Letter to a New Diabetic: Lowering Blood Sugar

Dear Concerned:

Welcome to the wonderful (and head scratching) world of blood sugar prediction. What works once may not work again the next time and what works for one person may not work for another. That's because reducing a high blood sugar is part science, part art and part luck.

The science is in doing the calculations. If your blood sugar is 200 and you want to lower it to be at 100, you need to know how much 1 unit of insulin will reduce your blood sugar (value of "x"). Then just take 100 / "x" to get the number of units to take. This is a fairly simple algorithm that you and your Endo (diabetic doc) can determine by fasting and doing food/insulin tests. You probably have a "basic" rule for reduction but the more you can do to make it specific to you, the more accurate and hence the better.

The art of treating a high blood sugar comes from knowing how YOUR body reacts to insulin, particularly when your blood sugar is at a higher level ( i.e., 1 unit = x reduction, but if the blood sugar is over 300, 1 unit only = 1/2 of x.) The only person that can take the time to figure that out is you. The other aspects that you have to consider include what you are doing at the time, e.g. exercising, moving, sleeping; how you are feeling at the time (as sometimes being sick = high blood sugar); and when and what you last ate and the amount of food still being digested in your system.

As for the luck in lowering your blood sugar, well, there is a dash of that as well. Sometimes you do everything right and "by the book" and then look at the numbers, scratch your head and wonder if it was all just a waste of time. It's not, of course, but it can certainly be frustrating.

Keep in touch,

Niko

Letter to a New Diabetic: Your first low

Dear Concerned:

Sorry to hear what happened, but it was a good lesson to learn early. It's a real learning curve, isn't it?

Two things caught my eye when I read your letter. First, you took insulin for a meal and then did not eat the meal. Second, you went for a walk without factoring in the affect it may have on your blood sugar level.

The first one is a huge mistake. If you give yourself a shot insulin, you MUST eat the meal or take some carbs to cover for it because your blood sugar will drop. In my experience, meals are missed either voluntarily or involuntarily. The voluntarily misses can be prevented by simply making sure you eat as much as you bolused for, whether you are hungry or not! The involuntarily misses are much more difficult. For example, I usually do not bolus at a restaurant until the food is at my table. I've had too many situations arise where I give myself insulin for my meal and then the food doesn't arrive for whatever reason. I've also had the situation arise where I became sick after the bolus but before I could eat.

The second issue is that you went for a walk. While perhaps not medically accurate, practically speaking exercise often increases the effectiveness of the insulin. So before you exercise, you need to check your blood sugar and either have it a bit higher, or have your meter and some carbohydrates with you as you work out/walk/run, whatever. It's a real pain in the ass, to be frank, but you do have to exercise. I've done some experience where instead of using insulin, I've used exercise to keep my blood sugar down. If you try it be sure to track your data and carry something to eat, such as the glucose tabs. For me, even something as common as mowing the lawn will cause me to get low, so I'll either eat before or keep an eye on my sugar level. A lot of people like the small boxes of Juicy Juice which are 15 carbs for those sudden lows. They are cheap and you can keep one or two in the car and drink them even when they are warm. Mmm, hot juice!

Hope this helps,

Niko

Letter to a new Diabetic: Welcome to the Club

Dear Concerned:

Good to hear from you but sorry it had to be under these circumstances. No doubt your head is spinning from your recent diagnosis and this is last thing you want to have to deal with. I'll not belittle the medical issues but, frankly speaking, have no doubt that you will do fine. Diabetes is a completely self-managed condition and if you pay attention to it you'll not be precluded from doing anything. There are type 1's (insulin dependent diabetics) who are in the Olympics, climb Everest, etc. I've traveled literally all over the world and have never had any issues. Some advance planning, yes, is needed. But nothing that you can't handle.

I can remember when I was diagnosed back in '99. It was a real surprise because I didn't know anything about diabetes nor even what a pancreas did. Mine, like yours, just burned out and quit making the hormone insulin. Like you, I had no family history and no one I knew who could answer my many questions--once I had enough information to even begin to formulate them. If you haven't already done so, you should find yourself a good Endocrinologist and Certified Diabetic Educator (CDE).

The first goal you and your doctor will work on will be to get your current blood sugars lowered from their high levels. There are two "numbers" you will soon learn are important: your at-the-moment blood sugar reading from your meter and an over-three-month reading (called your HbA1C) which gives you an average of the three months blood sugar levels. The aim of the diabetic management "game" is to get your HbA1C down to a normal level, i.e. something ideally in the 5 to 6 range. Mine was 14 or 15 when I was diagnosed. Yours is likely pretty high right now as well. The two weeks or so it will take to lower your blood sugar will, frankly, suck because your body had become used to the high levels so don't be surprised if you are irritable, tired, have headaches and the like.

There are essentially two types of insulin families: the first is for "basal" rates, that is to say a sufficient amount of insulin to keep your blood sugar level over a long period of time. The second is for a "bolus" or giving yourself an injection of insulin before you eat or to lower your blood sugar. Ideally, you want the basal amount to always remain steady so if you don't eat your blood sugar remains the same (say, 100). Then before you eat something, say a cookie, you give yourself a shot of enough insulin (a bolus) to balance out the increase caused by the carbohydrates in the cookie. Simple. ;-)

The days of "two shots only, one in morning one at night" pretty went out the window 15 years ago. My suggestion is that you immediately ask to get into multiple daily injection (MDI) therapy. If your current doctor doesn't know what that is then get another doctor. Essentially, that allows you to replicating a pancreas by giving yourself some shots of a basal rate insulin and separate shots of insulin before you eat to cover the carbs.

Oh, yes, carbs. They are every diabetic's craving and aversion. As you probably know, everything you eat is made of three things: fat, protein, or carbohydrates. The first two don't have much of an affect on blood sugar (although fat can cause change in the rate the body uses the carbs). Carbs, on the other hand, get turned into glucose, which is the form of sugar your body runs on. So before you eat a food, you just have to look up the amount of carbs in the food to figure out how much insulin you have to inject to "cover" the carbs and return your blood glucose level to what it was before you ate.

The other think you need to be aware of is a "low" blood sugar, called "hypoglycemia." That is what happens when you either take too much insulin or do something (such as exercise) which causes the body to use the insulin more effectively. If you do, you'll need to eat something to raise your blood sugar. I'd suggest you get some glucose tabs for the car and some Juicy Juice boxes or the like to keep on hand for when you go low, which you inevitably will.

The last thing to remember is that if you don't test your blood sugar, you don't know what the number is. Sometimes it is high and you feel one way, the next time you feel that way it is low. Check your blood sugar often.

Drop me a line if you have any more questions. Oh, and welcome to the club!

Niko

Dream a little

The challenge;

Sunday 5/16 - Dream a little dream - life after a cure. To wrap up Diabetes Blog Week, let’s pretend a cure has been found. We are all given a tiny little pill to swallow and *poof* our pancreases are back in working order. No side effects. No more insulin resistance. No more diabetes. Tell us what your life is now like. Or take us through your first day celebrating life without the Big D. Blog about how you imagine you would feel if you no longer were a Person With Diabetes.

For a while I would feel as if a part of me was missing. That would be my insulin pump. It's been attached to me for more than a decade now, 24 hours a day, 7 days a week. To not have it with me, clipped on my belt, would be... lonely.

I'd also miss carrying my man-purse everywhere since I wouldn't need my meter. Where would I carry my iPod?

But at the same time, I'd certainly LOVE not having to do all the fingersticks, infusion set insertions, math games, paying lots of $$$ each month for the medical supplies... I'd also enjoy the chance to be free to do anything, anywhere, anytime without having to worry about everything.

Let's get moving

The challenge:
Friday 5/14 - Let's get moving. Exercise . . . love it or hate it? Do you have a regular exercise routine? Or do you have trouble finding your exercise motivation? How do you manage your insulin and food to avoid bottoming out during your workout? Today is the day to tell us all about your exercise habits, or lack thereof.

A true story:

A few years back I underwent a treadmill stress test. It was one of the big ones, EKG patches and leads all over my body, oxygen regulator on my face, the whole nine years. I got on the treadmill and started walking along, completed the workout and waited for my doctor to view my results.

After a few minutes he came in and started looking at the chart. "This is amazing!" he remarked. He flipped through the numbers, looked at the squiggles on the EKG ribbon tape for a moment, then called over the nurse. "Come take a look at this," he remarked to her. "This is unbelievable."

I have to admit that I was a bit surprised, particularly given that I haven't really exercised much over the years. Or at all, my wife would tell you. Still, I must have done okay given the reaction.

The doctor and the nurse peered at the results, then looked up me. "I've never seen anything like this," he told me. "You are amazingly out of shape." He looked down at my body. "It's funny, you don't look out of shape. But I'll be damned if you aren't the most out of shape person I have ever seen in my career!"

Given that, perhaps you can understand my dislike of exercise. Oh, I know that some of you are thinking, "Heck, if the doctor told me that, I'd be exercising everyday!" My response? Yeah, sure you would. If you were that kind of person you probably wouldn't be sitting here, reading these words on your computer. You'd be out running a marathon or training for your next bike race or something. For me, exercise sucks. It's boring, my legs start hurting in about 5 minutes on the treadmill, I get dizzy, then I have to factor in the blood sugar issues... it's just too much of a pain.

But I do to get on the treadmill at least twice a week for 30 minutes. It's a start. I would truly love to be in amazing shape like those men and women in the PX-90 infomercials. Of course, that's the one I watch where I think I'd just like to look like the "before" picture, let alone the "after." I then wonder what kind of problems you must have with infusion sets if you only have like 7% body fat (compared with my 27% or whatever it is.) I don't think I have to worry about those issues for quite a while... if ever.

To carb or not to carb?

The challenge question:

Thursday 5/13 - To carb or not to carb. Today let’s blog about what we eat. And perhaps what we don’t eat. Some believe a low carb diet is important in diabetes management, while others believe carbs are fine as long as they are counted and bolused for. Which side of the fence do you fall on? What kind of things do you eat for meals and snacks? What foods do you deem bolus-worthy? What other foodie wisdom would you like to share?

I suppose I fall in the middle. Carbohydrates are certainly something to be limited if you wish to reduce the amount of insulin you inject. I've followed the low-carb way of eating off and on and I do have a lot of energy when I am eating low carb. It's expensive, though, and I usually end up freaking out and eating carbs after a week or so. More often, I just eat what I want and bolus to cover it. Life is too short.

That being said, I do have some simple rules:

(1) I can eat what I want, as long as I record it in my food diary and make the effort to look up the carbs.

(2) If I am going to drink soda (and I have a love/hate relationship with it for various reasons), it has to be diet.

(3) Whenever possible, eat food and not foodstuff. You know the difference. If it comes in a box, sits on a shelf or contains any ingredients you can't realistically find in your kitchen, it ain't food.


The final foodie wisdom I will share with you non-existent readers (yes, I'm talking about... you!), is to read and listen to author Michael Pollan. He does an excellent job of explaining food and agricultural issues and is practical (and realistic). I've read almost all of his books and would highly recommend them.

Because of him, we (a) have belonged to a CSA - community sustained agriculture - in which we support a local farmer and her family by buying all of our needed produce and eggs (fertilized AND really cage free!) from her; (b) haven't purchased bread in over two years because we make all of it ourselves in a whopping 5 minutes or so of work per day; and (c) make such "oddities" as our own, homemade corned beef, soups, etc.

My Biggest Supporter

The challenge:

Wednesday 5/12 – Your Biggest Supporter. Sure, our diabetes care is ultimately up to us and us alone. But it’s important to have someone around to encourage you, cheer you, and even help you when you need it. Today it’s time to gush and brag about your biggest supporter. Is it your spouse or significant other? Your best friend, sibling, parent or child? Maybe it’s your endo or a great CDE? Or perhaps it’s another member of the D-OC who is always there for you? Go ahead, tell them just how much they mean to you!

I've been reflecting upon this question for some time and have come to the realization that I don't have such a person in my life. While my spouse does her best to point out I need to keep better control of my blood sugar (usually when she finds mold growing in the toilet), she has her hands full enough with our three kids to be spending her time understanding and dealing with diabetic issues. I tried to show her how the infusions sets work and how to turn off my pump, but it didn't really take. As for math calculations when figuring out blood sugar and insulin issues, forget it.

I like my CDE since she is a type-1, much harder to bs your way through a meeting when the person you are talking with also has to stick her finger and wears a pump. She does her best but I'm probably not the easiest patient to deal with. Besides, I know what to do, I just have a problem with doing it.

I only know one person that wears a pump and he is more out-of-control than I, so not much of a good influence there.

So I'll plod on, figuring out things on my own and finding a helpful hint or two on the internet. Probably not the challenge response that you anticipated, eh?

Making the low go

Tuesday 5/11 – Making the low go. Tell us about your favorite way to treat a low. Juice? Glucose tabs? Secret candy stash? What’s your favorite thing to indulge in when you are low? What do you find brings your blood sugar up fast without spiking it too high?

Every diabetic has had to deal with a low blood sugar having no idea as to how much lower it will go before it levels out and/or begins to rise. When this happens to me, I treat using one of the following:

The best: glucose tabs. Essentially 4 grams of pure energy. They are so sickly-sweet it's hard to really overeat them.

A good alternative: a small can of orange pop. I've found this works pretty well because (a) there is only half a can, (b) it is drinkable, which is nice when chewing becomes an issue, and (c) you can drink it when it is warm and it doesn't taste bad.

The common: one of the problems I have with just glucose tabs is that they bring you up but there is nothing of substance there. In those cases (read: 2:30 am) I sometimes opt for a bowl of cereal and rice milk. 1 cup of each does the job. The trick is to stop eating after one cup. Better said than done, particularly when you a bit "out of sorts."

And now a quick story of a diabetic nightmare:

It was a large slice of chocolate birthday cake covered in frosting. Ever diligent, I computed the amount of carbs necessary to cover and gave myself the bolus. About the time my insulin pump beeped that it had injected all of the requisite insulin my stomach decided that it didn't want any cake. In fact, it didn't want anything inside it and caused me to run to the toilet and throw up.

So now I had absolutely nothing in my stomach and enough insulin coursing through my bloodstream to cause a serious medical situation. I grabbed a Coke from the refrigerator and did my best to chug it down, then threw it up, chugged more down, threw it up. It was awful. Adding to the problem is that due to its carbonation, it is pretty hard to chug large amounts of Coke. It is also sickly sweet, nauseatingly sweet.

I was eventually able to get enough sugar into my system to balance out the insulin, but the experience haunted me for a long time. I stopped bolusing before meals and would wait until after I had eaten. I've gotten over that, but still I rarely bolus until the food I've ordered has been delivered.

A day in the life of a diabetic

The challenge question:

Monday 5/10 - A day in the life . . . with diabetes. Take us through a quick rundown of an average day and all the ways in which diabetes touches it. Blood tests, site changes, high and low blood sugars, meal planning, anything that comes along. This can be a log of an actual day, or a fictional compilation of pieces from many days.


Surprisingly, I have never really given much thought to what it is like to live with diabetes. Perhaps that has been the result of simply having it for over a decade now. Or maybe it's just something that I'd prefer to ignore. This first challenge has been for me to stop and reflect upon everything I have had to do in one day that was in some way diabetic related. I picked the data from last Friday, 07 May 2010, to use which was the date that I started this blog in response to the challenge.

Equipment

Every day of my life I have to carry or wear certain equipment. No matter where I go or what I do the following items have to be with me, or readily accessible. The first of these is my MiniMed Paradigm Insulin Pump. That's the item on the right in the photo. It contains a reservoir that holds enough insulin to last for three days or so. From the reservoir runs a small tube about three feet long that connects to a plastic cannula which is inserted about an inch or so into my body. That constitutes the infusion set.

The location of the infusion set varies as I have to switch it every three days or so. Right now, on the day in question, the cannula is inserted into my left side, right in the "love handle." I'll give more description of that process later.

The second item I always carry is in the left of the photo. That is my glucometer or blood glucose meter. That is not attached to me physically, but it something that I always carry with me in a small black bag. My man-purse. Along with the meter I also have to carry a lancet device (which is used to prick my finger so I can get blood for the meter) and a vial of test strips for use in the meter. My man-purse has special spots for both of them, it also has a small pocket in which I carry a small needle syringe (in case of pump problems) and four glucose tablets (in case I get a low blood sugar reading).

The third item I carry is an iPod Touch. I use an application called Diabetes Pilot on it to look up foods in its database so that I can determine what their carbohydrate level is. I also use the program to record data I collect on amount of insulin given, blood sugar readings, etc. While you can also record this data in the glucometer, I chose to use the iPod because the glucometer has no food database so I'd have no idea what the carbohydrate content would be.

That constitutes the equipment that I take everywhere. And I do mean everywhere. I sleep with the pump and have my man-purse right by the bed. When I am in the courtroom at work I have it with me. When exercising or traveling I have to keep it within reach. Safe to say it is as much a part of me as my wallet.

Data

After I collect the data in the Diabetes Pilot program, I can export it in a number of different ways. What you see below is the graph data for Friday, May 7th:


So that you can get an idea as to what MY life is like on a daily basis (and since the above is all but illegible), I'll explain the above data and what my thought process was before and after the individual events.

My morning usually starts at 7:00 am. That is when I do my first blood sugar test. That involves pricking my finger with a lancet, drawing some blood and having the meter tell me what my level is. The photo on the left is an example of that. That's not my finger, btw. The sides of my fingertips are dotted with hundreds of small black dots from the tests I've given over the years (e.g. just 1 test per day x 10 years = 3,650 pokes!). Also, I rarely poke in the middle of the finger. I use the sides as it hurts less.

This morning my blood sugar was 144. That would be a bit higher than it should be in the morning. I try to have it around 100. The meter is connected via radio frequency (RF) to my MiniMed pump so the reading showed up in the pump. I pushed a button on the pump and after it did some internal math calculations using an algorithm, it told me that I needed 1.2 units of insulin to get the 144 down to 100. So I gave myself that much insulin (called a bolus) from what little remained in the pump reservoir and when it was finished, removed the infusion set from my body. I had exhausted the use of it and needed to insert another one.

During my shower the site where my infusion set had been itched a lot, likely due to a combination of reaction to the adhesive and keeping it on too long. It's recommended to change the site every two days but I can't afford to do that as the infusion set costs, after insurance, about $10 or so. Under my insurance plan (a quite good individual one), test strips costs me out-of-pocket about 0.10 cents each. Insulin comes to about $3 dollars per day. These are all after insurance costs. It's no wonder why pharmacists love diabetics.

After getting showered, I begin the infusion set insertion process. The photo on the right shows how the infusion set inserts into the body. The blue part is contains a needle which is removed after the cannula has been inserted under the skin. Incidently, that is not a picture of my side. In addition to being a lot skinnier than my own (not to mention likely a female's due to lack of hair!), mine is covered with red bumps, welts, dry skin patches and other consequences of a decade of infusion sets being inserted and taped to my skin. Doesn't look the best at the beach.

So the insertion process is quite simple: fill the reservoir with new insulin, clean the location with an alcohol wipe, insert reservoir into pump, prime, thrust into side, remove needle and throw all the sharps in my "sharp container" so that my kids don't get poked by them. The whole process takes about 5 minutes or so from start to finish. Of course, I don't know if the infusion set site I chose is a good one until later, around breakfast time, when I actually try to bolus some insulin. If it doesn't work (an on-going problem), then I have to run upstairs and do the whole thing again--at a $10 cost, mind you--and hope THAT site works. That's why I put "site change" on the report, letting me know that I changed on that day. Since it doesn't reference a number (such as "2 attempts", I know it worked on the first try. Yeah!!)

Once I get dressed and changed, it's down for breakfast. I eat a handful of different breakfasts, each already entered into my Diabetes Pilot program so I can simply call it up and it tells me what the carb level is. On another screen it gives the details (on this day, 1 scambled egg, 1 third of an avocado, 1 cup of Oat Meal squares cereal, 1 cup of rice milk, 8 oz of coffee and 1 pack of splenda) but I usually make a note as to what the carb was I ate for quick reference later. The whole meal was 76 carbs and the pump algorithm told me 10.8 units, so that is what went in. There was no dreaded "beep beep beep" sound that indicated an infusion set problem so I know it all went it. I took the kids to school and went to work.

2 hours later my pump beeped that I needed to check my "after breakfast" level. I finally got a chance to do so about 30 minutes later, only to find that my blood sugar reading was a high 213 instead of the 100 - 125 I had expected. What happened? This is the fun part of being a diabetic, trying to figure out what exactly happened to cause your blood sugar to go up or down in some unpredictable manner. Since I didn't eat or drink anything that morning nor exercised, I figured it was likely due to the avocado which, being high in fat, might have caused an issue with the insulin absorption. Or maybe it was the infusion set location, as some of them take more insulin than others. Or perhaps it was the insulin as it was the last of the vial so might have lost some of its potency. Satisfied, I bolused the 3.4 units as instructed by my pump and went about my morning.

I didn't bring anything to eat for lunch that day so I thought I'd grab a BBQ sandwich at a local BBQ joint. Since it isn't a chain store, I had to look up the data in my Diabetes Pilot. There wasn't an entry specific to BBQ pork sandwiches, so I had to make a quick decision as to whether or not I would take the 5 minutes to do detailed calculations (how much pork, how many carbs, what kind of bread, hmm... what about the sauce?) or just wing it using the closest entry in the database. That's what I did. I input the potato chip info from the bag so that was accurate enough (and it was now a part of my database for future use) and added a diet coke. Total carbs: 65.

Looking back, I can see that that was clearly a low carbohydrate amount. I might have calculated it incorrectly, or didn't factor in the sauce. Keep in mind that I was hungry, my food was getting cold, and I didn't have all day to figure it out as I had to get back to work, and you'll get a good idea as to my state-of-mind. So the 9.2 units of insulin (as per the algorithm) turned out to be insufficient. 2 and a half hours later, my after lunch test indicated my blood sugar was 257. Damn. The pump told me 6 units would bring it down to where it needed to be, so in went six more units.

I didn't get a chance to eat dinner until later that night, at about 7:30pm. My wife and I went out for Mexican food. My blood sugar level at that time was 82, which was a bit low (I get nervous when it is below 100) but certainly appropriate for getting ready to eat. After ordering I dutifully input my mean into the Diabetes Pilot database (1 cheese enchilada, 1 beef tamale, 1 cup refried beans, 1 cup spanish rice, 10 chips, 1 diet coke, 3 tablespoons salsa) and at 126 carbs, injected 17.1 units of insulin.

During the meal I should have paid more attention to the quantity of beans and rice given (maybe 1.5 or 2 cups each?), and I had forgotten to include the sour cream and guacamole, but I only ate 7 or 8 chips instead of the input ten. I also knew that the carbs in the refried beans would be a longer releasing carb than usual, not to mention the cheese in the enchilada might slow things down.

Before bed I checked again, at 11:13 pm. Oops. Blood glucose reading was too low, 68. I would have to either eat something more or use some glucose tablets to raise it. Of course, given the issue with the delay with the bean/cheese combination, I couldn't tell if I was going to spike a high blood sugar reading later in the night or if I had overbolused for dinner and given myself too much. I ended up taking 4 glucose tabs, for a total of 16 carbs, which should have been enough to raise it up past 100.

At 2:35 am I awoke in a cold sweat. This info is not on the record above as it appears on the record for Saturday since it was after midnight. It is still part of Friday, however, so I thought I'd add it. The cold sweat and feeling in my stomach told me that I was having a low, so I turned the screen light of my pump on so I could see, pulled out another test strip, poked my finger and took a reading: 53. Too low. Now the question, what do I do to raise it? I can (a) stop my pump for a period of time; (b) take some more glucose tabs, or (c) go eat something. Always a great decision to have to make at 2:30 am when your blood sugar is about half of what you'd like it to be.

Since I'd already tried the glucose tabs earlier, I decided to go eat something. So downstairs I went, and ended up having a cup of oatmeal squares and a cup of rice milk for 44 carbs. But when I input the carbs into my insulin pump, the algorithm told me to take an additional 3.1 units of insulin. So it's 2:30 in the morning, blood sugar at 53, ready to eat a bowl of cereal when I'm not particularly hungry and am being told to inject more insulin into my system. Which, of course, I did. First check the next morning: 128.

That's a day in the life of a diabetic.

Lancet? I don't need no stinkin' lancet!

I was reading this month's edition of The Atlantic when I came across the magical line:

Diabetics may someday be able to monitor their glucose without poking themselves to get a drop of blood.

The statement was made in an article entitled "Everything is Illuminated" and was referencing the latest medical technology to come about: Raman scanners.

What has brought this Star Trek wonder scanner to life is Raman spectroscopy: a quick, easy, and non-invasive tool that tells users in seconds what something really is at the molecular level. Recent improvements in technology have shrunk the once expensive, unwieldy tabletop device into an array of smaller, more commercially viable Raman scanners, such as the handheld drug detector by DeltaNu, which costs $15,000 and is being tested by police departments in several states. About 1,000 portable devices that identify hazardous materials are also in use. Within 10 years, DeltaNu expects its handheld devices to be in every police squad car in the country, as ubiquitous as the breathalyzer.

The underlying concept was discovered back in the 1920's by the Indian physicist C.V. Raman, who was the first non-white to get any Nobel prize in the sciences. No, I've never heard of him either but that's probably a good bit of trivia to know if anyone ever plays Trivial Pursuit anymore.

I don't know how it works either, but it apparently does. No doubt Bayer or one of the other "big players" in the diabetic market will purchase the blood sugar detection characteristic rights and figure out how to charge us each time we use it, but for now we can imagine a world without finger pricks....

Diabetes Explained

If you are reading this you are probably already a diabetic or know someone who is (these days, who doesn't?) so you likely know what a pancreas is. But if not, here is a picture:

 

Cute little thing, isn't it? It actually reminds me of a slice of homemade corned beef. Mmmm...

Without getting too medically complex, the pancreas produces two hormones your body needs: insulin and glucagon. These are produced in a cluster of cells called the islets of Langerhans. Glucagon is produced by the alpha cells in the islets of Langerhans and Insulin is produced by the beta cells. In my case, the beta cells no longer produce insulin.

Among other things, insulin is used for regulating the level of glucose in your blood. It does this by stimulating your body cells to use the glucose in your blood. Glucose is essentially the gasoline which fuels your body. Insulin is the key to unlocking the gas tank. Here is a diagram:

 
The process should work something like this:

1. you eat something,
2. the carbohydrates in the food are changed into glucose molecules
3. the glucose molecules go into your bloodstream to be transported throughout the body (which raises your blood sugar level)
4. when the glucose gets to a cell that needs energy, insulin allows the cell to take the glucose (which lowers your blood sugar level)
5. your body gets the energy it needs

Problems arise at step #4. If your body's pancreas does not create insulin, then the cells have no "key" to use to allow the glucose in the bloodstream to be used. This type of diabetic is known as a type 1 diabetic or an insulin-dependent diabetic. Alternatively, if your body's pancreas makes insulin but for some reason the cells are resistant to it (much as rust in a key hole can make opening a door difficult), your body can't use the glucose. This type of diabetic is known as a type 2 diabetic or an insulin-resistant diabetic.

Regardless of the mechanism, the result is essentially the same. Without a way for the cells to use the glucose in the bloodstream, the blood sugar level continues to rise higher and higher. The brain, which uses most of the body's glucose, will continually send out signals that it needs energy ("I'm hungry! I'm hungry!") which causes the person to eat more, which in turn puts even more glucose into the bloodstream raising the blood sugar level even higher. To keep alive the body will begin to consume itself by switching to alternative fuel sources, stored energy (i.e. fat) and then ultimately begin eating lean muscle tissue (i.e. the heart) and anything else it can until either the body is nothing more than a bag of skin and bones and the person starves to death or the person dies of heart, lung or other organ failure.

Or, such as in the case of a type 2 diabetic, the body will continue to pump out insulin to try and get the glucose it needs. Enough of the insulin will usually "work" so that the body won't shut down, but will instead remain in a state of hyperglycemia (too much sugar). This does a number of things, primarily slowing or stopping circulation in the smaller blood vessels of the body. This is why diabetes is the primary cause of blindness, amputations, strokes, etc. On the bright side, type 2 diabetics don't have to worry about their body eating itself. This is because another function of insulin is to store fat. So all that extra insulin that was being made is put to good use by storing the glucose in the fat cells of the body. They get bigger, the person gets fatter. If left uncontrolled, the person will eventually die of heart failure or a stroke--morbidly obese, likely lacking a leg or two and probably blind.

Now I imagine you are probably wondering how YOU can get such a fun medical condition as diabetes. It's not as hard as you think: you either get stuck with it or you choose to get it. Getting "stuck" with diabetes means that for some reason your pancreas decides to stop producing insulin. Perhaps you are born with a bad pancreas or it otherwise somehow breaks (auto immune disease? accident?). In such a case you become a type 1. Bum deal.

Most people, however, "choose" to get diabetes by simply eating too much crap food and not getting any exercising. They become type 2 diabetics, and unless you have been living in a cave for the past 5 years you know that this is "an epidemic" in the Western world. That's because we are all fat and lazy. So if you'd rather not die morbidly obese, blind and legless you might want to consider getting off the couch and stop eating junk food. Your call.

Diabetes snapshots

Saturday 5/15 - Diabetes snapshots. Inspired by the Diabetes 365 project, let’s snap a few d-related pictures to share today. Post as many or as few as you’d like. Be creative! Feel free to blog your thoughts on or explanations of your pictures. Or leave out the written words and let the pictures speak for themselves.

The challenge

I stumbled upon the Bitter-Sweet Diabetes Blog the other day and couldn't help taking up her "Diabetes Blogging Week Challenge." She's essentially posted 6 questions and drummed up enough excitement in her post and the resulting comments to get me to take up her challenge. I've been meaning to blog about my own experiences regarding living with diabetes so this seemed like a proper time to begin...