Jessica Apple - The Natural Diabetic

Jessica Apple grew up in Houston. She studied Bible and Ancient Near Eastern Studies at the University of Michigan, and completed an MA in the same field at the Hebrew University. She began to write and publish short stories while a student, and has continued to write essays and fiction while raising her three sons (and many pets). Read full bio

Diabetes and Marijuana: Marijuana Users Could Have Better Blood Sugar

Jessica Apple | May 16, 2013

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A study that might answer some questions about diabetes and marijuana appeared online  this week in the American Journal of Medicine:  The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults.  The study is the first to investigate the relationship between marijuana use and fasting insulin, glucose, and insulin resistance.

Marijuana-Cannabis_sativa_(Köhler)

Cannabis as illustrated in Köhler’s Medicinal Plants book from 1897

The American Journal of Medicine’s blog reports, “Participants who reported using marijuana in the past month had lower levels of fasting insulin and HOMA-IR [insulin resistance] and higher levels of high-density lipoprotein cholesterol (HDL-C). These associations were weaker among those who reported using marijuana at least once, but not in the past thirty days, suggesting that the impact of marijuana use on insulin and insulin resistance exists during periods of recent use. Current users had 16% lower fasting insulin levels than participants who reported never having used marijuana in their lifetimes.

Large waist circumference is linked to diabetes risk. In the current study there were also significant associations between marijuana use and smaller waist circumferences.”

The blog also quotes an author of the study, Elizabeth Penner, MD, MPH, who said that after subjects with a diagnosis of diabetes were excluded, the associations between marijuana use and insulin levels, HOMA-IR, waist circumference, and HDL-C were similar and remained statistically significant.

In summary, the study concludes three things about marijuana use:  It was associated with lower levels of fasting insulin and insulin resistance, and smaller waist circumference.  So marijuana users could have better blood sugar levels.

Does this study mean marijuana is safe for people with diabetes?  No.  This study is not a green light to pass the dutchie.  There’s not enough evidence here to conclude that marijuana and diabetes are a good combination.   But the study is significant because it’s a first, and it suggests that more research is needed to explore future treatments using the marijuana plant’s compound active ingredient, tetrahydrocannabinol, or THC.  

For more see Can a Diabetic Smoke Marijuana?

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Failing the Oral Glucose Tolerance Test: (Bad) Diabetes Memories

Jessica Apple | May 15, 2013

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I lived in Jerusalem when I pregnant with my first son, and though my doctor wasn’t concerned about gestational diabetes, she sent me to do the oral glucose tolerance test given to most pregnant women in the second trimester.  “You’re young, thin, with no first-degree diabetic relatives,” the doctor said.  “Don’t worry.  It’s routine.”

While it might have been routine for the doctor, for me there was nothing routine about being pregnant, and extra-nothing routine about drinking 50 grams of sugar on a fasting stomach.  I must have looked upset.  “It’s just like drinking cola,” the doctor said.   “The nurse will take your fasting blood sugar and then, one hour after you drink, she’ll take blood again.”

I had a lot of questions at that time, but no one to ask. None of my friends had been pregnant yet, and there was basically nothing in the way of diabetes blogs, and I didn’t know a thing about gestational diabetes.  All I had a copy of “What to Expect” and the comfort of knowing that Jerusalem was a city where everyone gave you advice and shared their opinions whether or not you requested.  And so it went – when I sat down in the lab, in a special room for pregnant women drinking glucose, everyone began to give me advice.  I was the only woman there who was pregnant for the first time.  Most of the other women in the room were religious – Jews and Muslims.  They were covered head to toe, a few of them had small children with them, and many read from prayer books.  And then there was me: long, free hair, and totally clueless.   A nurse whipped up a concoction of powered glucose and water.  She handed it over to me and told me to drink it quickly.  As I brought the cup to my lips I felt a wave of nausea.  After one sip I gagged. 

“I’m sorry,” I told the nurse.   “I don’t think I can drink this.”

“Everybody drinks it,” she said and walked away.

“It’s true,” said a women in thick black stockings despite the warm weather.  “You’re not special.”

“You need lemons,” another woman said.  “It’s better with lemons.”

“Do they have lemons here?” I asked.

“Why didn’t you bring lemons?” several women said at the same time. 

A few minutes later the nurse returned.  “Why aren’t you drinking?” she asked.  “You’re ruining the test.  Hurry!”

I took another sip and gagged again.

“Go to the bathroom if you’re sick,” the woman in the stockings said. 

I took a deep breath and two gulps of glucose.  I was about halfway done. 

I felt intense nausea and when I stood to walk toward the bathroom I felt dizzy so I sat back down.  I began to sweat. 

“You should have brought lemons,” someone said.

It took me about 15 minutes of baby sips, but I managed to finish the cup of sugar.  The nurse drew my blood and I went home, relieved to have the oral glucose tolerance test behind me.

The next day my doctor called to say my blood glucose results were in, and they weren’t good.  I would have to do another test.  This time I would do the 100 gram oral glucose tolerance test and the nurse would draw my blood four times: fasting, 60 minutes, 120 minutes, and 180 minutes. 

Double the sugar.  Triple the time in that room.  I cried a bit and then I told Mike I needed to get some lemons.

Mike took me to the lab for my three-hour oral glucose tolerance test and said he’d stay with me until I finished drinking.  I felt like a pro.  I showed him where the glucose room was, but realized that he couldn’t really sit there with me.  It wasn’t strictly women-only, but it was.  We’d have to sit in the general waiting area.

I held out my bag of lemons to the nurse, who was not impressed.  “Here you go,” I said. 

“You didn’t squeeze them,” she said.  “What am I going to do with a bag of lemons?  This isn’t a restaurant.”  She handed me two cups, each one with 50 grams of sugar and water. 

I felt nauseated just from looking at the cups.

“It’ll be fine,” Mike said.  “Just drink.”

I drank, one little sip at a time.  The nurse and Mike told me to hurry.  I couldn’t.  I sweated.  I cried a bit.  But, finally, I finished both cups of glucose.  I was proud and relieved.   And I’d done it all without any lemons!  Before I had a chance to revel in my glory, though, I was overwhelmed by intense nausea, as if I’d just guzzled a bottle of tequila. 

“Are you okay?” Mike asked.

I couldn’t answer.  I ran as fast as my big belly allowed, pushed my way into the restroom, and puked 100 grams of glucose into a toilet bowl. 

I came out teary and told the nurse what had happened.

“Don’t worry,” she said.  “Just come back tomorrow and do it again.”

As I turned to walk away, thinking that this glucose test should be illegal and that there had to be a better way, a woman in a floor-length navy skirt who’d overheard our conversation called me over with a word of advice.  “Next time bring some lemons,” she said.

This post is part of Diabetes Blog Week.

 

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Diabetes Petition: Blue M&M’s for the Treatment of Hypoglycemia

Jessica Apple | May 14, 2013

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Dear Mars, Inc., Manufacturer of M&M’s,

In the 90s, when I came of voting age, I experienced the joy of voting for President Clinton.  I felt as though I were making a difference in the world.  I was proud of myself and my contribution to the United States of America as I cast my vote in favor of gun control, higher taxes for the wealthy, a woman’s right to abortion without exception, and so on.  Then, just a few years later, in 1995, thanks to you, I had the opportunity to cast my vote on a matter, unlike all that other stuff I mentioned, that truly defined basic American values: the color of our M&M’s. You gave me the power to oust the tan M&M, a color so putrid it was only in dark movie theaters that we could eat it without thinking of baby diarrhea.

I was not alone in my desire for change. 10 million Americans raised their phone receivers to vote on the future color of M&M’s. More than 50% of us chose blue. 

Blue m&m

At the time I based my vote on a several things: First, I was a student at the University of Michigan and “Go Blue!” was one of my regular cheers.  Second, I truly believed the world was in need of more blue food. Now, however, as I have become a person with diabetes, blue has a whole new meaning to me. Blue is the color of diabetes awareness. A blue circle is the international symbol of diabetes.  I write to you today to ask you to become a diabetes advocate. Help me and my community raise diabetes awareness by declaring the blue M&M the international symbol for the treatment of hypoglycemia.

I propose the following: Create a blue M&M that contains one gram of carbohydrate per button.  Sell in packages of 15 M&M’s per pack.  In order to differentiate between regular packages of M&M’s, I suggest you add to your label “for the treatment of hypoglyceM&Mia”.  (Mars Pharmaceuticals could be your future!) If you agree to do this, and dedicate all of your profits to diabetes research and charities, I will write another petition asking my community to change the O in DOC to a blue M&M.

Now is the time.  It’s been 18 years since the blue M&M came to life.  Since then diabetes rates have doubled or tripled, or quadrupled!  All around the world people are sweating and shaking from hypoglycemia with nothing but barfy, chalky glucose tablets (exception: Glucolift) to save them from fainting.  Blue M&M’s (1g of carb per button) could change the face (and taste) of hypoglycemia.  Think of the testimonials you’d get:

Jess Apple: I used to dread hypoglycemia.  I ran my blood sugar high all of the time just to avoid going low.  Now that I know I can treat accurately with M&M’s, I smile at the thought of hypoglycemia.  The days of forgetting to take my insulin are long gone.

Mike Aviad: Some people think Mars and their products are responsible for the rising obesity and diabetes epidemic in America.  I say, who cares?  Unlike all of the other food companies selling crap, Mars is making a difference with Blue M&M’s (1g of carb per button) for the treatment of hypoglyceM&Mia.  When I am low, Mars brings me up.  Mars cares about people with diabetes.  They might be killing us, but they’re also saving our lives.

Anonymous: I love how small and discreet Blue M&M’s (1g of carb per button) are.   I used to feel ashamed of pulling out bulky glucose tablets in public.  Not so with my baby Blues! People think I’m just snacking. No one ever suspects I’m about to pass out.

Mars, Inc, you have the opportunity to change history again.   We’re all grateful (and alive) because of insulin.  But insulin is not a cure.  So take this slogan and run with my idea: Until there’s a cure, there’s blue M&M’s (1g of carb per button).

Yours Sincerely,

Jessica Apple

(Please leave a comment if you support this petition!)

This post is part of Diabetes Blog Week.  Today’s topic: We the undersigned.  Write a petition.

 

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15 Things I Want My Doctors to Learn

Jessica Apple | May 13, 2013

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  1. When I’m sitting in your exam room don’t talk to another doctor or a nurse about me as if I’m not there.
  2. I may not have a medical degree, but that does not mean you know more about my body than I do.
  3. Listen, listen, listen, listen, listen, listen!
  4. Ask the right questions.  Don’t say “Why is your A1c 8%?”  We both know my A1c is out of range because I have diabetes.  Instead say, “I see that your A1c is higher than we’d like it to be.  Let’s try to figure out where and why you’re having problems.”
  5. If my lab reports aren’t perfect, don’t assume I’m doing something bad.
  6. Understand that I come to you when I am needy, scared, or I don’t feel well.  Be gentle and kind when I am down.  Don’t add to my anxiety.
  7. Don’t give me prescriptions for medications without explaining why you are choosing a particular medication and what the side effects might be.
  8. Don’t send me to do tests without telling me what you’re testing for.  Be honest and straightforward with me, but don’t frighten me unnecessarily.
  9. Remember that I am a person – not a bunch of numbers. 
  10. Don’t dismiss my questions.  If I’m asking it’s because I don’t understand and I want to understand.
  11. Be respectful if I don’t think the medication or treatment you are prescribing is right for me.  Don’t automatically get angry or annoyed.
  12. If you don’t have enough time to be my doctor, don’t take me as your patient.
  13.  Don’t get offended if I tell you I want a second opinion.
  14. Let me get dressed before you discuss things with me.
  15. Do not ever tell me to look things up online because you can’t be bothered to explain. 

This post is part of Diabetes Blog Week.  Today’s topic is about sharing with our healthcare professionals.

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Dietary Fat and Blood Sugar: Should I Bolus for Fat?

Jessica Apple | May 12, 2013

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Say it isn’t so… A study of dietary fat and blood sugar suggests I might need to bolus for fat!  According to a Joslin study whose findings appeared in the April issue of Diabetes Care, dietary fat can affect blood sugar levels and insulin requirements for people with type 1 diabetes.  There goes my theory that I can eat mozzarella by the pound without a budge in blood sugar.  And what about my almond butter?  Are all those spoonfuls of nut butter screwing with my blood sugar?  Not according to my glucometer, but yes according to Joslin researchers:

Fat and Blood Sugar- Do I need to bolus for this?In reviews of continuous glucose monitoring and food log data from adult patients with type 1 diabetes, Joslin clinicians observed that  “several hours after eating high-fat meals, glucose levels went up,” says study lead author Howard Wolpert, MD, Senior Physician in the Joslin Clinic Section on Adult Diabetes and the Director of the Insulin Pump Program at Joslin. “We wanted to determine the underlying cause of these unexplained fluctuations.”

In Dr. Wolpert’s study, seven participants (adults with type 1 diabetes with an average age of 55) spent two days at Beth Israel Deaconess Medical Center eating carefully controlled meals and having their glucose and insulin levels monitored.

“All breakfasts and lunches featured identical low-fat content. The two dinners had identical carbohydrate and protein content but one was low-fat and the other high-fat. For two 18-hour periods beginning before dinner, participants had their insulin automatically regulated by a closed-loop system and their glucose and plasma insulin levels tested at frequent intervals.

Study results showed that participants required more insulin after eating the high-fat dinner than the low-fat dinner (12.6 units compared to 9 units). In contrast, the two breakfast meals required similar insulin doses. Despite the increased insulin, participants had greater hyperglycemia after the high-fat dinner with insulin levels elevated five to ten hours after the meal.  The average increase in insulin was 42 percent with significant individual differences.”

So what does this mean?  According to Dr. Wolpert, “These findings highlight the limitations of basing mealtime insulin dosing for type 1 diabetes solely on carbohydrate intake.”  

Mike always boluses for protein as well as carbohydrate, but neither of us thinks much about fat.  In fact, to my mind it’s pretty much a free food.  This study makes me very curious about the ketogenic diet and type 1 diabetes.  I’ve never eaten low carb enough to consider myself on a ketogenic diet, but I don’t skimp on fat, and as long as I don’t eat carbs, my blood glucose is usually in the normal range.

Apparently another study is planned “to assess whether reducing fat intake would optimize glucose control.” And, “in the coming months, Dr. Wolpert also anticipates developing new guidelines for clinicians and patients to enable them to determine whether high-fat foods are a factor in glucose control and make appropriate nutritional changes.”

Meanwhile… I guess I’ll eat more cucumbers. 

 

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Latent Autoimmune Diabetes in Adults (LADA), JADA, and the Cookie Trap

Jessica Apple | May 02, 2013

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I lurked during the recent conversations surrounding the petition to change the name of type 1 diabetes, but I refrained from commenting for several reasons:

 1. Lee Ann Thill said most of what I was thinking, and she said it well.

2. I feel sympathy for the mothers who started the petition and I don’t want to come across as being “against” them.  I understand their frustration and I believe the real message in their petition is that parents of children with diabetes want to make their children’s lives better and easier.  That’s not unique to diabetes.  For example, my son has a very severe allergy to several nuts.  I regularly say that I would like to rid the world of such nuts, make them as extinct as dinosaurs.  I’m joking, of course, because I know it’s impossible. But I’m also being totally serious.  I would do anything to make my son’s life better and safer, including wishing for the impossible.  So while a name change may be more likely than nut-extinction, I can relate to – and empathize with  – the feelings of the mothers behind the petition.   I vote, however, for putting our combined efforts to bringing the cure closer so that we won’t need a name for diabetes at all.

But while we’re talking about names, let’s talk about LADA for a minute.  LADA may be the most name-challenged of all types of diabetes.  For starters, it has at least three names other than LADA, which is short for Latent Autoimmune Diabetes in Adults.  There’s also Slow-Onset Type 1 Diabetes, Type 1.5 Diabetes, or Late-Onset Autoimmune Diabetes of Adulthood.  But it doesn’t really matter what you call it because practically no one has heard of it by any name, including most people in the medical field (outside of endocrinology).  My dermatologist tells me to just walk a little more and I won’t have diabetes. The OBGYN who treated me when I was pregnant still thinks I have gestational diabetes, even though I gave birth four years ago. And pretty much no two endos have the exact same take on LADA, which may have something to do with the fact that no two LADA cases are the same.  So, since no one agrees on what LADA is or what to call it, I will refer to my diabetes as its own unique subcategory, JADA, short for Jessica Apple’s Diabetes Autoimmunius (‘ius’ suffix for the Latin flair).    

And now I shall tell you about JADA.

JADA, for the most part, is easy to control (when compared to “real” type 1).  As long as I move and follow a low carb diet, I can avoid basal insulin.  But, if I eat carbs, I need to bolus with rapid insulin.

Most people don’t treat LADA this way, but since I have JADA, and I am the boss of me, I try not to eat carbs. My reasoning: if I can survive without insulin by eating eggs, nuts, cucumbers, cauliflower, tahini, avocados, etc, why get involved with insulin?

As long as I’m not faced with my own homemade baked goods, I feel fine with this decision.  For reasons I cannot explain, though, my own baking undoes me.  Don’t think for a minute that I have any baking talent whatsoever.  Nothing I bake is above average, and when I let Adam do the mixing, the quality drops significantly.  Still, while I have the will to turn down even the most tempting foccacia or creme burlee, I can’t stop myself from eating what I bake.

So I shouldn’t bake, right?

But my sons want treats and when I make them myself I don’t have to worry about nut contamination, I can use ¼ of the sugar, and I can swap in flours that aren’t white.  It makes my sons happy to get cookies straight out of the oven, and our apartment smells fantastic while they bake.  And since my oldest son has a school trip today, yesterday afternoon I baked his favorite oatmeal chocolate chip cookies to pack with his lunch.  As far as cookies go, the ingredients aren’t too bad.  Oats, whole wheat flour, butter, vanilla, milk, dark chocolate chips, and ¼ cup white sugar + 2 tablespoons of brown sugar.

According to the laws of JADA, if I took a bite of a cookie, I wouldn’t be in too much trouble.  But one bite turned into two, then three.  Then there was the cookie that broke so I had a piece of that.  Then there was the second batch that came out of the oven and I needed to taste that batch, too.  Over the course of an hour there must have been a few more nibbles, a few stray chocolate chips, and some crumbs that weren’t even big enough to count as bites.

Grabbing a crumb and a bite here and there is the worst way to manage JADA.  It means I have no way to know how much I’ve consumed and, therefore, I can’t predict the rise in BG, which means I have no clue how much to bolus.

So, genius boss of myself that I am, I didn’t bolus.

Then about half an hour after the baking was done, I felt like my heart was beating too fast and I wasn’t breathing normally.  I also had a weird feeling in my mouth.  These are classic JADA symptoms.  I began to monitor my BG.

 4:55 BG 151

5:24 BG 229

5:36 BG 232

5:53 BG 224

6:20 BG 179

6:40 BG 156

7:32 BG 94

At 94, I announced to Mike that I was finally back to normal.  My screwy, remaining beta cells had woken up and secreted insulin. Sounds great, right? A normal BG without a bolus.

Not great.  My own insulin had arrived three hours after I’d eaten the cookies. At that point, there was nothing around for it to do other than cause hypoglycemia.  I mean, poor insulin, it’s like arriving at a party and finding out it was cancelled.  What’s a hormone to do?

About two minutes after I’d announced the 94, I began to feel shaky.  I started to sweat.

I was sweating so much I had a hard time getting the test strips out of the container without getting them wet.  I dried a spot on my forearm with my shirt to test there because my hands were soaked.  Arm readings tend to be higher than finger readings  “How long until dinner?” I asked Mike.

 7:42 BG 73

“About four minutes,” Mike said.  I didn’t say anything to Mike, but I didn’t think I could wait.  My appetite was as big as an ocean.  I wanted to eat everything and anything.  But I also just wanted to lie down and go to sleep.  I was standing next to my desk and holding my glucometer.  I decided I wasn’t going to sit down.  Somehow the four minutes would pass while I stood there showering in my own sweat. I’d get to the table, eat dinner, and everything would be cool.  Then I had the feeling that I needed to test again, and I wasn’t going to be able to do it unless I sat down.  I gave in to myself.

 7:46 BG 65

The same part of me that didn’t want to sit down also didn’t want to eat.  I wanted to see if and when my body would respond with a surge of glucagon. How low I could go?  I’ve dipped into the 40s without having any insulin in my body, hoisted by my own petard of a pancreas.  I could feel that I was heading that way.  Thankfully, though, Mike was putting dinner on the table and I was wise enough to head that way.  I joined my family, and put an end to the hypoglycemia.

So, that’s my long-winded explanation of JADA.  Make of it what you will.  I’m off to start working on my JADA Wikipedia entry.

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I Feel Like a CGM

Jessica Apple | April 15, 2013

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Dexcom G4 CGM - Sensor and HandsetMy initials are JPA, not CGM.  Right?  But yet, more often than not, I feel like a continuous glucose monitor.  Like anyone who lives with or has a family member with type 1 diabetes – blood glucose numbers are a regular topic of conversation. And since Mike and I both have diabetes, it’s double the numbers.  My numbers, though, don’t usually go wildly out of range (thanks, LADA).  So I’m mainly talking about Mike’s diabetes.

Take the following as an example:

In a normal home if wife asks husband, What are you?, he may be puzzled and answer any of the following: a human being, a man, your husband, a Christian, Jew, or Muslim, etc.

In this diabetes home, however, when wife asks husband the same question, the answer is usually either high or low.  Or else the response is just a number.  It’s all about the numbers these days.  Day after day it’s daytime highs followed by nighttime lows. 

For weeks (months?) I’ve been attributing Mike’s BG issues to his marathon training, with the thought that it was all temporary and everything would return to as normal as life with diabetes can be after the marathon.  The days leading up to the marathon were extra full of BG frustrations, and now here we are 8 days after the Milano City Marathon and there’s no relief.  When Mike returned from his very early morning run today the first thing he told me was that he had a terrible hypo last night.

“But you set an alarm to check,” I said.  I felt so guilty I could hardly stand it.  Usually, I hear Mike’s alarms and nudge him to check.  I had been completely exhausted last night and thanks to Mike’s mother, who invited Adam for a mid-week sleepover yesterday, I was able to sleep with the only interruption coming from the cat trying to push me off the pillow.

I hadn’t heard Mike’s alarm at all, but he told me that he heard it.

“I checked,” Mike said.  “The hypo came later.”

I’m a lousy CGM.  I did not sense his hypo at all.  And our cats are not at all like those stories of cats that wake their hypoglycemic owners.  The cats are obsessed with me.  They wouldn’t jump on Mike at night unless he began to sweat tuna.

Sweat Tuna, Mike

Maybe I shouldn’t feel like it’s my responsibility to wake Mike to test his blood sugar.  But for whatever reasons, I do feel that way.  I hereby pledge to set my own alarms at night, not to depend on Mike’s.  I also pledge to harass Mike until he gets a real CGM.  It’s not covered by our insurance, and it’s a huge expense.  But you read it here first – Mike is going to get a CGM, even if it means we both take on more work to cover the costs of buying a Navigator 2 here ($2,175 + $600 a month to use).  A better option would be getting a Dexcom 4 CGM in the U.S. which, according to Diabetes Self Management costs $1,198 + $349. 

 

 

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Milan, Diabetes Style

Jessica Apple | April 09, 2013

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I’m in Milan using the slowest Internet since the days of dial-up.  For 25€ I can upgrade to a speed that might actually load the homepage of ASweetLife.  For 1,450€ I can buy the dress I like in MiuMiu.  For 1,050€ I can buy a beautiful Gucci bag.  The black spike heeled pumps I adore are at Saint Laurent at 685€  .   Prada totally disappoints this year.  The only reasonably cute shoes look like they were made from the leftover fabric of a picnic tablecloth.  And finally, I must tell you about the brown logo-print Louis Vuitton bag is the thing to have here.  It’s like every woman is a seventh grader who wants to wear the same thing as the popular girl. I went into the LV store to try to understand the obsession .I left without answers, but I did pick up some Japanese while browsing.  

I’m calculating carbs I could have here, too.  For two units of insulin I can have a few pieces piece of flat bread with olive oil and salt.  For three units I can have pizza.  Four units would get me the risotto with Parmesan and saffron.  With five I’d have ravioli and a scoop of gelato.

That’s pretty much sums up my time in Milan so far: observations and calculations of things neither my wallet nor my body can afford.

Milan's Duomo

That said, the Duomo, from the small glance I’ve had of it, is impressive and definitely worth seeing.  Since Mike and I arrived there on the heels of one of Mike’s most wicked lows, I can’t say I was able to really take it in. 

On our walk toward the Duomo Mike had been cranky and I was getting annoyed at him.  I kept my annoyance to myself, attributing his grumpiness to pre-marathon jitters.  As we passed by the Ferrari store, I suggested we go in to see if there was a toy car to buy as a souvenir for the kids.  The store was hideous.  It was overheated and the lights were so bright I had to squint.  Music of the sorts used to torture prisoners was blasting at nightclub volume.  Everywhere I turned there was a tacky red toy car.  I can promise you that Santa does not make a stop at the Milan Ferrari store when he does his annual gift shopping.  It would make him suicidal, and there is nowhere to park the reindeer because there are a couple of real Ferraris on the street in front of the store.  

Mike said he was feeling sick. He began to panic that he was coming down with something.  I said I felt bad in the store, too.  It was just the store.  Outside would be better.  When we got out Mike looked a little disoriented. “I really feel sick,” he said.  I could see the fear in his face. He was worried he was going to miss the marathon.  “Wait,” he said.  “My blood sugar.”

Mike tested in the middle of the street.  I held his bag and he held the kit.  He pulled back the lancing device with his teeth and pricked his thumb.  After having spent hours around 250 thanks to a carby lunch, and giving tiny boluses to bring his BG down, Mike was at 60.  It was clear he was 60 and dropping fast.  There was an unappealing café across the street.  “We’re going there,” I said.

At first Mike just stared at me, looking confused.  Then he said he didn’t want to go there.  He wanted to keep walking a bit and find a better place to get something to eat.

Usually, I don’t object to Mike’s blood sugar related decisions.  He is responsible and he knows his body very well.  From my own experience I know that just as it is with the weather, there are lots of factors involved in how your body feels.  Sometimes 70 feels like 50 and sometimes 60 feels just fine. I don’t like to second guess the way Mike’s feeling.  This time, though, intuition told me to interfere.

“We’re going over there,” I said, pointing at the café.

Mike was standing in place, not objecting, but also not responding.  I took his hand and pulled him along with me.  When he started moving in the right direction I ran ahead to get food.  I tried to explain to the man behind the counter that I needed food fast.  There were cookies and pastries in the glass case below the counter.  I got the man’s attention with lots of hand gestures and pointing.  I said things like sugar, fast, cookies, hoping I’d get something across.  As Mike stepped into the place I asked him if he wanted juice.  He arrived next to me and pointed at a little raspberry pie.  Mike said he would like it in a bag.  “You’re eating it now,” I said.  “We’re not waiting until you drop below 40.”

Milan - The NICE Cafe

I’m not sure the servers in the café understood what the problem was, but it was clear they realized we were having a problem.  As I paid for the little pie, the cashier took a piece of chocolate and handed it to Mike.  A gift of sugar.

The most important calculation of the trip: one too many units of insulin can kill you, and one little act of kindness can save your life.

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Their Carb Intake is None of my Business

Jessica Apple | March 23, 2013

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We celebrated my son Guy’s 10th birthday today with his entire class.  Because we can’t hold a party for 25 kids in our apartment, we held the event at a local museum.  A guide gave the kids a tour of the archeology wing, then they saw a short movie in the planetarium.  After the movie, they made aliens out of clay.  As far as I could tell, it was a huge success. 

While the kids created aliens, I ordered pizza.  I calculated 2-3 slices per kid and expected to have more than enough.  Unlike other birthday parties we’ve thrown, I decided to keep the food, especially the junk food, to a minimum.  We’d have pizza and cake, but not any other sweets – no cookies and candy on the side.  I had a small amount of salty snacks – potato chips and pretzels, just in case there were kids who didn’t like pizza.

Turns out, there was not enough food.  I felt both sorry and angry.  On one hand, I truly felt bad telling the kids that there was no more pizza, and that there was only enough cake for each kid to have one piece.  On the other hand, it upset me to see little kids eating three or four slices of pizza and coming back for more.  I explained that there would be cake afterwards and that they should save room. That didn’t stop them from wanting to eat more pizza.  And after they’d each received a generous slice of cake, many wanted seconds.  I recognize that it’s not my place to judge whether or not a kid is eating too much carb, but I judged anyway.  Although none of the kids was diabetic, all I could think about as they grabbed a third slice of pizza was that they were easily at 75 grams of carb before the cake! 

100+ grams of carbohydrate for lunch.

I know the stress that much carb puts on a pancreas, and I feel guilty for serving food that causes that kind of stress.  But I’m also stuck in an impossible position: pizza and cake are expected, much more of it than I provided.  No doubt there will be kids who tell their parents that Guy’s mother didn’t give them seconds.  And those parents will probably think I’m stingy and mean.  Mostly, I’m concerned.  In my professional life I spend a great deal of time thinking about the prevention type 2 diabetes.  It’s a bit disconcerting to feel like I’m promoting it.

 

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