LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Monday, October 22, 2007

The Real Time revolution

(Note: OK, nobody steal that title ‘cause I’m using it for my upcoming book:
The Real Time Revolution:
the art and science of controlling diabetic blood sugar using Continuous Monitoring Systems
….yeah, I know that the sub-title is a little long but there is a modern trend of plugging all the possible Google search words into your subtitle to try and drive book sales.)

The revolution started as they often do: with violence. I was so pissed off with the Guardian that I wanted to throw her against the wall.

I had just spent two weeks entering every move into her “memory.” Every fingerstick, both calibrating and non-calibrating. Every carb that went into my mouth. Every drop of insulin that went into my body. I weighed all my food and made copious notes in my food log. I was preparing for the ultimate post-game.

I was in control freak… errr…control enthusiast mode.

I logged on to CareLink, plopped the ComLink in my lap and downloaded, and downloaded, and downloaded, and downloaded, and…

Eventually, in the fullness of time, with the passing of the seasons, it was done. I eagerly ordered up a batch of reports and printed them. They were filled with red “no data” and blanks where the carb info and insulin numbers were supposed to go. Virtually all my carb and insulin markers were gone. All I had was SG (Sensor Glucose) data. I called up the log to see what happened. All the data was there, but it was not populating the reports.

Following anger, depression set in.

For the next week I didn’t enter anything. Why bother? It’s a pain in the ass, and it did me no good.

Then a number of things happened to me in rapid succession. I don’t know if I mentioned that I’ve felt like crap for some time. Months, maybe longer. Recent blood tests, done months late ‘cause I owed the hospital lab for ordered tests that weren’t covered by insurance so they would not accept more samples from me until I was paid up, revealed that I was VERY seriously over-medicated on the thyroid front. So that was adjusted. And my anti-depressant was doubled ‘cause I’ve been twice as depressed as usual.

Then I was exposed to the raw emotions of the survivors of T-1 who died from a hypo that may or may not be connected to a pump malfunction; but at the very least was exasperated by the worst possible medical advice. (Editor’s note: I’m working on this story and will post it in a few weeks. Stock up on Kleenex, you’ll need it.)

Anyway all of these things piled up and I re-discovered the Religion of Diabetes (ROD?) and became, once again, a Born Again Diabetic (ironically, “BAD,” which gives a whole new meaning to Bad to the Bone, given that it has recently been discovered that the skeletal system plays a major role in glucose regulation to the point that it may have to be considered part of the endocrine system).

(Oh yeah, that’s another title you can’t steal. I’m using it for the other book I’ve been charged with writing. So sometime next year you’ll have to add “Author of The Real Time Revolution and The Born Again Diabetic” to my tomb stone.)

So with a new sense of purpose I strengthened my will-power and started eating sensibly. While my Type-3s feasted on pasta I ate salad. While they had pumpkin pie in front of me, I drank water. Normally the first to answer the siren’s call of carbs I boldly walked past the brownies in front of my boss’s office and turned down a sample of allegedly sugar-free girl scout cookies.

Very quickly my sugars went from this:

To this:

With most of my meals around 15 or 20 carbs I’m nearly excursion free. My trace almost looks like a normal person. Almost.

But do you want to know the best part?

I feel good. Really GOOD. I haven’t felt this level of energy and mental clarity for…. Well, over a year anyway. I recovered from my EBay obsession (although I haven’t actually gone there for a few weeks to test my resolve, I’m not a complete fool. Not good for alcoholics to just “sniff” whiskey after all.) I have less aches and pains. I’m sleeping better. My mood and humor have recovered and I’m once again full of restless mental and physical energy that have always driven me forward under full sail.

Now, will feeling GOOD be enough to resist temptation in CarbLand? Time will tell. I haven’t been to the Elephant Bar since becoming BAD.

Coming to T-1 as an adult, I’ve got a lot of bad habits to overcome. Peers who’ve had T-1 since kid-hood generally agree as adults that it was easier to grow up under a set of rules than to change as an adult.

But some how, in the middle of this, I still didn’t start re-entering data in the Guardian. Unplanned, un-premeditated, and unconsciously I started using the Guardian Real Time in real time. I didn’t do post game. I took real time information and made real time decisions.

Damn, is it ever working.

On the second night of decent day-time sugar control I woke up too low for my taste and mental security. I ate my breakfast bolus-free to get back up above 100. The next night the same thing happened. I backed off my Levemir from 20 units to 18. And then to 15. Then 10. My total daily insulin is mere sips.

I am beginning to suspect that there is an un-discovered link between total daily basal requirements and total daily carb intake. But that science will have to wait for another day.

On the way home from work one day this week E asked me what I was eating. Quarter cup of Kashi with a sausage patty for breakfast, two low-carb SlimFast shakes at the clinic, and a salad for dinner.

“Huh. So you get to choose between your blood sugar killing you or starving to death? Is that what it comes down to?” she asked.

Yeah, pretty much.

Actually, I have a PLAN. I’ve put on almost twenty pounds over the last year. I’m somewhere in the mid 190’s now. I feel best between 175 and 180. Of course at that weight I have to put up with both my mother and wife insisting that I’m TOO thin. It’s nonsense, but they still remember the pre-diabetes fat man.

So I’ll coast down on weight until I close in on my goal. Then I’m going to try the Hunter-Gather Diet. I’m going to eat six or so small low-carb meals throughout the day. By keeping the carbs low I’ll avoid the excursions. By keeping the number of meals high I’ll pull in enough calories to avoid starvation.

The only risk is that I’ll die of boredom.

Oh yeah, and before the comments start piling up on the protein front let me tell you a little more about my salads at dinner. If the two T-3’s are eating something carbelicious then I’ll have a nice heaping pile or Romaine or Green Leaf lettuce with baby carrots, red bell pepper, sunflower seeds, and chunks of grilled white meat chicken. (I grill it on the weekend to stock up for the week, with heavy pepper, garlic salt, and paprika—you wouldn’t want to eat it straight, but it’s great on a salad.) On the side I have a third-cup cottage cheese, some slices of hard salami from Sam’s Club, and macadamia nuts from Trader Joe’s. If the T-3s are having fish, beef, pork, or chicken then I’ll join in on that portion of the meal and down-size my salad, passing on the dreaded high-carb side dishes.

Anyway, back to the subject at hand: I had wanted to flesh out some more detail on using the Guardian in Real Time to control the blood sugar in Real Time, but I think I’ve exhausted everyone’s attention span just setting the stage. I’ll have to blog the rest later.

Or maybe I’ll make you buy the book.


Blogger Kevin L. McMahon said...

I think you're onto something here w real-time being a totally different way to control blood sugars.

My guess is that you'll end up writing about how historical review & trend analysis don't have much value any more (at least in the way we think about it today). Count me in as a willing investor in at least 1 copy of your book ;)

8:33 AM  
Blogger Claire said...

A lurker comments!

(you just said a couple of things today that really rang a bell)

I'm totally in on your book; you seem to understand how to use cgm way better than I do, and I'm already obsessed with it.

(I'm all about the real-time, at least until minimed makes carelink work on my mac. For some reason, I've just been too lazy to bring all the requisite cables to work to download my data...)

You mention:

>I am beginning to suspect that >there is an un-discovered link >between total daily basal >requirements and total daily carb >intake. But that science will have >to wait for another day.

I absolutely believe this is true, as it is borne out by my own experiences. If there's any sort of science behind it, I'd love to hear it, because I find the link mystifying.

>“Huh. So you get to choose between
>your blood sugar killing you or >starving to death? Is that what it >comes down to?” she asked.

...and that's pretty much the trade-off, isn't it? I almost had this exact conversation with my mom:
Mom: "How's your diabetes control lately?"
Claire: "Oh, great, actually, never been better."
Mom: "Are you trying something new?"
Claire: "Well, I find that if I don't eat food, my blood sugar doesn't go up. So I'm going with that."


Anyway, it's good to hear you're doing well.

10:06 AM  
Anonymous Kelly said...

As an experiment for true numbers, my son ate prepackaged frozen meals, and his numbers came down to almost "normal." Amazing what some attention to details will do. Nice chart illustration. Looks like your support group's comments hit you. Now you can be a role model...
I do look forward to your book, but due to the expense of Diabetes, I am going to encourage the library to get it, and I'll borrow it.

10:26 AM  
Blogger Scott K. Johnson said...

Another great post Wil.

I really try hard to ignore the link between my poor eating habits and my poor glucose management, but I'm going to have to acknowledge it one of these days...

2:07 PM  
Blogger Don said...

I've felt for a long time that there is a total daily carb threshold. Above it control is impossible, below it it's easy.

9:07 PM  
Anonymous Ann said...

I agree with this completely, thanks for the post.

4:05 AM  
Anonymous Shawn ATL said...

Great post and insight. How did you get your Comlink? Did it come with your Guardian. I use a MM pump and it did not come with my pump. All of their information mentions the Comlink, and using it with CareLink, but I have yet to be able to find where to get it.

6:46 AM  

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