The Gastric Bypass Hype... Is It Really a Cure?

The headline declares: "Curing diabetes via surgery, without weight loss". It's a bold statement. It's enough to make one stop, and read. I admit I did just that.

Every week, it seems, we are bombarded with a new article declaring the magical, curative qualities of gastric bypass surgery. These articles make it seem like gastric bypass is the simplest, most sensible way of managing diabetes -- and gosh darn it -- everyone ought to pursue it so we can put a stop to this overwhelming epidemic that's going to just take over America, and murder us all. (Please note I am being sarcastic here.)

I admit I don't have all the answers -- if I did, I'd have long ago found a cure for all of us, and retired to my white castle atop a hill, facing the ocean. But what I can tell you is that I have a lot of questions and skepticism. And so should you.

Whenever there are articles like this, I look for red flags:

• Is the article edited properly? It might seem like a simple thing, but honestly, if someone in a professional, journalistic setting, doesn't care enough to edit their articles for grammar, spelling, content, and accuracy, they certainly might not care about outright lying to you to get some readership.
• Is the article unusually chipper or eager to present this as an 'all around' solution to a problem? Does it present ALL sides of the debate? Does it present ALL alternatives?
• Does the article portray accurate medical conclusions, information, and accurate explanations, or does it confuse the public about its target audience? 
• Does the article present accurate, statistical data, as has been reported by other research outlets, and scientific journals? 
• Is the study funded by third parties with deep pockets, and deep interests in the outcome of said study?

Taking all these questions into account, let's look at this week's gastric bypass article (which I have linked to above.)

Red Flag #1

The article starts off by telling us about Cristina Iaboni (a woman who was selected as a test subject for gastric bypass in leaner patients), and offers this description of her situation:

"Cristina Iaboni had the dubious distinction of being not quite obese enough. For all the pounds on her 5'5" frame, she did not meet the criteria for bariatric surgery to help control her type-2 diabetes.  

Yet six years of medications and attempts at healthy living had failed to rein in her blood glucose, leaving Iaboni terrified that she was on course to have her kidneys fail "and my feet cut off" -- common consequences of uncontrolled diabetes." 

Right off the bat, I'm kind of concerned about the quality of medical care Mrs. Iaboni may have received. Did her medical team question everything that needed to be questioned? Was she on insulin? When I read "6 years of medications," it literally screams at me that they kept her on every oral medication combination out there, and did NOT put her on insulin, like they should have. What kind of 'healthy living' changes did she attempt to make? Was she she still consuming a high carbohydrate diet, and just substituted her carbs for wheat, and whole grains? Did she even know how to carb count? Did her doctor ever test her for antibodies, and is she a LADA, instead? While the article declares she's 'cured,' I have the strong feeling this woman might rebound down the road.

Red Flag #2


Follow this logic statement with me: "If smoking triggers lung cancer, than smoking cessation should cure cancer."

Oh, it doesn't work that way, you say? Once you have it, you're stuck with it? Oh. Then why do some media and some 'researchers' assume that if obesity triggers diabetes (in those who are genetically predisposed, mind you), that losing weight should cure the diabetes?

The simple answer is "I don't know." The complex answer is "Because they probably have something to sell you."

Certainly, one can assume smoking cessation helps better manage cancer -- I am sure. One will be healthier, and respond better to treatments, and will have a stronger immune system... But one cannot say one is suddenly cured of the cancer. (Even when one is in remission.) Diabetes and weight loss are much the same: weight loss merely makes one healthier, and be able to respond better to treatments (ie, be more insulin sensitive, use less insulin and medications, sometimes none, etc.) These are only ways of tightly controlling diabetes, though, and slowing down it's progression. The absence of medicine is NOT an absence of illness. In this case, it is the strict diabetic patient's regimen that is the patient's medicine. The pancreas has damage, and this damage is irreversible, thus far. It is not, suddenly, magically healed.

Interestingly, this article seems ready to admit (though hesitantly so) that gastric bypass -- since people seemed to be 'magically' better just days after surgery -- proves that a diabetic 'cure' is NOT about weight control, or weight loss. However, here is where the red flag comes in: they are NOT willing to admit that the extreme dietary restrictions a patient must submit to (caloric and, consequently, carbohydrate level restrictions), post op, will play a role and immediately make less glucose available to the patient, and therefore, less high blood glucose issues. Now, normally, a patient who chose to control diabetes with diet and exercise would take a bit longer to achieve euglycemia (or normal blood glucose levels) when consuming a diet lower in carbohydrates and eating 'normal' amounts of food -- but they don't get a head start. A pre-op gastric bypass patient has to be on a type of fast with limited food and liquid intake, so they're already starting out with less available glucose in their system for a couple of days. Yes, they are going to have great numbers in just a few days. Barring other variables, yes, it's that simple, sometimes. I don't think this is rocket science.

Quite frankly, a patient could just go on the restricted diet, and skip the surgery, and achieve similar results... And not that long ago, some of these 'researchers' were practically claiming this same argument: A 'very low calorie diet' could cure type 2 diabetes. 


This article though, quickly sidesteps the discussion and dismisses it without much more than an acknowledgement.


Red Flag #3


The idea that type 2 diabetes begins in the gut is not a new one. It has been, however, a seldom reported one.

More commonly, you see articles speculatively linking the bacteria most known for leading to peptic ulcers (h. pylori), to endocrine disorders (as well as diabetes), and these have been quietly making the rounds since at least 2009, maybe even earlier. There's even an interesting study dating back to 1999, and involving children with type 1 diabetes, insulin requirements, and the presence of h. pylori. The most recent finding came this month, and it involves h. pylori and it's impact on A1C.

The underlying message is clear: bacteria, and inflammation, alter the body's ability to process glucose -- whether in the stomach, or in the gut.

But are the researchers missing the obvious clues? They mention that 'in the past,' patients with peptic ulcers who had surgeries altering their stomachs, and gut connection, 'cured' their diabetes. Or did they just achieve better control of their diabetes because a.) they were now having to, forcefully, eat far less, and b.) the surgery removed chronic inflammation from bacterial infection (which would have dramatically raised blood glucose levels)?

Other articles, and research, have pointed to a bacterial imbalance in the gut as a trigger to an imbalance in processing glucose, and development of type 2 diabetes, but they do NOT suggest surgery for 'curing' the disease. In fact, they suggest a more preventative method -- receiving gut microbiota transplantation. This seems to me like the less invasive, less dangerous, less costly and time consuming, way to go when it comes to researching a cure. Why are we not investing in this? Why is there such a PUSH for getting this dangerous surgery?

The attempts to also connect this surgery to a potential 'cure' or reversal of type 1 diabetes seem a bit far fetched, and improbable to me, and make me question if this researcher has a proper understanding of the etiology of type 1(a) diabetes -- and that it isn't just an insulin insufficiency scenario. I'm pretty sure people need insulin to live, and for many various metabolic functions, and just 'bypassing' a gut mechanism isn't going to make a person insulin independent. I'd like to see more than just three sentences in a poorly edited FOX news article, on the matter.

Red Flag #4


Numbers.

These articles always seem to exaggerate diabetes incidence numbers. This one is no exception. It claims that 8.3% of the world's population has diabetes, and that 11.3% of Americans, have it. Honestly, I don't know where the 11.3% figure came from, with these folks -- but according to the most recent data (released January 26, 2011 -- and not the 2010 date these folks claim) released by the American Diabetes Association, only 8.3% of Americans have diabetes -- and this includes all types, and the undiagnosed. 


Similarly, these folks make these grandiose claims for the 'remission' rates of Roux-en-Y to be 80-85%, and to be incredibly superior to other forms of gastric surgery. But major studies DON'T show that.

"New research reports that no procedure for weight loss surgery is any better at treating diabetes than another. The study, presented May 7 at the International Congress of Endocrinology/European Congress of Endocrinology in Florence, Italy, uses a large ongoing study to show that improvements to diabetes in patients undergoing such surgery is likely to be due to the degree of weight loss itself rather than the type of procedure." (http://www.sciencedaily.com/releases/2012/05/120507102225.htm)

And here's a more startling fact...

"Weight loss surgery is not a cure for type 2 diabetes, but it can improve blood sugar control, according to a new study published in the British Journal of Surgery. Whereas some previous studies have claimed that up to 80 per cent of diabetes patients have been cured following gastric bypass surgery, researchers at Imperial College London found that only 41 per cent of patients achieve remission using more stringent criteria." [emphasis added by me] (http://www3.imperial.ac.uk/newsandeventspggrp/imperialcollege/newssummary/news_4-1-2012-13-32-26)

And that's the ticket here, isn't it? What kind of criteria are these folks using to claim someone is cured? What are their A1Cs, now, and what are their average blood glucose numbers like? I've had folks tell me "I have an A1C in the 6.5% range, so I no longer have diabetes." But wait a minute? That's the number used to diagnosed diabetes to begin with! 

Hey, but you no longer need medicine (for now, anyway), so you must be cured, right? It sounds so pretty... It sounds like such a good sell.

And because it sounds like such a good sell... I give you:

Red Flag #5

"The cost of the bypass surgery is covered by a grant from Covidien Plc, which makes laparoscopic instruments and surgical staplers." 

Oh, so let me see... the people who profit the most from this surgery are the ones funding a study to tell me how awesome this surgery is, how high a success rate it has (even though it is absolutely not supported by independent studies), and how I will just be so cured.

Hmmmmmmmm. Let me think about that. Fox guarding the hen house much? This reminds me of last year, when the ADA published a study done by the Australian Dairy Association, claiming that milk consumption lowered risk of diabetes.

Of course you're going to tell me it's awesome! You want me to buy more of it, and you want me to fall in love with it. You need to make money, too, like everyone else! It's MARKETING.

The problem comes when the money making interests muddle the big picture, and really go against the best interests of the INFORMED patient.

What am I trying to get at, with this blog post? 


Should you avoid gastric bypass? Is it a dangerous alternative?

These are questions you must weigh for yourself... but what I would like to see is for patients to be able to weigh the TRUTH against the hype. NO ONE should promise that surgery will be a success, that it will heal and cure diabetes, or that it will be complication free; but, instead, they must help guide the patient to a point where they can soberly weigh their current health risks against the surgery's very real risks and potential failures. It is easier to accept the roll of the dice when we know that risks are possibilities -- and when we aren't lead to believe that this is just a simple, routine procedure, that will fix our woes forever.

More importantly -- the type of lifestyle changes required by these surgeries are far more demanding than say, pursuing a low carbohydrate regimen (like Berstein's Diabetes Solution, or Atkins), or even raw dieting. If a patient fails at these, or simpler life style changes -- when their life is not at stake -- what makes them feel they could do okay with the dietary demands of such a surgery? Because they got 'two weeks' of psychological counseling pre-op? Disordered eating, and compulsion, take years of counseling to improve (much more to 'fix')!

Additionally, studies have shown that after some time, people's diabetic symptoms may return, and some folks even regain weight and end up pursuing additional gastric surgeries. I am not entirely sure that the costs of surgery, with it's attendant complications, are worth my getting a 'free pass' for a few more years; especially, when I can just give myself that free pass with a more calorie restricted, low carbohydrate diet.

And I don't know about you... but I just like eating food in portions larger than a peanut.

The Moldy Cupcake Awards

Copyright © 2010 Julie King 
/ Gleeful Things. All Rights Reserved.

Today, I'd like to add a fun, new, regular segment to our blog called "The Moldy Cupcake Awards."

Ya' know... It's just so inspiring to read or watch the news, every week, and see ALL manner of misinformation, quacks, outright lies and drivel, just regularly being fed to the public for the sake of ratings. So, because you've inspired us, ALL of you who are the most deserving for writing, or producing, the shittiest materials out there for the public, will get a wonderful mention here... along with a not so sweet, and oh, so moldy critique.

You've worked HARD (not!) for it, so you're gonna get it! Today's deserving green, stale, sad, and moldy cupcake goes to... The View!

That's right. Earlier this week, the View produced this GEM for it's regular audiences.

 
Let's take a moment to examine this, not so educational moment, play by play. 
Right off the bat, I am immediately annoyed because for all her education, Barbara Walters CANNOT pronounce diabetes correctly. I'm sorry Barbara, it would seem you've spent your free days watching too many Wilford Brimley commercials.
If that doesn't annoy you, then the big letters headlining "The Fat Show," in the background, should. Oh, sure, Barbara, you aren't fat. Let's see your saggy behind in a bikini. I double dare you.  
She goes on ahead, and introduces this man, David Nathan, as the Director of the Diabetes Center at the Massachusetts General Hospital. It should SCARE the beejesus out of you that someone with such a title (and employed at a hospital, mind you) would get on such a show, and FAIL to grasp the opportunity: 

"So I think everyone recognizes that diabetes is a condition where your blood sugar is elevated. We all KNOW that. What many people don't understand is that when your blood sugar remains elevated over many years, blah, blah, blah... feet falling off... blindness... blah, blah..." (Okay, that's not entirely, a literal quote.) 

Dr. Nathan, for someone who calls himself a doctor you are surely very disconnected from reality.

1. NO, people do NOT know what diabetes is about. You could've spent a minute or two, telling people that our condition is a condition in which the body FAILS to be able to process glucose adequately, and that ALL food gets converted into glucose. NO, people do NOT know the difference between sugar, and blood glucose. People think if we just stop having Paula Deen lady donut burgers, and ho-hos, that blood sugar goes down, and diabetes goes away.

This is the kind of situation that gets people bullied by idiotic people thinking they can take on the role of diabetic police.

2. Meanwhile, everyone DOES know the serious complications diabetes may bring, so since they associate them with eating too much sugar, they are ALWAYS making jokes about our feet falling off, and us going blind. You could've clarified a little better that well controlled diabetes is the main cause of NOTHING... But you really missed the boat on this one. Thanks for letting the bullying cycle persist.

Now, I don't really understand why The View would have Paula Deen as some kind of 'interviewer' for this segment, asking things she really doesn't understand because she's just too new, and uneducated -- but it matters not, because this Dr. Nathan fails to answer her questions directly. She asks him what the connection is between obesity and diabetes, and he doesn't really say... He just muddles the picture by starting to talk about other majorly recognized risk factors, and how now, younger folks are getting diagnosed because of weight. Okay? So tell us something we DON'T know. Why not tell people "gee, the more you are overweight, the more your body will struggle to produce insulin -- and if you are genetically predisposed to insulin resistance, and diabetes, the more it will likely trigger your developing the condition at an earlier age..." Is it that difficult to speak to people with truth and honesty, and clarity? Do we think The View's audience are a bunch of simpleton housewives, who only know about dish soap? I wonder...

Oh, and I love how you describe Type 1 as "the insulin dependent, juvenile form... the Mary Tyler Moore form..." That's metaphor, right there!! A definitive moldy cupcake award for dialogue. Here's a TALL idea, for you: how about calling it the "my autoimmune system sucks, so it attacked itself" form. People will have this FOREVER, and can get it at ANY age. They don't grow out of it, and gosh darn it, MANY adults, every year, get it... WAY past their 'juvenile' years. Oh, and to add to it, you make it sound like type 2s don't need insulin, when in fact, if a type 2 diabetic is diagnosed early enough in their lifetime, they will more than likely need insulin before they die. MOST type 2 diabetics will go on to need insulin. It's a fact. Hell, it's an American Diabetes Association researched fact -- even when they're trying to act like it's not. 

One thing is pretty juvenile, though -- your casual approach to discussing diabetes. You nailed that one right on the head.

Now, dear Paula Deen tries so hard to stay relevant in this discussion. Paula, honey, NO ONE is born with type 1 diabetes. And I think an awful lot of parents out there would kind of take offense to your portraying their children as like 'having leukemia.' I say this, because while type 1 diabetes can be deadly and challenging, we all know you weren't trying to suggest they were 'troopers, fighters, survivors, and well adjusted kids...' No, you were trying to suggest they were sickly, weak, and likely to die from sneezing. Paula, I support your journey with diabetes, but sometimes... you gotta shut your lady burger pie hole. Okay? We should not comment on things we know not about.

I am not completely angry at the intense stupidity of this segment (okay, I lied...); I'm actually happy for your patient, Misty. I'm happy she's doing better, and is healthier.

What I'm not happy about is that Misty doesn't seem to understand what a diabetic diet is all about. She keeps talking about sugary drinks, sodas, juices. She doesn't talk AT ALL about controlling her carbohydrate intake, carefully weighing out her meals and portion control, in any way. In fact, NO ONE ever mentions carbohydrates and their role in any way -- and continuously focus on sugar!

Dr. Nathan, this is the BIGGEST disservice you can do for people -- letting them go on believing that diabetes is about sugar. IT IS NOT. Diabetes is NOT about juice boxes, soda, cookies, etc. It takes a hell of a lot more effort to control diabetes than to just cut out soda and juice boxes. In fact, I am so scared of Misty's apparent lack of knowledge of what it all entails, that I truly wonder what her A1C is, and what you justified to yourself was "excellent control" to make it seem she needed to get off the Metformin. I guarantee it's not in the 5.0-6.0 percent rating. It can't be. Not with her thinking it's just sugar. She probably goes home and has a plate full of wheat pasta, and calls it good.

"That's the beauty of type 2 diabetes... is that it is reversible." 

Diabetes is not reversible. Whenever folks discuss diabetes as 'reversible,' what they are referring to are the symptoms of uncontrolled diabetes. Blurry vision, dizziness, slow healing cuts, some forms of early neuropathy, thirst, continuous urination, headaches, mood swings, etc.

I have news, for you Paula... You'll still have diabetes, even when all those things are gone. You live life so that you CONTROL those things -- but you can't stop your routines, or those things WILL return. And quickly. Your diet is your MEDICINE. It's just exactly like medicine.

In this sense, Paula... ALL diabetes is reversible. Yes, even type 1 diabetes. It's a BOLD statement, but I know some pretty TOUGH type 1 diabetics out there that could run circles around me, any day, and to the average world look like they have NOTHING wrong with them. They have worked hard to REVERSE the horrible grip of uncontrolled diabetes which they had at diagnosis. TIGHT control is what we ALL aim for -- but it takes CONSTANT work and effort, and it is SO not a cure.

Photo by RingoFuentes

You can't go on living like just testing once a day, and not knowing what carbs do to you is, somehow, having diabetes in control. It is a full time job, and it causes a lot of psychological trauma, and exhaustion. There's just NO beauty in this pile of dung. (But you'd be a little prettier if you spoke a little less. :) Thank you.) The beauty is in US -- and how we evolve to adapt to the harsh winds of diabetes.

Additionally, Dr. Nathan, it is embarrassing that you would suggest to people that all they need to do is lose a modest amount of weight to better manage their diabetes -- this is untrue. While weight loss helps lessen some of the challenges of insulin resistance, it is NOT the way to control diabetes -- the way to control diabetes is to control one's diet and carbohydrate intake, along with weight lifting and resistance training, and sometimes, medication. When you tell people that losing 5-7% of their weight would reduce diabetes by 58%, you are leaving them with a lot of confusion, and mixed feelings. I mean... what the HELL does that even mean?????

You can't reduce diabetes by 58% when YOU ALREADY HAVE IT.

You must be talking about the poorly done, not so large, diabetic studies... who used a lot of extrapolation, inference, and ignoring of many, many additional risk factors and components, along with populations that did NOT represent a cross-section of the country... to claim that 58% of diabetes could have been PREVENTED. Which is another poorly used word. One can only REDUCE one's odds of disease -- not eliminate them. There is NO SUCH guarantee that you won't get diabetes, even if you do 'everything right.'

So, Dr. Nathan, Paula Deen, Barbara Walters... for all these reasons -- and I'm sure -- many more... You have earned yourself a Dung Cupcake. But they don't make dung cupcakes, so here's a moldy one, instead. You've earned it.

One big, so not so heartfelt, THANK YOU... for all the work you DON'T DO. You make the world one heck of a crappy place for diabetics everywhere.

(Oh, and in case you didn't get it... That's called sarcasm. It's a young people thing.)

. . . 

If you would like to submit 'nominees' for the week's crappiest stories worthy of a Moldy Cupcake Award, feel free to 'Contact Me,' and they shall be thoughtfully considered. :D We shall leave no moldy cupcake left behind. 

The School Lunch Debate: When Mystery Meat Is Truly A Mystery...

With the rising tide of juvenile type 2 diabetes, the debate on school lunches is one which is slowly starting to take the stage. It is, however, one of those subjects in which everyone has an opinion -- but not many have an actual evidence based opinion. Throw in the wrench that every school district is different, and you'll find mudslinging from all sides of the opinion spectrum:

Why can't parents just make healthful lunches for students? 

Well, right now, some schools are actually BANNING parents from preparing school lunches for their kids, claiming it is the parents making unhealthful meal choices. Of course, this is often true... No one can deny that. But it also makes many of us with diabetic loved ones CRINGE at the thought of what a school cafeteria lady, or health department, might think is a healthful school lunch. These places often lack in options. I'm thinking a main course of carbohydrates slathered in cheese and hot dogs, with a side of carbohydrates slathered in butter or salt, with a dessert full of carbohydrates, and a glass full of carbohydrates (because it has vitamins, so it must be good for your health, unlike that can of soda.) Your main sources of protein come from that powdered, grade A government issued cheese, and that powdered, grade A government issued milk. YAY. To top it off, throw an apple at it, for good measure, because apples make ANYTHING look healthy.

Some will argue, why can't parents just trust the school lunch system? 

'I always got healthful meals from the school system, and I turned out JUST fine.' I love these people the most. To them, anecdotal evidence is ALL the evidence that anyone will ever need, and it somehow, trumps everything. It's like seeing nothing but yellow parakeets, and assuming there are ONLY yellow parakeets in existence because that's all your local store carries. (Never mind that many of these folks have NO IDEA what a healthy meal even looks like, and tend to think that all a kid needs to do to stay healthy is to avoid candy and soda, and eat lots of fruitsandvegetables.)

Well, here's something that will blow your mind.

Did you know that the original idea of a 

'food pyramid' started  as a way to help 

ease food costs by spending money on basic, 

cheaper foods, and still get nutrition? The rest 

of the foods were meant as complements 

to enhance whatever nutrients were missing. 

Ever since the USDA started making low fat, 

high carb recommendations in the 80s, and 

implemented it's OWN food pyramid in 1992, 

obesity rates have skyrocketed.

The USDA describes their National School Lunch Program as: "a federally assisted meal program operating in public and nonprofit private schools and residential child care institutions. It provides nutritionally balanced, low-cost or free lunches to children each school day. The program was established under the National School Lunch Act, signed by President Harry Truman in 1946."

Right away, when you brush away the chaff... what should jump at you is the 'low-cost' descriptor used in this paragraph. What does this, casually thrown in, adjective have to say about this program? What is hidden between the lines? Well, what they don't tell you is that the National School Lunch Program started as a way to help a poor, starving population, through government subsidies --  the same subsidies programs which are still, to this day, overpowering our agricultural industry, and making it possible to produce mass amounts of low quality, less nutritionally dense foods. (McDonald's anyone?) When you invest in low quality, less nutritionally dense foods, they become LOW-COST, and easy to mass market to a multitude of industries, and other countries. Smaller farms CANNOT compete with the HUGE agribusiness industry that has come to dominate the markets, including... you guessed it -- the school lunch program market. While the school 'lunch ladies,' might VEND food for you, it usually comes pre-packaged, pre-made, or 'ready to make' sources, and local state federal agencies will contract their local school lunch program to a food service management company, to save a few bucks. If your local school district does not contract to one of these, they are the EXCEPTION.

The three companies, right now, that dominate the industry are Aramark, Compass Group, and Sodexo. They mass market less nutritional foods, serve nutritionally imbalanced meals, cut corners to save dollars, and contract with fast food giants to market to kids -- yes, including, soda manufacturers. Not only that, but they have been under investigation in the past, for serving foods SO low in quality, they were rejected by fast food industry safety standards. (It's gotta take a lot of balls to serve a kid something WORSE than fake fast food meat.) They have such a strong arm in the system, many of them have been able to lobby, and block legislation that would improve standards, including legislation that would have banned soda vending machines in some schools, for example. 

So when you throw in less nutritionally dense foods (so, even if you have a small serving of them, they're still not so great for you,) in an array of unbalanced meals (all carbs, and hardly anything else), no allowances for or enforcing of portion control (and just eat what you want, and how much you want of it), and the attending results of kids who will a.) not feel the stop and go of their hunger signals anymore, and b.) constantly feel hungry because they got no real nutrition, you will get increased likelihood of illness, development of chronic diseases, and a national fat kid tsunami.

That's right... every time your kid eats at one of these national school lunch programs, it's eating food that's probably worse than McDonald's. (And even if it would appear "balanced," the fact is... it's still food that is nutritionally inferior. Remember that. It's like comparing a home made creme filled cake, to a Twinkie. They are technically, the same thing, but that's where it ends. One of them still has FIBER, and many, many vitamins and minerals. I'll let you guess which one that is.)

Are you freaked out yet? YOU SHOULD BE.

Still, some people have blind faith in their National School Lunch Programs... And disbelieve or disregard those who try to stand up against it, and call for change. (Including some politicians.) But folks are fighting BACK. 


Folks like Sarah Wu, who "compelled by her own frustration with school meals — both as a mother and a teacher ... known anonymously as "Mrs. Q." committed to eating school lunch every school day in 2010 just like her students. Mrs. Q documented her experience and described the meals by blogging, tweeting and sharing photos on her blog Fed Up With Lunch: The School Lunch Project." Her blog is one of the first blogs to help capture national attention on this very concerning issue. Mrs. Q risked her employment on this... and there were many days I worried she'd get caught. Still, I cheered for her. Her voice has been effecting some serious awareness and change... but we need more.

More, nationally, as well as globally... Like little 9 year old, Martha Payne, from Scotland... who writes about her poor lunch school program at NeverSeconds. While you're not going to see her giving you an in-depth analysis on the corruption, and backdraft, of agribusiness subsidies... she will hold up every meal to critique, and scrutiny, so you can see with your own eyes what she and her peers are being served.

. . . 

America is at a critical point, right now... we are at a point where it's starting to matter very little what type of food you eat, because it was all cheaply made, and nutritionally bankrupt. Movies like "King Corn," "Supersize Me," and "Food, Inc.," have created some discussion... but quickly get swept under the rug as 'passing the buck,' and not taking personal responsibility for what we eat. But we are clearly living in a very obesogenic environment where it is getting increasingly difficult to make right and wrong decisions, and increasingly easy to be deceived. Yes, a lot of foods that make false health claims have food labels, and we could be better trained and educated at reading them... but what if we thought we were eating meat, and instead were getting meat with an incredibly high risk of bacteria, and lots of corn filler? What if it was given to us by a school lunch program, with no labels (just trust), and not the 'you should know better,' fast food industry?

Yes, we have freedom of choice, in America... as to what we eat. But to what EXTENT should we let the government and the food industry tamper with our food supplies? Market to us? To children who haven't yet developed some of the necessary critical thinking skills, and disciplines, to make good life choices? (Especially, when they don't even have a parent around, to help...) Or to populations with less income, less education, and less access to nutritious alternatives?

The rights and freedoms of those who want to make me less healthy (and not just by consuming more 'fats' and 'sugars,' mind you), start mattering VERY LITTLE to me... when the lives of children, and the future of our nations are involved.

I don't know how ALL chronic illnesses, cancers, and autoimmune conditions come to pass... but sometimes, I have a very good idea what might be contributing to their explosion... And it's not just having an extra piece of pie.

Guest Blog Post: A Diabetes Service Dog for Sarah

Here at the Angry Type 2 Diabetic, we see 'ourselves' as a voice to ALL persons with diabetes... So, even though we generally use this space to share about our own type 2 diabetic experiences, we'd like to cheerfully lend the spotlight, this week, to our friend, Michelle. Michelle is a wonderful mom to a type 1 diabetic child, and she has a very important message to share with ALL of you. You may find Michelle's regular blogging space at The Tightrope Tango, and show her some follow love.  

My name is Michelle, and first I want to thank my good friend Lizmari for lending me space on her awesome blog. Lizmari is an awesome advocate for all people living with diabetes, regardless of type. She’s also the reason we enjoyed some pretty awesome Ice Cream Sundae’s last August.

Most people I talk to (and I talk quite a lot these days) have never heard of a diabetes alert dog. We all know about Guide Dogs for the Blind, and most of us have heard of dogs to assist people with other disabilities such as mobility, seizures, hearing, etc. Diabetes alert dogs are specially trained dogs that focus on the scent of their person, and let that person know when their blood sugar begins to drop to an unsafe level. These dogs are most commonly used by people with type 1 diabetes, but some with type 2 diabetes are also using diabetes alert dogs to keep them safe.

Why is this necessary? Well, a lot of diabetics either never have, or lose the ability over time to sense changes in blood sugar. My daughter, Sarah, is 12. She’s had type 1 diabetes for about two and a half years. Since the beginning she’s had trouble recognizing when her blood sugar is low, until it is dangerously low (sometimes in the 40’s and 50’s mg/dL). Normal blood sugar (for a non-diabetic) ranges from around 70mg/dL to 130mg/dL. If blood sugar drops too low, unconsciousness, seizures, and death can occur. Sarah has difficulty feeling drops in her blood sugar during the day, but she does not feel them at night, period. Since she’s been diagnosed, she has never… not once… woken because she felt a low blood sugar. That is scary. The JDRF (Juvenile Diabetes Research Foundation) reports that 1 in 20 people with type 1 diabetes will DIE of a low blood sugar. 1 in 20! That's not a typo. It's not 1 in 20,000, it's 1 in 20. (http://www.jdrftalk.org/2011/11/07/percentage-people-type1-diabetes-die-low-blood-sugar-hypoglycemia/). I can’t let my beautiful child become a statistic, so right now I set alarms for 10:30, 11:30, and 2am. Sometimes more, sometimes less, depending on her food and activity for the previous day.

But I’m not perfect, and I make mistakes.

Once, last December, she went extremely low (27mg/dL). She was unresponsive. It was only around midnight and I only caught the low because I checked on her and found that she was horribly pale and covered in sweat. I saved her life that night, because she was still dropping and the body can't sustain a blood sugar much lower than that for very long. If I hadn't checked on her, she very easily could have slipped into a coma and been gone by morning.

We tried a CGM (continuous glucose monitor) but Sarah has a metal allergy and gets a severe rash. This is where the diabetes alert dog comes in. Diabetes alert dogs are not for everyone. They require a lot of care. They eat a lot, they poop a lot. Honestly, in the beginning I thought that a diabetes alert dog was too much responsibility for a child. But my child proved me wrong by volunteering many hours every month with Guide Dogs for the Blind. She learned to handle, groom, and correct them. She grew to love her new friends, and has taken weekend responsibility for a Guide Dog puppy on a number of occasions. 

I believe that in a few years, maybe 5, maybe 20, that diabetes alert dogs will be much more common and understood. Discounting the fact that an alert dog is a living animal, an alert dog is a medical device, a tool. An alert dog is always on watch with their wonderful nose. An alert dog can think, and will go find help if their charge doesn’t respond to their warnings. Guide Dogs call it intelligent disobedience, a term that describes when a dog makes a decision to take an action outside its normal training that is in the best interest of their person. This could be a dog that leaves Sarah’s side during school to go take the alert to the teacher or other adult. This could be leaving Sarah’s room during the night to come into my room and let me know that Sarah needs help.

The last thing I’d like to say to everyone who reads this is to not discount the needs of someone with diabetes simply because they don’t have an obvious disability. Many kids, like my Sarah, are active, funny, enthusiastic, and because their health, food and activity is watched very closely, they often appear healthier than the average child their age. I’ve had a few eyerolls when I’ve told people that my bouncy child, who just exudes health and vitality, needs a service dog to keep her safe. For someone with type 1 diabetes, safe and healthy require a lot of work, lots of acting on instinct, guesswork, etc. It’s not as easy as it looks, and even with constant effort we have lows and highs that could not have been predicted. Diabetes is always. It never stops. It never goes away or gives us a break. Sarah takes large doses of insulin 4-6 times a day. Any one of those could send her to a fatal low if she or I misjudge the carbohydrates in her food or misjudge how her activity will affect her.

Can you be 100% right ALL the time?

At this time, diabetes alert dogs are not covered by insurance. Those of us who have made this choice for our child must generally pay for the cost of training the dog. My hope is that once the abilities of these dogs are more fully understood and accepted, more groups like Guide Dogs for the Blind can be formed to raise funds and provide these amazing dogs at low or no charge to the family. The first step in making this a reality is education. Tell someone you know about these dogs, and help spread the word. Even if you don’t know someone with diabetes, someone you know does.

Talk. Educate. Your words can help save someone’s life.

If you’d like to learn more about Sarah’s journey to a diabetes alert service dog, please visit either her facebook page at https://www.facebook.com/ADiabetesServiceDogForSarah or her website at www.pawsforsarah.com. Sarah’s dog is coming from Canine Hope for Diabetics in Riverside, CA, hopefully in early 2013. 

Metformin and PCOS: Taking the Plunge... with Googly Eyes

"It is impossible to live without failing at something, unless you live so cautiously that you might as well not have lived at all." -- J.K. Rowling

I've been on every diet, I think. Every way of eating, or not eating, or thinking... or approaching. I've had the most success with intuitive eating, and with mindful control of carbohydrates, or lowered carbohydrate eating... and I stick to that.

People will say do this, do that, do the other... you're not doing it right, you ought to do x, y, and z... (while they ought to shut their pie holes.)

I've been on the chicken and lettuce diet, the LA diet, the beat juice diet, the LA Juice Fast diet... The 700 calorie a day, 36 grams of carbohydrate starvation diet... Weight Watchers, Doctor's Weight Loss, etc, etc...

You name it.

But with intuitive eating, and lower carb eating, I've lost the most weight and kept the most weight off long term -- AND, been happy.

Time passes by, however... and not in vain. I'm no longer 15.

Polycystic Ovarian Syndrome is taking it's toll on me, and while I've fought hard... with exercise, lowered carbs, birth control, and supplements for 20 YEARS.... I am now ready to admit that I need some help with it, and start a regular course of Metformin on top of my birth control regimen, and my Inositol.

A lot of people might see this as some sort of failure, or disappointment, but it's not. It's just a next step in management -- and in GOOD health. And my blood glucose numbers are fine, actually... But the hair that keeps camping on my face (while leaving my head), the continuous acne, darkening Acanthosis Nigricans around my neck, and the weight I've been putting on are NOT. I have MORE than paid my dues... and I'm quite happy to accept some help so that I don't spend more hours than I need to plucking hair. >:S

I don't feel bad about this decision; I actually feel quite relieved... I feel like maybe my ovaries won't get crushed under this weight, and I might have a chance (not that I want to, right now) to have a brat or two, one day. Who knows.

Or... maybe I might find a man who loves me and gets to see me while I actually still look like a woman -- and not, you know... like Homer Simpson. (Though there might be men out there who like the Homer Simpson look... Again, who knows.)

In any case, I am officially on Met... and no, my goal is not to get off of it, somehow. I will likely never get off of it. Even if my blood sugars are perfect; even if I weigh a 100 lbs. PCOS is a vicious disease... And in these 20 years, I've been so many different weights, it's not even funny. 170, 128, 190, 142, 248, 170... I know it's not going to go away, magically, with the next Dr. Douchebag's Book of Eat Green Raw Crap From the Ground, and Cure All Your Ailments with Monkey Poop.

So... why not do the NEXT best thing? Yes, I know you know...
PUT GOOGLY EYES ON THAT BIG ASS BOTTLE OF METFORMIN.

One should always put googly eyes on things one is hesitant to trust 

Take that, bitch. Ain't no one gonna make me feel like I'm downing horse pills. lol I will laugh at you... every time I see you. xD Bwahahahahahahaha.

What's in your pill and supplement arsenal? I'll show you mine, if you show me yours...

DBlog Week Day 5 : Setting the record straight

Today's DBlog Week topic asks "What is one thing you would tell someone that doesn’t have diabetes about living with diabetes?". Fortunately Karen seems to know how much we love the sound of our own typing: "Have more than one thing you wish people knew? Go ahead and tell us everything.". Well, since you asked...

Journalists
There is more than one type of diabetes. Actually there are *lots* of different sorts, and some of the 'types' are really just umbrella terms for a multitude of different, but fairly closely related conditions. This next bit probably bears saying slowly, because it seems that you have difficulty grasping it: Diabetes. Is. Not. Caused. By. Eating. Sweets. There, that wasn't so hard was it? In general terms you probably only really need to think about type 1 (around 10% of the diabetic population) which is an auto-immune condition where the body destroys it's own insulin-producing beta cells. Nobody knows what causes type 1 diabetes to develop. No-one. On the other hand there is type 2 diabetes, where the proper metabolism of carbohydrate begins to fail. Type 2 Diabetes makes up nearly 90% of the diabetic population and last time I looked *nobody really knows* what triggers its development either. Nobody. There does seem to be a genetic link (so you are more likely to develop it if a close family member already has it). It is also more common in certain ethnic groups. Additionally people who carry more weight seem to be more at risk of developing type 2. Let me say that again - AT RISK. This is not the same as cause. Perhaps 15% of people diagnosed with type 2 are normal weight or under weight at diagnosis. And bear in mind that perhaps 90% of the obese and overweight population do NOT have diabetes. Let's go over what we learned earlier - eating sweets does *not* cause diabetes. If a person is overweight it would be wise for them to consult their doctor to assess their risk of diabetes. The extra weight may be an indication that their metabolism is struggling to efficiently metabolise carbs - but please, please, please stop repeating that diabetes is a 'lifestyle' disease 'caused' by eating sweets.

Scriptwriters
This is getting silly. Please. For the love glittery cupcake-eating unicorns, will you PLEASE just have a two minute conversation with a person with diabetes the next time you have a Brilliant Idea about using insulin-dependent diabetes as a way to spice up your flagging movie/action adventure/medical drama. It really is Not. That. Hard! Time after time you get it wrong at the most basic level. The problem is you get things so messed up so often that 'normal' people will be beginning to think you have it right. You know there's this time-critical thing (a hypo) where the person can be minutes from oblivion. And you know that diabetes has to do with insulin, which is hard to come by on a jet plane struggling to make a landing, while Denzel Washington and Bruce Willis swap oily vests and wisecracks as they wrestle the deranged and inexplicably English-accented baddie into submission. It all looks ideal... How will our rosy-cheeked cherubic child make it through as she plunges into a hypo when the only insulin on board was smashed under the nasty Brit's suspiciously shiny shoe. STOP! Insulin will KILL her. If she is mid-hypo what she need is a little something from the kitchen. Hypo is *low* blood glucose. All she needs is a swig or two of Coke. We are very sorry that this is rather inconvenient in dramatic terms, but there you are. If she misses an insulin shot? Well unless she's on a pump (let's not go there right now) the chances are she has got *hours* - especially if she doesn't stuff her face. She might get a bit grumpy. Not very Hollywood, but I'm afraid it's all you've got.

GPs and NHS beancounters
There are all sorts of people. Tall ones, short ones, loud ones, quiet ones. Some are really clever, others not so much. A mixture of all of these people will be unfortunate enough to develop type 2 diabetes. Now given this bewildering variety, don't you think it is perhaps likely that one identical approach will not work perfectly for everyone. Diabetes, perhaps more than any other chronic condition will be affected by the behaviours of the patient. Some people will be happy to take your advice on what foods they should be eating to keep their blood glucose levels under control. You will give them advice based on your knowledge and understanding. What you believe happens 'on average'. The problem is, we are not talking about 'average'. We are talking about individuals. When a patient comes to you with a desire to test their blood glucose levels using an effective framework, and to use those test results to establish a varied and nutritious diet which does not spike their BGs please consider their future health. 80% of the NHS budget for diabetes care goes on treating preventable complications. Once a patient has spent a few months building up a picture of BG friendly foods, testing can drop back to a much lower maintenance level. There is no 'one size fits all'. Don't mistakenly jump to a conclusion of 'non-compliance'. If you are advocating a diet with lots of 'healthy' carbs for t2 patients, their problem might be *too much* compliance. The only way for a person to discover what foods, and quantities they can eat (and at what time of day) is with a meter. Not everyone will want to put the work in, but don't just automatically deny the means for people to control their diabetes.

80% of costs on preventable complications are absolutely appalling stats. Perhaps the time has come, at last, to rethink the high-carb/no-test approach if these are the results you are getting. I'll put it more simply for the hard of thinking: Give. Type. Two. Diabetics. Test. Strips. And. A. Copy. Of. Jennifers. Advice. Then. Support. Them. In. Keeping. Their. Diet. Balanced. And. BG. Friendly.

DBlog Week Day 4 : Things we'd like to see

Today's DBlog Week topic is all about fantasy future D gadgetry. If we could have any dream diabetes device, what would it be?

I had a crazy notion to write a post about a futuristic BG meter that was actually accurate to within 5% of a lab reading 100% of the time. Or maybe a CGM that was actually affordable for anyone that wanted one. I even considered writing about a pump that was constructed with such inexplicable ingenuity that it *didn't* have to bleep and warble about a temporary basal rate Every. Single. Hour. Which might be useful for anyone that ever needed to set a TBR to run overnight and values their sleep. But no. Let's at least keep this within the bounds of the possible.

I'm not even going to write about the cure. That's only a mere ten years away after all (well it always has been, ever since I was diagnosed in 1991, so I don't see why we should start changing that now).

What I would like to see (and I suspect some white-coated boffin in a gleaming laboratory is already working on this very thing) is an intelligent insulin. I can remember having conversations with people when I was first diagnosed who would say things like, 'Ooooh, I could never inject myself!'.

Like that was the hard part.

Let's face it after the first three or four hundred - the injections are a doddle. All the other stuff. The adjustment. The guessing games. The carb counting. The unexpected 'helping hand' given by the liver. The moving goalposts. The messy, confusing, illogical variability of it all. That's what I want rid of. Heck, I don't even mind carrying on with a fingerstick BG test every so often just to make sure things are toddling along OK.

So in my dream-world of the future, I just need to inject a whack of IntelligentInsulin^{TM pending} every day (it could be every few days, but I don't want to push it).

Once absorbed the IntelligentInsulin just sloshes around in my bloodstream bound-up and inert. Ready and waiting. I chance upon a sweet and sickly cupcake. As soon as I start eating it, and my BG begins to rise the IntelligentInsulin senses the change in my levels and immediately begins to work (none of this '4 hour profile' nonsense). Once the carbs are dealt with, IntelligentInsulin stops and waits again. Very tiny amounts of it working every so often to counter glucose released from my liver keeping my levels rock steady. If my BG falls below 4.5 (81), IntelligentInsulin stops working entirely and allows my liver a little room to top things up into a safe zone. When I eat a massive fat-laden uber-carb pizza-with-extra-dough-balls-and-garlic-bread IntelligentInsulin effortlessly matches the stop-start absorption of the food. Even when I have an entire cream-filled Pavlova meringue for dessert. Which is a neat trick since I have a horrendous cold at the time. And have not been to the gym for 2 weeks.

All I have to do to manage my diabetes is keep my level of circulating IntelligentInsulin topped up with an occasional injection, and take an occasional BG test to check things are OK. And that is all.

Welcome to the future ladies and gentlemen.

DBlog Week Day 3 : A little less of that please

Today's Diabetes Blog Week topic is 'What is the one thing you could do better'. I suspect I'm not the only one to be thinking, 'What... just one?'. Ask us what we do brilliantly and many of us will struggle. Ask us where we need to improve and suddenly a hundred things are jostling for pole position.

For the last two or three years I've been working working working... Trying to improve things. Trying to fix things. Reading and learning and experimenting. I have rarely kept better records. I have never tried so hard in the attempt to keep my BGs in range for as much of the time as I possibly can. But there is an aspect of my diabetes that I have made no progress on whatsoever. None. And it really needs fixing.

I still get too grumpy about out of range results. Every time.

In the old days I would get frustrated with diabetes' randomness. I still like to rage at the randomness every now and then, for old time's sake, but these days I am more likely to blame myself. I suppose this is a genuine downside of putting extra effort into controlling my diabetes. Results that I would not have batted an eye at a few years back now cloud my mind with 'Why's' and What if's'.

I still beat myself up.

All the time.

'Gah! I got the carb count of that meal waaaay off'
or 'I *knew* the fat in that would slow down the carbs'
or 'Stupid, stupid, stupid. I massively overestimated the fat-based carb slowdown and now I'm high'
or 'Low after the gym. Again!'
or 'High after the gym... Shouldn't have had those extra carbs'

These days, with Artoo I have even more ammunition to beat myself up with.

'Not enough of a TBR...'
'Too much of a TBR...'
'Should have/should not have used that square wave/dual wave/duration/split/timing...' (delete as applicable)

Carb counting? Exercise adjustment? Basal profiles? Food choices? Snacking?

In reality it is all of these things and none of these things that need improvement. All the time. I am reminded of a brilliant post by Kim of textingmypancreas entitled 'What we aim for'. We put in all this work. We make all this effort in the hope that nothing will happen. Nothing, as Kim points out, is a pretty lousy reward.

Occasionally I have had brief moments where my meter seemed to have slipped into some parallel universe of BG nirvana and almost refused to give me an out of range result however much I misbehaved. My problem is that once I had glimpsed that I began to want it all the time. Even though I know deep down that is impossible. Diabetes is too fickle, too variable. The goalposts move too often and chasing down the new 'normal' takes time and involves 'out of range' information to base decisions on.

Jane is forever encouraging me to relax a bit and give myself a break. As with so many things in my life I really need to listen to her.

DBlog Week Day 2 : One good thing

When I looked down the list of topics for DBlog Week I knew this one was going to give me some trouble... Something about diabetes that I nearly always do well? Talk about a hypodermic in a haystack. Tomorrow's topic of something I need to improve on is noooooo trouble at all. How many would you like? How long have you got? But something diabetes-related that I do well? Hmmmmm...

I nearly wimped out and posted about how brilliantly supportive and understanding my family is (however grumpy I get). Or how amazing the information, hints and tips are that come flooding from all corners of the DOC at the first keystroke of a 'Bah! Having a rubbish day today' tweet. But then it struck me as I fished a fluffy fruit pastille out of my pocket to counter what might (or might not) have been a slight dip in BGs. There is a little thing that I have done ridiculously well ever since I was diagnosed. Every day! It's so much a part of my life that I no longer even think of it, but occasionally when it is mentioned to non-D types I get met with a raised eyebrow and just a hint of "Well that's a bit weird" behind the eyes.

I am amazing at carrying hypo treatments around. I don't think I've gone anywhere in the last 20-odd years without pockets full of goodies 'just in case'. In sweetie-carrying terms I am way more reliable than a Werthers Grandfather (who only managed a measly 15 years). I have treatments. I have backups. Occasionally I have backups of my backups.

Just after I was diagnosed I was advised that I'd have to carry something sweet on me at all times. I found a little tin in a giftshop that had a nice vintage-label design printed on the lid. Initially I carried dextro-energy tabs in it, but they were vile and I discovered that it was just big enough to carry three of four sachets of sugar - the kind you get in cafés and coffee houses so took to carrying them instead. For many years I siezed hypos as an opportunity to have a funsized chocolate bar (even after I knew that chocolate was nothing like fast-acting enough really). I would have chocolate in my coat pocket and the tin in my jeans. The tin became my 'last line of defence'. If ever I was anywhere and the shops were shut or there was just nothing around I would at least have something that might keep me going. I began to develop heirarchy of treatments based on their suitability to the time of year. Skittles and Jelly Babies come in small bags in some funsize assortments and are virtually indestructible in a jeans pocket during the Summer - even in 80% humidity and scorching temperatures on a brief stay in Singapore.

These days my weapon of choice in tackling hypos is certainly Fruit Pastilles. A whjole pack is just a tiny bit too long until you have had the first two or three but I like to think the extra strain that puts on the tube gives it a lovable 'crumpled' quality. And the hypo-addled T2 came across and helped out a few months back didn't seem to mind. (I was able to give her a spare pack that was acting as the backup to my backup).

And the tin still goes with me. Everywhere. There's not a scrap of paint on it now, of course. It has been polished to a gleaming shine by thousands of hours in my pocket, and is just very slightly dented.

Diabetic Humble Pie

It was Wednesday at 2 AM, and I couldn't sleep. I stared at the walls intently as if they held hidden messages for me; my own hieroglyphs to decipher. Suddenly, just like an omen in a bad movie, the soft light that usually bathes the bedroom's walls was gone; complete blackness engulfed everything. Five minutes later, there was light, alright... Lightning and thunder made their explosive way into the picture. The stuff usually soothes, and helps me sleep, but that wasn't going to be the case on this morning. This morning I had to rise early, and walk to work... and it was going to be a very interesting, and very wet, walk to work.

And I can't begin to tell you just how interesting. 

Let's just say I completely underestimated the situation, and thought it was just... well... an annoying moment of rain, and some fading thunder. At 4 am, though, let's just also say that some things are better left unseen. 

Most of the homes on my city's main avenue are small, and unimpressive. Not a blight, by any means, but just average homes that probably serve as 'first homes' to many newlyweds, or even some retired folks. They don't really have much in the way of yards, trees, or shrubbery, but I got to see a few fallen branches here and there, and that's common out here in Iowa during some of our Spring storms. No biggie. 

But then, you hit a slight bend up the road... and the homes become bigger, 'stately', and with sprawling large front lawns, gardens, and trees. You might even see a posh car or two, parked on a driveway; testament to how much someone, somewhere, makes. And this is where the horror began. 

Have you ever seen a a tree trunk that's, maybe, a few feet wide, in diameter? Yes? Now, have you ever seen it BENT IN HALF, like the bending of a simple tulip stem; like a Twizzler... Like it was made of rubber? Well, at this point in my walk, very MANY of the trees were in this state.

I got quite scared. The city sirens never rang that morning, and no warnings or advisories were in effect for my county. But I know quite well a few of you KNOW what this represents. Unless the Jolly Green Giant's bratty son was out and about, or Godzilla, for that matter... the only two things I know that can do this to such large trees are tornadoes, and hurricanes. And we don't have hurricanes up in the northern Midwest. 

I really didn't know if this was still happening in the vicinity... I sure didn't hear anything in the way of a "freight train" noise. But by then, I was closer to work than to home, so I tried to finish the journey as quickly as possible, and get out of harm's way. Stupid? Maybe. Later, in the papers, experts were looking into whether a tornado 'potentially' touched down in Ames. Well, you sure could've fooled me. :/ 

I was very scared, and when I get scared... I tend to get angry at the impotence of the situation. Scared of being alone, scared I have nothing to rely on to save my own behind, and very angry. I don't know why... like what could I do? Slap the sky? I guess I just want life to happen smoothly, sometimes, and not scare the crap out of me. Not force me into confrontations, or situations I don't want. I JUST WANTED TO DO WHAT I HAD PLANNED - GET TO WORK! 

But life seldom cares what we want, and we have to roll with it...

So we come to Friday, at the second job. I worked an 11-5 pm shift, and I'd been sick with a stomach virus for a few days. Really, foolish or not, I didn't have much in my stomach at that moment; I was just too scared I couldn't keep any of it down. 

Lunch rush starts at this Mexican restaurant, and I'm quickly into the groove of things, making order after order after order. It's okay...! I'm in my element! Things are going awesome... 

And then, without notice, the floor was made of lava, and I was in a movie, and people were watching me. And I was making those burritos... on a compartment, atop a roller coaster ride, and trying to hold on soooo hard to the railing. I think I thought the burritos were the railing, at one point. Everything was funny, and sooo not funny, at the same time. I got scared, and very angry.

I wanted to stop, but there was no one else there. I'm pretty knew, so people don't really know much about what I need, or don't need, and frankly... I only work a few hours, part time. I guess I foolishly thought I could get away with it. I *knew* that I was having a quite sudden, and quite low, LOW. But I couldn't stop.

"I can finish this lunch rush," I say to myself... I can. By the time rush was done, I'm sure some of my folding, and wrapping, looked as mangled as those trees on my main avenue. I was so sick feeling, and so scared... Like a person drowning, and their head rising in and out of the water. Where the hell are the jellybeans? I quickly announced I'm going on break -- whether people like it or not -- and NO ONE refused. They must've seen something in my eyes, and wisened up. 

Funny, the place is typically crawling in ho-hos, twinkies, and jelly beans... and not a damn piece of sugar was in sight. 

Luckily, I ate through 3 pieces of candy I had in my pocket (too scared to go down the greasy, steep steps to the basement, and find my purse, and get the meter and the glucose tabs), and a cup of regular soda... 30 minutes later things seemed to improve. My break was only 15. 

I will have to ask if I can keep things upstairs -- we can't really keep personal things, nor food, in the work areas. But it's going to have to be... an uncomfortable conversation. I just don't like to bring it up.

ALL I WANTED WAS TO DO MY JOB, AND FINISH, AND GO HOME. 

In the end, I took a detour through Alice's Wonderland of Diabetic Crap, and finished with a terrible headache... and NOT from the magic mushrooms. :/ 

I hate Diabetes. *&^%#! Diabetes.

Lesson: We can't exactly plan for every situation, in life. Who the heck knows when a tornado's going to come in, and rip through your lunch rush, at work... BUT we must be willing to reach out to others, and identify safe beacons along the way. Don't hurt yourself because you want to be tough, and stubborn, and stupid. Just don't. It's so not worth it... 

"One order of diabetic humble pie, please. For here." 

Face-off: MDI vs Pump

A couple of people who are considering going on an insulin pump were asking how I was getting on, how I was finding it and whether I thought it had made any difference. 

An interesting question a little over 6 months into the experience. 

Pump win(?): Fear of attachment
The first thing to say is that the nagging worries I still had about attachment when I wrote a few weeks after starting on a pump have long gone. I know some people feel at one with their robot pancreas almost immediately, but it took me a good few months before I reached the stage where I rarely thought about being hooked up to Artoo, and even when I did, it didn't worry me. Things like getting changed, where the sense of inconvenience lingered, no longer strike me as irritating. If you have just started on a pump, and the attachment still frustrates you, hang in there. Not everyone gets used to it in a few days. Allow yourself time to adapt to the new 'normal'. Wearing and using Artoo is now second nature. No problem with sleeping either. 

Hugely unexpected pump win: Attachment
I think this bears repeating from my '2 month' post, partly because it was something I really didn't see coming. There have been many times since starting on a pump that being attached to Artoo 24/7 has given me back a feeling of spontaneity. Do you remember spontaneity? I'd pretty much forgotten about it myself too. That ability to just stop and have lunch there because you fancy it, rather than having to go back home because you weren't expecting to be out that long and didn't bring your kit. There have also been *no* times since November when we've had to stop the car at the end of the street, and run back to fetch my pencil case.

Pump win: Basal patterns
A properly flexible basal pattern was one of my main motivations to switch to a pump. Looking back, while on MDI my early morning 'fasting' reading of the day was more erratic than I realised at the time. Sometimes too high, sometimes too low. Only in a decent range say, between 3.9mmol/L (70mg/dl) and 7.5 (135), less than half the time (45% to be exact). Truth be known it's still wobblier than I'd like, but these days I get a decent first reading on two out of three days. That's a much cheerier start to the day for everyone at the breakfast table.

Pump win: Delivery options
I was invited to an evening arranged by Medtronic in March where pumps and pump therapy were discussed. It surprised me how many people had been on a pump for years but had never tried out different bolus patterns or temporary basal rates. If you are new to a pump I'd encourage you to get stuck in straight away. TBRs, dual and square wave boluses have more than lived up to my expectations. Many situations, like gardening and vacuuming which refused to play nicely for me on MDI have been more or less tamed by Artoo. I don't get it right all the time, but have a little 'cheat sheet' of notes for what seemed to work before to use as a basis for whatever I'm doing and I have avoided many many spikes and/or hypos since November.

MDI win: Infusion site failures
On the plus side set changes have become much easier and more automatic. They are a little more time consuming than a simple injection, but you do know roughly when they are due and can bring that forward/push that back slightly if it would come at an inconvenient time. The whole push-button dosing thing is so much quicker and easier than faffing about with a pen that my feeling is that I have a net gain of time spent/inconvenience endured dealing with diabetic rigmarole.

But. (and it's a biggie)...

I have had sites go wrong already. I still watch every set change carefully to make sure they have 'taken' properly. I had almost stopped being so paranoid, but two or three failures in quick succession have put me on my guard again. At least two cannulas have kinked on or after insertion so that insulin wasn't being infused properly. Not serious enough to get a 'low delivery' warning, but enough to cause a rise in BG levels. I had another site seemed to 'go off' at about 1.5 days. It had been fine, but suddenly stopped working as expected. I am putting these down to site issues because corrections did not behave properly, but as soon as the site was changed I was back on an even keel. I've also caught a big fat bubble in the tubing on at least two occasions when I've put Artoo back on after a shower/gym session - which makes me wonder if some odd but short lived rises in BG might be down to Artoo delivering 'bubble' rather than basal for an hour or two on other days. I check carefully every time I fill a reservoir and flick and fiddle until I am as sure as I can be that I have got all the bubbles out, but nevertheless I can still sometimes see a bubble in the reservoir at the next set change. These are not problems that you ever have with MDI. Even if you hit a dodgy site that is only going to be one out of the day's several injections. With Artoo all my eggs are in one basket. And sometimes the handle falls off the basket. I have had one-off levels on a pump higher than I've had for years on MDI, perhaps the highest since I was first diagnosed. And I've also tested positive for ketones since November - again not something I am used to. In all I've probably had to swap out maybe six sites since November. As a percentage of the total number of insertions it's not disastrous. but it's not ideal either.

MDI win: Injection site availability
Another part of this is the available site locations. I was never very adventurous on MDI, but I had far more area to play with in terms of a quick injection than is suitable to have something fixed to it for several days. I'm currently using sides and back for sites to give my abdomen a rest but have to be careful to find a spot with enough 'flesh' and some places end up being slightly uncomfortable when you lean on them/sit on them/risk getting them knocked out by waistband. In theory I could use my thighs, but there's not a lot of 'spare covering' there and most of the usable area seems to be right underneath my jeans pockets which I'm forever fishing stuff out of. I worry I'd just pull the site out when trying to get hold of my my keys.

But what of the results so far?
It's never very easy for me to spot how things are going from day to day. A couple of good (or bad) days on the trot and it can feel like I'm some sort of perpetual Diabetes Superhero/Catastrophe. Sometimes it feels like I've been having a problem for months, but looking back just a week or two and it becomes clear that it has only been a matter of days. 

So I dug back through my records and picked some results to compare from three periods. Some old paper records from around the time we started writing this blog, some records towards the end of my time with the Accu-Chek Expert and some more recent ones with Artoo. I pulled 60 days of results to try to reduce the impact of a dodgy few weeks. I avoided holidays/Christmas or other challenging times of year and tried to pick a couple of 'normal' months for each. I knew things have been getting better for me in recent years, but I've not really compared and contrasted in this way before. 

Testing frequency was roughly even in each case (between 7 and 8 times a day) and are made up of a mixture of waking, pre meal, post meal and bedtime tests. 

The first thing that surprised me was how much improvement I had been able to make on my own with MDI, even before the help of the Expert. Due to an, ahem, administrative/back-up error I don't have a full 60 days immediately pre-Expert to compare, but even so, before Artoo the number of highs and lows were substantially improved.

Hypos - below 3.9 (70)
Old MDI was the worst with 20% of readings, the Expert reduced this to 10% of readings and Artoo has made a small improvement taking this down to 8.7% - clearly Artoo and I still have work to do here.

Hypos - below 3 (54)
The old MDI records really don't do well here, with almost half of all hypos coming in below the 3 (54) mark. Compared to what I'm used to in recent years it made uncomfortable viewing. Both the Expert and Artoo fare much better with 2.4% and 2% of all readings coming in at that level. Both with the Expert and with Artoo, none of these hypos have been 'nasties'. I can't remember the last time I had a really bad one it was so many years ago. I've been functioning, spotted them and able to treat them all myself. That may not have been the case with the old MDI records.

Highs - above 10 (180)
The same pattern of worse, slightly better, better again repeats here. Old MDI shows 19% of readings over 10, with the Expert that falls to 16% and reduces to 13% with Artoos assistance.

Highs - above 13 (234)
This is where Artoo really shines at the moment. Despite having subjected me to an occasional stratospheric BG with a dodgy set, in the 60 days of data Artoo only allowed 0.04% of readings to stray over 13. The Expert does surprisingly badly here with 6% while even old chaotic-style MDI scrapes in with 5%.

Averages and SD
While averages can hide a multitude of unpleasant detail, I think that here they do seem to suggest positive progression. The old MDI average was 6.8 (122) with an SD of 3.3 (59), the Expert improves this with a slightly higher average 7.2 (130) but reduced SD of 3.0 (54). Artoo though trumps them all with the joint lowest average 6.8 (122) and a significantly lower SD of 2.4 (43).

So is it worth it?
YES! Absolutely. The ways in which Artoo has made my diabetic life easier to control, more spontaneous and simpler to get along with far outweigh the remaining niggles I have about infusion sites. Is it like being non-diabetic? No of course not. Actually I have to watch myself not to feel downhearted if I don't have perfect levels all the time because some mad part of my brain thinks that in theory this ought to be possible now. Well unfortunately Diabetes is still incredibly annoying and has lost none of its ability to throw out the rulebook and move the goalposts for weeks at a time. I don't suppose it ever will.

I have an HbA1c coming up in the next few months. It will be interesting to see if there is an improvement - my first post-pump A1c showed an 0.5% increase and I'm hoping I might be able to match my previous MDI result but with fewer highs and lows into the bargain.

We shall see.

UPDATE: Regarding set failures - I wrote this some months later. Set changes

Blue Cinco de Mayo...

In Loving Memory...

Gone too soon, nine years ago, today.

Gone, but not forgotten... 

Just one loving memory away.

Hector Rafael Collazo Santos

(September 11, 1938 - May 5th, 2003)

He may have lost his chapter with Type 2 Diabetes,

but the WAR continues with me.

I will keep on fighting, dad.

I will NOT give up.

Rest in Peace