BootCamp for Betics

Note: Only a certified medical professional can diagnose diabetes. BootCamp for Betics is not a medical center and nothing in this article should be interpreted as individual medical advice.

Type 1 diabetes is a rare but serious medical condition. For education and courses on diabetes and blood sugar management, visit the BootCamp for Betics Online School.

There's a ton of articles on the web describing the symptoms of type 1 diabetes in children. If you don't yet know what those symptoms are, you should read about them on one of the many sites that describe type 1 diabetes symptoms in children.

Sometimes, doctors misdiagnose diabetes as something else, such as the stomach flu, or dehydration. Undiagnosed type 1 diabetes can add serious risk to your child's life. The longer the diabetes does undiagnosed, the sicker your kid gets. And yes, you can die from undiagnosed diabetes. It's rare, but a few cases happen every year.

But all is not lost, my friends. You don't have to spend every hour of every day fretting that your kid might become diabetic on the sly.

Let me tell you a little known secret:
​You can test your kid for diabetes. It's really easy. And pretty darn cheap.

​Here's how:

First, buy these Keto-Diastix urine test strips: 
(Disclosure: I make a commission if you use the Amazon affiliate link below)

Next, have your kid pee on one of these strips whenever he or she shows symptoms of type 1 diabetes, OR whenever he or she seems sick (especially with vomiting or diarrhea), or, if you're a super-paranoid type 1 mom (like me), just test your kid every week.

Is it difficult for your kid to pee on a stick? No problem. Catch some of their urine in a paper cup.

​Is your kid in diapers? No problem. Do this:

Once you're waited the required amount of time for the test strip to develop, compare the two squares on the strip to the colors on the Keto-Diastix bottle.

NOTE: KETONES ARE NOT NECESSARILY BAD. PLEASE READ THE CHART AT THE BOTTOM OF THIS PAGE BEFORE DECIDING HOW TO REACT TO THE URINE TEST!

Let's practice this by looking at the example below:

If you've got a t1d kiddo or you've tried to use these test strips, please use the comments section below to tell us your story!

Hey Betics - 

Is anyone else freaking tired? Like, ALL the time?

I can't remember the last time I woke up feeling "refreshed" and ready to start the day (who ARE these people who can wake up "refreshed," anyway?)

Well, I've been doing some research and some experimentation for this past somewhat sleepy and miserable year.

You might be surprised to learn that there are more than fifteen possible reasons that a person with diabetes might suffer from chronic or incidental inexplicable fatigue, and most of these causes can be tested for, and treated.

I want to produce a free community webinar about this very topic, but first, I'd like to know whether you'd be interested in attending or not.

If you'd be interested in learning more about battling diabetes fatigue,

vote in my poll

and let me know!

With Betic Love,
Kara


P.S. Tell your friends

I totally tried Afrezza. Here is my official review of this high cost, inhalable insulin:

About a year ago, I decided I wanted to try Afrezza, the new (at the time) inhalable insulin.

My Endocrine PA wasn’t comfortable prescribing Afrezza (it had never been prescribed by anyone in her clinic before), and she wanted me to meet with one of the M.D. Endocrinologists in the office before getting the prescription.

Naturally, getting an appointment with the Endo M.D. took 8 months.

During that 8 months, I did some research and prepared my presentation to the Endo.

I’ll spare you the details, but here are the resultant highlights of the proposal I submitted to the Endocrinologist:

1. I would start by trying the 4-unit inhalable insulin cartridges (Afrezza comes in 4, 8, and 12 unit cartridges)
2. I would wait until my blood sugar was high (>250) before trying Afrezza, just because I’d  heard that 4 units of Afrezza does not affect the diabetic human body as predictably as 4 units of human or analog injectable insulin, so to play it safe, it’s best to start off with a high blood sugar before inhaling 4 units of Afrezza.
3. I would not use Afrezza regularly or even daily. I would use it for incidental cases only (unexplained highs, occasional planned carbohydrate binging, etc.) - this is because I learned that some people experience what amounts to a “tolerance” to Afrezza. In other words, the more often you use it, the less effective Afrezza becomes.

My Endocrinologist is pretty practical, and I think the fact that I'd done so much research helped me establish credibility with her, so she agreed to let me try the Afrezza.

But first, I had to wait for the insurance company to deny coverage.

Then, I had to wait for the insurance company to deny the appeal and prior authorization for coverage.

After receiving the expected insurance denials, I found and printed a coupon from the Afrezza webpage. Then I went into the pharmacy, coupon in hand, and shelled out $150 cash for my box of Afrezza cartridges, which is a pretty great discount, considering I would have paid more than $300 without the coupon.

That afternoon, I ate a carby snack and chose not to take any insulin, so that I could purposefully cause my blood sugar to go above 250 so that I could try my Afrezza.

After thoroughly following the instructions on the Afrezza package insert, I took my first “puff.” Then I waited. You can watch what happened in the video below, or your can read the short version below (just scroll past the video).

Here’s the short version:

• I purposefully caused my blood sugar to go high, so that I could safely experiment with this insulin.
• With a blood sugar of 275, I took a puff of Afrezza
• 5 minutes after the puff, my blood sugar was 268
• 10 minutes after the puff, my blood sugar was 269
• 15 minutes after the puff, my blood sugar was 246
• 30 minutes after the puff, my blood sugar was 222
• 60 minutes after the puff, my blood sugar was 196

Since the initial experiment, I’ve tried Afrezza numerous times and had a bunch of interesting experiences. Here’s what I’ve found:

1. The higher my blood sugar is, the less effective Afrezza is. For example, Afrezza doesn’t do much to my blood sugar if I’m super high (>350). It works best when I’m in the 200-300 range.
2. If I use Afrezza too frequently, it seems to become less effective over time.
3. When Afrezza works for me, it works VERY quickly to lower a high blood sugar (80 mg/dL in 60 minutes!).
4. 4 “units” of Afrezza equals about 1½ units of Humalog (for me). So it’s definitely not as potent as injectable short acting analogs.
5. I do not plan to use Afrezza regularly, as part of my daily routine.
6. I will use Afrezza as my “rescue inhaler” for high blood sugars.
7. Mannkind should not market Afrezza as an inhaler that can be used regularly.
8. Mannkind should market Afrezza as a rescue inhaler for high blood sugar. A rescue inhaler that all occasionally hyperglycemic diabetics should have.
   

Do you have experience with Afrezza? Leave a note in the comments!

I get a lot of questions from folks asking about natural remedies for diabetes, and I thought this short video would help clear things up.

Hey Betics,

I get a bit of mail from folks wondering about my thoughts on the low-carb-high-fat (LCHF) diet (also known as Way-Of-Eating or WOE) and why I'm not pushing this as a lifestyle to everyone who has diabetes.

Here's one of my latest responses to one of the more polite inquirers about this:

Thanks so much for you email! How funny you should ask about LCHF - I'm actually in the middle of Dr. Bernstein's book right now. I'm pretty familiar with the LCHF movement, though I wouldn't call myself a dedicated subscriber at this time.

I think the LCHF results that people are reporting are really promising, but absent a comprehensive study similar to the DCCTs that occurred in the 90s, I'm forced to hold back a true opinion because the only published evidence of LCHF's success is anecdotal and/or represents results from a very small study (though the evidence is, admittedly, quite compelling).

My focus is to spend less time encouraging others to conform to a specific treatment method (and LCHF is certainly one method that has resulted in success for many), and instead encourage people to focus on getting their blood sugar into target range as often and as safely as possible. For some, that might mean adopting the LCHF lifestyle. For others, it might mean something completely different. 

There are three other concerns I have about LCHF. Since you've been working with this WOE for awhile, maybe you can share your thoughts on them?

1. One concern I have is its sustainability. Are people actually going to be able to keep doing it for the rest of their lives? Obviously, some people are very successful at LCHF, but I'm not sure it's sustainable for every diabetic. 

2. Next is affordability - eating healthful, unsaturated fats and ensuring you're getting enough protein, etc. can be expensive. This may not be practical for people in lower income brackets. 

3. Lastly, and this is a big unknown for me - is adopting the LCHF way of eating a veritable rabbit hole of increased insulin resistance, essentially ensuring that if you start LCHF, you won't ever be able to stop, or even cheat? If you fail at LCHF, would you be worse off than if you'd never tried it in the first place due to the increased insulin resistance caused by the inevitable intake of saturated fat, the increased rate of gluconeogenesis, and the increase in hepatic glycogen conversion?

LCHF is a method of blood sugar control that I definitely intend to try, so perhaps I'll have more interesting things to say about it once I've done so.

Thanks for your email, it forced me to get my thoughts about this down on paper. I want my efforts with BootCamp for Betics/PureDiabetes to be as accurate and as helpful as possible, so, if you have some data that can help push me into the LCHF camp, I would love to hear it!

Thanks,
Kara

Hey Friends,

This video is a bit long, and I can't quite decide whether it's a rant or a plea. I'm feeling proud that I managed to keep my $--t together until the final minute or two.

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 was a sample size of one, of course. And my experiment was driven by personal curiosity, not scientific inquiry. I will post this on the blog to make that part more clear. 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.

Hey Betics,

Many of you are aware that I recently started experimenting with metformin, which is a medication typically prescribed to people with type 2 diabetes. But, according to many reputable sources, metformin can also help type 1 diabetics (along with insulin, of course, which is required for type 1s) with blood sugar management.

I wrote about metformin in my I'm using a diabetes drug recreationally article a few months ago. Feel free to read that at your leisure.

My main goal in starting metformin was to see if this medication could help stabilize and flatline my blood sugar levels during and after exercise.

Exercise had been so frustrating. Every time I went to an exercise class with a perfect blood sugar, my blood sugar would go up by 60 to 100 mg/dL. Yes, you read that correctly. Exercise *raised* my blood sugar.

Now, you might be wondering, "Why the heck did your blood sugar go UP during exercise? Isn't it supposed to do DOWN?"

Let me explain.

I take insulin. I take basal insulin, which is used to counteract the baseline level of glucose that's always hanging around in my blood thanks to my liver's gluconeogenesis. I also take bolus insulin, which helps the food I eat (mostly carbohydrates), once it's digested into glucose, get into my cells. I also use bolus insulin to treat incidental high blood sugars. Insulin moves sugar from my blood into my cells. My cells like this, because my cells use that sugar for energy (and some other stuff).

I did a bunch of experiments with exercise. More specifically, I wanted to compare my blood sugar's reaction to exercise while my cells were in a starving state vs. my blood sugar's reaction to exercise when I had bolus insulin on board (non-starving state).

I started capturing blood sugar data surrounding my exercise events.

RESULTS OF EXERCISING IN A NON-STARVING STATE
Let's say I eat breakfast at 8am, and take 4 units of bolus insulin.

The insulin helps my breakfast carbs get into my cells to give me energy.

Yay! Now, let's say I exercise at 10am, with a starting blood sugar of 140. I still have some insulin in my blood, and I have some very satisfied cells that are full of energy.

But, during the exercise, my cells start using up that energy. And my cells start to run out of energy. So my cells get hungry.

But guess what. There's still some sugar in my blood because my blood sugar is 140, AND there's still some insulin in my blood because, well, even short acting insulin stays in the blood for up to 6 hours.

So, my body uses the remaining insulin to suck as much sugar as possible into my cells to give me more energy.

At the end of the exercise, my blood sugar is down to 40, and I'm shaky, clammy and need a snack.

Naturally, because I feel so awful, I eat and eat and eat, which results in a high blood sugar a few hours later, and then I get to enjoy a blood sugar roller coaster for the rest of the day.


RESULTS OF EXERCISING IN A STARVING STATE
I'd wake up, and I would NOT eat anything for breakfast.

Then, at noon, I'd go to my exercise class with a blood sugar of, for example, 120. I'd exercise for the full hour, and then check my blood sugar immediately after the exercise. 200. My blood sugar was 200.

​Seriously, what??

Here's what happened. My cells were hungry. Since I hadn't eaten breakfast, those cells didn't have much energy to start with. So, I started exercising and I pretty quickly used up all the energy in my cells. But, since I didn't have any extra insulin in my body, there was no insulin available to pull sugar from my blood into my cells to give them more energy.

But it didn't end there. Did you know that you liver is supposed to store glucose, and give you a few squirts of that glucose when you need it?

Well, one of the times you need glucose is when your cells become starving. So, noticing that my cells were starved of energy, my liver helpfully squirted a bunch of glucose in my blood, raising my blood sugar to 200.

And...guess what. I didn't have any bolus insulin on board to carry that sugar into my cells. So basically, my cells were starving, and there was plenty of sugar in my blood to feed them, but unfortunately, the insulin required to move the sugar into the cells just wasn't there. So I had starving cells and high blood sugar.

So, HOW THE HELL is someone on insulin supposed to exercise while keeping their blood sugar at a flat line (or as close to target as possible)???

I contemplated three potential solutions to this problem.

One potential solution was to do my exercise in a starving state, and then use Afrezza, the super-fast-acting inhalable insulin, right after exercise, to lower my blood sugar. This is something suggested by my friend Dr. Gaja Andzel, whom I trust completely to give me diabetes-related advice. But, my doctor here in Wisconsin is pretty risk-averse, so I'm still in the process of convincing her to let me try Afrezza.

Another potential solution was to try metformin, a drug that suppresses the liver's glucose-squirting activities and reduces insulin resistance, to see if I could exercise in a starving state without getting that extra sugar kick from my liver.

Another potential solution was to try experimenting with the timing of my breakfast, insulin doses, basal rates, etc. I've been there, done that. It's pretty hit or miss at first, but you can eventually get it right. I know some athletes who've been really successful with this method. If you need some coaching on this, Dr. Matt Corcoran from Diabetes Training Camp is a great resource.

​My goal was to flatline my blood sugar during and after exercise. Since I couldn't get access to Afrezza (that's coming soon, I promise!), and since mucking with my dosing and rates is not easy and affects everyone differently, I decided to try metformin to suppress my liver from squirting a bunch of sugar into my blood during exercise.

I did some research. Then I did some asking around. Then I talked with my doctor and she agreed to prescribe me metformin. Then I did some more research and wrote the I'm using a diabetes drug recreationally article. And then I started taking metformin.

I decided to take the extended release version of metformin (marketed as ER or XR), because I'd heard horror stories about side effects from the "regular" metformin. The effects of extended release metformin apparently aren't as severe.

That's not to say there weren't side effects. For me, the side effect was pooping. Lots of pooping. It lasted about six weeks and then I didn't have the effects anymore. Other than that, I've experienced no other negative side effects.

My instructions were to start taking 500mg/day for a week, then increase by 500 each week until I reached the max dose of 2000mg/day.

During the dose increases, my blood sugars were all over the place. I was playing with basal rates, recalculating insulin sensitivity factors, adjusting bolus ratios, etc., and my blood sugars were all over the place. I was high, and low, and high, and low and on a total roller coaster for a few months. I decided to stick with 1500 per day, and do somebaseline testing.

Once I reached a dose of 1500 mg per day and did some baseline testing, I noticed three things:

1. I didn't need as much basal insulin. Due to the metformin, I had to reduce my original basal insulin by about 15%
2. I didn't need as much bolus insulin. Due to the metformin, I had to reduce my bolus insulin by about 10%
3. I had VERY little, if any, increase in blood sugar during exercise. Metformin solved my "exercising while starving" problem.

Once I reached 2000 mg per day, I noticed two more things:

1. I had to reduce my original basal insulin dose by 20%
2. I had to reduce my original bolus insulin dose by about 15%

So, overall, I'm getting exercise without screwing up my blood sugar. I'm also taking less insulin overall. Do you know what that means?

It means that since I finished the baseline testing and got the initial metformin-induced roller coasters under control, I've lost about a pound per week.

Why? Well, insulin is a hormone that helps glucose get into your cells, which your cells use as energy. If there's an overabundance of energy in your cells, your cells store that energy as fat. Yep. Insulin is a fat storage hormone.

You NEED insulin to survive, though. If you don't have insulin (either from a vial, a pen, or from your own pancreas), you will die.

Striking a balance among exercise, blood sugar levels, insulin, metformin, eating, and weight loss/gain is hard. Like, really hard. But I'm not going to complain about that.

What I will continue to complain about, however, is how much we have to FIGHT to get the diabetes supplies, education, and care we need in order figure stuff out like this.

Next up, Afrezza. They're marketing it all wrong. I'm going to run some experiments with it starting in May, and perhaps we can set Mannkind straight.

With Betic Love,
​Kara

This video contains instructions for drawing insulin into a syringe from a vial.

Hey Betics! Three quick things:


Thing #1: 
A company called OneDrop just released a subscription service that comes with a glucose meter and unlimited test strips, and this is not a joke.

I'll write a full article later with more details, but I wanted to make sure you got the news right away. I will say that UNLIMITED does not mean as many as you are able to hoard (bummer). It means as many as you actually use.

Still, this could be really freaking awesome for those of you who

1. have crappy prescription coverage
2. have no prescription coverage at all
3. have a strict test strip limit

Thing #2
I got some great feedback after I sent out the Diabetic Thanksgiving Survival Guide last month. One of you kindly advised me that the survival guide can be used for more than just Thanksgiving dinner. I'm not sure why I didn't think of this, but apparently you can use the Thanksgiving Survival Guide for parties, special events, holiday dinners and any other way it works for you. So, in case you have upcoming special events, here's the link to download the Thanksgiving guide (again).

Thing #3
I've recently learned there's a great need for a diabetic-friendly meal plan service that tells you specifically what to buy, what to cook, how to cook it, and how many carbs are in it, etc. I need to know more about what that service needs to look like before I start working on it (confession: I've already started working on it a little bit). So, if you have some time today, can you click the link below and give me some direction, here?

Sure, I'll give you some feedback.

Sorry, Kara. I'm too busy to help you.

With Betic Love,
Kara

​I gained a full percentage point.

Hey Betics,

I just checked my A1C and the results are very grim. My A1C increased by a full percentage point between September and December.

The reason? Well, I slacked off for about two months and stopped paying attention to my diabetes. And, as my A1C indicates, I am again forced to acknowledge (for the millionth time) that there is no time off from diabetes.

Ugh.

It is time to get my butt in gear and solve this problem. I know I can lower my A1C within the next month, but only if I start paying attention to my diabetes again.

Here's what I'm going to do.

1. I'm going to check my blood sugar more often.

2. I'm going to stop eating crap. Or, at least, I'm going to reduce the amount of crap-eating. This should be easier now that Christmas is over.

3. I'm going to reset my baseline blood sugar by doing a series of mini-fasts over the course of 3 days.

4. After I fix my baseline, I'll decide what to do next.

And - 

I'd like you to join me.

I'm inviting everyone on this list (type 1, type 2 and type 1.5) to join me for my next online Baseline Blood Sugar Challenge Event, which starts January 1. This is a 3-day blood sugar reset program.

Registration is FREE until December 31.

So, if your blood sugar is behaving badly thanks to the holidays, join me in setting our baseline blood sugars straight.

This is likely the last time I'll be offering this $59 web event for free, so if you haven't tried this yet (or if you did this in September and want to do it again), now is the time!

Will you join me?

Sure, I'd love to kick my baseline blood sugar's ass.

I'm not sure. Tell me more about it.

See you there!

With Betic Love,
Kara

P.S. If you'd like to invite a friend or family member, use one of the social share links below.

P.P.S. This course uses video, textual content and email. That means program registrants will get a daily email for 3 days. If you aren't available January 1-3, you can still register today and complete the course at a later date as long as you save the emails.