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Faprocar? Profaca? Carprofa? Huh? June 11, 2013

Posted by laosita in diabetes.
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“Okay, so tell me what I just said.”
Never once has a doctor asked me to repeat whatever he just told me. My face must have given me away because he said, “It’s complicated; a lot of people don’t get it.” I did as requested, and nailed it.

“Good,” he said with approval, “let’s see if that helps.”

What was it that I was repeating? A new meal calculation to bolus for protein. Protein + fat bolusing (profa? This needs a name). I’d coasted along with my 1:10 insulin:carb ratio (inject one unit of insulin for every 10 grams of carbohydrate). Pretty simple – I often do the calculation in my head, round up and manually bolus.

But that wasn’t working out quite right, so we added a second part to the equation: fat + protein. The sum of that gets a 1:20 ratio. This sounded like an interesting plan of attack, and I am willing to do the extra math for now. Last week’s lunch was a lettuce and hummus sandwich.

Hummus: Fat 3g, Protein 2g, Carbs 5g, Fiber 1g.
Ezekiel 4:9 Bread (1 slice): Fat 0.5g, Protein 4g, Carbs 14g, Fiber 3g.

The carb (1:10) ratio uses total carbs – total fiber.
For this sandwich, (2 x (14 – 3)) + (5 – 1) = 26. 26 at a 1:10 ratio means 2.6 units.

The profa (1:20 ratio) uses total fat + total protein.
So, (2 x (.5 + 4)) + (3 + 2) = 14. 14 at a 1:20 ratio means 0.7 unit.

Lettuce and hummus sandwich!

Total lunch bolus for what I’m eating (forget exercise or blood glucose corrections) = 2.6 + 0.7 = 3.3 units. Cool.

But, during my endo appointment it slipped my mind that I consciously shop low carb, high protein for a variety of reasons that work for me. Now I have to count protein into my insulin ratios as well? I felt unsettled.

When I look at a nutrition label, I first look at carbs. High carb items usually return to the shelf. Next, I look at protein (I’m still trying to remember to consider fiber). In my mind, the higher the protein without crazy calorie count is a food win. Except now I feel deflated about adding protein.

It seems in diabetes, large numbers often equate to failure, trouble, guilt and exasperation. A low-carb fake chicken breast (vegetarian active chick here) with 15 g of protein adds more insulin, so I question if it’s worth eating. I know that will barely add one unit, and with most meals it won’t be more than a half unit, but it’s yet another number. Another consideration. Another math problem. Another judgment. Another emotional hurdle.

And homemade food? Ha. I’ll let you know how the math is working on that in a year or so.


Accomplishments Big And Small: #DBlog Week, Day 4 May 16, 2013

Posted by laosita in diabetes.
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Dblog Prompt: We don’t always realize it, but each one of us had come a long way since diabetes first came into our life. It doesn’t matter if it’s been 5 weeks, 5 years or 50 years, you’ve done something outstanding diabetes-wise. So today let’s share the greatest accomplishment you’ve made in terms of dealing with your (or your loved one’s) diabetes. No accomplishment is too big or too small – think about self-acceptance, something you’ve mastered (pump / exercise / diet / etc.), making a tough care decision (finding a new endo or support group / choosing to use or not use a technology / etc.).

Thinking about this prompt, the first thing that came to mind is this blog. This blog is the biggest thing I have done BECAUSE I am diabetic. But, let me backtrack. I don’t think about my accomplishments with or because of diabetes. I don’t remember not having diabetes, so any accomplishment in my life celebrated the actual goal at hand. When I graduated college or bought a house, those accomplishments were not made any less important or more important because I’m diabetic. Riding my bike to work was huge for me – I wore my YouCanDoThis bracelet, but that is as close as diabetes got to that accomplishment. Losing weight, staying fit, eating healthy, are accomplishments because I feel better about myself. Those accomplishments make diabetes easier to manage (note – never easy), but I do not attempt those things just because I am diabetic.

It’s just part of who I am. Infusion sites, new technologies, crunching numbers are my every day life. I have always had to manage this whole extra set of stuff. The accomplishments I might have within that extra set of stuff are no different than someone meeting their goal to eat more vegetables, drink less, a weightlifter getting a max rep, or a body builder acing his pose.

Perhaps my biggest accomplishment is that diabetes has never been my biggest accomplishment.

Cure and Hope Are Four-Letter Words March 7, 2013

Posted by laosita in diabetes.
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This week has been one of posts about cures, hope, disappointment and encouragement because of an announcement made pertaining to a ‘cure’. The posts have been superb, and I’m so proud to be in this community right now. Check out links in this post, or my blogroll, for some phenomenal DOC reads and thoughts.

Hope. Cure. Technically, these are four-letter words. I use the less appropriate four-letter words more often. In the almost 25 years I’ve lived with diabetes, not once did I think I would be cured and never will I believe a cure is in my future.

While I don’t remember anyone telling me specifically ‘They’re working on a cure, hang tight 5 to 10 years’, I do recall countless reports of ‘cures’ in the next 5 to 10 years. As so many DOC members have shared, they would be cured twice or three times if that were true.

I do not believe in a cure in my lifetime. And I do not hope for it. Say a cure is discovered tomorrow. Great. That does not mean shit for me. Not every diabetic will be cured the day after FDA approval. FDA approved does not equate to accessibility. My control, as compared to ADA guidelines, is solid. Therefore insurance might tell me I don’t ‘need’ the cure. People with ‘out of range’ A1Cs or high risk of complications would top this cure list.

No eligibility restrictions? Cool. My health insurance rocks, so I might be in. But a cure comes with its own set of restrictions. A whole new way to care of my body, to care for whatever extra precautions I might need to take. Transplants come with a slew of issues the patient must be aware of and manage. I am not sure I would be willing to change my day-to-day responsibilities – that I’ve managed for two decades – for something brand new.

And what about folks without awesome health insurance? What percentage of PWDs would love a CGM or a pump, and CANNOT GET ONE because of cost or insurance issues? Kiddos in poorer nations cannot get daily insulin injections. In those countries, diabetes is still a death sentence. That.Is.Bullshit. The people who need a cure the most won’t be the ones to get it.

Hope for a cure is too uncomfortable, too foolish, too selfish for me*.

However. Hope for technology advancements, for improved education and for prevention – I am onboard with that. That is why I participate in the community. That is why I support JDRF, ADA, the DOC, mentors, educators, endos, scientists and studies.  And to me, that is as important as the cure is for a parent with a newly diagnosed kid.

But a cure is not something to count on. It is not something to teach your kid or your peers to count on. The goal of any diabetic is to survive and to live life. That is anybody’s goal. Yeah, your pancreas screwed you over. Use that to make you a better person. Is it easy? Never. Fun? There are upsides, but no not really. But You Can Do This. Having diabetes makes you smarter about your choices. Makes you responsible. Makes you grateful. Would I ever wish diabetes on anyone? Hell No. But for those of us with whacked-out pancreases, don’t let hope for a cure distract you from your achievements. We have enough distractions.

*Note: I respect those of you hopeful for a cure. It’s just not me. Truly, you make a difference. Truly, you contribute to a worthy and admirable cause.

104 February 20, 2013

Posted by laosita in diabetes.

The other night that number showed up on my meter display. My actual meter. (Note for those with functioning pancreases- blood glucose meter companies often show a ‘perfect’ blood check value on the meter packaging and advertisements. That number is often 104. In real life something, often inexplicable, went way right for that number to show up).

Those damn meter companies, I thought, that is the actual perfect number. I had exercised and sipped a cup of hot chocolate before bed. I accounted for both activities, but at night who knows exactly what will go down…or up.

103 would have made me just a tad concerned about dropping low in the next few hours while I attempted sleep.

105 would have made me consider a half unit bolus to cover any possible increase in the next few hours.

A one-point change that causes two very different reactions is ridiculous. I recognize this. One Point. Had I checked a second time, the chances of getting 104 are next to zero. Dex said 109. Yet I confidently went to bed with my 104. (Sure enough, I had a solid night of in range numbers.)

I would never aim for 104. Aiming for one number, a specific perfect number, sets me up to fail. I fail often enough with diabetes and even if the failure truly was not my fault, it sure can feel that way. Instead, I’ll aim to be around 104. I have a range of numbers that I am happy about. I have a range of numbers that make me worried. I have a range of numbers that piss me off. But not one number, one time.

Not even 104.