Mar 09

Glycemic Variability and A1C

By Cary diabetes, lifestyle 2 Comments »

I have never actually cared what my A1C number said when results came back from the lab.  And this all started when I was a child and learn about variability.  Ok, it may have been conveyed in a slightly different form.

As a kid, it was really quite easy to fake a good A1C by having a lot of variability in the numbers. For reference of variability, I would run 30-50 miles per week and could easily polish off an entire pizza by myself.  As I got older, my A1C went up and unfortunately, the results of A1C became of little value to me.  Over the past 20 years, what is considered a “normal” A1C for diabetics has changed up and down so many times that I made up my own system for determining how good I am doing.

First, we need to have a few baselines: my target BG is 115, I do not correct a BG below 180, my acceptable range is 75-190.  Additionally, every BG usually has Carbs on Board, Insulin on Board, or Exercise on Board (BGs trending up or down) – so a correction (or asterisks) of the number is necessary, since the number on the meter may no longer tell the story.

Once you have this set I can find the number of highs, lows, avg, standard deviations, and how many of them have an asterisk next to it – with an additional story.  If you take a look at a “good” A1C and find a lot of highs and lows in your adjustment, the A1C is not accurate.  However, if I have an “ok” A1C and have few highs and lows, and my average is acceptable – I am far better off health wise and tend to ignore the A1C result altogether.

Nb. I am not advising against getting your A1C checked – as huge swings in your A1C can be problematic of a greater issue.

Feb 07

Changing Time Zones

By Cary diabetes, lifestyle, MDI, pumping No Comments »

One of the more interesting aspects of life and sport is travel. Regardless if you are a pumper or MDI, planning ahead can make life easier when changing time zones (especially if you plan on actually living in your new time zone for more than a few days). Obviously the direction and number of time zones are the most basic principals.

For a simple example, take East Coast to West Coast of the US, a three time zone change – not the most drastic change in this globalizing world. On a pump, this could be a very simple task of changing the time in the pump right before take off. However, if you are taking off around midnight and will be flying through the night, temporary basal may be necessary – since many pumpers will utilize greater basal overnight to compensate for sleeping and dawn phenomenon.

On Lantus, I have two theories – one for once a day users and the other for twice a day users. For once a day, I always kept the time of injection the same on my “home clock” – which works well if the time is still easily working in the destination time zone. For twice daily Lantus users, giving the injection 12 hours apart may become a bit of an issue for some time zone changes because one of those injections will likely be at a time that does not correlate well with your schedule – you may be sleeping! Starting with the dose 12 hours prior to travel – I always try and delay or advance giving that injection somewhat (depending upon which direction I am traveling). So that 12 hours later, I will be more on-target with the time zone in my destination.  For once a day, if my daily injection does not align well with my destination time zone, over the course of 2-3 days before leaving, I will migrate the injection to the destination time (by a few hours forward or back every day) and compensate with shorter acting insulin.

Traveling can be a wonderful experience and with a small amount of foresight and planning, it can be a truly pleasant experience. And if you are lying by the beach, or going to ride 100 miles in a distant location – changing time zones should not hold you back. Let some gnarly hill climb be the most difficult part of your trip.

Feb 05

Where to Put the Pump?

By Cary diabetes, lifestyle, pumping No Comments »

My favorite trick in wearing the insulin pump is making it invisible. In basically all of my clothing I have cut a small 1-inch hole in the top of both front pockets (especially my suit pants!). Why? So I can run keep the pump in my pocket and run the tubing from the pocket to my body without and of it sticking out. This is especially great when wearing a shirt tucked in – looks just like normal. However, I started doing this to my running shorts and the back pockets of my cycling jerseys too. Not only does it take the tubing out of the way, but it keeps the insulin in the tubing out of the elements: sunlight, bitter cold, etc. The number one place I hook my insulin tubing on is in the kitchen at home – always on the draw handles. And why? At home I never use the hole in pocket technique.

These are tricks mostly for guys, but it would be great to have a full list that works for everyone: women, men, kids; in any type of clothing.

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