Today Barack Obama appeared on Chris Matthews' "Hardball College Tour" at Westchester University. While the interview overall was interesting, humorous, and insightful, one particular question before the second commerical break caught my attention:"As a type 1 diabetic, I was just wondering what you are going to do to gain further support for stem cell research."Obama responded that Congress was ready and willing to provide more money for stem cell research; that both the House and the Senate had already passed such a bill, with the only obstacle preventing its passage was President Bush's veto pen. He continued, "We just need one more vote, and that’s the vote of the president. And since I will be the president, we will sign stem cell research."
Sitting in my living room I cheered along with the thunderous applause from the audience. I am happy to see that a major Presidential contender not only acknowledges that seeking a cure for Diabetes is an important and worthy cause, but promises to fund such research early on in his Presidency.
The whole show (about an hour) is available on Youtube. Here is the section that includes the Type-1 girl asking Obama about stem cell research, about a minute from the end:
Link to Video
A new human trial is beginning at Massachusetts General Hospital in Boston after an animal trial resulted with diabetic mice being cured after being injected with BCG, a common tuberculosis medicine.
If effective in humans, they are hoping to have a cure available in 4 years. While I'm always skeptical of cures, I am cautiously optimistic with this one since it uses an established medicine and was effective in mice. If four years from now I'm cured, I'll throw a huge party. You'll all be invited :-).
Read more here: Link
"The vaccine destroyed abnormal white blood cells obstructing the production of insulin, which is needed to prevent diabetes, she said. The first step in the human study is to determine whether the same strategy using BCG vaccination can be used to modify the abnormal autoimmune cells present in type 1 diabetes."
If effective in humans, they are hoping to have a cure available in 4 years. While I'm always skeptical of cures, I am cautiously optimistic with this one since it uses an established medicine and was effective in mice. If four years from now I'm cured, I'll throw a huge party. You'll all be invited :-).
Read more here: Link
I love Las Vegas. I love getting off the plane and not having to look at the clock for three days. I love losing small amounts of money to friendly dealers while an even friendlier cocktail waitress brings me free drinks. I love walking from casino to casino, each one having a radically different theme but a radically similar scent of stale cigarette smoke, booze, and perfume. I love being in Ireland one minute, then ancient Rome, New York, Hollywood, and most of all, wherever the heck the Flamingo is supposed to be. I love how for that one weekend, everyone is friendly and outgoing, since everyone is there for the same reason.
I love Las Vegas.
However, there are some things about the Vegas Experience that I don't love. I don't love walking all the way from Planet Hollywood back to the Flamingo because my pump is low on insulin and the bottle's in the room. I don't love doing a blood test back in my hotel room and being 315 because I forgot that when you combine Red Bull with Vodka, it still has sugar in it. I *really* don't love being hung over and not being able to eat until 5PM the following day.
And this is what led me to decide, when Diabetes For Mortals was just a glimmer in my text editor, that I had to write a series on being Diabetic and in Vegas. There are so many aspects of Vegas that are awesome, but there are also a lot of pitfalls that are easy to make. I've been to Vegas 7 or 8 times in the past couple of years, both on the pump and doing injections. Some of the best memories of my entire life have happened there. But I've also made some stupid mistakes that luckily never had any serious consequences, but definitely resulted in bad BGL's and a few hours spent head-over-toilet.
In these articles I'm going to put a lot of focus on my uniquely diabetic experiences in Vegas, but I also can't resist telling you other random lessons and experiences I've picked up along the way. If you're smart about it, diabetes shouldn't keep you from having a fantastic, crazy, drunken (if you're >21), all-around hedonistic time in Vegas. Hopefully once you have the advice you need and some disposable income, I'll be seeing you there in no time. Order a Greyhound for me when you get there.
Just take insulin!
If the above advice is all you need to get back into equilibrium after a high blood sugar, then your body is much more obliging than mine. A "High", or "hyperglycemia" for the armchair endocrinologists out there, has less significant short-term effects than going low, but for me a high is harder to recover from. Doing the following when I go high helps me get back to my normal range while avoiding too many dose corrections and limiting my blood sugar's volatility.
Do a blood test as soon as you think your BGL might be high
Since going high usually isn't quite as obvious as being low, it is easy to ignore the warning signs and delay doing a test. (If you need a refresher of the warning signs, they include: excessive thirst, frequent urination, dry-mouth, a metallic taste in your mouth, and fatigue) I have found that if I catch a high early on, it is easier to correct and I have shorter, less severe side-effects.
Correct with an insulin dose ASAP
Sure, you most likely aren't going to have a major medical situation if you don't correct your BGL immediately. But the longer you are high, the greater the negative impact on your kidneys, circulation, and eyesight.
Drink a big glass of water
This is such a simple thing to do, and yet over the years I've noticed that it helps *a lot*. Hyperglycemia is exacerbated by dehydration, which in English translates into "drinking this water will help your blood sugar drop." Also, you're probably thirsty anyways, so enjoy.
Test an hour later, and correct again if you haven't reached your target
If you test before this point, your short-acting insulin may still be taking effect, and it is easy to over-correct. After an hour, test, and take more insulin if you're still above your desired BGL. Plus, this test will show your endocrinologist that not only are you back in range, but you are taking good control of your diabetes.
Taking these steps will help you get your blood sugar back to where you want it to be quickly, easily, and safely. You'll be feeling better sooner, your organs will sustain less long-term damage, and both you and your Endo can sleep easy.
If the above advice is all you need to get back into equilibrium after a high blood sugar, then your body is much more obliging than mine. A "High", or "hyperglycemia" for the armchair endocrinologists out there, has less significant short-term effects than going low, but for me a high is harder to recover from. Doing the following when I go high helps me get back to my normal range while avoiding too many dose corrections and limiting my blood sugar's volatility.
Do a blood test as soon as you think your BGL might be high
Since going high usually isn't quite as obvious as being low, it is easy to ignore the warning signs and delay doing a test. (If you need a refresher of the warning signs, they include: excessive thirst, frequent urination, dry-mouth, a metallic taste in your mouth, and fatigue) I have found that if I catch a high early on, it is easier to correct and I have shorter, less severe side-effects.
Correct with an insulin dose ASAP
Sure, you most likely aren't going to have a major medical situation if you don't correct your BGL immediately. But the longer you are high, the greater the negative impact on your kidneys, circulation, and eyesight.
Drink a big glass of water
This is such a simple thing to do, and yet over the years I've noticed that it helps *a lot*. Hyperglycemia is exacerbated by dehydration, which in English translates into "drinking this water will help your blood sugar drop." Also, you're probably thirsty anyways, so enjoy.
Test an hour later, and correct again if you haven't reached your target
If you test before this point, your short-acting insulin may still be taking effect, and it is easy to over-correct. After an hour, test, and take more insulin if you're still above your desired BGL. Plus, this test will show your endocrinologist that not only are you back in range, but you are taking good control of your diabetes.
Taking these steps will help you get your blood sugar back to where you want it to be quickly, easily, and safely. You'll be feeling better sooner, your organs will sustain less long-term damage, and both you and your Endo can sleep easy.
One of the biggest challenges facing us in our lifetimes as diabetics is how we include our loved ones in our journey with this disease. Like it or not, the genetic anomaly that resulted in us developing this chronic condition had an indelible impact on not just our lives, but the lives of those we spend our time with. Coworkers, friends, and family all have to learn about and cope with our disease to a certain level, some obviously more than others; and chief among these people is the romantic partner who, for better or for worse, spends almost as much time with Diabetes as we do.
This is the first part in a series of articles, each one progressing into a deeper level of sharing and understanding. How much you share with your partner depends on many factors: how curious they are, how committed your relationship is, how comfortable you are exposing such personal information and experiences, and more. What "level" you feel you are with your boyfriend/girlfriend/husband/wife/fiancee doesn't reflect on the quality of your relationship, just how comfortable the two of you are talking about the disease.
Level One : Your First Discussion
This seems obvious, but at some point you are going to have to tell the other person that you are diabetic. How soon this happens is up to you, although some things can definitely force the issue. Personally, I am outspoken about my diabetes (as you can tell from the website you are reading) and I usually bring it up as soon as I am beyond the "flirting over a drink" stage. Since I wear an insulin pump, try to test frequently, order diet sodas, and always wear my medical bracelet, girls pick up on the hints pretty quickly and ask me about it.
The "Single Sentence Rule"
When I am explaining diabetes to someone for the first time, I use something I like to call the "Single Sentence Rule". I limit my explanation or response to just one sentence. For example, if someone asks, "Why did you order a Diet Coke?" or "What does your bracelet mean?" I simply respond, "I have Type 1 Diabetes," and then *stop*. This accomplishes a couple of things. Obviously, it answers their question. But more importantly, this prevents you from :
While diabetes is obviously a serious condition and an integral aspect of our lives, the most important piece of advice I can give you is to keep this first discussion light. Explain the basics, make a few jokes, and be ready to dispel a few commonly-believed misconceptions. Odds are good that the cute guy or girl won't give it a second thought the rest of the night, and you can focus on the really important topics of discussion such as "Light Beer versus Dark Beer" and the relative merits of The Beatles and Fall Out Boy.
This is the first part in a series of articles, each one progressing into a deeper level of sharing and understanding. How much you share with your partner depends on many factors: how curious they are, how committed your relationship is, how comfortable you are exposing such personal information and experiences, and more. What "level" you feel you are with your boyfriend/girlfriend/husband/wife/fiancee doesn't reflect on the quality of your relationship, just how comfortable the two of you are talking about the disease.
Level One : Your First Discussion
This seems obvious, but at some point you are going to have to tell the other person that you are diabetic. How soon this happens is up to you, although some things can definitely force the issue. Personally, I am outspoken about my diabetes (as you can tell from the website you are reading) and I usually bring it up as soon as I am beyond the "flirting over a drink" stage. Since I wear an insulin pump, try to test frequently, order diet sodas, and always wear my medical bracelet, girls pick up on the hints pretty quickly and ask me about it.
The "Single Sentence Rule"
When I am explaining diabetes to someone for the first time, I use something I like to call the "Single Sentence Rule". I limit my explanation or response to just one sentence. For example, if someone asks, "Why did you order a Diet Coke?" or "What does your bracelet mean?" I simply respond, "I have Type 1 Diabetes," and then *stop*. This accomplishes a couple of things. Obviously, it answers their question. But more importantly, this prevents you from :
- Talking too much, and blathering on until you end up scaring away a possibly interesting person
- Responding to an innocent, casual question with something intimidating and somewhat of a "downer"
- Wasting your time explaining something important to someone who won't understand
While diabetes is obviously a serious condition and an integral aspect of our lives, the most important piece of advice I can give you is to keep this first discussion light. Explain the basics, make a few jokes, and be ready to dispel a few commonly-believed misconceptions. Odds are good that the cute guy or girl won't give it a second thought the rest of the night, and you can focus on the really important topics of discussion such as "Light Beer versus Dark Beer" and the relative merits of The Beatles and Fall Out Boy.
Nobody likes going to the doctor. Usually we're going either because we're too sick to do anything more worthwhile, we've gotten to an age where certain "uncomfortable" exams are necessary, or we partied a bit too hard and woke up with neither memory nor clothing. Despite all of these things, I think that the hardest part of going to the doctor is choosing one in the first place. Unless you have a friend or coworker that can recommend theirs, chances are you're going to have little or no idea what he or she is like until your first appointment.
Here's what you should look for during your first appointment:
1. Is this somebody that you can be honest with? Your doctor is going to find out the most about you not through examination but through your statements. Sure, your blood type, gender, height, weight, blood pressure, and lack of functioning pancreas are all pretty obvious by looking at you or doing simple tests. However, some of the most important factors influencing your health are pretty much impossible for your doctor to find out from a couple sporadic visits. Does your family have a history of heart disease? Are you sexually active? How often, and how much, do you drink? Do you smoke cigarettes? Do you abuse marijuana, cocaine, prescription drugs, or any other kind of drug? You should not be embarrassed telling this to your doctor. He or she is not there to pass judgment on you, but to help you survive and live a healthy life. This is absolutely imperative. If you feel like you can't tell these things to *anyone*, then you need to reassess how you're living. I am sexually active (though monogamous), I binge drink occasionally, I don't use any of the drugs listed above, and my doctor knows this.
2. Does your health insurance cover this doctor? Although this seems to be strictly financial on the surface, there are definitely health ramifications. There are a couple reasons your insurance might not cover this doctor: if you have an HMO, he or she may be "out of network", or your insurance may consider your doctor's practice a hospital visit. If this is the case, a routine appointment for a cold or the flu could set you back over a hundred dollars. For comparison, no matter what I see my doctor for, I am responsible for only a $10 copay.
How does this affect your health? Simply put, the more expensive it is to visit your doctor, the less you will go. You'll think, "Is it worth $150 to find out if this is strep throat or just a cold?" and more than likely you'll decide that it isn't. Money shouldn't factor into your healthcare (although apparently a lot of political candidates think it should) so choose a doctor that you can afford to see often without causing you financial stress.
3. Is this doctor okay with you having a separate endocrinologist? I *strongly* encourage all diabetics to see an endocrinologist that is an expert in diabetes; the details of that deserve a whole separate article. However, it is very important to make sure that your primary care physician (also known as GP, or General Practitioner) is okay with you seeing an outside doctor for your diabetes care. I was lucky enough to find a doctor that even encouraged it, asking me unprovoked during our first appointment whether I had an endocrinologist yet. It may be an ego issue, a control issue, or just a trust issue that makes some doctors uncomfortable...whatever it is, make sure your doctor doesn't have a problem with it.
4. Is the doctor overbooked? This is probably the easiest to tell without actually having to see the doctor in person. When you call to schedule your "new patient physical", do they ask you what your schedule is like next week, or next April? When you're sick, you need to see a doctor soon; while a waiting list may make a doctor seem popular, it can keep you from getting antibiotics or other health care in time and may mean this is not the doctor for you.
Choosing the right doctor is not easy. Look at it like a job interview; it will be a long relationship, and sticking with a doctor that is wrong for you doesn't help you, and definitely doesn't help the doctor. Be open, be honest, and if the answer to all the questions above is "Yes!", odds are you've found a great doctor that will help keep you healthy for a long time.
I find that there are a lot of small things that, if you get in the habit of doing them, makes living with Diabetes much easier. Sometimes these habits are so simple and straightforward that they seem like no-brainers, but put into action they have a profound effect.
Doing a blood test right before bed is a good way of getting 7 hours of good glucose numbers easily. Odds are good that if you are a good number when you go to sleep, and your basal rate is correct, that you will wake up an equally good number. Despite this, late-night lows are impossible to totally avoid (as you know if you've read this site, they are one of my "tough spots" with Diabetes). By keeping three things on your bedside table, you can make nighttime much easier and low-stress:
1. Blood test kit. By remembering to bring this to the bedroom when you go to sleep, it is easy to do a bedtime blood test. Also, if you wake up in the middle of the night you don't even have to get out of bed to see what your BGL is.
2. A low. Preferably some kind of candy that doesn't go stale quickly (Starburst or Skittles are two of my favorites.) This way, if you wake up low in the middle of the night, you don't have to take a dangerous walk to the kitchen to get sugar into your system. Try to avoid juices since it's easy to knock the glass over and make a mess. If you have juice that comes in sealed plastic bottles, that'd be perfect.
3. Insulin and a syringe. If you wake up having to pee and you're thirsty, do a blood test since you're likely high. If you need to dose to correct your BGL, both needle and insulin are right there, saving you another trip to the fridge.
I love little tips like these that you pick up over the years of being a diabetic. I'm to the point now where I can roll over in the middle of the night, do a bloodtest, and never wake up more than halfway. The power of simple habits continues to amaze me.
Doing a blood test right before bed is a good way of getting 7 hours of good glucose numbers easily. Odds are good that if you are a good number when you go to sleep, and your basal rate is correct, that you will wake up an equally good number. Despite this, late-night lows are impossible to totally avoid (as you know if you've read this site, they are one of my "tough spots" with Diabetes). By keeping three things on your bedside table, you can make nighttime much easier and low-stress:
1. Blood test kit. By remembering to bring this to the bedroom when you go to sleep, it is easy to do a bedtime blood test. Also, if you wake up in the middle of the night you don't even have to get out of bed to see what your BGL is.
2. A low. Preferably some kind of candy that doesn't go stale quickly (Starburst or Skittles are two of my favorites.) This way, if you wake up low in the middle of the night, you don't have to take a dangerous walk to the kitchen to get sugar into your system. Try to avoid juices since it's easy to knock the glass over and make a mess. If you have juice that comes in sealed plastic bottles, that'd be perfect.
3. Insulin and a syringe. If you wake up having to pee and you're thirsty, do a blood test since you're likely high. If you need to dose to correct your BGL, both needle and insulin are right there, saving you another trip to the fridge.
I love little tips like these that you pick up over the years of being a diabetic. I'm to the point now where I can roll over in the middle of the night, do a bloodtest, and never wake up more than halfway. The power of simple habits continues to amaze me.
When transitioning to an insulin pump from injections, by far the most foreign concept is that of a cord connecting something in your pocket to something that is inside you. After a couple of days, the strangeness went away and now there are even times where I couldn't tell you which side of my body my site is. However, there are sinister forces working against the beautiful pairing of person and pump, and foremost among these is the doorknob. The first question a lot of people ask about the infusion set is, "Does it hurt when you take it out? What if it gets ripped out?" After taking a moment to let the wave of sarcasm inside me subside (No, there's a tube inside of me, and even though most people complain about taking off A BANDAID, it feels great when the tube gets torn out!) I tell them that it hurts surprisingly little.
If you're not on the pump, or if you're on the pump but have never had a site accidentally come out, you should know that it hurts surprisingly little. It's definitely not comfortable, but is only slightly more uncomfortable than the aforementioned bandaid. The most painful part, of course, is that now you have to put a new site in. I've probably had a site pulled out six or seven times in the roughly two years I've been on the pump. Every time except for one has been because of a doorknob.
This is the situation that I want you to avoid, because it has happened way too many times to me: It's the middle of the night, you have to pee, and you stumble to the bathroom half-asleep. You have no idea where your feet are stepping, let alone where your pump cable is. And as you step through the doorway, you feel a tug on your hip and see your pump cable hanging from the doorknob. This is one of the times where syringe-users have it easier. In this situation, pump-users, I want you to shake your head a little, blink your eyes a couple of times, and wake up just a bit before walking to the bathroom. Sure, it will take you roughly 74 milliseconds longer to fall asleep once you're cozy back in bed, but this is far better than having to wake up all the way so you can insert a brand new site.
Doorknobs are evil. They are simple and overlooked, and they are jealous of your smart, cherished pump. They will lurk on their doors, trying their hardest to look innocent, but give them one teensy inch of looped pump cable and they will exact their jealous vengeance. It has been six months and counting since my last "doorknob incident", so maybe I've learned my lesson; hopefully now that you're warned you can avoid such incidents of doorknob rage altogether.
If your endocrinologist appointments go anything like mine,you've heard"Diabetics have to take special care of their feet!" about a hundred times. Although mostly associated with older or long-term diabetics, even young Type-1ers like me have to be careful. Now, add even more support to that argument. New research is showing that by using an infrared thermometer, diabetics can check for "hotspots" on the bottom of our feet. Areas that are abnormally warm can be a sign of tissue breakdown, a precursor to ulcers. Finding the damaged tissue early and resting for a day or two can give the tissue time to heal before becoming a full-blown wound.
Insurance coverage is spotty, but more and more doctors are writing prescriptions for the $150 gadgets. Even more promising, new technology is being developed to function like a bathroom scale; stand on it every morning, and it will automatically test multiple locations and warn you of any high temps. Not only will this be easier than hand-held units, it will make it possible for the elderly or very overweight to check their feet as well.
I personally won't be purchasing one yet, but am glad that some very good medical minds are paying close attention to a very real, very dangerous long-term risk to us diabetics. If such a thermometer sounds like something you'd like, talk to your doctor! He or she will let you know if it's a good fit for you. And speaking of good fit, be sure to keep following the standard preventive care on your feet: where good-fitting shoes and regularly check your feet for redness, lumps, and cuts.
For the third year in a row, I have had to adjust the level of insulin I take to follow drops in temperature. Since I live in northern California, it isn't snowing or anything, but the interior temperature of my apartment is around 54 in the wintertime as opposed to 74 or higher in the summer.
While one would usually assume that a seemingly-minor 20 degree difference in temperature wouldn't affect blood glucose levels, once again this year my overnight BGL's have dropped along with the thermostat. Sunday night I woke up at around 3 AM with a BGL of 63; Monday, around 4 AM at 75; and last night again, around 4:30 AM at 68.
How can I prevent this from happening? Three years ago, it meant moving from one Lantus injection per day to an injection in the morning and a smaller dose in the evening. Now, the pump makes it easy by allowing me to create a custom dosage rate between midnight and 5AM during which I only receive 85% of my usual basal rate. I'll have to be rigorous about doing a blood test when I wake up to zero in on the proper custom rate, but these late-night hypoglycemias are wrecking me sleep pattern.
Of course, this may not happen to you or the diabetic you love, but it is something to keep in mind. Keeping your blood test kit and some form of sugar on your bedside table also helps reduce the impact such "Late-Night Lows". As for me, I'll see how this custom rate goes and throw another comforter on the bed.
While one would usually assume that a seemingly-minor 20 degree difference in temperature wouldn't affect blood glucose levels, once again this year my overnight BGL's have dropped along with the thermostat. Sunday night I woke up at around 3 AM with a BGL of 63; Monday, around 4 AM at 75; and last night again, around 4:30 AM at 68.
How can I prevent this from happening? Three years ago, it meant moving from one Lantus injection per day to an injection in the morning and a smaller dose in the evening. Now, the pump makes it easy by allowing me to create a custom dosage rate between midnight and 5AM during which I only receive 85% of my usual basal rate. I'll have to be rigorous about doing a blood test when I wake up to zero in on the proper custom rate, but these late-night hypoglycemias are wrecking me sleep pattern.
Of course, this may not happen to you or the diabetic you love, but it is something to keep in mind. Keeping your blood test kit and some form of sugar on your bedside table also helps reduce the impact such "Late-Night Lows". As for me, I'll see how this custom rate goes and throw another comforter on the bed.