Four Ways To Lower An A1C… But Not Gain Weight

The other day on Facebook, someone posted whether or not it would be possible to ever lower an A1C but also not gain weight. I’ve heard this a lot over the years about how it seems like weight gain is inevitable with type 1 diabetes. And trust me, I have definitely struggled with this. But this year I’ve dropped 20 lbs and lowered my A1C over a percent. So I thought about what I did this year that made a difference and I made a brief list of my thoughts. Ginger Vieira saw it and suggested that I blog about it.

And when Ginger tells you to do something, you do it!

The main thing I figured out is that even though I don’t think insulin causes you to gain weight, but it doesn’t help when it comes to losing. Obviously you can’t go without insulin, but I do think that cutting down insulin safely helps. How do you do that?

Four Things I Did To Take Less Insulin (without ruining my blood sugar) 

1) Always work on getting the right basal and bolus ratios (and tweak them as often as necessary) in order to avoid using correction boluses. Most people take more insulin when they correct bloods sugar than when they raise their bolus or basal rate to avoid the high. This is a great way to get your blood sugar in better control but not have to take a lot more insulin. Plus, it’s no fun chasing highs and lows. 

2) Getting on Victoza. This isn’t available to everyone, but it made my body more sensitive to insulin and it decreased my appetite. Both of these helped me take less insulin. Other drugs, like Symlin or Invokanna, can help you take less insulin and sometimes it will curb the appetite too. 

3) Exercise regularly, especially strength training. I know, it’s a PITA, both time-wise and BG-wise, but it’s so helpful in so many ways. Insulin sensitivity is just one of many benefits to regular exercise. And don’t worry about needing to eat before or after working out. Your body actually needs some fuel to work out. As long as you’re not eating more overall throughout the day, there shouldn’t be an issue. 

4) Eat less. There are a myriad of ways to do this, but I’m not going to argue about the most effective eating plan. But I will say that when you eat more than your body needs, you’re going to gain weight. Insulin’s entire mechanism is to bring the sugar your body needs to the cells, and then store the rest as fat. I’m not saying everyone who is overweight overeats, that’s why I listed those other 3 things first. I think they are just as important as your diet. 

 

And there you have it. Four little ways to lower your A1C and not gain weight at the same time.

Defending Insulin

The strangest thing happened to me at work the other day. insulin

sI work a couple part-time jobs in retail, one that’s more or less permanent, and the other one that’s just for the holiday season. At the holiday season job, I recently learned that one of my coworkers (who I really like) has type 2 diabetes, and her mom has type 1 diabetes. Because of that, she is very well-educated about everything, and she even started educating me about type 2 diabetes before I gently told her that I already know everything (well… almost).

A few days ago, I was recovering from a low blood sugar. Another coworker asked, “Are you feeling better?”

“Not really,” I said, explaining that it can take 10 or 15 minutes for the feeling to really go away.

She made a casual remark about feeling bad when she’s low too.

“I think a diabetic low is like five or ten times worse than a non diabetic’s low,” I replied.

“Oh, I know, but I have type 2 diabetes, and my husband has type 1 diabetes,” she said.

Ah, okay.

“Wow, there are more of us here than I thought!” I said.

She then explained that she took Metformin, but she was hoping to get off of it because her A1C was 6.1% but her endo didn’t think that was a good idea.

“Your A1C is 6.1% because of the Metformin!” I said.

“Oh I know,” she replied, and then added: “I’m just doing everything I can so I don’t have to go on insulin.

Call me crazy, but I felt a little offended! I’m not entirely sure why, because it’s not like I like being on insulin. I’d avoid insulin too, if I had the choice! And it’s not like I have these lovey-dovey feelings toward insulin. I take it because I have to, that’s all. But I couldn’t help but feel a little defensive! Like she was somehow attacking me or people who take insulin or something ridiculous like that.

I literally had to swallow the urge to reply, “Being on insulin isn’t so bad!”

I mean, really? God, I can’t believe those words actually ran through my head. How embarrassing.

But of course, I stopped myself. And reminded myself of who I was talking to. I took a few deep breaths and completely agreed with what she said. It is good to avoid the progression of the disease! Yes, it may happen, but what good is saying, “Oh well you’ll probably have to go on it anyway”? Her A1C is 6.1% on metformin alone. That’s awesome! That’s fantastic results. There’s no need for me to go rain on her A1C parade with comments about how wonderful insulin is… especially when it’s not very accurate. Yes, insulin can provide a lot that oral and injectable type 2 drugs can’t do, but insulin also comes with a whole host of other problems. I’ve never met a diabetic medication that didn’t have some sort of issue that came along with it, insulin included!

But it just surprised me that I had such a knee-jerk protective reaction toward taking insulin. Has anyone ever felt quasi-defensive over their diabetes devices?

Epic Lows

Have you ever wondered what it was like to have a low blood sugar last two hours?

Well, let me tell you. It sucks. And it’s happened to me three times this week.

It’s not a question of why I went low. I’m pretty sure I know why I went low. The first (and probably second time) it was likely from stacking insulin during a rage bolus. And the third time it was from taking my normal bolus right before going to working at a retail store that involves a lot of walking.

All three times the lows weren’t exactly unexpected. But what happened after I went low was surprising.

I couldn’t come up.

My first epic low happened in the wee hours of Saturday morning, and it took 3 juice boxes — with my blood sugar tanking to 35 mg/dl! — before I started to sputter northward. I ended up flying into the stratosphere during the day only to crash land after dinner that night, complete with a LOW on the Dexcom. Yikes. A couple days passed before an epic low at work, which took two cans of Dr. Pepper  — that’s more than 120 grams of carbs! — before I resurfaced, and even then, I only topped out around 200 mg/dl.


photo 1-7Saturday morning’s epic low (there are actually 2 lows in that second dip — I didn’t come up until the third juice box)

photo 2-7Saturday night’s epic low

I have never needed more than a juice box to correct a low blood sugar, and certainly not two cans of regular soda (the equivalent to about 4 juice boxes). I mean, really?! I know I probably had a little too much insulin on board, but it’s not like the contents of my pod emptied into me!

I can’t quite figure it out. I’m now completely paranoid about going low because it’s not just a momentary hiccup. These lows are lasting hours. They are quite unpleasant. I can’t figure out what’s going on. If this is a complication of diabetes, it seems like the oddest sort. I thought for a moment it might indicate gastroparesis, but this would literally be the only time my blood sugar didn’t respond to glucose. My body responds to food at every other occasion! It’s just when I’m super low, my body is suddenly like, you know, we’ll get around to it when we feel like it. 

Ugh.

I know epic lows can happen to the best of us. But three times in a week? That just seems… weird. I know I still have diabetes because I’ve had plenty of high blood sugars when I’m not low! Has anyone gone through a string of epic lows? Did you ever figure out what the problem was?

Happy World Diabetes Day!

photo-1_thumbWell, I almost missed it, but I’m here! Hoping everyone had a productive World Diabetes Day. I spent part of the day participating on the 24-hour long Twitter chat for World Diabetes, which was definitely enjoyable. I don’t participate in Twitter chats nearly enough, mostly because on Wednesday nights I work until 8pm and so I don’t get home until the chat is more than halfway through.

My bit of diabetes advocacy for the day came in the form of a guest post for Anne of Fannetastic Food, a big healthy living blogger. Last month Anne posted about some recent blood work, and she talked a little bit about diabetes. I suggested to her that I could write a guest post about diabetes for World Diabetes Day and National Diabetes Awareness Month, and she agreed! I was so excited! But I was very anxious writing this guest post. Eventually I decided to write 14 things that people might not understand about diabetes, but in reality, I probably could have written about a hundred! It was very stressful trying to decide what to write and how to condense it so that it wouldn’t become a book. So far the comments have been amazing, so I’m really happy about that.

I’ve been kind of quiet around these parts mainly because school and work have taken up so much of my brain power that I haven’t been able to put together any thoughtful posts recently. But I’m going to try to get a few lingering posts up in the next couple of weeks, before the holidays roll in. Can you believe 2014 is almost over?!

How did you mark World Diabetes Day? Do anything special?

Walking A Mile

Easy-3They say that you really don’t know someone until you’ve walked a mile in their shoes. Well, I’ve never walked a mile in the shoes of someone who has type 2 diabetes or gestational diabetes or someone who was diagnosed with diabetes as an adult or any other variation of this dreadful disease. And there are a lot of variations.

When I saw the prompt for this month’s DSMA Blog Carnival (which I’m horribly remiss in responding to regularly), I was stumped:

Anything easy about living with your type of diabetes that isn’t easy for another type?

There are a few things about this that made me question whether or not I could even answer a question like this. First and foremost, I speak for my diabetes. Not yours. Or hers. Or that guy over there. Just me. And my perception of what is “easy” may not be so easy for someone else.

The second thing that got me thinking was that I don’t really know what is easy or hard for another type of diabetes because I don’t live with that disease. For example, I have a horrible gag reflex. I choke on aspirin. I had a hell of a time taking metformin a few years ago when I decided to see if I could help my insulin resistance. So to me, taking injections is easier than swallowing a pill.  Does that mean taking injections is easy? Not by a long shot (ha! pun!). But other people might think, Allison, it’s a freaking pill once a day. Get over yourself.

A few years ago, I had dinner with a friend of mine who has type 2 diabetes and she mentioned how her blood sugars affected not just what but when she could eat. She said if her blood sugar was high, she would have to delay a meal and often would go on a walk to bring it down. She couldn’t just pop a pill to lower her blood sugar. It took a lot more effort. I remember thinking that sounded terrible, because I just pressed a few buttons on my pump and that took care of business.

I suppose the flexibility to take insulin whenever I want is a perk of type 1 diabetes… or at least, a perk of someone who uses insulin. (And if there’s even such a thing as a perk with diabetes.) But using insulin comes with a whole host of things that are not easy. Pump failures. Bad insulin. Poor absorption. Miscalculating carbs and crashing or soaring. It’s really not that easy.

I can’t even talk about stigma, because the stigma against type 2 diabetes often trickles down to the rest of us who bear the title “diabetic.” I suppose there is less outright discrimination against me, because most people have a general concept that type 1 diabetes is not lifestyle related.

“That’s the one you’re born with, right?”

“That’s the really bad kind, right?”

“Should you really be eating that?”

I might not be discriminated against, but my ears are still bleeding.

On the surface you might think, “Well, type 1 PWDs can eat whatever they want,” but that mentality can end up being a lot more dangerous and counterproductive than you’d think. I don’t even want to think how many high blood sugars I’ve suffered because I thought “Well, I can just bolus for it” and then completely underestimated what I was eating. I might not have to suffer with people telling me that I “did it to myself” but I still have to listen to stupid, ignorant remarks and misguided advice from the Diabetes Police. And while I didn’t have to integrated diabetes into the already chaotic world of college, I still had diabetes in college and it still sucked, regardless of how long I’d had it.

But I will tell you what I do think is easy. I think it’s easy to think that you have it worse than someone else. We live in our own skin with our own experiences coloring our perceptions. We struggle to overcome the obstacles that diabetes puts in our way and because we are so intimately familiar with our own journey, we can feel each painful rock we have to step on in order to get where we want to go.

We are so focused on our own arduous path that we rarely look over to see if someone else needs help. We judge people based solely on a few sideways glances, never really looking to see what they’re working against.

I think it’s easy to think we have it worse than someone else. It’s much harder to swallow that belief, make ourselves vulnerable and ask if there is something we can do to serve other people.

That Time I Ran A Half Marathon

B0z0cM_IgAAaVbBSo, I ran a half marathon on Saturday.

I know, I know. I didn’t really tell anyone about it. I had a couple false starts this summer with other half marathons and I got a little gun-shy talking about it. I didn’t even really talk about it on my other blog. But I did it! Want to hear how it went? Good, because I’m telling you anyway!

Friday evening a couple of my local D-friends and their respective husbands came over for dinner. Even though it was right before a race I felt comfortable because they are both healthy eaters so I knew I wouldn’t have an issue. Well, turns out I did! Not with high blood sugars, but with lows. I crashed pretty bad after dinner (I think I overestimated the carbs) and ended up having to drink and eat more than I expected.

At about 4 am I woke up to a blood sugar of 187 mg/dl on the Dexcom, and took a baby correction. No, I didn’t test. Yes, I know better. I’m sorry…

I woke up at 7:00 am with a blood sugar of 90 mg/dl. Not terrible. But context is king in diabetes and I was not so happy with that number at that time. I had a gluten-free piece of toast (more on that another day) with some chocolate peanut butter and coffee then we were out the door!

When we arrived at the start, I took a quick test. I was only going to carry my Dexcom with me, and Erik was going to meet me at the halfway point for a quick test to see how on track the Dexcom was. At that point, I was 89 mg/dl. Ugh. So I gulped one of two juice boxes I had (the other would be staying with Erik if I needed it at the halfway point) and prayed that would be enough. I was carrying five HoneyStinger gels which have 25g each. I only planned on using 3, maybe 4, so I anticipated it being enough but I was starting to get nervous!

I felt really good for the first couple of miles, but at mile 2.5, I heard a familiar buzzing sound. It was my pod. My pod had failed. As predicted.

You see, as much as I love the Omnipod (and I really, really do like it a lot), it has this really unfortunate tendency to fail on my runs. It doesn’t happen all the time and it doesn’t happen with any particular mileage or any particular pod placement. But if it’s going to fail, it will be while I’m running. I had actually prefilled a pod earlier that morning in anticipation of this but, as luck would have it, that doesn’t work.

Pods apparently start a timer when you put insulin in it, and by the time my pod failed, the backup pod had already timed out. The PDM couldn’t recognize it as being a new pod. I quickly called Erik and told him he need to go home, get a new pod and bottle of insulin, and meet me at the halfway spot, which was 4 miles away.

Just a little while later, the Dexcom started buzzing that I was below 75 mg/dl. Ugh. I was at Mile 3, and had planned to fuel at Mile 4 so it wasn’t too far off from my plan. I took a little extra walking break but continued my run / walk pace because I felt just fine. In fact, I’ve noticed that the lower my blood sugar is, the better I run, so long as I don’t actually have hypoglycemia symptoms.

After mile 6, the Dexcom alarms again that I’m 58 mg/dl. I’m not sure I believe it but I take another HoneyStinger just in case. I wasn’t far from where I was planning on fueling again anyway. Erik calls me just before I reach our meeting place, and he’s actually behind me, so he sprints to catch up! We pull over and I do a pod change and BG check. I’m actually 108 mg/dl, and I’m glad I checked. Dexcom can be such a little liar sometimes.

I take off again and manage to keep a pretty good pace for the next few miles. The Dexcom doesn’t alarm at all the rest of the race, but I take a HoneyStinger at Mile 10, and a little bit of Powerade at mile 12.

I finish the half marathon with a time of 3:05:34 and a BG of 187 mg/dl.

The first half of the race projected me at a sub-3 hour, and I know that stopping for a pod change really slowed me down. I’m pretty pissed about it, because I don’t know what to do to stop it from happening. I’ve been on the pod for over a year, and did tons of runs without any issue until it started this past August. Part of me wonders if there’s something funky with the last shipment of pods. There just isn’t any rhyme or reason to it. I wish I’d known not to prefill a pod, because it was such a waste of time. If I’d had a pod and bottle, I could have easily changed my pod while at least walking.

I’m also pissed off at Dexcom. It told me I was 106 mg/dl at the finish, a whole 80 points off from what I was. It just isn’t reliable when I exercise. I never wear it while running or working out anymore. I find it totally useless. I don’t know why I thought I could get away with only testing once.

I definitely should have brought strips and a poker with me. My FlipBelt that I was wearing could have easily held everything I needed: a PDM (which I was already carrying), test strips, poker, pod and insulin. None of those things even weigh that much, so it’s not like that would be a big issue. I could have done what I needed to do during the walk breaks I was already taking. Sigh. Lessons learned, right?

Of course, I’m happy to just have finished. I keep telling myself that the time doesn’t really matter, at least not for the first one. No matter what, I set a personal record because I’d never done a half marathon before. Overall, it was a pretty good first race.

Yep. First race. Not last race. There will definitely be more.

 

Wanna Talk To The FDA?

SurveyOn November 3, there will be an unprescendented conversation between the diabetes community and the FDA taking place and YOU can get involved! DiaTribe wants to collect as much feedback from the diabetes community (type 1, type 2, caregiver, whoever) so that they can really know where we stand and what we need from the FDA. This is our chance!

There will be a live webcast from 1-3pm EST so you can listen to the conversation happening between patients, the FDA, and experts from ADA and JDRF. Registration and a finalized agenda for the meeting will be available soon, but save the date!

Head on over to the survey now and answer the questions. They need the answers within the next five days in order to have time to analyze the results before the meeting. I took it and it takes about 5-10 minutes to do. Very easy! No trick questions!