The Reluctant Diabetic Is Now On A Sweet Life
October 25, 2009, 6:31 pm
Hello, everyone — from here on forward, the Reluctant Diabetic will appear as a part of A Sweet Life, a fantastic new diabetes site that you should check out (and spread to family and friends).
As a result, I’m no longer updating this blog — but you can get all the posts you want (plus much more) at A Sweet Life.
Thanks!
They had me at avocado
I was just reading Tara Parker-Pope’s “Well” blog in the New York Times and came across this announcement for a diabetes-friendly food expo taking place this weekend in NYC. Far from being a showcase for Splenda, this event will bring together some top doctors and chefs to “offer health and cooking advice for people with diabetes.”
The blog post primarily focuses on Jason Wyrick, a type 2 diabetic and author of “The Vegan Culinary Experience” — and I’ll admit that the title almost lost me. Life without cheese? Forget about it.
But then I noticed that the recipes Ms. Parker-Pope chose to post all prominently feature avocados. Which are no substitute for a good gruyere, mind you. But anything featuring such a delicious, fatty food still warrants a closer look.
Nota bene! In about a week, this blog will permanently move over to the great new diabetes site, A Sweet Life. Check it out.
Symlin and Harry Potter
There are things I tend to find out about early, like the latest top 40 hip-hop hits. And then there are things that I’m slower to pick up on, like children’s fantasy novels. Case in point, my experience with Harry Potter: I *just* read the 6th and 7th books last week on vacation. I did so in back-to-back marathon reading sessions (this after insisting for years that I was “not that into Harry Potter”) — and now I’ve got all the curses and charms floating through my head. Just last night I was asking my husband where he put the neosporin, and wishing I could cast an “Accio!” charm to make it leap into my hand. Alas, I am not a wizard, and my wound continues to fester.
But anyway, I bring this up in the context of Symlin — because when you take symlin, as I’ve been doing now for nearly three weeks, you start having a very different relationship with food. Granted, for the past few days my relationship has been one of nausea, where if I look at food after I eat it I sort of want to hurl. But previously I’d just been experiencing a weird sense of satiety, an ability to look right in the face of a freshly baked cookie and say, “You know what? I think I’ll pass” — with no feeling of self denial at all.
And I got to thinking that symlin’s effect on appetite is almost like a spell — you jab yourself with a magic wand (okay, fine, a needle) and then all of a sudden, no appetite. Gone. Eating decisions are suddenly no longer about self control.
I’m feeling a little less romantic about my symlin this week, given its tendency to make me feel barfy — but I’m still amazed at how one simple shot can completely change your attitude toward food, with no will power required.
Now, about that neosporin. . . .
As previously noted, starting in a couple days, this blog will move to a new home at A Sweet Life – come check it out!
I Love Symlin So Much I Could Barf
Wow. I was getting ready to write this really pro-Symlin post, explaining how it’s really done a great job of smoothing out my blood sugars and is helping me lose weight to boot. I was even going to drop a little line in there saying that despite a week or so of nausea when I first started, I was totally acclimated to my synthetic amylin and no longer felt like I was suffering from the diabetic equivalent of morning sickness. But then I ate my breakfast and now I take that all back.
Here’s what happened: I ate breakfast, which today consisted of a ginger yogurt from the Old Chatham Sheepherding Company (it’s delicious; try it) and then, fifteen minutes or so later, started getting hit with a wave of nausea that is not being helped, at all, by the fact that the empty container is still sitting on my desk, close enough to smell. It’s probably also not being helped by the fact that I’m having a sensitive nose day (does anyone else have those? Where you have a temporary, dog-like ability to pick up odors from across the room?). I know this won’t last too long, but at the moment, if you offered me another bite of my delicious sheep’s milk yogurt, I’d probably puke in your face.
As is perhaps not surprising, Symlin is definitely having effects on my appetite — and in the first seven days when I was taking it, during which time my husband and I were on vacation, eating a lot of Mexican food, I lost four pounds. So it’s not all bad.
But still, I think I’m going to throw out the yogurt container.
Nota bene: In about a week, the entire Reluctant Diabetic blog is going to be transferred over to a great new diabetes website called A Sweet Life. All new posts will be going directly there — so be sure to check it out!
Symlin: A Primer
I’m coming up on week two of my Symlin experiment, and I’ve got to say: I love it.
Symlin, as you probably know, is a synthetic version of the human hormone amylin which — to quote the FDA — is “a naturally occurring neuroendocrine hormone synthesized by pancreatic beta cells that contributes to glucose control during the postprandial period.” Translation? It’s another hormone made by your pancreas (in addition to insulin) that helps control your blood sugar after you eat.
You don’t technically need amylin to stay alive, which explains why its role was discovered decades after insulin’s. But it turns out that when a non-diabetic person eats, their pancreas secretes amylin in patterns that closely mirror insulin. Check out this chart, courtesy of the FDA:
Turns out that amylin is like insulin’s wingman, helping to control blood sugar in at least three important ways:
-it slows down the rate at which your stomach empties food into your small intestine, which can prevent glucose spikes after meals. (It doesn’t, however, affect the amount of overall nutrients that are absorbed.)
-it stops your pancreas from releasing excess glucagon at mealtimes. This one’s a little confusing, so let me clarify: when you eat, the pancreas occasionally gets so excited by the presence of your bran muffin that it pumps out some extra glucagon, a hormone that triggers your liver to convert some of its stored glycogen into glucose and dump it into the blood stream. The result of this added glucose? Even higher blood sugars than the food itself would cause. I can’t help but feel like this is a little bit of overcompensation on the pancreas’s part (“I can’t make any insulin . . . but how about this other stuff?”) Regardless, excess glucagon screws up post-meal control, and tamping it down is a good thing.
-Lastly, amylin helps control your appetite. And, so the theory goes, the less you stuff down your throat at once, the easier post-meal control will be.
Sounds great, right? Well, there are a couple caveats. First, Symlin’s given by injection, adding yet another set of daily puncture wounds to your daily routine. It also can make you really nauseated, especially when you first start taking it. Lastly, and most importantly, it can result in severe hypoglycemia.
Let me explain a bit more on that point: Symlin slows your stomach’s emptying. So if you take your normal dose of a rapid-acting insulin like humalog, the insulin is likely to kick in before the food actually makes its way out of your stomach. That itself can be extremely dangerous. But making matters worse, you can’t just eat something to bring your sugar level back up, because — remember? — your stomach is stalled.
If the hypoglycemia isn’t severe, you can wait for a bit — once your stomach begins moving the food, your blood sugar will rise. But if it’s really low, or dropping, you need to take more drastic actions. Sucking on glucose tablets can help (to try to get the glucose to absorb through your mucous membranes). And it’s a good idea when you’re on Symlin to carry a vial of glucagon with you just in case.
However, I think a bit of this concern is overblown. Symlin itself does not lower your blood sugar; insulin does. Therefore, when you take Symlin, there are a couple easy steps to lower your hypoglycemia risk. First, delay your insulin dose (a square or dual wave bolus is great for this, pump users). Second, cut down your dose — experts recommend halving it to start and then working your way back up to an appropriate level. Do this, and in my experience, at least, you’ll minimize your risk of a disaster.
The flip side of Symlin, however, is that it can give you a bit of a false sense of security. You can eat a dinner of pasta with no noticeable effect on your blood sugar for one, two, three, even four hours. But when your stomach finally does empty, your blood sugar will rise. More gradually than had you not taken the Symlin, mind you, but it’ll trend upwards nonetheless. So you need to be sure to test more than just 2 hours after meals, and be aware that the rise can be higher (and occasionally more delayed) depending on how you react to certain foods. Case in point: last night I ate a small bowl of pasta at 7:15 and hovered happily around 120 until I went to bed. It was only when I examined the record of my CGM this morning that I noticed that I’d gone up to 185 for two hours around 1 in the morning, only to come back to normal by the time I woke up.
Next time: more about Symlin, including one of its pleasant side effects — weight loss.
For more information about Symlin in the meantime, check out the FDA’s description.
Symlin: The First Attempt
So I took a little Symlin (15 mcg) with breakfast today and am eagerly waiting to see what’s going to happen. My breakfast was not a “major meal” as defined by the Symlin manufacturers (i.e. less than 250 calories and fewer than 30 grams carb). But since it routinely requires three times my normal insulin-to-carb ratio to cover it (perhaps because it’s yogurt and it’s morning) I figured I’d take 15 mcg, cut my insulin dose by two thirds, and see what happened.
So far, I just feel a little funny — not straight up nauseated but a little gaggy and not all that excited about eating anything else at the moment. My blood sugar is holding steady at around 96, though then again, it usually takes a little bit for it to shoot up. The strangest thing was to eat first and take the insulin afterwards — my usual m.o. these days is to take my morning dose first and wait an hour before eating. We’ll see how this goes. . . .
Symlin
Sugar Lumps
Okay, so this is less about diabetes than it is about the Flight of Conchords. But it has the word “sugar” in its title. Ergo. . . .
Flight of the Conchords
Symlin Questions
I’m always grateful for my husband, Peter, but there are times when he goes above and beyond the call of duty. Like, for example, tonight. After waiting two weeks for my Symlin pens to arrive, I eagerly opened the box to discover that my doctor had forgotten to give me a prescription for pen needles. Thanks, Dr. M___. It’s nice to see that after berating me for wanting to try Symlin to begin with, you then forgot to give me the needles necessary to actually take it.
Anyway, it occurred to me today that perhaps I could get needles without a prescription — just to tide me over till the others arrived. Only problem was, I wasn’t sure what gauge or size to get — which resulted in Peter spending a half hour in Walgreen’s as the woman behind the pharmacy desk tried to figure out the appropriate size. Was she correct? I’m not sure — by the time he got back, I’d already had dinner.
But all this is neither here nor there. I am planning on taking a sample dose tomorrow and I am interested in hearing from people who have tried Symlin. First, how important do you think it is for the meal to be at least 250 calories and 30 grams carb? I tend to have trouble with breakfast (which, at 15 grams carb, doesn’t seem like it should be a problem) and I was thinking of trying Symlin to see what effect it would have.
Second, by how much do you reduce your dose of Humalog? I know you’re supposed to start by cutting it in half, but I’m curious to hear from people how this worked. Also, how long did you wait between taking Symlin/eating and taking your insulin dose?
And lastly, from my brief flirtation with Symlin in 2004 (where I took it for one dinner and then sort of forgot about it), I do remember that my blood sugar stayed remarkably constant for several hours and then crept up. What suggestions do people have for dealing with this gradual rise? In particular, I’m trying to decide between taking a square wave right when I eat or just waiting for a while after eating to take a normal bolus, since Humalog seems to take a while in my body to work.
Thoughts?
Symlin
Symlin: a new adventure
I had my tri-monthly checkup at my endocrinologist’s today, and convinced him to let me try Symlin. They faxed in the prescription for me today, and I’m eager to receive it and start giving it a shot. (That pun was unintentional, I swear.)
It’s strange — my doctor seems to think that Symlin is not worth trying, but I’ve heard from other doctors and read on other websites that it can really make a huge difference in blood sugar control. I’m one of those people whose stomachs seem to start emptying before I’ve even swallowed my second bite of food, and I’m hoping that combining my meals with symlin might help prevent post-meal spikes.
I’ll keep you posted on my progress, but in the meantime, I have questions for anyone who’s tried the stuff:
-how do you recommend taking it for lower carb meals? For example, I eat yogurt and fruit for breakfast –a total of about 15 grams of carbs — and have trouble dealing with it b/c of increased insulin resistance in the morning. I would like to try Symlin to see if it can help smooth out the post-breakfast spike, but am nervous about taking it with such a low-carb meal. Suggestions?
-secondly, when do you recommend taking insulin? It seems, from what I’ve read, that it’s best to take your insulin as a square wave bolus after you take the Symlin. Or, alternatively, to wait for an hour after eating and *then* bolus — though that approach makes me nervous that I’d either forget the dose, or not take the insulin soon enough to cover the food. When do you find to be the best time to take an insulin bolus? And how much less do you recommend taking?
Also, since going on a CGM I have gained about 6 pounds (which may or may not have to do with the constant awareness that the CGM brings). I’ve tried dieting, I’ve tried exercising more (I already do so about 5 times a week) and nothing works. I’m hoping that Symlin might help — and would love to hear any experiences people have to share.
Here goes!
PS: Here’s the first in a series of useful blog posts about diabetes, in case it’s helpful. And, for that matter, a very funny video clip. Does laughter help lower blood sugar? Whatever — watching this makes me very happy:
amylin, Diabetic Distractions, Symlin
Diabetes tip #421: Join A Dance Troupe
This weekend, I made an amazing discovery: if you want to control your blood sugar, you should dance.
To elaborate: last week I decided that the best way to deal with the emotional mess that has been this summer, I should join a no audition dance troupe for 30+ year-old women. I mean, hell. I’ve been taking cardio hip hop classes for a year or so now and every once in a while I entertain fantasies of performing a dance on stage. It’s unclear what the motivation behind this fantasy is, since I don’t think I’m a particularly great dancer, and I also have stage fright. But I find it very satisfying to stand in the back row, watch the teacher, and pretend that he is me. Seriously, try it.
So when said dance teacher sent out an invitation to this special older ladies troupe, I thought fuck it. Why not? And so I spent much of last week trying to memorize a dance routine set to the Black Eyed Peas’ “Boom Boom Pow.” It culminated in a Sunday afternoon performance in front of a crowd of several hundred people. Yes, I forgot a couple of moves. But other than that it was great.
What does this have to do with diabetes? A lot. Turns out that spending two + hours a day popping and locking does help your blood sugar. I’m no stranger to exercise — I try to work out at least five times a week — but there’s something different about dancing. It’s low impact (and entertaining) enough that you don’t really realize that you’re being really physically active. But then you test your blood sugar and notice that it’s dropped 80 points.
I wish that were the case right now — today I have eaten plain yogurt, strawberries and a cabbage and chicken salad and my blood sugar is currently refusing to dip beneath 200, despite the fact that I rode my bike to my office and spent my lunch hour walking around. Perhaps my body has now adapted to my new lifestyle as a professional dancer and is refusing to utilize its insulin until I start shaking my butt.
There’s only one way to find out. . . . 
