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BootCamp for Betics Blog

I'm using a diabetes drug recreationally

10/30/2016

3 Comments

 
Update 3/6/17
This is an update based on a Facebook discussion about how successful Metformin is, overall, at reducing weight in the general diabetic population. 

Note: Studies don't show consistent weight loss with metformin use, that's for sure. My hypothesis is that in order to experience successful weight loss on Metformin, you have to meet some very specific conditions. First, you have to be euglycemic virtually all of the time before starting the metformin. This is hard to do, especially when you're on insulin. You also have to remain euglycemic as you continue to take the metformin. And insulin dependents have to do this by adjusting (read: reducing) basal and bolus dose calculations. This is not easy. But starting metformin while euglycemic and remaining euglycemic throughout the treatment will, I hypothesize, result in weight loss, because it results in less sugar in the blood, which means less required insulin, which means less fat storage. I am a sample size of one, of course. And my experiment is driven by personal curiosity, not scientific inquiry. I would like find some research on whether metformin has caused weight loss in people withOUT diabetes. I'm sure it's out there, and that I just haven't found it yet.

Now, continue on to the article below.
I’m using a diabetes drug experimentally, and I’m having loads of fun doing it.

Every once in awhile, when I get bored or curious, I experiment with drugs (legally prescribed ones, that is). And, since so many new diabetes drugs have hit the market in the last few years, and since my blood sugars have been mostly stable since the birth of baby George in December, I’m ready to resume my drug experiments.

The next drug I’m going to try is Metformin. Now, I know a LOT of people take Metformin, but not everyone knows how it works.

Most doctors will tell you that Metformin (of the drug class biguanide) is a medication that “makes your body less insulin resistant” or “improves how your body handles insulin.” Which is true, but, have you ever wondered HOW Metformin does this?

Well, in order to understand how Metformin works, we have to understand something very important about our liver. Your liver (and everyone else’s liver) stores a bunch of glucose.

In addition to storing glucose, your liver releases a fairly steady stream of glucose into your body throughout the day to give you energy.

Your liver also releases *extra* glucose into your body as a reaction to other stimuli (at last count, I had a list of 24 non-food events that can cause your liver to release glucose into your blood).

So basically everyone (diabetic or not) gets a steady drip of glucose squirted into their blood thanks to the liver.

Well, Metformin’s job is to suppress the release of glucose by the liver, which, of course, lowers the amount of sugar “hanging around” in your blood, thereby lowering your “baseline” blood sugar levels.

Metformin is good stuff for type 2 diabetics. But, it can also be good for type 1s and for non-diabetics, too!

Here’s what Metformin would do for you, based on your circumstance:

  1. Metformin can help people with type 2 diabetes who have high blood sugar by lowering overall baseline blood sugar levels. If you get diagnosed with Type 2 diabetes and you’re prescribed Metformin, the drug will suppress hepatic glucose release (doesn’t that sound fancy? Hepatic means “of or relating to the liver), causing *less* sugar to get squirted into your bloodstream, ultimately resulting in lower blood sugar levels. For you, Metformin is a blood sugar lowering drug.
  2. If you’re type 1 (like me), you take insulin. Well, Metformin does for you the same thing that it does for people with Type 2 diabetes - it suppresses hepatic glucose release (causes less sugar to get squirted into your bloodstream), and, if your blood sugars were already under control before you started taking metformin, the metformin will cause your body to need *less* insulin. This will cause your cells to soak up less glucose, which means less fat storage. So for you, the end result isn’t lower blood sugar. It’s weight loss. You slowly start to shed pounds. For you, Metformin is a weight loss drug. Also, if you pay cash for insulin or if you don’t have insurance, you can save a lot of money because you won’t need so much insulin if you take Metformin. Metformin is about $5 per month and insulin is at least $520/month. For you, Metformin is also a money saving drug.
  3. If you are type 2 diabetic and your baseline blood sugar levels are within target range and you’re not already taking Metformin, you can start taking Metformin and you will probably shed pounds. For you, Metformin is a weight loss drug. If you are on insulin, Metformin can also save you money because you won’t need so much insuilin.
  4. If you are NOT diabetic, you can start taking Metformin and you will probably shed pounds (remember, Metformin causes your liver to release less glucose into your blood, thereby causing your body to require less insulin, which is a fat storage hormone). For you, Metformin is a weight loss drug.
  5. (Important) If you are AT RISK of getting type 2 diabetes due to a family history of type 2 diabetes, you can start taking Metformin at any age (the earlier, the better) and significantly reduce (and, in some cases, potentially eliminate) your chances of getting type 2 diabetes in the future (more on this, later). For you, Metformin could be a preventive drug.

Why am *I* trying Metformin?

Well, as it turns out, my liver squirts an obscene amount of sugar into my blood throughout the morning (this has always been the case), requiring lots of insulin (which equals lots of fat storage), and, my liver squirts even MORE sugar into my blood when I exercise.

I started a new fitness program three months ago and as a result of the hepatic glucose release during my high intensity exercise, I’m having to take extra insulin after my workouts.

I’ve been working out pretty intensely for the last three months (minimum 3.5 hours per week) and have put on 6 pounds, despite keeping the same diet. Now. I have very detailed data on working out and why it’s good and why I’m going to keep doing it, but that deserves its own article topic, as does the “Why the hell aren’t we diagnosing insulin resistance at its onset, instead of 15-30 years later, once it’s full-blown diabetes” article.

But for now, I’m going to see if I can continue to exercise withOUT gaining any more weight. Stay tuned, you guys. And stay well. And for goodness sake, can someone start a change.org petition to add Metformin to the water supply?
http://www.bootcampforbetics.org/blog/im-using-a-diabetes-drug-recreationally
3 Comments

Dear Diabetes,

10/30/2016

0 Comments

 
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This is all I have to say to you today.

Love,
​Me
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A 1 Minute Mug Muffin That Doesn't Suck

10/21/2016

0 Comments

 
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Photo Credit: http://i0.wp.com/goodnessgreen.com/wp-content/uploads/2013/08/DSC_6187.jpg
Ingredients:
  • ¼ cup milled flax seed
  • ½ teaspoon baking powder
  • 1 tablespoon Splenda (or 1-3 packets to taste if you don’t have Splenda in a bag)
  • 1 teaspoon cinnamon
  • 1 egg
  • 1 tablespoon oil (I use extra virgin olive oil)

Directions:
  1. Mix dry ingredients in a coffee mug
  2. Add the egg and oil to the mug
  3. Stir thoroughly
  4. Microwave for one minute on high
  5. Slide a knife around the inner perimeter of the mug to remove the muffin
  6. Eat immediately, otherwise it’ll dry out

Nutrition Info:
​
(per muffin)
Picture

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​Notes:
Fiber, which does not break down into glucose, is included in the total carbohydrate measurement in foods. The “net carbs” indicates the number of grams of carbohydrate that will actually turn into glucose in your body. If you take insulin, you should bolus for the “net carbs” in my recipes, and not the total carbs. Other websites and companies have different definitions of “net carbs,” so please be careful when applying net carb rules to your meals & snacks.

This isn’t a new recipe. In fact, there are variations of this recipe all over the internet. I found that the other recipes produced a very dry and flavorless muffin, so my version has a lot of extra fat and sweetener. If you’d rather have less fat (and a dry muffin), use less oil. Feel free to titrate the other ingredients to your satisfaction.

Sometimes, I multiply the dry ingredients in this recipe by 8 to create a big batch of “muffin mix,” which I store in a big ziploc bag. When I’m ready to have a muffin, I scoop about ¼ cup of muffin mix into a mug, add the egg and oil, stir, and stick it in the microwave. Making big batches saves a lot of time.
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Reducing post-meal blood sugar spikes by eating more food? Yep. I went there.

10/20/2016

2 Comments

 
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​If you're anything like me (diabetic), you've probably had this experience.

Sometimes, I eat a completely normal healthy meal, take insulin or meds as usual, only to discover that 1 hour after eating, my blood sugar has shot up to 250 or 300. Gah!

Blood-boiling rage doesn't even begin to describe my emotional state when this happens.

Why does this happen, anyway?

Well, one theory is that I took the wrong amount of insulin/medication.

Another theory is that I screwed up my carbohydrate counting.

A third (and more satisfying) theory is that my blood sugar is an asshole.

But, what if I didn't mess anything up? Is it possible for my blood sugar to spike after meals, even though I've gotten everything else right?

Yes. Yes, it is totally possible.

Why?

Sometimes, carbohydrates metabolize and turn into glucose quite quickly after you eat them. This can cause a blood sugar spike in people with diabetes. The insulin (whether you take injectable insulin or whether it comes from your pancreas) just can't keep up with the glucose absorption, so your blood sugar spikes high, and then eventually comes back down to normal once the insulin has had a chance to work. When carbohydrates metabolize more slowly, this blood sugar spike is much less severe.

Now, there is a bunch of information on the web about glycemic properties of foods, and if you have a bunch of time and want to learn more about these properties, you can go online and spend days reading articles about the glycemic index. There's also a bunch of stuff you can do with insulin, if you take it, that can help with blood sugar spikes. We cover that topic pretty thoroughly in BootCamp for Betics.

But. If you don't have a bunch of time to go prowling the internet, let me give you a quick solution that will help mitigate post-meal blood sugar spikes.

How? Well, wouldn't it be nice if we could FORCE our bodies to absorb carbohydrates more slowly? Is this even possible?

Yes. It very much is.

There are two nutrients that, once consumed, have the effect of slowing digestion. If you consume these two nutrients just a few minutes before you eat your regular meal, your food will take longer to digest, glucose will take longer to absorb, your insulin will have a chance to do its job, and you won't have such a big blood sugar spike.

It's not magic. It's science.

1. Soluble fiber increases the thickness of stomach contents after a meal, which slows digestion and glucose absorption.

2. Fat takes a quite awhile to move through your GI tract, so when you eat fat, this gums up your body's absorption of carbohydrates, slowing down glucose absorption.

Now that we know this, how can we practically apply it to our daily lives?

Well, we need to be careful with fat. There's saturated fat and unsaturated fat. Saturated fat can raise our triglycerides and cholesterol, and put us at higher risk of heart disease. Ew. But unsaturated fats don't do these bad things.

What does this mean?

Well, it means that if we eat soluble fiber and/or unsaturated fat shortly before a meal (like 5 minutes before you take your first bite), we can reduce postprandial spikes.

Next time you eat a meal, try doing one of these things 5 minutes before your first bite:
  • Eat 10 walnuts (NOT the candied kind)
  • Eat 10 pecans (again, not the kind that's dipped in sugar)
  • Eat 10 almonds
  • Eat 1/2 of an avocado
  • Eat 1-2 tablespoons of peanut butter
  • Eat 1-2 tablespoons of almond butter
  • Eat flaxseed (I've got a mug muffin recipe that I'll send in a few days)
...Or find another food that contains soluble fiber, unsaturated fat, or both, and consume it 5 minutes prior to your meal.
2 Comments

Test Your Diabetes IQ

10/19/2016

0 Comments

 
(a diabetes test)
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About That "Artificial Pancreas..."

10/6/2016

1 Comment

 
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You keep using that word. I don't think it means what you think it means.
You guys. Healthcare News lost its freaking mind last week about Medtronic’s “Artificial Pancreas” getting FDA approval.

It’s always exciting when a new device or device enhancement becomes available to people with diabetes because it usually means that if I can get my hands on said device, I’ll have better blood sugar results.

But I’m concerned that the “breaking news” media reports have caused people to believe that there’s finally a solution that will relieve diabetics of our constant daily struggle to keep our blood sugar in target range.

So, no.

Medtronic’s new 670G insulin delivery system (“artificial pancreas”) is no such device.

If you look closely at the FDA’s announcement, you’ll notice that the FDA has not called Medtronic’s new device an “artificial pancreas.”

In fact, if you look at Medtronic’s announcement, you’ll notice that Medtronic, the creator of this device, doesn’t even call it an “artificial pancreas.”

Also, the Medtronic Minimed 670G is approved for type 1 diabetics only (1.25 million people in the U.S.), not type 2 diabetics (27.9 million people in the U.S.)

So let’s all hold our damned horses and chill the heck out, here.

You might be wondering whether the new Minimed 670G insulin pump/CGM system is even worth getting excited about? You bet! In fact, the new 670G system has new features that other pumps don’t have, and two of these features are what make the 670G different (and more automated) than other insulin delivery systems.

The two features the 670G has that other systems don’t have:

  1. The 670G can now suspend or lower the basal or “insulin drip” rate based on the reading from the continuous glucose monitor.

  1. The 670G can now increase the basal or “insulin drip” rate based on the reading from the continuous glucose monitor.

For some very basic details on insulin delivery systems and the 670G, take a look at the table below.
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Based on what I’ve read about the Medtronic 670G and based on what I know about insulin delivery systems and how they work (since I’ve been using them for 16 years) Here’s my quick assessment:

  1. I think the Medtronic 670G is an improvement over previous models.

  2. I think the low glucose suspend feature is really awesome (this exists on a prior model, too), and may even save lives.

  3. I think the high glucose basal adjustment is neat, though I’m dubious about how quickly it’ll actually lower a blood sugar. I think I’d prefer a bolus, and not a basal adjustment, if my blood sugar is high.

  4. I think the media (and insulin delivery technology companies) should be more careful about calling a device an “artificial pancreas,” because its subtext implies that people won’t have to pay attention to their diabetes anymore, which is totally wrong.

  5. I think that Medtronic has had annoyingly painful and inaccurate continuous glucose sensor technology for awhile now, and my hope is that this new 670G sensor is less painful and more accurate than previous sensors, because basing automated insulin decisions on inaccurate sensor data isn’t cool.

  6. I’m impressed that insulin delivery technology continues to improve. But. I think that people with type 1 diabetes who use Medtronic’s 670G will still have to check their blood sugar multiple times per day using a finger stick, and I think that this pump will probably make mistakes based on inaccurate sensor data which will have to be manually corrected. But, the automation is an improvement that has a real chance of resulting in better blood sugar outcomes for people using this pump.

My verdict?

If you are a type 1 diabetic using the Medtronic 670G system, you are still going to have to work just as hard to manage your blood sugar as you always have, but, if the new Medtronic sensor is more accurate than Medtronic’s previous sensors, there’s a non-zero chance you’ll get slightly better blood sugar results from your efforts if you use this system. And a better result, no matter how slight, can make a world of difference for some.

As for me, I'm going to continue to use my old Medtronic pump along with my Dexcom sensor, even though the two devices don't interact with each other. If diabetics using the 670G start raving about the painlessness and accuracy of the new Medtronic sensor, then maybe I'll give the 670G system a try. And if you are using the 670G, I invite you to add your opinion in the comments section below. For now, because I've been scarred (emotionally and physically) by Medtronic's prior sensors, I just can't give up my Dexcom (which, thus far, has been a far superior CGM) anytime soon.
1 Comment

What should my A1C be?

10/6/2016

1 Comment

 
​Hey Betics,
During BootCamp for Betics this week, one of my students asked a really great question about what your A1C should be.

Question:
If my goal is to lower my A1C, how do I realistically determine what it could/should be in 3 months or 6 months? How do I figure that out?​
​

Answer:
That's hard to answer since everyone is so different, but I'll give it a try. As you know, the A1C is a nicely predictive value that tells you and your doctor how well "controlled" your blood sugar is, but it is not a totally accurate data point.

For example, your blood sugar could be 40mg/dL 50% of the time and 240mg/dL the other 50% of the time and your A1C would be 6.5 (control is not great, but A1C is good). Likewise, your blood sugar could be 110mg/dL 50% of the time and 170 the other 50% of the time, and your A1C would still be 6.5 (control is much better, but the same A1C as before).
So while the A1C number is a good reference point, it's only part of the goal. Here's what I'd suggest.

First, choose a baseline target bg (wait, what the heck is a baseline target bg?) that is safe. Let's say, for example, you want your baseline bg to be 110 to start off, just to be on the safe side and avoid hypos (if you're not on insulin or sulfonylureas, your eventual baseline target should be lower than 110). Next, pick a max postprandial bg goal (post-eating for a type 1 can be 140-180, sometimes higher depending on your circumstances. If your A1C is currently above 7, start with 180, which I'll use in this example). Add the two numbers together (baseline goal + postprandial target = 110 + 180 = 290, and divide that total by 2. The answer in this case is 145, and that's your average blood sugar goal. Then, go to this website: http://www.phlaunt.com/diabetes/A1Ccalc.php and type your average blood sugar target into the mg/dL field, which will help you figure out what A1C that corresponds to (it's 6.7).
​

One thing you (and everyone else) should consider before lowering your A1C, though, is whether or not you have *any* diabetic retinopathy. If you have existing retinopathy (proliferative or not), you can exacerbate your eye issues by lowering your A1C too fast. If you don't have any preexisting retinopathy, this warning doesn't apply to you. But, the faster you can lower your A1C, the more your kidneys, heart and nerves will thank you. It's a total catch 22 if you have any retinopathy at all.

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So, if you do have retinopathy, then you need to take your current A1C into account and be careful to lower your A1C slowly. I think a half a percentage every month is slow enough, but you should check with your ophthalmologist​ about what they recommend. So, let's say your A1C is 9. Try to lower it to 8.5 by next month, then to 8 the month after that, etc., until you can get it to a healthful and attainable target. An A1C of 8.5 corresponds to an average blood sugar of 197 according to the A1C calculator. Multiply this average blood sugar by 2 (197x2 = 394), and then subtract your baseline target bg, which should be on the high side if you're looking to lower your A1C slowly. Let's say it's 130. So 394-130 is 264. 264 becomes your absolute "not to exceed" number for the month that you're trying to get your A1C to 8.5.

As for a *final* A1C goal, well, that's up to you. If you're prone to hypos, an A1C of 6 or even 6.5 may not be realistic for you, and you may want to hover right around 7, which isn't perfect, but again, it's another catch 22. You want to keep your bg low enough to not cause any complications, but you can't keep it so low that you have constant hypos and seizures.

With Betic Love,
Kara
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