Insights into my personal life.

This blog includes the personal details of my experiences as a recently diagnosed Type I diabetic and the impact of that diagnosis on my endurance athletic pursuits.

Please understand that I consider myself to be a work in progress. I am willing to share both my successes and failures, so please do not take my words to be professional dietary or medical advice. This is a blog, this is only a blog. I research my choices carefully, and take my health very seriously. The choices I make are my own, I am doing the best with the resources and support that I have. If you have questions or concerns feel free to comment, but please be constructive and understand that this is my life. I value it dearly.

My goal is to live a happy, healthy and active life where I can balance my internal drive to push my physical limits and the challenge of safely maintaining stability despite the challenges of Type I diabetes.

Wednesday, November 12, 2014

The burden of diabetes?

Burden is such a negative word, however the daily burden of diabetes care is not the part of diabetes that I want to talk about.  The burden of diabetes I'd like to discuss is the burden of proof required to make a consensus decision that nutritional therapy is the most powerful intervention available.

Diabetes is expensive.  I'd like to rant on that topic for a moment since I believe that the cost of the disease, both personal and systemic, are related to the larger burden on the evidence of proof required for organizations such as the ADA to prioritize the most powerful intervention (a low carb diet) as the standard of care for diabetics.  That is a burden.

Diabetes is physical burden, but the fact that following a low carb or even a ketogenic diet as I have to manage my diabetes is at odds with the established (and failing) convention adds to my mental burden.

[To reinforce this point on the burden of diabetes, my OmniPod insulin pump just went to the flat-line tone indicating that I need to do an equipment change at this very moment....  break to change Pod].  

...And I'm back.  Diabetes can definitely interrupt your life, but it can also suck you dry.  Even with the best insurance I could afford, I just paid $250 for 3 months worth of test strips and another $100 for 50 days worth of insulin.  That's on top of the $400 for a 3 month supply of the actual insulin pump's pods need that I stick to my body but am required to replace every 80 hours.  Then there is the adhesive enhancers, tape, alcohol wipes, lancet needles (which every diabetic should replace more often), batteries. 

I don't want to get too distracted by my rant of the personal financial challenge, but I'm as frugal as I can be with my diabetic expenses.  Why my insurance doesn't cover more is a topic for another morning, but when you value your health to the same degree as I do, it's easy to justify expenses in your own well being.  It's unfortunate that those "medical expenses" take away from the part of my budget dedicated to the intervention that has the greatest positive influence on my health (food), and will reduce my risk of supposedly inevitable diabetic complications.  Those complications would then spiral off into new realms of expenses.  How much is an open-heart surgery these days?  $40,000?  A hospitalization for diabetic ketoacidosis, which is a condition where a diabetic can go into a coma as a result of high blood sugar that can happen while following an ADA style diet).  I'm sure that stay wouldn't be cheap.  In a perfect would, my insurance would be paying 80% of my grocery bill enabling me to source the highest quality food.  I know I can eat a lot, and at times I could have expensive taste - but it would be nowhere near the cost to my insurance company of covering the cost of the pharmaceuticals involved with diabetes.  This argument is even stronger in the case of type 2 diabetics, which are an rapidly growing group suffering from a disease that can be reversed in most cases with early detection and nutritional intervention.  (rant over...for now)

So here I am, a very motivated diabetic... I've figured out how to manage my blood sugar numbers with a precise standard of "tight control" with a nutritional intervention.  But because the ADA was on the wrong path regarding their understanding of low-carb intervention, they have been slow to make the announcement that a low carbohydrate diet is an acceptable (excellent in my opinion) for of intervention for weight loss for up to 2 years.  

Why 2 years?  Because that's how long the 2 year study proves the intervention works.  You can assume if the study goes 3 years then the ADA would be able to recommend 3.  Sounds reasonable when you are adhering to evidence based standards.  That's actually ironic. There was very little evidence supporting the ADA recommended low-fat way of eating.  Now there is a burdon of proof to prove that a nutritional intervention works.  I have my own anecdotal evidence.  I've been diabetic for almost 2 years and I have been able to achieve an A1C of 5.1% which places my blood sugar control below the diabetic range.

My 5.1% is average for an average non-diabetic person.  But among type 1 diabetics, my achievement of a 5.1 is a 3 sigma event, which means it's 3 standard deviations from the norm.  To brush off your statistics knowledge, 1 standard deviation puts you in the 67th percental.  2 sigma is 97 percent.  3 sigma?  99.9th percentile.  That's right, I've won the lottery!  What is my prize?... health. I am happy and grateful for my health.  Health is a prize and it is worth pursuing.  The same health the average American takes for granted, but that's not you, right?

I've achieved diabetic control better than 999 out of a 1000 diabetics?  In two years?  In college I was only a B+ student.  In soccer I made it to All-conference, but never All-State, or All-American.  In triathlon I was happy to finish in the top 10% of the field.  I dedicated decades of my life to those pursuits, why am I so exceptional with diabetes after only 2 years?  There are incredibly diligent diabetics out there with years of experience who assuredly care about their health as much as I do.  But it's rare to see an A1C under 6%, an in all actuality, most doctors would reprimand a type 1 diabetic for pursing an A1C less than 6 because of the underlying assumption (based on the blood sugar variability typical of a high carb ADA diet), that tight control leads to severe hypoglycemic episodes....  an issue that I am yet to experience.  I've never been surprised by a low.  Never had a low I couldn't treat myself.  So why am I so good?  It's not ability.  It's not talent.  It's simple.  It's food.  A very low carbohydrate approach should be the first approach.  It was for me.

It is my own decision to not wait for the burden of proof.  Large organizations like the American Diabetes Association and the American Heart Association are like big ships that take too long to turn around.  Diabetes and Heart Disease are icebergs near on the horizon.  The ship started turning last year.  If that ship is like most medical knowledge it will take another 15 years before those ships end up on a better path.   

I'm enjoying this analogy. Consider me man-overboard. I have chosen my own path. Luckily, I am a strong swimmer.

For more information from respected MD's and PhD researchers who are blazing this path well ahead of the curve, please check out the most current research from Feinman et al., in journal Nutrition.  This article discusses the unfair burden faced before conventional medicine will fully support and endor

Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base

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