I received and was able to read my copy of Dr. Stephen Ponder’s new book “Sugar Surfing” last weekend. He is Pediatric Endocrinologist from Texas and has had T1 himself since 1966. I have followed him on FB for a while and enjoy his interesting and informative posts in which he shares his approaches to various tactical situations and shows how his results unfold with helpful annotations. Thankfully, the b the results and sharing his thought process which helps managing his BG very effectively, achieving near-normalized A1Cs in the low to mid 5s. He uses annotated CGM lines, showing dosing, when various events “appear” and then how things play out. They are not always flat and he points out in both his posts and his books that people without diabetes don’t ever have straight lines! Thankfully, this self-published book features lots of examples of these helpful and informative examples to illustrate the text.
The book itself lays out what Dr. Ponder describes as dynamic diabetes management. He explains that change and variation and, well, numbers being off, are part of the game but, instead of giving up, he lays out his approach which is similar to what I’ve been able to do, but his book lays out a methodology that we can use to take control of our BG and feel successful about it. He contrasts this dynamic approach with a more static approach, where you have a plan and measure yourself against your success in meeting a rigid plan. Here, Dr. Ponder lays out that diabetes itself has considerable dynamism that, to many experienced people with diabetes, makes following a rigid plan a questionable approach. Given his own lengthy experience with diabetes management dating from the dark ages of color coding, Dr. Ponder speaks credibly at the same time he’s being very informative.
Dr. Ponder uses a “surfing” metaphor and successfully throughout the book, adding an amusing spirit to the serious topics under discussion. The motif fits well with the waves in the pictures of annotated CGM lines that he uses to illustrate his excellent and apparently very well-founded tactical approach to managing diabetes. He suggests treating diabetes with respect, rather than fear, but lays out an approach to diabetes management that will allow us to put diabetes in it’s place successfully and take our management to a new level. We know how to use the tools we have but using them a bit differently has produced great results for Dr. Ponder. I’ve done many of the same things for years without the framework, or credibility to get people to try them out.
I’d say that the main drawback I noticed in the book might be that the approach seems to benefit CGM users… There are several sections where he touches that the method can work with frequent BG testing but doesn’t “coach” non-CGMers through it. This would be difficult in a manageable book but is certainly something to hope to see more of in the future.
Some PWD might object that Dr. Ponder’s methodology as presented here could be considered to be labor intensive. The proposition of looking at your CGM more doesn’t seem odd to me as I am a big fan of glancing at mine but someone who is used to maybe checking in on their CGM 10-20x/ day might find 40-50 to be intrusive. Some of this might be a simply that checking a lot isn’t comfortable but, diabetes is rarely comfortable. But it can be successfully managed and Dr. Ponder’s method shows a path not just to “OK” but to excellent, repeatable results that can improve the quality and, from an actuarial perspective, the duration of our lives.
I don’t count on how often I check my CGM, but I am sure it is way more than 20x/day, and probably closer to 50x/day, depending on the day. I get a huge amount of value by seeing the trending and analyzing in near real time what is going on before and after meals, before bed, after exercise, breaks from work, etc, etc.
Today was a great example, as I had my normal, carb-heavy breakfast, but didn’t see the 60 - 90 point rise that I normally get. This led me to reduce my basal rate even earlier than I normally would have. I still ended up crashing down to the low 50s, but because I was able to see the trending, I was able to prevent an even more serious low.
Diabetes is a dynamic disease. Since adopting a CGM six years ago, I’ve been able to make some great gains using small moves like temp basal off for 30 minutes to counteract a trend in the low direction. I’m also much more apt to change basal rates more quickly than in years past.
The whole idea of rigidity in diabetes management seems so “R/NPH out-of-date.” The body does change from day to day and not flexing with it is a major flaw in any diabetes regimen.
I’ve always thought the flatline ideal was not what gluco-normals experience but that ideal does provide a nice beacon to help stay between the lines. The dimension of a flat line that most appeals to me is the lack of volatility. It is this characteristic that sets gluco-normals apart from most of us.
I discovered a few years ago that the seemingly endless requirements that diabetes demands from us are indeed finite. Once I gave it all the attention it required, it behaved better and demanded less of me, a paradox. The power of habit also relieved me of much of the burden. Many conclude that they just want to live life and not obsess with the minutia of diabetes. I say give D the minutia it seemingly requires and you may find out you have a much better quality of life without an undue burden.
Thanks for the review. It’s now on my list to see what I can learn
Thanks for the book review, Mike. I keep in touch with Dr. Ponders Facebook posts and “The Power Within”. I’m sure his book will sell like hotcakes. Since he is a Pediatric Endo, I wonder if his book will be appropriate for T1D child care, as well as for us adults.
As I say, the above are just what I dug up on my own. Please sanity check them and let me know if got something wrong.
@TuDiabetes_Administr I posted these links because I viewed them as more informative than promotional. But I also wanted to give you a “heads up” so you can review and potentially disagree.
I was concerned that links might seem like spam however I’m not employed by Dr. Ponder but think his message is worth sharing. Thanks @irrational_John!
@acidrock23 - I followed the links above yesterday because I’m interested in Ponder’s techniques. I’m waiting on the e-book release this summer and look forward to reading what he has to say.
From what I glean so far, he advocates making micro-adjustments to stay in range. He uses the metaphor, “putting on the brakes,” so I assume he has one called, “stepping on the gas.” I can envision several techniques I already use as possibly being used in his overall strategy.
I use a temp basal when I can set it two hours before an expected event, like a minus temp basal when I plan rigorous exercise. I dose every meal with an immediate carb bolus and an extended protein/fat bolus. If I observe my BG trending higher than expected post-meal, I’ll cancel the extended bolus and immediately deliver the remaining insulin. Conversely, if my post-meal BG is trending lower than expected then I can just cancel the extended bolus and not deliver the balance.
I also use a super-bolus, where I’ll borrow some of the immediate future basal and deliver it as an immediate bolus. This can be done at mealtime and also in between meals.
Does he have any other pump techniques that can be characterized as “stomping on the gas or brakes?”
I agree that we already do a lot of what he does but I liked the validation of having a doctor sort of call out the conservatism that seems to pervade diabetes philosophy and lay out a step by step plan to do better. But you already do really well @Terry4, it’s sort of a judgement call about dropping the money. I have enjoyed kibbitzing with Doctor Ponder and his bearded lizard Rango on FB and feel strongly enough about supporting his voice in the diabetes Weltanschauung to toss some $$ into his crowdfunding campaign way back when he kicked it off so I was very happy to get my name on the “False Idols” page!! hee hee.
