Tag: Diabetes

Apple Watch and Health

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Photo by Tanja Heffner on Unsplash

Having that thing go off, it's less about it going off every hour and asking me to stand for a minute, but of reminding me of the passage of time, that as a human being, I feed off of motion the same way that I feed off of food.

How often will the watch ask you to stand or move? If standing and moving intrude on my focused work effort which should win out? The stand/move or the focused concentration? What do I do if I am merely a participant in a 2-hour meeting with high-level executives? Do I just stand up in the middle of the meeting and walk out because my watch told me to?

Then linking that into, wow, I actually have more pain today. Tomorrow, I'm going to make more of a conscious effort to really pay attention to when the watch tells me to get up and move, and maybe have a walking meeting.

How do walking meetings work in practice? How easy is it to convince a group of people (or a single person) to go outdoors in very cold or very hot weather and work (think) while walking? What if one member of the group says no (perhaps they have a medical reason)? Does the other members of the team pile on in convincing that person to do a walking meeting?

My wife just walked by while I was reading this article and suggested we go for a walk. I asked her if we could go in about 30 minutes. My Dexcom indicates that my blood glucose is 50 mg/dL. I need a glucose gel. If this had been a request for a walking meeting at a specific time I would have had to decline. For medical reasons that I would not want to explain to anyone.

Were you mindful when you were eating? Did you eat things that, at the end of the day, are going to balance out to cover all of the different nutrients you needed so that your body and your brain can function?

Yes. Sure. I have type 1 diabetes. I already do way more testing and monitoring and daily nutritional analysis than most people.

When we're talking about health and wellness with colleagues, with patients, or with clients, one of the things that we definitely do talk about is it's a buffet. It's rarely going to be a one-size-fits-all. It's really about paying attention to what it is that you need, and finding that best fit.

Truth!

A few of my friends and family have asked why I don't have an Apple Watch. They read some hyperventilating article about how Apple is working on a blood glucose monitor for diabetes. My Dexcom G5 CGMS is helping me do 24⁄7 blood glucose monitoring because of the ever-present risk of hypoglycemia because, like most people who have lived with Type 1 diabetes for a while, I have hypoglycemia unawareness. It's not a quantified lifestyle device toy.

Even if the Apple Watch could accurately monitor my blood glucose, it would need to be connected to me 24⁄7. My Dexcom transmitter battery last three months. Snapping in a new pre-charged transmitter takes two hours. The Apple Watch is good for 18 hours and needs to be connected to a charging stand to re-charge. This is nowhere near to being a replacement for my Dexcom G5.

Diabetes and Outdoor Photography

Ten years have passed since my Type 1 diabetes diagnosis, and as I get to know myself more as a person with diabetes, I have learned that to do what I’ve always loved to do and to try new things is possible, but both require more planning than in the past.

Managing diabetes requires me to regularly consider what I need to live every day regardless of what I am doing or where I am. I have to deliberate, prepare, and strategize before heading off into the woods and away from the safety of home and a comfortable routine. What did I forget? What if I my CGMS stops working? What if my insulin gets hot? What if I run out of glucose gels?

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diabetes, checklist, Wunderlist, screenshot
My diabetes check-list in Wunderlist.
For about a year and a half, I’ve worn the ACCU-CHEK insulin pump. It’s about the size of an old Blackberry pager (if you are old enough to remember what those looked like), along with a glucose meter about the same size, which acts as a remote control. The insulin pump is attached via plastic tubing to a small port inserted into my stomach. Every three days I change the plastic tubing and port location on my body, and every five or seven days I fill a new plastic cylinder with insulin and insert into the pump. I check my blood sugar on the glucose meter about six times a day.

Once I count and enter the number of carbohydrates I am going to eat; the glucose meter suggests a dosage (called a bolus) which I can accept or alter as needed. When I decide to be active, I can choose a higher or lower baseline insulin rate depending on my activity level (it’s all guesswork). This system functions as my personal external electronic pancreas, and it’s helped me to live a more flexible life than when I was on 4 to 6 shots a day.

Before I go into the woods to hike or take photos, I run through the list of things I would need. I’ve learned that the added exertion of walking in the woods or long walks around a large city causes me to burn glucose at a faster rate, and it takes me a while to get enough carbohydrates in my system to sustain my activity.

During one recent hike this past spring I downed two 22g glucose gels just to keep my blood sugar high enough to walk back to my car. I brought what I thought was enough glucose tabs to handle possible hypoglycemia and adjusted my insulin based on an estimate of excursion. 30 minutes into the hike and my blood glucose dropped, and the devices started beeping. I used up all the glucose tabs, and things did not improve. Thank goodness my friends had snacks.

The other thing I have to consider is that there is no cell signal out in the woods. If I have a hypoglycemic episode (undetectable without my bio-hardware) or a diabetes device failure, having someone with me provides added comfort in knowing there is someone who can help me if I need it.

T1 (autoimmune) diabetes is not something about which a patient can escape thinking. But over time I’ve developed a go-to checklist, with my medical supplies listed next to my photography essentials, diabetes no longer gets all the attention when I’m planning.[/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]

Can a Low Carbohydrate Approach to Type 1 Diabetes Management Be Successful?

On the TuDiabetes T1 and LADA forums, Jessica Strickland, a woman with Type 1 diabetes, posted a question about low-carbohydrate diets.

I've been looking at diets lately. I've discovered Low Carb High Fat Diet (LCHF) and noticed that many people have had success with this way of eating. Have any of you Type One Diabetics ever tried it and had success? And was your Endocrinologist on board with it?

Thanks in advance, for your advice! Jessica Strickland

This question engenders heated debate and hurts feelings whenever the topic comes up. I wanted to post a response that was both informative and without emotion. I wanted to make sure that my answer did not cause any hurt feeling that their choices about how they manage diabetes were wrong. Here's the text of my answer.

My endocrinologist has always been on board with reducing carbohydrates in my diet. She has no particular recommendation on paleo, low-carb, south beach, diet etc. Together we define success or failure based on the numbers. Are my A1C, triglyceride, cholesterol, and frequency of hypoglycemic and hyperglycemic episodes within the normal range?

We don't discuss the emotional side of diabetes. We don't discuss whether I like eating only one slice of pizza or never eating cake or ice cream. We don't discuss what I've given up to help manage my diabetes long-term. From that perspective, trying to eat like ordinary people is irrelevant. It's a recipe for depression to focus on what has been lost instead of focusing on what is possible. I spoke with a friend who is a clinical social worker, and he helped me put "D" into perspective when I was at a low-point.

Whether or not your diet is low-carb or not is relative. There is no one definition.

According to the Institute of Medicine, the organization that sets the recommended daily intake of nutrients, adults and children over the age of 1 should eat 130 grams of carbs a day. ~ WebMD

Here's one very specific definition from a 2008 study.

Low-carb ketogenic diet (LCKD): less than 50g carbs and 10% calories daily of a 2000kcal diet Low-carb diet (LCD): 50-130g carbs daily and between 10-26% of calories of a 2000kcal diet Moderate-carb diet (MCD): 130-225g carbs daily and between 26-45% of calories of a 2000kcal diet ~ Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndromel

My current average daily carbohydrate intake is about 100 or less. My most recent A1C was 6.2 and has been as low as 5.5during a time when I tried eating about 70g carb per day and exercised).

Some people need more daily calories than others. A 165 cm tall man who sits in front of a computer most of his day and does not exercise needs fewer calories than a 165 cm tall man who hikes, jogs or runs every day. My advice is to reduce your carbohydrates and eat more fat and protein but design your diet. Call it the @Jessica_Strickland88 diet. If your diet helps you meet your diabetes management goal, whatever they are, then continue. If not, then adjust as needed.

As stated above, my diabetes management goal is simple. Do what I must in the present to reduce the risk of complications in the future. It's long-term versus short-term thinking. It's similar to retirement planning -- look at the numbers, adjust, and leave out the emotion.

I won't argue whether a low-carb, diabetic diet can be done. There are many sources of credible information on this topic. Do your research, make your own decision, and live with the consequences1 of your choices.

You may have to decide for yourself how low you want to go, depending on your meter readings and how you feel. ~ Low-Carb Diabetes: What You Need to Know

  1. The word consequence means: the effect, result, or outcome of something occurring earlier: Consequence is not a bad word. It's just often used in that context. The consequence of my going to graduate school is that I have skills that allow me sometimes to negotiate a higher income. The consequence of me eating a slice of cake at dinner is a sleepless night spent fighting hyperglycemia. ? ↩