Precision Carb Counting, and how

I have something to confess.  I suck at estimating carb values.  Don’t get me wrong.  I count carbs like a pro.  I read nutrition labels with the best of them and calculate the carb content of baked goods and homemade soup like nobody’s business.  However, when it comes to eyeballing, estimating, approximating and downright guessing, I struggle.  You’d think after sixteen years I’d have more skill but, when a plate of pasta is placed before me, I have no concept of its volume.  2cups? 3cups?  Who knows?!  I have no knack for imagining a serving of protein as a deck of cards or a serving of grains/starches as the size of my fist.  What is standard fist size, anyway?  I know half a small apple is about 15g of carbohydrate, but could someone please tell me what constitutes a small apple?!

To deal with my lack of carb-estimating skill, I wield my ever-faithful diabetes tools, my trusty diabetes accoutrements, my superhero-worthy diabetes accessories, my…measuring cups and kitchen scale.  Okay, okay, maybe these aren’t quite as cool as a lasso of truth or a whip and fedora but if Wonder Woman or Indy had diabetes, they would be all over my kitchen utensils.

It wasn’t until about three years ago that I really started taking carb counting seriously.  Previous to this, I would rely on my not-so-great estimating skills.  And, as you can probably imagine, this resulted in an unacceptable amount of avoidable highs and lows.  Why didn’t I pay more attention to precision carb counting, you ask?  Well, there are a number of reasons…

1. Living in residence at university, I was embarrassed to carry my measuring cups around with me, hand them over to the cafeteria lady and ask for a reasonable portion of rice, potatoes, pasta, etc.  Instead, I would take the mammoth portions they offered, eyeball what I thought was 15 or 30 or 45 carbs and pawn the remaining portion off on one of my hungry classmates.
2. Like most Type 1 teenagers, my sugars had been all over the map throughout high school (gotta love them hormones).  So, when I entered my early-twenties, I didn’t realize that precision carb counting would make a significant difference to my blood glucose results.
3. Precision carb counting takes thought and time and effort.  And sometimes, it’s just easier to guess and move forward.  No muss, no fuss, no unwanted attention towards the fact that I have diabetes.

But, things have changed.  I have changed.  Now in my mid-twenties, I have learned to embrace the fact that I have diabetes.  I want to do all I can to avoid future complications, to get my control to a level suitable for a healthy pregnancy (one day) and to enjoy my life on a daily basis without unnecessary highs and lows.  So, I weigh my fruit, I measure my porridge and I count my Cheetos.  When eating out, I ask the server for a second plate, pull out my handy, dandy measuring cups and measure an exact amount of pasta (of the gluten-free, rice variety) onto said second plate.  No guessing required.  And whatever’s left on that first plate tends to make for some tasty leftovers.

Now, don’t get me wrong.  I am by no means perfect and there are times when I’ll grab a handful of potato chips without first counting them or pour myself a bowl of cereal and milk without even glancing at my measuring cups.  But, these instances are rare and becoming rarer.  Instead, armed with my measuring cups, kitchen scale, Calorie King and a calculator, I’m a self-proclaimed, unstoppable carbohydrate counting machine!  And, for those of you who haven’t tried it, doing some basic math before eating really works up an appetite for those 72g of carbohydrate in the meal to come.  Oh, wait…make that 68g.  I forgot to subtract the fibre.

My Favourite Number…Walks!

Team My Favourite Number will be at Beaver Lake bright and early on Sunday, June 14th, ready to show our support for JDRF by participating in this year’s 5km Walk to Cure Diabetes…and we’d love to see you there!

Come out with your family and friends and show your support for this cause!  You can register to walk online.  If you live in (or near) Victoria and are interested in joining Team My Favourite Number, please send me an email at laura (at) myfavouritenumber (dot) ca.

As part of the walk, Team My Favourite Number is seeking pledge support.  Money raised will aid JDRF research initiatives.  Donations can be made online through the JDRF Walk website.  In the “Support a Participant” box, simply search for “My Favourite Number” and follow the instructions.

If you don’t live near Victoria but would like to participate, search for a walk near you.   There are dozens of walks taking place across the country.  So, grab your sneakers, spread the word and let’s start walking!

Chloe Steepe: empowered, inspired and active!

This past weekend, I had the chance to catch up with Chloe Steepe, founder of Connected in Motion, an organization dedicated to uniting and inspiring people with type 1 diabetes through outdoor, experiential learning.  Established just a year ago, Connected in Motion is growing quickly and, by bringing type 1′s together to share their knowledge and personal experiences, Chloe is already changing the face of diabetes education in Canada.

Tell us a little bit about Connected in Motion and what inspired you to start it.

It takes a little bit of history in terms of what inspired it and why it exists.  I was diagnosed when I was 18 and, because of that, missed out on the whole pediatric side of diabetes and camps and pretty much any opportunity to meet people my own age with diabetes.  I just thought that diabetes was something that you did on your own.  It wasn’t until the past couple years that I had the opportunity to meet some people my own age with diabetes and, not only that, but people who have like interests – interests in the outdoors and being physically active.  I realized that I have a huge need for knowing other people with diabetes and I needed more support than what was available through the hospital system.

Last year, I was down in Australia and New Zealand doing some travelling and cycle touring.  I found this group called HypoActive.  It’s a group of Australians, based out of Melbourne, who get together and do some fun events every year.  They were having a cycling event while I was down there.  There was about twenty of us, all with type 1.  All our drivers, all our support crew, everybody had type 1.  Learning how to ride with a group of cyclists, you basically keep close together and draft in behind each other.  In doing so, you can conserve your energy and, as a group, you can travel way farther, way faster than anybody could on their own.  And it hit me as I was cycling – that whole weekend, it was like I was in a slipstream just being surrounded by other people like myself with diabetes.  It really empowered me and inspired me.  Not that things were any easier but it felt easier to have diabetes that weekend because everybody around me did.  And so, that idea of a slipstream just sort of stuck with me.  And I said, you know what, I need to make my own slipstream when I come back to Canada.

Do you have plans to expand across the country?  I know you’re currently centralized around Toronto.

We are expanding already, yeah.  Just last week I booked the first weekend of October at a camp in Nova Scotia.  And I’m working with some people on the West Coast to hopefully get out to Vancouver Island soon.  So, you’ll have to come!

Definitely!  Since Connected in Motion has been up and running (pun intended), have you seen participants become more confident when it comes to managing the balancing act of blood sugar, exercise, food and insulin requirements?

This is actually something that I’m really keen to pursue and do a little bit more research on as we run more events.  What is the impact of being involved in a program like this?  I think definitely as a result of the Winter Slipstream Weekend, people came away with new tidbits and new things that they were going to try.  The very first night people arrived around seven o’clock and about nine o’clock a girl came up to me and said, “I could go home right now.  This is amazing!  I just learned that I can put my infusion set in my arm.  I never even knew that!  Why didn’t anybody ever tell me this before?!”

Your determination to get outside and get active is really inspirational.  From canoe tripping to dog sledding to bicycle touring, it seems you’re up for anything!  So, if I were to tell you that you just won the My Favourite Number Million Dollar Lottery, what would be your next big adventure?

There’s a long list of things that I would love to do but what I really want to do right now, and something that I’m working on, is the idea of making Connected in Motion mobile, something that can be accessible to people with diabetes across the country.  What I would absolutely love to do with a million dollars would be to buy a funky, old tour bus and put together a team of Slipstreamers, or people who are living their lives without limits, get on a bus and tour across the country from east to west.

What has been your greatest tool or resource for leading such an active lifestyle?

For me, when I think about my diabetes, I think that knowledge is freedom.  I really try and learn as much as I can about diabetes and about what sort of impact exercise has.  I try to track everything that happens so that I can feel really confident that I have the knowledge to deal with situations as they arise.  Diabetes totally can be a barrier but not one that can’t be overcome.

When you’re going to be active, how do you prepare diabetes wise?  Have you ever experienced a major diabetes emergency?

Knock on wood, I have not.  I’m lucky to be able to feel my lows and they’ll wake me up in the middle of the night.  In terms of being prepared, it totally depends on the exercise that I’m about to partake in.  I wear a pump so I do a lot of basal reductions.  I always carry glucose on me.  When I go running, I shove stuff in my socks.

What advice do you have for Type 1′s who want to tackle a new workout, sport or other exercise challenge?

Go for it.  Experiential education is so key and, for me, it’s really the only way – especially with diabetes.  You can read so much and talk to your doctor so much but, ultimately, it’s what works for you.  You really do just have to go out and do it.

Can you tell us about some of Connected in Motion’s upcoming events?

Next weekend, here in Toronto, there is a little 10km run so there’s a few of us going to wear our Connected in Motion t-shirts and do the run.  There’s a few of us who are going to Ottawa at the end of May.  Some of us are going to try a half marathon and some are going to do the 10km.  June 7th there’s a bunch of us entered in this thing called the Mud Run.  It’s a 5km run and it’s apparently like an obstacle course with mud pits and climbing over and crawling under…it should be fun.  We’ve got the canoe trip coming up in August and then the next Slipstream Weekend in Nova Scotia in October.

And finally, what is your favourite number?

Well, it’s always been seven but I don’t really know why.  That’s just sort of always what it’s been.  Seven’s not bad when it comes to blood glucose either so I’d have to go with seven.

Thank you, Chloe!  And good luck keeping your pump clean at the Mud Run!

The best cookie in the world…

While in Seattle, I did more than root root root for the away team.   While exploring Pike Place Market, my husband and I came across this enlightening newsflash – the best cookie in the world is now gluten-free!  Who knew?!  Unfortunately, I wasn’t in the market for one of these $4 monster cookies (or the carbs it contained).  But, given how good the Americanos were at Cinnamon Works Specialty Bakery, I’d definitely trust their judgement.

First Impressions: Love at First Sight?

I’ve been pumping for almost three days now…wow, time flies!

Thus far, things are going fairly well though last night was a rough one.  I woke at 3am with a reading of 17.6, had a mild freak-out (why is my sugar so high? what if my pump stopped working!?), corrected for the high (by which I mean over-corrected), waited an hour to make sure my sugar was decreasing, went back to bed and woke with a reading of 2.5.  Eek.  I guess I know my pump’s working…and really, who doesn’t like a spoonful of honey first thing in the morning?

Last night aside, I’m falling in love with my pump already.  I’m still in the tweaking-values-sorting-it-all-out stage but I’m confident I’ll get to a point where I don’t have to do twelve blood tests a day.  And I love all the advanced features!  Enter carbs, enter blood glucose and, based on my preprogrammed insulin:carb ratio, insulin sensitivity factor and insulin on board, my pump suggests how much insulin I should bolus.  It’s almost like having a co-pilot with whom to consult each time I have a meal!

I have yet to tackle the issue of exercise but I’m seriously looking forward to honing my skills as a pumping cyclist.  A short ride yesterday to, appropriately enough, the CDA store (for infusion sets, reservoirs and ketone strips) allowed me to put the temp basal feature to use.  While I still have some learning to do (I probably didn’t need the 10g of fruit in addition to the 20% basal reduction), the ride was successful and I didn’t go low or too high!

It’s funny.  I’ve had diabetes for most of my life and am more than competent and practised when it comes to dealing with the highs and lows (both literally and figuratively) of this disease.  But, put me on an insulin pump and part of me feels like I’m back to learning everything for the first time.  I’ve been showering for years but, suddenly, I need my nurse educator’s advice on the best showering methodology.  I check and double check the manual before I use a new feature and triple check my pump’s screen before approving any action.  When my sugar was high in the night, there I was sitting on the futon, pouring over the “Action Plan for High BG” section of my pump workbook.  Maybe I’m being over-cautious but I want to give this new chapter in my diabetes management all I’ve got.  And for me, that involves a methodical, stepwise approach to all things insulin pump.

Even if it’s subconscious, I think I’m still ever-so-slightly nervous to be relying on this new device.  It was strange to toss my insulin pens in the back of my diabetes supplies container, close the lid, turn my head and focus my attention on my new pump.  I’ve never been one to dive into a relationship.  I need a bit of time to get comfortable…some flowers, a movie, a sunset over the ocean, you know?  These first few days with my pump are kind of like those first few dates and are allowing me to get comfortable with my new pumping lifestyle.  And, as I said earlier, I think I’m already falling in love.

Twenty Eight: It’s All About Context

This past weekend, my hands-down, without a question, all-time favourite number was…(insert drum roll here)…twenty eight!

“Twenty eight?” you ask with sceptical surprise, “but that’s a horrible number!”

Well…yes, in some contexts twenty eight is definitely not desirable – hyperglycemia in the range of 28mmol/L has been a rare occurrence in my diabetes life and it is neither a good nor a pleasant experience.  However, last weekend my favourite number had nothing to do with diabetes.  Rather than discussing millimoles per litre, I’m instead referring to #28, Curtis Granderson, starting center fielder and leadoff man for the Detroit Tigers…

Those of you who know me know that Curtis Granderson is my Tiger.  Apart from being an amazing athlete (he is the only American Leaguer to collect 20 doubles, triples, home runs and stolen bases in a single season), he has established the Grand Kids Foundation to support youth education and baseball programs in inner city schools.  Very cool.  Not only that, but he recently changed his contracts with his sponsors so that, instead of receiving a retainer, his sponsors donate equipment to inner city ball teams across Michigan.  Love that.  And, to top it all off, he makes some amazing catches!

So, why the sudden need to blog about this admirable athlete?  Well, a large component of our recent trip to Seattle involved spending some quality time at the beautiful Safeco Field.  The Detroit Tigers were in the Pacific Northwest and Daniel and I weren’t going to miss seeing our boys in action.  We arrived at the Sunday afternoon game about an hour before game time to watch batting practice and meet Curtis Granderson.

“What?!” you ask with shocked surprise, “you met Curtis Granderson?”

Yeah.  Well, sorta…kinda.  By “met,” what I really mean is, “he signed my ball glove” and “we exchanged a few brief words.”

Our conversation?

L: “Thank you so much, Curtis.”
CG: “You’re welcome.”

What a civil and polite exchange!  Of course, on the inside, I was extremely excited and slightly aflutter (as blatantly indicated by my afternoon sugars in the range of 13mmol/L).  But, for just a moment – that moment spent standing by the visitor’s dugout in throngs of devout Tigers fans, handing my glove over to Curtis Granderson – my blood sugar could wait.  I would take Rapid for my ballpark-worthy lunch (pretzels and pepperoni sticks with a Washington apple from Pike Place Market thrown in for good measure) and correct for my high blood sugar soon.  Soon, but not now.  No, now I was making memories and meeting one of my heroes…

Curtis handed back my (newly-autographed) glove and Sharpie.  I thanked him again and returned to my seat, smile on my face as I did a blood test, injected my insulin (correcting for the out-of-target result), tore into my bag of gluten-free pretzels and prepared to enjoy a great ball game.

Me, my ball glove and Curtis Granderson

To pump or not to pump?

Today is the day I start pumping and, as you already know, I am pumped!  But, I haven’t always been.  Despite my recent excitement, I haven’t always been keen to permanently tether myself to an electronic device.  I received an email from an old friend, Alex (another type 1), asking me about my interest in switching from multiple daily injections (MDI) to pump therapy – how did I evolve from being (as he put it) “vehemently opposed” to insulin pumping as a teenager to the eager wannabe-pumper I am today?

Well, I can tell you that it didn’t happen overnight.  For six years I’ve considered, contemplated, doubted and debated my personal candidacy for pump therapy.  While I know pump therapy is not for everybody, I hope this post will shed some light for those struggling with the “to pump or not to pump” dilemma.  Alex, this one’s for you.

I first considered pumping in my final year of highschool.  I was 18 years old and had just completed a cooperative education placement at the local pediatric metabolic (diabetes) clinic.  I knew maintaining control of my diabetes throughout university was going to be both an important and challenging task.  And the pump seemed like a viable option to help me achieve this desired control.  I met with a pump sales rep, I even bought a pump, I wore it with saline for a few days…and I realized that I absolutely did not want to be attached to the thing!  Could somebody please take it off of me, please?  I just wasn’t ready.  And all the cons of pumping suddenly outweighed any potential pros.  I did not like the tubing, I was nervous to sleep with it, I was of the opinion that my insulin pens provided me with more freedom (once I’d injected, they were out of sight, out of mind).  Not only that, but I was moving away from home for  the first time and there was something comforting in sticking with MDI, a certain security…

Fast forward five years.  I’m finished university and in a stable routine with a stable job.  My insurance will cover the majority of the pump cost and the potential for improved glycemic control is hard to overlook.  So, I do some research, meet with a pump sales rep (for the second time) and submit the insurance verification forms.  But then, I wait.  And wait.  And, by the time my insurance company has verified that I am, in fact, eligible for pump coverage, my husband and I are in the throes of an upcoming cross-country move.  Not only am I stressing about finding a new apartment and new job, I’m preparing for a complete changeover in my diabetes healthcare team.  Given this impending stress, my endocrinologist and I decide that it’s in my best interest to stay with MDI.  So close and yet so far…

Fast forward six more months and that about brings us up to date.  When I learned that my new insurance plan would cover an insulin pump, I knew that this time was the time.  The third time is supposedly the charm, after all.  So, I met with a sales rep (for the third time!) and things fell swimmingly into place.  In the last six years, I’ve gotten over any trepidation I previously had about pump therapy.  I’m confident that I’ll get used to the tubing, I’ll find inconspicuous places to hide the pump and I’ll learn to sleep with it attached to me.  Instead, I am excited about the lack of needles (1 for every 15 I currently take), the ability to correct a high blood sugar reading with the press of a button, the potential for spontaneous exercise, the fine-tuned tweaking of dosages and the ability to alter my basal rates throughout the night.  I know pump therapy won’t necessarily result in better glycemic control but, given all these positive reasons for pumping, why the hecky-darn shouldn’t I be pumping?

Editor’s Note: The views expressed in this post reflect my own opinions and experiences.  Insulin pump therapy is not the best choice for everyone.  If you are interested in pursuing a different method of diabetes management, please talk to your doctor.  Good luck!

Seattle or Bust

Off to catch the ferry to Seattle!  I’ve been looking forward to ferrying through the Strait of Juan de Fuca and Puget Sound for months…espresso, Pike Place Market, Safeco Field, here I come!

In doing some pre-travel research, I discovered that Seattle is a perfect choice for a recently-celiac traveller.  Aside from being home to Ener-G Foods (a major manufacturer of gluten-free products), Seattle offers gluten-free crepes, bakeries, Chinese food and pizza…though I am packing my own gluten-free pretzels for the ball game.

While Daniel and I don’t have a set itinerary, we do plan on doing some extensive exploring and hope to get in some outdoor activity (bicycle rentals, anyone?).

But that’s enough blogging – I need to finish packing!  In addition to the items on my well-honed diabetes/celiac travel checklist, I’m tossing my raincoat and sunglasses (gotta be prepared for the fickle weather of the Pacific Northwest) into my backpack and heading down to the ferry terminal.  Be back Monday – I don’t want to miss my pump training!

A hero you can count (carbs) on

Who is every kid’s favourite hero? …well, every kid with type 1 diabetes diagnosed circa 1992… You guessed it, CAPTAIN NOVOLIN!

When I was ten years old, I attended a weekend diabetes camp hosted by my local pediatric diabetes clinic.  I don’t have many clear memories of the experience but I do know it involved swimming in the lake, eating hamburgers, enjoying campfires and me rebelling against the annoyingly chipper sounding, “Bare Belly Breakfast.”  No way was anybody getting me to stick a needle in my belly!  Oh, how attitudes change.

One clear memory involves sitting in the dining hall with the other campers, writing about our favourite camp experience.  While the other campers probably provided one sentence of praise about the friends they met or the amount of Crystal Light they consumed, I took the assignment as my cue to write an epic story – an over- exaggerated ode to my first diabetes camp experience.

While the story itself is mostly forgotten, I do remember some highlights including a dramatized description of our dungeon-like cabins full of cobwebs, spiders, dust and dirt and a subtle reference to the fact that one of the staff nurses was rather witchlike.

After handing in my story, I promptly forgot about it.

A few weeks passed.

And then, at my next endocrinologist appointment, I was told that I had won the creative writing contest at camp (who knew there was such a thing?) and my prize was a copy of the Super Nintendo game Captain Novolin!  Needless to say, I was both surprised and amused.  Not only had I alluded to one of my nurses being a witch, I had won myself a hilariously awesome diabetes education Nintendo game in the process!

So my question is, does anybody else remember Captain Novolin?  Truth be told, I still play sometimes.  Despite the fact that it has been hailed as an embarrassing failure of the SNES age, I think it’s downright fun.  Released in 1992, the game was made possible by Novo Nordisk and the instruction manual describes the game as such:

“You must help Captain Novolin make it through waves of sugary junk food aliens and defeat the alien commander, Blubberman.  You must also help Captain Novolin manage his diabetes by checking his blood glucose, taking insulin and following his meal plan.”

Easier said than done…

The junk food aliens kidnap Mayor Gooden (who also has type 1 diabetes) and Captain Novolin must save him before his 48 hours worth of diabetes supplies run out!  As Captain Novolin, you attack enemies like ‘Fizzy Floyd’ (crush the can of sickly-sweet soda if you can), ‘Larry Licorice’ (this licorice monster is best avoided by ducking) and ‘Cereal Killer’ (this box of sugary cereal could give the Captain a stomach-ache), while consuming healthy food choices in accordance with Captain Novolin’s food plan – on the old exchange system.  Throughout the game, you check Captain Novolin’s blood sugar – using Chemstrips and a colour comparison chart – and take insulin as required – two times a day.

Now, the fact that Captain Novolin keels over and dies if he runs into too many junk food aliens isn’t a particularly realistic image of life with diabetes.  However, it is important to remember that this game was released in a different era of diabetes management – the age of NPH and Regular insulin, the food exchange system and reagent strips for blood glucose testing.

When I stop and consider that this game was released within the last twenty years, it really makes me appreciate all the advances that have been made in diabetes technology (let alone in gaming systems technology).  I remember the days of mixing cloudy and clear insulin in orange-capped syringes, waiting a full minute for my blood glucose meter to display a result and choosing my meals via the exchange system.  Fast forward not even two decades and look how far we’ve come!  Smart insulin pumping, five second glucose monitors, carbohydrate counting, continuous blood glucose monitoring, exciting stem cell research, an amazing online diabetes community…and the list goes on.

I can only hope that Captain Novolin will be reinvented for Wii gameplay – an insulin pumping, alien-crushing hero for the modern generation.  And instead of keeling over after too many encounters with junk food aliens, he simply does some quick carb counting and takes an extra bolus of insulin.  That’s my kind of hero!

It’s here!

At 8:30am, my endocrinologist called and gave me my starting values.  At 9:45am, a Purolator truck arrived containing my new green pump!  Training has been scheduled for Monday evening.  And,
in T minus 5 days, I’ll officially be pumping!

That’s a big box for a little pump!