Diabetes Specialty Center: Guest Post

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Senin, 25 September 2017

Guest Post - "I Know Better"

08.40 0

Today we are excited to have a guest post from a VMG patient about his experience with diabetes. Seth has type I diabetes and has completed our diabetes education program. Thanks Seth!

My name is Seth Rothberg. Let me tell you something about myself that embarrasses me. There's a plate of homemade brownies up in the staff room. My CGM tells me I've had an even blood sugar all morning.

I walked to work. And I seem to have hit the mark for my lunch time bolus. I know I should resist the brownies. But there they are, cut in small squares, with light brown crispy tops, and walnuts peeking out from fudgey sides.

Carbs unknown, but maybe a square is 25 grams, plus or minus, probably plus. I'm not even hungry, so of course I bolus for 150 carbs and grab 4 and I know without thinking about it that I�ll be back in a few minutes for a couple more. An hour later my CGM beeps. It�s showing two arrows pointing up and a blood sugar about to hit 200.

I don�t bother to test, I just give my self a 7 unit bolus. Why 7 units? I have no idea, but 2 hours later I�m gobbling glucose tabs. What embarrasses me about this is not just that I do it, but that I think that this kind of behavior defines me as a diabetic. I feel that I�ve just told you nearly everything there is to know about me and my diabetes.

I ask myself 2 questions after I pig out on brownies, or pretzels, or oreos, or Pepperidge Farm Sausalito cookies (to list a few of my sins). Why do I do it and (I�m sure you saw this immediately) how do I manage to not manage it? The truth is, I�ve never been able to answer these questions. I�ve done everything wrong. Either I guessed wrong for my bolus, or I over ate. What�s worse, I bolused again based on nothing but impulse.

O.k. I should give myself a little break here. After all, I started the day really well. I had yogurt mixed with blueberries and walnuts for breakfast. It was a perfect 50 degrees when I walked to work and there was a full blue sky.

The gardens and hedges of the houses I walk by are blooming with flowers I can�t name, but their colors stun me. I�ve managed to keep my blood sugar in the low hundreds. It didn�t just happen. I managed it. Yes! Not to mention that I had those glucose tabs when I needed them.

Let me tell you a little more about myself. If you asked me what the most important thing to me about my diabetes was, I wouldn�t tell you the brownie story.

I would tell you that I've been diabetic for 48 years, since I was 10, and that I�m aiming for the 50 year Joslin medal. I�ve noticed, though, that when I bring this up outside of medical appointments, no one's as proud of me as I am. I guess I understand that.

Who wants to hear an old man going on about how he had to walk 10 miles to school, in the snow, in bare feet. One of the few things I really do know better is not to bore you with my early days on regular and lente insulin, or how I had to pee into a cup to test sugars.

In future blog posts I will try to limit any of my �in those days� tendencies to what I hope will be stories that are still relevant to what�s it�s like to be a diabetic now.

Kamis, 19 Februari 2015

Update from the Diabetes Support Group

Recipe

10.19 0

Hi all! Today Margie Sobil, our nutritionist in Greenfield, has an update about the Diabetes Support Group. Also below - a quick easy alternative to sugary grocery store fruit-flavored yogurts!

The diabetes support group is in its 3rd year now! We continue to combine a mixture of activities at the meetings:

member sharing and support
Tips, skills building and new ideas
Recipes and food demos

At some of our recent meetings, we all got a chance to practice a variety of chair exercises thanks to Ann Marie (great for many of us who feel confined to home during this time of year of being snow-bound) and we looked at the Diabetes Blog on the Valley Medical Group website- where we got to see our favorite VMG volunteer (from our support group)- Ann Marie.

Some comments from participants about the group:

�What I like about this group is the sharing of ideas and having a place to talk about what is working, and the challenges. I get help for myself, and sometimes it just feels good to offer some ideas and help someone else.�

�I like the food samplings and new recipe ideas- it helps me to know I can expand my food options and know that I am eating something that is healthy for me without overdoing the carbs�

AND, we have been learning creative/tasty tips for lower carb food items that are simple to prepare.
Zucchini and summer squash spaghetti spirals, saut�ed and combined with whole wheat pasta, to create a low carb spaghetti that everyone loved. We also learned that 2 oz dry pasta on the box (40-45 grams of carbs) is about 1 cup cooked- something everyone had to admit has always been a mystery to figure out.

But today I want to share this easy way to make a healthy alternative to grocery store fruit-flavored yogurts. After looking at a variety of yogurt containers, we learned that there are only about 6-7 grams of carbs in a container of plain yogurt. Many people in the group eat flavored Greek yogurt- the �light� Greek style yogurt has only about 9 grams of carbs, while the sweetened yogurt has about 20 grams. Once we figured out the difference between sweetened yogurt (20 grams) and the plain (6 grams) = 12 grams, we learned that 12 grams sugar is equal to 3 teaspoons of added sugar.

Instead try this, for almost 2x as much food as fruit flavored cups, without all the sugar:

1 cup frozen berries (strawberries, blueberries and blackberries) thawed in microwaveable bowl
Pulse with small blender or chopper
mix berry mixture. 3/4 cup plain Greek style yogurt and 1 packet stevia or Splenda.
Mix and enjoy.
Carb count: approx 20 grams carbs

At 22 grams of carbs (minus a few grams of fiber from the fruit)- we got a serving of yogurt and real fruit for roughly the same amount of carbs as a sugar sweetened yogurt. Not only that- but everyone, even the most skeptical members of the group- had to admit that it was DELICIOUS!!!!

So, if you haven�t been to the group for a while, or if you would like to give it a try- come any month- 2^nd Tuesday. Our next meeting is Tuesday March 10, 5:30-7:00 p.m. Feel free to call Margie with any questions at (413) 992-7392.

Senin, 01 Desember 2014

Thoughts from a Doc: Why do my sugars DO that?!? (Part 3)

Guest Post

07.01 0

Today's post comes from Dr. Stuart Chipkin, Valley Medical Group's Endocrinologist and Diabetes Program Director

This is Part 3 of 3 of this series from Dr. Chipkin. So far we have heard his thoughts on exercise, food, insulin, and counter-insulin hormones. This week - his thoughts on a few remaining factors that can influence your numbers.

Insulin-sensitizing hormones: these are sometimes called �incretins� because they increase the action of insulin. There are now medications based on these incretin hormones which help to lower blood glucose levels and also have modest benefits on weight loss. Examples are exenatide [Byetta] and liraglutide [Victoza]. Other medications inhibit the enzymes that break down the body�s own incretin hormones- these medications generally don�t help with weight loss- they include sitagliptin [Januvia], saxagliptin [Onglyza] and linagliptin [Tradjenta]

Factors x, y, and z: These are the wild cards that sometimes make it really hard to either predict or understand why glucose values do what they do. Most of these won�t change blood glucose values by large amounts but can contribute to not having them be exactly on target. Examples can include: hormonal changes during phases of the menstrual cycle, the efficiency or inefficiency of how food is absorbed from the intestines, emotional stresses, antibodies that some people make against insulin, etc.

With all these different factors, and the ways that each of these factors can change blood sugar values, it�s pretty impressive we every get things close to being on target!! This is where each individual has to learn their own personal diabetes and some of the �quirks� of how their body responds.

Kamis, 30 Oktober 2014

Thoughts from a Doc: Why do my sugars DO that?!? (Part 2)

Guest Post

03.00 0

Today's post comes from Dr. Stuart Chipkin, Valley Medical Group's Endocrinologist and Diabetes Program Director.

This is Part 2 of 3 of this series from Dr. Chipkin. Last week we heard his thoughts on how exercise and food impact blood sugars - this week we get his perspective on some medications that can influence your numbers.

Thoughts from a Doc:
Why do my sugars DO that?!? (Part 2)

Insulin: (as my daughter would say- d�uh!). Oral pills like glipizide [Glucatrol], glimepiride [Amaryl] or glyburide [Micronase] cause your pancreas to release insulin which can certainly lower glucose values over the course of many hours. Other medications (repaglinide [Prandin] or nateglinide [Starlix]) act more rapidly and only cause insulin to be released for a few hours. But the effectiveness of these pills is based on two things: (1) the ability of your pancreas to make and release insulin; and (2) the ability of your body to use the amount of insulin made by the pancreas. If your pancreas �worn out�, then these medications won�t be very effective (the analogy is that you can�t squeeze anything out of a dry sponge). Even if these pills help the pancreas to release insulin, if your body is very resistant to insulin, then it won�t be enough. Resistance to insulin can occur for many reasons including excess weight, infections, and steroid medications such as prednisone, hydrocortisone or dexamethasone.

Counter-insulin hormones: These can be thought of as �anti-insulin� hormones - fighting against the action of insulin. The most common of these are steroid medications like prednisone, hydrocortisone or dexamethasone. These medicines are sometimes used as pills for weeks at a time and can raise blood sugars a lot. Sometimes, they are injected into joints or other locations and can raise glucose values for a few days. Other counter-insulin hormones are stress hormones that are released when people are sick with other illnesses.

Next week's post will discuss a few other factors, including the "element of mystery" that anyone with diabetes knows all too well. Not as simple as it seems, sometimes!!

Senin, 27 Oktober 2014

Guest Post - "I Know Better"

Guest Post

06.12 0

Today we are lucky enough to have another guest post from Seth, a VMG patient. Seth has type I diabetes and has completed our diabetes education program. Thanks Seth!

I hate vacations, not that this has ever stopped me from taking one. Maybe I should say that it's my diabetes that hates them. Truly, I'm not sure I can tell the difference between me and my diabetes. It�s the excess that usually does me in. Excessive lack of exercise and excessive eating push the bg bar line on my cgm up to Himalayan levels. I feel rotten about my poor self-control.

For the past week I�ve been on a staycation. This time was going to be different. In the end It was, too. Just not exactly what I wanted it to be. I told myself I was going to be very, very, good. O.k., I knew I�d be pretty good and, really, I have been. I�ve exercised and eaten right almost everyday. I relaxed. I watched the final two seasons of Borgen. I read magazines that had been piling up on my sofa. I finished a book I�m preparing for the book club I lead. I even lost a few pounds. Heaven.

I still hate vacations. Most days started well. I managed to wake up with a bg around 100 and feel 100% proud of myself. I had the kind of super healthy breakfast certain internet sites say will prevent colds: a single portion of steel-cut oatmeal with half a banana and walnuts, soymilk and an egg on the side. When I�m working, I count that at 25 carbs�yes, I know that it�s actually more than that, but that�s what I bolus for if I don�t want to sink into the 70s two hours later�and, yes, I know there's a better of way to do that.

So there you have it. I�d wake up with a great, no, not just great, a perfect blood sugar. I�d eat a beautiful, healthy breakfast. I�d drink too much coffee, but I�m pretty sure that�s a good thing. Over the next 2 hours my blood sugar would rise a bit, just as it should. I'd get on the exercycle and peddle through half-an-hour of a Borgen episode. Post-exercise my bg is back to it�s near-hundred level. I�m in the groove. I�m throwing a no-hitter. I�m going to Harvard on these test scores.

Then it all goes wrong. For the rest of the morning my bg would rise until by lunch I�m around 140. This happened all week. I know 140mg isn�t that bad. But a lunch time bolus for 65 carbs�way more than I�m really eating�didn�t change anything. I'm eating the kind of super healthy super foods that certain internet sites say cure colds, and in good portions, too. Still, my blood sugar was the same or worse at dinner, and even then, bolusing for way more carbs than I ate worked just as well as it did at lunch. I�d finish the day with a correction bolus.

Which is why I really hate vacations. As much as I need them, my diabetes needs special coaxing to behave itself when I change my schedule. I�m guessing that it missed the small, steady amounts of activity I get at work. I tried upping my basal. But that didn�t help, either. Probably I should have upped it more than I did, but for once I thought I�d better be cautious. I decided I didn�t want to bump it again because I�d be back at work in a few days, anyway. I have a suspicion that makes no sense, and I should have known better. At least I'll go to work tomorrow. Hope no one has left any cookies in the staff lounge.

P.S. Borgen is a great TV show.

Senin, 06 Oktober 2014

Thoughts from a Doc: Why do my sugars DO that?!?

Guest Post

11.58 0

Today's post comes from Dr. Stuart Chipkin, Valley Medical Group's Endocrinologist and Diabetes Program Director.

This is only Part 1 - stay tuned in coming weeks for more.

Thoughts from a Doc:
Why do my sugars DO that?!? (Part 1)

I get asked this question several times a week. I usually take this as a chance to remind people how complicated blood sugar control is.

There are at least six factors that influence blood sugar (glucose) levels. Let's start with two:

Food: obvious, and yet not so easy. �Simple� sugars cause rapid increases in blood sugar. More complex sugars (those from milk, grains, starches) cause glucose levels to rise more slowly and over a longer period of time. We try and take advantage of that when we talk about eating more �complex� carbohydrates- either to let your body �catch up� to the carbohydrates that have been eaten or to be available over a longer period of time (after exercise or after a low blood sugar). And it turns out that the way sugar is absorbed can be affected by other foods such as fiber or fat. So sometimes foods make sugar levels go up fast and sometimes they go up more slowly.

Exercise: also obvious but also not so easy. Activity that uses a lot of muscles cause those muscle cells to absorb glucose (sugar) from the blood. But your liver usually makes extra glucose for your muscle cells. Very vigorous exercise (e.g., running longer distances) can cause your body to release adrenalin (also called epinephrine) which makes your blood glucose levels rise further. But those muscle cells that absorbed the sugar during exercise continue to absorb it after exercise. In addition to �soaking up� more sugar following exercise, muscle cells also become more sensitive to insulin. In some cases, the increase in sensitivity can last over 12 hours! So sometimes exercise can raise your blood sugars initially but sometimes exercise can make your glucose levels decrease after exercise and then, sometimes, your body may seem to overreact to insulin for many hours afterwards (not typically more than 18 hours).

Next week's post will discuss other factors, including hormones, medications, not to mention the "element of mystery" that anyone with diabetes knows all too well. With all these different factors, and the ways that each of these factors can change blood sugar values, it�s pretty impressive we ever get things close to being on target!! This is why each individual has to learn about their own personal diabetes and some of the �quirks� of how their body responds.