Month: April 2018

Guest Post: Behind the Scenes of Diabetes Research

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Today I’m handing over the reins to Caroline Rudnicka, a diabetes research officer who also lives with type 1. I first connected with Caroline after hearing her speak at a local event hosted by Diabetes Research Western Australia, and today she shares with me a little about her connection to diabetes and an upcoming event to support diabetes research. 

I must admit that I don’t think too often about an end game when it comes to diabetes, so I really appreciate hearing from people like Caroline and the team at Diabetes Research WA who share such a passion for research. 

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Frank: Hi Caroline. Can you tell us a little about your connection to diabetes? 

Caroline: Hi Frank and thank you for the invitation to guest blog on Type 1 Writes.

I was diagnosed with Type 1 Diabetes in 1989 while my parents and I were holidaying in Europe. My diagnosis was a horrible shock for my parents, who had mistakenly attributed my mood swings, weight loss and lethargy down to my young age and traveling. Furthermore, with no family history of T1D, my ‘spontaneous’ diagnosis really astounded my parents, who were previously completely unaware of the condition.

My diagnosis drove me to pursue a T1D-orientated honors project through the University of Western Australia. Currently, I work for Royal Perth Hospital as a research officer, and I have been fortunate to work in a lab group, supervised by Professor Vance Matthews, that is dedicated to type 2 diabetes research (although we are starting to investigate T1D complications too).

I feel lucky to be in the position where my work environment encourages me to constantly reflect on the potential mechanisms which promote diabetes development, and provides me with unlimited access to read high quality diabetes journals.

Frank: We first connected through your work with Diabetes Research WA. Can you tell us a little about that? 

Caroline: It was actually through my boss Vance that I was introduced to Sherl Westlund and Nat Caudle from Diabetes Research WA (DRWA) in late 2017. At the time, Sherl and her great team were organising their information night, “Diabetes, where is the cure?” when Sherl contacted me and asked me if I would like to present a talk about my experiences with T1D and diabetes research.

I must admit, I was initially apprehensive as I wasn’t certain that the audience would find me or my experiences very engaging. I was always under the impression that only diabetics cared about diabetes. However, having worked with Vance previously on a DRWA funded project, I felt flattered to do something for DRWA, a local organisation that strongly supports diabetes research. Hence I accepted their invitation.

I was surprised to receive a lot of positive feedback following my talk that night, and I was humbled that the experiences which I discussed managed to move many people in the audience. When I was driving home that night with my husband, he commented that my talk really opened his eyes to what I go through living with T1D, and this is despite the fact that we had been living together for years!

This made me realise the importance of openly discussing T1D and sharing experiences, to link T1D patients with each other and non-diabetics to raise diabetes awareness. As such, I was delighted to act as that link between DRWA and their audience on that particular night, and I hope to do more events with DRWA in future.

Frank: Your husband Joey is going to be participating in a charity fundraiser for Diabetes Research WA later this month. Could you tell us a little about the event, and how we could get involved? 

Caroline: My husband Joey is literally putting his body on the line as he participates in the “100 Fights in 100 Minutes Charity Benefit” on April 28th.

This is an event being hosted by the fantastic owners Noah Greenstone and Ron Amram from Leederville’s Combat Arts Institute of Australia (CAIA), a self defence facility where my husband trains. Noah and Ron are the masters of technique, and it is going to be so enjoyable watching all the competitors on the day.

The charity benefit is essentially a test of endurance, as each competitor participates in 100 friendly rounds of sparring (kick boxing or jiu jitsu) at one minute long each. Funds are raised by sponsoring a fighter for each round they are able to fight. The Institute is hoping to reach its $6,000 target through sponsorship of the fighters.

My husband, being previously motivated by my DRWA talk to support diabetes research, liaised with the owners of CAIA, and I am extremely grateful to Noah and Ron for selecting DRWA as the beneficiary for this fundraiser.

Their decision really excites me, because diabetes research relies on community support to continue. Working in a diabetes research lab, I can see that funds are necessary to promote and develop scientific ideas, and donations from the community are the key to unlock the dream of a diabetes cure into a reality.

So please sponsor my husband Joey Balczer as he literally “fights for a diabetes cure” using this link: http://combatartsinstitute.com.au/100fights2018sponsors/view/form

The event is free to watch, and there will be delicious food trucks on site, so I encourage everybody to attend.

What:
100 Fights in 100 Minutes – Charity Benefit for Diabetes Research WA
Hosted by Combat Arts Institute of Australia

When:
Saturday April 28, 2018, 5.30pm

Where:
341 Oxford Street
Leederville WA 6007

http://combatartsinstitute.com.au/component/k2/item/76-100-fights-100-minutes-2018-perth

Frank: Do you see a cure for type 1 diabetes coming from a particular form of diabetes research? 

Simply answered, the end goal as a diabetes researcher is to find the cure, and as a diabetes patient it is to be cured.

When I was diagnosed in 1989, the Dr told my family that a cure was only “10-15 years away”. As a T1D patient, such claims anger and frustrate me because almost 30 years later, I still have T1D.

However as a diabetes researcher, I see what goes on behind the scenes- the long hours that are put in, the numerous experiments, the lack of funds, government imposed restrictions, the endless paperwork, lengthy clinical trials, etc. Therefore I can appreciate that finding a diabetes cure is a long, tedious, difficult and frustrating process. It literally takes years and years to turn a “lab bench idea” into a clinical trial, and then there is no guarantee that the initial idea will eventuate into a marketable good or service.

It is also crucial to highlight that in order to cure something, we need to fundamentally understand it better. Through research, our grasp on diabetes is constantly improving (just not always at the pace us diabetes patients would like). Incidentally, as technology advances, this will provide researchers and clinicians better ways to test, analyze and understand diabetes, and to use that diabetes knowledge to formulate potential cures.

Consequently, I dont classify one area of research as being more promising than another. It is important to distinguish that given the complexity of diabetes, including multiple environmental and genetic factors, age of diagnosis, and length of disease duration, a future T1D cure may take on many forms. I personally do not believe it will be a “one solution fits all” scenario, but rather, a cure will need to be somewhat personalised, similarly to how we approach current diabetes management options. What works for one person, may not be suitable for another.

I would like to add that finding a way to prevent T1D from developing is as important as ridding the condition entirely once it has developed and I think that this is also an exciting area of diabetes to explore.

Of course, it is difficult to convey these notions with diabetic patients who do not work in the scientific or medical industry, and are exasperated that “nothing is being done”.

Believe me readers, something is definitely being done. Don’t lose hope.

Learning to Fuel My Body with Type 1 Diabetes.

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Trying to stick to a diet of 8,000 kilojoules a day is hard work.

I know that when I do eat enough to sufficiently fuel my very active body, I don’t feel lousy, exhale air or yawn half as often as I’m used to. I have more energy, focus and enthusiasm to pour into my day. In fact, I’m so focussed on getting those kilojoules into my body that I don’t think think about chocolate or even coffee half as often (no, I am not kidding).

I also know that this 8,000 kilojoules a day business is hard work (have I said that already?). Organising meals and snacks takes time out of my day, even though I am more than capable in the kitchen. It’s been very easy for me to slip back into my old habits of existing on rabbit food until dinner time when I haven’t organised myself in the mornings.

I embarked on this new eating-to-fuel-my-body kick at the end of February, rebounded for some part of March after I got sick and the Cadbury Choc Chip Hot Cross Buns kicked in, and am only just getting back on track in the past week or so.

I first learned about eating to meet my daily energy needs after reading The CSIRO Total Wellbeing Diet and The CSIRO Low Carb Diet last year. Despite it all making perfect sense, putting kilojoule counting into practice on top of carb counting, checking blood sugars and all of those other diabetes tasks felt extremely overwhelming. Thankfully, the smartphone app My Fitness Pal made tracking my kilojoule intake really easy.

The biggest change since I’ve began eating more is increased insulin sensitivity. Which I guess is a good thing, right? It started with unusually easy to manage blood sugars in the evenings after dinner. I would then wake up low during the night, have a glucose tab or two, only to wake up low again a few hours later. Fun times, right?

I’ve dropped my basal rates by about 10% overall, and so far, so good. My biggest challenge is continuing to eat this way so that I can maintain the same sensitivity to insulin.

I’m not really focussed on skewing a particular way with protein, fat or carbohydrate, but do find myself eating more protein than I was before. At the moment I’m honestly just focussing on eating enough, eating well and getting a balance of everything in there.

I find myself eating more significant meals for breakfast and lunch, rather than a slice of toast or a toasted ham and cheese sandwich. Like this amazing Sunday roast of pistachio stuffed chicken breast wrapped in prosciutto that has doubled as Monday lunch.

I embarked on this way of eating for more physical reasons, but the benefits seem to have extended into my diabetes as well.

I have more energy and focus in the short term, and I’m hoping that this will only replicate further in the long run (if I can keep it up!). The increased insulin sensitivity is making blood sugar levels much easier to manage. In the past I’d correct stubborn highs with little or no effect, and override the suggested correction on my pump with a larger bolus. Now, a correction seems far more effective than before.

I get that balancing food and blood sugar levels is no easy feat, but I don’t think I ever truly appreciated just why it is so important to eat.

Help Test a New Survey Tool For Women With Diabetes Considering Pregnancy

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Are you a woman with type 1 or type 2 diabetes who may be considering pregnancy in the next 1 to 5 years? My friend and longtime T1D blogger Helen Edwards of Diabetes Can’t Stop Me is looking for some women to help out with her PHD research, and today I’m lending her my blog to share some of the details of this research.

What is the project about?

We are developing a Contemplating Pregnancy in Diabetes Support Tool to determine preparedness for pregnancy. The aim is for the tool to be used by diabetes health care providers with women with type 1 and type 2 diabetes, when contemplating pregnancy within the next 1 – 5 years. Pre-pregnancy counselling can help women in planning their pregnancy. However, lots of women do not attend pre-pregnancy counselling for different reasons. This can include not knowing the importance and usefulness of pre-pregnancy counselling, not having access to this, thinking they already know all they need, or having past negative experiences around pregnancy information. The survey tool aims to help with increasing awareness about the importance of pre-pregnancy counselling and encourage women to attend this when ready to plan a pregnancy.

The survey results would be used to have a discussion about how the health care team can best support the woman to take steps towards planning a pregnancy at some stage in the future. Even if she is unsure if she wants to have a baby one day, it is a useful exercise to find out more about what may be important. The tool would be used in a cycle of care, such as every 6 – 12 months when visiting her doctor or diabetes educator.

What will participants be asked to do?

If you agree to participate in the research we will ask you to do the following:

  • Complete the survey tool online – this will consist of about 40 questions with options for you to respond. It will be around your thoughts and feelings around pregnancy and your diabetes
  • A small number of women will then be invited to participate in a video interview via Skype with Helen Edwards. We will randomly select these women, and invite them to join. If agreed, the questions for the interview will be provided to you prior to the interview, and Helen will then set up a time that suits you to carry out the interview.

How much time will the project take?

We expect the survey to take you no more than 30 – 45 minutes to complete. There are no further requirements unless you are one of a small number of women who are invited for an interview. If so an interview will take about 2 hours and will be conducted online.

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Helen is a longtime T1D and an amazing advocate who has given tirelessly to the diabetes community here in Australia. If you are able to help her to help other people with diabetes, please get in touch at helen.edwards@adelaide.edu.au. And please do spread the word!

A Little Piece of My Mind, HBF Health…

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Since you asked, HBF, here’s a little piece of my mind after visiting your branch yesterday.

“I’m not feeling particularly positive towards HBF given that I am being discriminated against for having type 1 diabetes. It’s a condition that I did not ask for, and already drains me financially, physically and mentally every day of my life.

Upon my visit yesterday I learned that it will now cost me an additional $600 a year to maintain coverage for an insulin pump, a device that significantly improves my quality of life. I don’t feel like HBF truly understand what it’s like to live with a chronic condition like my own.”

While I am yet to make a decision on the direction I will take with my health insurance, I am currently shopping around for the best possible option that will not significantly penalise me for having diabetes.

Four Foods I Cannot Bolus For To Save My Life

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I remember starting off on vague insulin doses of 5 to 10 units at every meal instructed to me by the hospital. Then I saw a diabetes educator, and learned to carb count. Adding up every gram of carb on worksheets supplied by my dietician only led to frustration over why logic was not translating into steady blood sugars. (Of course, little did I know about the gazillion other factors that could affect my blood sugar back then…)

For a few years in the middle, I just swaggered by and thankfully lived to tell the tale.

Fast forward to today where I’m using an insulin pump, carb count nearly everything I eat at home and have a pretty good idea of what most foods that I eat will do to my blood sugars. I know exactly why my blood sugar is high as I’m typing this right now (hello, potato bake with no pre-bolus). Overall, I feel pretty comfortable with being able to eat, give insulin and manage my blood sugar levels today.

That being said, there are still a few select foods that I cannot bolus insulin for if my life depended on it.

Pasta.

If there’s one food that confuses the life out of me, it’s Pasta. You can’t go by what’s on the packet, because most packets only refer to the uncooked weight. Seriously – who in the world eats dry pasta? If you were to make that mistake, I‘d be surprised if you weren’t chugging down litres of coke or making a dash to the emergency room.

Logic tells me that Pasta has around 28% carbs in it. The carb counts in our plates of pasta at home would be huge, because who on earth can only eat 1 cup of pasta? But if I were to give a massive insulin dose for all that carby goodness, I’d be eating glucose tabs for dessert.

All the extended boluses in the world can’t keep me from the Pasta lows, which can only mean that Pasta must be a really really really slowly digested food. These days I tend to settle for bolusing for 50 to 60% of the carbs at the time of the meal, accepting that the remaining 40% of the carbs that have absolutely no effect on my blood sugar whatsoever must be magic.

Soup

If there’s one meal that I despise purely for diabetes reasons, it’s soup. Who on earth can count the carbs in all those lentils, veggies and pastina that have been sitting there in the pot stewing all afternoon?

Then there’s the hassle of attempting to drain all of the liquidy goodness from the soup ladle for the purposes of weighing my plate, and then scooping up only liquid from the pot to add to my dry plate.

Add to this the same principles as pasta – all of those lentils and pastina are really slowly digested and would send me low quite easily. With carb free veggies and meat in the mix, I’ve sort of settled on bolusing for about half the number of carbs I would with Pasta.

Bananas.

Fun fact: I cannot eat a Banana without going low. Which is shit, because I actually happen to like them a lot. I very much look forward to my mid morning coffee and banana, while other times I slice it up to mix in with my Overnight Oats.

Logic tells me that a Banana with skin intact has around 13% carbs in it. But if I were to weigh my banana and bolus that much, I would be low within the hour. I’ve sort of settled on bolusing for around 50 to 60% of the carbs in my bananas, and some days this does the trick while other days it does not.

Steak and chips. Or Pizza. Or any kind of restaurant meal, really…

I have a love hate relationship with pub meals. I love how delicious and mouth watering and salty a steak and chips are, but I absolutely hate the night sweats and resilient high blood sugars that follow in the aftermath.

After learning that restaurant meals tend to be higher in fat to make them more delicious, I tend to set a temporary basal rate increase of 50% on my pump for 8 hours to combat the insulin resistance. I don’t prebolus for anything, given that fat slows down the digestion. I might also bolus for 40 to 50% of the protein in my steak after the meal is over, using a extended bolus over 2 to 3 hours.

Get the insulin in too early, and you go low. Get it in too late, and my blood sugars go up, up, up. It’s definitely a case of hitting the sweet spot.

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Ahh, food and insulin…if only it were as easy as counting the carbs, giving an insulin dose and catching a unicorn 2 hours later.