It is very fortunate that you laid the ground work for good control in his childhood. Although it may not seem like much now, early control and youth usually help type 1's get through the years of rebellion that typically occur somewhere between 16 and 25 years of age. Believe me, they almost all go through this, and they all survive. Eventually he'll decide he doesn't like feeling poorly and he'll start to think about better control. Here are a few suggestions that MAY help:
First, I believe that he's depressed; time in a youth facility and the almost "hand-in-hand" nature of diabetes and depression make it very likely. I love phototakers suggestion that a counselor he made a connection with before might be a good resource.
Second, you might try a few verbal strategies with him to make him think about how his decisions are affecting his health. For example, you might say, "I notice that you have a lot of pain in your side every day. Do you think that any of the choices you're making (not controlling diabetes, drinking alcohol) are making that pain worse? What do you think you could do differently to feel better? What would it take for you to do that? How can I help you? Do you remember when you had better control of your blood glucose? I remember that you felt good, had more energy, didn't have pain... etcetera." These are not threatening or blaming statements, but they are statements that often help to get people thinking differently. Just toss them out there, be supportive, and offer to help in any way that you can when he's ready.
You might want to call customer care at Dexcom (1-888-738-3646) and ask if there is any patient assistance program that would help you to continue to get your supplies while you are unemployed. Kind regards, LaurieView Thread
There is no question about the positive benefits to many people from adequate omega 3 fatty acids; they do help to improve the good:bad cholesterol ratios for most people and they have a positive impact on inflammation. For some individuals this means less pain from inflammatory sources such as arthritis and inflammatory bowel disorders. For me it helps control carpel tunnel pain. I think this article gives a balanced assessment of both supplements and food sources and talks about the risks and benefits of taking them.
It's important to know that these supplements CAN increase bleeding risk in some people, so like all medications your health care provider should be aware of your decision to take them, and it should be pointed out to anyone who is going to perform surgery on you of any kind.
Finally I agree with this article that if you have any problem with the medication "repeating" on you that freezing the capsules and taking them frozen will help to reduce or eliminate this side effect.
it is not only possible, but very likely that insulin requirements will change over time. This can result from weight gain, decreases in activity levels and illness. It would be very helpful to his health care provider to have some "patterened" blood glucoses to evaluate his control. By this I mean testing in a pattern that gives reading from different times in the day. I ask my patients to do the following: on the first day of the pattern test first thing in the morning before eating anything (fasting test), then testing one hour after breakfast (or morning meal or snack). On the second day, skip the fasting test and check just before the lunch meal and 1 hour after eating this meal. On the third day test just before dinner/evening meal and 1 hour after eating. Do these 2 tests a day for 7-10 days and WRITE THEM DOWN in a log book or on a piece of paper, then take them to the office visit with you. These numbers will help to find out where the challenging times are in the day, and to target medication changes. It will also help you to see if the mealtime insulin ratio of 1:15 is enough or not. Please make an appointment within the next 7-10 days and test his blood sugars and take those numbers with you. Kind regards, LaurieView Thread
Hi, In June 2009 the American Diabetes Association announced at their scientific sessions in New Orleans that a group of diabetes experts had determined that using the hemoglobin A1C test was a reliable and more convenient way to diagnose diabetes. The members of this expert panel decided that an A1C cut-point of 6.5% or higher would be used to establish a diagnosis of diabetes. They also recommended that the diagnosis be confirmed with a repeat A1C test unless the person had clinical signs or symptoms of diabetes overall glucose levels over 200 mg/dl. they also suggested that people with an A1C in the range of 6 to less than 6.5% are at higher risk of developing diabetes (also called glucose intolerant or pre-diabetes in some sources). These individuals should be targeted for lifestyle modifications to prevent or delay the development of diabetes.
The committee also said A1c values are more stable after collection compared with the other tests. Blood glucose levels in samples taken from nondiabetic patients have been known to decrease by 3-10 mg/dl in as little as one to four hours when kept at room temperature. While that may seem like a small decrease, it is enough to move someone out of the diagnostic category of having diabetes if their blood glucoses are borderline, causing individuals and their health care providers to have a false sense of security. Hemoglobin A1C values vary less than fasting plasma glucose, or FPG, levels, and the measurement of an A1c has technical advantages compared with fasting glucose testing. These include the ability to test without regard to fasting state, to test immediately when in the office rather than requiring the patient to travel to the lab on another day, and the stability of the A1C test within the test tube versus that loss of glucose over a few hours time.
On a personal level, I find that many individuals test at times of the day during which they may get their best readings, such as in the fasting state. As others point out, your "worst" readings may be in the first 1-2 hours after eating a meal, rather than in the fasting state when you first arise for your day. So if a person misses seeing those points where there glucose is high, they might think that things are ok. This was the reason for the development of a number called the estimated average glucose, or eAG. This calculation turns your A1C into a number you are familiar with, such as you might see on your meter. The eAG for an A1C of 6.3% is 134 mg/dl, which is above the range of "normal" glucose. Your health care provider is being a wee bit aggressive (?) shall we say by calling you a diabetic, however he or she is probably looking at your lifetime risk of developing diabetes and assisting you now to control your risk of uncontrolled blood glucose and the complications that come with it.
Hi, it's great that you have found a health care provider who is comfortable to work with; this is SO important to your overall care and well-being.
I am a little confused by this information: "everything I read today says people with insulin resistance from PCOS should start at getting 40% of their calories a day from carbs and keep working backwards." It's the working backward part that I don't understand. The recommendations are 45-65% of overall calories should come from carbs, 10-35% from protein, and 20-35% from fat. These are very general recommendations, for example a person with heart disease or diabetes should eat few calories from fat, in the 20-25% range, and this range is likely to result in weight loss. For most people it's also helpful to spread out their carbohydrate servings fairly evenly through the day. This helps the body and the medications to match the carbohydrate intake and to control the blood glucose rise. Depending on your particular situation, very specific recommendations would be made as to how many grams of carbohydrate you should eat in order to help you meet your goals. One set of general recommendations is that a person eat 45-60 grams of carbohydrate per meal (the lower number for women and the higher for men), and 15 grams of carbohydrate for any snacks. If you read the labels on any canned or boxed products you'll be able to see what a serving size is and how many grams of carbohydrate that serving represents. I also recommend that you seek the assistance of a dietitian to help you to meet your individual goals.
Since you are experienced at managing your blood glucose while eating a usual diet, I am sure you can get a handle on this! As someone else pointed out, once you make some adjustments in your basal insulin for the lower carbohydrate intake in the WW diet, you'll have fewer lows. You will also have to make the suggested adjustments in basal insulin as you lose weight. I'd look for some points options that are about 15-20 grams of carbohydrate to use when you are low, but as you point out, low trumps points. Juice and lifesavers are both rapid acting options when you are having a low, and I agree with the suggestion that you follow a rapid glucose source with a meal or snack that includes a little fat and protein to help sustain your blood glucose. Your best bet would be to meet with the person who helped you to start your pump management so you can review your current glucose trends and make the necessary pump adjustments.
Hi, actually a small snack of 15-30 grams of carbohydrate before exercise may be just the ticket to prevent a blood sugar rise after exercise. For people with type 2 diabetes blood glucose readings depend on the balance between the medications and the production of blood glucose in the liver. When you exercise the liver may go into high gear to make glucose for the demands of exercise, especially if you have too little insulin in your blood or your body isn't able to use the insulin that it's making (insulin resistance). If you give your body a little food to work off of for the exercise session your liver may not go into overtime. The best way to figure this out is to test your blood glucose before exercise and about 30-60 minutes afterward. If your reading is better with the snack than without it, then you'll know what to do. Let me know if you have questions about this idea. Kind regards, LaurieView Thread