Diabetics: How do you satisfy the nom nom nom?

In My Humble Opinion
61

Meh, I bitch about it, but truly it’s not THAT bad. I was pretty freaked out at first, but really, in the larger scope, it’s a disease that’s relatively well understood, there’s lots of choices on how to treat it, and it’s definitely controllable. I’ll take that over about a gazillion other diseases out there that aren’t well understood or controllable.

From my perspective, my lifestyle has changed maybe 5 or 10% since diagnosed, and most of those changes were healthy changes that I’d been wanting to make for a long time anyway but wasn’t sufficiently motivated. I spend maybe ten or fifteen minutes spread out throughout the day taking care of it.

The very worst thing about day-to-day life with Type 1, IMO, is the nights I misjudge my dinner carb counts and end up with higher blood sugar than I like before I go to bed. I don’t like sleeping with active insulin, so if I decide to give myself more insulin to correct the high, I have to set my alarm to wake me up in a couple hours so I make sure I’m not going low. Hoo-boy, what a hassle! :rolleyes: If that’s the extent of what it takes me to control this disease, I’m fine with that.

Oh, and the expense. It’s pricey, considering I pay my own insurance (self-employed). But them’s the breaks…

62

Athena, what’s the big expense? Is it the insulin?

For me it’s the testing strips, but my RD gave me a bunch of them.

63

I figure all my various meds and supplies run about $680/month with the insurance-negotiated rate. If I didn’t have insurance and were paying list rates, that goes up to around $1500/month.

Insulin isn’t so bad - costs maybe $130/month. No insurance rate on prescriptions, I just pay what the pharmacy says (and get reimbursed if I’ve met my deductible).

Test strips are crazy expensive. They’re over $1/each, list price. My insurance negotiates them down to like 40 cents each. Given that I test between 4 and 10x/day, that adds up. So let’s say an average of about $90/month. I know that’s cheaper than insulin, but boy, looking at those things, it’s hard to justify the price. They’re just fancy cardboard.

Then comes pump supplies. $800/month list price, insurance-negotiated price is $300/month. The pump controller runs around $800-$1000 if I remember right, but only has to be replaced every 4 years.

I recently also got a continuous glucose monitor - a little gadget that tells me what my blood sugar is all the time. I love this thing! But that runs, lessee, $374/month list/$159 insurance-negotiated for supplies every month, plus I think I need a new transmitter once/year, and that’s $1600/$629.

The way my insurance works, I’m responsible for 100% of the negotiated price until I meet my yearly deductible of around $4K (that’s for both Mr. Athena and I, but he’s relatively healthy so it’s mostly me). After that, they pay 100%. So I just plan on my health insurance costing me $4K/year, plus the monthly premium which is currently around $650 (for 2 of us) that goes up all the frikkin’ time. The premium I’d have regardless of health (but maybe could shop around and get a better rate were I not diabetic and therefore uninsurable until next year when reform kicks in).

So yeah, diabetes is expensive. If I gave up the CGM and the pump, it’d be a LOT cheaper. But I have no doubts I wouldn’t have as good health, either. There’s no way I could get the fine control I have with the pump by using syringes - you just can’t dose .45 of a unit with a syringe, for example.

64

Wow, that’s crazy expensive. I couldn’t afford to be you.

65

Well, assuming you have insurance, for Type 1s at least, they tend to pay for it. I’ve heard people having trouble getting the CGM, but the pump and all that is pretty much standard for T1. I just happen to pay my own insurance as opposed to all you employed people who probably just pay your copay/deductible. I do set my work rates to cover it, so not a huge deal, though I’d rather not pay it if I didn’t have to.

66

I’m not sure if I’m a type 1. I assume not, but I’ve never been tested until September.

But my RD gave me a One-Touch Ultra along with test strips.

Gave.

67

Oh yeah, they give 'em away. Never pay for a meter. I have about a dozen on the shelf.

I’m guessing, though, that once you run through the free batch of strips, you’ll need to pay for more through your insurance.

68

That’s better than paying CVS’s prices!

69

I just changed back to vial/sysringe Lantus from the autoinjects. I could eyeball it to about half a unit, the syringes are actually 1-100 units. I think there is a vet syringe that goes finer than 1-100 units, let me hit google my vet bag is in the barn.
Yup, Easy Touch makes a .5 ml syringe - I would have to compare it to one of my insulin syringes to double check. I can always ask the pharmacist for a peek.

70

Back to the issue of medical professionals not always knowing what they’re talking about when it comes to diabetes…

A few years back when pregnant with my first child, I had horrible morning sickness (the Princess Kate kind) and ended up in Urgent Care. The doctor had me take my blood sugar – it was 156 – so he rushed off to get me a can of juice and told me to drink it. I gave him a look and asked “Why would I do that?” He actually *argued *with me that my blood sugar was too low. I refused his juice and went to a real hospital.

And when I got my appendix out about 15 years ago, the nurse refused to give me access to my insulin after the surgery. She said I couldn’t eat anything, and therefore didn’t need any insulin. I tried to explain to her that I needed insulin (long-lasting insulin, not fast-acting) even if I wasn’t eating, and she told me I was wrong. My mother, an RN, kidnapped me out of the hospital the day after the surgery and brought me home to recuperate…and get some o’ that sweet insulin.

So I no longer believe everything the “experts” in the medical field tell me. It’s one thing to study a disease in a book – it’s another thing to live with it for 25 years.

Diabetes education classes are great, espcially if they are free. I’m glad, tdn, that you have access to something like that. When I was pregnant, my doctor sent me to a dietary specialist who taught me a LOT I didn’t know, especially about carbs and their effect on my blood sugar.

Athena – I just got the CGM too (because I’m all pregnant again) and it’s amazing! The constant alarms drive me a little batty, though – I know I can adjust them, but I love knowing when my BG is dropping or heading up. Really eye opening!

71

Oh! What’d you get? I decided to try out the new Dexcom G4, and it’s WONDERFUL. I had the Dexcom 7 Plus a couple years ago, and wore it for something like a month before tearing it out and never putting it on again because the damn thing was so inaccurate. The G4 is the total opposite - it’s within 10 points of my meter about 90% of the time. Sometimes it’s EXACTLY on, which is eerie. Occasionally it’ll be more than 10 points off, but it tends to be when I’m higher than normal, and I can deal with that. And it’s very rare that happens, anyway.

Overall, I like it a lot more than I expected to, given my experience with the other one. And it’s BLUE, which makes me happy.

72

Hijack: can somebody please tell me what exactly is each of these “carbs” which Athena and some others are talking about as if it was a unit? I’m used to thinking of “carbs” as a family of substances whose content can be measured in many different units, not as a unit. What is the actual unit I’m guessing they are skipping?

73

From context, I infer that they’re talking about grams of carb in a serving of a given food.

74

Yup. “12 carbs” means “12 grams of carbs”. It’s just shorthand. Most insulin-dependent diabetics dose their insulin based on how many grams of carbs they eat. You have a ratio - so let’s say your ratio is 7 grams of carbs needs 1 unit of insulin, 12 grams of carbs would required you to dose about 1.7 units.

I think a unit is something like .001 mL, but don’t quote me on that. It’s really, really tiny. I go through about 1 tiny vial - about 2" high - of insulin per month, I think it contains 1000 units.

Non-insulin-dependent diabetics also are aware of carbs, because they may need to regulate how much they eat at once or per day in order to keep their blood sugar in the correct range.

(note: there are other methods of insulin therapy other than the one I describe above, but they’re less common nowadays.)

75

Thanks for the details on insulin dosing. DH is a Type 2, managing with diet and exercise.

76

Thank you, I thought it would be either something like that (but with Americans, it could have been an ex-Imperial unit) or something related to actual concentration (unlikely, from my experience).

Lousy UoM if you ask me, because the amount of “carbs” you measure in a piece of food will vary depending on the testing method. The number is worthless without the actual unit, but also without indicating how it was measured.

77

I use the USDA site if I am not certain what the data are on the food I am interested in. There are also books that are commonly used. You can also load cookbook programs that have nutritional databases.

78

This is kind of important, especially right now as you are being overwhelmed by all this. Anything you do will be better than before, and you don’t have to quit everything at once, or even ever. Just do less. Less eating, more exercise.

For example, my doctor asked if I drank soda pop (yes, about 4-6 cans/day). So how about we try for only 2 cans per day? (I was already doing the diet pop.) I could face that, and I’ve found it possible to keep to it. A tip – I found it hard to work at my computer without something to drink. So a glass of ice & water, with several drops of lemon juice concentrate or lime juice worked fine for me – enough taste to distinguish it from water, and better than pop.

Remember that it took years to get to the condition you were in when diagnosed, so don’t expect to make all these changes at once. Just keep working at them, and be satisfied with improvements.
He also asked about eating candy – yes, I ate a lot of it. So again, try to limit it to 2-3 pieces per day. So I get the good chocolate, that I can let slowly dissolve in my mouth. Or some hard candy like butterscotch that goes slowly – not something that you eat quickly. Sometimes when I get the urge I unwrap a piece, and set it there, to eat a bit later, not right now. And sometimes I never get around to eating it that day.

Go through your kitchen & pantry and get rid of food that you shouldn’t eat so much. I love pasta, and used to buy it when it was on sale. Also rice, etc. So I packed up about half of what I had on hand (3 grocery bags full!) and gave it away to needy people. Keep things like carrots, snap peas, popcorn on hand for snacks.

Exercise helps a lot. If you over-indulge on eating, you can somewhat compensate by increasing your exercise. If you normally walk for a half-hour, make it 45 minutes - 1 hour on such days.

79

Not following you on this one. You’re saying 1 gram of carbs will vary depending on how you measure it?

Regardless of how they measure it, the info provided in any number of books and websites has been working for diabetics for many, many years now. So however they do it, it’s at least accurate enough to use for insulin dosing. When I’m cooking for myself, I use a food scale and nutritional info on the food itself or from one of my many nutrition guides to figure out carb counts. When I’m really being anal, I’ll weigh the finished food as I portion it out as well so I can get as accurate a carb count for what I’m about to eat as possible. If I go through all this trouble, I get my insulin dosage correct 99% of the time. And by “correct”, I mean that 3-4 hours later (which is the time it takes for a dose of insulin to do its thing) I’m neither running high or low blood glucose.

When I eyeball it, not quite so accurate. But after doing it for 4 year now, I’m pretty good at looking at a plate of food and figuring out a carb count. That’s my super power.

80

This is very helpful, thank you. It’s pretty easy to feel guilty over one transgression. I was doing great all Saturday… until we heard “Would you like any coffee or dessert?” Oops.

But my BG was 199 this morning – an all time low since late September.