Oral Insulin as a New Horizon

Recently, a friend of a friend was talking to me about oral insulin and how it might be used in a person with type 1 diabetes mellitus. I wrote him a lengthy letter back and thought many of the comments were good to put here as well.

To start, I want to say that there are many opinions out there. What I think is just another opinion, but I also give information and answer questions with facts and references.


Oral insulin (insulin in a pill) is a target for several pharmaceutical companies focused on diabetes medication. Basically, insulin is a small protein that acts as a hormone to regulate sugar metabolism. Generally, diabetics that need insulin will take a shot (ouch!). Insulin doesn't come in a pill form because just like most proteins, the stomach acid breaks insulin down before it can get into the bloodstream to do its job. The idea behind oral insulin is that there may be a way to package insulin in a pill to protect from being destroyed and help save all those diabetics from having to take shots or wear insulin pumps. Will it work?

Oramed sure thinks so...

Parenting with Diabetes

I've neglected my writing lately, but it's with good reason. A few months ago, my wife gave birth to our beautiful baby girl and our world was turned on its head. I'm sure many new parents can testify that the first months are incredibly challenging as Mom, Dad and Baby try to work out the new norms of everyday life.

Parenting is a challenge. Unfortunately, in addition to the diapers, doctors, vaccines and insomnia, I am also trying to manage diabetes. In the first weeks, I had reached out to other Type I Diabetics (T1D) on the JDRF LinkedIn group and Juvenation site after I found myself staggering through the days of being a new parent. I asked them what kinds of tips and tricks parents with diabetes use to get through it all?

A calmer moment with our little girl.

I collected up those comments and thought of a couple of my mine to share on my blog. The tips seem like common sense. In fact, I think most of these tips would be useful for any new parent.

Dealing with the Adrenaline Rush

Type I Diabetics have a very familiar list of suggestions from doctors. The list usually includes exercising regularly, eating a well-balanced diet, monitoring daily blood sugars, taking medication as indicated, and trying to reduce stress.

There are many variations, but regular exercise is one of the items always on the list. ALWAYS.
Despite the eye rolling from patients tired of repetitive doctor nagging it’s very true that exercise is a great way for diabetics to reduce insulin resistance, improve blood circulation and immune response, and make the disease easier to manage overall. So you could imagine the irritation from diabetics that experience unexpected high blood sugar levels when they do finally go out and exercise. By all rationale reasoning, exercise should help lower blood sugar and increase sensitivity to insulin, but there are many times when the blood sugar level goes up.
Why does this happen?...

Keeping on tops of the news

I know I haven't kept on top of my posts. Its because I recently started the Christine Mirzayan Science and Technology Policy Fellowship in Washington DC and I have been incredibly busy learning how the National Academies work. For those of you that aren't familiar... well... its complicated.

Maybe that's not a fair statement. I don't actually feel that the National Academies is very complicated in the big picture, but climbing into the beast and working with the nuts and bolts was a bit daunting the first couple weeks. The big picture (in my own words) is that the National Academies is a for-hire organization of truth-seekers. You call the National Academies when you want a non-partisan, scientifically-based study and you want recommendations for solutions to a question or a problem.

Here's an example - 

Let us say the US Dept of Energy wants to start using more Nuclear Power. Great. More people, more power, no problem. Let's start building... WRONG!

An Artificial Pancreas Could Sweeten the Deal for Diabetics

The “artificial pancreas” is making headlines in diabetic communities. People are claiming that it will all but eliminate diabetes from our existence. The JDRF campaign says it will be like becoming a “bionic” diabetic and many groups are hoping it will give more freedom to people living with diabetes.

But what is an “artificial pancreas”? And where do you get one?
The short answer is that the artificial pancreas is a combination of devices and technologies designed to automatically deliver insulin as needed using an insulin pump and a continuous glucose monitor. No surgeries. No extra drugs. As for availability, the US is running far behind other countries and you are most likely to see this system develop in Europe well before the United States at our current rate.

Define Normal

Italian book of monsters from 1618.

I can’t say how other people felt when they were diagnosed with Type I Diabetes, but for a long time I felt like I would never be normal again. All of a sudden, I needed to check my blood for sugar and I needed to take shots and carry an emergency kit around if I happened to crash really bad. The school nurse had to send notes to all my teachers and coaches warning them that I wasn't like the other kids. It wasn't as bad as the guy in the picture above, but I certainly wasn't normal anymore.

I remember one time early on in my disease, a doctor tried to scare me into monitoring my sugars more closely. He told me point blank, “Everything is different now. You have diabetes and you need to accept it for what it is. Stop thinking you're normal”...

That's Just Plane Crazy

Luggage? Check.
Boarding pass? Check.
Passport and credit cards? Check.
All your fluids sequestered into 3oz. containers and in a Ziploc baggy? Check and check.

While most people go through the more common airport checklists, diabetics have a few atypical tic-boxes to consider. Such as a note from your current doctor explaining that you are a diabetic and that you need to carry your liquid medication. And that the medicine needs to be kept cool in a container that will most likely have some kind of jelly or liquid inside. Insulin pump wearers especially need to be weary when going through security because you must NEVER put the pump through the X-ray machine. Every insulin pump wearer knows

Heart Helping News

I just read an interesting news announcement from the grocery store chain Publix, most common in southern states of America. From the Publix press release-

LAKELAND, Fla., Aug. 23, 2011 — Beginning today, Publix will offer free 30-day supplies (up to 30 tablets) of lisinopril to customers with a prescription for the medication. 

Very briefly, lisinopril is an ACE inhibitor that is primarily used to lower blood pressure and treat hypertension. However, ACE inhibitors are also routinely used to help with kidney and heart disease, both of which are common in diabetics. In fact, many diabetes specialists recommend ACE or ARB inhibitors as a preventative drug to keep blood pressure at a very healthy and low level. By incorporating ACE or ARB inhibitors before any problems arise, doctors hope to prevent the very common onset of kidney and heart disease seen in diabetics.

A lot of health care changes that have been accepted in the Affordable Health Care Act include provisions for preventative health care in what feels like a paradigm shift in the medical field to prevent the health problems before they even occur in patients. Diabetes is a special group of interest because of the rise in the number of diabetics and cost to treat illnesses like kidney failure, which could require the incredibly expensive process of dialysis treatment.

Publix announcement is possibly the first that I have seen of a business chain making a commonly used drug available for free. Many big box stores like Walmart and Target have flaunted reduced prices, but none have offered medication at no cost.

Lisinopril isn’t exactly an expensive drug. It usually costs $2-4/month with most prescription plans and has generic versions readily available. It is also worth mentioning that the Publix promotion doesn’t cover another commonly used combination version that includes hydrochlorothiazide (HCTZ). But the step forward with Publix trying to help the public is still impressive to me.

Rising Sickness

Being sick stinks. Slowly feeling sick is especially stinky. But the stinkiest of stinks for me is dealing with diabetes while I'm sick.

The problem for diabetics is that being sick makes their blood sugar rise higher than normal. In fact, diabetics can tend to have higher blood sugar when their bodies are stressed from many things, not just the common cold. Simply put, all kinds of stress can cause blood sugar to rise. Such a short statement carries so many implications for the health of millions of people.


The complexity of stress is buried in the its definition.

What's the big deal about insulin?

You've  probably heard the word insulin many times. You probably even know some relatives that talk about going to the pharmacy to buy their insulin. But do you know what it is or why they need it or even how they take insulin? You don’t!!! Well, then this entry is just for you.

Diabetics are the most common group of people who need and take insulin. I’m a diabetic myself, which means I have a chronic illness that causes high blood sugar. High blood sugar is usually caused by resistance to insulin or depreciated production (typically Type 2 diabetes) or flat out no insulin production at all (Type 1 diabetes). I’m a Type 1 diabetic, so my body doesn’t produce insulin at all, which means I need to give myself insulin manually. All Type 1 diabetics and even some Type 2 diabetics need insulin to control their blood sugar.

Insulin is a clear liquid that comes in a vial or sometimes a device that looks a lot like a pen. It even has a cap and button at the top! Starting from this point, I’ll try to answer some questions that people frequently ask me when they see my insulin vial or learn that I’m a diabetic.

HOW DO YOU 'TAKE' YOUR INSULIN? CAN YOU USE PILLS?
Insulin is actually a sensitive hormone made up of amino acids, just like proteins, so we cannot take it in a pill. Just like proteins, insulin has a three-dimensional shape that is important to its activity and ability to work properly in the body. Stomach acid has an incredibly low pH, which destroys the 3D shape of insulin and makes it completely useless to the body. So diabetics can’t take insulin orally without destroying

Diabetic Dining in Korea

My wife and in-laws are Korean and that means we eat a lot of Korean food at home. I love when our home is filled with the smells of hot soups, spicy meats, and steaming dumplings.

We try to visit Korea every other year. When we travel, food is always a major part of our trip and it’s even more important when we travel to Korea. Of course we have a lot of the same food and ingredients at home, but the flavor, quality, and variety in Korea is incomparable. This year, our trip landed right in the middle of the rainy season (June until the end of July). And so I’ve been looking forward to a lot of hot soups and noodles.

As a diabetic, I may seem like a killjoy when it comes to eating out. I’m mentally measuring and questioning each dish, trying to find the integral for the area under the curve of my pasta. In the states, I’ve become pretty adept in figuring out my food when we’re away from home, but cuisine in Korea is particularly challenging. I wanted to share a couple major challenges and offer a few solutions so that people can understand the thoughts of a diabetic eating out in Korea.

Who should be allowed to buy your doctor's data?

 Pharmaceutical companies hold a special niche. With their research, they provide the drugs our nation now rely on for treatment and recovery. On the other hand, corporation’s insatiable desire for profit bottlenecks drug delivery and advancement by creating a system of profit over people. Big Pharma thrives because of their money enables the research and development of new drugs. So how do we balance the power between Big Pharma companies and the people that their drugs are meant to serve?

An interesting story about this struggle has been growing out of Vermont. In 2007, Vermont enacted a law to restrict how Big Pharma uses information bought from pharmacies. These restrictions only applied to Big Pharma marketing. According to §4631 (see Vt. Stat. Ann., Tit. 18, §4631), pharmaceutical companies are forbade from buying prescriber identifiable data for the purpose of marketing. Statute 4631 is meant to prevent a tactic called detailing and the manipulation of drug costs and prescriptions. Data mining companies, as well as pharmaceutical industries and many other agencies, claimed the law infringed on the Freedom of Speech in the First Amendment. The Supreme Court of the United States (SCOTUS) heard the case in April 2011 and a decision was handed down on June 23rd 2011. (Outline of case here) (Decision outlined here)

In the end, Vermont lost the case of Sorrell, Attorney General of Vermont, et al. vs IMS Health Inc., et al.
Justice Kennedy of SCOTUS wrote,
“Vermont argues that its prohibitions safeguard medical privacy and diminish the likelihood that
marketing will lead to prescription decisions not in the best interests of patients or the State. It
can be assumed that these interests are significant. Speech in aid of pharmaceutical marketing,
however, is a form of expression protected by the Free Speech Clause of the First Amendment.
As a consequence, Vermont’s statute must be subjected to heightened judicial scrutiny.
The law cannot satisfy that standard. “

I will define a few key vocabularies so that we can fully appreciate the case and the verdict. First, when doctors write a prescription, the patient goes to the pharmacy. It is then the pharmacy’s responsibility to record the prescription, including the drug, the dose, and even the name of the prescribing doctor. This info identifies the doctor and what the doctor prescribed. In many states, this info can be legally sold by pharmacies as prescriber-identifiable (PI) data. Many times, the data is sold to data mining companies, such as IMS Health. Data mining is the detailed sorting and analysis of the information. Mined data is a valuable source of information for many purposes, such as clinical research and marketing. The mining companies can then be turned around and sell this precious info to other businesses and agencies, such as pharmaceutical companies. And so to reiterate, Vermont statute 4631 was created to prohibit pharmaceutical companies from purchasing this data for marketing, while other forms of use by other groups was allowable.

It’s important to note at this point, that the laws allow the legal gathering and sale of PI data and that it only restricted Big Parma from buying the information marketing. The reason the Vermont Attorney General and petitioners wrote the statute was to limit a process called “detailing”. Many legislatures felt that allowing Big Pharma to purchase the data would lead to companies targeting specific doctors with visits and invitations for lectures and meeting, all of which would encourage them to use their drugThis is a process called “detailing”. By this detailed marketing approach that targets the prescribers, Big Pharma could potentially raise drug prices and manipulate the drug market at the physician level.

However, companies that mine the data and agencies that use the data claimed that the restriction was an unfair discrimination and infringed on the right to Freedom of Speech. In this context, the respondents (IMS Health, et al.) claimed that communication and therefore speech was being restricted unfairly due to assumed interests and actions of the pharmaceutical industry. SCOTUS agreed with IMS Health in the case.

Each side had several major supporters (see the list and the briefs written by the groups at the Vermont Office of the Attorney General). Supporters of §4631 argue that limiting Big Pharma protects patient identifiable data that could be backtracked by the PI data and prevents the manipulation of the medical system of prescription. Opponents of §4631 question the legality of the reason for limiting Big Pharma and worry that the statute could lead to limiting other groups as well.

On example is clinical research. Clinical researchers routinely use data from pharmacies and hospitals to evaluate efficacy of drugs and benefits of therapies. The data goes into the planning process of new clinical trials so that clinicians are not constantly reinventing the clinical wheel by repeating work that was already done. To reduce the waste of unnecessary repetitive clinical trials, many believe it would behoove the general public to allow clinicians access to PI data, which could give valuable information in the types of prescriptions being used in the public and how it might impact therapeutic approaches. If Big Pharma is restricted from using PI data because of a negative assumption then a door may to opened to enable the restriction of many groups, including clinical research.

On the other hand, Big Pharma is big business. Billions of dollars are used annually to market and manage the drugs doctors already prescribe. Big Pharma routinely encourages brand name pharmaceuticals even when generic versions are available. By allowing access to PI data, many groups argue that we are allowing Big Pharma access to a very direct form of info for marketing groups to specifically and more efficiently target doctors. Even though the doctors have the final say in what they prescribe, Big Pharma could dramatically influence their decision and foster a system where the patient’s best interest isn’t the highest priority and public health is second to the quest for higher profit.

Overall, SCOTUS decided that the state of Vermont could not restrict the use of legally obtained information for only Big Pharma companies. Simply put, IMS Health argued that you can’t restrict just one group from an otherwise open and legal system – that’s discrimination and it’s unconstitutional. This case was a benchmark for many questions and cases to come as legislation starts to tackle healthcare in the US as a major issue. Several policy programs are centered on assessing current treatment and therapies and the accessibility of database information to clinicians, which returns us to similar questions of who should have access to what kinds of information.

Hoping to cure diabetes through the Edmonton Protocol

Hundreds of thousands of people live with diabetes. Diabetes causes people to have high blood sugar because their bodies either don’t produce the right amount of insulin or are resistant to the insulin they're making. For us to understand diabetes, we must start with understanding insulin and how it works in people without diabetes.

Insulin is a very critical hormone that regulates the amount of glucose that is in our bloodstream from the carbohydrates and sugars we eat. Glucose comes from breaking down the carbohydrates and sugars we eat to provide energy for our bodies; however, insulin is needed to move the glucose from the bloodstream to the cells. Insulin allows the liver and muscle cells to accept glucose from the bloodstream and keep the blood glucose level at a healthy level. Cells will use the glucose to either store energy as fats or glycogen (glucose molecules linked together in long chains) or to use it for energy right away through glycolysis.

Now we will consider a diabetic. Type 1 Diabetes (T1D) is when a person has stopped making insulin completely. T1D is commonly called “Juvenile Diabetes” and requires insulin to be manually taken, usually as an injection. Type 2 Diabetes (T2D) is when a person has become resistant to insulin and sometimes isn’t making enough insulin. T2D can develop from being unhealthy, overweight, elderly, or having a genetic predisposition (meaning it can “run in the family”). Sometimes T2D can be treated by diet or medication alone, but ~40% of T2D patients will also use injected insulin to manage their diabetes as well.

For myself, I consider T1D and T2D very different diseases. Mainly because of when and how they develop and are treated. But for now, I will talk about one treatment that was first tried to treat T1D.

The EDMONTON PROTOCOL was developed at the University of Alberta in Edmonton, Canada and was first published in 2000. The procedure was used by doctors to cure T1D by transplanting insulin-producing cells into patients with T1D. Islet cells produce insulin and grow on the pancreas of non-diabetic people, but people with T1D don’t have islet cells because of an autoimmune response that has destroyed all of their islet cells and caused their T1D. By transplanting new islet cells from deceased donors, doctors from the University of Alberta hoped to give patients a new way to produce insulin and hopefully cure them of diabetes.

The protocol was to give donor islet cells to recipient diabetics through an infusion using the portal vein. The portal vein is a special vein that is not connected to the heart, but rather runs through the abdomen and ends at the liver. There the transplanted islet cells attach and continue to grow and produce insulin from the liver (see picture, from NIDDK). Of the original recipients, 10% of them are still free from requiring insulin shots and most of the others require much less insulin than before the transplant. The doctors believe that the reason islet cells didn’t continue working for many of the patients was because their bodies attacked the islet cells as foreign material (a common transplant problem) or that they slowly lost the islet cells through the same process that caused their T1D originally.

To overcome the transplant problems, doctors had patients take immunosuppressant drugs to reduce transplant rejection. After the initial trial, doctors added an antibody treatment to prevent rejection. The antibody treatment (daclizumab) blocks the body’s immune system from creating new antibodies that would attack the islet cells. By preventing the attack, doctors believe the islet cells were allowed to attach and begin growing without being rejected by the patient’s immune system.

The addition of the antibody treatment seems to have worked very well and from several dozen procedures, ~74% of the patients that received the antibody treatment are still free from diabetes after 5 years or more. This is incredible news for people with T1D! The Edmonton protocol has many advantages including minimally invasive surgery and relatively high curative rates past 5 years. Doctors hope to improve the Edmonton protocol by using improved anti-rejection techniques or using the patient’s own stem cells to create islet cells identical to the patient, which could prevent rejection entirely.

Overall, the Edmonton protocol is an incredible example of the powerful possibilities of curing diabetes and ending a terrible disease that costs our medical system millions of dollars and thousands of lives.

Read more about the Edmonton Protocol online...
Global News – Toronto
2006 International Trial of the Edmonton Protocol for Islet Transplantation

High road for me today

Its been one of those nasty, unexplainable weeks with my diabetes. My blood sugar has been difficult to manage and keep constant. I have had times where my blood sugar skyrockets overnight and then dips too low when I correct. Other times my corrections are just fine and the expected dose works well. Because of this fluctuation I can't really make changes to the three holy numbers of pumpers;
Basal rate
Bolus ratio
Correction ratio

Because SOMETIMES it works and SOMETIMES it doesn't.
Diabetes know the stress of diabetes, but it is difficult to explain to others. Diabetes is a disease with a personality and the way it affects our lives changes from day to day. Many times, there are sudden and unexplained changes in blood sugar. It could be that the seasons are changing, or there's a tickle in my throat, maybe the extra stress at work or depression, anxiety, possibly its traveling. But worst of all is when it is a combination. Its a conundrum of diabetes that becomes a discouraging factor in everyday life and I personally feel that its something medical doctors tend to quickly forget.

Last night, I was 200 before dinner... probably because I was 279 before lunch, crashed at 60 after lunch and overate before dinner. Before bed 150. Morning..... 379!!! These aren't typical numbers, but they are frustrating.

Diabetics need consistent normal blood sugar to be healthy. They need exercise and good food and plenty of sleep. Fudge up any of those factors and the wheel gets lopsided and problems start compiling. Didn't sleep well? Your BG could go high, making you sleepy and sluggish and not sleep well the next night. Not eating well? Missing meals? Then you're in the high and low game. Sick?.... the problems work off each other so the combination is exhausting.

Solutions? Check often and correct often. Do your best to get good long sleep. Avoid caffeine and try to breath deeply at work. That is all you can do. But as a diabetic, if you have the same kind of day as me, you should know I sympathize with you.

Morning Highs

For the past week, my blood sugar seems to be very irregular in the morning and is followed by strange changes later in the day. For example, I could wake up a bit on the low side (70's) and by lunch it could be close to 300mg/dL. Even today I began at 95 and now at 11:30am, its at 244mg/dL.

I haven't been able to pinpoint the cause. As of late, I have been working quite a bit and not sleeping very well so it could very well be a lack of rest and possibly an illness coming on. What I do know is that times like these are very frustrating. Ever type 1 diabetic I know has had these periods of unexplanable changes in their blood sugars and every person I have talked to has the same advice... just monitor it and ride out the problem for at least a couple days.

I know that for myself, the transition from Winter to Spring is always really tough for me. The basal rate, correction and carb ratios tend to change a little bit between summer and winter, which requires a time to completely transition. I'm hoping these highs settle down soon.  I'm keeping tight control on my diet and monitor more frequently until the problems subside.
Wish me luck!

Bloody mess

Today, I'm talking about a new issue I've encountered with my infusion set for the insulin pump. I should have learned my lesson the first time, but I repeated my mistake. I thought I would share my experience to possible help others in the future.

I use the Paradigm Insulin Pump from Medtronic and the Silhouette infusion set. A couple days ago, when I put on my new infusion set, I noticed a little blood in the catheter. No problem, I needed a morning Bolus and the blood went away instantly. However, because of a past experience, I believe I should have changed the set right away. The site began to look progressively worse over a couple days time and I took it out this morning.

I was very surprised by what happened next (warning for those that are squeamish about the description of blood). From the site, blood began coming out at a pretty good flowrate. Bright red and quickly streaming down my side. I scrambled for a napkin to sop up the mess and as quickly as I could I covered the site and applied pressure for several minutes.

This is the second time this has happened within a year's time. In very basic terms, it really freaked me out. A stream of blood coming from a puncture on your stomach would do that I guess. Now I'm left with a very sore and bruised area about 1/2 inch in diameter. I cleaned the area thoroughly and bandaged it as I would bandage any other basic wound.

Blood in the catheter should have been a strong warming that the site was not good for me. I had crazy high blood sugar readings for nearly 3 days and I was also very high this morning. Aside from using excessive amounts of insulin, the experience was frustrating and then frightening. I don't like having to change an infusion set right away because its painful and wastes supplies, but in the long run, I felt much worse when I kept it on and I wasted insulin, time, and health. It just isn't worth it to save an infusion set

Sick and Tired

I've been feeling worn down and sick for a little over a week. Moreover, I've been staying up late and having trouble staying asleep. When I'm feeling sick and/or tired, I get unexpected high blood sugar readings. Many doctors will warn diabetics that illness can lead to extra bodily stress and cause elevated blood sugar in diabetics. Being under other kinds of stress can do the same and in some people, taking antibiotics also can make you go high (see comments http://www.tudiabetes.org/forum/topics/being-sick-high-blood-sugar).

The truth is, there's many more things that can raise your blood sugar than can lower it. The advice for diabetics that are feeling under the weather or super stressed is the monitor more frequently (maybe 6-8 times a day instead of the typical 4) and to correct as frequently as needed.

Another cautionary tale is to avoid making changes to basal rates, correction and bolus ratios until you are feeling well again. I know that I have felt the pain of being sick and having high blood sugar in the past and wanted to ignore the problem and hope that the sickness passes soon. Unfortunately, ignoring the high blood sugar can compound the problems of illness and actually make recovery time much longer.

Throughout most of the winter I have this on and off again sick feeling which really messes with my health for a couple months. I don't know that warmer climates would help me throughout the year, but staying inside for 3-4 days in a row because of massive Baltimore blizzards has certainly kept me feeling awful.

Changing my set changes the effect

Every so often, I change the infusion set for my insulin pump and my blood sugar rises unexpectedly. Sometimes I see this effect for an entire day. I follow the common advice of frequent monitoring and correction as needed.

Because this happens regularly with my Silhouette infusion sets, I began to ask why it would be happening. My endocrinologist suggested my basal rate needed to be adjusted, however, when I increase my basal I tend to be too low after the first day. At my next appointment with a nurse practitioner, I heard anecdotal accounts of problems with sites immediately after changing. I also read similar stories on other blogs
http://www.insulin-pumpers.org.uk/badsite/
http://www.diabetes-insulin-pump-therapy.com/high-blood-sugar.html

I really enjoy the UK Insulin Pumpers site because there is so much useful info that I can't seem to find anywhere except from people's personal experience. But I digress. Back to my original question - Why would you get high blood sugar from changing your site? From other diabetics and physicians, I found several possible explanations.

• The site could be too close to muscle or the infusion set slope is angled to steep and is too close to muscle causing higher blood sugar because insulin absorption is hindered.
• The site becomes swollen or irritated or at worst, infected, which causes inflammation and compromises your insulin activity and/or absorption.
• The site has hardened fat tissue, which prevents absorption.
• Site isn't taken very well and your body reacts to it negatively for a number of immune response reasons, which leads to inflammation and results in the same problems as above.

This problem doesn't happen all the time. Maybe 2-3 times per month out of 10-12 at the most. Usually if I give myself the infusion set and it really sings for a few minutes afterward, I know its going to act goofy for a day. Another case would be if its sensitive in that area when I press on the infusion set. I am now considering changing the type of infusion set I use to see if there is another set that may work better.


If you do call a helpline, I can give you an example of what you might hear, but please do call and do not rely on my personal account to make judgements on your own situation.

First, the insulin pump company asked me to perform a Pump Self-test and to make sure the tubing wasn't tangled or leaking. Ensure that the basal rates and bolus ratios are correct. Make sure the site isn't painful or problematic (is it red? swollen? is there blood? was it primed correctly? were there air bubbles?). You may need to change the set.

I found this MiniMed site helpful.
http://www.minimed.com/help/sitemanagement/index.html#a6
And there are also the National Institutes of Health and Center for Disease Control with useful sites too. http://www.cdc.gov/diabetes/ndep/index.htm
http://www.ndep.nih.gov/partners-community-organization/index.aspx
And I really like this book called "Insulin Pumping"... here's the website founded by the authors.
http://www.diabetesnet.com/pibook.php

Bipbimbap overload

Some days it feels more difficult ot control my blood sugar than others. Today was an example of my diet and stress making my management difficult.

I had homemade tom yum soup with rice noodles for lunch. I particular love rice noodles in my Thai food but there's something about those high carb noodles that tends to throw my levels for a loop. They have a lot of carbs to begin with, but then if we boil and wash them too long, I tend to go low because we are washing off a lot of the starches on the outside of the noodles. If I'm eating a lot, that makes a larger difference in how much insulin I take versus how much I need.

Today, it resulted in a mild drop in my blood sugar. Its important to follow the trends because I will revisit this dish and then I'll be able to take the correct amount. It requires mindfulness of what most people consider mundane details of daily life.

Later we had bipbimbap and doen jang (two of my favorite Korean dishes)soup for dinner. These dishes I eat frequently and I can control very well. However, the first few times I wasn't very successful and my blood sugar went very high. It turned out that I wasn't accounting for the gochu jang (pepper paste) that has some carbs, as well as the carrots.

But after some trial and error, I almost never have any problems.

Finding New Spots for my Insulin Pump

I use the Paradigm pump from Medtronic with the Silhouette infusion sets. For a variety of reasons, I sometimes have red irritated spots when I change the set. I was getting tired of a dozen dots on the front of stomach and last night I tried my back on ride side just above the hip. It was a little challenging getting the inserter steady, but with a mirror, I was able to successfully place my pump.

3hr post dinner, I was very high (288) and I corrected before bed. This morning I was surprisingly still high (235). My feeling is that there is less fat on my back and adsorption is not the same. Unfortunately, I had just filled it last night, so I don't want to throw out the reservoir of insulin.

I planned to ride this one out and monitor throughout day. Perhaps, I just needed time to adjust.

By lunchtime, my blood sugar was 166. Not too bad! Later, I would be going to a JHPDA Happy Hour. The Happy Hour started around 5pm, and I tried to only drink Michalob Ultra and not eat chips (instead I ate cheese, veggies, and the toppings on the pizza). It was a very successful Happy Hour and lasted for a long while. I got home around 9pm with a blood sugar of ~200. I corrected and ate some Ramyun for dinner.

I have a feeling my site needed time to adjust. The back seems to work just as well as the stomach and I should continue looking for sites to rotate my infusion sets.