Tips for Newly Diagnosed Individuals with Diabetes

Navigating the world of diabetes management can be overwhelming — especially for those who have been recently diagnosed. Having diabetes means adjusting to a new diet, checking your blood sugar levels, and sifting through occasionally confusing information and resources. Considering all of these new changes being implemented into one’s life, it can cause depression, anxiety, and stress for those with diabetes. Finding ways to manage these symptoms while also managing a recent diagnosis is key towards living a healthier and happier life with diabetes.

The following are three tips to help newly diagnosed diabetics deal with the shock and lifestyle changes that come with their diagnosis.

1. Accept your emotions and let yourself feel them all.

When first being diagnosed with diabetes, many feel angry, scared, and lost. This can include feelings and thoughts such as, “Why me?” It is important to let yourself feel these emotions. Diabetes is stressful, and it is likely to alter your lifestyle. But, remember that that does not mean your life has to change drastically. With proper resources and information from your doctor, you can manage your diabetes. Learn healthy ways to cope with your emotions, and try to let yourself feel whatever they may be. Repressing them can potentially cause issues further down the road, including denial and depression.

2. Confide in loved ones or professionals.

During this time, emotions will be high. Some individuals have the instinct to repress how they are feeling or isolate themselves. By talking to family and friends, it can help you work through your feelings. Express yourself, and be honest and open. Let them know that you would appreciate their support, as well as how you would like them to be there for you during this time. This may include help with going to doctors appointments, setting alarms for checking your blood sugar levels, or even just being there to listen. For some, looking into the possibility of professional help may be beneficial as well. Confide in your doctor or therapist to help figure out what is going to work best for you.

3. Find a community.

Many individuals with diabetes feel alone or misunderstood when they are first diagnosed, as sometimes they are the only one in their circle of friends who has the condition. Being able to relate to others is extremely important because it can help those diagnosed with managing their diabetes and looking to them for tips and advice.

The Diabetes App is a free application that can be downloaded in any mobile device app store. This application is solely for the diabetes community. It has users who are type 1, type 2, and supporters. It acts as a social media platform where users can create a profile, join groups, post, message, and add each other. It also has access to resources including meal plans curated by dietitians, access to professionals, live streams, exercise videos, and more. By joining The Diabetes App, those who are recently diagnosed can receive access to invaluable resources and friends who will all be able to relate to what they may be experiencing and offer insightful advice.

To conclude, being newly diagnosed with diabetes can be a troubling time. It can cause distress and concern about changes that will occur in the individual’s life. This is why it is important to figure out what will work best for you in terms of managing your diagnosis. Some helpful tips include confiding in loved ones such as family friends, and leaning on them for emotional support.

Be open about how you are feeling, both to yourselves and your doctors or family. Reach out to others when you need help, and let them know how they can assist you. Find a community that understands you and can relate to you.

Proud to be working with Diabetes Canada | Lace Up Virtual 10K Event

This September, Diabetes Canada is rallying Canadians together to Lace Up to End Diabetes. A virtual 10K event – where you exercise, move, run, or ride your way!

It’s been 100 years since the discovery of insulin – the most notable Canadian medical breakthrough of the 20th century. However, insulin is not enough. It’s the starting line, not the finish line for diabetes.

Diabetes is successful at outrunning us all. Even after 100 years of insulin, the problem of diabetes is bigger than ever. Today, one in three Canadians has diabetes or at risk of diabetes, and young people face a greater than 50% chance of developing diabetes in their lifetime.

This year I’m leading a Lace Up to End Diabetes team (Team Diabetic Dad) to help bring Canadians across the country together in a movement—Lace up to End Diabetes!

We invite you to do your #LaceUp10k your way!

You choose the activity and you set the pace. Walk, run, ride or dance your kilometres, whether it’s in two hours, two days or two weeks.: a virtual 10k but done in your own way! You choose the activity and you set the pace. Walk, run, ride or dance your kilometers in, whether it’s in two hours, two days or two weeks.

Profile and bio picture of blogger Mark Hanlon, Ontariio, Canada
Yep — this is Me! Why not sponsor Diabetes Canada or better yet – join my team!

A Little About Me

 I am a T2 diabetic on insulin. I also have an irritable bowel disease called Crohn’s disease. Although many people see chronic illness as a shadow that looms over them, I remind myself that living with diabetes or any chronic disease (or two) does not dictate what we can accomplish, if anything, it motivates me to show the world that I am in control of what I can achieve, which can be seen in my running, hiking, and cycling. That’s why I’m participating in Lace Up to End Diabetes: a virtual 10k in my own way! Read more about me here.

WHAT IS THE LACE UP 10k?

I invite you to do your #LaceUp10k your way! LaceUp 10K is a virtual event by Diabetes Canada where you choose the activity and you set the pace. Walk, run, ride or dance your 10 kilometres, whether it’s in two hours, two days or two weeks, during the month of September. 

Run

Whether you’re more of an adrenaline junkie or a moving meditator, running is one of the quickest ways to clock your kilometres.

Ride

Hop on your bike, scooter, or skateboard to go the distance. Indoor bikes count, too! This is the easiest way to take the 100k Challenge!

Walk

Walking is an easy way to exercise, and a great way to get the whole family involved parents, kids, and pets!

Move

Join us by stretching, toning, or dancing in your living room! Every two hours of a works out to about 10 kilometres of distance travelled.

For me, I am setting my goal high:

Staying active for 2 hours a week (about 20k if I run) for the month of September!  

WHY AM I LACING UP?

The funds and awareness I raise supports education, support services, advocacy and funding diabetes research that may just lead to the next big medical breakthrough.

I am lacing up this year to help redefine what it means to be a T2 diabetic and to continue to remind my two boys that despite what life throws at us, we can still accomplish anything. 

SPONSOR ME NOW

Please show your support by helping me reach my fundraising goals, by donating to LaceUp (link below) or joining my TEAM and committing to stay active. Check back often to see updates on my progress.

Thank you for cheering me on!

Discussing Hypoglycemia and Diabetes with Beyond Type 2

For those that visit my blog regularly, you have read countless words on the importance of good diabetes management and risk associated with insulin dependence for both Type 1 and Type 2 diabetics. The other week I had a chance to sit down with my friends at Beyond Type 2 (beyondtype2.org) to talk about a shift happening in the Type 2 diabetes community — more discussions surrounding the experiences of low blood sugar, also called hypoglycemia.

I won’t take the fanfare and glory from the great article that T’ara Smith at Beyond Type 2 pulled together, however, here is a teaser of the start of the article. A link to the entire article discussing Type 2 diabetes, hypoglycemia, and the risk of sever hypoglycemia is at the bottom of the page.

STAYING READY WITH NASAL GLUCAGON

Image: Article at Beyond Type 2 where I discuss my struggles with hypoglycemia and Type 2 diabetes.
Read the entire article at BeyondType2.org where I discuss my struggles with hypoglycemia and Type 2 diabetes.

It’s known that the primary focus of Type 2 diabetes management is on high blood glucose, but there is a shift happening in the Type 2 diabetes community — more discussions surrounding the experiences of low blood sugar, also called hypoglycemia. People with Type 2 diabetes like Mark Hanlon, who was diagnosed with diabetes in 2009, are sharing their stories to promote awareness about hypoglycemia and why it’s important for people with Type 2, especially those on insulin, to be prepared for an emergency.

“Hypoglycemia changes your day. If I’m at work and experience hypoglycemia, I can feel gross and sweaty, but most importantly, it tires me out and I get exhausted,” said Mark Hanlon, who lives in Toronto, Canada.

Hypoglycemia can occur at any time. But for people with Type 2 diabetes, it’s a condition that can have major consequences if not treated. While candy and juice are traditionally the ways people with diabetes treat a low, there’s a new emergency treatment on the market called Baqsimi, a nasal glucagon spray, is an emergency treatment for severe hypoglycemia episodes when a person is unable to drink or eat something or when they need assistance from someone else. It’s a more user-friendly version compared to the other glucagon kit, which requires the user to use a syringe to treat a patient having a low blood sugar emergency.

Those with Type 2 who take insulin are at a higher risk of experiencing hypoglycemia than those without who do not take insulin. If you’re starting an insulin regimen, it’s important to ask your doctor about how to treat a low blood sugar episode in the event it happens. For Mark, who started on basal (long-acting) insulin and later bolus (mealtime) insulin, he and his doctor never had those conversations.

“Everyone from my physician to my endocrinologist would say I’m well-informed,” said Mark. “Still, hypoglycemia wasn’t touched on. I think there’s this expectation that adults with diabetes know enough or can figure out these concerns for ourselves.”

For example, Mark was instructed to take four units of bolus insulin before meals and instructions on how much more insulin to take if his glucose was above a certain level before meals. However, he wasn’t advised on how to adjust the amount of insulin to take for certain kinds of meals……

Continue reading this great article at the Beyond Type 2 website a Staying Ready with Nasal Glucagon – Beyond Type 2.

What are the Benefits of using a Dexcom G6 or Freestyle Libre Continuous Glucose Monitor (CGM) for Diabetes Control?

What are the benefits of using a Dexcom G6 or Freestyle Libre Continuous Glucose Monitor (CGM) to manage your Type 1 or Type 2 Diabetes? As an insulin-dependent T2D, I am always looking for new or better ways to manage my diabetes and learn about how my body manages the carbohydrates I consume. 

I have been using a CGM to manage my diabetes since the fall of 2018. Here are some of my observations of the benefits of using a Continuous Glucose Monitor (CGM) from the perspective of an insulin-dependent Type-2 diabetic.

REMINDER: This information and website is not intended to provide any medical advice, opinion, or decision making, and cannot replace or be a substitute for your relationship with your healthcare provider.

What is a Continuous Glucose Monitor (CGM) for diabetes?

A Continuous Glucose Monitor or CGM is a medical device that continuously checks the glucose in your body every 5 to 15 minutes, all day and all night. A CGM allows you to monitor your glucose day and night without the need for traditional blood glucose finger tests. A CGM also allows you to see the trends and patterns in your glucose to help you and your diabetes team make more informed treatment decisions. Different CGM devices collect information in different manners using tiny sensors. In some cases, the sensor is placed under the skin of your belly in a quick and painless fashion, however, a CGM typically adheres to the back of your arm or your belly for 10 to 14 days.

Me sporting my FreeStyle LIbre CGM.
Me sporting my FreeStyle LIbre CGM to manage my blood glucose and diabetes control.

The picture to the right is me wearing my 14 days Freestyle Libre CGM sensor. You can read more about my thoughts on the Libre here. I also have a series of questions and answers about the FreeStyle Libre that are very much applicable to all CGM systems.

Four of the most common CGM’s on the market are the Dexcom G6, Abbott Freestyle Libre, Medtronic Guardian Connect CGM and Eversense (this one intrigues me).  However, not all CGM’S are available in every country as they are subject to approval by your federal health / drug administrations as approved treatments for diabetes.  Within Canada, both the Dexcom G6 and Freestyle Libre are available as approved diabetic devices and are covered by most public and private health insurance; although in most cases there is a requirement to be on insulin. 

How does a CGM read (blood) glucose?

The technology used by each CGM is slightly different.  However, unlike traditional finger blood glucose tests that use a sample of your blood to test for the amount of glucose in your body, a Continuous Glucose Monitor typically reads your glucose from your interstitial fluids below your skin.

Interstitial fluid (IF), or simply tissue fluid, is a mixture of water, ions, and small solutes that are forced out of the blood plasma by the systolic pressure created when the heart pumps. Plasma is a mixture of water and many other constituents, which carry blood cells and oxygen to various parts of the body. I look at IF, as the fluid that sits beneath our skin.  As if is born from our blood, it carries our glucose and is read by the CGM. Hint: CGM’s work best when we are well hydrated.

Here is a great info-graphic that shows how typical CGM sensors interact with the interstitial fluid and the glucose travelling in your blood.

Image showing how typical CGM readers estimate your glucose from interstitial fluids (IF). Glucose travels from the blood vessels to the IF which is read by your CGM.
Image showing how typical CGM readers estimate your glucose from interstitial fluids (IF).
Source: http://www.medtronicdiabetes.com/

There are 1,440 minutes in a day? How many times a day do you test your blood glucose?

There are 1,440 minutes in a day?  How many times do you test your glucose? Can you really say how well you know what your blood sugars are doing?

To be conservative let’s say as a typical diabetic we test our blood glucose with finger tests five times a day – a fasting glucose test when we wake up, before breakfast, lunch, and dinner and before our correction dose at bedtime. Presuming each test is a 1-minute snapshot of our glucose levels, that is less than 1% of the total minutes in a day or 5 minutes of testing?  What are your blood sugars doing the other 23 hours and 55 minutes (1,435 minutes)?  Even if you tested your glucose 10 times a day with a finger test, besides our poor fingers feeling like a pin cushion, we still have huge gaps in our glucose trends.  This is where your continuous glucose monitor truly shines.

A typical CGM tests your glucose every five minutes or 288 times a day. Using our same 5 traditional finger blood glucose tests, that still accounts for only 2% of the day. With a CGM, you now have the ability to track and monitoring your glucose up to 24 hours a day as you can see below in the black trend line.

24 Hour Glucose Trend Line from my Abbott FreeStyle Libre CGM (Continuous Glucose Monitor). You can see the spikes in my blood sugar.
24 Hour Glucose Trend Line from my Abbott FreeStyle Libre CGM (Continuous Glucose Monitor). You can see the spikes in my blood sugars with each meal and the spread or gap between the start of the spike and the end of the rise.

Studies have shown that there is a positive relationship between testing your glucose and better A1c results

Did you know that studies have shown that the more often a diabetic test their blood glucose the better their diabetes management? A 2013 study published by Diabetes Care (iv) showed that the higher number of blood glucose measurements per day was strongly associated with a lower HbA1c level. Results from the study suggest that if you test your blood glucose 2 times a day, your A1C is usually around 9%. Diabetics that test the blood glucose more than 10 times reduce their A1c to closer to 7%.

Graph: The more often you test your blood glucose, the better your A1C will be (Source Abbott UK).
Graph: The more often you test your blood glucose, the better your A1c will be (Source Abbott UK) (Source iv).

Imagine the successes you can have with your glucose control if you CGM tests your blood glucose 288 times a day? A similar study by 50,000 CGM readers worldwide suggests that the typical CGM user scans their sensors / checks their CGM readers 16 times a day can drop their HbA1C to less that 7% [Blue Graph]. More importantly, the events in minutes per day of Hypoglycemia falls by 40% in high vs infrequent testers (v) [Red Graph].

Graph: Real-world CGM data comprising 50,831 readers and 279,446 sensors worldwide, shows that frequent glucose checks with higher rates of CGM scanning is linked to improved glycaemic markers, including increased time in range and reduced time in hyper and hypoglycaemia.
Graph: Real-world CGM data comprising 50,831 readers and 279,446 sensors worldwide, shows that frequent glucose checks with higher rates of CGM scanning are linked to improved glycaemic markers, including increased time in range and reduced time in hyper and hypoglycaemia (Source: Diabetes Research and Clinical Care).

A CGM will help us understand how high, how quickly and how long our blood glucose reacts to the foods we eat

A CGM will help us understand how high, how quickly and how long our blood glucose reacts to the foods we eat. Looking at the image above, you can see the spikes in my blood sugar with each meal (breakfast, lunch, and dinner) and the spread or gap between the start of the spike and the end of the rise, for how long it took my T2D body to return back to “normaL”. You can also see the benefits of better carbohydrate and balanced meal consumption with a smaller spike at dinner. You can also see my not so great snack around 10:30 at night. The dots were where I took a specific glucose reading.

From the insights gained from our CGM, we can that how our Type 2 bodies can manage certain foods will be different for all of us depending on how much “natural” glucose control we have.  Do you know what foods work better with your diabetes than others?  If for no other reason, I truly believe this is one of the main reasons why EVERY diabetic should wear a Continuous Glucose Monitor, even for a short 10 to 14 day period between diabetes clinic visits. This includes both Type 1 and Type 2 diabetics on insulin as well as Type 2 diabetics that are managing their diabetes with pills, diet, and exercise.

Imagine as recently diagnosed Type 2 diabetic, for a 10 to 14 day period, the power of keeping a food log and being able to see EXACTLY:

  • How high did my blood sugars rise with certain foods
  • How quickly did my blood sugars climb, and did they return back to the normal range?
  • How long did my blood sugars stay above 10 mmol/L (180 mg/dL) after I ate?

Do your sugars rise with everything you ate?  Are your sugars increasing as they naturally would with food, and coming back down to a normal 5 or 6; or are they following a steady staircase as the day progresses, coming down but not as much as they increased, eventually leaving you in the high teens or twenties by bedtime?  How well do certain types of food work together? What works better? FOOD X, or FOOD X and Y? How good or bad is that “diabetes” friendly snack?

The successes with diabetes management are as much about learning as they are about good habits.

CGM can help support Diabetes Biohacking

Biohacking is the practice of examining and changing our body chemistry, in the case of Type 2 diabetes, our bodies’ ability to self-manage glucose, through food science and self-experimentation. CGM is a critical tool in diabetes biohacking. What do you consider your gold standard of glucose management?  For me, through a balanced diet (carbohydrates, fibre, and the glycemic index of foods, and medication), how well can I get my T2D body mimic the glycemic response of a typical or healthy adult? 

What is a typical glycemic response to food?

What is the typical bodies’ response to a controlled oral glucose tolerance test (OGTT) or incremental glucose peak (IGP)?  For the OGTT test, you will then be asked to drink a liquid containing a certain amount of glucose (usually 75 grams). Your blood will be taken again every 30 to 60 minutes after you drink the solution to measure how high, and for how long your glucose remains in your blood.

We are all aware of how our bodies “should” work. We consume carbohydrates, cells in your pancreas (known as beta cells) are signalled to release insulin into your bloodstream. Insulin then attaches to and signals cells to absorb sugar from the bloodstream. Insulin is often described as a “key,” which unlocks the cell to allow sugar to enter the cell and be used for energy. (i)  How much sugar (glucose) in our blood; after 2 hours; is an indication of glycemic control or diabetes.

The OGTT tests how well our bodies respond to the sugar drink.  In other words, you drink the sugar drink, your sugars rise. Your body releases insulin and over the next two yours, the insulin helps your body convert the glucose to energy until your glucose levels return to a normal range between 3.9 and 7.1 mmol/L (70 to 130 mg/dL). Depending on the results of OGTT, we are diagnosed with diabetes.

What is your diabetes diagnosis: Normal Fasting glucose is typically 3.3 to 5.5 mmol/L (60 to 100 mg/dL) and after 2 hours of the glucose tolerance test, a blood glucose less than 7.8 mmol/L (140 mg/dL). In contrast, a pre-diabetic or someone with impaired glucose tolerance have an OGTT of A 2-hour value between 7.8 and 11.1 mmol/L (140 and 200 mg/dL). We are diagnosed with Type 2 diabetes with a 2-hour OGTT value of 11.1 mmol/L (200 mg/dL) or higher.

What does this mean for a Type 2 Diabetic?

As Type 2 diabetics, how well our bodies can manage our glucose varies depending on how extensively our disease has progressed. In the early stages of a typical Type 2 diagnosis, we can improve our glycemic control through a better diet (don’t consume as many carbohydrates) and exercise (force our bodies to use more carbohydrates).  As our disease progresses, oral medications are used to improve our glycemic control, eventually progressing to a lifestyle similar to a Type 1 Diabetic, where Insulin is required to replace the insulin our pancreas would normally produce.

Why is this important to recognize? The severity of our Type 2 Diabetes, directly relates to how well our body can manage glucose, and more importantly how that relates to the foods we eat.  The same meal consumed by one Type 2 Diabetic and how well we can use the carbohydrates in that food, will be completely different for each of us. More importantly,  how much glucose is left in our bodies between meals will be very accordingly. This is where bioHacking and our CGM’s shine.

Jessie Inchauspe, the BioHACKING wizzard behind IG's GlucoseGODDESS. If you are eating a meal that has carbs, eating the carbs last will be better for your glucose levels.
Jessie Inchauspe, the BioHACKING wizard behind IG’s GlucoseGODDESS. If you are eating a meal that has carbs, eating the carbs last will be better for your glucose levels.
Source: https://instagram.com/p/B8b0eyRoHc0/

Preliminary published by the American Diabetes Association (ii) found that when vegetables and protein were eaten before carbohydrates, there were a reduction om glucose levels by as much as 37%, compared to when carbohydrates were consumed first. More recently, research has suggested that the extent of the glucose-lowering effect of protein and fat was found to be even greater when they are consumed before carbohydrates than mixed with them (iii). Give it a try and let us know what you observe with your CGM? How bad for your sugars are your favourite bowl of cereal? How bad is that All You Can Eat (AYCE) Susi (Check out my IG Post) (ADD LINK)

CGM’s Can Help Warn of you Severe Hypoglycemia or HyperGlycemia Events’

How well do you know when your blood sugars (glucose) are getting out of control? Are they getting dangerously high, are they too low to safely drive or at risk of a hypoglycemia event? A continuous glucose monitor can work to warn you or your caregivers when your glucose is getting out of range. CGM’s like the Dexcom G6 can work with your mobile phone, to continuously communicate with your mobile phone (about once every five minutes) via a Bluetooth connection to notify you if your glucose is above or below a defined threshold. The FreeStyle Libre, with the assistance of a 3rd party receiver to read the Near Field Communications of the Libre such as the Ambrosia NightRider BluCon and MiaoMiao that can read the sensor every 5 minutes and send the data via Bluetooth to an app which then notifies you of approaching highs or lows.

Although neither device is perfect, for example, your phone needs to be on and charged, your phone needs to be within the Bluetooth range of the sensor, and the app needs to be continuously running. However, this opens up some incredible opportunities. Despite these imperfections – something that could never be achieved with finger tests alone.

CGM’s are Opening the Doors for Automated Insulin Delivery for Type 1 Diabetics

Unlike Type 2 Diabetics whose pancreases and use of insulin are not as efficient as they need to be, Type 1 Diabetics do not produce insulin naturally and rely on doses of insulin with each meal to allow their bodies to manage their carbohydrate intake and fuel their bodies. Many T1D’s have migrated taking individual doses of insulin with each meal to the convenience of using an insulin pump to manage their insulin dosing.

An insulin pump constantly gives you a small amount of insulin, called a “basal rate,” throughout the day and night to help control your blood sugar. When you need extra insulin to cover a meal or to correct high blood sugar, you tell the pump to give you a small dose of rapid-acting insulin. Similar to a CGM saving your fingers from daily glucose tests, an insulin pump saves a diabetic from routine insulin infections, limiting them to a single catheter needle every two or three days. To date, insulin pumps are not “smart”, they are simply an easy delivery method for daily insulin use.

This is where the magic of CGM, an insulin pump, and a “highly experimental and not an approved therapy treatment for diabetes”, called Looping start to play well together.

Looping is highly experimental. You take full responsibility for building and running this system and do so at your own risk.

So What is Insulin Looping?

Loop is an app template for building an automated insulin delivery system. Loop works much like an artificial pancreas. Using your CGM, the loop system knows what your glucose levels are at any given time. Have you been exercising and your sugars are lower, did you just participate in an AYCE Sushi lunch and they are spiking higher than estimated, or were on the go and just could not eat as well as we normally do. An insulin pump requires manual adjustments to balance these needs. With Looping, the changes are seamless – with your CGM, working with the looping framework / application to then adjust the amount of insulin automatically depending on your glucose level – aka an artificial pancreas. Imagine a diabetic world where blood sugars are close to normal, without the concerns of hypoglycemia or hyperglycemia occurrences?

Although looping is not at the point where it is a mainstream diabetes solution – it does open the doors for where this blending of technologies will take us over the next generation of insulin pumps and continuous glucose monitors.

My thoughts about Continuous Glucose Monitoring for Type 2 Diabetics

Continuous Glucose Monitors are a game-changer for diabetes education and management. The simplicity and convenience of tap and scan to download the last 8 hours of readings from you Freestyle Libre or the Bluetooth connection to your mobile device with the Dexcom G6 has a direct relationship with patient responsibility and accountability to their diabetes management. Most of us are very visual learners, while others are still in denial as to the extent our bodies are no capable to manage carbohydrates on their own. I would be the first to admit, I Have tested my body time and time again, to see if just this year, things are improving on the diabetes front not continuing to slide towards insulin dependence.

A few days into using a CGM for the first time, a user in a diabetes FaceBook group I participate in enthusiastically wrote, ” I’ve been using Libre for a few days, blown away by how easy it is, how convenient, it’s a joy to test now! Doctor didn’t want to prescribe it to me as he felt it was just for type 1 diabetics .. doctors need an education about how easy these things are to use and how they can benefit anyone that is diabetic. “

Being able to see my blood sugars 24/7 has certainly helped me improve my glucose management and be a more responsible diabetic. Top image - my average 14-day glucose from early 2019. 55% of my day I was in my target range. Bottom image - Today, thanks to my CGM I am in my target range 88% of the time and no very high glucose.
Being able to see my blood sugars 24/7 has certainly helped me improve my glucose management and be a more responsible diabetic. Top image – my average 14-day glucose from early 2019. 55% of my day I was in my target range. Bottom image – Today, thanks to my CGM I am in my target range 88% of the time and no very high glucose.

Being able to see, how high did my blood sugars rise with certain foods, how quickly did my blood sugars climb, and did they return back to the normal range, and how long did my blood sugars stay above 10 mmol/L (180 mg/dL) after I ate are important lessons for any Type 2 diabetic. I strongly believe for that reason alone, insurance companies should be funding the use of CGM on a short term basis. Why not make them part of your diabetic equipment annual maximum for any non-insulin dependent Type 2? The long term benefits of proper diabetes care are well known and documented.


REFERENCES

Online Learning | Tools to make your learning from Home successful

As we approach the first anniversary of Covid-19 Lockdowns and remote learning. Here are some of the great tools, tips, and resources that have been helpful to make learning from home a success. It doesn’t matter if you are a college or university student, a high school student, or an elementary school student learning from home. There is something in this list for you.

Be sure to add your comments below on what has been your most helpful tool for learning from home.

Online Discounts Designed for Students

Amazon Prime for Students (6-months Free)

Did you know that as a student you qualify for a 6-month Free Trial of Amazon Prime and 50% off the Prime monthly rate? Why not give it a try – you can Cancel Any Time. Join Amazon Prime at a Student discount today. Prime Student members enjoy the same FREE delivery, streaming of popular TV shows and movies, on-demand, ad-free music streaming, Twitch Prime, early access to deals, and more.

Start your 6-month Trial of Amazon Prime Now!

The Deal: 6 Months Free. After your trial, your membership will upgrade to Amazon Prime for 50% off. Cancel anytime. Quebec residents get a 7-month membership for CDN $3.99 instead of a trial.

You Amazon Prime Access gives you:

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  • 50% off student discount for the normal Amazon Prime rate after your trial period.

Buy your Winter TextBooks Online

Save yourself a trip to campus. Check out Amazon’s extensive list of textbooks and save up to 20%. Textbooks from K-12 and University.

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Credit: Cover photo by Vlada Karpovich from Pexels

Review: DMP – The Diabetes App for iOS and Android

One of the newest apps in our diabetes toolkit is TDA – The Diabetes App for iOS, Android, and your web browser. This post is a diabetics review of the TDA App, or formally called the DMP or Diabetes Management App.

As Type-1 and Type-2 diabetics, one of the greatest tools we have to help manage our disease is the diabetic community. The hints, tips, and advice on how to better deal with our glucose control, eating and diet tips and recipes, and just overall mental support, from those that can directly relate in invaluable.

Image: DMP Is a free app for the diabetics community with community forums, livestreams, resources, and professional contacts
DMP Is a free app for the diabetics community with community forums, livestreams, resources, and professional contacts.

In this post, I will take a deep dive into the DMP – The Diabetes App from a diabetic’s perspective.  I hope this review of the new diabetes community app will be helpful to my fellow T1D and T2D diabetics.  However, before I get into my review, here is a quick overview of the DMP App available for iOS and Android. See the links at the end of this post to install the App.

What is the DMP – The Diabetes App?

The Diabetes App or DMP is a free app for iOS and Android devices that is dedicated to the diabetic community. On DMP, diabetics and their caregivers can connect with individuals from around the world to make new connections, get community support from people with the same type of diabetes (Type-1, Type-2, Gestational, etc.), who are the same age or have similar struggles. DMP also has a Find Professional area to connect diabetics with support from dedicated diabetes professionals from around the world.

What are the key features of the DMP App?

Like most blogs dealing with diabetes (this one included) and social media platforms like Facebook, DMP offers diabetics a convenient avenue from which to knowledge share and to educate themselves on diabetes, gain hints and tips on any variety of topics ranging from diabetic-friendly diets, advice, motivation, my favourite topic on our CGM or other diabetics technology (Hint: Want tips on how to keep your Libre or Dexcom CGM stuck to your armRead more here), and much, much more. 

IMG: DMP App is available for iOS and Android.  A community app for T1 and T2 diabetics.
The iPhone version of the DMP App – a community resource for T1 and T2 diabetics.

Where DMP takes knowledge sharing to an entirely new level is in providing a one-stop resource for diabetics integrated into a friendly app. The DMP App also has a website version. 

The great features are available through the DMP – The Diabetes App for iOS and Android include:

  • Live Streams – At least twice a week DMP host live streams in their app or on the Instagram Channel.  Many of the sessions are hosted by health professionals including registered nurses, physicians, psychologists, diabetes educators, and passionate members of the diabetes community
  • Online Chat Groups – Bulletin boards and chat groups have been the foundation of the internet since its inception.  DMP brings together diabetics and caregivers across a variety of diabetic topics.  Post a question, get a reply, or just some kudos to get you over that hump.
  • Resources – Links to online resources, articles, and blog posts for diabetics. Some of the topics include the benefits of exercise, recipes, exercise videos, podcasts, and achieves of livestream events
  • Professional Advice – The Find a Professional area is dedicated to connecting diabetics with trained professionals with expertise in diabetes management.
  • Ask DMP – Directly message the DMP team with questions, concerns, feedback, or wishes that you have for the App and how it can better support the diabetes community.

A diabetics review of the DMP App for iOS and Android

As many of my readers know, I am active in several Facebook groups, diabetes forum topics and through my blog to help Type 2 diabetics like myself manage the disease, how to better work with our CGMs, and as an insulin-dependent T2, learn from the amazing Type 1 diabetic community with tips on how to train my 40-year old self how to manage life on bolus and basal insulin.  So where does DMP fit into my toolbox of diabetes resources?

Does DMP Simplify navigating the diabetes Support Community Forum

Facebook has 1.7 billion daily active users, and hundreds of groups on diabetes alone. As an example, my Type-1 diabetes support group has 43k members. Online communities / forums are a great resource that follows a question and answer model – ask a question on just about anything diabetes-related and a community member will likely be able to respond with a personal antidote or provide links to online resources. Sure, there are loads of similar resources on Facebook and other websites, but, like all things, not all groups are created equal.

DMP Diabetes App - Community Forum Question and Answer
DMP Community support at its best answering one of my questions on tips for a newly diagnosed diabetic.

The DMP App and website were designed to simplify the search for online diabetic resources and bring the same community, conversations, support, and userbase to a dedicated app for iOS and Android.  In my opinion, the DMP App has done just that with flying colours.

When I asked the DMP Team how they feel the Diabetes App improves the existing experience that is found in Facebook groups and similar online sources, they raised a few great points:

  • Rules found in Facebook groups, which while useful in eliminating spam, can sometimes prevent conversations that provide helpful information.
  • DMP does have basic community guidelines, the rules allow for the sharing of helpful information with a goal is to help people thrive. The DMP want to hear about someone’s diabetes podcast, blog that they started up, or a social media account dedicated to their journey. Oftentimes these are the links that get silenced in Facebook groups. 
  • The idea of an all-in-one app, having an app-specific to those living with diabetes allows people to have a place where everybody on the app can relate to one another.
  • It also allows people to foster friendships whereas Facebook group notifications can get lost in the clutter of other notifications from Facebook unrelated to diabetes.
  • It’s a safe space that allows people to acknowledge their diabetes while having control over how they wish to engage whether that’s participating in community forums or simply utilizing our resources. It caters to a variety of needs.

From my experience, the DMP App has dedicated Community Groups / Forums for Type 1 and Type 2 diabetics, open groups for all diabetics to get together, and more specific topics such as tips to help slow down (reverse) the progression of Type 2 diabetes or parents of Type-1 diabetics (under the mom’s section).  The screenshot shown above was a recent question I threw out to the community asking “what is the #1 tip you would give to someone that was recently diagnosed as a diabetic?”

As of January 2021, some of the DMP Community Groups included:

TYPE 1 DIABETESTYPE 2 DIABETES
Daily ChatsDaily Chats
TeensReversing Diabetes
Young AdultsDiet
AdultsMoms
Moms 
The mom’s group includes found under both areas includes: Moms with Diabetes, Moms to T1D kids (psst, what about Dads?), and Gestational Diabetes

How is the DMP Community?

DMP has been available in the Google and iOS App stores since the Summer of 2020. In a few short months the DMP App has growth into a community of over 1,500 active users and close to 4,000 downloads.  Every day I logged into the app there are new and fresh faces in the community forums.  This early into an app’s history, it would not be fair to hold being “new” against them. 

That being said, the DMP – the Diabetes App team has done a fantastic job hosting a wide variety of Weekly Live streams dedicated to diabetes and diabetic friendly topics via the app and Instagram Live.

A great variety of weekly Live Streams Catered to Diabetics

My first experience with DMP Live Streams was a Live from the Kitchen session for making  Blueberry Lemon Scones hosted by Corey a Type 2 Diabetic and food blogger at @thistastegoodcorey (https://www.instagram.com/thistastesgoodcorey/) who’s tageline is “sharing my journey of recently being diagnosed with diabetes one meal at a time”. 

DMP typically holds two livestreams each week on a variety of topics. Prior to the livestream, users are sent push notifications to their App advertising the live event.  Most of the live events do take place within the DMP app with a few held on Instagram Live as well and usually around 30 minutes in length.

Sample of one of the DMP Livestreams – get the DMP Community App for Diabetics.

To raise awareness about these events, DMP promotes on their social media platforms prior to the event. In addition, users are also sent push notifications on the app when the event is about to start which will direct them to the Livestream page. 

Some of the recent live events included:

  • The Importance of Peer Support and Treating Depression by Hannah (Senior Pharmacist for Diabetes and Endocrinology in the UK) – View
  • Managing Seasonal Depression and Diabetes by Harpeet Nagra (Licensed Psychologist) – View
  • Achieving your Health Goals by Natalie (Certified diabetes educator and life coach) – View
  • Live from the Kitchen: Blueberry Lemon Scones (Type 2 Diabetic and food blogger) – View

The best feature about the livestreams is that they are recorded and made available for viewing at any time under the Livestream Archives allowing you rewatch or even more importantly, watch them at a time that is convenient for you.  After all, life is busy – convenience is the key, reinforcing the DMP idea of a one-stop-app for all your diabetes needs.  Kudos to DMP!

The livestream hosts are informative, dynamic, and the sessions are frequent. It will be great to see if the DMP can keep up this cadence of online hosts as the months and years go by.

Find Diabetic Professionals

One of the most unique features of the DMP – The Diabetes App is the Find a Professional section which is dedicated to connecting diabetics with trained professionals with expertise in diabetes management. To be clear, this area only provides you with an introduction, and the services provided by the professionals may be subject to fees for service. That being said, one of the biggest challenges we face as diabetics is finding advice beyond our family physician or endocrinologist.

the DMP App features a find a diabetes professional section.  Images of three of the professionals featured in the app.
Three of the diabetic professionals featured in the DMP App. Michelle Nouraei, Gary Scheiner, and Dr. George West.

The international list of professionals ranges from diabetes educators, health coaches, physicians, nurses, pharmacists, personal trainers, and more. Although the existing list of professionals is small at the time I wrote this post, it is a great start. I cant wait to see the list grow to include dietitians, naturopaths, and more.

Areas where the DMP – The Diabetes App can improve?

  1. GROWTH IN THE COMMUNITY: The App is one of the newest support platforms on the internet for Diabetics.  Continued growth in active users and the community forums will be critical.  This is where you come into the picture, give DMP a try and let me know in the comments below what you think?  Links to install the App for iOS, Android are listed at the bottom of the post, or check out their website here.
  2. ADDING SEARCH FUNCTION: Many of the sections of the app are chronological lists with the newest content on the top.  This works ok for a new app, but as the months and years go by and the amount of content increases exponentially, search functions, filters, and tagging content with keywords will be critical. 

    For example, what if I only want to find Livestreams on exercising or cooking?  That is a lot of scrolling to find the hidden gems
  3. CONTINUE TO BE FREE: The app is advertised as a free resource for diabetics.  At this point, it literally is free.   The app is clean without any advertising pop-ups or subscription fees.  It will be interesting to see how the DMP Team maintains this model going forward.  Speaking to the DMP team about this very question, the team provided some encouraging news “Currently, DMP is self-funded. As we move forward, we look to generate revenue through the introduction of an e-commerce feature which will allow us to sell diabetes supplies via the app.”  So great news to the DMP Community that the app will continue to be offered for free.  Time will tell
  4. MOMS, WHAT ABOUT DADS: Ok, this one is a bit of a comical pet-peeve, but as a single parent, I did get a bit offended by the Moms section and more so to the Moms of T1D Kids.
  5. FIND A DIABETIC PROFESSIONAL: There is a great variety of resources here from life coaches, medical professionals, health coaches, pharmacists, and more. It would be great to know if the professional can support users from anywhere in the world, or limited to a specific country.

Expect a big update to the DMP App in early 2021!

With version 1 of the app released in mid-2021, there is some room for improvement with the app.  The DMP team has provided some hints for what to expect with version 2 of the app expected in late spring 2021. 

Here are some of the new features we can exepct:

  • A new e-commerce feature will allow the users the buy diabetes supplies via the app.
  • Integrating a snapshot calorie counter and diet/lifestyle tracker. Whereas there are plenty of tracker apps available for those living with diabetes, DMP’s goal is to eliminate having to use multiple apps to manage diabetes. By having everything in one place, all information can be tracked in one place and used to spot trends and adjust as needed. 

Find the latest version of DMP App in the iOS App Store and Google Play:

Download DMP App at the App Store
Download the DMP App from the Google Play Store

In addition, for those who are not very familiar with using apps or want the convenience of a web view, DMP also has a desktop version:

The link for the desktop version of DMP is: https://dmp.disciplemedia.com/

People can use the same login and see the same content on both the app or the desktop version. 

Freestyle Libre 2 Coming to Canada in 2021

FreeStyle Libre 2 Approved in Canada
Approved by Health Canada in December 2020, Freestyle Libre 2 CGM will be available in Canada in early 2021. Source:Abbott.com

Health Canada has approved an upgrade to the FreeStyle Libre Continuous Glucose Monitoring System. The FreeStyle Libre 2 system continuously measures glucose data every minute with customizable, optional real-time alarms1 to alert users when their glucose is high or low without scanning.

Approved to for children (ages 4 and older) and adults with diabetes, this latest technology sustains excellent performance for up to 14 days, providing trends, insights and actionable data on a reader or with the FreeStyle LibreLink mobile app – all at the same price as the current FreeStyle Libre system.

Latest sensor-based glucose monitoring technology will be available in the coming months to more than 3.7 million Canadians with diabetes2.

Update: FreeStyle Libre 2 is Now Available in Canada

The Freestyle Libre 2 is available in Canada as of the week of March 22, 2021. The Libre 2 is now available to your local pharmacy or available online through Bayshore Pharmacies (Abbot Libre Canada) website.

I started using Libre 2 on April 10th, 2021. The process was pretty easy — my pharmacist had my doctor update my prescription and my private insurance did not give me any issues with Libre 2. So far, smooth sailing.

I picked up my first Libre 2 today (April 10, 2021). It looks near identical to the Libre 14-day.

New Features Added to the FreeStyle Libre 2 include:

  • Improved accuracy – the Freestyle Libre is the only CGM that measures glucose every minute, meeting the highest level of accuracy standards – taking 1440 readings per day. This is the highest number of daily readings in any CGM currently on the market. That’s five times more glucose readings than competitor brands.
  • Optional, real-time alarms1 that measure glucose levels every minute, FreeStyle Libre 2 gives users the option to be alerted in real-time of critical events such as hypoglycemia (low glucose levels3) or hyperglycemia (high glucose levels4).
  • The new system will be priced at the same cost as the current FreeStyle Libre system.
  • Improved accuracy right from day 1. Studies by Abbott have shown a 9.1% mean absolute relative difference (MARD)

Want more quick information about the Libre 2. Read of Frequently Asked Questions about the Abbott Freestyle Libre 2 System. Read the post here.

What was approved?

Unlike Libre 14 day where the sensor was approved in mid-2017, and the App for iOS and Android made available almost 18 months later, Health Canada has approved the entire suite of Libre 2 products.

The approved devices include:

Device nameIdentifier first issue dateDevice identifier
FREESTYLE LIBRE 2 (IOS)2020-11-3072086-01
FREESTYLE LIBRE 2 APP (ANDROID)2020-11-3072085-01
FREESTYLE LIBRE 2 READER KIT2020-11-3071970-01
FREESTYLE LIBRE 2 SENSOR KIT2020-11-3071993-01
FREESTYLE LIBRE SOFTWARE2020-11-30VERSION 1.0
Source Health Canada. Freestyle Libre 2 – Medical Device license: 105518

You can read a copy of the Health Canada Medical License webpage in the attached PDF here.

How FreeStyle Libre 2 Works

Using Bluetooth technology, when activated, the FreeStyle Libre 2 system automatically alerts users when their glucose is high or low without needing to scan the sensor.

Similar to Libre 1, the FreeStyle Libre 2 sensor is worn on the back of the upper arm for up to 14 days and measures glucose every minute to help users and their healthcare providers make informed treatment decisions. With a one-second scan using FreeStyle LibreLink, a smartphone app, or handheld reader, users can see their glucose reading, trend arrow and eight-hour history. Users can also share data with their physicians or family members via the LibreLinkUp mobile app.

Abbott′s FreeStyle Libre 2 system utilizes the same proprietary wired enzyme technology as the FreeStyle Libre system.

What is a CGM and what are the benefits of using Libre 1 or Libre 2?

CGM allows you to monitor your glucose day and night without the need for traditional blood glucose finger tests. A CGM also allows you to see the trends and patterns in your glucose to help you and your diabetes team make more informed treatment decisions.

A real-world study published in the British Medical Journal shows that the use of FreeStyle Libre system over one year is often associated with improved quality of life and that work absenteeism rate and diabetes-related hospital admissions decreased by two thirds.

Read more about the benefits of using a CGM in our previous post on WHAT ARE THE BENEFITS OF USING A DEXCOM G6 OR FREESTYLE LIBRE CONTINUOUS GLUCOSE MONITOR (CGM) FOR DIABETES CONTROL?

What is the PIN for Libre 2?

My pharmacist had trouble finding the PIN / DIN for Libre 2. For convenience here is information they may need.

Libre 2 Reader = 97799074

Libre 2 Sensor = 97799075


1 Notifications will only be received when alarms are turned on and the sensor is within 20 feet of the reading device.

2 Diabetes Canada. https://diabetes.ca/DiabetesCanadaWebsite/media/Advocacy-and-Policy/Backgrounder/2020_Backgrounder_Canada_English_FINAL.pdf. accessed November 24, 2020.

3 FreeStyle Libre 2 User Manual. Based on low glucose alarms set at 70 mg/dl.

4 FreeStyle Libre 2 User Manual. Based on high glucose alarms set at 180 mg/dl.

What is it like to have a Colonoscopy? A step by step chronology

Worried about having a colonoscopy? I took the time to recount my colonoscopy procedure.  Prepping my body, medications, eating, how I felt, and the procedure itself.  Give it a read and you will be more prepared for the next 48 hours.

Prologue

I wrote this post a few years ago and sit here laughing as I reread my words, not at what I wrote but the fact that I think I have lost count as to the number of times I have prepared for a colonoscopy.  If I hold the numbers noted in this post as accurate, I had my 7th scope in February 2017. What is even more humorous, is asking myself how can one forget about a tiny camera being snaked deep through your digestive tract? Then again, with a hint of sarcasm, not bad for a guy that is in his early 40’s? In comparison, I think my stepfather just had his first scope at the great age of seventy-four.

Putting all kidding aside, I hope you find this recount of my my preparing for and the colonoscopy procedure helpful and more importantly reassuring.  I would love to hear your comments so feel free to add any at the bottom of the page.  Truth be told, having a colonoscopy isn’t as bad as my opening paragraph made it out to be, promise!, we will make it through the next 48 hours together.

My Story …

Monday I am off to have my 5th Colonoscopy (circa 2011) as a check up from last years hospitalization and a recent flare-up of my Crohn’s Disease.  So why not recount the steps in preparing for a colonoscopy  and if nothing else, hopefully put some people’s minds to ease.

For Crohn’s sufferers, 5 Colon scopes is certainly not a record but for a guy that has yet to hit 40, it is still ahead of the curve.

So what is a Colonoscopy?

Borrowed from eMedicieHealth.com a Colonoscopy is:

a test to look at the inside of your colon. The colon is the large intestine and the last part of your digestive system. Its job is to dry, process, and eliminate the waste left after the small intestine has absorbed the nutrients in food. The colon is about 3-5 feet long. It travels from the lower right corner of your abdomen (where the small intestine ends) up to your liver, across your body to the spleen in the upper left corner and then down to form your rectum and anus.

The doctor will use an instrument called the colonoscope to perform a colonoscopy. It is a long (about 3 ft), thin (about 1 in), flexible fiberoptic camera that allows the doctor to visualize your entire colon.

A colonoscopy is the main way to check for diseases of the colon, such as crohns, colitis or colon cancer, and to identify or remove colon polyps.

  • A polyp is a mushroom-like growth on the inside wall of the colon or rectum.
  • Polyps grow slowly over many years.
  • Some polyps become cancerous, others do not

I actually found a fun video on YouTube of a healthy Colon as viewed through the colonoscope that you can take a look at:

[youtube=http://www.youtube.com/watch?v=6kg5wZQfADQ&w=570]

Preparing for the Colonoscopy

I think most people would agree, the preparation for the colonoscopy or scope (cleaning and emptying your bowels) is far worse than the procedure itself.

Every Gastroenterologist is a bit different on the preparation procedure they would prescribe (follow your doctor’s directions), however in short, your doctor needs to clean/ empty out your colon, small bowel, and stomach to give him or her an unobstructed view of the colon’s and small intestine’s surface.  What that basically comes down to is cleaning or emptying the bowel with the help of over the counter medications and a mild laxative to get your body rolling.

Each of the colonoscopy procedures I have had (with two different doctors, although both sets of instructions were generally the same) involved being under a mild sedative, so basically you sleep through the colonoscopy procedure, and wake up in the hospital recovery room, overall pretty simple.   However, as the doctor fills your bowels with air to get a better view, you may feel a little “bloated” following the scope but otherwise, generally, the procedure is painless.

Preparing for the procedure on the other hand, my body has always put up a bit of a fight and I would consider this the worst part of having a Colonoscopy.

Although each doctor has a bit different procedure to prep for the scope, mine have typically followed the following three steps to prep for a colonoscopy

  • Step 1 – Mild Laxative (2 days before procedure) at 5 PM
  • Step 2 – Only clear fluids the day before the procedure; and through to the procedure (yes, no food however clear fluids, including soup broth)
  • Step 3 – An aggressive flush of the bowels which usually starts late afternoon the day before the procedure.

HINT: Drinking plenty of clear liquids is important to ensure you do not get dehydrated, and I would highly recommend liquids high in electrolytes such as those found in many sports drinks or ginger ale.  Unfortunately, beer does not qualify as a clear liquid, however, the goal is to drink one cup per hour while up are awake after starting the liquid prep (i.e. Pure-oDan).

My 5th Colonoscopy Procedure – A journal of the next 48 hours.

Well I am not sure how to keep this section up to date but will give it a try to keep tabs on the “preparation for my colonscopy” with a bunch of edits to the post:

Saturday June 11, 2011

  • Mid-afternoon – Well I made my trip to the pharmacy to pick up my bag of goodies – one box Dulcolax (Stimulant Laxative) and a box of Purg-oDan (Oral Purgative) or Pico-Salax.
  • 5 PM – Took two Dulcolax, now let the fun begin.  Also had a nice steak dinner with BBQ vegetables to tied me through the next 48 hours.
  • Evening – Feel a little crampy and bloated.  Once I get the kids to bed I can relax a little.
  • 2 Bowel movements by bed time. Then again, as a Crohn’s survivor – a piece of cake.

Sunday June 12, 2011

  • Hardest part with today was making breakfast for everyone and not being able to eat it.
  • Consistent feelings of slight nausea and very bloated stomach – thank you laxatives
  • Overall, bowels have been quiet; just waiting until 5 pm when I need to start taking the Purg-oDan.I am not looking forward to that one as it is always a challenge for me to keep it down.  HINT: One thing I have learned over the past few scopes, “Follow the Instructions“.  As terrible as the stuff taste, it is NOT better to dilute it with more water – more water means, more to drink!  Use the 125 ml that it recommends and simply “get-er-done”.  Otherwise it is just pure torture.
  • 5:45 PM – A little late but otherwise on track however the verdict is in, this stuff “Purg-oDan” is pure torture and defiantly exemplifies why the preparation is the worse part of the entire procedure.
  • 6:30 PM – Similar to breakfast, it is hard to make dinner without eating or nibbling.  The BBQ Chicken turned out great – figures!
  • 9:00 PM – Still pretty quiet, but a general unwell feeling.  I thought I remembered the “Purg” taking a little less time to do it cleanse.  Just wasted a bit of time on the Play Station 3.
  • 10:00 PM – Ok, three tips to the bathroom in 10 minutes.  Just in time for my second does of “Purg-oDan”
  • 11:00 PM – Second does down, but certinally worse than the first — had to hold back a few sips from coming right back out.

Monday June 13, 2011

  • 3:25 AM – A night wakening and rush to the bathroom.  Somehow I managed NOT to step on the black dog sleeping on the floor as I rushed across the room.
  • 6:00 AM – Time to get up and start the day.  My procedure had been postponed from 9:30 am to this afternoon so the biggest decision of the day is if I am going to go into work for the morning
  • 6:30 AM – Three more trips to the bathroom this morning; think the office is out of the question.  It is amazing, not much left in my body as “things” are looking pretty clear.
  • 7:30 AM – Feeling a little dehydrated — remember, be sure to drink plenty of liquids.
  • 9:42 AM – Teleconference finished, time to get settled for the day.
  • 11:40 AM – Showered and dressed and just waiting for my ride to get here.  One thing to remember, you will be given a sedative for the procedure so you will need to arrange a ride to the hospital and someone to accompany you home.  My hospital will not let me have the procedure unless my ride home signs me in.
  • 12:55 PM – Arrived at the hospital and checked in.  Waited a few minutes in the lounge before a nurse called my name and brought me to a change room.  Shoes, socks and two hospital gowns (one open to the back and a second as a make-shift housecoat).
  • 1:05 PM – Interview with the nurse, medical history, medications, blood pressure (think my first one was 200 over 96; another arm much better at 120 over 80  didn’t think I was that nervous about today).  

    Another suggestion – bring a list of your medications, it is easier to remember.  I always have them stored in the notes section of my iPhone, and more recently under the Health Application.
  • 1:15 PM – Intravenous time (a piece of cake, even with my little veins).
  • 2:05 PM – Escorted to the procedure room.  After a few introductions, the nurse affixed a blood pressure cuff and some oxygen and my doctor gave me a needle.  Then seconds later ……….
  • 3:00 PM – Woke up in the recovery room to a smiling nurse and offered a juice and cookies.  On previous occasions my doctor was around to give you a quick rundown, today was simply a note to make a follow-up appointment with his office.
  • 4:15 PM – The chauffeured drive home was a little uncomfortable, with a consistent escape of air — the only comfort was that I knew my bowels were empty so it could “only” be air.  Once I arrived back at home I literally stumbled straight to bed and slept until dinner.
  • 8:25 PM – As I sit here at my desk, I think I probably overdid it with dinner but it was good to have food back into my body.  Total weight loss ~ 5 LBS but I am sure that will be back on by the weekend. At the same time, Congratulations!  You survived your Colonoscopy.

Now for Some Fun

A quick overview on  the lighter side is certainly needed.  Check out this little YouTube video by comedian Billy Connolly on his recent experiences with a Colonoscopy:

What are your experiences?

No matter the reason for the scope it’s never a fun experience to say the least. I would love to her your stories about preparing for a colonoscopy to help lighten the mood.

Do you have any hints or tips to survive the 48 hours? Feel free to leave a comment below or send me a message. I would love to hear your stories.

Hypoglycemia and Type 2 Diabetes | Learning to be a better diabetic

One of the hardest lessons I have had to learn as being a diabetic was – how to manage hypoglycemia and the risks of severe hypoglycemia. Here are some of the lessons I have learnt.

Diagnosed as an Insulin Dependant Type-2 Diabetic

No matter if you are a Type 1 or Type 2 diabetic, diagnosed as an adult, learning how to be a good diabetic has a steep learning curve.  Bolus, pre-bolus, basal, carbohydrate counting, glucose, CGM (Continuous Glucose Monitor), when to make the move to an insulin pump, it is enough to make your head spin.

What I found even more challenging, there does not seem to be the same rigour and education given to adults learning to manage the disease as there are for parents in the juvenile diabetes community. I found I was learning by trial and error. Don’t get me wrong, my local diabetes education clinic is amazing – however, their adult programs are geared more for typical Type 2 diabetics and not someone like myself that is insulin-dependant.

In the three years I have been an insulin dependant type 2 diabetic – hypoglycemia or low blood glucose (or blood sugar) has been one of the harder lessons I have had to face. 

What is hypoglycemia?

Blood glucose (or blood sugar) is your body’s main energy source. When you have an abnormally low level of blood sugar, your body’s ability to properly function may be impaired as a result. This condition is called hypoglycemia, and it’s officially defined as:

  1. A blood glucose level of below 4.0 mmol/L (70 mg/dL),
  2. The development of autonomic or neuroglycopenic symptoms as described in the table below, and
  3. Symptoms responding to the administration of carbohydrate (1).

Hypoglycemia is most frequent in people with type 1 diabetes, followed by people with type 2 diabetes managed by insulin, and people with type 2 diabetes managed by sulfonylureas.

What are the signs and symptoms of hypoglycemia

The signs and symptoms of hypoglycemia affect both Neurogenic and Neuroglycopenic aspects of our bodies. Some examples of these symptoms can include:

Neurogenic (autonomic)

  • Trembling
  • Palpitations
  • Sweating
  • Anxiety
  • Hunger
  • Nausea
  • Tingling

Neuroglycopenic

  • Difficulty concentrating
  • Confusion, weakness, drowsiness, vision changes
  • Difficulty speaking, headache, dizziness

Learning to be the best diabetic possible

As a newly diagnosed diabetic we leave our endocrinologists office or the Diabetes Clinic with a prescription for insulin, some general guidelines on bolus and basal insulin dosing, and well….  What more is there right?  For me, I was told, 4 units of insulin with each meal. 

SIDE NOTE: As a Type 2 diabetic, my pancreas is running at about 15% efficiency.  Bonus, it still does something.  I take a few daily pills to help give it a bit of a kick start, so let’s say –25% efficiency with the help of my T2 medication.  My bolus (mealtime) insulin is there to help my body along and not necessarily to do all of the work as insulin would with a Type 1 diabetic. Read more about me here.

So Ok easy enough, right?  4 units, I have this!

  • Pizza – 4 units (Carbs: 50g)
  • Subway 6” Spicy Italian Sub Sandwich – 4 units (Carbs: 40g)
  • Subway 12” Spicy Italian Sub Sandwich – 4 units (Carbs: 80g)
  • All you can eat sushi – 4 units (20 pieces = Carbs: 200g)
  • Green salad, balsamic dressing and grilled chicken – 4 units (Carbs: 3g)

My Carb-Counting Blunder and Hypoglycemia

Wait – hold it right there? 3 grams of carbs with my salad and 4 units of insulin?  Can you guess what happened the first time I gave this a try? 

Let’s just say 80% of the hypoglycemia symptoms hit me about an hour after lunch.  There I was sitting at my desk, beads of sweat forming on my brow, then my chest – before long, my shirt was drenched with sweat, and not quite knowing what I had done wrong and the frightening feeling of the onset of hypoglycemia.   Fortunately, I was able to consume the recommended dose of glucose tablets Buy Here to raise my blood sugars, however, not before literally sweating through my clothing. A moderate to severe hypoglycemia event is truly a #daychanger.

Over the few times I have been hit with a mild to moderate hypoglycemia accident I have been prepared enough to have been able to navigate away from a severe hypoglycemic situation where I may not have been able to consume enough glucose to stabilize my body needing 3rd party assistance such as an emergency Glucagon injection like the recently approved Baqsimi Nasal Glucagon, or even worse emergency medical services.

My bigger concern?  What did I do wrong?  How could I be better prepared? No one told me how serious my hypoglycemia situation could have escalated to if I didn’t have glucose tablets on hand, and more importantly would my office friends have known how to have helped if I had not been able to treat myself? Would they have even known about Glucagon, the standard treatment for Severe Hypoglycemia, would she have known how to mix the syringe, or had the confidence to even try?

As Donald Rumsfeld said “there are also unknown unknowns. There are things we don’t know we don’t know.” The simple risks associated with a life relying on insulin was one of them.

Treating Hypoglycemia

The goal to treat for hypoglycemia is to detect and treat a low blood glucose (or low sugar) level promptly by using an intervention that provides the fastest rise in blood glucose to a safe level, to eliminate the risk of injury and to relieve symptoms quickly. It is also important to avoid over-treatment since this can result in rebound hyperglycemia and weight gain.

The typical treatment for Hypoglycemia is 15 g of glucose to produce an increase in BG of approximately 2.1 mmol/L within 20 minutes.  This provides adequate symptom relief for most people.  Examples of 15 g of carbohydrate, as recommended by Diabetes Canada, for the treatment of mild-to-moderate hypoglycemia include:

  • 15 g of glucose in the form of glucose tablets
  • 15 mL (3 teaspoons) or 3 packets of table sugar dissolved in water
  • 5 cubes of sugar
  • 150 mL of juice or regular soft drink
  • 6 Life Savers™ (1 = 2.5 g of carbohydrate)
  • 15 mL (1 tablespoon) of honey

Note: Be sure to discuss your best treatment options with your diabetes professional.

Hyperglycemia and Severe Hypoglycemia

Many Canadians living with diabetes are less familiar with severe hypoglycemia, where a person is unable to take fast-acting sugar on their own and relies on someone else to help them. While less common than mild or moderate hypoglycemia, anyone receiving insulin or insulin releasing medication is at risk.

Baqsimi is a nasal version of Glucagon. Simple, no injection safety for sever hypoglycemia
Baqsimi Nasal Glucagon – Non-injection of glucagon for severe hypoglycemia.

Typically, blood sugar levels fall below 2.8 mmol/L during a severe episode and the person may show some or all of the signs of mild and moderate hypoglycemia. In addition, they may lose consciousness or have seizures. In rare cases, severe hypoglycemia can be life-threatening.

Diabetes Canada (2) recommends that a severe hypoglycemic episode in a conscious person with diabetes should be treated by consuming 20 g of carbohydrates, in the form of glucose tablets or other another source of fast-acting sugar.   

Severe hypoglycemia in an unconscious person needs to be treated with a glucagon emergency kit such as Baqsimi Nasal Glucagon. In these situations, emergency services must be called. Baqsimi is a treatment for severe hypoglycemia, which is a known risk for diabetics but not the only cause of hypogycemia.

Hypoglycemia can happen anytime, anywhere: Ensure you have a Hypoglycemia Plan

As a diabetic, you are at risk of severe hypoglycemia anytime, anywhere.   I have had to deal treat mild to moderate hypoglycemia at home, at work, at the gym working out, and even simply while out for a walk. 

Make sure your close friends and family know what to do in the case of a severe episode, so they can take action if you need help. In every case of severe hypoglycemia, I always carry my Baqsimi and glucose tablets wherever I go. 

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What is your Workout Ritual? A Diabetics Perspective on Exercise

What is your exercise or workout ritual? As an insulin dependant Type 2 diabetic, exercise has become a critical component of managing my diabetes and Crohn’s disease.  I run, hike, cycle, mountain bike, and walk to help maintain a healthy lifestyle and manage chronic illness.  How do you help manage your diabetes?  As a diabetic, what is your workout ritual?

WARNING: Speak to your health care professional before starting any exercise program, including how to reduce the risk of low blood sugar during and after exercise

Exercise is a critical component to a healthy lifestyle

Exercise is a critical component to a healthy lifestyle, even more so as a Type 2 diabetic. Regular exercise has special advantages if you have diabetes. Regular physical activity improves your body’s sensitivity to insulin and helps manage your blood sugar levels (1).

What is considered exercise?

We can look at exercise as a form of physical activity that is done at enough intensity to improve your fitness. Resistance training, brisk walking, cycling, and jogging are examples of exercise. As exercise is more challenging than just accumulating physical activity through your day, it often needs some planning, a certain level of ability, and a little more effort.

The Canadian Diabetes Association recommends that if you’re living with diabetes regular physical activity is one of the most important things you can do to lower your blood sugar. For Type 2 diabetics, increased physical activity can work just as effectively as some medications, with fewer side effects. (2)

Some of the traditional benefits of exercise include:

  • Lower blood pressure
  • Better control of weight
  • Increased level of good cholesterol (HDL)
  • Leaner, stronger muscles
  • Stronger bones
  • More energy
  • Improved mood
  • Better sleep
  • Stress management

How much exercise should we aim for?

Strive to complete at least 150 minutes of moderate-to vigorous-intensity aerobic exercise each week (e.g. 30 minutes, five days a week) and resistance exercises (like lifting weights) two to three times a week.  If the thought of finding 30 minutes of exercise too difficult, you can break up the exercise into shorter periods, say 10 minutes here and there, aiming for a minimum of 30 minutes at the end of the day. 

What is my workout ritual?

How we manage the energy needs of exercise different for everyone, as diabetics we are not an exception.  Long before I was diagnosed as a diabetic, I was well aware of the risks of severe hypoglycemia, as my body had troubles managing my glucose during high-intensity exercise.  It was a common occurrence, whether at the gym lifting weights, or doing a cross-fit class, that I would experience low to moderate hypoglycemia, and would need to be assisted by my trainer or workout partner with some juice, elevating my feet, and me fighting maintain consciousness as I fought through a hypoglycemic occurrence.

What is hypoglycemia?

Hypoglycemia is the condition when your blood glucose (sugar) levels are too low.  Mild to moderate Hypoglycemia can lead to sides effects such as Shakiness, Dizziness, Sweating, or confusion, progressing to severe hypoglycemia which could include clumsiness or jerky movements, difficulty speaking or slurred speech, inability to eat or drink, convulsions or seizures, or unconsciousness. Read here for a full list of the warning signs and symptoms.

Managing the Rewards of Exercise and the Risks of Hyperglycemia

Those that read my blog know that I have used exercise as a tool to not only maintain a healthy body but as equally as important, a healthy and positive attitude towards managing life and not one, but two chronic illnesses (diabetes and Crohn’s disease).  To read more about my struggles, check out “Drawing A Short Straw In Life: Fighting Back Against Chronic Disease” and how I used my running to battle chronic illness.

Senior Citizen Exercising with Bands Image by Anna Shvets from Pexels
Senior Citizen Exercising with Bands Image by Anna Shvets from Pexels

Exercise is hard, but you can do it too

Don’t get me wrong – exercise is hard.  It takes time, motivation, progression through injury, good weather, and bad.  However, huge personal milestones and successes?  How many people do you know that can say they have run 21.1KM (13.1 miles) or jump on their bicycle a Saturday morning and ride 75KM (46 miles) just to justify eating a butter tart at the halfway point? 

As I opened up today, I run, hike, cycle, mountain bike, and walk to maintain my mind and body.  Cross fit on the other hand – I have not been as successful.  However, what works for me, may not work for you and vice-versa. 

What is even more important to remember, I didn’t start out running 21KM.  1 KM, turned to 2 KM, then 5 KM, and so on. Cycling, or any sport for that matter, starts very much the same. The biggest secret is simply, just start!

Starting to exercise can be as simple as going for a walk

Make a commitment to yourself to start exercising.  It is as simple as that.  if you run for 1 minute and do it regularly, you “are a runner”.  It is as simple as that. 

Exercise is not about winning medals or meeting some predetermined finish line, it is about doing something for ourselves and building a habit that improves our lives in countless ways. 

In addition to walking, running, or cycling, one of my favourite resources for beginners to exercise is the Canadian Diabetes Association video library that was pointed out to me by my local diabetes education clinic.  The websites video library has great videos exercises you can do at home with little or no equipment and has exercises that may be suitable for people of all ages, including seniors with Type 2 Diabetes:

As a diabetic, listening to my body is an important part of my Exercise Tool-Kit and my work-out ritual

As I noted earlier, hyperglycemia is a concern for me when I exercise.  Although I have managed this concern through the choice of exercise I participate in, I ensure that I plan for the worst-case scenario of my blood sugar dropping unexpectedly during exercise.

Me experiencing moderate Hypoglycemia after exercise
Me experiencing moderate Hypoglycemia after exercise

This includes always carrying my exercise nutrition, either in my cycling jersey, my running belt, or my hydration backpack, at the treadmill or beside my indoor cycling training, and following my diabetic friendly exercise rules:

Tips to help exercise as a diabetic

  • Listen to my body, not every workout will be the same.  Know my limits
  • Ensure that I am always well hydrated, even more so during our summer months
  • Continue to hydrate with a sugar-free electrolyte while I exercise
  • Carry a fast-acting carbohydrate with you in case you need to treat low blood sugar (hypoglycemia), e.g. glucose tablets or exercise gels
  • Monitor my blood sugar before, during and many hours after my activity to see how it affects your blood sugar levels. My CGM is a great help here as I no longer need to worry about finger tests
  • When possible, I exercise with a workout buddy that can assist in the case of injury, hypoglycemia, or administer my Baqsimi nasal glucagon in a severe hypoglycemia incident
  • If I am cycling or running alone, use an incident detection device such as my Garmin Edge Cycling Computer or Garmin Forerunner watch to automatically notify friends or family if I need assistance

Comment below on what is your exercise ritual?

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