Sh*t Cyclist Say

Couldn't resist posting, one of the funniest videos I've seen in a while...

Disgusted by Paula Deen

As most of you have read by now Paula Deen will be a spokesman for Novo Nordisk to promote their type 2 diabetic drug.  In my view this alliance and Paula Deen's development of the disease represents everything that is wrong with both the American health system and the obesity issue in America.  Paula Deen should in no way be viewed as a role model for people with type 2 diabetes, she should rather be viewed as the poster person for EXACTLY HOW NOT TO EAT.

I took a quick look at her top recipes on foodtv.com, I've listed the high fat, high carb ingredients in the top 3 recipes:

• Chicken & Rice Casserole - 1 can condensed cream of celery soup (220 calories, 13.6 g fat, 21.4 g carbohydrates), 1 cup mayonnaise (916 calories, 78.5 g fat, 56.2 g carbohydrates),  for a total of 1,136 calories, 92.1 g fat and 77.6 g carbohydrates.
• Lady & Sons Chicken Pot Pie - 1 quart heavy cream (3,284 calories, 352 g fat, 24 g carbohydrates), 1/3 cup butter (542 calories, 61.3 g fat, < 1 g carbohydrates), 2/3 cup all purpose flour (309 calories, < 1 g fat, 64.6 g carbohydrates), 4 sheets frozen puff pastry (1.036 calories, 71.6 g fat, 84.8 g carbohydrates) for a total of 5,171 calories, 484.9 g fat and 173.4 g carbohydrates
• Chicken & Dumplings - 1 can condensed cream of celery soup (220 calories, 13.6 g fat, 21.4 g carbohydrates), 2 cups all purpose flour (910 calories, 2.4 g fat, 191 g carbohydrates) for a total of 1,130 calories, 16 g fat and 212.4 g carbohdyrates

Even in moderation the foods above should be avoided at all costs; the human body simply should not process foods that dense in calories, fat or carbohydrates.  And to keep it simple I didn't break down the difference between good and bad fats above or include the level of sodium in each dish.  Fat tastes good, no question about it, but after years of eating clean the mere sight of the nutritional content above makes me nausesus.

Rather than promoting someone whose cooking habits and lifestyle no doubt led to the development of a lifestyle disease shouldn't we celebrate people like Jamie Oliver or studying the glycemic index of foods like Michael Montignac suggested?  Paula Deen is addressing the problem after something has happened rather than making a chance prior to the problem happening.  Think about what would happen if you didn't change the oil in your car's engine until after your engine seized.  That would be a tad more expensive than the $40 oil change and your local shop, right?  That's exactly what Novo Nordisk is suggesting by using Paula Deen as a spokesmen.  We need to get ahead of the problem and change eating habits, not address the consequences once we are too far downstream.
 

Ooozing Insulin

So this may be my grossest blog post of all time...

Upon my return trip from Thailand (full bolus food report forthcoming) my blood sugars were unsurprisingly wacky.  A 12 hour time change and 30 hours of travel to make it home can send a person's metabolism totally out of whack, even if they have no issues to speak of.  So for a type 1 diabetic extensive travel often comes with some blood sugar management issues.

However, when I got back from Thailand my blood sugars were all over the map.  My bs didn't want to be consistent, cropping up at weird times and staying stagnant for a short period of time after a meal until a big spike occurred.  I assumed it was just my body getting used to a different eating schedule and planned to suffer through for a couple days.

On one of my last boluses before changing my infusion set I began to think something other than the time change was affecting me. The long trip had my stomach in knots and a wacky sleep pattern had me not very hungry.  So for my first 2 days back in the States I was living on toast and chicken soup.  For dinner on Wednesday night I had 2 pieces of whole wheat toast and a can of Campbell's Chicken & Stars soup - we're talking a total of no more than 80 grams of carbohdyrates.  Even though I took in 7.5 untis of insulin for that meal my blood sugar spiked to 308 about an hour and 1/2 after my meal.  I had around 7 units of insulin left in my pump so it was time for a change anyway.

When I removed my infusion set and was rewinding my pump I suddenly felt a ton of wetness on the side of my stomach.  When I looked down there was something that looked like water around the injection area.  I then ran my hand over it and it smelt like insulin - hmm odd I thought.  I ran my finger over my infusion old infusion site and some more insulin seemed to pop out.  So then like any curious person would do I squeezed the old infusion site and the hole gushed insulin - I'd say at least 10 units!

Disgusting! As I changed my infusion site insulin was freaking leaking out of my body, doesn't it know it's supposed to stay in there!  I checked out the old cannula and it was crimped at the end - something that seems to be happening way more often with my Animas sets than my old Medtronic sets.  At least I finally have an answer for where all the unused insulin goes when your site is crimped, it comes out the other end...

X Factors - Family Holiday Party!

Happy Holidays to all my readers!  I hope each of you had as fantastic of a holiday as I did.  Since I moved across the country family time has become increasingly more meaningful and special so this Christmas was extra amazing.  Especially since I had the opportunity to meet my significant other's entire extended family.

With each holiday season I am however reminded how tough family parties can be with the D.  From extra booze to your favorite Aunt's desserts bolusing is never easy.  Add to that a sporadic exercise schedule and a routine far from normal and you have a recipe prime for diabetes disaster.

On Christmas Day I went to my SO Uncle's house for her family's Christmas party.  Once there I was greeted with sausage rolls, roast beef on baguettes, baked bree and pigs in a blanket. In other words, a carb counter's nightmare!  When I woke up Christmas morning I did some hill repeats and made up my own cross-fit routine so had gotten in about 45 minutes of exercise.  For breakfast I had some greek yogurt and for brunch an omelet so I was a bit surprised that my blood sugar was 220 when I first bolused for the holiday appetizers.

After peeing no less than 5 times in an hour I wondered if my 5 unit 2 hour extended bolus wasn't enough.  Upon testing I saw that my blood sugar was 295 so I gave myself another 3 units of insulin.  5 pee breaks later my blood sugar had crested to 341 and I took in 10 units of insulin.  The next time I tested I was at 271 and for the most part hadn't eaten anything in the past 2 hours.  I decided to give myself another 5 units of insulin and told my girlfriend to watch out for the warning signs of a low.  Before leaving my blood sugar was still in the upper 200s so I took in more insulin yet again.

At that point I wondered if sausage bread really could be that bad for you or if there was any possible way I had eaten more than 700 grams of carbohydrates (or what my bolus rate would have translated to).  Once back at my gf's house I took in 12 more units of insulin since I was at 221 and had a bite of cheesecake assuming that I was headed low at some point. Finally my blood sugar dropped to 150 making me worry about a nighttime low but 30 minutes later I was back at 175 so I took in another unit of insulin and had a gel and some other sugar goodies well within reach.  When I woke up with a blood sugar of 281 I wondered if I was getting sick...

On the 26th I went out for a 10 mile run and finished with a blood sugar of 180 even though I had only taken in 1 gel and 2 fuel belt bottles of gatorade.  I felt my infusion site and realized it was a bit sore so I removed it.  Once I removed the canula I was greeted with a lovely 90 degree kink that for whatever reason didn't cause the occlusion alarm to ring!

I should have checked my infusion set far sooner than I did but I figured since the food on the table was so delicious that it must have been bad for you.  Live and learn I guess...

X Factors - Red Eyes

Travel is pretty much unavoidable during the holiday season; especially when you and your significant other's family lives on the opposite coast.  Historically, changing time zones has been one of the most difficult variables to manage for my blood sugars.  Usually heading east I'll go low and heading west I'll go high. So last night it was with great trepidation that I tried Ambien for the first time.

I'm not a good flyer, even though I flew close to 100k miles during my time at Keas, I freak out just about every time my flight takes off.    Bumps make me break out in a cold sweat and god forbid the flight has more than a moderate amount of turbulence.  I can tolerate flying but frequently have to close my eyes and imagine I'm on a bumpy road riding my bike.  So I was excited to try anything that would take the edge off. 

But taking something that makes you stay and fall asleep has its consequences.  What if I encountered a low and did not wake up to the normal warning signs?  What if the effects of the medicine made me go extremely high or extremely low.  I'm nervous anytime I introduce a new variable into my system but was especially nervous to introduce Ambien to my system in an environment that I quite frankly hate.

So I got onto my Virgin America red eye, opened my bottle of water and swallowed the blue pill thinking of Neo.  About 20 minutes later I noticed a tingly feeling in my lips, took some food and then was out for the count!  For someone who hates flying this is a miracle drugs, bumps were met with the smile of a child on a roller coaster and the 5 hour flight felt like 45 minutes.  I did however sleep the entire van ride to my parents house and continued to sleep for another 4 hours once I got home!  But best of all my blood sugar was perfect!

When I got onto the flight my blood sugar was a slightly low 78.  I ate a kashi protein bar to up that a bit before passing out and landed with a beautiful bs of 98!  Upon getting to my parents house I tested again and was greeted with a 91 and haven't crested 125 all day.  Traveling and especially red eyes have always been met with blood sugar difficulty, I try and eat as cleanly as possible in the days leading up to them and get a bit of extra exercise but its never easy.  Good luck controlling those blood sugars as all of you travel home to your families!

Random Thoughts - Features that Matter

When I first received my Animas pump after years with Minimed/ Medtronic I was incredibly excited to be able to program my pump from my meter.  No longer did I have to awkwardly stare down under the table at dinner, contort myself in a movie theater chair or worry about lifting up my shirt just to get access to my pump for my bolus.  For the first few weeks I thought programming my pump from my meter was like the greatest Christmas gift of all time.  But as time wore on the bulk of the meter out weighed the cirque de solei act I perform to sometimes bolus.

That got me to thinking what features really would make managing diabetes easier.  I'm not talking all out revolutions like the artificial pancreas project just simple product feature updates that would have huge value at a low cost.

• Pump programming from my cell phone - Several phone and health companies have been working on incorporating a glucose meter into a cell phone. That would be a huge help but what would also be useful and perhaps a quicker win would be an insulin pump that could be programmed from an Android or Iphone app.  Lets face it the interface of pumps are freaking awful; the amount of buttons I have to hit to perform a simple task makes a bolus seem like a lunar landing.  Cell phone apps provide a simple elegant cheap solution to improve the UX and make programming a pump more intuitive.  Plus my cell phone already has a happy place in my pocket so its not like adding another device to deal with.      
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• Size - My favorite glucose meter is the One Touch ultra mini.  Its far from the most feature rich meter on the market but what it lacks in bells and whistles it makes up for in ease of carrying.  Whether exercising or wearing jeans the ultra-mini meter takes up a fraction of the space of most other meters while doing exactly what I need (and nothing more).  

• Readability - Although Animas markets their pump as the easiest to read because of its color screen in bright sun light its really tough to read.  Further, the ultra-mini does not have a back light and several other meters are hard to turn the backlight on.  One would think since loss of eye sight can be a major complication of diabetes  more effort would be put into readability.

• When the lights are off - to my knowledge the only meter which has a "flashlight" type feature is Freestyle.  I thought that idea was GENIUS.  Having to turn on the bedroom lights just to test is annoying and can disrupt our partners.  Alot of the time rather than turning on the bedroom light I shuffle to the bathroom to test at night.  Not only is that inconvenient its dangerous.   That same thought process exists for movie theaters, or any other dark environment.  We should be able to test wherever we are, not be forced to find a light to test under.

Those are just some of my thoughts on features that would be a huge help at a low cost.  You guys have any others?

Wednesday Wackiness - Business Lunches

One of the things that causes me some anxiety is testing for the first time with business colleagues.  I'm not embarrassed or nervous to test at all, its more the anxiety that in some way testing and bolusing will become a distraction.  After a business colleague knows "my deal," testing becomes routine as my office mates and peers will see me test and bolus multiple times per day.  But that dynamic changes when its a one off sales meeting, interview or other business meeting.

I think my anxiety stems in part from two issues:

• In a business meeting when time is a scarce resource I don't want to take 5 minutes away from the task at hand to explain what I'm doing
• And this is probably the bigger one - perception

The 5 minutes (if that) taken away from the meeting is easily over come; as long as the conversation doesn't rat tail into the difference between type 1 and type 2 diabetes (perhaps adding to my anxiety).  If that happens then 5 minutes could quickly turn into 10 if not 15 and greatly detract from anything I'm trying to accomplish in that hour.

But the bigger issue, perception.  In business meetings I want to be focused, viewed as attention oriented, determined and strong.  Although its a necessity for me to test and bolus prior to eating I never want to seem "distracted" during a business meeting.  Due to that I feel the need to explain what I'm doing (circling back to issue 1) which in itself is a distraction from the meeting.

So there in lies the challenge - excuse myself to the bathroom, test and bolus before the meeting (taking the chance I'll eat within 20 minutes) or roll the dice and deal with the anxiety...