All these names for the same thing? So far, yes!

LADA is diagnosed with a positive GAD (glutamic acid decarboxylase) Antibody test, and progression of the disease can be seen with a c-peptide test, the results of which continue to fall over time. Not enough testing is being done, not only for people who don’t fit a typical Type 2 profile, but for people who do fit, but are really not Type 2.

The average time to needing full replacement insulin is 6 years – but that’s just a number. No publication that I have seen, states any definite numbers for the outer limits – the shortest progression to insulin and the longest what they call “honeymoon”.¹

While at the time of writing, there’s no official diabetes classification of LADA – it’s just classed as Type 1, LADA and Type 1 are not the same thing.²

I believe my progression was way longer than the average 6 years – maybe 15-20 years or maybe more. I’ve seen a reported case of one man who had a honeymoon of 20 years, so I’m not alone.

While it should have been, going to insulin really was no clue for my endo because it had been some 30 years since I was first diagnosed. A Type 2 can progress to insulin (with a background of overproduction of insulin because of resistance progressing to ‘beta-cell burnout’) way before that, so no real alarm flags were raised with him.

See history.³

I was in the overweight category (BMI between 25-29.9) and believe me, whereas once the weight would fall off me when I uttered the word ‘diet’, by by 50s almost nothing I do other than major calorie restriction and fasting will shift the weight. Of course, taking insulin is weight-promoting, so that doesn’t help!

Apparently you get more insulin resistant as you get older, so even a few pounds overweight and an initial diagnosis of diabetes would look like Type 2.

So everything looked like I was Type 2, having been diagnosed years before. That was their first mistake – assuming. I already had another autoimmune disease (Lupus), and that’s another reason to get tested for LADA – autoimmune diseases often go hand-in-hand or run in families.

There’s a lot of information out there about LADA – not all of it correct. Literature pushes for testing of normal weight Type 2s and although that’s right, limiting the testing to healthy-eating, exercising, normal BMI Type 2s, makes the rest of us miss out!

The LADA testing criteria should be broadened, and the medical community should stop assuming only normal weight Type 2s could have LADA.

There are plenty of overweight  and even obese people misdiagnosed with Type 2. In some trials with mass testing of Type 2s, they found that around 20% of Type 2s are misdiagnosed.⁴ And although for some, LADA takes on some features of Type 2 and some genetic markers of both Type 1 and Type 2, (which is why LADA is sometimes called Type 1.5 ), it may not for all.

The problem with LADA is the slow onset to when the body produces little to no insulin. In Type 1, can be weeks or days usually with obvious DKA. In LADA it can be years, often making the disease look like Type 2. Type 2s can also have a progressive failure of pancreatic beta-cell function against a background of insulin resistance.

Why is diagnosis important? Because it’s thought that early intervention with insulin may preserve precious beta-cells and therefore the body’s own insulin production. Taking drugs that promote insulin production in your beta-cells is surely counter-productive! There’s only one study I know of that came to this conclusion. Another study concluded it didn’t matter. Which one to believe? I’d rather err on the side of caution until they know for sure.

Beta-cell preservation is important on many levels, not the least of which is that when the body produces its own insulin, it produces other assisting chemicals including c-peptide – it’s so much better for so many reasons.⁵

There’s another, equally important, reason in my opinion – a psychological one.

At one time, I was accused of not following diet and medication advice. I was! They weren’t working for a reason! I’m pretty bold and figuratively stuck my middle finger up at the person who accused me, but how many others slink away, guilt ridden, and have no idea why a dutifully followed regime isn’t working for them? Must always be their fault, right? Wrong!

More importantly, the longer your body is exposed to higher blood glucose, the more possibility for long-term damage. I got to the point where I didn’t care because whatever I was doing, wasn’t working as well as it should have. That’s not a good place to be. It’s like diabetes burnout – something that happens to many for other reasons!

I have to tell you that an enormous weight was lifted from my shoulders once I had the right diagnosis!

At what appears to be an early stage of LADA being known (it was discovered in the 1970s⁶), I’m hearing that many medical people still don’t know what it is!

If you have been diagnosed as Type 2 and have progressed quickly to needing insulin or if the oral medication you take doesn’t work the way it is supposed to, then it’s a good enough reason to push for testing, WHATEVER weight you are.

But you need to be brutally honest with yourself. Is the medication not working because you’re not following a healthy lifestyle – eg lower carbs and exercise? Is it not working because you’re really not following the plan all the time? Have you not educated yourself enough to understand the relationship between what you eat and your blood glucose? Or do you have a genuine reason to suspect you may have LADA and increases in medication isn’t having expected effects?

You still may not have LADA, but if you suspect you do, I encourage you to push for GAD antibody and c-peptide testing (along with testing of other diabetes antibodies, often done at the same time). If your doctor won’t order the test, find one who will, and give them convincing arguments! Do the research and go armed!

———-

FOOTNOTES

Morning basal tests are never a problem. In reality most mornings are basal tests for me. And I know for sure that my basal is exactly right.

Note: Basal is the insulin I get 24 hours a day – the background insulin that is needed all the time, without food. If you do not have diabetes, specifically Type 1, your pancreas does this for you automagically. The most important reason is that your brain needs glucose to function. If your blood glucose is low this is one of the reasons you end up in a kind of brain-fog, unable to function.

Back to breakfast. Often, however, I don’t eat anything at all for many hours after I wake up. Yeah, that’s supposed to be bad for you. Breakfast is the most important meal of the day, they say.

If I end up having a reasonable breakfast within a few hours of waking, then I can forget about lunch. I’m just not hungry.

So why am I carrying around all this extra weight? No idea! Most of the time I do reasonably low-carb. All that falls over in the evening. Doesn’t matter what I do during the day – eat, not eat, snack, have big meals, the evening is the deal-breaker.

If I ever had to do lots of little meals a day (they say that’s better for metabolism), I know I couldn’t cope.

Unlike breakfast, in the evenings, I can eat when I’m not even remotely hungry. It’s a real struggle to tell myself I don’t need that snack and I’m not hungry. My brain tells me I am. Maybe it’s something to do with leptin not functioning at that time of night? I don’t know. Sometimes I’m successful at resistance and sometimes I’m not. (Yes, resistance is futile!) Even so, everything’s easier with an insulin pump. I can bolus in the middle of an extended bolus with anything I add to dinner, like desserts or snacks, or even more dinner. It’s so easy!

I think it’s the evening snacking that is playing havoc with my weight, but even if I don’t have them, I’m not losing a single ounce. It’s sooooo annoying! I think having a desk job doesn’t help either. And truly, I hate planned exercise, but I know I have to do it. I just keep putting it off. Lupus and arthritic pain doesn’t help. Any exercise I could actually do, probably wouldn’t make any difference. It never has before.

Exercise doesn’t really burn off calories… well I guess it does when you do enough of it. Figure out how much exercise you’d have to do to burn off a Big Mac! I don’t think anyone has THAT much time on their hands, let alone the effort-value. Exercise helps your cortisol levels, which in turn helps a whole bunch of things in your body. That should be the primary reason to do exercise, not the calorie-burning part of it but the cortisol part.

One time I always lose weight. When I have to move house! Something to do with skipping tons of meals, not snacking and moving bits of me a great deal (like 12 hours at a time) while packing boxes. If only I could do that every day! Moving house is coming up for me in the next few months. Something to look forward to in terms of weight loss!

As this year goes, it’s been a pretty horrid one, culminating in an even more extremely blah birthday.

Yes, I had some calls from my wonderful friends who’ve been around me for 20 and 30 years. It’s always a delight that they remember. Most of them are 10 hours drive away. If I could afford to fly them all up and we could go out and do daft birthday things.

It was my 50th when we were all last together. A riot of a party with a Middle Eastern theme and I did a beached-whale-belly-dance in full (but modest) costume! It was more than fun and fabulous. It all went a bit downhill from there. I miss them but I know I could never live back in Sydney. Too busy, to crazy, too everything for me.

Of my other close friends, 1 died early this year and 3 more are overseas with only 1 returning later this week, 1 over there for a few years and 1 coming to visit for 3 months, but nowhere near me.

Birthdays have morphed into days that I take stock. The more psychologically challenging stock-taking is still being mulled over.

Of the more mundane stuff…  What fashion item, shoes or makeup do I now need to throw in the bin because it has ‘mutton dressed as lamb’ written all over it? When do I have to get my hair cut short because I’m over 50? When do I have to go to bed at 10pm, have an afternoon nap, and have a fibre-filled breakfast?

When will I accept that the wrinkles and sags are here to stay and that I’ll probably never fit into the kind of fabulous clothing my 21 year old daughter wears, let alone look ok in it? (Oh, how shallow! Right?)

As I write this, I’m channel surfing and happened to land on the Fashion Channel. It always makes me want to throw up or cry. Wow those girls look fantastic! I was probably never that reed-thin or that gorgeous, but 20 years and more ago, I could certainly wear almost anything out of my mother’s clothing boutiques and get away with it.

Now count me in with weight-gaining insulin, post menopausal pounds and a penchant for good food and you get beached-whale – almost. Not quite in the BMI obese category but hovering and at times, falling in.

These days, I can’t wear heels (sore feet and lack of balance), and designer clothing is made in one size either way of reed-thin and often priced out of my league, so that’s out too. In fact, this past week, I’ve been hobbling around with a fractured toe on my left foot (the middle one), wondering why I still don’t have a car with automatic transmission (because they’re always $2,000 more than I can afford) or special shoes for broken toes.

But there was one good thing amongst a few others today – cake!

— Persian Love Cake

I was going to makeanother Persian Love Cake, but yesterday, time got away from me. Here’s the one I made last year for my husband’s birthday.

Theoretically, if you have insulin, you can eat whatever you want. On the other hand, theoretically, if you have diabetes, if you keep the carbs down, you can control the diabetes much more easily and blood glucose spikes can be reduced. Both theories are true. I like a combination of the two.

If your diabetes is out of control, lower the carb intake to start with. It goes a long way to help the control.

On birthdays, all that flies out the window.

I have cake-eating with insulin-taking down to a fine art. And while a store-brought piece of cake doesn’t come with carb instructions, I’m pretty good a guestimating after the first bite.

So, tonight my fancy was taken by what was labelled as a Jaffa Chocolate Cake. Yes indeed – carbs multiplied by carbs!

— Chocolate Jaffa Cake

The first bite was heaven. I could taste the dark chocolate, orange and the surprise of coconut. It was unexpectedly moist, with a measurable layer of thick chocolate ganache on top.  As cakes go, this one took the cake!

With an insulin pump, if you get the carb-guestimate right, it’s so much easier than trying to manage a fat-laden (read: long-absorbing), high carb slice of heaven with injections, although certainly it can be done.

A combo bolus over 2.5 hours did it. At 4 hours post ingestion, I was a tad high at 9.0 mmo/l (162 mg/dl), but all things considered and without an exact carb amount per slice, I think I did ok. A quick correction bolus and I was done.

Maybe it wasn’t such a bad birthday after all! Did the cake make up for the absence of close friends? Um.. I think the right answer is ‘no’, but my honest answer is… kinda… yeah it did, for a few scrumptious chewing and tasting minutes!

I’m still reeling from the events of the last seven months. It’s been a sometimes horrendous, oft challenging, occasionally scary and always exhausting ride.

Thank heavens for my insulin pump! No way I would have coped as well without it. For a change, however, this post isn’t about diabetes.

I’ve been through the death (murder) of my best friend (last March), and what seemed like the endless police investigation back then. The managing, at first of two of his stores – one a newsagency, one a 24 hour convenience store, then working 50+ hours a week, doing several people’s jobs and trying to sort out the disaster I was left with.

First the newsagency was wound up pretty quickly. It was ludicrous to keep plugging away at a business that had been losing money since it started, but even more so in the last couple of years, when it had been… well… mismanaged by the other partner, who was to become an ex-partner last December.

When my friend had initially asked me to get re-involved in his businesses last year, (I had stopped consulting for them in 2007, for reasons I won’t go into here), I agreed, knowing the other partner would soon be an ex. In doing so, I had to give up several of my existing clients to fit more project hours. Little did I know what would happen and how many extra hours I’d be doing running the whole shebang without him. This was to be an ongoing project for me, for at least the next 2 years, and it brought financial security and a wonderful challenge.

Now that the last store closed a few weeks ago, I have no financial security, but I definitely do have a challenge!

We found out that the Deceased Estate, rather than having plenty of money and assets to pay it debts, as I’d been repeatedly told, is stone motherless broke! The lawyers screwed up, the bank screwed up and heaven knows who else, and the result is a bunch of good people who are owed money, including me!

Getting clients back in this economic climate won’t be easy and doesn’t happen overnight. It could take months to get new companies I want as clients. In the meantime, what happens to my mortgage that doesn’t get paid?

So, I was thinking that maybe I should sell up and move on.

I’ve been in beautiful Byron Bay for 11 years – loving almost every moment. The peace and quiet, the laid back lifestyle, the wonderful people here… Byron was a breath of fresh air (literally) after the  hustle and bustle of Sydney. I’ve made some great friends here, plus I’m involved in community activities.

In the 11 years I’ve been here, Byron has slowly priced itself out of any housing market I could afford to buy into again. Prices have skyrocketed in the last 10 years – everyone wants to move here. It also seems to be going through a belated recession. Shops closing everywhere, no on on the streets, few tourists around. It’s been pretty awful this winter.

Sure, I’ve made money on my house in the last few years, but not enough!

So maybe I need to go somewhere I can afford? Maybe I need to go to an area where medical services are way better than here? Maybe I can go to an area where there are more of my husband’s “landsfolk” and somewhere he can get a job more easily? Maybe I can start again somewhere else?

I don’t want to, but I think I pretty much have to.

The results showed that the subjects failing to initiate prescribed insulin commonly reported misconceptions regarding insulin risk (35% believed that insulin causes blindness, renal failure, amputations, heart attacks, strokes, or early death), plans to instead work harder on behavioral goals, sense of personal failure, low self-efficacy, injection phobia, hypoglycemia concerns, negative impact on social life and job, inadequate health literacy, health care provider inadequately explaining risks/benefits, and limited insulin self-management training.

So, whose fault is it that these 35% of surveyed patients think that insulin therapy is the cause of what are actually complications of poorly controlled diabetes?

I’m gobsmacked that a survey can come up with this data! Is the survey saying that it wasn’t known before that misconceptions about insulin are so prevalent?

Again, I ask, whose fault is that. In some 90 years of insulin therapy, you’d think that by now patient education would be far better than what this survey reveals.

On the other hand, despite the Internet and its information revolution, the general misconceptions about diabetes are huge! The basic difference between Type 1 and Type 2 – people can’t even get that right!

Type 1 is an autoimmune disease in which antibodies attack and result in little or not production of insulin. No definitive cause (possibly genes and some trigger) and no cure for Type 1 (and all its variants – LADA, MODY etc) at this time folks unless you have a transplant, or some other experimental therapy, which aren’t widely available.

Type 2 is caused by a number of factors, but not autoimmune disease. Sure, if you have autoimmune disease and you’re taking cortisone, that will raise your blood sugar and can bring on Type 2 Diabetes. But Type 2 is not autoimmune in nature. It’s more about fat resistance and because of it, an overabundance of insulin. More info about Type 2 and its causes can be found at Blood Sugar 101, which has by far the best info about type 2, especially the article entitled, You Did NOT Eat Your Way to Diabetes. This article should be required reading for every doctor, nurse and diabetes educator, and anyone else who has anything to say about Type 2 Diabetes, especially those who like to comment with insulting and uneducated remarks.

With all the misconceptions about diabetes, is it any wonder that some people think insulin therapy itself is some kind of fatal risk?

Come on folks! If medicine wasn’t so much about money, education would have come a lot further by now. People who didn’t want to start insulin might not have gone on to having the very complications they thought they’d have by using insulin. Crazy isn’t it?

Since December (see prior post), I’ve been under the most incredible amount of stress.

I’ve increased my working hours from 20 in my home office to 50 per week outside, doing a favour for my best friend in running his businesses (the other director has “left”).

Then I had to deal with the sudden and unexpected disappearance of this same friend on 8th Feb, and eventual discovery that he’d been murdered.

Dealing with his distraught family, closing one business, attending the police station every day in those first couple of weeks to assist with inquiries and more has been horrid!

And as if that’s not enough, sometimes eating 2 carb-laden meals in town (when I usually do much lower carbs), including burgers, sushi, fries and worse, just grabbing a bag of crisps off the shelf when I was starving. And then ignoring the ‘test-now’ reminder on my pump because I was simply too busy. It made me very reluctant to have this test, which was already 2 months overdue and I had a big cringe with I heard the doctor’s voice on the phone this morning.

But I’d been doing combo boluses and TAG, thanks to being encouraged to learn more and understand how to do it better.

All things considered, a HbA1C of 6.8 is way better than I could have ever expected in a million years. And I’ve halved the protein I’m throwing! Wow… imagine if I could actually do my usual lower carb, wasn’t so stressed (usually raises my BG) and done combo boluses – imagine what the results would have been!

I was congratulated by my lovely family doctor, and I’m unexpectedly delighted today (you can’t imagine the numbers I was expecting). It’s still not ideal though – I’d like to be much lower – the kind of numbers research suggests causes the least long-term harm.

Definitely something to aim for!

For the past several weeks, I’ve been involved in a project with a friend and business owner involving several serious issues with another director, who, incidentally, hates my guts. Water off a duck’s back – the feeling is mutual. What that sneaky, underhanded, thieving director has done would fill volumes. While I’ve worked hard to make sure the evidence has been handed to the authorities, it’s taken many hours of my time and energy. I also knew that at the end of it, I’d have a project to sort it all out and to manage the two stores that were born of the original partnership.

On 23rd December, that other director, after we went to the lawyers with a 50 page document I’d prepared, was forcibly removed and he now no longer has anything to do with one of the businesses. The day manager was also given a DCM (don’t come Monday). So with 2 management staff down, I’ve taken both their jobs as well as what I would have been doing for the company anyway, as a consultant. I’m now fixing the sabotage as well. It’s been a complete nightmare and thankfully after 10 days we’re finally seeing some light.

So how am I faring with my pump and diabetes while doing 10 things at once and racking up around 58 hours work a week? You’d probably be as surprised as I was.

Despite carb-laden food being almost the only options for lunches and dinners from take-away stores and restaurants (who’s had time to do grocery shopping in the last 12 days?), and add to that all the stress, crazy hours, phones jangling, faxes pouring in and more, I’m surprised that not only does my pump allow me to handle all this with ease, the numbers prove that I’ve managed pretty well, all things considered!

I was supposed to be working in the other business – a much newer place with a lovely office. I was only meant to be doing 4-6 hours a day until things were sorted and then cut it back to 2-4 hours on 2-3 days a week (I still have other clients), but no one knew what a shambles the businesses would end up in, and no one anticipated the sabotage that happened in the 10  inutes before the police took the other director away. There are still some major problems with the other business, so it’s been closed since before Christmas. Because of that I’ve been working in the original business, in a small hole, slightly bigger than a broom cupboard. Getting to that hole in the wall, you have to go through a storeroom and through a bathroom. Gorgeous it ain’t! But I can see the humour.

I’m now doing a whole bunch of things that weren’t anticipated – rosters, fixing a POS System I’ve never laid eyes on before, ordering stock, handling staff problems, directing staff, putting new procedures in place, counting cash and a whole lot more, while still doing my regular IT Consulting and being an accounting software specialist. And then there have been times staff haven’t shown up, so I’ve raced in there, after 2 hours sleep, and got on the tills to get the customers through, with the phone in one hand trying to find someone to work the shift. It never stops – it’s a 24 hour place, and very popular.

New Years Eve was another nightmare with lines out the door. Thought I’d never walk properly again with the sore legs I had from standing. (I’m usually at a desk with a screen in my face.)

The remaining director, who has been a good friend for many years, fully acknowledges the ‘conditions’ under which I’m working. Believe me, he’s paying handsomely for my services, but there are a few issues he can’t pay for, even with all the tea in China. So, I wrote him a memo. I thought you might enjoy it too. We both needed a laugh after what was a horrendous week.

Here it is…

Dear Sir Mr Boss Man, Stockholm Syndrome Black-Belt, Slave Driver,

There are several issues I wish to raise in this brief lengthy and official letter.

Due to entirely foreseen circumstances, my legs, hip and back have failed. Under the law, people with this kind of disability must be catered for. After all, you do have a stinky dirty disabled toilet right outside my office and I?m forced to listen to the entirely un-mellifluous tinkle of nature, while trying very hard to concentrate in this chaotic environment.

Further, during those times, I?m unceremoniously imprisoned in my inhumanly small, stuffy and hot oven office at the will of the tinkler. (Check the Geneva Convention laws about the minimum size of cells). I am also now living in abject fear that one day I may be imprisoned there forever, without food, chocolate or cigarettes. That would be a tragedy of the worst kind, for which my estate will be bound to sue the pants off you (I changed my will today to force them to act on my behalf).

Because of the failure of certain parts of my body, I wish to respectfully request that a supply of Nurofen or similar be paid for by the company to comply with the law and to show me the smallest measure of respect for the terrible hardships I have to endure while employed by you. Perhaps you might also consider some No-Doz, but of course this is not essential, and probably not provided for under the law.

I understand that you have now perfected the method to age someone 10 years in 8 days, and I applaud you for it, but might I ask where your integrity is with this cruel and unusual treatment of loyal, hard-working employees? I understand that it?s provided free, so I really don?t want to look such a generous gift-horse in the mouth, so to speak, but surely you?ll agree it?s a tad excessive. I only expected to be aged 5 years not 10! This kind of misrepresentation is surely punishable by the Department of Fair Trading.

Further, I will be contacting the agency that has jurisdiction over abuse of old people and slave labour. This 17 hours a day you are forcing me to work, might well be considered excessive in the Western World and could be a crime with a lengthy jail sentence. Please be on notice that you could be charged under the law, and be forced to pay compensation as well as do jail time. And because I like working here… most of the time… I will only be claiming $10M compensation (not $20M as the law provides), and recommending that you not go to jail for these heinous crimes.

I have submitted a copy of this letter to my lawyer so that you cannot force me to retire on the grounds that I am making these complaints. Please be aware that on 1st January, the Fair Work System comes into effect. It provides massive overtime for all work over the standard 38 hours per week (note, not “per day”), which an old and decrepit person like me shouldn?t be forced to do anyway. Ha, and I thought a labour government was for the people, not for employers! This is the kind of nonsense they promote when they want to get votes from rich people. I know their game. And I now know yours too.

Did Mr Gone-Director ever force anyone to work 17 hours in one day? I doubt it! Even the wicked witch Miss Director’sWife didn?t have to work the 25 hours she got paid for. Wow, Mr Gone-Director sure treated his staff well and was especially generous with them, paying them for work not done. You?d do well to do the same! As you know, I?d never claim such a thing, so perhaps some kind of bonus is in order? It?s tax deductible, you know!

I?m truly sorry I have to bring these matters to your attention, but there will be far-reaching consequences if I don?t – both for myself and my long-suffering, working-man, non-English-speaking husband and my beloved CharlyDog, who simply will not fit in my office, as promised, no matter which way I rearrange the furniture. My husband fails to understand why you are stalking me from work to home all the time. Would you care to explain that to him after the police release you on bail?

You must surely admit that you did lie about the luxurious conditions at work, didn?t you? You got me to work there under false pretences, promising me a spacious office with air conditioning and a bed for poor Charly, who now has to stay at home all alone crying because you are so cruel.

Anyway… here are my demands. And I will not budge an inch on them.

By 4pm today, I demand an occasional company-supplied packet of Nurofen, otherwise I will have no choice but to take further action.

For insurance purposes I am bound to report these nefarious activities to the police and other authoritative bodies. To that end, I have already prepared a lengthy 50+ page report with dated photo and audio evidence of the alleged jailer-tinklers and the abject conditions I must endure, which I?ve given to my lawyer, and which will be taken to the police forthwith at 4:01pm if my demands are not met.

Oh and one more thing. I have also asked Mr Gone-Director to testify on my behalf, which he is very willing to do. I may even have to get <someone else> to intervene if this keeps up. After all, Mr Gone-Director had to endure these horrendous conditions for 6 long and arduous years! No wonder he?s a bit angry now! While I?m not as childishly vindictive as he appears to currently be, I am, unfortunately, forced to make these grave complaints because you are long past the agreed 2-4 hours a day you proposed when you hired me. Your name will be dirt when this gets around the community! You can buy my silence with good quality dark chocolate.

At 4:02pm, after my report is faxed around the globe (at my own cost, of course), I am considering beginning strike action.

Yours faithfully,

Miss Brunhilde Longsuffering Hardworker,
Emotional Blackmailer (EB) and Qualified Expert Letter Writer (QELW)

I made a comment as follows:

Lately I’ve been studying TAG (Total Available Glucose) of not only carbs, but protein and fat too. It’s a much better and more accurate way of bolusing for T1 than just counting carbs. I have a pump, so I do extended boluses for all but small meals and snacks. That seems to work better too.

The one thing that also drives me crazy is the inaccuracy of meters. Thank heavens we have them, but really, by now they could be much more accurate. The other one is that I wonder sometimes how some manufacturers get to their carb counts on food packs. I’m sure sometimes they’re just guessing.

TAG is a system that takes into account not only the carbs in foods but also the available glucose of protein (about 58%) and fats (about 10%) and working out boluses on that.

Not that boluses are inaccurate only because you’re not doing TAG. There’s so much more to take into account: fighting an infection, inflammation, pain, stress, weather, hormones and a whole lot more. It makes looking after diabetes, once thought of as a science, more of an art-form at times.

There’s a great discussion over at TuDiabetes. It started off about doing combo/extended boluses on a pump and evolved into a discussion about TAG. Read more about the posts in “Dual Wave Bolus”

Even if you don’t have an insulin pump, it’s well worth the read.

I do know how much and how easily my BGLs go up with stress – any kind of stress… the kind of stress that you wouldn’t ordinarily call stress. Day to day living is a stress of sorts. Having to be somewhere on time is stress. Trying to get a job done on time, even when you have plenty of time, is stress. Being in a crowded room with the din of everyone talking, is stress. Unless you’re in a meditative state 24/7, it’s all stress of sorts. While I may be more sensitive than some, daily living does have an effect on everyone. Managing diabetes is sometimes more an art form than a science.

Put stress together with the really hot weather we have here (in Australia) over late spring and summer, and it’s time for me to take a good look at my basal rates. Weather definitely has an effect on insulin needs too.

I know my current basal rates are not serving me the best way they could at the moment.

Who’d have thought in just 3 weeks, what was once a nearly-perfect basal program, is now quite off at some times of the day?

The problem is that being as busy as I’ve been, I’ve hardly had time to notice. Yes, I’ve noticed the numbers being off, but I’ve also had a much more varied diet (read: mostly more carbs than usual) and I’m very aware of my BGLs going up some 4-6 hours after a meal that is only a tad more than would be considered ‘light’, let alone a heavier meal – that one is a disaster! Mostly after dinner, the struggle with BGLs going up consistently, so long after dinner, is something I’m not yet sure how to handle.

Despite using extended boluses over several hours, I’m thinking I have to extend any bolus I do quite a bit longer. It doesn’t matter what time I eat, it still happens around the same time later. If I skip dinner (rare), it doesn’t happen, or if I have a very light meal, it also doesn’t happen. It’s called gastroparesis – delayed stomach emptying. Many people who’ve had diabetes for a long time have it. And it’s a bitch to handle, whether you’re on a pump or on MDI.

Sometime in the next few days I have to formulate a plan to test all the basals I have right now.

Remember that on injections (MDI), you do possibly 2 injections a day and it’s pot luck whether the relatively flat-line of Levemir or Lantus can come close to what the human body really needs. This is one of the reasons a pump is so great. You can adjust your basals any way you want and have as many as you need.

If you’ve never seen basal rates for a pump, this is what mine looks like at the moment. The time indicates what time that rate starts, and it continues until the next time listed. The number next to the time is the units-per-hour of insulin. I have 6 different basal rates at the moment. After I reassess it could go to 4 or 8 or whatever I need with the rates I need for that time of day. I used to go very low around 4-6am so the reduced basal rate at that hour is great! Also remember that you’re adjusting the rate for a peak around 1-2 hours later.

Basal Rates

12:00a 1.100

01:30a 0.925

02:30a 0.750

09:00a 1.075

03:00p 0.900

07:30p 1.125

I’m fast coming to the conclusion that unless you’re a total creature of habit – go to sleep the same time, wake up the same time, eat the same things at the same time, do exactly the same thing every day, on time – then the daily, and sometimes inexplicable fluctuations in blood glucose needs quite a bit more managing. Even creatures of habit have fluctuations, but certainly not as much as if the criteria changes drastically from day-to-day. I’m definitely not a creature of habit and I wouldn’t change that for anything. You live with some things, you change others to manage diabetes. Some things are not negotiable!

November 14th is World Diabetes Day. The theme for 2009 – 2013 is Education and Prevention. This is goes for both Type 1 and Type 2. While we still don’t know the trigger for Type 1, research on prevention is just as important as it is for Type 2.

November 14th is the birthday of Fredrick Banting, who along with Charles Best, is credited with the discovery of insulin in 1921. Imagine if you can, how people with Type 1 diabetes coped without insulin. They didn’t. It’s a painful death without insulin with 100% mortality. Now, some 88 years later, there are still people in the world who have no access to insulin. Thanks to global organisations like Insulin for Life, some insulin does get to people who would otherwise not be able to obtain it. It’s mostly economics. No, we are not all equal – certainly not in the realm of being able to afford what is now a simple, abundantly available medication.

Which country do you think has the highest rates of Type 2 diabetes? You’d be wrong if you thought the USA. From what I’ve read, it’s India!

Which countries do you think have the highest rates of Type 1 diabetes? You’d be wrong if you thought the USA. It’s Sardinia and Finland.

Which areas of the world have the lowest incidence of Type 1 diabetes? Zunyi, China, and Caracas, Venezuela.

Do you know the differences between Type 1 & Type 2 Diabetes? Can you name at least 3 other forms of diabetes?

Education!

I was not all that shocked to read what Kate from the T1DN, after attending the conference in Montreal in October 09, wrote in her report:

A central area in the conference was the Global Village where all the world’s diabetes association (the equivalent of Diabetes Australia in every country) had displays and staff there to chat with you about what they were doing. Through the Congress I tried to do the rounds of these stands and find out about anything that other countries were doing to support adults with Type 1 diabetes. I have to say I was shocked and amazed at how many times this conversation ended up with me explaining that Type 1 really is very different to Type 2 and the supports and services people with Type 1 need are also different. That Type 1 occurred in large numbers in adults was also not well understood – when I asked about Type 1 I was often informed about children and had to push and prompt. This appeared to be news to many of the associations I chatted with including several with high prevalence of Type 1 – Canada and Denmark, for example.

Even in this day and age, I also come across so many medical professionals who seem to know a lot of rubbish and unproven information about Type 2, and know even less about Type 1. They also know next to nothing about other forms of Type 1 Diabetes of adulthood. Why? Where is the education for professionals?

If the International Diabetes Federation (IDF) wants education to be the focus of its World Diabetes Day, they really need to start with doctors, nurses, Certified/Credentialed Diabetes Educators, pharmacists and the people who work for the various diabetes organisations world-wide! Educating these people is paramount and is the first line to the rest of the education the IDF wants.

But how is the right kind of education going to happen when so many professionals can’t get it right. Being mis-diagnosed for 30 years, as I was, isn’t confidence inspiring. Neither is being given totally wrong information on how to manage diabetes, from people who should have known better… and still probably don’t.

The IDF states (here) that

Prevention of Type 2: Lifestyle changes aimed at weight control and increased physical activity are important objectives in the prevention of type 2 diabetes. The benefits of reducing body weight and increasing physical activity are not confined to type 2 diabetes; they also play a role in reducing heart disease, high blood pressure, etc.

Wrong! Plenty of thin Type 2s. Emerging evidence that people don’t necessarily eat their way to diabetes. Plenty of obese and morbidly obese people don’t have and will never get diabetes. If in doubt, this article is a must read! As Jenny writes:

While people with diabetes often are seriously overweight, there is accumulating evidence that their overweight is a symptom, not the cause of the process that leads to Type 2 Diabetes.
Even so, it is likely that you’ve been told that you caused your diabetes by letting yourself get fat and that this toxic myth is damaging your health.

Blaming you for your condition causes guilt and hopelessness. Even worse, the belief that people with diabetes have brought their disease on themselves inclines doctors to assume that since you did nothing to prevent your disease, you won’t make the effort to control it–a belief that may lead to your getting extremely poor care.  READ MORE

If the professionals can’t get it right, what hope is there for the media which influences a vast number of people who, when we’re around them, can make our lives with diabetes so much more unpleasant than it already is?

The food police (“Should you be eating that?”) – yes, I’m Type 1, I have insulin and theoretically, I can eat whatever I want.

The totally misinformed (“Oh you have Diabetes, just lose some weight”) – no, there’s no cure for Type 1, plenty of thin Type 2s, plenty of Type 2s who need insulin and have already lost weight, plenty of Type 2s who do exercise, eat like birds and can’t shift the weight.

And please, folks, going low fat will do a whole lot less for diabetes than reducing carbs in your diet.

Learn about fructose without fibre and high fructose corn syrup and what they do to your body and your insulin response! See prior posts on this issue – here and here.

Yes education is always the key, but how can so many people (who should know better) get it so wrong for so long?