And This Bowl is Just Right

One way I keep my portion sizes under control is to have different sized bowls for different foods. Finishing an entire bowl of anything is satisfying, even if it's a small bowl, and it's easier to resist going back for seconds. It also makes it easy if my husband is putting together a snack - he knows if I ask for a 'bowlfull' to go for the small bowl. We've gotten most of our small bowls in Chinatown - the stores often have a selection of small rice and condiment bowls for reasonable prices. I find them a good size for cereal and servings of fruit, as they hold about a cup. I'll fill them to the brim with berries, and half full for cereal.

The tiny 'ice cream' bowls are actually teacups, and hold single small scoop of ice cream or pudding. Having a tiny cup makes me eat it slower and reminds me to savor the flavor. It was a bit of an adjustment - and every so often I'll upgrade to a larger size - but it really does help re-enforce moderation in sweets and carb heavy foods.

The big bowls are regular salad/soup bowls, and I try to make sure I'm not using them for anything but veggies.

I do this with glasses as well. The only time I use a large glass is if I'm drinking water, crystal light or some other sugar free beverage.

Anything carb heavy like milk or juice gets a small glass, usually only half filled. We found the small glasses in a six pack at the dollar store, so they were really inexpensive.

I find it really tedious to pull out the scale or the measuring cups every time we eat, so having our serving dishes in the appropriate sizes really helps.

The only thing I don't use smaller things for is plates: For those I just try to make sure half the plate is covered with veggies, though I'm not always successful.

Australian Meter/Game System: Glucoboy

Found another new meter, unfortunately only available in Australia right now. The Glucoboy is made Guidance Interactive (I can't find any other meter products by them) in partnership with Nintendo, and is targeted at children. Apparently this became available in November or December 2007 after several years of development. I'm not aware of any other meters specifically designed for juvenile diabetics, and I think it's a great idea.

Aside from the standard meter functions, the Glucoboy has a bunch of built in games that offer reward points though 'GRiP', a guidance reward platform. This includes an online community to help encourage good diabetes management. It sounds like testing regularly earns you more points, which are then spent inside the games or on the website.

The Glucoboy requires you own a Nintendo DS or or a Gameboy Advance to play the games - You plug it in as if it were a Gameboy cartridge to play. The device itself is designed in white and bright orange, and looks very kid friendly. It retails for $299.00 AUD, so it is quite expensive for a meter or a game (Though I don't know how other meters compare in Australia - in Canada meters run about $50 CAD, though you never have to pay for them). The strips are bright orange, and retail for around $31.30AUD for 50. They're planning a lot of accessories to go along with this meter as well.

I'm not Type one, so I have no experience with being a child with diabetes, but I'd like to think this device is a good idea. It seems like a way of making all the unfamiliar changes that come with a diagnosis a little easier to learn by putting it in the familiar context of video games. I would think one of these would be 'cooler' to take to school.

Of course, any child is going to get tired of a game after a while (or at least I always do), but it might be a good way to form the habit of regular testing. Of course, it would be great if Nintendo continued to put out games, or found a way to link the incentive points with their regular offerings.

Any Type 1's or Type 1 Parents out there care to give an opinion in this? I'm really interested in hearing a thought from the inside.

A Pretty Concept Meter - Ninos

Concept art for diabetes products seems to be a new trend. On the one hand, it'll be great if any of this stuff actually hits the market. On the other hand, these concepts always seem to be promotional pieces for designers with little chance of actually getting picked up by an equipment manufacturer.

The one that caught my eye today was a dual concept study called the Ninos As & Ninos GL. They are very stylish, very pretty in modern black and silver.

Reading the story though, I wondered how much research had been done. The Ninos As is an insulin inhaler concept. As sleek and streamlined as it is, I'm not sure how valuable a concept it is when Inhaled Insulin has been linked to Lung Cancer.

The blood meter concept (the Ninos GL) looks a lot like a cellphone. It has a shiny touchscreen and all the charts and graphs you need built in. I love this concept.

However, the concept meter uses a "bloodless glucose measurement system". Apparently you're just supposed to press your finger against a notch in the top. Again wonderful, if the technology existed. As far as I know, it doesn't. The first meter that doesn't use test strips is going to have millions of people flocking to it.

I haven't been able to find much about these concepts - most of my searches online have returned reprints of the same article, often written as if these were actual, available devices. I think they may be German, from squinting at the photos provided. I don't know if there part of some contest or just a designers portfolio.

Love the prettiness of these, but I do wonder about the science behind them.

Whole Wheat Biscuits

I took a stab at converting our favorite 'Touch of Grace' biscuits to whole wheat this weekend. My mother loves these, so we have an excuse to make them a couple times a month. Now that they're becoming a regular part of our diet, I thought it was time to make them slightly more diabetic friendly.

I've never tried to convert a recipe before, and I wasn't quite sure what the rules were for changing things up. We ended up just winging it. The recipe calls for 1 1/2 cups of white flour, and we substituted 1 cup whole wheat and 1/2 cup white instead. We've made this recipe enough that we know what the dough should look like, and that made it a lot easier. I had to add a half cup of extra milk to get it to look right. Now I know that whole wheat flour absorbs a lot more liquid.

They turned out great. Still had plenty of 'biscuit' flavor, nice and fluffy, and in no way did I feel deprived of my regular white biscuits. I'm going to try all whole wheat flour next time - and use buttermilk (we were out this weekend) because I did miss the buttermilk taste. But overall, a great experiment.

Whole Wheat "Touch of Grace" Biscuits
adapted from The South The Beautiful Cookbook

1 cup whole wheat flour
1/2 cup white flour
1 1/2 tsp baking powder
1/8 tsp baking soda
1/2 tsp salt
1 tbsp Splenda or sweetener of choice
3 tbsp vegetable shortening
1 1/4 - 2 cups Milk or Buttermilk
1/2 cup additional flour (any kind)
2 tbsp melted butter

Preheat oven to 500 F/ 260 C. Lightly coat an 8" pan with cooking spray.

In a medium bowl, mix the first six ingredients. Work the shortening in, forming pea sized lumps with a pastry blender or your fingers. Gently stir in milk or buttermilk until just mixed. You want add enough milk that all the flour is moist. We find we need less milk than buttermilk, but you will need at least 1 1/4 cups for the whole wheat version. This is a thick, wet, drop biscuit dough, sort of like thick muffin dough.

Let the dough stand 2-3 minutes. The dough is so wet that you cannot shape it in the usual manner. Pour the last 1/2 cup of flour into a plate and flour your hands. Spoon a biscuit sized lump of dough into the flour, and sprinkle with flour to coat it lightly. Shape the biscuit into a soft round, shaking off any excess flour. Place into the pan. Continue with the rest of the biscuits until the pan is full, or you run out of dough, pressing each biscuit as close to the others and the pan edge as possible.

Brush the biscuits with melted butter and bake 15-20 minutes until brown. Let cool for five minutes, then serve and enjoy.

Offline Diabetes

Sometimes I wish everyone diabetic wore a button. I know there are many diabetics around me, but I rarely meet them offline. Those I have met with diabetes, including my stepmother, aren't really interested in talking about it. It's a closed door. I tend to share it, though I don't (I hope) ram it down people's throats.

Meter comparisons, concerns about doctors, venting about daily stress, any acknowledgment of the day to day frustrations and successes.. these only exist for me online. I read a lot of blogs, soaking up those other experiences.

When I go out, now and then, I watch the people around me. Perhaps someone will pull out a meter or I'll see a pump. I don't know that I'd do anything if I did. I'm far to shy to approach a stranger, and diabetes can be very personal. I think perhaps a great number of people don't want to discuss it. Sharing a disease doesn't make you friends or acquaintances. Given the variability of diabetes, their experience could be far removed from now.

But it would be nice to not be the only diabetic in the room all the time. To have a face to face conversation about it. I'll get there, sooner or later.

Blood Sugar 101

After much anticipation, my copy of Blood Sugar 101 by Jenny Ruhl arrived this week. It did not disappoint. The book is full of the best tips, techniques and information from Jenny's site, BloodSugar101.com. I've loved Jenny's site since I first encountered it, so buying her book was an absolute must.

Despite the somewhat alarmist subtitle - "What they don't tell you about Diabetes!", the book is very straightforward and to the point. I think this should be a standard 'Textbook' for diabetics. It's got so much useful information on diabetes itself - all backed up by actual medical studies - combined with information on insulin, oral meds, supplements, plus useful techniques for lowering your sugar levels and A1C. I would have never realized chest pain is a Metformin side effect without her detailed analysis.

She asks and answers a lot of very critical questions: Does Diabetes have to progress? (No), At what blood sugar level does organ damage start? (140-160 [7.8-8.9] post meal levels), What should you eat to reduce your blood sugars? (Fewer Carbs).

She explains how to use your meter to find out what foods you react to - no one size fits all diet plans here - as well as coping techniques to stay on your diet. One of these I really like is the idea of 'off plan' eating instead of cheating. How you think of things, the words you use, have a huge effect on how you feel about them. "Cheating" brings a lot of guilt and shame, but "Off Plan" eating brings the focus back on the fact that it's your choice.

It can be a very scary book at times - Jenny is very straightforward about how the disease progresses and the risks of various complication. But it's enormously hopeful too, because it gives practical techniques for avoiding them by keeping your blood sugars low. There's a very simple progression of techniques - Adjust your diet, adjust/add meds, adjust/add insulin - to help you find the right balance of techniques to meet your own goals. She really promotes the least expensive and invasive techniques (diet) before medication and insulin, without pretending that a diet solution is going to work for everyone.

If you have questions about the different types of diabetes, how insulin and glucose are managed by the body, what causes diabetes, how effective different drugs are and what side affects they have, what supplements actually work, and what your doctor should be doing to help you manage your disease, you'll find answers both in the book and at Jenny's website.

I'd recommend this book for anyone with diabetes, and anyone who knows a diabetic. It's available from Amazon or through Jenny's site. But don't just stop at the book. Be sure to visit BloodSugar101.com for even more incredibly useful information, plus Jenny's blog critiquing the latest published studies.

Blimpies 3 Inch Sub

One of my husband's favorite fast food meals is a Blimpie's Sub. My father owned a sub shop (not a Blimpies) for five years so it's a bit of a nostalgia meal for me too. I made a lot of subs in high school.

I like the freshly sliced meats, the extra tasty mayo and the provolone cheese at Blimpies.

Of course, the problem with any sub place for me is the enormous sub bun. A 6" wheat is about 40 carbs according to a few nutritional sites. I'm not eating all that.

Instead, I ask them to cut it in half, then dump all the filling into one half and munch my double thick three inch sub.

Yum!

Parents - Leftover Disposal

Since we moved to the same city as my folks, we have them over for dinner a couple times a month. It's something I really enjoy. For one, I like feeding my folks - it's a great reversal of all the meals they've fed me, and I know they appreciate having someone else doing the cooking. We usually play a couple of board games as well which is great fun, and difficult for two people.

Every time they come, they leave loaded with leftovers. I end each evening looking around and going 'what else don't I want'. Tonight they not only took the supper remains (chicken, cauliflower, biscuits), but dessert - 3/4 of a boston cream pie, and a half a bag of cookies I was trying to avoid eating. It was great to have the boston cream pie - we never buy it because it's too big to finish, and I can't be tempted by extra biscuits or cookies if they're gone.

It's nice to give away extra food - and especially extra carbs - instead of letting them go to waste.

Jelly Straws

The import foods aisle at the Real Canadian Superstore is always filled with strange and interesting things. Most of it eye with astonishment and skepticism. Dried Squid? Corned Mutton? Wasabi Peas? Grass Jelly (Jello)? No thank you.

I do run across something I like now and then though. Jelly straws are now a staple snack in our house. It's a pretty simple product - assorted flavors of Gelatin in a tube. We don't have Jello in our house much, as it seems impossible to find sugar and aspartame free varieties, at least up here in Canada. These are a great alternative.

Each straw is only 4 carbs, so they're a great quick sweet snack. I find the flavoring fairly subtle - each pack has a mix of grape, pineapple, lychee, apple and strawberry. I wouldn't recommend them for lunches because I've never been able to get a tube open without scissors.

Gelatin has always been a treat for me - I never had it much growing up, so I appreciate being able to have it anytime I want.

Stuttering

Apparently when I was very young, four or five, I used to stutter. I don't remember doing it at all, but in the last year or so it's come back.

When I'm tired, or stressed, or need to eat I start to feel this chattery teeth sensation. Then I'm forcing myself to slow down to get words out. It's really disconcerting, because I can be one of those mile-a-minute talkers. Not being able to get words out, or not being able to get past repeating a single word or syllable is another is scary scary.

Of course the big part of the fear is that I'm once again out of control. So far I haven't been unable to get words out at work, but today I wasn't feeling well and I had to slow my speaking down to keep talking.

I've tried looking up any tie between diabetes and stuttering, and come up empty. I'm guessing that it's just co-incidence that it's come back so soon after my diagnosis and medication. It's definitely one of the strangest and scariest changes I've had in the last couple of years.

Insulin Envy .. and Admiration

I'll admit to feeling a twinge sometimes, when I hear an insulin dependent type comment on eating something especially sweet or having bread and potatoes AND dessert for dinner, or otherwise exceeding the 20 carbs at a time limit I try to stick to. 100 or 150 carbs in a single meal? I just can't do that. I wish I had the ability to 'cover it' with insulin, and have that freedom of diet, or simply having a way to make those numbers go down instead of "don't eat it" and "wait it out" techniques I have access to.

Of course, insulin is not that easy. Sure, you can take insulin to cover what you eat, but it's not like you have a choice in it. And it's not like it's always predictable, or figuring out how much and when is straightforward. No insulin, and you're in bad territory. Too much insulin, same deal. I can't image waking up with the shakes of a low or struggling to get numbers down when you're dealing with a bad batch of insulin, or having to insert pump needles every few days.

I don't think I'd be willing to trade that uncertainty for the ability to counteract the effects of a big chunk of cheesecake. It's reading all those blog entries about the realities of being insulin dependent that keep me motivated to avoid progressing to that stage. My image of the insulin dependent lifestyle has changed from a simple 'lots of shots' idea to a complex, challenging system of checks and balances you can't take a break from.

It's amazing and admirable to me to know of all the people who make it work, and find the strength to deal with it every day.

Brownies & Bad Moods

Alright, brownies are on the 'eat less of' list, but it's been a while, and they looked delicious.

I was careful. I only ate half my multigrain burger bun at lunch. I waited a couple hours to let it digest.

Then I had a small brownie. Not tiny, but within what I can usually handle for a brownie. I was quick to regret it. It was small, but sweet, and very lacking in that chocolate fudge flavor that was the entire point of eating it.

Then I started feeling that sugar rush. The fatigue, the swirling stomach, the fuzzy head and lack of focus. It always makes me just want to curl up somewhere until it passes - not really possible at work. I have no idea how much sugar that baker used but it has to be considerably more than the average brownie to get that reaction.

For some reason, the sugar rush never seems quite reflected in my sugar levels - I tested at 7.7 (139), which is high for me - I try to stay under 6.5 (117), but it's not hugely over.

Fries, I will note, can easily raise me to 9 (162) with no adverse reaction. It takes sugar to screw me up.

Usually I figure once the sugar rush is past, the worst is over. But I'm very slowly starting to clue in to a secondary reaction: the sudden bad mood, five or six hours later. There's such a huge time frame between the sugar rush and the bad mood it's taken me a long time to connect that they're related.

Especially since, once again, it's not reflected by my blood sugars. I'm holding at a stubborn 6.0 (108), even though aside from some roast beef I've barely eaten in 5 hours. Not a bad number, but it means I have to be careful what I eat if I don't want to get past 6.5 again today.

I still haven't figured out how accurately judge what's going to give me a sugar rush. I'm glad I've figured out that sugar rush means an oncoming bad mood later - and my husband will certainly appreciate the warning - but I feel foolish for taking so long to clue in. I need to remember that even if my meter isn't showing crazy numbers, what I eat can be affecting me in a lot of other ways.

Explaining Insulin with Pizza

I've been trying to come up with a good metaphor for describing some of the ins and outs of diabetes. One I've come up with for insulin is a Pizza Delivery Comparison, as illustrated below:

I like this one for a couple of reasons: Pizza's a pretty understood concept. I don't think many people in the western world haven't had pizza delivered at least once. Sugar's easy enough to equate to other food too. Insulin triggers the opening of cell doors to let in food, so that's a pretty straightforward comparison too.

It makes explaining insulin resistance really easy too. If you've got insulin resistance, as Type 2 Diabetics, Pre Diabetics and some Type 1 diabetics do, then some of your 'doorbells' are broken. So you're wondering if that 30 minutes or it's free delivery deal is still good, and outside the pizza guy is wondering if anyone is home.

I'm not sure how to create a good image with this metaphor to describe a lot of other aspects of diabetes - lack of insulin production (Type 1, Insulin Dependant Type 2) is easy enough to talk about, but an image of a pizza guy with no hands doesn't work for me. Beta cells and insulin factories don't really work with hands either.

Still, it's a start.

Diabetics on TV

The TV world we watch rarely seems to include diabetes. I can't remember ever watching a show with a diabetic on it. Part of me objects to this - there's a huge number of diabetics in the world, and you'd think we'd be mainstream enough to include. The other part is a little glad, because diabetes could so easily get sensationalized for dramatic effect. I wouldn't want to see a diabetic on TV if it was all seizures and comas and the like.

But I do wish there would come a show that'd show it in an intelligent way. After all, the day to days of diabetes, the blood testing, the shots/pills/pump, the carb counting, the rest of it, is pretty boring. A character that was all about diabetes would be really boring and one dimensional.

But one that was diabetic as just a character trait, not a character focus, would be worth watching.

I wouldn't object to the occasional diabetes-specific shows. Say one for an upcoming A1C, or having a meter break, or a bad batch of insulin. Things that are handled in a realistic fashion, not an 'OMG DIABETES EMERGENCY' one.

But the gold would be in the tiny details. I can picture little vignettes.

A bunch of teenagers sit down to eat, and one of them pulls out a meter and tests.

A college student accidentally hands in a term paper with a test strip attached.

A young woman hurries to make an appointment on time after having to reset her pump insertion.

Someone gets snarky in a conversation, and is asked if they've checked their blood sugar.

At a restaurant, one person at the table cuts their potato in half and sets it aside, or removes the third slice of bread from their whole wheat club sandwich.

How awesome would it be to see these little slices of diabetes life in the "mainstream"?

Diabetes History

Today's all about awareness in the Diabetes Online Community. We've all got our own personal histories with the disease, and it's amazing how far we've come in some ways, and how much we have left to travel in others.

I thought I'd link to a diabetes timeline. It's got some interesting tidbits.

There have been some interesting miss-steps - apparently in the late 1850s, patients were prescribed sugar. Between 1900-1915, they were trying carb heavy diets based on milk, rice, oats and potatoes. Elliot P. Joslin, a leading diabetes researcher in the early 1900s proclaimed diabetes as one of the best of the chronic diseases, for being, among other things, 'seldom unsightly'.

Of course, there are some important advances too. Insulin, oral drugs, blood meters, awareness and education campaigns. We're in the middle of so many potential advances. Hopefully in the next few decades, we'll see the disease itself become history.

Diabetic "Sucess"?

I know what I consider being successful at this disease. Reaching say, 80 or 90 without getting any of those nasty complications will definitely be a success. That's my ultimate goal.

The problem with this goal is that the only signs of success are the lack of signs of failure. I know my A1C's have been good, so I assume that I'm on the right track. So far I'm able to keep my sugars in control with the combination of diet and exercise and medication I'm on now. I don't have any diabetic complications.

But I wish I could go in to the doctors and find out that I've sustained the same amount of beta cells, or that my nerves are free of damage or see my level of insulin resistance go down. I'd like some way to guarantee that I'm holding my own.

I come out of each A1C feeling like I've gotten a report card: really good at measuring past performance, but still no guarantee of the future. Just because I have an A this term doesn't mean I'm not going to flunk out next year.

I wonder if I'm going to go to the doctors one day, and they'll do some tests on my eyes or nerves and give me bad news. Even if I feel like I'm more or less doing everything right, there's always that push to try and do better, just in case some silent damage going on in the background. Something that I won't know about until it's too late to reverse it.

I know there are no guarantees of the future, but that blindfolded feeling is one of the things that scares me the most.

Glamorgan Bakery - Whole Wheat Cheese Buns

This is a whole wheat cheese bun. I've finally found one! I love any kind of cheese + bread combination but try to avoid all the white bread.

This one was discovered at the Glamorgan Bakery. We'd been told they had good sausage rolls and cheese buns and decided to check them out this weekend. The cheese buns did look good, and exceptionally cheesy. I didn't spot the brown ones on display, but they had a sign up so I knew to ask.

For me, about half of one of these is enough. They're really packed with cheese, both inside the bun and on top, so it tears apart in cheesy layers. I did find them a little salty for my taste, but still something I'll buy again. I don't eat a lot of salt so I find I don't have much tolerance for it.

I'll be having cheese bun for breakfast all week!

Weight Loss.

After years of steadily putting on weight, I'm very proud of myself for losing 40+ pounds. I'm about 5 pounds away from the top range of a 'normal' BMI for my super-short height. I want to lose another 10-15, so that even if I mysteriously gain 5 or 10 pounds overnight I'm still in a good spot, BMI wise. Of course, I haven't been that weight since Grade 9.

Strangely, I don't feel I've done much to lose the most of the weight. It started just FALLING off me at a rate of 3-4 pounds a month when I went on Metformin. I know I've gradually started to eat less now that I pay attention to portion sizes, but there was never a quick change. I've always felt it was the Metformin that made the real weight difference. Unfortunately, that quick and easy weight loss did not last.

Losing the first 30 was easy. It's the last 10 pounds I've had to struggle with. That bit of fat just likes to pop back constantly. It's really hideous the way weight comes back.

Trying to lose any more has, as of yet, been impossible. I'm even resorting to regular, low impact, EXERCISE. Hopefully it'll do the trick.

In any case, losing the weight has made me feel so much better about myself. I've watched inches come off my measurements, and sizes come off my clothes. I have new, fitted shirts to replace my old baggy ones. I almost enjoy clothes shopping. I'm willing to take a few more risks in what I wear. I got half my hair cut off, which I'd been putting off for years.

And I'm proud of myself every time I get rid of that stubborn 10 pounds. Again.

Food Blogs

I love reading food blogs. Tastespotting is my go-to place for finding great food ideas. All the stuff I'd love to eat, would never eat, can't believe people eat. A thousand funky new veggies and ways to serve them, as if I ever would.

I don't -cook- you see. Well, on very rare occasions. But I've really got no intention (time, desire, willpower) to actually find ingredients and follow instructions and figure out what it is I'm doing wrong. After all, what I make never looks like it does in those luscious food photos.

Still, I like to browse, check the newest postings as if it's a huge menu I place imaginary orders from. I'll take the flan please, and those cookies are great, and those meat skewers from Malaysia... The salads and veggies and soups and whole wheat/oatmeal/seed bread never make it onto my ideal plate. Except when I see blt salads in bacon cups. Those, I'd make an exception for!

When I read these blogs, I tell myself that one day I'll find that one recipe that makes eggplant appealing, or a way to eat zucchini that doesn't involve disguising it in chocolate cake. I know I need to add a LOT more veggies to my diet. The five or six I eat get very boring.

Salad. Carrots. Broccoli. Cauliflower. Asparagus. Corn. Tomatoes. Cucumber. When I try to convince myself that olives should count too, or that mushrooms have a lot of nutritional value, then I know I'm just lying to myself.

I have been trying. I have decided that even deep frying cannot make a yam palatable for me - though yam fries are everywhere I go these days in Calgary. I went out for Ethiopian - and that was too much shock for my westernized taste buds. I'll eat bok choy at a Chinese place - but it's only a few shades removed from broccoli.

But really, I'm struggling. I'm tired of the veggies I do eat, the rest either I don't like or I'm unwilling to believe I would like. I love the voyeurism in reading these blogs. I get to imagine being at a dinner where they're serving espresso panna cotta, or ordering an extra large poutine or munching fresh baked cookies.

At the same time, I look at the healthy stuff and think, "Hey, someone out there obviously enjoys Brussel sprouts. And beans. And squash. So maybe, if I keep reading, that perfect recipe will come along and somehow I'll enjoy these things too."

Counting the Cost

Will at Life After Dx posted a vision today:

A dollar bill with a test strip taped to it. A dollar bill with a test strip taped to it and a sticky note that says "I pay one dollar per strip. I need six strips a day to stay healthy and in control of my diabetes. Can you spare me two grand?"

I pictured hundreds, thousands, tens of thousands of envelopes piling up on someone’s desk. But whose desk? Who can help us?

I think this sort of thing could be hugely powerful in showing the financial costs of diabetes, though I'm not sure who's desk it should end up on. As a general awareness campain, something directed at a politician, to insurance agents? I can see this on billboards or posters, but I don't know if that's going to reach the right people.

I'm going to be watching this discussion and see where it goes, but I hope that he can find a way to use this idea and pass on the message.

We don't use dollar bills up here in Canada, but here's my version, to show my support:


I hope others will head over to Life After Dx and join the discussion.

Hungry Days

I am having one of my hungry days. They usually happen on weekends, so I've been blaming them on the lack of my usual breakfast. I count on those weekend breaks to avoid being too bored with my repetitive breakfast.

However, I ate my breakfast today, and I'm still hippo hungry. I had breakfast. I had a snack. And another. And another. Let's all pretend they were low-carb snacks. I feel like I could go out and eat a cow. (Medium rare, with baked potato.)

Lunch just arrived and my stomach is growling.

I hate these days because I've never figured out how to turn it off. I eat carbs. No luck. I eat protein. No go. I eat fatty foods. Nope.

I'm not doing anything unusual today. No extra exercise, no extra stress. No changes in schedule, no trouble sleeping. Just rampaging, insatiable hunger.

I'm going with my backup plan after lunch: lots of water and gum. There's sure no need for me to eat anything more.

Another new blogger - The Diabetes & Stuff

Okay, so I'm really new at this blogging thing. But I'm not the only one. I realized today there's another new diabetes blogger on the block - The Diabetes & Stuff.

I really enjoy seeing new blogs. There's always a new perspective, a new voice, a new concept that gets me thinking.

I like what I've seen at Lora's blog so far - there's a no-nonsense, honest and straightforward tone to it that really appeals. I'm trying to keep this blog as honest as I can, and it's great to see someone else doing the same, and doing it well. She's also very organized, with a nice little glossary up as her second post.

Great work Lora, and keep it up - I'll be reading.

Diabetes Made Visible

Diabetes Made Visible is a really fabulous project. Hosted on flickr, it's a repository of photos showing how diabetes affects daily life. The photos are a mix of portraits, graphs and charts, artwork, food and technology shots. It's incredibly evocative to see these images and to read the commentary that accompanies them.

Seeing a tiny hand with blood testing pinpricks, or a bag full of supplies that someone can't leave the house without really enforces the effects this disease has on every day life. Or simply someone sharing a new food they've found they can eat, or those horrible/great numbers.

I feel a great connection to these images too. That person uses the same meter as me! She knows what it's like to prick your finger too! I'm not the only one who misses cookies or distrusts sugar alcohol.

It's also reassuring. Hey. This person has a smile while they test. That person has transformed a wasteland of needles or lancets into beautiful art. Despite it all, Life is good.

My favorite is this piece. What's yours?

The iTest (Keynote) vs The Contour

As a reward for my shiny A1C, I bought a new toy - the iTest meter, aka the Keynote Wave in the States. I was almost out of strips anyway, and since I have to buy some more, might as well get a new free meter to try.

This is the third meter I've tried. The first was a Breeze 1, which I didn't care for. The Breeze 2 is undoubtedly better than the 1 (smaller size, faster), but I just didn't like the packet of test strips concept.

My usual meter is an Ascencia Contour. It's a good meter, with a small sample size and nice speed. The iTest is supposed to use a different, more accurate calculation for blood sugar, which is one reason I chose it.

The Case:
My first thought when I saw it was 'wow, that's smaller'. The I Test carrying case is in standard black, and smaller than my Contour case. It looks less bulky as the fabric is a bit thicker. I'm not sure this photo shows off the difference well, but it's thinner and not as wide.

Unfortunately, the case doesn't have a belt loop, which is a small detail that I appreciated on the Contour case. If I'm not carrying a purse, it's nice to have the option of attaching it to a fanny pack or belt. However, the smaller size will make it far nicer to tuck into my purse.

The Lancing Device
The lancing device on the iTest is pen shaped, and I already like it better than the Contour lancet. It's far more natural to hold and push the button. The needle is definitely thinner, and it has depth settings going from 1-8, while the contour has 5. It makes a far smaller pinprick. I find on my fingers these means a lot more stretching/massaging to get enough blood to test. My fingers have lots of familiar smudges. If I prick closer to the nail it flows better, and this technique is helping me avoid bruising. I think as I continue to practice, it'll get even better. I haven't picked up my Contour lancing device once since I tried the iTest version.

The Lancets
The lancets are visually very different, and you get 100 with the iTest. Both are equally easy to handle and load.

I prefer the lancet cap on the Contour meter. The cap lays straight before I take it off, and sideways when I push the needle into it after use. I can instantly look at a lancet and know if I've used it or not, even if I've jumbled them together or dropped my case and sent some flying. I keep my sharps container at home, so it's not unusual to have a mix of lancets in the case.

On the iTest, the lancet cap goes on exactly the same way after you've used the lancet, so there's no way to really see that it's already been used. I tried pushing the cap on backwards, but it falls off pretty easily. The tiny needle just isn't strong enough. I've been mashing the lancets against the nearest hard surface to bend the needle. Once it's smushed, I'll never confuse a used one with an unused one.

The Strips
The iTest strips are smaller and seem more flimsy than my Contour Ascenscia strips. I accidentally bent the first one I picked up, so now I handle them more carefully. They slide into place without a lot of feedback. On my Contour, there's an audible beep when you insert a strip. On the iTest, you have to watch the screen, or bent strip! I'm sure once I get used to the new meter, it'll become a habit, but for now I'm really having to watch what I'm doing. At my pharmacy both strips are the same price.

The iTest also requires coding, which the Contour didn't. This hasn't made any difference to me. The number that automatically pops up has always matched the number on the vial.

I've also run across 1 dud strip so far (Error 1, "Wet, Used or Damaged Strip" on the meter), which has never happened with Contour strips. Maybe I dented it without realizing, or maybe it was just a bad strip.

Testing
The iTest uses 0.5µL and the Contour 0.6 µL. Somehow it feels like the iTest uses a considerably smaller amount. I think it's the smaller strips and smaller display window.

I also like the countdown better on the iTest. It's actually a second faster - 4 seconds instead of 5, but instead of a simple number countdown, it fills part of the screen with lines. Because there's always something moving on the machine, it feels faster. A second can seem really long when you're waiting for a number to flip. I really like that animation.

The Results
I expected the iTest to read higher than the Contour meter. Nearly every mention of this meter I've found online has talked about higher numbers. My meter is no different.

Here's a sampling of the differences I'm seeing:

iTest	Contour	Difference
6.0 (108)	5.5 (99)	0.5 (9)
5.6 (101)	5.3 (95)	0.3 (6)
8.7 (157)	7.5 (135)	1.2 (22)
7.9 (142)	6.0 (108)	1.9 (34)
5.4 (97)*	5.0 (90)*	0.4 (7)
5.9 (106)*	4.4 (79)*	1.5 (27)
5.7 (102)	5.4 (97)	0.3 (5)
*These four were taken at the same time.

Almost half the time, the iTest was more than a point higher than the Contour. Without a lab to verify, it's impossible to say which readings are correct. Certainly the much higher iTest readings aren't what I'm used to seeing, and my low A1C would support lower readings as well. And hey, we all want to believe lower numbers over higher ones, right? I'm out of Contour strips now, so there won't be any further comparisons, but I'd love to see this meter in a mixed meter clinical trial to see how it really lines up compared to other meters.

Another feature I am missing on the iTest is the 'bad reading' indicator. If I'm testing someone else (which happens occasionally), or I know a reading is crazy off, I can immediately mark it as invalid on my Contour, so it doesn't affect my average. The iTest does not have this feature.

Other Features
The iTest does have a bunch of features I haven't tried out yet, namely charts and graphs. It automatically organizes your results into breakfast, lunch, dinner and bedtime, and provides an average of each. I'm not sure if I like this or not. My fasting readings are being marked as breakfast, and I'm wondering if my two-hour post breakfast readings will show up as breakfast or lunch. The Contour has a simple post/pre meal flag, which I never used.

The iTest does come with six alarms you can set for any time of day. The Contour has a single alarm that you can set to go off 2.5 hrs after a test once you've marked the reading as 'pre meal'. I didn't use the Contour alarm, though I would have if I could have adjusted the default time frame to 2 hrs. I don't have a predictable schedule for most of my meals, so I'm not planning on using the iTest alarms either. I'm sure there are others who would use these alarms.

The iTest also calculates 14, 30 and 90 day averages, which I'm interested in seeing. The Contour has a 14 day average only. You can flip into graph mode on the iTest to see a simple chart showing your ups and downs, which also looks interesting.

Both meters have high/low summaries, but being a pre-diabetic, I never hit those ranges so I can't give an opinion. They also both count the number of tests you've done.

Finally, the iTest comes with a "Zero-Click" software package via USB cable. I haven't hooked it up yet, but from the screen shots on the website, it looks more updated and shinier than what I downloaded from Ascencia. Once I've got a few more readings in the meter, I'll take it for a spin.

Conclusions

So, my first impression is fairly neutral. There are a few things they've really done well, and a few important details I feel they've missed. I like the smaller meter, smaller case, smaller blood samples and pen style lancing device. I miss the auditory feedback, belt loop and 'bad reading' settings my Contour has. I'm really liking the "waiting for results" animation, but fairly concerned by the higher readings. I don't care for the iTest lancet cap, but that's something I can get used to. Once I've got enough data to graph, I can start evaluating the software.

Once I get close to the end of my strips, I'll post again to give a second opinion.

Sobey's Mini Desserts

We went to our local Sobeys (Grocery Store Chain) today, trying to find something to sooth my sweet tooth without skyrocketing my sugars. We usually go on weekday evenings when the bakery section is a little bare, but it was fully stocked today.

They have an entire section they call 'Assorted Pastries', which is filled with twenty or thirty itty bitty desserts. Chocolate things, mini tarts, cakes.. I was too busy trying to pick out a couple to really register what the complete selection was.



At 50 cents each, I was able to pick up a miniature butter tart (always a favorite), and a mini roll cake, shown here with a quarter for size comparision. The pastry on the butter tart was a bit bland for me, but the filling with one or two raisens was great.

The roll cake is the sort of thing I never buy, because even one slice is way too much and who's going to eat the rest of the cake for me? This one was very sweet, with tons of icing and took about four bites to eat. It was just perfect in size. I wouldn't have wanted any more, and it definitely satisfied the sweet tooth.

We'll have to go back on weekends now, so I can continue to sample selections now and then. For me, this is a much better option than a chocolate bar, or a cake that I'd have to slowly eat over a week before throwing out the remainder.

Major Yays for appropriately sized sweets!

Eating Your Meter

I have to admit, every time I read about 'eating your meter', I have this image in my head.

Eating your meter refers to checking your meter after each meal you eat, and removing or reducing the quantities of the foods that run your sugars too high.

It's a good technique for keeping sugars in range - I know from this that a personal size, multigrain crust pizza doesn't do much damage to my sugars, but a serving of fries does.

More on the Non-Invasive Front - Breath Testing?

Ran across an article today on a new new theory in blood glucose testing.

The gist of it is this: Dr. Pietro Galassetti at the University of California is the guy in charge of the study. They've found that the concentration of a certain gas (Methylnitrate) in the air you breath out is related to blood sugar levels. When the kids they studied had high blood sugars, that had more methylnitrate too.

There's also an interview with Dr. Galassetti, that goes into more detail. I love what he says about finger pricking:

"The prick is not very painful, but doing it five times a day all your life becomes very obnoxious."

It's clear this a very preliminary concept. Dr Galassetti talks about '5 or 10 years down the road' and needing to develop a profile of gases related to blood sugar. But it's nice to see research being done on alternate methods.

Edit: Jeff @ Go Do A Test! pointed to me to an older article on the study, with more specifics on the experiment.

A1C's Should Make Sense

At the end of last year, I was in the zone. I ate my meter. I stuck to 150 gms of carbs a day. I exercised semi-regularly. I did all the stuff I was supposed to do. And my A1C went UP. From 5 the year before to a 6.

This freaked me out. My meter averages had me expecting an A1C in the low fives. After that, I pretty much stopped testing. Between the holidays, finding a new job, moving, my diet was out the window.

We made dozens of cookies for Christmas. With sugar, not splenda. I ate bread, muffins, and, on the many long car trips, potato chips. We ate out every night for weeks. And of course I started putting on the weight, which is always a danger sign.

I was worried about getting my A1C back after those months of reckless eating. What number do I get today? 5.5!

I have no idea if it's the reduced stress or if my meter is less than precise, or what. I was expecting to leave the doc's today with some plans for getting my A1C under 7. Instead, I'm trying to remember what I was doing back then. I sure wasn't food logging. I'm still not testing, but in the last month or so, I've been back to a reduced carb diet.

But I guess I can relax a bit with the carbs. I'm still going to try and lose those holiday pounds, but I'm really not sure what else to do to keep this level steady. And for now, bask in that pretty number.

So, so weird.

Joe's Goals

I'm trying something new right now: tracking my goals with JoesGoals.com. It's a nifty little website. You create an account, set up a few postive and negative goals, and then track by clicking on each day. It's really nice visual feedback to see all the little checks and xes over a week. There's a live demo on the site (see image below) that lets you test it out without creating an account, which also sucked me in.



I know I forget my lunchtime metformin a lot, and I'm not getting close to exercising daily. This seems a really good way to track that sort of thing, without going to a lot of effort. I get really tired of detailed logging, and this one-click-and-you're-done style will hopefully be more effective.

I'm not sure I'd ever use it for blood sugar logging - I like charts and graphs that break it down by time of day and give me monthly averages. In theory I'll start cross referencing food with blood sugar and actually stick with it in the future. For that, I'll want to use diabetic specific software.

But for simple goals like increasing exercise, cutting down coffee, and remembering pills, I think this will work wonderfully.