiraz that the roofers gave us because their work has been so delayed by the rain. The wine was smooth and lovely and went perfectly with dinner. Half a glass for me and I already feel tipsy, so I didn't push my luck.

Off to the hairdressers tomorrow. Wanted to do a colour myself but because I'm going a little darker (too ash blonde at the moment) I thought I'd let them do the first change, and then I can keep it up afterwards. Done this many times before and have learned my lesson from when I was younger - not to do a first major colour change myself. I've ended up with green hair before!

Hypo Food Fest

I've been laughing at unusual stories of people having a hypo (low blood sugar) thinking that nothing like it would ever happen to me. I'm way too methodical when I treat a hypo. Always got my 15g carbs with me. Get it out, eat it, test in 10 mins by which time the shaking has eased a little and can get a test strip out without shaking them all out of the canister. Get on with what I was doing. That's how it works, right? Not necessarily... I had a whopper this afternoon. I must have over bolused for something I almost never have for breakfast. Some 6 hours later, it hits me without any warning.

I was able to get a test in before the shaking got too bad. Ah not good... need food. Thought I was going to faint but made it to the kitchen even though my legs threatened to buckle. No idea why I headed for the kitchen, my hypo carbs were sitting right next to me.

Once in the kitchen, I'm sure I ate all of this week's and next's carb ration! I honestly have no idea what I ate. I can only assume what I might have had by what's left on my benchtop - at the very least, I had some hummus, a glass of apple juice, a piece of chicken (really bright with no carbs), some chocolate, several homemade shortbreads, some pita bread with babaganouj, a mandarin, and then still feeling faint, I must have come back to where I was sitting and had 10g of glucose tablets. That's the least of what I know I had. Heaven only knows what I really had.

During my hypo-feast, my husband came into the room, and I was apparently arguing with him about what our address was because he thought he needed to call emergency. Where he's from, they give addresses backwards (suburb, street, then number) and I was adamant that you can't do that here.

I do remember shouting, "You can't... the form, the form!!!" Meaning that they have a form on screen that they fill out when you give the address the normal way, but I was totally unable to explain. Poor guy, he gets totally freaked when I hypo, because sometimes I don't make sense. He keeps asking if he needs to call emergency, but I keep telling him only to call if I am unresponsive and not treating the hypo.

I've had a few hypos in 30 years, but never one as crazy as this one!

4 Weeks To Go!

With 4 weeks to go until my pump-start, the hard work really starts 2 weeks before.

While I'm sure I know what my basals will be, my Diabetes Educator still wants me to document everything for the last 2 weeks - food, insulin and many blood glucose tests during the day and night. She wants the evidence, so I have to be hyper vigilant about writing everything down. I'm just not that kind of person, but I have to be.

Having recently swapped to my iMac as my main computer (PC for many years before that), I use Diabetes Logbook X to record when I'm home, and when I'm out, the equivalent for the iPhone, which hooks into the Mac and updates the records on the iMac. It's really easy to use and is in a format I'm used to and like. The reporting is also fairly comprehensive and very easy to read for someone who isn't used to the software.

I've had a persistent cough for a couple of weeks. I went to my doctor last week and he decided I had some strange fungal thing going on and gave me some medication. His conclusion just didn't sit right with me.

After doing some research on something completely different I came across the following:

The most significant side effect with ACE inhibitors is a relentless cough. If you develop such a cough while taking these drugs, tell your doctor and ask to be switched to a newer drug in the ARB family. These ARB drugs, which include Cozaar, Diovan, and Avapro work in a way that is similar to ACE inhibitors but they do not cause the troubling side effects.

How conincidental it is that I was put on an ACE inhibitor just before this cough started? Fungal, my ass!

I am so anti-doctors and this is yet another thing that validates what I think. Why didn't the doctor connect the symptom with a medication he just put me on a couple of weeks ago? Too concerned about dollars and getting me out the door, I suspect. If I can make the connection reading just one article which states that this is a common side-effect, why couldn't he? He's the one with the degree and the experience!

I've long believed that despite what some doctors think - that they don't want us doing any research on the internet - we truly need to. As long as it's done in an intelligent way and from a very trusted source. We need to be very sure of our facts before we go running to a doctor. Something as obvious as the ACE inhibitor thing, shouldn't have needed any research, but the state of our medical system and the apathy and dismissiveness of some doctors, actually requires it! And we pay handsomely for the privelege of seeng a doctor for the 10 or 15 mintues we're allowed.

Pity!

Blogged with the Flock Browser

Well on the Road...

I'm now well on the road to my pump start date of early June. The Animas 2020 was ordered and it's still the one I want.

I tossed up between the pink and the black, and despite urging from others to go with the pink, I went for the black. What did I say to someone? Oh yeah... I'm not sure I like the idea of looking like an elephant in drag.

Black is far more sedate and serious. Not that I'm either of those two, and I don't mind wearing it in a pocket or outside my clothing. If anyone notices that it's not a mobile phone or a 1970s pager, then it's a great opportunity to explain the difference between Type 1, Type 1.5 and Type 2. And if they're really interested, I may continue to Mody Diabetes.

During Passover, I had the chance to play with an Animas 2020. It was awesome to be able to look at it and play with it. It more than confirmed it was the right choice for me.

The screen is fantastic. In a pinch, I could probably read it without my glasses on, which is a huge bonus.

The scrolling that some people complain about is nothing compared to the advantage of the bright screen.

I'm only worried about one thing. Some people say the 2020 gives boluses (meal insulin) too quickly and that it can sting. I suspect there may be a way of getting around that, all of which I'll learn on pump-start day.

Even though there's just over 5 weeks to go for the pump-start, I've already finished Pumping Insulin by John Walsh (the bible), and I plan to re-read those parts which I feel is most important to my situation. I also plan to keep reading the Animas 2020 instruction manual, which I've downloaded from the Animas site. And I've played with the virtual pump on their site, several times.

So, I'm counting the days - about 40 to go. Sounds like an inordinately long time to me. Yet, the last 20 years since my daughter was born, have flown by!

Today, I finally managed to get around to cutting back the passionfruit vine that has been growing on the trellis for the last 2 years. With all the recent rain, it went totally wild and was encroaching parts of the house, allowing bugs and critters to climb up and have even better access to the house. That part of the house is on stilts, so without the vine, there are only 6 places that afforded access up the poles.

It was very sad to be cutting off the parts with passion flowers. They are truly unusual and gorgeous. I had waited 2 years for those flowers to come out. But we still left plenty to turn into passionfruit, some of which are already growing.

The Road to an Insulin Pump

My way or the highway... that's what I heard from my diabetes educator, although not in so many words.

I was diagnosed with Type 2 Diabetes in 1978, wrongly as it turned out some 30 years later. I'm actually what they call Type 1.5 or LADA - Latent Autoimmune Diabetes of Adulthood. It is like what they used to call Juvenile Diabetes (Type 1), but has a very slow onset. And like Type 1, and unlike Type 2, LADA has an autoimmune basis where auto antibodies destroy the beta cells that produce insulin.

Wind back to a few years ago when I started thinking about an insulin pump. How would I get one? I was still officially Type 2 then, and government subsidies for insulin pump supplies only stretched to Type 1s. Without this subsidy, it would be a monthly cost of around AU$200. Not something I could easily afford. Yet I still continued to explore possibilities.

Earlier this year (2009), I was talking to my endo about ruling out any possibility that I had anything other than Type 2. It involved having a GAD Antibody blood test. Much to everyone's surprise, including mine, it was strongly positive.

Then came lots of questions - when had I acquired it? Because of the time-span, had I actually had Type 2 first and then LADA? No one really knows. 80% of LADA patients are insulin dependent within 6 years. I was below normal but still producing some of my own insulin. Was I on the longest diabetes honeymoon on record or had I acquired LADA within the last 6 years? No one can tell me.

More questions than answers really, but one answer did come. This new diagnosis now put me firmly in the Type 1 category. Insulin Pump here I come!

So, last week I got the letter from my health insurance that they had approved payment for the pump. And last week I was also the most frustrated I've ever been - my diabetes educator (DE), who has little experience in pump-starts, is putting the cart before the horse and asking that I have perfect blood glucose numbers before I go on the pump, or she wouldn't 'allow' me to have the pump on my tentative start-date in May. While it's possible to have good numbers, it's almost impossible to have them all the time, every single time you test. The whole point of going on a pump is to improve the blood sugar readings. The mere command had me foaming at the mouth. It's not usual protocol from the many forums I went to and asked.

It's a long story, but one that is still making me extremely angry that someone is holding me to ransom like that. There's not another DE for miles around.

Be that as it may, I'm still on my way to a pump-start date.

After weeks of doing research, I settled on the Animas 2020 Insulin Pump. While I'm a tad worried about the capacity of only 200 units (as opposed to 300 in the rival pumps), the deciding factor for me was the hugely superior screen, and the luer locks on the insets.

My blood glucose numbers have been reasonably ok of late, but that hasn't been without a great deal of hard work on my part, and severely restricting the carbs. It's really the only way to keep on top of it. Dr Richard Bernstein explains it very well on his website and in his books. And despite his being against insulin pumps, I'm still quite a fan of his theories.

If you don't eat huge amounts of carbs, then you're only correcting small spikes in blood sugars. Less room for error, and less chance of hypos or not correcting properly. Least that's the theory and is borne out by many with diabetes who do lower-carb.

I'm not saying that good blood sugars aren't possible if you do higher carb. In my experience, it's just not possible for me.

So, I'm testing and testing some more. I have my basal insulin just about right, and my mealtime insulin is right about 85% of the time. The other 15% is governed by who knows what? Definitely not by logic or any science that I know about. Some days I get it exactly right - insulin to carb ratio is spot-on. Other days, the ratio and my body, refuse to cooperate! I think the Sugar Fairy picks on me from time to time. I wish she wouldn't!