Protein high?

Type 1 and LADA
21

My Mom fixed it so I can get a Humapen Luxura pen and humalog cartridges at Matsumoto Kiyoshi drug store in Shinjuku. Me and Yoko are going down to pick them up this morning. Now I'll have 2 luxura pens because I already ordered one from northwestpharmacy.com in Canada. It is better to have a backup in case I drop it or it malfunctions. This will be the first time going this far on the trains since I became diabetic. I've got my bag packed with insulin pen, meter and supplies all set.

We are going to get unagi kabayaki for lunch. It will give me a chance to try increasing my insulin because the unagi sauce is sweet and I like on top of a bowl of rice. I think it should be 2 extra units of humalog but I better only take 1 extra. I wouldn't want to get low on the train ride home. I wish Teruo was going, he could tell me how many carbs it is, he is good at that. I'm still mad at him, but I miss him and if he calls me I might forgive him.

22

A big bowl of white rice is a huge carb load. You may be surprised how much insulin it requires, and how high you go if you don’t inject enough.

23

Sometimes you have to forage for supplies while out & about. If you ever get caught going low and need to buy something to raise your BG, look for candy that is primarily dextrose. It's essentially the same as glucose tablets as Gary Scheiner explains.

The text below is taken from this Q&A.

Gary Scheiner says

The reason glucose tablets and gels work so well is that they contain DEXTROSE, the same stuff given by IV when somebody is unconscious from a low. Dextrose is glucose in its purest form (2 glucose molecules linked together), and thus raises blood sugar the fastest.

Many candies are made with mostly dextrose, and will also work very quickly. These include Smarties (called Rockets in Canada), Sweet Tarts, Nerds, Runts, Spree, Bottlecaps, and a bunch of others. Many are branded under the name “Wonka” candies. Just check the ingredient list: if dextrose is the first thing listed, it should be a winner!

-iJohn

24

A normal Japanese bowl of rice is about 1 cup of rice. I count it for 55g carbs. I've eaten rice at least once a day all my life. There's no way I could give it up.

25

For many of us we can't bolus successfully for rice, Madison. You need to evaluate the results two hours after eating. If you are consistently too high two hours after eating rice, then maybe it isn't working. I have given up sugar, rice, cereal and I've limited pasta and potatoes all of which were a part of my diet. You can do anything you decide to do. Regular high blood sugars can cause complications that can negatively impact the rest of your life. it is your choice.

26

Are you at all flexible on the type of rice you eat? Short grain white rice is the most likely to cause high blood sugars. Brown rice and converted rice may be a little easier successfully dose.

I gave up rice after diagnosis and have switched to quinoa which I find much easier to handle. Maybe you can mix it up a bit.

27

I got my new pen and a box of 5 humalog cartridges. The pharmacist showed me how to use it. I like it much better than the humalog pen I have been using. They had a whole section with just diabetes things. I bought some glucose gel tubes in 4 different flavors.

We didn't go to the eel restaurant, instead we went to a merrygoround sushi bar. I only had 6 pieces of sushi, 2 plates of sashimi and a bowl of miso soup. It was about 2 hours after lunch when we got home and I tested 201. The doctor had told me that one unit of humalog would lower my glucose 60 points so I injected 1 unit with my new pen. I'm still waiting to see how that works out. I almost hope I'll go low so I can try out my new glucose gel tubes.

28

Listening to two westerners talk about rice to someone from Japan has, for me, the surrealism of listening to someone who lived their entire life in Phoenix, AZ talk to a native Norwegian about x-country skiing. But I digress ...

The only way to know how it will work for you, Madison, is to (carefully) try it and find out. And it may take time to work out your details. Also, those details may change with time depending on if/how you body might change in the future.

But I agree with you that working out a diet that doesn't involve rice in Japan is not a rational starting point. I'm not sure if I could come up with an analogy for the US simply because there seem to be so many options in the US. This is more like asking someone to give up bread in a place where there pretty much isn't anything but bread. I realize that is also not accurate. But maybe closer?

I am curious what the CDEs (Certified Diabetes Educator) in Japan suggest for the meal plans. I never thought to wonder before. Have you talked with anyone who has told you anything which was of use to you in this area?

For whatever it may be worth, here is a link to an article which may be of some help. (Not for your train trip & lunch but maybe over time).
High Blood Sugar After Meals And What To Do About It

If that one article is not helpful, there are others out there. Try Googling about.

The main tool used to limit a postprandial spike is probably the pre-bolus. However, that is a tool which you want to be careful of given your concern about hypoglycemia.

If you decide you want to work harder on limiting your highs after meals, it helps to have a CGM. And not just because it can give a better picture of how your BG behaves after a given meal. It also makes it much easier to "see" when & how quickly your insulin is starting to take effect. This can make pre-bolusing safer IMO.

BTW, if you do go high don't panic. Short term, it's more frustrating than dangerous. And I doubt you will go that high since you still produce some insulin.

Yesterday I apparently did not reconnect my pump to my infusion set correctly after I showered. Later, I ended up with a BG meter reading of 582. Ooops.

I survived, though I felt lousy until I was able to fix the problem.

-iJohn

29

Madison, have you ever read the book Think Like a Pancreas by Gary Scheiner? You can get it for e-reader from Amazon. It can help you understand how to test your doses, to see how and when you need to change your basal doses, insulin to carb ratios, find what your correction factor is, who long rapid insulin lasts in your system etc. If you have limited contact with docs who do T1 diabetes treatment on a regular basis, then is a huge resource. Is an easy and fun read and full of helpful information.

30

I've got "Think Like a Pancreas" from Amazon. I haven't had a chance to read it yet, it's next on my reading list. Does it explain how to calculate insulin sensitivity? My new insulin pen is real nice. I have been injecting 4 1/2 units for most meals.

My new doctor doesn't know any more about type 1 diabetics that the doctor at the hospital. If I don't find another doctor or clinic I'll just have to learn it on my own. I'd still need the doctor to have access to insulin and other supplies.

I'm having a problem with my fingers. They have little red marks from all that testing. When I wash dishes, sometimes the soap makes my fingers hurt. Maybe I need to change to another type of lancing device.

I have a medic bracelet they gave me at the hospital. It is kinda ugly and a little too big for me. I've told my parents that I want a new one for my birthday. I saw a gold one I want on Amazon, it costs a lot but I really like it.

31

Yep, TLP is a pretty comprehensive manual for this condition.

Doctors are less important than good nurse practitioners.

Don’t test on the parts of your fingers that you use, you’ll create calluses and lose sensitivity. Test on the sides. If your BG is stable, you can even test elsewhere, though most of us stick with fingers.

32

My brother is a doctor, and when I was dx'd with T1, he was shocked to find out that everything he was taught in medical school was wrong. It's baffling how much ignorance is out there, considering this is a major diagnosis. My new dentist's wife is T1, and we had a great conversation last week. And so, the world is not totally absent of those who have a clue. We just have the extra burden of continually pressing for the care we need. (sigh)

33

Gary Scheiner has a website for his practice. FWIW here's the link to it: Integrated Diabetes Services And here is a link to the "quiz" on his website. I'm going to give it a shot after I post this. Knowledge & Skills Examination for Insulin Users

Oh. One more thing. I don't know if you already saw it, but Emily Coles did an hour (or so) interview with Gary recently for TuDiabetes. It's on YouTube if you're curious ... February 4, 2015 Gary Scheiner interview

Apparently he's going to do these interviews every other month. The next one is on April 1, 2015. (If you have a question you want to ask him you could send it to Emily.)

I have a medic bracelet they gave me at the hospital. It is kinda ugly and a little too big for me. ... I saw a gold one I want on Amazon, it costs a lot but I really like it.

It is immediately obvious to me that I have nothing to offer you in the way of advice about IDs. To give you an idea how wide the personal preferences gulf is, here is a link to the site I got my "med alert" thingee from: RoadId.Com.

I like it because it is durable yet (relatively) inexpensive. It also offered lots of room for my personal info. Still, if you get a really nice ID which you really like then a RoadID might make a suitable "backup" for those times when you don't want to risk losing the ID you actually like.


Do you have any other thoughts about your new doctor? You have not said much about your recent visit or how you & the new guy got along.

As Lorainne pointed out, as you learn more about what diabetes is like for you, you may grow more & more ... confounded & confused perhaps? ... by how formulaic many doctors are about treating diabetes.

They often don't ask enough questions. To make the best use of them you often need to learn how to ask them the questions yourself. It's a different doctor patient dynamic than most people with more casual contact with the medical community are used to.

-iJohn
T1 LADA since ~1978; first pump Minimed 507 ~1997
currently: Minimed Paradigm 723 (Apr 2013) + CGM (Dec 2014)

34

Keep in mind these are dynamic processes, so don’t treat highs as static numbers to be corrected, try to get a sense for the curve and where you are on it. A CGM is immensely helpful in this regard.



And don’t over correct lows, either, or you’ll rollercoaster. A tube of glucose is a lot!

35

And yes, you will likely want to moderate rice consumption. Cutting it out isn’t necessary unless you go low-carb, and yes, that’s as feasible as cutting potatoes, pasta, or bread in the US.