Tag Archives: Type 1 Diabetes

Mhealth, Mtechnologies, Mexplainations… MT1?

I love Dr. Bennett’s blog, whitty, quick reads on new mtechnology/mhealth minutia.

Although not specifically aimed at one health problem, his main focus is on obesity research via mobile or computer technologies. Although knowing virtually nothing about mhealth technologies, his blog has offered up a wealth of information allowing me to dive head first into the pool. He mainly offers insight into the challenges that many mobile health technology apps face, and how to avoid them. But, he also gives other insights that are helpful for academics, such as tips on writing a R01 grant. Finally, he gives good background and insight on popular press items relating to technology, such as the FB algorithm “Year in Review” that has received some, well, negative reviews?

The rise of mtechnologies has also expanded T1 care options… I have vivid memories of astonishment as one of my beloved T1 camp counselors, talking about what it was to have T1 in the 1960s; boiling glass syringes for shots, and using “pee sticks” as affordable glucose meters were yet to be invented. [A cool entire history lesson of T1/T2 can be found here. ] Yet, as of 2014, it is possible to send data from your test meter to your iphone, and the new tslim pump design includes a touch screen. Additionally, the possibility of a bionic pancreas controlled via iphone commands has been postulated as a future direction of T1 care. The advancement of technology for treatment options and rise of information has completely transformed the experience of having T1 in a matter of years… and for those who are young and technologically literate, it works to our benefit. But what about individuals who are not as technologically advanced? Are the new technologies user-friendly enough to be accessible for older generations? And with the shortening of patient-provider time during medical checkups, is there the opportunity for those who are not in the tech know-how to catch up? And does the advancement in technology in the U.S. and other Western countries increase the gap in care opportunity and availability in middle or low income countries?

Defeat via Gender?

I just finished reading an amazing book, The Places in Between, about an adventure taken by a young man through Afghanistan in 2002, right after the Taliban fell. He decides to follow the famous Emperor Babur’s footsteps, walking across Afghani terrain to Kabul. Weaving the tale with threads of personal anecdote, history and observations of another culture, Rory Stewart’s adventure held my attention captive. He tells of evenings sitting with men discussing local politics and religion; moments of possible danger, trying to understand the motives of individuals, what the best answer to a question would be given the region and religion; he tells of moments of loneliness, uncertainty, and ultimately triumph when he accomplishes his goal. I looked forward to sitting down to read a chapter during a quiet period, holding a cup of tea close, taking in each scene he portrayed, the emotions he felt, the physical difficulties he endured.

 

What made him successful? Firstly, Rory’s knowledge of the language, culture and religion was of great importance in his journey, enabling him to get out of several very dangerous situations. Secondly, he is generally in good health, although experiencing some sickness on the trip. Finally, he is a man. In an Islamic society, I highly doubt a single woman, no matter her nationality, would be able to take such a journey alone. At one village, Rory describes that the women had never left that village, not to even visit a neighboring one. A woman traveler therefore might be at constant danger from local men who believe it is wrong for a woman to walk alone. As Rory often slept in mosques or village leader’s houses, there might not be a place for her to sleep, as she might not be welcomed.

 

While reading his memoir, I felt a certain sadness, due to the fact that I don’t think it would be possible for me to complete a similar trip. I’ve had almost a year of travel and living in new cultures, but my travels have stayed within certain limits. I was never in a place where I couldn’t get food or water, or where my safety was continuously threatened, or where my gender put me at a larger disadvantage.

But there are two strikes against me completing a similar journey to Rory’s: the first, having T1 diabetes. This is a huge logistical challenge, requiring a lot of attention and dedication, but can be overcome. But the second challenge, that of being female, is much more difficult to more beyond. As a woman, I am unsure I would be able to walk alone for hundreds of miles across an Asian, Middle Eastern or African state without putting myself in extreme danger, simply due to my gender.

 

Working so hard to pursue the dreams that motivate me, I have been able to overcome the challenges of Type 1 Diabetes in moving to Kenya, traveling solo in different countries and cultures, and learning about my body and limits. So how can something as basic as gender be the Achilles heel of adventures?

 

 

Weighing T1

Backpacking around Europe, Asia, New Zealand, Latin America, Australia, or the US is an amazing adventure, rocked with incredible experiences, questionable moments, and of course, the excitement of seeing new things, meeting new and different people, and the ability to grow and learn from these experiences. I have read a lot of blogs that talk about what and how to pack into your pack, in order to have enough stuff (i.e. underwear), the right items (like the REI fast dry towel), and not too many items weighing you down (do you really need to pack a second pair of tennis shoes?)! These girls (and a few boys) have the perfect-pack down; their bag is beautifully packed, perfectly minimizing clothing, shoes, toiletries, cameras, journals, and a yoga pad into a 40-liter backpack.

 

I would love to tell you that I too carry a 40-liter pack only weighing 15kg… but I don’t. I carry a 60-liter pack, weighing closer to 22kg. Why? Because months worth of pump and testing supplies takes up a lot of room, and weight. When having to carry them on your back for miles through airports, train stations, and twisting streets in search of a hostel, I’ve learned that things like test strips are surprisingly heavy! But, of course, a little extra struggling is worth the opportunity, and even gives me a bit of extra cardio exercise each day (there is always a silver lining). But here is how I pack my T1 supplies, in order to minimize the space it takes up, so I too can pack minimize my clothing, shoes, toiletries, cameras, journals, and my diabetes supplies into my 60-liter pack.

 

1. Take all pump sets, reservoirs, test strips out of boxes, and tightly repackage into 1-liter Ziploc bags. I get about 16 sets per bag, and can get up to 50 reservoirs into a bag. (The edges of pump site packages can rip through thin plastic, so try to find thicker plastic re-sealable bags).

2. When initially flying out of the US to Kenya in fall 2013, I left the insulin vials in the prepackaged box, with a sticker of the prescription on each box. Once I had arrived, I unpacked the insulin vials into my Frio-packs to keep them cool (as I have not had a fridge to store the insulin in). I have since traveled with all my insulin/diabetes supplies, and have not had a problem with the vials in the frio-pack. I simply carry a letter from my doctor in case any TSA official stops me and asks me about this.

3. In my big pack, at the very top, I stick the same letter from my doctor, saying I’m allowed to be traveling with needles, insulin, test strips etc. I put it in face up, so the very first thing a TSA official searching the pack will see is this letter, explaining why I am carrying 200 needles and other drug paraphernalia.

4. I prefer to carry all insulin and test strips in my carry on while traveling… in case my pack gets lost in transit, I can usually find a way to get needles in the country I am in, either in a pharmacy, or a hospital. Insulin and test strips are different, as some countries only have some brands, and usually, they are very expensive to buy in the places I’ve been and asked (Kenya, Italy, France). I feel more comfortable knowing I have the insulin and strips on me, as I have more ability to keep track of a carry on.

5. If you are nervous about supplies getting stolen while staying in a hostel, book hostels that specifically have lockers, and carry your own padlock. This way, you can lock up your supplies, and feel comfortable while you are traveling around a city, enjoying the traveling more. And bringing your own padlock means you don’t have to rent one, saving yourself 2 euro!

6. Buy local, cheaper, snacks for lows. I keep a small baggie of glucose tabs in my day pack in case I ever get into a jam (which is also my carry on), but I save these for emergencies, such as having a low while trying to go through a very long airport security line, and not having any juice or ability to buy anything without getting out of line and starting the 2 hour wait all over again.

 

 

Happy T1 Travels!

Taking fluids in Kenya

Dehydration is a major threat during hot periods for people with T1, and can result in prolonged high blood sugar and possible DKA!

It’s gotten very hot here in Kenya- January through March is the dry seasons, and the hot sun makes the temperatures sore! If not taking enough fluids, the intense heat can cause dehydration.

A couple weeks ago, I fell into this pit- my blood sugars were high for several days, my insulin didn’t seem like it was working, I was feeling sick. Luckily, in Kenya, you can go to a pharmacy and buy bags of saline, tubes and IV insertion sets. My clinical-officer friend gave me the IV, hooked me up with a liter of intravenous fluid, and within the hour my blood sugars started to come down!

Lesson of the week: water is essential (it makes up the majority of our cells), and we have to remember to respect the fluid balance!

October Post… FROM KAKAMEGA KENYA!!!

Wow, I can’t believe how remiss I have been about posting since getting to Kenya!! The entire concept of “Kenyan time” is clearly affecting me, seeing as it doesn’t feel possible that it has already been 4 weeks since I arrived in Nairobi. I am now in rural northwestern Kenya, near a town called Kakamega. This experience so far has been amazing—my eyes are open to so many brand new things, I feel that I am learning a lot and my views are changing.

But… as this is a blog on health and diabetes, I probably should not get on my soapbox about all things social and public health… or at least not until I get my update on diabetes done!

So, here we go. Things with my blood sugars have been pretty good considering all the changes- it is much hotter here than I am used to, meaning that I sweat more, so I have to keep focused on rehydrating! I have used Gatorade powder that I brought from the States, and on the couple of days that I have felt very under hydrated, they have helped restore water content and salt (both of which is lost through sweat). The food is also very different here, I eat a lot of maize (similar to corn) and grains, some vegetables, and occasionally fruit. This is a shift from my diet that has a lot of fruit in the US… but I’ve found that even though I am eating more grain here, my blood sugars seem more stable. I attribute this to the lack of processing—most things here are pretty fresh! And in general, I need less insulin for things like bread… the only thing I’m finding that causes me consistent challenges is corn flakes! A surprise to me! Lunch time is usually getheryi, a mixture of maize and beans, with some vegetable (recently, it has been kales!), which ends up being a pretty big bolus for me during the day (around 6-8 units, depending on amount and the day’s activity).

Another surprise was that I had a lot of middle-of-the-night low blood sugars, causing me to change my basal rate (which I haven’t made any significant changes to for about 2 years)… this fixed the problem, and I usually wake up around 100 if my blood sugar is doing well the night before.

Like Eugenie said in her interview, it has been pretty easy to find local snacks to treat low blood sugar, from juice boxes to local candies… so this hasn’t been an issue. Additionally, I was pleasantly surprised to find that certain chemists (pharmacies) in Nairobi carried Humalog in addition to several other types of insulin (several that I had never heard about), so I have a pretty local backup plan in case of any insulin emergency. But for now, the 20 bottles are keeping chilled in my FRIO packs, a product that I will happily recommend to anyone doing any traveling or needing a way to keep insulin cold when on the move!

I think that is all for now, beyond the general encouragement I would like to offer to any yearning travelers… don’t be afraid, having an amazing adventure despite T1 is totally possible with the right preparation. So go, be brave, have adventure, and look forward to learning about the world around you and yourself!

KENYA!

It is my 5th day in Kenya, and my final day in Nairobi—tomorrow, I will head northwest to the town of Kakamega. Spending my first few days in Nairobi with the director’s family has been very helpful in acclimating me to a very new environment and culture. Likewise, being in the capitol city for the first few days in a new country has given me some peace of mind, as it is in Nairobi that I will have the greatest access to extra insulin supplies should I have any issues with what I packed.

From my last post, you know that I was nervous about Kenyan customs having a problem with the amount of needles and other “drug” supplies I was bringing into the country… upon arrival, I was relieved to see that my checked bags looked to be about the same size as they were in the US, and taking the advice of an older friend who has traveled in and out of Kenya many times, I made it through customs just fine by smiling and making light small talk! In fact, the only thing they asked me about was the rectangular shape in one of my checked bags, which was the board game Sorry! After asking me a few questions about this (what is this? – a child’s board game… how much is it worth?—probably 5 American dollars, it is used… used?—yes sir, I used it as I grew up), the security guard nodded, and let me on my way.

Upon arriving at the home I am staying at for my time in Nairobi, I took a minute to myself to check the bags for my supplies, and confirmed that nothing appeared to me missing! Huzzah! Storing my extra supplies of insulin in the fridge, I proceeded to enjoy my time getting to know the director and her family, going around Nairobi, and visiting the Giraffe Home and getting a giraffe kiss!! Wonderful!

What the Gluten?!

The interview with Eugenie was really awesome to share with everyone—I was particularly excited because it gave me some insight into what it is to travel in another country with diabetes supplies, considerations to think about, and it supported some things I’ve already done to prepare, validating the amount of effort I’ve spent (which feels great!). There was an additional point of interest that I had not expected: Eugenie’s comments on trying a diet that avoided gluten. I was intrigued, and reached out to some of my gluten free (GF) friends, to hear about their experiences and insights! And here is what I found!

The people:

Sara: 18, started GF in 2004 after being diagnosed with T1 and Celiac

Lydia: 22, started GF August of 2012 after suffering from small, but not insignificant, health problems (tiredness, frequent stomachaches, bloating, mysterious aches and pains)

Jen: 20, started GF fall of 2007 after being diagnose with Celiac disease

Summer: 19, started GF summer of 2012 after being diagnosed with Crohn’s disease (GF diets help reduce symptoms)

Question 1: Tell me about your overall experience with a GF diet?

Sara: When I first started a GF diet (9 years ago), it was very difficult, as the GF industry had not become popular, so we had to order food from Canada that tasted like Styrofoam. I was forced to mainly eat vegetables.

Jen: Within the past 3 years, the GF industry has exploded. Now many restaurants are aware and even popular brands like General Mills and Betty Crocker provide options for GF.

Lydia: Now, it’s actually not that hard. I’m a GF vegetarian, so you’d think my options would be limited… but, I can substitute GF pasta and bread products when I want them. I’ve gotten into baking and even made my own GF pasta and gnocchi!

Question 2: What physical effects do you experience with a GF diet?

Sara: At first, I had a really hard time staying completely away from gluten… sometimes it was a matter of not being able to resist Oreos, and sometimes I wasn’t aware there was gluten in so many things, like red food coloring. At first, I would barely notice the difference, so I ended up eating a lot of gluten. After about a month of eating gluten, I ended up in the hospital with some serious side effects of not being on a GF diet. The result has been that I am now much more sensitive, so I have to be very strict—any contamination can send me into a puking fit and eventually to the hospital with DKA (diabetes ketoacidosis).

Jen: Similarly, removing gluten from my body didn’t change much beyond not getting sick anymore.

Lydia: When I started, I didn’t know what would happen to my body on a GF diet, but I have found that I feel much more rested, and my energy is way up.

Summer: I believe GF diet is a main factor in what keeps most of my Crohn’s symptoms away. Some added benefits of a GF diet include: stopping having skin breakouts, the puffiness under my eyes is greatly reduced, I have more energy, and I feel “light”… not like a weight thing, but more of a feeling.

Question 3: What do you classify as gluten—what do you avoid?

Summer: All grains in general, so soy, wheat, rice, corn, and oats.

Lydia: Wheat, barely, rye, malt. Although barley malt hasn’t made me sick… I wonder if I’m only allergic to wheat and not barley and rye.

Sara: I stay away from anything risky because my sensitivity to gluten is so high. I absolutely cannot eat wheat, rye, barley or oats. What makes it difficult is that gluten can be in so many things: red food coloring, a lot of preservatives in drinks and candies. I also avoid anything I cannot pronounce on the first try. Also, I recommend to avoid dairy if you are going to slip up a bit and eat gluten—dairy makes the reaction way worse.

Jen: I classify gluten as wheat, rye, barley and malt. I also always avoid all types and never make exceptions. I also consider oats as gluten, as they are often farmed in the same field as wheat. But, I will eat specially grown gluten-free oats.

Question 4: What is your perception of GF diets for the masses (like the Atkins diet)?

Sara: I love that people are so interested in GF! The more people who are interested, the more opportunities I get to eat (as more companies produce better and a wider range of products)!! It’s a really healthy diet and I have heard from a large number of people that they just feel better after not eating gluten anymore, regardless if they didn’t feel like anything was wrong in the first place.

Jen: I have never been a fan of fad diets, so I don’t believe there is one type of food or one solution to a healthy diet. As in anything, I believe that gluten is appropriate in moderation, and whole grain wheat provides important diversity in nutrition.

Lydia: Do a GF diet it if you feel better! If you don’t have health problems related to gluten, you are just restricting yourself pointlessly. Avoiding gluten isn’t necessarily healthier. You have to see what personally benefits you. No harm done in trial and error!

Summer: I think everyone has his or her degree of tolerance for gluten. So if a person is even a little bit intolerant, they might benefit, but if they are perfectly tolerant, there is no reason to spend the extra effort and money to go GF.

Question 5: Any other insights on certain foods/food categories and health?

Sara: There are a lot of great bakeries that make GF options, and there simply isn’t anything better than being able to walk into a place expecting temptation and tourture and walking out with a cupcake that won’t make you sick.

Lydia: The best gluten free breads are Schar, Udi’s and Kinnickinick.

Jen: One time I went two weeks trying a pseudo-raw diet without eating processed or packaged food. I really felt a lot better, but it was too challenging. Since I don’t leave much time for cooking from scratch, I only was eating vegetables and rice and missed things like pasta, granola and yogurt in my diet.

A few weeks ago, the FDA released an announcement that it has (finally) created a gluten free label that will be regulated and enforced: products sporting this label must have no more than 20 parts per million of gluten in the product. (http://www.npr.org/templates/story/story.php?storyId=209265283) What’s your take on this ruling?

Summer: I’m for the new regulations on the labels. 20 parts per million is a very small amount… it would be like adding an 8th a teaspoon of flour to a loaf of gluten-free bread. I don’t think its likely gluten free manufactures would bother to do that, so I think the FDA has set a pretty high standard. Even if they were to add it, the gluten would be so saturated within the gluten free product itself it likely wouldn’t cause much harm. I would use the analogy that this is similar to the 99.9% of bacteria that anti-bacterial soap eliminates…that other .1% probably won’t get you sick.

Lydia: 20 parts per million is small enough for me. I am able to get away with eating non-GF labeled products that “may contain wheat”; they usually don’t make me ill. So, yes, I will eat things with a GF label!

Jen: I would ideally like to see it down to 10 or 5, but I understand testing for those amounts can be much more expensive.  As a celiac, every molecule of gluten I digest contributes to colon damage. I generally will eat products with the 20ppm labeling without any physical response, but to me it is not 100% “safe”.

A big thanks to you ladies for sharing your experiences and insight!