Here is a quote from a d-parent I know: "Our daughter has had type 1 diabetes for 6 years, her A1C runs as high as 8%. We've recently been using the insulin pump but can't seem to control or balance the blood sugars during activities or after changing the infusion site. Can you advise us on how to adjust the pump?" Ok, reasonable and common concerns I've heard for years. And I certainly understand the intent. But the focus might better be placed somewhere else besides primarily on the device. Patients and parents often tell to me they want to get themselves or their child "back in control" of their diabetes. Questions like these are often asked in a way that implies that I've got a secret I
Installment #10 What follows is a quick and dirty list of my top of mind quick tips. A gram of alcohol has 7 calories. Foods with carbohydrates and lots of protein and fat are broken down into sugar more slowly. The glycemic index of a food indicates how quickly it turns into blood sugar. The glycemic index of a donut is 76 The glycemic index of white bread is 70 The glycemic index of whole milk is 22 The glycemic index of skim milk is 32 The glycemic index of low fat ice cream is 50 The glycemic index of pretzels is 83 The glycemic index of low fat yogurt is 33 After reading through the list, how did your knowledge compare? As always if you any questions or have a quick tip that you would l
Installment #9 What follows is a quick and dirty list of my top of mind quick tips. Children with diabetes are more likely to miss days at school than non-diabetics. Glucagon should only be given if someone with hypoglycemia is unable to take food by mouth. People with significant diabetic retinopathy can have 20/20 vision. Get regular eye exams. Levemir and Novolog can be mixed together in the same syringe, but the Novolog works slower. Injecting insulin at room temperature is less uncomfortable than injecting cold insulin. One starch or bread exchange is equal to 15 grams of carbohydrate and 3 grams of protein. One milk exchange equals 12 grams of carbohydrate and 8 grams of protein A gra
Installment #8 What follows is a quick and dirty list of my top of mind quick tips. Basal rates are best changed at least 2 hours before desired effect. An extended insulin pump bolus for pizza may require up to 8 hours. When you see a pattern of both high and low blood sugars, fix the lows first. Fasting blood sugar patterns are the last to change when coming out of the honeymoon. Some insulin pumpers need a more aggressive insulin to carb ratio in the mornings. Anti-GAD65 antibodies, IA-2 antibodies and insulin autoantibodies are often found in persons with type 1 diabetes. Celiac disease (intolerance to gluten) can occur in 3 to 8 percent of persons with type 1 diabetes. Hypothyroidism ca
The glycemic trend line on a continuous glucose monitor (CGM) is always telling a story. It's the story of your blood sugar control. So much is revealed by the trend line if you only know how to look for it and interpret it. Sugar Surfing is the Rosetta Stone to deciphering the mysteries of your or your child's blood sugar control challenges. Graduates of my Sugar Surfing Workshops and students of the book can quickly identify "structures" on the trend line. These include colorful labels like: 1. shelf 2. delta wave 3. lag time 4. pivot 5. drop 6. nudge These are "first order" terms which Sugar Surfers quickly start to recognize on their trend lines, even during the course of a workshop. A h
Installment #7 What follows is a quick and dirty list of my top of mind quick tips. During any illness, check blood sugars more often. The dawn phenomenon is high morning blood sugars caused by overnight growth hormone. Most persons with type 1 diabetes will have over 5000 episodes of low blood sugar in a lifetime. The three macronutrients in our diet are carbohydrates, fats and protein. A meal plan for a person with diabetes should be individualized to their unique needs. A scheduled meal or snack should not be withheld for a high blood sugar. A scheduled insulin dose should not be permanently withheld for a low blood sugar. Only rapid acting insulin can be used in an insulin pump. The aver
“Know thyself” Greek philosophy and Sugar Surfing have something in common. Never in the past would I have imagined requiring a total of 10 units of insulin for an avocado steak salad with balsamic vinaigrette dressing on the side, plus a small appetizer of fried avocado topped with crab meat and a light remoulade topping. I’m not here to be a nutritional role model, just to explain how I managed this situation using Sugar Surfing methodology. The first dose was for the meal itself (4 Units lispro). The second dose was almost two hours later as a classic delta wave was occurring. This is standard Sugar Surfing: preempting a rise when I knew my duration of insulin action was waning. This is t
Installment #6 What follows is a quick and dirty list of my top of mind quick tips. The hemoglobin A1C reflects the average glucose levels over 3 months. Target blood sugar levels 2-3 hours after a meal should be under 180 mg/dl. Check blood sugars 15 minutes after treating a low to make sure it’s coming back up. Nightmares may be a symptom of overnight low blood sugars in young children. Bedwetting may be a symptom of high blood sugars in children with diabetes. For 30 minutes of moderate exercise, consider using 15 grams of carbohydrates. A blood fructosamine level measures average blood sugar over two weeks. Learning to recognize patterns in your blood sugars is the first step to good con
Installment #5 What follows is a quick and dirty list of my top of mind quick tips. Research has proven that it’s best to review your own blood sugar records every 4 to 7 days for abnormal patterns. Less frequent reviews are significantly less effective overall. Toddlers are usually extremely sensitive to small amounts of insulin. The dose of glucagon by injection for children under 4 years old is 0.5 mg. Nausea and vomiting are possible side effects of glucagon use. After injection, it takes about 20 minutes for glucagon to raise blood sugar. Limited joint mobility is a risk factor for future development of diabetes complications. Insulin requirements are lowest between 2 and 4 AM, during s
Installment #4 What follows is a quick and dirty list of my top of mind quick tips. Glargine (Lantus) and Detemir (Levemir) are also called basal insulins. Lispro (Humalog), aspart (Novolog) and glulisine (Apidra) are also called bolus insulins. Adults with diabetes should try to keep their hemoglobin A1C level under 7% and ideally below 6.5%. Blood pressure of adults with diabetes should ideally be under 115/75. Persons with diabetes should have their lipid levels checked yearly. The target LDL-Cholesterol level (aka ‘bad cholesterol’) for diabetics should be under 100 mg/dl. Persons with type 1 diabetes have a higher risk of developing thyroid problems and should be checked by their physic
Sugar Surfers reflect on inflections. What does that mean? It means that keeping an eye on changes in the direction of your blood sugar trend line. Whenever the trend line changes direction (inflects), it's wise to think about what might be causing this shift to occur. The only person who will best know this is you. This ability to reflect and respond is vital to learning how to control the line's direction of flow. When a glycemic trend changes direction and it is NOT because of a proactive action you took (i.e., an insulin, exercise or carb pivot), this change will carry significance to you, the Sugar Surfer. When viewing a glycemic inflection you should reflect on WHY the trend line is
Installment #3 What follows is a quick and dirty list of my top of mind quick tips. Beta-hydroxybutyrate is the primary ketone found in diabetic ketoacidosis. Diabetic ketoacidosis is caused by lack of insulin more than by overeating. Nausea or vomiting suggests the need to check blood sugar and ketones. Ketones can be checked in urine (about a 2 hour lag time) or blood (several minutes lag time). Fat and protein slow down the breakdown of carbohydrates into sugar. Sugar spills into urine when blood levels are greater than 180 mg/dl or higher. Ketones are the result of fat being broken down for energy. It takes one-tenth the amount of insulin to prevent ketones compared to lowering sugar lev
Installment #2 What follows is a quick and dirty list of my top of mind quick tips. Lipohypertrophy happens when insulin shots are always given in the same location. It takes 2 to 4 hours before NPH insulin starts to work. Lispro insulin (Humalog) works best at 60 to 90 minutes after injection. Lower doses of insulin detemir (Levemir) may require a split dosing schedule. For example, half at breakfast and half 12 hours later although there variations on the split. If you insert the syringe needle quickly; it hurts less. 4 ounces of apple juice equals 15 grams of fast acting carbohydrates. The duration of the honeymoon phase tends to be shorter in younger patients. Daytime fatigue or sleepine
Installment #1 What follows is a quick and dirty list of my top of mind quick tips. At diagnosis, most persons with type 1 diabetes have lost 85-90% of their ability to produce insulin. An open bottle of insulin should be discarded after 1 month. Rapid-acting insulin starts working about 20 minutes after injection. The honeymoon phase is defined by a total daily insulin dose of less than 0.5 units/kg/day. A bottle of NPH insulin should be gently rolled at least 20-25 times before using. Never freeze insulin: it destroys it. If you see clumps inside the insulin bottle, throw it away. When drawing a mixed insulin dose, always draw out the longest acting insulin first. It is not necessary to as
