New Toy ...

... I just got a new blood glucose meter.

I've been with the Abbott FreeStyle line since I was diagnosed in early 2008. But the new Contour USB Meter caught my attention about a year or so ago when it was initially approved by the FDA. The device intrigued me as it was a USB stick. And I HATE keeping my readings via a log book with a pen and paper. I figure that I would simply print out my readings for the last 2 weeks for my doctorb. Ie. less work for me! I finally took the plunge and purchased one for $64.99 today!

I haven't done much with it. I took a reading ... I love the strips! You can actually see the blood fill in the little compartment so you know if there are enough blood, unlike the FreeStyle strips, as it seems that I would simply attempt *guess* if there is enough blood. Other then that, its currently charging and I haven't been able to access the on device software (since I some how uninstalled JRE on my Mac). Once I fix that I'll probably have more to review. But its late and I just remembered I have a tech spec to write for work ... so I'm going to do that and then see if I can get things to work ...

And Some More News ...

... Again, the Globe and Mail has another article about diabetes. "Pancreatic stem cells discovered in mice" outlines that researchers have found stem cells in the pancreas and under 'abnormal injury' they coaxed these cells into turning into beta cells. Of course, again, its in mice. I believe this is good, because if I have stem cells in the pancreas that can create beta cells, then there would be no need to autoimmune suppressing drugs. Activating it is what is the problem. Again, this would be a treatment, and not a cure, since there doesn't address the root of the problem.

I have always wondered why there isn't more research or money spend on curing the root cause of the disease. Shouldn't most of the efforts be put towards that? Or even fast-tracked for people? I've looked at the JDRF (Juvenile Diabetes Research Foundation) and I see alot of money being thrown towards better 'treatments' such as the artificial pancreas project, beta cell transplantation, beta cell regeneration. They all don't solve the root cause, they are just more treatments. Instead of injecting insulin multiple times a day, I go and get a transplant or I continually have something stuck in me.

News organizations are all gun-ho for stem cells and its exciting and new. Its like if there is some sort of news nugget about stem cells, the mass media are all over it. I'd really like to see the bulk of any research money go to curing the root cause of the problem, instead of treatments. Once if you fix the root cause, then you can look at replacement/regeneration. What if you stop the autoimmune disease, and the body automagically creates beta cells again? Then all of that money for regeneration/replacement therapy is sort of wasted. So, how about we figure out what is causing the body to hate itself and then figure out a way to regeneration/replace beta cells?

Book Review: Cheating Destiny

Here is my next book review, "Cheating Destiny: Living with Diabetes, American's Biggest Epidemic" by James S. Hirsch. This is an excellent book. I highly recommend everyone read this. Not just diabetics or loved ones of diabetics, but everyone.

Hirsch was diagnosed with diabetes when he was a teenager and has lived with it for 29 years. This is an excellent novel. It starts out with his son and his own diagnosis of type-1 diabetes (at the tender age of 4). The novel goes through the history of diabetes. Each chapter addresses various aspects of diabetes. Topics he touches are diabetes in the deep south, history of insulin, the U.S. health care system, Dr. Bernstein's Solution on normalizing blood sugars, Dr. Denise Faustman ('maverick' doctor who has cured type-1 diabetes in non-obese diabetic mice), and the lows of the hypoglycemia.

I loved this novel. It was well-written and kept my interest. There are some really really scary things and sad stories. Some of it made me think about my own life, especially relating to children. There is also stories about people who have persevered and live life to the fullest. Highly recommended read for all.

Another Step ...

... the Globe and Mail has an article, "Stem Cells Stop Diabetes in Mice". The article outlines a breakthrough (although in mice) about stem cells being used to create new beta cells (the cells that are needed to produce insulin).

Why is this good? With stem cells, they are cells without an identity and apparently can form any cells in the body, including beta cells (those insulin generating ones). Up until now, they haven't been able to transplant stem cells and have them survive in a new mouse (I guess in this case), without the damaging autoimmune suppressing drugs. Ie. drugs that block the immune system from working properly. These drugs are usually necessary in transplants so the immune system doesn't go and kill off the new organ or cells. This is important because if the body can generate its own beta cells from the stem cells, there will be no rejection and no bad drugs.

Why is this isn't so good? Again, its with mice. Mice and humans are different. Also, this is NOT a cure. This is a long-term stop gap. Ie. so I don't have to jab myself in the gut 4 times a day. I may be able to just get a transplant once every 5 years or something like that. A true cure for type-1 diabetes, would be to eliminate the autoimmune attack. Once that has been eliminated, I'm sure that the body can just regenerate its own beta cells ... maybe. If not, then this technology would be needed to assist the body in the beta cell replacement.

How do you get diabetes? ...

... This has been a question that a lot of people have been asking me. I want make sure that everyone knows what causes someone to get diabetes. I have touched upon it in a previous post. But here is the straight answer.

You cannot *get* diabetes or be *infected* with diabetes. So, touching someone with diabetes or getting intimate with someone will not cause you to get diabetes. Scientists have learned that type-1 diabetes is an autoimmune disease, which means that the body is attacking itself. Type-2 diabetes is not an autoimmune disease. They body becomes less sensitive to insulin - ie. the body builds up sort of an insulin resistance.

So, what actually causes it? There is some sort of genetics involved here for both types. If someone close to you (grandparent, parent or sibling), there is a greater chance that you may develop diabetes then someone who does not have anyone close to them with diabetes. Furthermore, we know that its not purely genetic because only 40% of identical twins BOTH have diabetes. If it was a genetic disorder, then both twins all of the time would have diabetes.

For type-1 diabetes, the second factor that is needed is what is called an environmental factor. Something needs to trigger the 'genetic defect' to attack the body. Usually its some sort of infection that will awake the immune system to attack the body.

For type-2 diabetes, a poor diet and sedimentary lifestyle seems to act as a catalyst for type-2 diabetes. I'm actually not sure what causes the body to become less sensitive to insulin. When the body becomes less sensitive, it needs to create more insulin to process the same amount of carbohydrates. There are people who aren't overweight or obese that have type-2 diabetes; however, almost all of them are over the age of 60. You normally do not find someone in good shape who has type-2 diabetes who is under 40.

What doesn't cause diabetes?
For type-1 diabetics, lifestyle does not matter. There is nothing that people can do to avoid getting type-1 diabetes. For type-2 diabetes, lifestyle can help the body become more sensitive to insulin (losing weight and exercise). But again, really you probably can only delay the onset to your later years.

Side note, I just want to say that sugar does NOT cause diabetes. I believe they reason why is people hear, 'elevated blood sugars'. Sugar equals sweets! So, sweets must cause it. Saying sweets and candy causes diabetes is like saying, eating too much bread or pasta will cause diabetes. Bread, pasta and sweets all have to same effect on blood sugar levels.

Terminology ...

... surrounding the different types of diabetes. Many people have said to me, because you are so old when you got diabetes, it must be adult onset diabetes. This is yet another misconception or it is mostly mislabeled. Yes, I was an adult when I was diagnosed with diabetes; however, its not type-2 or adult onset diabetes. I have type-1 diabetes.

There are 3 types of diabetes.

Type-1 (formerly called juvenile onset) also known as insulin dependent. This form of diabetes is far more serious then the other types. Mainly because before the discovery of insulin, people would only have a few months to live. The body has lost the ability to create insulin. The reason why type-1 diabetes was called juvenile onset diabetes because no more then 10 years ago, if you were diagnosed with diabetes younger then 20, it was type-1. This type cannot be managed solely by diet, exercise and weight loss. People must take insulin injections (hence insulin dependent). There is not a 'typical' looking type-1 diabetic, they could be anyone.

Type-2 (formerly call adult onset) also known as non-insulin dependent. This form of diabetes is far more prevalent - it makes up 90% to 95% of all diabetics. When you read that there are millions of people out there that don't know they have diabetes, they are mostly referring to this type, as if they were type-1s, they would be dead with in months (see above). This form of diabetes can managed with diet, exercise and weight loss. Insulin sensitizers are often prescribed (Metformin is an example). However, as type-2 diabetics have the disease for longer and longer, it usually becomes necessary for them to have to start to take insulin (in combination with sensitizers) as the insulin sensitizers become less and less effective over time. A typical type-2 diabetic is older (45+), overweight (or obese) and lead a sedimentary lifestyle. Since most type-2s are older, it was dubbed "adult onset". However, the scary part is that because of the American sedimentary lifestyle, younger and younger people are being diagnosed.

Gestational Diabetes is a type of diabetes that occurs only in pregnant women. It is similar to type-2 diabetes, where the women can manage it through diet. Usually women who are overweight or obese are diagnosed with this type of diabetes. After pregnancy, blood glucose levels usually return to normal levels. It should be noted that, women who are diagnosed with gestational diabetes have a higher chance of developing type-2 diabetes later in life.

Book Review: The Little Diabetes Book You Need to Read

I was looking around on the Internet and checking out various blogs (which I will get around to posting my favourites) for books that maybe of interest to me about diabetes. In one of the sites, I came across this book by Michael A. Weiss & Martha M. Funnell "The Little Diabetes Book You Need to Read".

I really liked this book. Of course, coming from reading Berenstein's book where he is a doctor on a high horse, almost anything would have sounded more sympathic. The book opens up with a brief introduction on how the book will help you. Then it goes into the usual what is diabetes is, what caused it, and what not. It essentially outlines how you can be successful in managing this disease or condition (whatever you want to call it).

I liked this book because it essentially says that everyone is different in how they manage their diabetes. What works for one person doesn't always work for someone else (unlike Berenstien's book). They start to refer to diabetes and YOUR diabetes. Its not someone's else, because you are basically in charge of your own care. The doctors, specialists, educators and dietitians can give you the tools and advice for you. But ultimately you are the one who is responsible for how much or little you follow the advice.

The book isn't just for diabetics but there are sections at the end of each chapter for loved ones or people who care for diabetics to read. Again, its about the person who has the disease and how they deal with things. Some people can get really frustrated if their s/o constantly asks how is your blood sugar? Or nags and says, "You can't eat that ..." Other people may thrive on such demands by their loved ones, I don't. Again, its all about who you are.

I really enjoyed it and provided steps for an 'action plan' to manage your diabetes. It uses a lot of sports references in the development of the action plan, learning your enemy (diabetes), knowing your teammates (specialist, doctorb, dietitian and loved ones) and developing a plan (daily testing [glucose monitor], yearly testing [blood tests, eye exams, foot exams, etc ...]). It tries to make the disease more of an ongoing experiment on what works for you and what doesn't. Change plan, experiment, check results and tweak plan.

Character ...

... As I was writing up my next book review, I had thought of what this disease or condition has done to me. I realize it shows the true character of someone. What they are made of and how much they can take. People react differently to their situation (sort of the basis of the book). Some people ignore and don't care about tight blood sugar control. They deal with the complications as they come up. Others do want to stay healthy because the complications are so scary that they don't want to burden others. It also has shown who truly cares for you. These people give you the time and space when you need it. They give you an ear when you need to talk to someone. They truly care for you. These are the people that I cannot let down. I feel if I don't get my body under control, then I will have let these people down. I cannot fail. I will not fail.

Diabetes has also showed that I have a blinding hope. Blinding hope that they will find a cure soon. Hope has been sky high ever since they've discovered insulin - and that was 80 years ago. For 80 years, people have said that a cure has been just around the corner. For 80 years, people's hopes have been raised and dashed. A new treatment here and there that cures diabetes in some animal - now just apply it to humans, never happens. Some people cannot take anymore; others continue to believe. I will believe, I have to believe, its the only way that I can keep on giving myself injections because I really hate needles. But with the light at the end of the tunnel, I know that I have one less injection I need to give myself.

If they invent the 'hypospray' from Star Trek ... that's a different story.

Book Review: The Diabetes Solution

Here is my first book review. It also is one of the first books I've read on the subject of diabetes. Its "Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars" by Dr. Richard K. Bernstein.

Dr. Bernstein is a bit of a jerk. He preaches an Aiken's style diet. Actually, its more like Aiken's diet times 10. 30 carbs per day. That's it. That's all you get. Here is a list of things you cannot eat: Sweets (including "sugar-free" ones that contain sugar alcohols), Sweet & Starchy Veggies (beans, beets, carrots, corn, onions, potatoes, tomatoes), ALL fruits, ALL fruit & veggie juices, milk, yogurt (except plain), anything with flour in it, rice, pasta, cereal and a ton of commerically prepared food. That's quite the list. When I first read it, I looked in my cupboard and saw virtually nothing that I could even eat according to his diet. What is left? Meat, cheese, some veggies here and there. Now that is SOME diet.

One thing I do like about this book is the information contained in it. There is so much information on various common ailments for diabetics that I haven't really seen in any other book. He devotes a full chapter to 'Delayed Stomach Emptying', chapters on different type of insulin regimens, and what to discuss with your diabetes specialist and family doctor, what tests need to be done to ensure you are healthy and why things are happening to you.

Overall, I liked this book for the information it contained about diabetes and its affects on the human body. (Given that it was one of the first books I've read about diabetes, most of my information came from the Interweb). However, I didn't like the tone of the book. It seems he feels he is better then you and everyone should be in this diet and if you cannot do it, you aren't as good as he is. Good for information about what diabetes is and what is does to you. Bad for advice on how to control your blood sugars.

Misinformation ...

... this story piqued my interest this morning "Can Sugar Substitutes Make You Fat?". Mainly because I have been using artificial sweeteners to sweeten my coffee and I have been drinking diet sodas. On the advice of my dietitian and diabetes educator.

Overall the story is pretty sound; however, near the end of the story the reporter writes, "Excess sugar in the diet can lead to diabetes and heart disease, even independent of its effect on weight. " Excess sugar DOES NOT lead to type-1 diabetes. I also believe that it is not the direct cause of type-2 diabetes either. If you eat a gallon of sugar, you will not get diabetes.

For type-1 diabetes, it is a combination of genetics and an environmental trigger that causes it. The trigger could be several things, most probable would have been an infection.

For type-2 diabetes, it more of the years of a sedimentary lifestyle. Which would cause weight gain. Young people (under 45) who are type-2 diabetic are obese and overweight. Thus it becomes more difficult for the body to be as 'sensitive' to the insulin it releases. Hence, doctors will prescribe insulin sensitizers. Its not the sugar that is causing the diabetes. The biggest thing is that not everyone who is overweight or obese has type-2 diabetes. So, there must be some sort of genetic disposition that also must present. Again, like type-1, its probably genetics and an environmental trigger that causes the body to be less sensitive to insulin. The weight gain could just be a catalyst (but I'm not a scientist, so don't take the last comment as truth).

Mythbuster ...

... I figure I'll start a new label to dis spell any myths about diabetes. Most of them will be in reference to the type-1 diabetes.

In recent days, I have started to let people know that I'm diabetic. They usually have several good questions and a lot of preconceived ideas about this condition. So, I figure I would attempt to correct them in subsequent posts. I believe I may have touched upon some of these myths in previous posts. But I'd like to re-enforce them.

I've also been doing a lot of reading. There is a ton of information about diabetes out there and I probably haven't even scratched the surface. I'll probably end up doing some sort of book reviews in the upcoming days, if I don't feel lazy ... or ill (I have a bit of a cold).

Doctorb Day ...

... I've pretty much caught you up on everything that has been happening with regards to diabetes. I've been still reading a bunch of things and I'll probably start ranting about some of the annoyances I've found.

Today was DoctorB today! Three appointments. One with the diabetic specialist, one with a diabetes educator (registered nurse) and one with a dietitian. I was pretty lucky about the diabetic specialist. Especially since I'm a type-1 diabetic and I absolutely NEED insulin injections. In my previous post, I really wanted to try to get away with diet management alone; however that is not possible.

The unfortunate part of the health care system is that people cannot get absolute immediate attention. It would have been nice to meet the diabetic specialist the next day after I was initially diagnosed so then I could actually get started on the insulin regimen. However, that wasn't possible. It took about 3 weeks for me to finally get an appointment with the specialist.

Diabetic Specialist:
We chatted for a little bit. He sort of scared me when he said that the Metformin that I was taking cause side effects like liver and kidney failure. He told me its impossible for me to control it through my diet alone and I was probably in a *honeymoon phase* with my diabetes - which I suspected. He also mentioned that I could actually go for a second opinion, but I'm fairly confident that he was correct in his assessment. Especially since I've read ALOT of literature about diabetes in the last 3 weeks. He wrote out a prescription for two types of insulin. A basal insulin and rapid or fast-acting insulin. I will explain what they are later. He wrote out instructions for my dosages - X units 3 times a day before meals and X units once a day. He examined my feet and told me I had to see the eye doctorb every year starting now. Then he gave me a free insulin pen - its the Novus Junior pen.

Diabetic Educator:
This was about an hour long session. There was a little mix up in that they believed that I was a type-2 diabetic since I was prescribed Metformin. Apparently, type-1 individuals need to have a longer session because of their insulin injections. Thank you Mr. Walk-in Clinic DoctorB. Luckily I had just seen the specialist and he had just given me my prescription for the insulin. I showed the educator the paper that had the doses for my insulin. Once that was sorted out, we sat down and discussed various aspects of diabetes. Diet, meals, low blood sugar, exercise and alcohol were all discussed in-depth. If you know me, I really really like beer ... alot. I haven't had a drop of alcohol since I was diagnosed.

Dietitian
Again, there was the mix-up with the type-1 and type-2 diabetes with the dietitian. She pretty much said to me, I didn't think you would be type-2 since you are underweight and pretty young ... finally someone called me young :) Anyways, she asked me to describe how I eat. Its actually pretty tough when you think about. Eating is usually something that most people just do without any regard for anything - it just happens. So, I attempted to say how I eat. I usually just graze at my desk all day and that I didn't have set meal times, I would just 'eat'. After that she looked over what I like to eat and when. She said that there wasn't really anything wrong with my diet and that we won't be counting any calories because I could really stand to use to gain some weight (Believe me, I've tried ... and failed). She outlined a pretty easy to follow diet plan with real numbers for carbs. Something that I wanted since I was first diagnosed.

That was my day. Full of medical people and talking. There was a ton of information. I'm sure I'll probably share the bulk of it over the next few posts or so.

Changes ...

... So as a stop gap I have been given Metfomin to take 3 times a day with food. Hopefully this would be the way I can control my blood sugars. I believe this is a little over optimistic since I'm a type 1 diabetes (ie. just look at me, I'm 1.65 m (5'4"-ish) and weigh about 53 kg (~120 lbs). That's underweight. Plus I'm only 29 and I'm reasonably active. The Metformin (from what I've read is only for people who are type-2). Who knows what the doctorb prescribed me.

So, I have reduced my carbohydrate intake by at least 50% (by doctorb's orders) and my blood sugar readings have stabilized from 5.5 to 9.0. This though may just be the *honeymoon phase* [definition: Its the period of time shortly after someone with is diagnosed with type-1 diabetes where there is some magical restoration of insulin production by the pancreas. However, this is only TEMPORARY and does not mean I'm magically curing or reversing my diabetes]. I'm not a doctorb or specialist or educator, so I don't really know. Its been tough and I've been eating a lot of salad ("You don't make friends with salad").

Its been a little overwhelming with all of the reading that I've done. I've looked at several websites and started to look at diabetes books. Here is a list of websites that I've been reading:
The Canadian Diabetes Association [http://www.diabetes.ca}
The American Diabetes Association [http://www.diabetes.com]
The Juvenile Diabetes Research Foundation [http://www.jdrf.org/]
The Juvenile Diabetes Research Foundation (Canada) [http://www.jdrf.ca]

There are a few people that have been great to me over the past few weeks in helping handling this condition.
Crystal, my girlfriend. She has been a steady as a rock and source of alot of my strength through this. I don't know where I would be without her support. My boss at work. He has given me all of the leeway to ensure that I can get healthy again. He doesn't just see me as another employee but truly cares for my well-being. Colin, a co-worker who has always been there for me. Always has an ear for me to talk to him. Thanks all.

Follow up ...

I found myself back at the walk-in clinic. The doctorB armed with the results from my blood work. We looked through them together. Generally I was in good health. My *good* cholesterol was excellent and the rest of the blood looked good. He pointed out my A1C levels were pretty high (~11.0) and my blood sugar levels were pretty terrible (~16.0). He was impressed and surprised that I was feeling so well.

We discussed what the next step would be, which was to make an appointment with a diabetes educator and dietitian. Unfortunately, their 'scheduling' system was down and they could not make an appointment until the following business day. They will call me back to arrange an appointment. When I got the call from the diabetes centre, the earliest appointment would be February 5th - so I have to wait.

The doctorb in the meanwhile prescribed me Metformin and 200 test strips and lancets and gave me a few more tidbits of information and off I went. Without any in-depth knowledge on of what I needed to do or what was to come. I went off to Shoppers Drug Mart to fill the prescriptions and get a blood-glucose monitor.

Life Changing ...

The next few posts are going to sound more like a little novel as I've needed time to reflect and look back on what has happened over the last few weeks ...

Earlier this year, I finally went to the doctorb [the B stands for bargain] to get my blood work done. I just went to the local walk-in clinic. There was nothing in particular wrong with me. I mysteriously lost 5 pounds. My resting heart rate is around 80 to 90 beats per minute (which wasn't really a cause for alarm, but I was a little concerned about it). Occasionally I would have to get up in the middle of the night to go to the washroom but I figure that would be because I kept on drinking so much juice (Lemonade, McCain's Orange Punch, etc ...). Also, I would usually take a daily 10 to 15 minute nap at my desk at work. I figure because I would be up late the previous night. I would find out the real answer to this conditions.

So, the doctorb went through a quick examination. Checked my heart rate, blood pressure and what not. He was a little concerned about diabetes with my family history. He agreed that I needed to get my blood work done, so filled out a form and then instructed me to go to a lab in the morning. I went to the blood analysis lab in the morning and they took several vials of blood and I got to pee in a cup.

A few days later while waiting for a table at Morty's the doctorb called me and said, "You better watch your carbohydrate intake. You've tested positive [for diabetes]."