Trick or Treat

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Trick or Treat

October 31st is a significant day for me. I have 3 major memories that I associate with this day.

1. Going out for Hallowe’en as a child living with Type 1 diabetes.

2. October 31, 2000 is the day I dipped my 7 year old son Kurtis’ urine to discover he had 4+ sugar and thankfully no ketones but knew he had developed Type 1 diabetes. I dipped his urine as he refused to let me test his sugar with a glucose meter. I had poked his fingers 2 years earlier and knew this day would come.

3. I became a parent of a child with Type 1 diabetes trying to figure out how to let him enjoy going out for Hallowe’en without allowing his blood sugars to go askew.

This Blog is 1 of 3 parts sharing my experiences with October 31st.

Part 1:

When I was a child there were no pumps, rapid acting insulin or carb counting. My Mom did not have the technology at her finger tips to count carbs, push a button &/or inject & eat the treats. For the first few years, my Mom & Dad would take me out for Hallowe’en. They would use the bag of treats for when I had low blood sugars. I don’t recall having them as a random treat.

I don’t recall how old I was but I was under 10 when there came a time my parents figured I would be old enough to keep the bag of Hallowe’en candy in my closet. They told me I could keep it in the closet in my bedroom on condition that I tell them when I felt “funny” so I could dip my urine…yes…dip my urine!! to test to see if I was negative (a possible low). Then I could ‘treat’ with my treats.

I recall trying to have self control but what child under 10 can keep a bag of candy in their closet & not eat it at will? I understand why my parents did what they did, they wanted to try and incorporate some normalcy for me. They felt by doing this it would help me feel included in choice.

What happened? Each day when everyone was busy I would sneak candy. How did I get caught? My Dad was an avid runner. He always chewed gum when he ran. One day he went to go out for a run and realized he was out of gum. He came to me and asked to take some gum from my Hallowe’en bag. I still remember the panic. I felt horrified. The bag was full of wrappers but nothing else.

Little did I know that my Mom had been perplexed for weeks wondering why my urine was dipping positive for high sugar. After trying to avoid my Dad from going into my closet to get my bag of stash that no longer existed I knew the jinx was up.

I stood there with a full body panic as Dad looked into my bag. Dad was pretty cool. I do believe in that moment in time he knew that him & Mom shouldn’t have allowed this to happen. It was explained to me the implications of what happened to my sugars as a result of my choices. Mom was relieved because now she knew why!! Two very important lessons I learned and interestingly will never forget.

What happened with subsequent Hallowe’ens? It was actually pretty cool! Mom, Dad & I with my little sister & brother would go through our stash as most do. When we did, Mom, Dad & I would negotiate the price of my stash. It was a game. With that money I was allowed to go shopping for my own treats. Off to the local convenience store I would with my $1-$2 and go buy whatever sugar free treats that were offered.

I don’t feel like I missed out. Not once.

Stay tuned for Part 2.

Once a Mom Always a Mom

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Once a Mom Always a Mom

What drives a Mom of a teen & young adult crazy? That our child living with Type 1 thinks they are invincible. With or without Type 1 most teens & young adults do. My biggest worry as a Mom of a 20-year-old son living with Type 1, who is very, very active working as an apprentice in the construction industry with his Step Dad & driving on his own, is being low on the job site or while driving. He usually remembers his insulin pen but sometimes forgets pen tips.

Pictured is what I pack for him to help him keep with managing his diabetes daily as well as ease some of my worry. One kit is for his car, one kit is for working on the job site. He is on multiple daily injections so after treating a low blood sugar with juice & reaching a blood sugar of 4.0 mmol/L he needs a carb/protein snack to prevent him from going low again.

I bought a 6 quart/5.83L Rubbermaid plastic container with lid for $2.00. I can fit 10 Minute Maid orange juice boxes which contain 23 grams of carbs, 6 Nature Valley chewy protein bars which has 17 grams of carbs,11 grams of protein & 1 box of 100 NovoFine 6mm pen tips. The only items I am missing are a Frio® pack http://www.readycareco.com/splashpage_frio.htm & 1 Novolin Pen Echo®.

We never stop being Mom’s or Dad’s but we assume once they enter into their 20’s they have enough figured out to survive & thrive BUT they don’t. They aren’t going to tell you that. Our job parenting a Type 1 teen & young adult is to slowly let them go while gently supporting them when they need it. This kit is one way I can support my son Kurtis without looking like I’m in his face about his diabetes. He will never tell me this but I believe it gives him a sense of security knowing he has the kit when he needs it & that he is supported by his Mom & Step Dad.

Making Diabetes Sexy

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Making Diabetes Sexy

Pictured is my “Keeping Diabetes Sexy” bag. If you saw it in my purse you would think it was a make-up bag. It’s pink, it’s pretty, it’s girly, it’s sexy. It has character & looks glamorous. But, that is not the sexiest part of this bag, what is? The contents contained within.

Inside is a back up infusion set, tubing, cartridge, Tegaderm, AAA battery, pen tip, lancet, 1/2 unit pen with rapid acting insulin, test strips, Dex 4 gel, SweetTarts (in it’s own sexy container), ketone meter, ketone strips, BG meter & gum. GUM?!? Yep. What’s the one thing that is so not sexy when you have a high sugar??? Bad breathe!!

So why are these items that are products to support my diabetes in a time of high or low blood sugars sexy? Let me convince you they are by telling you what is not…

1. In 1995 I worked full time at a daycare. Driving home from work I realized that I was going low. All I had with me was a really ripe banana. Cayla & Kurtis were in the car with me. I managed to eat the banana & arrived at a convenience store only to discover I had no money on me. At that time there was no debit, no cell phone. I decided I could make the 15 minute drive home to get the juice I so badly needed. I don’t remember driving home. I could’ve killed my children, someone else or left my children without their Mom.

2. Just this past November we attended a Christmas dinner. We stayed overnight. About 2am I woke feeling very, very sick to my stomach. I tossed & turned until I realized I should run to the bathroom. I didn’t make it. From that time until about 8am I continued to vomit violently. My muscles ached, I couldn’t shake it. My BG’s were between 12-15 mmol/L. I determined they were high because of the stress of vomiting. I thought for sure I had food poisoning as the salmon I ate dinner was a bit ‘funny’. I continued to correct & at one point did see my BG drop to 8 mmol/L. Finally at 8am when I was struggling to breath, my chest felt so heavy, every breathe I took burning like acid, I turned to my fiancé & asked him to take me to the hospital, something was really wrong. It was at that moment I picked up my pump to correct a high one more time & realized I could feel the wet insulin coming through the tubing at the connection of the cartridge. It was only then I realized I was in DKA. Thankfully I had an extra site change, tubing & cartridge with me. I changed it up & took a sufficient bolus to avoid hospitalization. I reversed the DKA fairly quickly on my own. I had no ketone meter & no ketone strips to test & avoid this. So not sexy…my fiancé cleaning up after me every time I threw up not knowing what else to do.

What’s else makes our diabetes look unattractive?

1. Having a low & asking someone for something… anything… because we didn’t have our sexy bag.

2. Running out of test strips & ‘guessing’ BG’s only to find out they were out of target & resulted in being sensitive to someone that was unnecessary…or thinking you’re low when you’re high, treating & ending up being really high…because we didn’t have our sexy bag.

3. Being stressed because the infusion set tore out & now acutely making a Plan B to get insulin by injection or an infusion site….because we didn’t have our sexy bag.

4. Having the insulin pump run out of insulin & no access to any for several hours…by the time you get to some you are very high, feel sick & really, really crappy…ugh!! Not sexy!

5. Having the lancet device in your ‘poker’ bend (believe me it’s happened!!) & have no way to check for a full day because there isn’t a sexy bag with a back up…refer back to #2.

6. Having your infusion sweat off to the point of you having to hold in place for hours because the ‘sticky’ stuff is no longer working or accidentally ripping a stainless infusion set out when taking off your shirt to put on a gown for an x-ray. Sexy is having a Tegaderm & infusion site to to stick it down or replace it.

All these events don’t sound so attractive do they?…quite frankly, if you stood back & watched someone have these things happen AND they had pulled out their “Keeping Diabetes Sexy” bag you would’ve thought to yourself…wow, that person has it together, even living with a 24-7-365 disease…that’s attractive!! AND…what is so good looking & sexy about a plain old blue or black case that stores your pens, meter & pump stuff?? Dress them up, make them yours!!

SO….go shopping!! Have fun picking out a bag that says who you are. Fill it up! It’s time for you to own “_____________(insert your name) Keeping Diabetes Sexy” bag….it’s time to make your diabetes sexy!!

Cravings

Want tips & tricks on eating well & losing weight? Here is Eden’s next Blog about her Journey. Eden is a busy woman!! She lives with Type 1, at the end of her years in University, about to graduate in May and working hard to lose weight & exercise so she is looking good for her height for graduation.

Help me support Eden in her goals as she moves closer to her goals!! Cheers, Tracy

“Hey Everyone!
Sorry my blogs have been so spaced out! Last week of classes so my blogs will be every other day lol Lots going on! So I thought I would share some of my favorite snacks that I tend to have during the evening. Sometimes in the evening is when I feel like eating the contents of my fridge ha ha! Before I started caring about my weight, I would typically not think twice about eating chips, cookies, 2 granola bars (sometimes more) and god knows what else! So it is hard to not want to eat at night, and I know if I don’t I will be hungry and probably have low blood sugars. So these are some of the things I now LOVE
1. One thing I always have is a drink of water, and a HUGE chai tea with one Truvia (or 2 splenda) and my almond milk. Almond milk takes a month or so to really get used to in beverages, but there is NO SUGAR and VERY LOW FAT! I LOVE IT!
2. Another thing I love having is almonds. I usually buy Blue Diamond Lime and Chili almonds, these are salted, but I only allow myself 11 at night if I choose this. If I choose this, I usually have 1 cup (usually 6) strawberries or a small apple with cinnamon baked for 1 minute in the microwave.
3. My Cheat Night Snacks: Ok so everyone has these, and if you were to tell me I would never have another chip or cookie again, I would die! So I figured out different ways to have things I love, but that are healthier for me. So tonight (for example) I had Special K cracker chips (they have sour cream and BBQ flavors) 18 cracker/chips are 80 calories, 1.5 grams of fat and 14 carbs! Compared to regular chips which are ten times the amount of fat and calories!
For cookies, I make my own which take 20 minutes MAX! I usually put in a bowl 1 cup of oatmeal, ½ cup of egg whites, 1 or 2 splenda, and I use half a scoop of chocolate protein powder (I think cocoa would be fine) I mix it all up and bake them in the oven for 10 minutes at 400 (depending on your oven, keep an eye on them!) I also like adding some natural peanut butter on top for some extra flavor. If you mix it up, and it seems dry add some more egg whites and some water 
Hopefully you like some of my ideas! I always have a chai tea because of its health benefits and it makes you feel full ”

The Latest & Greatest

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The Latest & Greatest

Up front I will post a disclaimer. I worked for Novo Nordisk in Canada for 4 1/2 years. I loved working for the company. I know the clinical studies they provided inside out and backwards. In researching this article I have done my best to be impartial to the information I offer. The pic is a result of the fact Kurtis & I use Novo Nordisk products. I have no other product to showcase in my portfolio. I am presenting this blog as a health care professional & peep & Mom of a peep living with diabetes, not as a sales person.

Here is the ‘low down’ in a nutshell based on current clinical evidence AND practical information for intermediate & long acting insulin…

NPH (Novolin NPH, Humulin N): first created in 1950 by Novo Nordisk – NPH is an  intermediate acting insulin. The onset is 1-2 hours, peak (meaning the insulin is at its highest potency) is in 4-12 hour & it lasts 18 − 24 hours. Upon injection it can cover about 1/2 a day or night. It is a highly variable insulin, it can add to the challenges of achieving goals of long-term metabolic control. To equalize the distribution of crystals within the solution of NPH , it needs to be rotated an excessive number of time. This in itself does not guarantee accurate distribution.

Glargine (Lantus): It is a long acting insulin. I can not find when it was first created or by who, so I won’t show what I know from that perspective. It’s onset is 1 − 1 1/2 hours. On product monograph it claims to have ‘no peak’. Duration of action is 18 − 24 hours. Once injected it cover about 1 full day, 24 hours. It is an acidic solution so upon injection there may be burning & stinging. There are studies being conducted with regards to concerns of carcinogenicity. Results will not be published for a few more years.

Detemir (Levemir): It is a long acting insulin. Unlike any other insulin which is bound to fat, it binds to albumin. When bound to albumin, it is inactive. It is unclear when it was created. At any given time 98% of Levemir is considered inactive because it is bound to albumin providing more predictability. It’s onset is 1 − 2 hours. It’s peak is 6 − 8 hours. Duration of action is up to 24 hours.depending on dose. It is shown that smaller amounts injected offer smaller duration of action. Many people living with T1 need 2 injections per day.

If you look up the impact of NPH vs. long-term analogue it may seem that is a better choice. As a sales rep & practitioner, I have seen this. Clinically, it doesn’t the peeps that do the studies aren’t ready to say so yet.

So regardless of what insulin you are on, here are some tips & tricks to help make the insulin you are taking work better:

1. Label each insulin bottle upon opening.
2. Discard that insulin, whether it is finished or not, 28 days after first date of taking out of the fridge.
3. Keep insulin at room temperature. If it freezes or gets too warm (>28C) THROW IT OUT!!
4. Know your insulin.
5. Know your body.
6. Know how to inject properly. (any needle tip more than 8mm should be changed under your diabetes team watch!!)
7. Don’t switch brands without consulting with your diabetes team.
8. Do not mix Lantus or Levemir with any other insulin!
9. Levemir & Lantus are CLEAR!! Read the label before injecting!!
10. Keep to the same site to rotate your sites. HUH?!? you say….I tell my patients…Long acting legs, short acting stomach. BUT, rotate. It prevents lipohypertrophy (fat deposits) but guarantees more predictability with insulin release.
11. Higher doses of insulin reduce the blood sugar levels more than lower doses.
12. If you have exercised be conscience of where you have injected or are going to inject. Areas that have been exercised & then injected with insulin offer more unpredictability.
13. Do not apply heat (such as bath, shower, heat pack or massage) to the area injected. Heat speeds the insulin along.
14. Keep hydrated. Insulin is not absorbed as readily when there is not as much fluid available because blood isn’t flowing as easily as it should.

I also urge you to Google the brands. Ask your health care team. Read, read, read. That’s how I started on Humalog!!

Insulin is a complicated topic. It’s variables are abounding. But with common sense, getting to know you or your child well & being informed to the choices available as well as asking for the change that may be needed, this enables you & your loved one to live with Diabetes Beyond Borders.

As Exciting As the Discovery of Insulin!

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As Exciting As the Discovery of Insulin!

In 1983 and for the next 10 years, researchers began to study whether intensifying diabetes management among people living with Type 1 made a difference. Up to this point there had not been long term research to provide data to prove this to institute change.

When I was diagnosed in 1975, I started on one injection of NPH and Toronto in the morning.  A Keto-Diastix before & after school & at bedtime was dipped in a urine sample to determine sugar & ketones. Little did we know that it was not an accurate test of glucose control. Every 3 months my blood work was done & thankfully my A1C as well. We would see the Paediatrician shortly after.

In 1981, an extra injection of NPH & Toronto was added at supper time. Around that same time I received my first glucose meter.

This study has changed the way people with Type 1 diabetes are managed. It was & still is exciting!

Here is what the Diabetes & Complications Control Trial is about.

There were 1,441 people from Canada & the U.S from 29 centres living with Type 1 diabetes more than 1 year but less than 15 years. They could not take part if they had too many or severe low blood sugars, severe complications or limited life expectancy. The ages studied ranged between 13 and 39. Young children were not studied. There were 2 groups; 1 had their diabetes managed intensively, the others managed as before.

The main goal was to keep blood sugars as normal as possible through a criteria of intense methods for diabetes management.

Clinical findings & significance:

1. The risk of eye complications were reduced 76%.
2. The risk of complications of the kidney were reduced by 50%.
3. The risk of nerve complications were reduced by 60%.
4. By keeping blood sugar’s as normal as possible, the onset & progression of eye, kidney & nerve damage caused by diabetes slowed.
5. Even those who had a history of poor control who sustained any type of BG lowering showed a difference in the progression of complications.
6. For those who already had eye complications by participating in intensive management of their diabetes, they saw the progression of the complication slow by 54%.

What is Intensive Management?

1. Testing BG 4 or more times a day.
2. Injecting insulin at least 3 times per day or using an insulin pump.
3. Following a diet & exercise plan.
4. Monthly visits to a health care team which consists of a physician, nurse, dietician & behavioural therapist.

Risks involved with participating in an intensive management therapy? Low blood sugars. It was clear that less stringent goals are appropriate for some patients.

This trial has become the pioneer of studies that changed the management of Type 1 diabetes . Since completion of the study in 1993 there has been further work done to answer more questions & give more data. I will continue to post on these.

March Break Travel Tips & Tricks

For those anxiously awaiting for March break…are you travelling away from home? How do you plan for travelling with diabetes?

Since 50% of our family had Type 1 diabetes, back in the day when my kids had March break, to keep organized and sane I created a standard packing list which also included everything imaginable for diabetes supplies. If we were going away for 1 week, I would pack double the supplies.

I gave both of my kids their own packing list. Kurtis’ list also included the diabetes supplies he needed. I would encourage him to pack it himself. I reviewed the list with him to make sure it was all in his suitcase and carry on, if flying.

A few tips:

1. If on an insulin pump, call the company and ask for a back up pump about 2 weeks earlier (or find out from the company how much notice they need)

2. If on an insulin pump, bring enough insulin, syringes or pen and pen tips to sustain you or your child for the entire vacation IF by chance your pump malfunctions and you have to go back on multiple insulin injections.

3. Make sure all medication are in its original containers.

4. Have your family doctor or diabetes specialist write a letter stating you have diabetes and the specific list of supplies you will carry with you. (Kurtis & I have been pulled over by Customs. We have had to pull the list out and go through the bag taking inventory with list in hand.)

5. Wear Medical Identification such as a bracelet, necklace or tattoo.

6. Pack a water proof container where sugar tablets can be placed for any activity that they may come in contact with water.

7. If packing insulin, make sure to keep the insulin between 2-8C when in transit. It can be exposed to temperatures between 15-25C for up to 28 days. The best product to use for travel to keep insulin safe to use is a http://www.frioinsulincoolingcase.com

8. Buy Travel Medical Insurance

9. Pack a Glucagon kit.

10. NEVER leave your diabetes supplies on the beach. (I had a young client I sold an insulin pump to just before he and his family went on vacation. Carefully folding his pump in his towel on the beach, upon his return from playing in the water to hook back up he realized it was gone!)

11. Bring an empty water bottle if you use needles. You can place them in the water bottle and safely bring them home for appropriate disposal. Make sure to put the bottle with sharps in your check in not the carry on.

12. Make copies of travel documents, doctors letter, and contact information. Give it to one or more of your family members and/or friends if you lose any of this information.

If you would like an example template of the packing list I have used and still use, let me know, I will post it.