Insulin timing

Posted on August 30, 2013 by janekdickinson

A situation I experienced tonight made me decide to post the following:

If you take mealtime insulin, avoid taking it too far ahead of a meal. This type of insulin is meant to “cover” or compensate for the meal you are about to eat. Because it works fast, if you take it too soon, there is a risk of going low (hypoglycemia).

Humalog, Novolog, and Apidra (usually called “rapid-acting”) start working in approximately 10 minutes and their peak action happens in about 90 minutes. Within just a few hours, they are gone (although how long they last can vary from person to person). So if you are at home preparing your own meal, it makes sense to take it shortly before you start eating. That way, the insulin has a chance to get started and is working when the food you eat turns to glucose in your blood stream.

I try to take my rapid-acting (mealtime) insulin about ten to fifteen minutes before I start eating. If my blood glucose is low prior to a meal, I take my insulin and eat immediately – or even treat the low by eating some sort of carbohydrate food first and then take the insulin. If my blood glucose is high, I take my insulin about 20 minutes before I start eating. This way it really has a chance to get to work lowering my blood glucose before I go and raise it again with food.

Tonight I had supper at a barbecue-type event. I took insulin inside the building and then went out to get my food. It turned out that I did not eat as much carb as I had planned and I ended up low afterward. This reminded me of an important message: it’s very – very – important never to take rapid-acting insulin before leaving home if you are eating out (at a restaurant or someone else’s house). Wait until you are seated, have ordered, and there is food in front of you. In other words, wait to take your mealtime insulin if you don’t know how long it will be or how much food you will eat. Better safe than sorry!

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What is balance?

Posted on August 28, 2013 by janekdickinson

justice scaleI love when this happens: I am reading a book that inspired me to write about balance. When I searched my old blog posts to see when/what I last wrote about balance, I discovered that Balance Awareness Week is coming up (again). Almost perfect timing for another post about balance.

And maybe “almost perfect” is a good intro to my definition of balance. In the book I’m reading (it’s called “The One Thing” by Gary Keller with Jay Papasan and so far, so good!), the author says balance is a lie. More specifically, “a balanced life is a lie.” For someone whose motto/catch-phrase/blog name/book subtitle is “it’s all about balance,” I had to sit with this for a little while.

While I do agree with the author’s point that we can only truly focus on one thing at a time, I do not agree that a balanced life is a lie and here’s why: for me, balance means not hyper-focusing on diabetes. It means having a healthy respect for diabetes, managing it – giving it the attention it needs (and my health deserves), being prepared for situations diabetes can potentially create, and then living my life. In other words, diabetes is not the most important thing about me or my life.

While I work hard to achieve balance in my life, when I am in balance, it doesn’t feel like hard work. We often hear the line, “I know what I need to do; I just need to do it.” For me that rings true for many things in addition to diabetes: the biggest one I can think of is keeping my office clean. When my office is clean I feel more productive and less scattered (sounds familiar, diabetes?).

I strongly believe that balance helps me live more, live well, and enjoy life. So I’m sticking with my motto: it’s all about balance. Now I need to go clean my office.

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Sharps Disposal

Posted on August 26, 2013 by janekdickinson

image_miniLet’s avoid throwing our sharps in the trash or toilet; I don’t want to see them wash up on the beach and you probably don’t either. It’s even more important to avoid having some poor person get stuck and not know whose needle it was – that is painful and scary.

In the diabetes world, sharps include lancets (for sticking fingers), syringes, and needles. Labs and clinics typically pay by weight to have their sharps taken away and disposed of, so they usually don’t want the public bringing their sharps containers in.

So how do we “properly” dispose of sharps? The FDA has an informative webpage on sharps disposal. They refer people to the Coalition for Safe Community Needle Disposal for state-specific information, as rules vary state by state.

If you use an insulin or other medication pen (Byetta, Victoza), pen needles can be removed and disposed of in your “sharps container.” For those taking Bydureon, the needle that comes with the medication kit can be removed from the syringe and thrown in the “sharps container.” And for insulin pump users, needles can be separated from tubing and/or cartridges. This helps keep extra, non-sharp clutter out of the sharps container. That stuff can go directly in the trash.

When traveling within the United States, I carry plastic bags. I put used syringes either in a separate compartment in my suitcase, or in one of those bags. When I get home I dispose of them. I also keep a sharps container in places I visit most frequently (the homes of family). One friend reported that during International travel she has been asked to leave her used sharps at Customs, so there may be times when you won’t have to lug them home, and hopefully Customs will dispose of them properly.

Any other tips?

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Hypoglycemia and cardiovascular health

Posted on August 23, 2013 by janekdickinson

Managing diabetes is about protecting blood vessels. High blood glucose (sugar) over time can lead to damage in both large (macro) and small (micro) vessels in our bodies. The large vessels feed the heart and brain with oxygen, and we can’t live without oxygen or without healthy vessels.

We have known for a long time that diabetes – high blood glucose – is a risk factor for heart disease, and now there is evidence that low blood glucose (hypoglycemia) may also lead to heart disease. This is even more support for “closing the gap” – in other words, avoiding blood glucose levels that are too high or too low.

blood-vesselHow do we deal with news like this? We can use the many tools available to keep blood glucose levels in a healthy range: healthy food choices, exercise, medications, insulin pumps, continuous glucose monitors, blood glucose monitoring, and visits to diabetes health professionals.

For me, it’s a matter of really being in tune with my body, and finding out what works for me. When I change my exercise habits, or try new foods, it takes some work (and time!) to figure out how to keep my blood glucose level in my target range. And doing the work always pays off eventually.

So rather than reacting to a message like this (hypoglycemia can cause heart disease) with fear, frustration, or even anger (or rather, after my initial reaction of fear, frustration and even anger), I’m going to continue to work on taking good care of myself. I’m going to focus on keeping my blood glucose in a healthy range most of the time in order to have healthy blood vessels.

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Diabetes Strength (through words)

Posted on August 21, 2013 by janekdickinson

My mother once gave me a hard time for letting my son choose where he was going to sleep when it was naptime (we were visiting my parents). I explained that I wasn’t giving him a choice about taking a nap, but I was giving him some ownership by choosing the spot (couch or bed).

Giving kids choices is a great way to help them develop independence, which I believe is my job as a parent. One day they will be out in this world by themselves and I won’t be there to hold their hands. As hard as it is to think about that – I want them to be prepared when that time comes.

When I recently heard a ten-year-old girl say over and over, with regard to various aspects of her diabetes life, “I have to do it. I have no choice,” it really bothered me.

I realize that as parents we often say, “you have to do this,” or “you have to do that,” and frequently it’s because we are trying to keep them safe or healthy or successful. For example, we tell our kids they have to wear a seatbelt or bike helmet, and they have to look before they cross the road.

With diabetes, it’s still a matter of keeping kids safe, healthy and successful, but I guess what struck me about this girl saying, “I have no choice,” was that she is likely to go through the rest of her life thinking that she doesn’t have choices. When she does.

One thing we can do as parents is teach our kids why it’s important to wear a seatbelt and bike helmet, etc. We can teach kids with diabetes why it’s important to check blood glucose levels, take insulin, and make healthy lifestyle choices. We can also let them choose whenever possible, for instance, the finger to poke, the site to inject or insert an infusion set. We may not want to say, “it’s your choice whether to do this or not” when they are 10, but instead we could say, “you need to do this so you can play soccer (or whatever).” Keep it positive and keep it relevant.

Later on, as our kids get older, if they’ve been used to making choices (that is, they’ve been empowered to manage their diabetes), there’s a much better chance they’ll understand not only that is their choice to manage their diabetes, but that they’ll be motivated to continue to do so – even without Mom or Dad around. The words we use with kids send powerful messages that can stick for a lifetime. With diabetes (and everything else), we can use words that build kids up and give them strength to be safe, healthy and successful.

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Take a (healthy) break!

Posted on August 19, 2013 by janekdickinson

13125677-business-lunch-executive-people-looking-menu-ordering-meal-at-restaurant“If you fell down yesterday, stand up today.” H.G. Wells

I like this quote because it reminds me that when I mess up, I still have a chance to fix things. And it really hit home for me because I had “fallen down” – as far as food choices, exercise, and blood glucose levels go -when I was away from home this summer and earlier this year. When I thought about my “falling down” experience(s) I realized I was in vacation mode most of those times, and other times stress definitely played a role.

I think that, within reason, it’s ok to take a break on occasion: relax my eating habits, check my blood glucose less frequently, exercise less intensively, but still take insulin. For me, the important thing is to find a balance between such a “break” and still feeling good and having energy.

Earlier this month I learned an interesting trick: using “triggers.” I can teach myself to keep up healthy choices/habits when I’m not in my usual routine, by establishing triggers.

One thing I find challenging is consistently making healthy food choices in restaurants. Maybe I could say, “When I’m in a restaurant, I will think about healthy choices as soon as I pick up the menu.” So picking up the menu is the trigger. I can make it a little game or challenge for myself – to find a healthy choice on the menu.

Another challenge for me is getting to bed at a reasonable time. When I go to bed really late I want to sleep late in the morning, which leads to less time for exercise. Maybe my trigger could be a certain time. “When it’s 11:30 pm, I will go to bed.” This way, I can get up early enough to exercise and still do the things I want to do.

What are some triggers you use to help yourself maintain healthy habits while away from home?

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Inhaled Insulin

Posted on August 16, 2013 by janekdickinson

Do you remember Exubera? This was the first inhaled insulin product to hit the market, and it was available for just one year in 2006-2007. Exubera was pulled from the market because it wasn’t bringing in the sales that had been anticipated.

Was the diabetes public not ready for inhaled insulin? Was the “inhaler” too big and awkward? Were providers not ready/not prescribing it? Was it too expensive?

Now we may have another shot at it (no shots involved, however). A new, inhaled insulin called Afrezza is performing well in studies. The inhaler is described as being the size of a whistle, and research shows that Afrezza is more effective than injected and oral treatments. One of the concerns with Exubera was the potential for lung damage or even lung cancer. I will be anxious to see information regarding lung toxicity and Afrezza.

What are your thoughts on inhaled insulin? Are you waiting for it with baited breath? Or are you skeptical?

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Blood Glucose Meters

Posted on August 14, 2013 by janekdickinson

IFARSELEMKHere are some things to think about if you need a meter for the first time, or if you are replacing one:

  • Strips are the most expensive thing about checking blood glucose levels. Meters are often given away (check with your diabetes provider if you haven’t already). You will want to know which type of strip (each meter goes with certain strips) your health insurance covers. That’s the meter you will want to use (unless you are independently wealthy or otherwise want to pay out of pocket for a different meter/strips). If you do not have health insurance, or if you do not have sufficient coverage, there are generic (store-brand) meters with strips that are markedly cheaper than the brand-name ones.
  • If your health insurance (or bank account) allows you the luxury of choosing between different brands of meters, some things to keep in mind:
  1. Type of battery: I had to change my meter batteries yesterday (not sure why I didn’t get a warning, instead it just stopped working), and my meter, it turns out, takes a somewhat obscure battery (two of them). Luckily I had a couple on hand, so not a crisis, but it certainly would have been easier if a) I had a warning and some time to buy the obscure batteries or b) my meter took the kind of batteries I have hanging around the house.
  2. Meter display: For many people, reading the result (numbers) and messages on their meter display is challenging (face it, we are not getting any younger). There are meters with larger displays, lighter/darker numbers, backlights, and so on. For those who need them, there are even meters that talk.
  3. Carrying case: I use my blood glucose meter “kit” as my wallet, so I need to fit not only my meter, strips, poker thing, insulin and syringe in there, but also my ID and credit cards. I am also very picky about my meter, strip bottle and poker thing being oriented in such a way that I can place strip in meter, poke, and apply blood without ever removing anything from its holder. Saves a lot of time!

What else do you look for in a glucose meter?

 

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Beware of shopping hungry

Posted on August 12, 2013 by janekdickinson

cutcaster-photo-100119140-People-shopping-for-produceYou may have heard this before, and here’s a study that supports the warning that shopping when we’re hungry affects the types (and amounts) of food that we buy. So here are some healthy ways to shop for food:

 

  • Shop when you are not hungry (right after a meal or snack).
  • Shop the perimeter of the store (where all the fresh, non-processed foods are located).
  • Buy groceries/ingredients for several days worth of meals if at all possible (fewer trips to the store equals less temptations to buy unhealthy food).
  • Prepare your fresh veggies (wash and cut) right when you get home (so they are ready for a healthy snack when you want/need one).

What other suggestions do you have for healthy ways to shop? What about ways to buy healthy foods and still keep the cost down? Perhaps we can collect and bring coupons to the store. Instead of unhealthy, packaged/processed foods, we can opt for fresh produce. Other ideas?

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Elite Opportunities with Diabetes

Posted on August 9, 2013 by janekdickinson

2013-blog-team-novo-nordisk-cycling-1I am currently attending the annual meeting and exhibition for my professional organization: the American Association of Diabetes Educators. AADE is a group that started meeting 40 years ago, and strives to improve the work of diabetes educators.

The annual meeting is a great time to attend sessions that provide a fresh look at particular areas of our work, and there are always some great keynote speakers. On Wednesday I heard Phil Southerland speak: Phil founded Team Type 1, a professional bike racing team. Phil has had type 1 diabetes since he was 7 months old. Team Type 1 is now Team Novo Nordisk, and from what I have heard and read appears to be comprised of all racers with type 1 diabetes.

Phil spoke about a turning point in his diabetes life when he realized the choice to manage his diabetes and determine his success or failure and health or lack of it, was his to make. He said that when he’s racing, he doesn’t fail because of diabetes, he fails because he didn’t manage his diabetes properly (and it sounds like he doesn’t fail very often). Another important point Phil made was that it’s never too late to change.

The last few AADE annual meetings that I’ve attended have given me an opportunity to witness the impressive grassroots work that’s happening by and for people with diabetes. Phil and the folks at Team Novo Nordisk are just one example. There are many opportunities for people with diabetes to connect and participate – all for the sake of empowering people with diabetes to manage their disease, get and stay healthy, and go out into the world and enjoy life.

It’s inspiring to see so much energy put toward living well with diabetes.

 

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