Diabetes and.....

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Saturday, December 30, 2006

Time is running out!

Holy Snikeys!!! We've only got two more days left in the year, and I've yet to make good on any of the resolutions I set for 2006.

Yes, that's right. The Guru is just like you. I set a gillzillion resolutions with the best of intentions, and by the third week of the new year they've been thown to the way-side. But would you beleive that last year I actually set a resolution and kept it (I lowered my A1c). Well that mean's I've got to do another - gotta keep the streak alive?!?

So first let's take stock of what I wanted to accomplish this year...I probably won't have time to cure diabetes, and that probably means there won't be enough time to create the energy efficient pump either. So let's go on to plan 'B' - improve myself in some small way, (very small) learn some new skill to say I ended 2006 on a high note.

Off to the garage to rummage through boxes and see if I can come up with any ideas. And low and behold here's the answer. My Spanish CDs! Fantástico! (That's Spanish for fantastic for all of you who don't know.) I'd purchased them believing I'd surprise the wife with my fluent Spanish on our trip to Mexico. Yet as I put in the first CD (the first of sixteen mind you) and began to listen to a woman who sounded a little like the the teacher in the Charlie Brown cartoon specials (wa-wa-wa-wa), I realized I should move on to plan C (that's C in spanish in case you did not know).

How about the piano? I played in the band in high school, even had some music theory in college. Surely I could learn at least one song, maybe even a tune for the holiday? Down on the stool I sat and prepared for my musical masterpiece. With my fingers ever so lightly touching the keys, I fixed my eyes closely on the pages before me. Ok, that first note is a G, definitely a G. Or is it an E? Hmm, well we'll skip that one and come back to it. The next one is definitely an F. Wait a minute, that numeral sign at the beginning of the music, what does that mean, something about the notes being sharp, right? Or maybe lowercase?

Ok, I can read the writing on the wall better then I could read this music. Drop the idea and move on. Time is running out fast. What to do? I've only got three hours before Ma and Pa Foster show up, and the wife is already hitting me up with the 'Honey-do' list....I've got to think fast. On to plan, yup, that's right, plan 'D' (or 'D#', yes it's definitely plan D#).

My meter! Yes! The Guru is a genius! I was so excited to the new BG meter last month I stuck a battery in it, coded the vial of strips, and was off and running without setting the date or the time. This is perfect, I'll keep my streak of resolutions in tact and be able to keep an accurate record of my BGs (Boy, I hope my doctor isn't reading this...)

Up the stairs I ran to where I keep all of my diabetes supplies. I threw the doors of the closet open to search for the instructions that would lead to my salvation. All my diabetes supplies were stored in boxes stacked on top of one another - infusion set boxes, cartridge boxes, old meter boxes, shoe boxes, shipping boxes. Yes sir, everything in a box and a box for everything. One might call it a mess, yet I prefer to use the word, 'systematic'.

I finally find the instructions for the meter, it was a booklet of about four million pages long, give or take a page. (You'd think I was building the meter from scratch with parts from a radio.) I sat on the bed and began to scan the table of contents in the hope of bypassing the introductory stuff to get what I needed. Welcome, no....Precautions, no....Waiver, no....A-Ha! Time and date!

Frantically, I fumble with the meter and work to enter the time and date. Scroll, scroll, scroll. Enter! Scroll, scroll, scroll. Enter! I felt as if the countdown to the new year was upon me. Ten. Nine. Eight. Wait, wait, Wait! I've got to scroll back and fix the month. Seven. Six. Five. Darn It!Four. Three. Wait, wait, wait! Two...

Whew! Got the time and date done in the nick of time. The streak lives on and no one's the wiser (especially me). As I throw the instructions onto the top box of one of the stacks, the weight of the instruction booklet toppled the stacks over, causing the other stacks of boxes to fall over like a big stack of dominoes. Crash!

'What honey? My parents are here? Ok. I'll be right down. No, that noise was nothing. Trust me.'

Well, looks like I've got a resolution for 2007, I've got to get these supplies organized....

Thursday, December 28, 2006

The Best and the Worst of 2006

Although there are countless examples of breakthroughs and outstanding stories about Diabetes this year, here are my top five...


1) Kris Freeman competes in the 2006 Winter Olympics - Kris Freeman pushed forward the belief that those with diabetes can accomplish anything they set their minds to by qualifying and competing in the 2006 Winter Olympics. Kris competed in a total of three events: the Men's 15k Interval Start (placing 22nd in a field of 97), the Men's 4x10k Relay (the U.S. team finished 12th of 16) and the Men's 50k (placing 61st overall). For more on Kris and his amazing accomplishments, click here.

2) Team Type 1 wins the Race Across America - A group of eight insulin dependent diabetics were not only the first with diabetes to compete in the prestigious 25th annual Race Across America, they won their division. They completed the grueling 3,052 mile race in five days, sixteen hours and four minutes. Not only were they empowered by the idea of proving to others with diabetes that they can accomplish anything, they raised funds for the Juvenile Diabetes Research Foundation. For more on Team Type 1, click here.

3) Johnson and Johnson buys Animas - Johnson and Johnson took a giant leap forward in their intent to 'Create a world without limits for those with diabetes,' by acquiring Animas Corporation, maker of the Animas 1250. Not only did their purchase have them enter the insulin pump market in a leadership position, they set a standard for what is to come in the realm of partnerships between insulin pumps and glucose meters (Johnson and Johnson also owns Lifescan, makers of the One Touch Meters). To learn more about the acquisition, click here.

4) FDA release of the Dexcom - Not since the release of the Glucowatch has a product gotten more interest in the realm of continuous glucose monitoring. The Dexcom is used as a trending device to show the speed at which these changes happen, and for those who understand it's benefits it truly is monumental. The only drawback to a product as wonderful as the Dexcom, is that it does not live up to the dreams of what those with diabetes want - a device to replace finger stick testing. To read more about reviews of the Dexcom from Children with Diabetes, click here.

5) A cure for diabetes? It's been theorized for years that the body's nervous system has an influence on Diabetes, but a group of scientists took a huge jump in proving this theory. Although this isn't the first time that scientist has gotten the hopes of millions up with a possible cure, the latest in research shows this group in off to a good start. For more on the breakthrough, click here.

Sunday, December 24, 2006

All I Want For Christmas....

Sung to the tune of, 'All I Want for Christmas is my Two Front Teeth.'

Oh boy, I bolused all wrong for the cookies,
My BG is as crazy as can be.
I don't know which dessert to blame for this catastrophe,
But my one wish on Christmas Eve is as simple as can be....

All I want for Christmas
is a good BG,
a good BG,
yes a good BG.

Gee if I could only
have a good BG,
then I could
eat dessert for Christmas!

It seems so long
since I was in range,
No thanks to the rigors of
the holiday shopping.

But if I think
about it long and hard,
It prob'ly started with
all candy from Trick or Treating.....

Ohhhh.....

All I want for Christmas
is a good BG,
a good BG,
yes a good BG.

Gee if I could only
have a good BG,
then I could
eat dessert for Christmas!

Happy Holidays All!!!!

Thursday, December 21, 2006

Terms and Defintions from the Guru

A

Active Rest: The Guru’s best example of an exercise oxymoron. Active Rest stands for movement during the rest periods between intervals (as opposed to the very scientific method of stopping and keeling over).

Aerobic Exercise: Aerobic literally means ‘with oxygen’ (don’t know where the word came from, but you can pretend the Guru invented it if you want). It stands for exercise performed at moderate levels of intensity for extended periods of time that maintains an increased heart rate.

Algorithm: Sounds like a word only those who attended ‘havad’ would use, but it’s actually a step by step plan for determining how much insulin to take for both the blood level of glucose and the intake of carbohydrate.

Anaerobic Exercise: Anaerobic literally means ‘without oxygen’ (again, feel free to give me the credit…) It is any activity that is brief, and where oxygen is not needed for energy purposes. These are ‘all out’ activities, like the 100 meter sprint.

Anaerobic Threshold: The specific point at which your body moves from aerobic exercise to anaerobic exercise. This signifies a change in the energy that your body uses for activity.

Apidra: A rapid acting insulin manufactured by Aventis®. Onset of action of Apidra is 10 to 15 minutes, peak action is 60 to 90 minutes, and the duration is less than 5 hours.

Arthroscleroses: A disease involving the narrowing of the arteries, which is caused partly by deposits of cholesterol in the arteries. (Picture the gutters of your house getting clogged with leaves duirng the fall.) These deposits can be caused by both genetics and by eating foods high in cholesterol.

Artificial pancreas: A ‘very large’ machine that can measure blood glucose and release appropriate insulin. (Large is the key word here…These machines are entirely too large to be carried around with us, unless you want to pull a wagon that weighs a few hundred pounds).

Aspart (Novolog®) insulin: A rapid acting insulin analog manufactured by NovoNordisk®. The action of aspart insulin is faster than Regular insulin. Onset of action is 10 to 15 minutes, peak action is 60 to 90 minutes, and duration is less then 5 hours.

B
Basal: The amount of insulin needed to meet your basic metabolic insulin requirements; this includes even the simple act of breathing (yes, breathing requires energy!)

Basal Rate: A ‘pumping’ term that stands for the amount of insulin that is continuously delivered by an insulin pump. It is measured in units per hour (U/hr).

Bicycle, dual action arm handles: Sounds quite ‘techy’, but this type of bike is simply one with handles for your arms which force you to use arms as well as legs.

Bicycle, recumbent: A type of stationary bicycle where you sit and pedals are in front of you. (kinda like you’re riding a Harley.) This type of machine is better for those with weak lower back muscles.

Bioelectical Impedance: Another fancy shmancy way to determine your amount of body fat. An electrical impulse travels through your body (no you won’t feel it) and is able to tell the amount of fat. The slower the signal, the more fat you’ve got.

Blood Glucose: The glucose carried through the body by the blood stream. Also known as BG

Blood Pressure: In a nutshell, this is a measurement of how ‘open’ your blood vessels are; the lower the number, the more ‘open’ your blood vessels (and more importantly, the easier it is on your heart to get blood to all parts of the body). Ideal blood pressure is 120/80 or below. The top number is your systolic blood pressure, a measure of pressure when your heart is ejecting blood. The bottom number is your diastolic blood pressure, a measure of the pressure when your heart is relaxing.

Body Composition: A breakdown of your weight that shows the proportion of your body weight that is fat as opposed to your lean body tissue (all of the other stuff). Aka Body fat percentage

Body Mass Index: A number that represents the body’s mass. It’s determined by dividing the weight in kilograms by the height in meters.

Bolus: A ‘pumping’ term used to denote the amount of insulin delivered at one time, usually before a meal or when blood glucose is high.

Bone Density: This test has nothing to do with how smart your bones are, it is a measurement of how thick (and there for how strong) your bones are.


C
Cadence: This number represents how many times you turn the pedal every minute. Also known as RPMs, revolutions per minute.

Cannula: A ‘pumping’ term, a small tube (or catheter) that is inserted into the body and lies just underneath the skin to infuse insulin.

Carbohydrates: One of the three major classes of foods and numero uno when it comes to effects on raising blood glucose.. Carbohydrates are found in grain, fruits, and vegetables. Carbohydrates have 4 calories per gram and a healthy diet should account for 50% of your calories. slang term – carbs

Carbohydrate Counting: Estimating (I prefer to use the scientific term ‘guestimating’) the amount of carbohydrates in food(s) in order to determine insulin needs by way of an insulin to carbohydrate ratio.
Cartridge: The container that holds insulin for use in a pump or an insulin pump. Cartridges are not interchangeable. A cartridge for an insulin pen will not fit into a pump.

Certified Diabetes Educator: A healthcare professional qualified by the American Association of Diabetes Educators to teach people with diabetes how to manage their condition Also known as CDE

Cholesterol: A form of fat that is needed for the body’s production of some hormones, examples include butter and egg yolks. It has no calories but will raise the amount of cholesterol in your blood, and excessive levels of cholesterol can lead to atherosclerosis.

Collars: Clips that attach to the end of a weight lifting bar to prevent weights from sliding off the end of the bar and making a scene in the gym.

Conventional Diabetes Treatment: A system of diabetes management practiced by most people with diabetes involving only one or two shots of insulin daily, self-monitoring of blood glucose and a standard program of nutrition and exercise.

Continuous Subcutaneous Insulin Infusion: A method of insulin delivery where insulin is delivered under the skin by an insulin pump to mimic the way the body provides insulin. Also known as CSII

Cool down: The process of an easy, full-body exercise that will allow the body to transition from an exercise mode to a non-exercise mode. Depending on the intensity of the exercise, one may need to take a slow jog or walk, or one may simply stretch.

D
Dawn phenomenon: When I first heard of this I thought it meant if I ever happened to wake up before the dogs, but it’s actually, the tendency for your blood glucose to rise early in the morning due to secretion of hormones (like growth hormone, cortisol and adrenalin) that counteract insulin.

Delayed Onset Muscle Soreness: Soreness of the muscles that can occur up to 48 hours after your workout. Also known as DOMS

Diabetes: A disease where the body cannot maintain healthy blood glucose levels because either the body no longer produces insulin (type 1), or the body cannot appropriately use insulin (type 2) Type I has also been known as insulin dependent diabetes mellitus, IDDM, and juvenile diabetes. Type II has been referred to non-insulin dependent diabetes mellitus, NIDDM, or adult onset diabetes.

Diabetic Ketoacidosis: A serious condition resulting from a high level of ketones in the body because of a deficiency of insulin. Also known as DKA

Diabetes Control and Complications Trial: The decisive 10 year study (1983-1993) of type I diabetes that showed the intensive control of blood glucose would prevent and delay complications of diabetes. Also known as DCCT

Dietitian: A specialist in nutrition who educates others on the role of food and nutrition as part of their healthcare plan. A registered dietitian (R.D.) has special qualifications.

E
Endocrinologist: A physician who specializes in diseases of the endocrine system, and a specialist in diabetes. slang term – endo

Epinephrine: One of the hormones secreted by the body that helps the liver release glucose and limit the release of insulin. ‘Epi’ as it is also known, can make the heart beat faster and raise blood pressure. Also known as adrenalin.

Exchange plan: A dietary plan where foods similar in type are grouped together so that one can substitute foods for another within that group. Groups can include: starches and breads, meats, fruits mild vegetables, and fats. (Think of the weight watchers diets…)

Extended bolus: a ‘pumping’ term that allows a bolus to be delivered over an extended time (30 minutes -12 hrs) rather then all at once. Extended boluses are often used for meals that digest slowly such as meals high in protein or fat.

F
Fartlek: A Swedish word for interval training that has no specific measure or distance. Also known as Speed play.

Fat: One of the three main classes of food and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They also serve as energy stores for the body. See also saturated and unsaturated fats.

Fat, Saturated: Found primarily in meats and dairy products, these solid fats (at room temperature) raise your total cholesterol. Because of this, it is recommended to be kept under 10% of total daily calories. Some examples include butter, lard, meat fat, solid shortening, palm oil and coconut oil.
Fat, Unsaturated: Found in plant oils such as olive, peanut, corn, cottonseed, sunflower, safflower and soybean, these liquids tend to lower the level of cholesterol in the blood.

Fiber: A plant based substance that can not be digested; it provides ‘0’ energy but is low in fat and may help prevent heart disease and colon cancer. Fiber helps in the digestive process and is thought to lower cholesterol and help control blood glucose. See also soluble and insoluble fiber.

Fiber, Soluble: A type of fiber found in beans, fruits, and oat products; thought to help lower blood fats and blood glucose.

Fiber, Insoluble: A type of fiber found in found in whole-grain products and vegetables; passes directly through the digestive system, helping to rid the body of waste products.

Fitness Evaluation: Measurements of your current resting heart rate, body fat, strength and flexibility.

Flexibility: Plastic Man’s super power - how far and how easily you can move your joints. See also sit & reach test

Flexibility, Sit & Reach Test: A test of the flexibility of the lower back and rear thigh muscles.

Fructose: The sugar found in fruits, vegetables and honey. It is absorbed slower in the body then glucose (but personally my favorite).

G
Galactose: A type of sugar found in milk products and sugar beets. It is also made by the body. It is considered a nutritive sweetener because it contains calories.

Glargine (Lantus®) insulin: A long acting insulin analog manufactured by Aventis® Pharmaceuticals. The action of glargine is slow and constant, usually lasting 24 hours, which allows for once a day injections. Glargine is used as a basal insulin for injection therapy.

Glucagon: A hormone made in the alpha cell of the pancreas that raises glucose and can be injected in sever hypoglycemia.
Glucose: The major source of energy for the body and comes from the digestion of food (protein, carbohydrate and fat). Carbohydrate provides the most consistent source of glucose.

Glycemic Index: The effect of different foods on blood glucose (sugar) levels over a period of time. Researchers have discovered that some types of food may raise blood glucose levels more quickly than other foods containing the same amount of carbohydrates.

Glycogen: A substance made up of sugars. It is stored in the liver and muscles and releases glucose into the blood when needed by cells. Glycogen is the chief source of stored fuel in the body.

Glycogenesis: The process by which glycogen is formed from glucose. Also known as glucogenesis.

Goals: Objectives that you set as benchmarks for your exercise plan. See also back up, long term, short term.

Goals, back up: These are goals that are often referred to as Plan B. They are secondary goals that are made should something unforeseen prevent you from attaining your primary goals. (Example – a sprained ankle may prevent you from competing in your first marathon, but may not deter you from your overall goal of becoming more active.)

Goals, long term: Goals set to be achieved 3-6 months from now.

Goals, short term: Goals set to be achieved anywhere from one week to a month.

Goniometer: A device that a measure of flexibility for your hamstrings, looks like a giant protractor.

Gram: A unit of weight in the metric system. There are 28 grams in 1 ounce. In some meal plans for people with diabetes, the suggested amounts of food are given in grams.

H
Heart Rate: The number of times your heart will beat in one minute. Also known as pulse. See also max, recovery, and target heart rates.

Heart Rate, Max: The maximum amount of beats your heart can beat per minute. An easy method (220 – your age = max heart rate) uses your age to calculate your max heart rate, because your max heart rate should decline as we age.

Heart Rate, Recovery: Checking heart rate one minute after exercise is stopped. This amount measures your recovery - the larger your drop the ‘fitter’ you are. (Is ‘fitter’ a word?)

Heart Rate, Target: A set of numbers that represents the recommended range of your heart rate when exercising. This amount is typically 50-85% of max heart rate.

Hemobglobin A1c: A measurement of blood glucose control reflecting the average blood glucose for the last 60 to 90 days. Also known as.Glycosylated hemoglobin.

High Density Lipoproteins: A particle in blood that carries cholesterol and helps reduce arteriosclerosis. Also known as HDL

Hill repeats: A workout that involves running intervals uphill (because it’s harder then running downhill).

HDL / LDL ratio

HDL: cleaners removing LDLs and sending to liver

Honeymoon Phase: A period of variable duration, after diagnosis of type I diabetes when the need for injections of insulin is reduced and / or eliminated. This is because there are still beta cells in the body producing insulin.

Hyperlipedemia: Elevated levels of fat in the blood

Hypoglycemia: Levels of blood glucose lower than normal, usually less then 70 mg/dl. This will occur when there is too much insulin, too little food, or has exercised more than usual. Symptoms include dizziness, shakiness, rapid heartbeat, sudden hunger, cold or clammy skin, fuzzy vision, confusion, mood changes, and tingling or numbness in the hands, arms, tongue or lips and, if left untreated, can lead to unconsciousness. Also known as, Insulin reaction, low blood glucose, insulin shock.

Hydrogenation: a process used to turn liquid vegetable oils in to solids. process

Hypertensive: A fancy word for high blood pressure.

Hemoglobin A1C: A blood test that measures the amount of glucose (sugar) attached to hemogloblin. Hemoglobin is the part of the red blood cell that carries oxygen to the cells. The HbA1C test shows what the person's average blood glucose (sugar) level was for the 2- to 3-month period before the test. Also known as HbA1C.
Homeostasis: When the body is working as it should because all of its systems are in balance.

Hormone: Released by special cells, hormones are chemicals that tell other cells what to do. For instance, insulin is a hormone made by the beta cells in the pancreas. When released, insulin tells other cells to use glucose (sugar) for energy.

Hyperglycemia: It occurs when blood glucose levels rise above 180 mg/dl, and the body does not have enough insulin or cannot use insulin correctly to move glucose (sugar) into the cell for energy. Symptoms of hyperglycemia include nausea, vomiting, muscle and joint aches, blurred vision, excessive thirst, and frequent urination. Over time, weight loss can result. Hyperglycemia can occur even while using an insulin pump. Hyperglycemia can lead to diabetic ketoacidosis (DKA) if untreated. Also known as high blood glucose (sugar).

I
Intensity

Insulin: the key hormone that emits glucose to enter the cells

Insulin pump: Device that slowly pushes insulin through a cathetar under the skin but can also be used to give a large does before meals. Personally, the best invention since sliced bread, and without it I can’t eat sliced bread….

Insulin reaction: the result of too much insulin in the body without glucose to compensate for it. AKA Hypoglycemia, low blood glucose, or my favorite ‘the lows’

Insulin resistance: A condition where the body cells resist or do not respond to insulin being secreted by the body. An early stage of those with type II diabetes.

Intensive diabetes treatment: A classification of diabetes management using three or four insulin injections based upon measurement of blood glucose along wth very careful diet and exercise t approximate the normal range of glucose

Intervals: A workout involving alternating short intense periods of exercise with periods of relatively easy exercise. For example an interval workout may consist of 8 intervals of one minute hard, one minute easy..

Infusion set: a ‘pumping’ term, for a length of thin plastic tubing (24" or 43" long) with a Luer™-lock connector at one end, and a small cannula at the other end. The cannula is placed under the skin. It is connected to the insulin pump and used to deliver insulin to the body.

Infusion site: a ‘pumping’ term for the place on the body where the infusion set needle is inserted under the skin. The most frequently used areas include the upper, outer arm; stomach (just above and below the waist, avoiding a 2 inch circle around the naval). and the front and outside portion of the thigh. These areas can vary with the size of the person. Discuss appropriate site selection with your healthcare professional.

Injection sites: Places on the body where people can inject insulin. The most frequently used areas include the upper, outer arm; stomach (just above and below the waist, avoiding a 2 inch circle around the naval); c

Injection site rotation - Changing the places on the body where a person injects insulin. Changing the injection site keeps lumps or small dents (called lipodystrophies) from forming in the skin. Discuss appropriate injection site rotation with your healthcare professional.

Insulin - A hormone produced by the beta cells in the pancreas. Insulin is needed by the body to regulate use of glucose.

Insulin pen: An insulin injection device the size of a pen that includes a needle and prefilled cartridge (vial) of insulin. It can be used instead of syringes for giving insulin injections.

Insulin pump: A small, battery-powered device that mechanically pumps measured amounts of insulin through an infusion set into the body. The pump is not automatic. You program and control it, and you must check your blood sugar four to six times a day to ensure delivery of appropriate amounts of insulin by the pump.

Insulin resistance: Many people with Type 2 diabetes produce enough insulin, but their bodies do not respond to the action of insulin. This may happen because the person is overweight and has too many fat cells, which do not respond well to insulin. Insulin resistance is also linked to high blood pressure and high levels of fat in the blood (also called Metabolic Syndrome). If a person with insulin resistance uses insulin injections, they may require very high doses of insulin (over 100 units a day) to bring blood glucose (sugar) levels into normal range.

Intensive management: A form of treatment for Type 1 or Type 2 diabetes in which the main objective is to keep blood glucose (sugar) levels as close to the normal range as possible. The treatment consists of three or more insulin injections a day or use of an insulin pump; four or more blood glucose tests a day; and adjustment of insulin, based on food intake, activity levels and blood glucose test results. See also: Diabetes Control and Complications Trial.

J
Juvenile diabetes mellitus: The previous term for type I diabetes. It wad given it’s name because those who were diagnosed with type I were usually diagnosed during adolescence.

K
Ketones - are substances produced when the body burns muscle or fat for energy. Ketones develop when there is not enough insulin available to help glucose enter the cells for energy. The body, in turn, burns muscle and fat for energy. A waste product of fat burning is ketones. In uncontrolled diabetes, the process becomes unbalanced and ketones can accumulate in the blood, pass through the urine and ultimately result in diabetic. AKA ketone bodies

Ketoacidosis (DKA). Also see diabetic ketoacidosis.

L
LDL stick to the walls of your areteries and can obstruct blood flow

Lancet: A sharp needle to prick the skin used to prick the skin for a blood glucose test (aka ‘the sharpies’)

Lente Insulin: An intermediate-acting insulin that works in 4-6 hours and is gone by 12 hours.

Lipoatrophy: Indented areas where insulin is constantly injected

Low Density Lipoprotein A particle in the blood contining cholesterol and thought to be responsible for atherosclerois aka LDL

Lispro insulin - lispro insulin- A rapid acting insulin analog manufactured by Eli Lilly®. Also called Humalog® insulin. The action of lispro insulin is faster than Regular insulin. Onset of action is 10 to 15 minutes, peak action is 60 to 90 minutes, and duration is less than 5 hours.

Luer™-lock: A ‘pumping term’, the Luer™-lock is a special threaded fitting used to connect the infusion set to the pump's insulin cartridge.

Lean body tissue: everything else.

M
Maximal Test: evaluate your heart rate while you’re going all out.

Meal plan: A guide for controlling the amount of calories, carbohydrates, proteins and fats a person eats. People with diabetes can use plans such as carbohydrate counting, the Exchange Lists or the Point System to help them balance their meal and insulin requirements so that they can keep their diabetes under control. See also: Exchange lists; point system.

Metabolism: The term for the way cells chemically change food so that it can be used to keep the body alive. It is a two-part process. One part is called catabolism-when the body uses food for energy. The other is called anabolism-when the body uses food to build or mend cells. Insulin is necessary for the metabolism of food.

Mg/dL: The unit used to measure blood glucose levels. It is the abbreviation for milligrams of glucose per deciliter of blood.

N
Nutrition: The process by which the body draws nutrients from food and uses them to make or mend its cells. YOU ARE WHAT YOU EAT!!!

NPH: An intermediate-acting insulin, which starts to work in 4-6 hours and ends in 12 hours; a choice for those on multiple daily injections.


O
Occlusion: a ‘pumping term’ for a "blockage’ in the infusion set. This can occur if the tubing is squeezed, ort if the cannula is bent. Insulin pumps may or may not have alarms built in to warn you of a possible occlusion.

Ophthamologist: A doctor who specializes in diseases of the eyes

Osteoporosis: A disease of severe bone loss that occurs with aging, affecting women more then men. Weight bearing activity and lifting weights will help to decrease the amount of bone loss.

Overtraining: Pushing your workouts too hard and too fast; symptoms of overtraining include an elevated heart rate, chronically sore or weak, chronic colds, and not sleeping well.

P
Pancreas: The organ behind the stomach that contains the Islets of Langerhans

Podiatrist: A person who specializes in treating the feet

Protein: One of the three major classes of food. Proteins are made of amino acids, which are called the building blocks of the cells, responsible for allowing cells to grow and to mend themselves. Protein is found in foods from animals but also plants. Proteins have 4 calories per gram and should account for 15-20% of your daily intake of calories.

Pancreas: The organ that hosts the Greek Fraternity of the body, producing both alpha cells, which produce glucagon, and beta cells, which produce insulin.

Peak action: The time period when the effect of the insulin is having the most effect on lowering the blood glucose.

Postprandial Blood Glucose: Blood glucose taken 1-2 hours after eating to measure the amount of glucose (sugar) in the blood. This is used to determine if the meal dose of insulin was enough. Also known as PPBG

R
Radial Artery: An artery that runs on the inside of your forearm. This is one of the easiest places to take your pulse. Find it by placing your middle and index fingertips of one hand just below the base of your thumb on the opposite wrist.

Range of Motion: How far you are able to move a particular joint.

Ratings of Perceived Exertion: A method of gauging intensity of your workouts. Using the numerals 0 to 10, 0 will represent ‘easy as pie’ exercise, while 10 represents ‘please end this pain’ exercise. Also known as RPE.

Regular Insulin: A fast acting insulin active in 1-2 hours and gone by 4-6 hours. This type of insulin is used in insulin pumps.

Rebound: A swing to a high level of glucose in the blood after having a low level. This often occurs from over treating for a low blood glucose.

Repetition: One complete motion of an exercise, from start to finish.

S
Set: A group of consecutive repetitions.

Submaximal Test: A test that will evaluate your heart rate when you’re working at less then your maximal effort.

Stress Hormones: Hormones released by the body in times of intense physical or emotional stress. These hormones cause glucose stored in the liver and muscle to be released for energy, which can result in high blood glucose. Also known as counter-regulatory hormones

Subcutaneous: Beneath the skin, but just above the muscle. The infusion set used in insulin pump therapy is placed subcutaneously, and so are injections.

Skinfold Calipers: A devise that looks like salad tongs, used to determine the measurement of your body fat. The literal translation for the phrase, ‘pinch an inch’. Accuracy is dependent on the person completing the measurements.

T
Tempo workouts: Workouts that cause (as my mom used to say) ‘a good sweat’. It’s faster then challenging but not brutal, lasting between 4-10 minutes.

Trans Fatty Acids: Unsaturated fats that are chemically altered through, ‘the miracle of modern science’, with hydrogenation. Unfortunately this process causes these fats to act like saturated fats. Also known as TFA’s

Talk Test: A non-scientific term for determining your intensity during exercise. The idea behind the talk test is that when you are exercising you should not be gasping for air, but you should also not be able to sing along to your favorite song (Brittany Spears) blasting through your i-pod.

Temporary basal rate: a ‘pumping’ term describing an option on some pumps to increase or decrease the amount of basal insulin. This is incredibly useful for periods where an increase or decrease in your basal rate is needed (home sick with the flu, mowing the lawn, etc.)

Tendons: Tissues which connect muscle to bone. These were unfortunately left out of the song ‘elbow connected to the arm bone, arm bone connected to the shoulder bone.’ But still very important.

U
Ultralente Insulin: A long acting insulin that lasts 24 to 36 hours; a choice for those on multiple daily injections.

Underwater Weighing: A method of body composition testing. Body composition is determined by placing you (in your skivvies, or you birthday suit if your that bold) on what looks like a large scale that is placed into a tub of water. By exhaling every last ounce of air in your lungs (yes, every last ounce) you begin to sink; the amount you sink helps to determine your body composition. This method is very accurate but not always easily accessible.

V
Visceral fat: The fat that collects around the waist. This is what all of those exercise gimmicks focus on by emphasizing the idea of ’spot reduction’ (they don’t work).

Very Low Density Lipoproteins: A portion of your total cholesterol. This is the main particle in the blood that carries triglycerides. High levels are assocaited with a number of diseases and metabolic states. When thinking about your VLDL number try to remember ‘Very Low Densiity Lipoproteins need to be as Low as possible.’ Also known as VLDL

W
Warm up: Think of this as the ‘pre-game’ to the main event, the main event being your exercise session. This is performed before participating in exercise, generally consisting of a gradual increase in intensity in physical activity.

Z
I got nuthin for ya here…


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Monday, December 11, 2006

Ok, Time for a New Goal

It's been three whole weeks, and the excitement of my last marathon is finally coming to an end. The medal sits proudly on my bookshelf, the back of the race number has been enscribed with the race date and my time and carefully placed in a scrapbook, and my BG meter /insulin pump histories have been downloaded to my computer to analyze later. Whew! It was really quite a rush! But what's left now? What do you do after the excitement dies down?

Well for starters, I relaxed a little (ok, I actually relaxed a lot). After all, all work and no play makes Brian a dull diabetic. So what did I do? Boy oh boy, where do I start? I caught up on old episodes of 'Everybody Loves Raymond'. I read 'It's Not About the Bike' by Lance Armstrong(some parts twice). And finally I put together a puzzle of runners at the New York City marathon I had gotten last year for Christmas.

But as the last week came to a close, I began to worry that reaching my goals might have enccouraged me to be a bit lazy (if a marathoner can consider himself lazy). Reaching both my marathon goal and my blood glucose goals at the same time was an enormous accomplishment for me - and one that I now have to be careful of. Because sometimes, if we don't keep moving forward we end up digressing - if we're not careful, reaching the top of the mountain can cause us to about get caught in a landslide downward.

That's a big worry in the sports world. If you're a true fan of any sports team, you not only worry about the big emotional game with the team's biggest rival, but with the game your team has to play the following week. Because as any sports fan knows, it's usually after the emotional win that the team can suffer it's worst loss.

There are plenty of examples of this outside of sports too. How about in the business world? My dad was a businessman, and always seemed to worry more about the second quarter of the year then the first, and the fourth quarter more then the third. Why? He always said after a great quarter of sales is when you could end up losing the gains you made from the qaurter before. And what about school? My worst test scores were after my best. (No wait a minute - bad example. There were'nt any best scores to begin with, but I'm sure there's someone out there that could agree with the idea.)

My reason for highlighting all of this? Well, this is also true of our exercise programs. Whether it's after reaching your goal of losing five pounds or completing your first marathon, the time after reaching your goal is a crucial one. It's very easy to slip into a mode of over eating and under exercising (very easy). And the only way to try and combat this? You've guessed it -another goal.

In order for us to keep improving ourselves, we have to keep setting goals. It doesn't mean you have to keep losing weight if you're at a healthy weight, but you do have to find something interesting to keep you at your desired weight. How about training to complete a 5k run? If you've run a marathon but you're not interested in a faster marathon, how about training for a triathlon? It doesn't matter what the next goal is, as long as you enjoy it and it keeps you moving towards a healthier you.

My new goal? Well that's going to be a secret, at least for a little while. But it won't be for long - I'll let you know soon enough.

Friday, November 24, 2006

What did you do last week?

Marathoning is hard...You've got to get up really early, it's a really far distance (26.2 miles in fact), and boy, the effort it takes to complete one really blows the rest of you day. And that's just race day, let's not forget the weeks of work (yes, that means exercise) it took to get you there to race day.

That's just one view of marathoning, it's the glass half empty view. For me and the hundreds of thousands of others who tackle them each year, the glass half full take is incredibly more appealing. Through training for a marathon you learn discipline, you learn time management, and you learn the rewards of achieving goals, not through a magic pill infomercial that offers a 100% money back guarantee if you're not completely satisfied, but through good ol' fashioned exercise. Not to mention looking and feeling better.

For those of us with diabetes, there's an extra challenge. Marathoning with diabetes is tricky; you have to worry about fueling your body with enough 'carbs' so that you don't 'hit the wall' ( a term used to describe the feeling you get when your body is completely out of energy) in the marathon, but you also have to do this while maintaining your your blood glucose. They sound like the same thing, but to someone with diabetes they can feel like complete opposites. When I'm running marathons, I like to try and stay in the blood glucose (BG) target range of 120-180 mg/dl. That is higher then normal, but as my wife has said many many times, 'your running is not normal.'

Now I've been running marathons for some time now, but last week's http://cbs3.com/sports/local_story_323094612.html was one of my better ones. not only in my time to finish, but for blood glucose control. And the description of it is the subject for today's post. There's so much to talk about in marathoning, it can be hard to focus on just one aspect, but in an effort to keep things moving we'll just focus on that day in particular.

The race was set to go off at 8AM, which means I was up at about 4:45 AM (my dogs didn't even want to get up at that hour); my BG when I woke up was 187 mg/dl. For a marathon I'll eat at least three hours before the start because my insulin has an absorbtion rate of about three hours, meaning if I take my insulin for breakfast at 4:45 AM, the it would be out of my system three hours later. I also set an extended bolus of 0.08 for about an hour because I tend to get so excited at the thought of running my BGs tend to skyrocket if I don't take some extra insulin.

By 5:30 the breakfast is in, the dogs have gone out and been fed, the coffee was made and the wife was slowly moving around upstairs. By 6:00 we were in the car for the 45 minute drive to Phily.

OK - fast forward to the beginning of the race. I had dropped my basal rate to about 1/3 of it's normal rate at the same time the extended bolus was ending (between 6:00 and 6:30), and had kept track of my insulin on board through my insulin pump to see that by the time the race was going to start I would have about 0.3 of a unit left from the extended bolus I took. I figured I would need about 30 grams of carbs and grabbed a Gatorade bottle with 2.5 servings http://www.gatorade.com/formula_and_nutrition_info/ from my bag which equaled 35 carbs - perfect. My BG before having the Gatorade was 143 mg/dl - a perfect start.

My plan from the start was to stick to the pacer from the Clif Bar team http://www.clifbar.com/play/marathon.cfm?location=paceteam. Clif Bar promotes marathoning by having runners in the race that are experts at pacing, and if you're worried about your marathon pacing all you have to do is stick to them to run your specific time. They had an individual who was running a 3.10 marathon, and in order to qualify for the Boston Marathon again that's what I needed.

I chose to do something a little different this time around with my diabetes management, along with the usual H20, I started eating right from the very start instead of waiting an hour. I had a honey packet http://www.foodreference.com/html/art-honey-health.html (17 grams of carbs) at 20 minutes, and about 8 ounces of Gatorade (14 grams of carbs) at 40 minutes. I checked my BG at the one hour mark and was 136 mg/dl - perfect!

I kept on taking small amounts of carbs about every 20 minutes. I checked again around mile 14 and was at 127 mg/dl - this time I had two honey packets, and a Shot from Clif Bar (25 grams of carb) http://www.clifbar.com/eat/eat.cfm?location=shot&id=105.

I checked again for the last time during the race at around mile 20 -I was back up to 147 - holy mackerel! The last 6.2 miles were great. I had gone out reserved, and began to pick up up the pace on the last few miles miles up. I ended up 'dropping the hammer' (meaning I pushed it) for the last mile and ran it in about 6:20, which brought me to the finish line in about 3:06.23.

Back to the diabetes - I had turned my basal rate back up before the end of the last mile. And as soon as I crossed he line and got a a medal slung around my neck and a thermo sheet pulled around my shoulders I checked my BG - 114 mg/dl! I quickly took a big bolus and increased my basal by +50% for about an hour. This was because within the next 20 minutes I was going to begin wolfing down any food in sight, and since my basal had been about 1/3 of it's usual rate for the last three hours, I was going to need insulin to compensate.

So there you have it. I hope if you got anything from reading my post it's that goals are possible. I've run many marathons, but never one where I acheived both goals for time and BG control. It does not mean the others were failures, nor does it mean the others did not have enough effort put in them. Sometimes, these finalities are purely luck. It should not take away from the acheilvment of working hard with a goal, it just makes the goals all the more worth while. And after one goal is met, a new one is made. That's the mark of a good runner, and a good diabetic.

Tuesday, November 14, 2006

Rock, Paper, Glucose?

So there I was, trying to catch up on news events after breakfast via the web. While scrolling through the news, I came across an article on the international Rock, Paper, Scissors (RPS)tournament, which was held in Toronto Canada http://www.usatoday.com/news/offbeat/2006-11-13-rock-title_x.htm?csp=34

My first reaction was, 'Oh yea, that's the game my brother and I used to decide who got to ride in the front seat of the car with dad when we were kids. (I use the term 'used' as if we would no longer do that, but I do recall last Christmas when we used RPS to decide who got the last piece of cherry pie - I won). Then I read that the winner of the tournament took home almost $ 9,000 dollars! $9,000!!! I was shocked when I thought that someone who won a game of chance could win that much money. That's all RPS is is a game of chance, right?

While I sat there actually thinking about how many glucose tabs I could actually buy with $9,000 dollars, my Check BG reminder on my insulin pump went off. I had set it to go off two hours after breakfast, because by then I should have come back down to my target range. So, I dutifully got out my meter and strips to check my BG.

Then I go the number. 243 mg/dl! Are you kidding me! I was so mad, so very, very mad. What had gone wrong? I checked my BG before breakfast so I knew where my starting point was. I had counted my carbs perfectly, I even weighed my raisins (which I almost never do). I used my insulin to carb ratio to deliver the exact amount of insulin i would need. I even double checked my bolus in the pump history. How could that happen after all of that work. It's not fair!

My BG really threw me into a tirade (which usually happens when my BG is high). Hey my BG control is pretty much a shot in the dark, right? It isn't that much different from the RPS tournament; it;s just another game of chance right? Well then I'll start my own tournament just for diabetics - Rock, Paper, Glucose (RPG). Yes, I can see it now. We'll pit our inability to control our blood sugars in mono y mono style. We'll eat some carbs, take a bolus, and two hours later we'll guess at what our blood sugar is; whoever is closest to their actual BG wins - or maybe it should be whoever is farthest from their actual BG wins?

Wait a minute...Maybe my control isn't nearly as erratic as I make it out to be. I scrolled through the history on my BG meter and found lots of BGs that were in target. Sure there were some high and lows ones, but for the majority of them I was were I had tried to be.

I often make the mistake of focusing on the high BGs, not the others where I do everything right and my BG is exactly where I want it. That's a natural reaction, but the important point to remember is that the result should not take away from the effort it took to get the result. Eventually, the work will pay off.

So maybe I'm wrong. I can't have a tournament about the 'chance' of diabetes management because for the most part - it does follow the rules. If you eat right, exercise, count your carbs, and take your medication when you need to, you'll be on track for the majority of the time.

So I guess the dream of the RPG tournament died as quickly as it started. That's ok, I was never good at games of chance anyway...

Thursday, November 09, 2006

Ready, Set, Go!

So this is it huh? Blogging on the internet...Well, I'll be honest and admit it's not exactly what I expected. It wasn't that I was thinking there would be fireworks, parades, and fanfare. But I honestly didn't think it would be this easy. (Thank you by the way to Blogger.com for making it so; I'm not really what you call a computer savvy guy). As I'm writing this, I keep telling myself, ' I could say absolutely anything on this! What a rush of absolute power!' (and you have to imagine me saying that in a very powerful and mighty voice in order to get the full effect; otherwise the whole thing just sounds weird). But I'm afraid that in addition to be not being a computer savvy guy, I'm also not an not much of an R-rated guy, so you won't find any forbidden stories or racy photos here - sorry if that's a letdown.

So if you haven't clicked away already, let me give you the very simple, and the only reason I started my blog. I've got diabetes. Boy, in order for you to get the full meaning of that you really have to feel what I'm saying, and regular old 1o point times font doesn't cover it. . Should that be in bold letters? I've got diabetes. No, that's no good, maybe in italicize. I've got diabetes. Hmmm, no still not right. What about bold, italicize, and a color change, eh? I've got diabetes. There, that's better. You got the full effect now, I'm sure of it.

But did you? How could you? They're only words (and only three words at that). Three little words. But those three words sum up an enormous part of my life. Those three words have played a role in every decision, every day for the last 25 (almost 26 years). Those three little words encompass so much more to be said. So much more.

When I was diagnosed (and that was when I was seven) I felt like the only one with diabetes. And in my town I practically was. My pediatrician (who was only a year or so from retiring) had never had a patient with diabetes, the school where I attended had never had a child with diabetes, and no one in my family had diabetes.


Out of desperation for me, my mom bought me a notebook to write in (and as a seven year old boy I absolutely insisted on it being called a journal - it was not a diary) and had me start writing. She had me write anything and everything about diabetes and more; good thoughts, bad thoughts, and everything else in between. It became my outlet to write about the things I couldn't share with others. As I got older I wrote more and more; I've continued writing to this day.

This blog then is going to be a just that (a continued description of both the good and the bad) in the hopes that anyone, whether you have diabetes or not, can get something out of what I have to say.

The name Just Check It (by the way) refers to the idea that those of us with diabetes have to 'check' our blood sugar often - it's a part of having diabetes. Simple, to the point, and yes, for now it's simply the way it is.

So, I guess that's it. The end of the first official blog.

The parade may commence now, fireworks and fanfare will follow.....