Thursday, December 31, 2009

Speedy Biodel

Watching CNBC this morning, I noticed that a company was making financial waves for developing some cutting edge treatments for diabetes. Biodel asked the FDA to approve its VIAject fast-acting injectable insulin product. It's currently wrapping up its phase III clinical trials and has reported some very promising results. Biodel has formulated special ingredients along with recombinant human insulin to make it act more like insulin non-diabetics make. VIAject would reportedly treat meal time spikes better and then not "hang on" in the bloodstream as long as other fast acting insulins. Here's a side by side comparison graph that Biodel showed on their website:

Wednesday, December 30, 2009

Time for the Diabetes Devil

Sometimes during a nasty high or low blood sugar event, the diabetes devil comes out. The diabetes devil is not the sweet child who so often makes her mother and I beam with pride or hold our sides laughing at her antics. No. She is a fearsome, willful and irrational being who has no respect for authority or acceptable behavior.

After dealing with the diabetes mood swings for more than ten years with our daughter, I think the best advice is to remember during these episodes is that you are dealing the diabetes devil - and not your pride and joy (who would act totally differently in a normal blood sugar state). It's tricky business to teach respectful or appropriate behavior during these times of "UN-control," but it's something you should definitely do.

So trying to argue or correct bad behavior during a low or high isn't very productive. In fact it sometimes leads to even more emotional pain on both sides. Nasty words get spoken. Voices get raised. It's better to discuss the bad behavior rationally, after the high or low. And don't let it slide- nobody in the outside world is going to cut your child any slack for her diabetes, and you need to help her be aware of herself. Just pick the right time to do it.

Tuesday, December 29, 2009

Peanut Butter and Pickles

Invariably, Christmastime leads to someone in our family getting a cold or the sniffles. It's only natural. Season's greetings mean lots of hugs and handshakes from friends and family who may be (unintentionally) carrying a bug.

This year, Cassie picked up a nasty case of the coughs. Even though it's not as serious as H1N1 or the seasonal flu, the common cold can wreak havoc on blood sugars and result in what I call the "holiday highs." Between Thanksgiving and New Years, holiday highs are stubborn blood sugars that range from 200-350 mg/dl and are super difficult to get down.

One thing we do to help keep blood sugars in check when Cassie's sick is to offer low carb or high protein choices for meals and snacks. But when you're sick, appetites ebb and flow and sometimes nothing sounds good to eat. Last night the only thing for dinner that sounded good to Cassie was a big spoonful of JIF peanut butter and a big Vlasic pickle. Both were low carb, and the peanut butter was hi-protein. It wouldn't have been my first choice, but why not let her eat whatever combination of things she wants as long as it helps keep the blood sugar down? It'll be interesting to see what kind of pregnancy cravings she'll get when she decides to have kids.

Monday, December 28, 2009

A Mother's Face

Nicole Purcell contributed a very intimate and touching story on NPR about what it's like to grow up with diabetes. She recounts how she always studied her mother's face and expressions whenever they faced diabetes' challenges - from diagnosis to minor triumphs. It's not just our words as parents that impress our children. It's our actions and reactions as well.

You can listen to Nicole's story online by clicking here.

Tuesday, December 15, 2009

On Santa's List

All I want for Christmas is an insulin pump controller for the iPhone. Really. Why couldn't this killer smart phone - which many people carry around already - and something ANY kid with dibetes would want to have - be the control center for a pump? Or receive and record blood sugar readings wirelesssly from a smart glucometer? Or send emails and texts to mom and dad when it's time to switch out a site or add insulin?

I'm sure there's a smart pump company (maybe at the North Pole) working on something like this. If not, there should be. Diabetes- shouldn't there be an app for that?

Saturday, December 12, 2009

On Washington's Radar

This Thursday, December 10, 2009 the House of Representatives passed, by a voice vote, House Resolution 35, a resolution urging increased federal funding for type 1 diabetes research. H. Res. 35 acknowledges the recommendation of leading diabetes researchers to double the current level of NIH funding for type 1 diabetes research. Rep. Gene Green from Texas was one of the key people behind the resolution, and it was co-sponsored by 101 other House members. This non-binding resolution highlights the economic toll diabetes places on our society and the serious complications faced by people with type 1 diabetes. Hopefully this will keep the issue of type-1 diabetes and its hardships on our Congressional representatives' minds as they allocate funds for research in 2011 and beyond.

Friday, December 11, 2009

Breakfast Highs- Over Easy

In the earliest years with diabetes, managing breakfast blood sugars had always been a challenge for us. First, there's a period of insulin resistance that naturally occurs in the early morning called the "dawn effect." Sometimes this would lead Cassie to have relatively high blood sugar levels, and it would take an unusually large amount of insulin to bring down. This was really hard to treat when she was an infant on shots.

Once we put Cassie on the pump, it got a little easier. We were able to adjust for the dawn effect with slightly higher basal rates, and we set up a different insulin to carb ratio for her breakfast bolus. And here's the magic step that brought everything together- we gave her the breakfast bolus (around 30 grams worth) about 45 minutes before eating. The pre-bolus routine usually meant that upon waking, we'd grab the glucometer to check; do a correction bolus if she was high; then also tack on a 30 gram "breakfast bolus." At times, we'd get into trouble if she wasn't hungry once she got to the table. At that point we'd try to load her up with really sugary things like orange juice or even candy- anything to counteract the insulin we'd already put into her system.

But making smart food choices are also a key method for morning control. Sugary cereals are notorious for causing huge blood sugar spikes in throughout the morning, and the spike is usually followed by a quick crash.

We encourage our daughter to have higher protein breakfasts- bacon and eggs or a fruit smoothie are great choices especially if she wakes up high. Another not so sugary and wonderful option is oatmeal with berries and brown sugar. It's filling, yummy and healthy. Plus by adding the brown sugar yourself, you can control the sugar amount, rather than having to be stuck with what Kelloggs decided.

If your child only wants "bready" things, think mini. Mini portions that is. Kelloggs makes Eggo brand frozen mini pancakes, and waffles. That way, it's easier to do portion control. Don't forget to use "lite" low-carb maple syrup.

It's a lot to think about when your head's still fuzzy from a night's sleep. But hopefully this technique that we've come close to perfecting over the years helps you out.

Thursday, December 10, 2009

Research Update

I attended a highly informative diabetes research briefing today led by Dr. Dick Insel, JDRF's Chief Science Officer. He reported that, sadly, the incidence of type-1 diabetes has increased increased 5.5%, especially in young children ages 1-5. It helps to justify the foundation's funding of research of "at-risk" and "recent onset diabetes" stages of the disease.

There has already been some promising work with anti-cd3 therapies that can help preserve beta cell function in the newly diagnosed. 2-3 week therapies seem to have a long-term positive effect - up to 4 years after therapy - to reduce the amount of insulin a patient may require to regulate her blood sigar. My family has had some first hand experience with this. My wife Marinda, took part in the Phase II clinical trials for Tolerx's drug TRX4 and has clearly benefited from it. The problem is that some of these treatments may be unsafe for younger patients. It's still too early to tell.

An interesting chart that Dr. Insel shared was one of the best I've ever seen to illustrate the progression of the disease:

Wednesday, December 02, 2009

Explaining Diabetes in Spandex

Growing up, I was a big comic book fan. I stumbled upon Medikidz, a UK site that has created a comic book series to help children understand different medical conditions. For some kids, this vehicle may be an entertaining and informational way to learn about their diabetes. If your son or daughter would be intrigued, it may be worth checking out. It could be one way to keep their blood sugars from going up, up and away!

Tuesday, December 01, 2009

Holiday High

During this festive season, many of us are lucky to have the opportunity to partake in feast after feast. Unfortunately, large, rich meals can lead to super high blood sugars as your diabetic child gorges on the goodies. I'm not one to tell you to make your child pass up every tempting treat. I think that's unfair. Rather, I suggest you help guide her toward moderate portions. Most everything is OK in moderation, and you should set a good example and follow this advice for yourself too.

One tip I can't promote enough: give an insulin shot BEFORE the meal is over (or prebolus on your insulin pump). That way you get the insulin in your child's system the same time the food does. Happy Holidays!