Bolus Calculations Part II

Think Like a Pancreas Chapter 7, Your Cheat Guide!

Part II

So, how sensitive are you? 

Does the Notebook make you cry? Do kittens make you warm inside? 

Just kidding.

How sensitive to insulin are you?

There are many variables that increase and decrease your sensitivity to you insulin, but when it comes to the basics, see below for the steps to determine how your body responds to your insulin dose:

  1. Test your blood sugar at least four hours after your most recent bolus.
  2. If your sugar is high, calculate and give yourself the correction dose. Go about your usual activities but do not eat or exercise for the next several hours. 
  3. Test your sugars four hours later
  4. Calculate how much your blood sugar came down and then divide by the # of units you gave. This should come close to your sensitivity factor. 

Bolus Insulin On-Board.

Other terminology: Bolus on board, active insulin, insulin remaining/actively working in your body.

Quick fact: The fastest insulin takes about four hours to complete its job (sometimes even longer!)

So what does one do when your experiencing a high blood sugar but still likely have insulin on-board? Aggressively treat? (Im)patiently wait for it to come down? 

Let’s find out.

First, this concept of knowing how much active insulin is in your body is crucial because stacking leads to increased likelihood of low blood sugars. To get a visual idea of (estimated) insulin on board since your last bolus, check out Table 7-6. below: 

Example: Let’s say you injected 6 units of insulin for a 2PM snack and then check your blood sugar at 4pm. According to the table above, you still have 35% of your bolus remaining (6 units x .35 = 2 units). Considering this before your next bolus is important for proper dosing.

Another way to determine how long it really takes for your bolus insulin to finish working is to check your blood sugar every 30 minutes after a correction bolus and see how long it takes for the blood sugar to stop dropping. ***Tip: once you do a correction bolus, do not eat, exercise or give any more boluses until your blood sugar flattens out. 

Example: If you are experiencing a high blood sugar, considering the IOB will help you determine the correct dose for proper balance. Naturally, you may want to bolus/correct. But if you have 2 units on board, you should probably not take anything at all to prevent a low!

HP TIP: All of this can seem very confusing and complicated—which it is. My personal HP suggestion is to keep MINIMAL insulin on board (by mainly eating lower carb), to decrease the likelihood of variability. The more insulin you are injecting, correcting, stacking, etc., the more variable your blood sugars will be. 

Adjustment for Physical Activity—THIS IS A BIGGIE!

As I am sure you already know……insulin sensitivity increases with physical activity. 

In a normal situation, where (1) unit would lower the blood sugar 50mg (2.9 mmoI/I), it might lower it by 75+ (4.4 mmoI/I).  A unit that usually overs 10 carbs, may cover 20!

Anything that has us using our muscles, or has us moving around, can and will affect our response to insulin. The more intense and prolonged the activity, the greater the enhancement in insulin sensitivity. Increased work = your muscles are much more sensitive to insulin.

Your dose for upcoming and previous physical activity can and will vary. Head HERE, and learn how working out can be responsible for falls and rises in blood sugar depending on what kind of workout your doing. 

If you find yourself constantly using food to offset the fear/reality of lows during workout, send me an email! I will be happy to help you calculate and get better control of this, everyone is different and this is no (per usual) one-size-fits-all. 

My go-to method is this: workout first thing in the morning! If your basal dose is correct, you should have minimal to no risk of dropping low. You can workout stress free and focus on really enjoying your workout (working out should NOT be stressful). Depending on the type of work out (click link above to workout post), you may require 1-2 units to offset your liver dumping glucose which can lead to a rise/high blood sugar. 

If you are working out mid-day, you must be mindful of how much insulin you have on board to avoid a low. The less active insulin you have on board, the less variety (risk of the common lows) in your blood sugar.

For high blood sugar prior to exercise, take half the usual correction and drink plenty of water.

If your pre-workout number is extremely elevated, be mindful of ketones. This can be very dangerous and not something to take lightly. 

Inactivity: Sensitivity in Reverse.

Do you sit all day at work and/or class?

Are you intentional about getting some sort of exercise in for your mind and body?

The reality is, the more sedentary you are, the less reactive your body will be to your insulin. The more active you are, the better your body’s response will be! 

If you plan to be more sedentary than usual, like long travel/commute, long school classes, etc. consider taking your bolus up in small increments. 

Bolus Timing. 

TIMING—will make or break your blood sugars. 

Improper timing = unhappy blood sugars.

This is so so hard for me!

Sometimes I just want to snack on blueberries or take a few bites of something… hoping that for some strange miraculous reason my blood sugars won’t rise by much.

Ultimate fail is when I decide to dose while I am snacking….. and 30 minutes later I see my 200+ reading.  I would be lying if this is not bi-weekly occurrence. 

Timing (how soon you can eat after injection) is based on: 

  1. Type of food (glycemic index) 
    1. High GI (will make your blood sugar rise quickly—leaving it difficult to control) example: Fruit juice, soda, waffles, bagel, cereal. 
    2. Medium GI (moderately raising your blood sugar) example: berries, grains, dairy. 
    3. Low GI (containing fiber or large amounts of fat) example: avocado, bacon, greens. 
    4. Click here for a detailed GI food list breakdown: https://ultimatepaleoguide.com/glycemic-index-food-list/
  2. Your pre-meal blood sugar (i.e. are you working with 75 or 210?)

Check out table 7-12. for a visual on adjustments to bolus timing based on GI and pre-meal blood sugar

Sooooo that was Chapter 7 Part II! What did you think?

I think I need a cookie.

I hope you were able to take away something applicable for your day-to-day blood sugar management. 

Next week is Chapter 8, Welcome to the Real World. 

xoxo

Bolus Calculations (Part I)

Think Like a Pancreas: Chapter 7, Your Cheat Guide!   (Part I)

I don't know about you, but calculating is not my forte. 

Before having Type 1, I was a free bird and whimsically ate whatever the heck I wanted. I still ate pretty clean back then, but I would eat an entire watermelon or grab a few crispy crunchy chocolate chip cookies whenever I wanted. *Sigh* 

Sure, I can still eat those things, but this disease has taught me mindfulness on what foods do what to my body and excess sugar intake is the root of many illnesses and disease. So cheers to healthier living thanks to Type 1. ;)

Okay, let's dive into Chapter 7.

Bolus Calculations

Boluses are bunches of rapid acting insulin used to cover carbs or lower high blood sugar levels. 

Four Factors that are used to determine bolus dose:

  1. the amount of carbohydrate in a meal or snack
  2. the blood sugar level at the time of a meal or snack
  3. the amount of insulin still remaining from previous boluses
  4. the amount of planned (or completed) physical activity. 

Part I. Insulin to Cover Carbs

To determine how many grams of carbohydrates each unit of rapid acting insulin covers we use the “insulin to carb ratio (I:C).”

Example: A “1:10 ratio” means that one unit of insulin covers 10 grams of carbs, and a "1:20" ratio means that each unit injected covers 20 grams. To figure out your I:C ratio, simply add up the grams of carb in your usual meals and divide the units of rapid acting insulin. 

Example: If you enjoy 30 grams of carb for breakfast, divide this by (your normal dose) 3, which = 10, so it appears that each unit of insulin covers 10 grams of carb. 

The I:C ratio gives you flexibility to accurately account for as much or as little carb as you choose, but you still must be mindful of spacing meals and snacks a few hours apart.

The more you snack, the less control you are likely to have because it keeps you in a perpetual state of blood sugar rise versus allowing for the bolus to kick in and normalize your blood sugars. 

Your I:C CAN VARY. Many people find that their highest bolus need is at breakfast (due to hormones), and lowest in the middle of the day (due to increased activity). 

 

Using Your Weight I:C Method:

This approach is based on the fact that insulin sensitivity diminishes as body mass increases…i.e. each unit of insulin will cover less food in a heavier person than lighter. 

First, divide 1,800 by your weight in pounds. For me, its 1800/145 = 12.41

This translates to 1:12

While this method is generally effective, it does not account for the variables that affect insulin response such as age (hormone production) and insulin sensitivity (how healthy and/or active you are).

Again, keep in mind, your I:C will vary. 

 

Fine Tuning Your I:C Ratio:

Trial and adjustment is necessary as you fine tune. 

To help with accuracy, be mindful of certain factors that can/will affect your blood sugar levels such as: major emotional stress, start of menstrual cycle, after a low blood sugar, unknown carb content (eating out), high fat meals. Each of these can skew your numbers and affect your average data. 

  • First, check your blood sugar (pre-meal) and log your number. 
  • Second, log the amount of carbs consumed & bolus given.
  • Third, check your blood sugar (post-meal) three hours later, without taking in any calories or bolus insulin in between. 
  • Attempt this process for at least one, or even two weeks to fine tune your I:C ratio.

Considering this is diabetes , and nothing can be simple (WHYYY?!), your numbers could not all be consistent, but you should see a trend fur sure. 

See Table 7-3 for visual example:

 

Part II. Correcting your blood sugar

When correcting your blood sugar, you must first determine:

  • Your current blood sugar level
  • Your target blood sugar level
  • Your sensitivity factor (how much each unit of insulin is expected to lower your blood sugar). Stress, surgery, inflammation, pregnancy, growth, etc. are each variables that affect your sensitivity to insulin. 

Gary recommends the 1700 (94) rule for figuring out your correction ratio/sensitivity factor.  

Take your total daily insulin (including basal and bolus) and divide into 1700 (94 if measuring blood sugar in mmol/1). 

Let’s say you are taking 50 units daily (on average): 1700/50= 34 (94/50 = 1.88)

This would translate to every unit of rapid acting insulin should lower your blood sugar approximately 34mg/dl or 1.88 mmoI/1

Example: If your target blood sugar is 120, you should add one full unit for ever 34 points over 120 you are, and subtract 1 unit for every 34 points below 120. 

Formula: In mg/dl: (current blood sugar—120)/34

If your blood sugar was 250, it would be: (250—120)/34    Which would translate to needing 3.8 units of insulin to correct your blood sugar to the goal of 120. 

If your blood sugar was 100, it would be: (100—120)/34     Which would translate to taking away .5 units from your meal dose to avoid a low. 

See Table 7-4 for estimating your sensitivity factor based on your total daily insulin:

 

Lots of numbers. I know. I warned you. 

I would be lying if I said I used these calculations religiously when it comes to dosing and correcting. 

Like I mentioned before, I am a free bird at heart and I generally live some-what whimsically when it comes to my dosing. I am able to get away with this because I am injecting minimally (3-5 units on average per meal for low carb), which = minimal variabilities. 

That being said, I am logging and practicing these calculations all week! 

With love,

xoxo

Whitney

 

Basal Insulin Dosing (Part II)

Think Like a Pancreas: Chapter 6, Your Cheat Guide!

(Part II)

Fine Tuning Pump Basal Rates

When you go on the insulin pump, whatever you do, don’t assume the initial basal settings are correct. 

Testing, adjusting, and retesting basal rates can be exhausting but worth it. 

During your basal test, the only thing raising blood glucose should be the liver, and the only thing lowering it should be basal insulin. All other influences (food, bolus insulin, exercise activity, major stress, hormonal changes) need to be eliminated.

How do you figure out if your basal is set properly?!

  1. Wait approximately 4 hours after your last bolus/meal—this will give the carbs time to finish digesting and the bolus time to finish working. No food should be digesting.
  2. No bolus insulin should be working.
  3. Your body should be producing its normal amount of glucose. If your on your period, have unusual stress, or if you had a recent low blood sugar (in the past 4 hours), do not run the test.
  4. Allow basal insulin to be delivered at its normal rate
  5. Maintain your normal level of physical activity

Testing Schedule Example: Table 6-4

Table 6-4 Basal testing schedule.jpg

 

During the test, If your blood sugar drops more than 30mg, the basal rate is probably too high, if your blood sugar rises more than 30mg, the basal rate is probably too low. 

Tip:  Make basal changes before blood glucose starts to rise or fall.  If you are experiencing a high from 1am-4am, an adjustment for 12am-3am would be best.  Basal rates needs to be changed prior to observed changes. Gary also recommends to make setting changes on the hour, i.e. 1:00am instead of 1:30am—he sees it as more practical and manageable. 

Tip: Adjust in appropriate increments. The amount of the basal change needs to reflect both the magnitude of the observed blood glucose change and the individual’s sensitivity to insulin. If you are on larger doses, larger adjustments may be needed to see a the needed change, if you are on low doses, then it would be the contrary. 

Tip: Stick to mimicking your body’s natural rhythms. A basal program that includes multiple peaks and valleys is almost always incorrect……you are likely compensating for some other aspect of the insulin program that is not set up properly (too much or too little bolus insulin, or over eating to compensate incorrect dosing). 

Remember: You are your best pancreas. You know your body. You know your stress.  You are the ultimate decision maker regarding your blood sugar plan. To allow for happier blood sugars, schedule a day (what about next Friday?), to check to see if your Basal is set correctly. Sometimes it takes a few fasting adventures before your fine-tuning is mastered, but trying it once could shed much light on the reason behind some of your highs and lows!

xoxox

Should you adjust your usual pre-meal bolus dose? Find out next week in Chapter 7, Bolus Calculations!

 

Basal Insulin Dosing (Part I)

Think Like a Pancreas: Chapter 6, Your Cheat Guide!

(Part I)

 

Your basal insulin serves as the foundation for your entire insulin program. If you have a high or low blood sugar, knowing what to adjust is difficult unless you already have established the proper baseline.

“With a solid, level foundation, you can build something great, but with a cracked or crooked foundation, you will need to manipulate everything placed on top of it in order to avoid epic disaster.” —> In laymen terms: If your basal insulin dose is not set properly, you will be constantly adjusting your rapid acting insulin and/or food intake to avoid highs and lows. 

When looking at typical dosing patterns and formulas, use them only as starting points—everyone’s needs vary. 

 

Initial Basal Dose for Those Injecting Insulin

First, one must mindful of what factors affect your insulin requirements:

Weight. 

Age (stage of growth, i.e. hormones).

Physical Activity.

Insulin Sensitivity.  

The amount of internal production of insulin from your own pancreas (if any).

To estimate your total daily insulin requirements review this table:

K… kind of confusing, now what?

First, convert your weight to kilograms (your weight x .454 = kg) then multiply by the total daily insulin requirements (units per kilo body weight) found on table 6-1

1. (Weight) 140 x .454 = 64.56 kg

2. (Moderately Active Adult) 64.56kg x .50 = estimated 32

3. (Moderately Active Adult) 64.56kg x 1.0 = 64.56

Total estimated daily insulin requirements for a moderately active adult weighing 140 = estimated 32-65 total units daily (this will vary base on carbohydrate intake & insulin sensitivity).

To estimate your total basal insulin requirements review this table:

First, convert your weight into kilograms (your weight x .454 = kg) then multiply by the daily basal insulin requirements (units per kilo body weight) found on table 6-2.

Example: If your weight is 140, age is 25, and your’e very active:

1. 140 x .454 = 64

2. 64 x .15 = 9.6 units

3. 64 x .40 = 25 units

You would require between 9.6-25 basal units. Starting conservative is most ideal, slowly increasing and/or decreasing based on your trending highs or lows.

More tid-bits for your fine-tuning basal adventure:

—How many carbs do you eat in a day? Estimating your daily carb consumption is crucial. Lower carb eaters generally have larger proportion of basal insulin than higher carb eaters because they are using less fast acting insulin prior to meals…i.e. less stacking of larger amounts of insulin

—The right dose of basal insulin should keep the blood sugars fairly stable during the night (given you do not eat, take rapid acting insulin, or exercise.)

—A consistent rise or drop of more than 30mg/dl indicates a need to change the basil insulin dosage. 

How do you determine if your basal needs adjusting?

  • Eat a healthy dinner: Low carb and low fat—think veggies and lean protein! Fat can trigger a rise, and carbs increase variability in blood sugar numbers. 
  • If pm exercise is part of your norm, go ahead, but nothing too long or too intense. This can cause blood sugar drops several hours later.
  • Three hours after dinner, check your blood sugars. As long as your blood sugar is above 80 mg/dl and below 200 mg, do not take any food or insulin and proceed with the experiment!
  • Check your blood sugar again in the middle of the night and first thing in the morning.
  • If your blood sugar rises or falls less than 30 mg from bed time to wake time, congrats! Your basal dose is likely in good range. 
  • If it is dropping by more than 30 mg, decrease your basal by 10% and repeat the test. 
  • Continue to adjust until your blood sugar holds decently steady through the night. 
  • Confused? Think this:
    1. If you were going to sleep at 185, and woke up at 120, your basal is too high since it dropped by 65 mg while you slept.
    2. If you were going to sleep at 87, and awoke at 160, an increase in the basal insulin would be in order. 
    3. If you were going to sleep at 95, and woke up at 77, WOOHOO! Minimal change = correct dosing for your body (for now). 

Killer Somogyi. What the heck?

The Somogyi Phenomenon (named after its discoverer) is when you drop during the night (below 70), and your body secretes hormones that raise the blood sugar by morning. 

Long story short, you need to know what your “in the middle of the night” blood sugar number is to ensure your wake-up number is an actual depiction of your blood sugar levels.

While you may waking up high, you could be dropping low and rebounding to a higher level by morning.  

Next week..... we will dive into (Part II) Fine Tuning Pump Basal Rates.

I didn’t want to overwhelm you with too much info this week. 

My goal is to make this as simple as possible. 

When numbers, a sucky pancreas, and "guesstimating" are involved…. I know things can get overwhelming. 

You got this!

xoxox

The Basal/Bolus Approach

Think Like a Pancreas: Chapter 5, Your Cheat Guide!

The liver’s main function is to store glucose (in a dense compact form called glycogen ) and secret it steadily into the bloodstream.  This provides your body’s vital organs and tissues with a constant source of fuel. “This is what keeps your heart beating, brain thinking, lungs breathing, and digestive system, uh, digesting all the time.” (Scheiner).

A working pancreas typically puts out small amounts of insulin into the bloodstream every couple minutes. This the purpose of your basal insulin (i.e. long lasting insulin). Too little basal insulin = sharp rise in blood sugar levels. 

Each person’s basal insulin requirement is unique, but typically, basal insulin needs are highest during the night and early morning and lowest during the middle of the day.

Why more in the morning? Dawn phenomena—sugar raising hormones. 

Why less during the day? Physical activity—i.e. moving around increases your sensitivity (response) to insulin. 

Basal (long lasting) insulin can be supplied in a variety of different ways: 

A. Intermediate-acting insulin (NPH)—covers insulin needs for about half the day or overnight. This type of insulin is often combined with a rapid- or short-acting type. 

B. Long-acting insulin (Lantus, Levimer)—covers insulin needs for about one full day. This type is often combined, when needed, with rapid- or short-acting insulin. Offers (typically) peak-less insulin levels for approximately 24 hrs. 

C. Insulin Pumps— deliver rapid-acting insulin in small pulses throughout the day and night; peak or action time is not an issue.  Pump therapy allows for best basal insulin coverage.

Gary discusses (6) insulin therapy options, below are the (2) go-to therapy's:

The Muscle Car: Breakfast, Lunch, Dinner, Snacks: Humalog/Novolog. Any time of day, consistently: Lantus.

Overview: Long lasting insulin may dissipate earlier than 24 hours, but for most, it provides a steady level of basal. Its consistent absorption minimizes the risk of hypos. Multiple injections are not ideal, but provide rapid-acting response to cover meals and snacks. This regimen sometimes produce high readings in the morning (dawn phenomenon not covered) or lows in the middle of the day (as basal insulin needs tend to lessen). 

The Engineered Import: Insulin Pump Therapy.

Overview: Offers the ability to fine-tune and adjust basal insulin levels throughout the day and night. Allows great freedom and flexibility in terms of food, activity and sleep patterns. Basal insulin levels can be adjusted for events such as menstrual cycles, pregnancy, stress, illness and extended exercise.

---------

Basal/bolus therapy varies person to person. There is no one size fits all.  Learn and listen to your body, chat with your health specialist, and adjust accordingly to your specific needs and/or lifestyle preferences. Your body is ever changing. Whether it’s stress, hormonal imbalances, pregnancy, increase in fitness level, each bring the need for small (or large) insulin adjustments.

Tips!

Fast. This will shed light on whether or not your basal is correct. Holding steady and not trending high or low (rise or drop of 30mg) is the goal. If your basal is not correct, it’s very difficult to keep happy blood sugars!

Log.  Trends are best discovered when written down! Adjusting your dosing for your body’s needs shouldn’t be a guessing game. It’s complex and needs your attention!

Open Mindedness. Poor control? Feeling tired of the pump? Don’t feel stuck! Reach out to others and speak with your physician about making a therapy transition if you feel you need to change things up. 

Until next week....

xoxo

The Three Keys to Control

Think Like a Pancreas: Chapter 4, Your Cheat guide!

Ultimately, quality control = balanced blood sugars and achieving the lowest possible A1C without frequent lows. 

Your A1C represents the % of red blood cells that have glucose stuck to them. With normal blood sugars, approximately 4-6% of red blood cells will have glucose attached.  For a visual: Think of a donut (a red blood cell). Even though this seems sad (when it comes to donut talk), ideally you want minimal sprinkles (glucose) on your donut (red blood cell). The more sprinkles, the more stress to your red blood cells.

Your mission for your diabetes journey is: minimal glucose stuck to your red blood cells. 

The 3 keys to help balance your sugar are: Tools, Skills, & Attitude.

THE OBVIOUS TOOLS. 

Insulin—via injection or pumps, medication (if needed), glucose monitoring system (meters, cgm), supportive health care team (endocrinologist and other necessary specialists—mental health, dietitian, naturopathic, etc.). 

THE SKILLS.

Self monitoring.  While you don’t want to be obsessive, being in tune with your sugar levels throughout the day is crucial. Minimal monitoring during the day is the same as missing 90% of a movie. You miss the big picture—the full context of what is going on with your bod.

Record Keeping. Are you experiencing trends in highs and lows that you may be unaware of? Maybe! You won’t know unless you keep record. If your goal is gain better control, logging your: foods, dosing amounts, physical activity, stress, etc. are all factors that directly affect your A1C. 

Questions you may be able to answer with sufficient logging:

Do lows tend to occur after highs? Maybe you are over-correcting.
Do highs tend to occur after lows? Maybe you are over-correcting.
Do glucose levels frequently drop overnight? Maybe your basal insulin needs adjustment.
Do certain foods constantly trigger high blood sugars? Maybe you need to avoid them. 

Carb Counting.  All carbs covert into blood glucose fairly quickly. Having a handle on conversions of carbs and correct dosing is important. The more accurate you are at carb counting, the better control you will have. 

Dietary discipline. 

Space. Spacing between meals is crucial to allow blood sugars to normalize. Constant snacking (especially on carby/sugary items), creates a constant “stream” of glucose into your bloodstream. Gary suggests spacing meals and snacks at least three hours apart. 

Fat. Large amounts of a fat slows digestion and blood sugars from rising as quickly. Keep this in mind to avoid sneaky falls and rises in blood sugars. I.e. That pizza you had for dinner. The (fat) cheese will slow the absorption of sugar (carby dough) which can cause a drop in blood sugars (if dosed timing is off) then a rise hours after the meal. 

THE RIGHT ATTITUDE. 

You can have skills and the tools to manage your blood sugar levels but if your attitude is poor, your management will suffer. Problem solving, persistence, discipline, and acceptance are crucial traits in successful blood sugar management. Set goals & realistic expectations for yourself to help improve control. Changing too many behaviors at once can = burnout & let down. Write out your goals (seriously, do it today… or even better, right now) and take baby steps towards better control! Idea: Grab a piece of paper and start writing down the carb counts of your foods along with your blood sugar and insulin doses. 

Until next week...

xoxo

Basics and Beyond

Think Like a Pancreas: Chapter 3, Your Cheat Guide!

The type of diabetes you have is defined by what caused it, not how it’s treated. 

  1. Type 1 - The kind caused by loss of the ability to produce insulin
  2. Type 2 - The kind who has insulin resistance i.e. can’t utilize insulin properly.

As a Type 1, your body has (for some reason) attacked itself, destroying the insulin producing beta cells. Possible triggers of Type 1 include viruses, major stress, environmental toxins, exposure to certain foods, and genetic markers. 

As a Type 2, the body is stressed (due to poor lifestyle choices) and becomes insulin resistant. 

---

Major factors that lower your blood sugars are: insulin and physical activity. 

The heart of truly understanding diabetes is the hormone insulin. What’s insulin’s job?  To lower blood sugars. To facilitate the movement of nutrients—particularly glucose, out of the blood stream and into the body’s cells where they can be burned for energy.  When you don't have enough insulin, or body cells cannot use the insulin properly, blood sugars rise.

When injecting, be mindful that the source of injection affects the action of the insulin. In order of most rapid to slowest absorption: tummy [fastest] —> arms —> legs —> buttocks [slowest]. 

Physical activity is your BFF when it comes to lowering your blood sugar. Working out makes your body more sensitive to your insulin by shuttling sugar out of your bloodstream and into your cells. When your sedentary, your muscle cells aren’t burning a lot of energy. When your moving, cells can easily do their job, i.e. lower blood sugars in an efficient way!

Major factors that raise your blood sugars are: carbohydrates and stress hormones. 

What you eat is the foundation of blood sugar control. Carbs are the biggest player when it comes to the biggest response in blood sugar rise. While proteins and fats can and will affect your blood sugars, they are minimal. Diets that are primarily [high] fat and [high] protein, blood sugars are affected more. 

Glucose, sucrose [table sugar], fructose [fruit], lactose [milk], and starches [breads, chips] each have major effects on your blood sugars. High consumption of these = less control over your blood sugars. 

Stress [emotional & physiological] raises your blood sugars. Did you know the liver serves as a storehouse for glucose? The liver will secrete glucose back in the blood stream if triggered by stress hormones. Anxiety, anger, excitement, pain, sickness, each stress the body because of the stress hormones secreted. Keep healthy and practice mindfulness to decrease your stress load!

Until next week.....

xoxo

What's the Dang Diddly Point?

Think Like a Pancreas: Chapter 2, Your Cheat Guide!

 

Amidst walking the stressful, fine line of managing your best blood glucose numbers (not too high! oh wait... but not too low) 24/7, we can neglect the reality of the benefits of exactly why are body needs us to try our very best. 

Chapter 2 discusses the "What's in it for your now?' & "What in it for you later?" i.e. What are the benefits of short term and long term blood sugar control, while also bringing to light the consequences of high blood sugars.

Balanced [happy] blood sugars (70-130), allow your body to perform at its best physically & mentally. When your blood sugars are elevated, every system of your body is affected. 

Elevated glucose hinders fuel from entering your body’s cells for energy. Even a temporary [blood sugar] high can slow you down. If you want to feel your best, be present for work; your family & friends, and have enough endurance to get through your workouts, keeping blood sugars balanced is crucial.

Dehydration is another consequence of our bodies response to high blood glucose, this is why it’s important to keep hydrated and nourish your body throughout the day. Muscle fatigue, stiffness, and diminished strength occurs due to sugar blocking the connection between the muscles and the nerves.

Do you find yourself catching the cold or flu’s easier? While having Type 1 is naturally stressful for your body (making you more susceptible to disease/fatigue), bacteria and viruses LOVE sugar. The higher your blood sugars, the more at risk you are at picking up that cold or flu going around. 

What about weight gain?

There are many factors that affect your physique, and elevated blood sugars is one of them. Chapter 2 discusses the importance of leptin, a hunger controlling hormone that tells the brain how much fat is stored within your body. High blood sugars can compromise the power of leptin leading you to eat more and carry extra fat on your body.  If you want to lose fat, you must keep excess sugar out of your blood stream and into your cells.  

Feeling mentally scattered, drained, and exhausted comes with managing a chronic illness but with better control, you will find more clarity. Blood sugar imbalance can decrease your ability to focus and be creative. Mood swings, anxiety, and depression are also culprits of poor control. 

Having elevated blood sugars over the long term leads to the elevated risk of disease and internal damage. Every major system of the body is effected when you allow your blood sugars to range high. “Let the fear and anger associated with longterm diabetic complication serve as a positive motivator.” 

Blindness, amputation, kidney failure, and heart disease are some of the tragic realities of long-term poor blood sugar control. Long term imbalance = long term stress on your body. 

While it’s a scary, depressing thought to encounter any complication, if you maintain good glucose control, you CAN avoid them. 

Until next week friends…

xoxo

Staying fit with Type 1

There is a common misconception of insulin directly causing weight gain--but this isn't the case!

Maybe you are Type 1, and you feel that since being diagnosed you aren’t where you want to be physically. I have totally been there and I am still working daily towards my best!

Before diagnosis, I was down about 15 lbs of my normal weight, i.e. SUPER frail and skinny.

After diagnosis and getting my body healthy again, I put weight back on.

As a girl, you are like ah… what the heck!—or at least I was. It’s shocking to see your body change, especially when it’s going in a direction you aren’t necessarily wanting it to.  Maybe you can relate?

I was diagnosed in January 2014, and I felt like after a year of having Type 1, I was carrying a little more extra weight then I wanted/needed. I wasn’t overweight by any means, but I for sure wasn’t feeling my best.

I was learning the in’s and out’s of managing this disease 24/7. Constantly fixing the highs and lows—injecting more to correct the exhausting highs, and gorging myself to correct the scary lows.

It can be a vicious cycle.

I’m not too sure what your story is—whether you have had Type 1 since before you could remember, or if you are newly diagnosed, but here are: SIX simple, yet solid tips on how to get your body where it needs to be while managing your Type 1 diabetes:

 

1. DON'T LET TYPE 1 DIABETES KEEP YOU STUCK! 

You have Type 1, but this doesn’t mean you are stuck or hindered to get where you want to be physically! Yes, it takes work (extra work then someone without Type 1), but you CAN get there. Check out Nick Jonas!—he is living his dream and keeps his body solid even with Type 1.

2. TYPICALLY TOO MANY CALORIES ARE CAUSING THE      WEIGHT GAINNOT THE INSULIN. 

If you are eating more calories than your body is using and you are taking insulin to keep your blood glucose levels normal…… you will likely gain (keep on extra) weight.
Taking too much insulin and then having to eat more to prevent lows will also cause weight gain.

3.  CONSTANTLY CORRECTING LOWS?

Your basal (long acting insulin), may be set too high! Dropping low in the middle of the night, or randomly experiencing lows when you haven’t had much to eat can mean that your long acting insulin is too high. Getting this correct will minimize overeating and fixing constant low blood sugars.

4.  ARE YOU WORKING OUT?

If you want to get in better shape, it starts with diet but also must involve a consistent workout regimen!
Don’t let Type 1 hinder you from joining a gym, going for a run, or joining fitness classes or your health. This is SO important for your physical, mental, and emotional wellbeing. 

5. FIND YOUR HAPPY!

What do YOU enjoy? Getting out and moving takes effort for sure, but making sure you love the style of workout you are doing will help push you towards your fitness goals. For me, it’s Crossfit—I love the accountability, community, and the variety of workouts. I also love to take my furry child for long walks and runs. Mixing it up keeps staying fit fun and less of a chore!

6. WORKOUT RESOURCES!

Crossfit offers varied functional movements: strength training & metabolic conditioning. The community is also something I love.  It keeps me accountable and I love the team setting. Crossfit has helped me GREATLY with my mental health upon diagnosis. Click here to find your closest Crossfit!
Yoga is great for a deep stretch, flexibility and mindfulness. While I don’t practice often, Hot Yoga is a good option for a good sweat and quieting your mind. Try this Yoga Flow for beginners and a great stretch.
HIIT & Circuit Training is an awesome starting point and perfect for overall body composition. Check out Personal Trainer and Mental Wellness Coach Taylor at: mybodytaylor.com for some great FREE workouts. I try implement her workouts 2-3 times a week and have seen a big difference in toning and leaning out!  
Get moving and start with this workout today!  

Feel free to message me anytime for education & encouragement that you might need while managing this disease!

We got this :)

xoxo

-Whitney

 

"To dose, or not to dose pre-workout?" That is the question.

Have you ever experienced a HIGH blood sugar POST workout?

Experiencing low blood sugars during (or post) workout tends to be the typical experience for a Type 1 so this concept may seem a tad foreign. 

The idea of needing insulin prior to a workout can seem like one is just asking for a random low--which can be true, it just depends on the type of workout (and a few other variables)! 

Physical activity can actually affect blood sugar in multiple ways. 

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Example #1: Aerobic exercise. i.e. jogging, hot yoga, elliptical, cycling. 

These types of exercise raise your heart rate for an extended period of time which consequently will generally trigger your blood sugars to fall. This type of exercise uses glucose primarily for fuel. 

A blood sugar drop is triggered due to enhanced insulin sensitivity and accelerated glucose consumption by muscle cells. 

Tip: You can reduce your insulin dose, increase carbohydrate intake, or a do combination of both prior to this style of workout.

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Example #2 Anaerobic exercise. i.e. HITT, Crossfit, Weight Training, etc. 

This style of exercise is what can cause a SPIKE.

Trial and error have been my BFF for this because I start my day with Crossfit first thing in the morning within minimal active insulin & food in my body. 

I would wake up with an amazing 84 reading, head to Crossfit, and check my blood sugars post workout and they would be 200+!

Blood sugar rise during anaerobic exercise is caused by a surge of stress hormones that oppose insulin’s action and cause the liver to dump extra sugar into the bloodstream. 

Ahhhhh.

So now what? 🤔 

Think like a pancreas! 

In higher intensity/stress environments, we need extra insulin.

In a working, healthy pancreas, it knows what to do: it churns out some extra insulin to offset the “fight or flight” response. This is due primarily to the stress hormone production or “adrenaline rush” that accompanies this style of workout. 

But not mine. 

And not yours (if you're Type 1). 

Okay, so now what? --- Trial & error. Keep a log journal. Consistently monitor blood sugar levels and look for trends.

My routine typically looks like this:

1. Wake up, 

2. Check my blood sugars,

3. Dose around 1-2 units (depending on what my number reads)

4.  Eat 15-20g of carb 20 minutes before my workout session. ( i.e.1/2 sweet potato, 1/2 banana, or protein shake with banana). Carbs + small insulin dose mixed with high intensity exercise will turn off your livers sugar tap!

---

Despite my efforts, I still experience a random high here and there but they have been drastically minimized and better controlled. 

So....."to dose, or not to dose pre-workout?" If you are doing aerobic exercise you shouldn't need to, but if you are doing anaerobic training, dosing is likely necessary to avoid the spike (especially first thing in the morning).

Please remember, there is no exact science in managing this disease. There are countless variables that affect our blood sugar levels, i.e. hormones, anxiety, protein, fat, weight gain, medications, stress...... and the list goes on but we will save these for a future post!

Closing thoughts:

1. Minimize high carbohydrate meals for optimal control and blood sugar balance.

2. The less you need to inject (stick with lower carb, nutrient dense meals), the less variability you will experience!

Do you have any tips or tricks on how to avoid lows and/or highs during your workout routine?

xox

-Whitney

 

 

Fiber, your magical friend.

 

Meet your new magical friend: FIBER.

Due to the body’s inability to breakdown fiber (indigestible), it has no negative effect on blood sugar levels.  

Several studies have shown that the adverse metabolic effects of high-carbohydrate diets are neutralized when fiber and carbohydrate are increased simultaneously in the diet for diabetic patients. 

While I don’t really recommend a high carbohydrate lifestyle for anyone, “neutralizing” the effect of carbs within our bodies sounds good to me.

So what does this mean?

When you consume fiber, it delays food digestion which consequently effects carbohydrate metabolism. For example, raspberries contain 15 grams of total carbohydrates and 8 grams of dietary fiber (per cup). Since fiber is a carbohydrate that your body cannot digest, subtract the fiber count from the total carb count, which = 7 total impact carbs for 1 cup of raspberries. Pretty good! 

FYI (in countries like UK or Australia, total carbs labeled do NOT include fibre, which means they already represent what is known as net carbs in the US.)

You may have heard that whole grain products are high in fiber. However, the starch in grains quickly turns to sugar and overwhelms any blood sugar-blocking effect the fiber would traditionally have! So when you see whole grain pasta, or whole grain bread…. It’s not really doing much when it comes to slowing digestion and avoiding a blood sugar spike. See it as an indulgence and not as a healthy alternative.

Keeping your blood sugar steady is an important tool for preventing insulin spikes, which can lock fat into your cells and prevent it from being used for energy.

The more blood sugar rollercoasters you find yourself on during the day by choosing unwisely, the greater risk you are for disease, excess body fat, mood swings, and depression.

HP TIP: You can blunt blood sugar-raising effects by increasing your consumption of whole, high fiber foods and decrease your consumption of starchy, sugary, refined foods.

HP ACTION STEP: A good way to ensure that you get enough fiber in your diet is to supplement some of these tasty foods into your day: Dark leafy greens, broccoli, red bell pepper, avocado, lentils, raspberries, artichokes, chia seeds, sweet potato, flax seed, and squash.

 

xoxo

 

Good vs. Bad Carbs

Are carbs bad for us?  Yes and no.

First, this subject matter varies depending on your lifestyle.  Daily carb intake depends on your activity level, overall wellness, and other factors.

Considering that carbohydrates represent a broad spectrum of foods, there is no one-size-fits-all answer for this, as different carbs break down differently within the body.

So, what is a carb?

Carbohydrates are commonly broken down into either COMPLEX (whole) or SIMPLE (mostly refined).

Complex carbohydrates refer to sugars with a complex molecular structure of three or more parts. Because of their intricate structure,  it takes the body longer to break them down. They usually contain valuable minerals, vitamins, and fiber which aids in overall health and digestion.   They offer continuous, sustainable energy and less blood sugar roller coasters. I.e. your friend. 

Examples: 

Some fresh unsweetened fruits

Non-starchy vegetables

Whole grains (whole grain rice, oats, barley, quinoa, corn, etc)

Nuts and seeds of all types

Unsweetened nut butters

Unsweetened coconut

Whole legumes (beans, peas, lentils)

Guacamole

Unsweetened salsa

Olives

Unsweetened pickles

Soy products (like tofu and unsweetened or sugar-free soy milk)

100% stone-ground wholegrain breads or crackers without sugar added

Unsweetened tomato sauce and other unsweetened, starch-free sauces

Herbs and spices

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Simple carbohydrates consist of a simple molecular construction of one or two parts and are rapidly absorbed into the bloodstream, causing spikes in blood sugar and insulin levels. They offer little value for your body and can lead to negative health effects. Consuming simple carbs results in a crash that can trigger hunger and cravings for more high-carb foods.  I.e. your enemy. 

Examples: 

Table sugar/white sugar (aka sucrose)

Confectioner’s sugar (powdered white sugar)

Honey (Even though honey exists in nature and isn’t refined, it is a pure sugar that is difficult to obtain in significant quantities without special equipment or risk. Honey affects our health in exactly the same way that other sugars do.)

Agave syrup

Corn syrup and high-fructose corn syrup

Brown sugar

Maple syrup

Fructose

Dextrose, dextran, dextrin, maltodextrin

FRUIT JUICES except for lemon/lime juice. Most fruit juices require special equipment to produce in significant quantities.

ALL KINDS OF FLOUR including wheat, oat, legume (pea and bean), rice, and corn flours. 100% stoneground, whole meal flours are less refined and not as unhealthy as other types of flours because they are not as finely ground and take longer to digest.

INSTANT/REFINED GRAINS including instant hot cereals like instant oatmeal, white rice, polished rice, and instant rice

REFINED STARCHES such as corn starch, potato starch, modified food starch–essentially any powdered ingredient with the word “starch” in it

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So, complex (whole) carbohydrates are GOOD for your body in moderation, and simple (refined) carbohydrates offer minimal nutritional value and increased blood sugar levels. . . which = bad for your body.

If you are including carbs in your diet, reclaim real foods by choosing WHOLE carbohydrates with MINIMAL sugar and/or additives.  

 

xo

-Whit


 



 

Roller Coaster Blood Sugars

The more unstable your blood sugars are, the worse you will feel.

Brain fog, energy slumps, sugar cravings, stimulant cravings, and mood swings are consequences of consuming high glycemic, high carb foods.

If your Type 1 Diabetic, you’re at an even greater risk and more likely to have sudden, dramatic blood sugar swings and long term, serious health complication because of them.

Why?

Put simply, it is virtually impossible to mimic your pancreas.  A non-diabetic, with a healthy pancreas, cannot even maintain efficient energy/health control with an out of balance diet.   

The higher the carb  ➜ the higher dose of insulin that is needed  ➜  the more insulin you use, the greater the level of uncertainty.

In theory, you could weigh and count everything you eat down to the last gram and give yourself that dose, but I am 99% certain you will fail at maintaining acceptable blood sugar levels.

Our idea of what we are actually consuming and its effect on our blood sugar levels is extremely ambiguous.  Do you think our injections move the blood sugar out of our blood at the exact same rate our bodies metabolize those carbs? No. But that is a complicated topic that I will get into in another post.

 

➜ The larger carb consumption, the larger margin for error.

➜ The larger carb consumption, the greater the roller coaster.

 

Choosing foods to fuel our lifestyle efficiently is what we need to strive for.

If the kinds of foods you’re eating give you consistently unpredictable blood sugar levels, then it will be impossible to normalize blood sugars. 

But it is possible and empowering to fuel your body with foods that minimally effect your blood sugars. You will feel GREAT, look great, and have greater control of your diabetes.  

 

FOODS YOUR BODY HATES:

Breads, pasta, sugary drinks, processed foods. 

 

FOODS YOUR BODY LOVES:

Chicken, eggs, fish, lean red meats,  avocado, nuts, berries. 

Veggies, psyillium, almond meal, coconut flour, flax.  

 

QUICK FACTS:

➜ Everything you eat is converted into glucose—the fuel that drives our body's processes.

➜ A food's GI (glycemic index) score is based upon how quickly it converts to glucose in the body.

➜ Foods with a high GI convert rapidly into glucose, while foods with low GI convert more slowly—minimizing blood glucose spikes. 

 

xoxo

 

 

What is a Pancreas.....?

Okay, I have Type 1 Diabetes.  My pancreas no longer produces insulin and I have to give myself injections anytime I want eat — but what does REALLY this mean?

I feel most people don't fully understand the function of the Pancreas — non-diabetic or diabetic. It's scary when someone is diabetic and is still clueless as to what the heck is going on with their body (or not going on with it). 

While I am still learning, here is my best overview of the: PANCREAS.

Because the pancreas isn’t seen or felt in our day to day lives we just accept the wonderful fact that it keeps our body functioning the way it is supposed to.

Lose that wonderful functioning, and it's importance is brought to light. 

The primary role of your pancreas is to make enzymes to digest proteins, fats, and carbs in the intestines, and produces the hormones insulin and glucagon.

Soooooooo what does this mean? 

If you are non-diabetic 👉 You eat. Your pancreas releases digestive enzymes to breakdown your food. Your glucose level in your blood rises  (based on how much/what you eat), which then triggers the pancreas to make insulin - which is then released into the bloodstream.  This is how your body transforms glucose into energy. 

 

  Non-Diabetic Blood Sugar Levels throughout the day (50-400mg/DL). 

Non-Diabetic Blood Sugar Levels throughout the day (50-400mg/DL). 

If your Type 1 diabetic 👉 You eat.  Your pancreas releases digestive enzymes to breakdown your food. Your glucose level in your blood rises  (based on how much/what you eat), but then the pancreas fails to make insulin. Glucose stays in the bloodstream (slow acting poison). Levels remain high until properly treated. If left untreated (i.e. if insulin is not injected), kidney failure, nerve damage, poor circulation, weakened immune system, or even death will/can emerge. 

  Type 1 Diabetic Blood Sugar Levels through out the day   (50-400mg/DL). 

Type 1 Diabetic Blood Sugar Levels through out the day (50-400mg/DL). 

The cause of Type 1 is unknown. The body's own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys the insulin-producing (islet) cells in the pancreas.

As you can see from the charts, Type 1 diabetics face roller coaster blood sugar levels (next blog post!) quite frequently. This can be exhausting (mentally and physically).   It's almost impossible to keep well controlled blood sugars unless your fueling your body with foods that have minimal affect on your blood sugar.. As Type 1's, we cannot mimic the exact science of the pancreas. While this disease is considered controllable, it takes constant work and sacrifice to obtain semi-regular blood sugars. 

Without understanding the role of our Pancreas,  it is really hard to know why we should fuel our body with healthy choices.  If us Type 1 diabetics can't succumb to the full time job of properly controlling our blood sugar levels 24/7, we are inviting the short and long-term complications that will occur.

The better we understand our body's functions, the greater longing we will have to make it HAPPY.  

 

 

P.S. I can't forget about Type 2 Diabetes.  Type 2 diabetes is a metabolic disorder and accounts for the vast majority of people with diabetes (95%). Apart from genetics and other underlying illnesses and conditions, poor eating habits and physical inactivity are the primary causes of Type 2. 👉  Excess body fat, and the consumption of refined foods and drinks can cause inflammation in the body leading to insulin resistance. Type 2's still produce insulin, their body is just unable to use the insulin right away.  Changing diet and lifestyle can almost always reverse type 2 diabetes (depending on the severity).

 

 

 

The Murkiness of Being Diagnosed With Type 1 Diabetes

 

A few months from now marks my two year "diaversary." 

The words: "It's Type One diabetes... we don't know the cause...its autoimmune,"  was something I was NOT ready to hear. Or wait... I didn't even know what this meant. 

Are you sure? Maybe I am pregnant. Maybe it's pancreatitis. Maybe it's every other treatable disease/illness that Google and WebMD is telling me. Perhaps it's a tumor? Can you check again? 

Denial.

I was actually in denial for a few months. Searching relentlessly for what the heck was going on with me. There was NO way I was stuck with this for life. 

Shots? 4-5+ a day? EVERY. SINGLE. TIME. I. WANTED. FOOD? Constantly pricking my finger to gauge where my sugar levels were at? Striving for 75-100 but reality could often bring 30-300+.      OMG. This can't be happening to me...... I left the endocrinologist's office that day with my mom and just sat in the car and cried. 

Before being officially diagnosed with Type 1 Diabetes, I was initially being treated for bronchitis and other random things because my blood was saturated with sugar for months unknowingly. Finally, after 4 doctor office/ urgent care visits... my blood levels were checked. 

Awakening to many missed phone calls and voice mails from doctors.... " Your blood sugar levels are 400, please go to the ER."  

What.....?

I felt my season of being diagnosed and "learning" how to manage my sugars was similar to that being plunged into a murky sh$! show. 

The fact that the ER gave me tons of material for Type 2 diabetes and prescribed me medications for type 2 blew me away. Are these medical professionals that uninformed on this disease? Sure, I get I am not the "typical" Type 1 patient since I am in my twenties, but still.  Doctors and nurses should be well-educated on the differences because it could save a life. 

My endocrinologist was good, and I wont devalue her efforts and treatment.....but she didn't have Type 1. 

My nutritionist was good, and again, I wont devalue her efforts and data.... but she didn't have Type 1. 

Sure, I was given the tools to understand that I need X for Y to be in normal range BUT I was still very misinformed as to the science of what foods are going to be tragically difficult for you to keep this disease well managed. 

I had the science of Type 1, but the science of nutrition was left up to me. 

I have learned SO much in the past year and a half when it comes to what does what to my sugar levels. Since my pancreas produces zero insulin..... I am my pancreas 24/7. 

Being a pancreas is an interesting adventure. I have had many scary lows and many stressful highs. If I am depending just on the information that was given to me by my endo and nutritionist I would find myself on a constant roller coaster of blood sugar levels. Count your carbs, adjust your insulin, fix your lows with sugar/fast acting carbs, fix your highs with insulin. It can be a vicious cycle. . . and I feel many people still find themselves here unfortunately. 

While my sugars aren't always perfect, I believe I have gained great control of my blood sugars because of my awareness and comprehension of HOW certain foods do what to our bodies. 

While everyone should be mindful of this (autoimmune disease or not), as Type 1's, we have to be. Calorie King and My Fitness Pal are aimless tools if we don't know what foods are doing what to our bodies. 

And lastly, constantly changing meals and eating frivolously unfortunately = poor sugar control and subsequently long term health complications. 

Yes it's hard work to manage this disease..... and yes it really is a FULL TIME 24/7 job, BUT there is hope in this. And there is a sense of clarity that arrives when we understand what we are fueling our bodies with. 

While we can feel defeated or limited by this disease, we must remember that amidst the murkiness, and amidst the highs and lows, it is manageable. 

And that is what I am here for. 

To keep learning.

To offer some joy in the suffering.

And to provide nutritious and yummy food choices that ensure you have a HAPPY PANCREAS.