It's November again! For those new to this blog, that means it's time for me to post one diabetes fact per day, generally something I think is interesting or often ignored by the diabetes community.
Today's fact is that people diagnosed with autoimmune type 1 diabetes at different ages (and it can be diagnosed at almost any age- although autoimmune diabetes diagnoses in people under about six months should be looked at squinty) have really different overall profiles for complication rates as well as for associated conditions that aren't complications.
A person diagnosed at the age of two, compared to one diagnosed at the age of twenty, will on average have a much shorter honeymoon (if he has one at all), has about four times the risk of developing celiac, a much higher risk of leukemia, and if female, ovarian cancer. She has a dramatically lower risk of developing end stage renal failure, and a much lower risk of losing his eyesight from diabetes.
This is extremely important to know because when people talk about trends in diabetes complications, they often compare cohorts with really different ages at onset of diabetes. It's also somewhat important to know because people should always look at the ages at diagnosis in the people in any particular study before they start thinking that the study is relevant to their own risks.
While some of the difference in risk probably has to do with genetics, other parts of it clearly don't, because the difference in complication rate based on age at diagnosis is apparent within families.
Some studies that make me certain that this is factual:
The Risk of Proliferative Retinopathy in Siblings With Type 1 Diabetes, a study of sibling pairs. The younger diagnosed sibling (average age at dx: 8 years) had, after 30 years, a 37% risk of proliferative retinopathy. The older diagnosed siblings (average age at dx: 16 years) had, after 30 years, a 53% risk of proliferative retinopathy..
This study on Mortality in Finnish Type 1 Diabetics compares risks 20 years from diagnosis for people diagnosed above and below the age of 15 (all dx below age 30). I am not entirely certain that it proves my point because it doesn't follow the younger diagnosed people longer, but it does certainly show that, in the 20 years after diagnosis, the causes of death in those diagnosed at different ages are pretty different. For one thing, at least in Finland, alcohol is a major cause of death for those diagnosed in late adolescence/ early adulthood.
Studies that compare the rate of celiac in people diagnosed with diabetes at different ages can be found by clicking the linked words in this sentence. I will admit to cherry picking: I did also find two studies that didn't find a linkage but I consider them small in comparison to the studies that do find a linkage, especially given how strong of a linkage many of these studies found.
A number of studies on kidney disease and type 1 diabetes have shown that being diagnosed young- the younger the better- with some studies not having any diabetic kidney failure in people diagnosed under age 5- is protective against kidney disease, or at least against advanced kidney disease. However, the risks don't keeping going up for older and older ages at diagnosis- those diagnosed as adults are at lower risk than those diagnosed in their teens.
http://www.ncbi.nlm.nih.gov/pubmed/20424230
When age at diagnosis is the same, type 2 diabetics are at much higher risk of kidney disease and failure than type 1 diabetics.
Thursday, November 01, 2012
Friday, October 19, 2012
Must Read Study on Meter Accuracy
http://www.journalofdst.org/September2012/PDF/VOL-6-5-ORG2-FRECKMANN.pdf
This is a comparison of 43 meters, and I think they did a great job. Please check out your meter. I think the biggest surprise on this list was that the Bayer Contour USB performed pretty poorly (it was by no means the worst on the list but it is surprising because it's one of the pricier ones on the list). Bayer Contour USB was within 5% only a third of the time. It was more than 10% off about a third of the time. It was more than 20% off in 4% of tests- which I think is a lot. I mean, if my bg is actually 200, it only would guess between 190-210 a third of the time. And it would guess outside the 160-240 range for 1 in 25 tests. That's a couple times per week if you're a 7x per day tester. The iBGStar did similarly poorly.
Two meters were within 10% on all 200 tests. Those were the Accu Chek Active and the Freestyle Lite. Of the two, the Freestyle Lite was within 5% a larger portion of the time. That means, if your blood sugar was 200, it should tell you a number between 180 and 220 every single time. At least 4 times out of 5, these two would give you a number between 190 and 210. That's pretty good.
The Accu Chek Active is so old that the strips change color depending on your blood sugar, and it takes a 1 microliter blood sample.
The Freestyle lite takes 0.3 microliters and has the modern standard of a 5 second wait time.
The way I see it, if you want to think about what accuracy is okay, corrections are what's most important. I'm gonna correct for the number I see. I need to be pretty sure that the number I see represents a narrow enough range that if I aim for a blood sugar of 110 with my correction, I'm not likely to go lower than 70- that means the range that the bg I see might actually represent would ideally be less than 40. At a blood sugar of 200, a 10% error means a 40 point range in blood sugar possibilities. The meter I use, the Accu Chek Aviva, missed this mark 9% of the time. That's 1 in 11 tests. If you test 7x per day, that's about 4 times per week.
Actually, that's just what their stats suggest. If you look at the graphs, you can see it even better. The accu chek aviva was actually off by more than 40 mg/dl in a few of their tests, and all the tests they did where the Aviva was off by more than 40 mg/dl, the Accu Chek read lower than the real value. This means that there isn't really as much risk of over correcting as I might worry; there's a much bigger risk of undercorrecting.
Bayer Contour, on the other hand, did read more than 40 mg/dl higher than the actual value in multiple instances in the study. The Freestyle Lite had a tendency to read low and didn't once read more than 15 mg/dl higher than the actual value. At very high values it tended to really under read numbers. That's something I'd be comfortable correcting off of. At blood sugars like 300, the iBGStar read more than 60 mg/dl high. Not cool.
There's also a chart in this study about the percentage bias different meters tend to have.
Like I said, a must read. Please click on that link!
This is a comparison of 43 meters, and I think they did a great job. Please check out your meter. I think the biggest surprise on this list was that the Bayer Contour USB performed pretty poorly (it was by no means the worst on the list but it is surprising because it's one of the pricier ones on the list). Bayer Contour USB was within 5% only a third of the time. It was more than 10% off about a third of the time. It was more than 20% off in 4% of tests- which I think is a lot. I mean, if my bg is actually 200, it only would guess between 190-210 a third of the time. And it would guess outside the 160-240 range for 1 in 25 tests. That's a couple times per week if you're a 7x per day tester. The iBGStar did similarly poorly.
Two meters were within 10% on all 200 tests. Those were the Accu Chek Active and the Freestyle Lite. Of the two, the Freestyle Lite was within 5% a larger portion of the time. That means, if your blood sugar was 200, it should tell you a number between 180 and 220 every single time. At least 4 times out of 5, these two would give you a number between 190 and 210. That's pretty good.
The Accu Chek Active is so old that the strips change color depending on your blood sugar, and it takes a 1 microliter blood sample.
The Freestyle lite takes 0.3 microliters and has the modern standard of a 5 second wait time.
The way I see it, if you want to think about what accuracy is okay, corrections are what's most important. I'm gonna correct for the number I see. I need to be pretty sure that the number I see represents a narrow enough range that if I aim for a blood sugar of 110 with my correction, I'm not likely to go lower than 70- that means the range that the bg I see might actually represent would ideally be less than 40. At a blood sugar of 200, a 10% error means a 40 point range in blood sugar possibilities. The meter I use, the Accu Chek Aviva, missed this mark 9% of the time. That's 1 in 11 tests. If you test 7x per day, that's about 4 times per week.
Actually, that's just what their stats suggest. If you look at the graphs, you can see it even better. The accu chek aviva was actually off by more than 40 mg/dl in a few of their tests, and all the tests they did where the Aviva was off by more than 40 mg/dl, the Accu Chek read lower than the real value. This means that there isn't really as much risk of over correcting as I might worry; there's a much bigger risk of undercorrecting.
Bayer Contour, on the other hand, did read more than 40 mg/dl higher than the actual value in multiple instances in the study. The Freestyle Lite had a tendency to read low and didn't once read more than 15 mg/dl higher than the actual value. At very high values it tended to really under read numbers. That's something I'd be comfortable correcting off of. At blood sugars like 300, the iBGStar read more than 60 mg/dl high. Not cool.
There's also a chart in this study about the percentage bias different meters tend to have.
Like I said, a must read. Please click on that link!
Tuesday, October 09, 2012
G4 Platinum
The big news in the US diabetes online stuff is that the FDA approved the Dexcom G4 Platinum. It's shipping now, and I can order one as soon as my warranty on this one is up (in two days). I'll be waiting until I use up my sensors for the 7+ though, 'cause they won't work with the new system, and hoping my 7+ receiver works that long.
I just downloaded and watched the entire G4 Platinum tutorial (ugh) and here's what I learned that I didn't get from just looking at the press release and website:
- It is still only approved for belly sites, still has a problem with acetominophen, sensors still have the same storage recommendations, still can only be calibrated in the 40-400 mg/dl range (I am in the 30s often enough to be annoyed by this), still need to be calibrated every 12 hours, have a 2 hour warm up, and want two readings at that point, and still continue to provide readings if you miss a 12 hour calibration point. It also still has a 55 mg/dl low alarm you can't turn off, and still vibrates before beeping no matter how you set the alarms.
The transmitter is now expected to die after 6 months. Minimed has a transmitter it warranties for only 6 months and the 7+ transmitter is warrantied for a year; for me that was one of the selling points of Dexcom. But the tutorial says the transmitter will last roughly 6 months and that the receiver will give you a warning that your transmitter battery is dying, after which the transmitter is expected to last only one more week.
The range is now advertised to be 20 feet rather than 5 feet. Which is great, but apparently that 20 feet thing is only when you're out of water. Which means it might not help me in the swimming pool. It is still true that the sensor and transmitter (when attached to a sensor) are waterproof but the receiver is not even splash resistant.
Although the website says (in the for professionals section) that you can calibrate no matter how fast blood sugar is changing, in the tutorial it says not to calibrate when blood sugar is changing at a rate of 2 mg/dl/min or more. Since mine is doing that what feels like most of the time, that's an issue.
While watching the set up thing in the tutorial, I noticed that the settings for the low alert now offers an option of a low alert at 85 mg/dl (currently Dexcom only offers these low alert options: OFF, 60 mg/dl, 70 mg/dl, 80 mg/dl, 90 mg/dl, and 100 mg/dl). Hopefully this means that there are now more options to choose from for both high and low alerts.
For alert settings, there are now alert "profiles". Rather than being able to individually set each alarm to off, vibrate only, or vibrate then beep, you now choose from one of five profiles, which are: Vibrate only, Alarm Softly, Normal, Loud (they have a special name for loud), and Hypo Repeat (which is Normal, except the hypo alarms get louder and louder). You'll notice there doesn't seem to be an off option. Except for the fact that there's a loud option (which it desperately needs) this does not strike me as much of an improvement.
The sensor looks the same. My guess is that it's really only different by the way that the transmitter attaches, because the transmitter is shaped slightly differently.
So now, I have a few questions in my mind.
Question one is, what if my Dexcom 7+ receiver, which is almost out of warranty, breaks before I use up my remaining sensors (which will be in roughly 6 weeks)? Will I be able to pay for a new 7+ receiver without having to pay the $400 upgrade price (which is what is being charged if you bought a 7+ system before September 2012 and want to upgrade).
Question two: There are three color options, pink, blue, and black. The pink doesn't look real macho. Should I get blue or black?
Question three: So, say my G4 transmitter dies. Will insurance really pay for two transmitters per year? Will Dexcom really replace it for a reasonable price?
Question four: Is the system really as basic as it looks in the training video???
I just downloaded and watched the entire G4 Platinum tutorial (ugh) and here's what I learned that I didn't get from just looking at the press release and website:
- It is still only approved for belly sites, still has a problem with acetominophen, sensors still have the same storage recommendations, still can only be calibrated in the 40-400 mg/dl range (I am in the 30s often enough to be annoyed by this), still need to be calibrated every 12 hours, have a 2 hour warm up, and want two readings at that point, and still continue to provide readings if you miss a 12 hour calibration point. It also still has a 55 mg/dl low alarm you can't turn off, and still vibrates before beeping no matter how you set the alarms.
The transmitter is now expected to die after 6 months. Minimed has a transmitter it warranties for only 6 months and the 7+ transmitter is warrantied for a year; for me that was one of the selling points of Dexcom. But the tutorial says the transmitter will last roughly 6 months and that the receiver will give you a warning that your transmitter battery is dying, after which the transmitter is expected to last only one more week.
The range is now advertised to be 20 feet rather than 5 feet. Which is great, but apparently that 20 feet thing is only when you're out of water. Which means it might not help me in the swimming pool. It is still true that the sensor and transmitter (when attached to a sensor) are waterproof but the receiver is not even splash resistant.
Although the website says (in the for professionals section) that you can calibrate no matter how fast blood sugar is changing, in the tutorial it says not to calibrate when blood sugar is changing at a rate of 2 mg/dl/min or more. Since mine is doing that what feels like most of the time, that's an issue.
While watching the set up thing in the tutorial, I noticed that the settings for the low alert now offers an option of a low alert at 85 mg/dl (currently Dexcom only offers these low alert options: OFF, 60 mg/dl, 70 mg/dl, 80 mg/dl, 90 mg/dl, and 100 mg/dl). Hopefully this means that there are now more options to choose from for both high and low alerts.
For alert settings, there are now alert "profiles". Rather than being able to individually set each alarm to off, vibrate only, or vibrate then beep, you now choose from one of five profiles, which are: Vibrate only, Alarm Softly, Normal, Loud (they have a special name for loud), and Hypo Repeat (which is Normal, except the hypo alarms get louder and louder). You'll notice there doesn't seem to be an off option. Except for the fact that there's a loud option (which it desperately needs) this does not strike me as much of an improvement.
The sensor looks the same. My guess is that it's really only different by the way that the transmitter attaches, because the transmitter is shaped slightly differently.
So now, I have a few questions in my mind.
Question one is, what if my Dexcom 7+ receiver, which is almost out of warranty, breaks before I use up my remaining sensors (which will be in roughly 6 weeks)? Will I be able to pay for a new 7+ receiver without having to pay the $400 upgrade price (which is what is being charged if you bought a 7+ system before September 2012 and want to upgrade).
Question two: There are three color options, pink, blue, and black. The pink doesn't look real macho. Should I get blue or black?
Question three: So, say my G4 transmitter dies. Will insurance really pay for two transmitters per year? Will Dexcom really replace it for a reasonable price?
Question four: Is the system really as basic as it looks in the training video???
Friday, October 05, 2012
Thursday, October 04, 2012
That ADA Ad
... the one that says Diabetes Kills More than AIDS and Breast Cancer Combined! is showing up on practically every webpage I visit right now and it's bugging me.
Numerically speaking in the United States, diabetes is listed on more death certificates than AIDS or breast cancer, neither of which is a big killer. But diabetes isn't even close to being a bigger killer in terms of "years lost", because people dying of diabetes are on average 73. People dying of HIV and breast cancer account for more years lost as computed by the CDC because they are substantially younger than people dying of diabetes.
But even if that weren't the case I don't like that ad.
Numerically speaking in the United States, diabetes is listed on more death certificates than AIDS or breast cancer, neither of which is a big killer. But diabetes isn't even close to being a bigger killer in terms of "years lost", because people dying of diabetes are on average 73. People dying of HIV and breast cancer account for more years lost as computed by the CDC because they are substantially younger than people dying of diabetes.
But even if that weren't the case I don't like that ad.
Wednesday, October 03, 2012
I just got my flu vaccine
and if you're reading this blog, you should too.
Vaccines are not totally effective at preventing disease (any disease) because not everybody's immune system will respond. To protect the people with the weakest immune systems, everybody who comes into contact with them needs to be vaccinated. That means you.
This has been a public service announcement from Jonah.
What the CDC wants you to know about diabetes and influenza: http://www.cdc.gov/flu/diabetes/index.htm
Evidence that diabetes is a risk factor for flu infections severe enough for hospitalization:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890346/ (9 out of 162 people hospitalized for swine flu had type 1 diabetes in this one hospital study- I don't have to tell you that 9/162 is way more diabetics than you'll find in the general population)
What the ADA has to say: http://care.diabetesjournals.org/content/27/suppl_1/s111.full
Vaccines are not totally effective at preventing disease (any disease) because not everybody's immune system will respond. To protect the people with the weakest immune systems, everybody who comes into contact with them needs to be vaccinated. That means you.
This has been a public service announcement from Jonah.
What the CDC wants you to know about diabetes and influenza: http://www.cdc.gov/flu/diabetes/index.htm
Evidence that diabetes is a risk factor for flu infections severe enough for hospitalization:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890346/ (9 out of 162 people hospitalized for swine flu had type 1 diabetes in this one hospital study- I don't have to tell you that 9/162 is way more diabetics than you'll find in the general population)
What the ADA has to say: http://care.diabetesjournals.org/content/27/suppl_1/s111.full
Monday, September 24, 2012
Dexcom
On September 2nd, I left my Dexcom receiver on the el. No worries, I got it back... on September 12th. In the meantime I did a lot of worrying. I called the lost and found about four times before they said they had it. I called Dexcom to ask how much a replacement receiver would cost. The answer was: $199 for a receiver as long as I have one in warranty, which means that if I want to buy one for whatever reason (lost, backup) I can do that by October 11th. If I want to do it later than that, too bad, out of warranty, must buy new system. I'm trying to figure out if I should do that (or even just send this one back on grounds that its broken because the backlight, which I didn't like anyways, no longer works). I'd read some rumors that the Dex G4 was coming out in the US in December, but the person on the phone said they'd just submitted to the FDA and I shouldn't count on it. However, I'm hopeful anyways that it will be out by the time I next need to order a new system.
It's These Kinds of Weeks That Make Me Wonder
According to my Dexcom data, in the last seven days, my blood sugar has been below 200 mg/dl 97% of the time. I haven't had a real low (I've been down to 58 and no lower). My average for the week is 124. My standard deviation for the week is 36. I stayed below 200 on five days.
Over the last three months, I've spent only 90% of the time below 200, and have been above 200 about 5 days per week. My average is 134, I spend 3% of the time above 240, I go below 55 on the majority of days, and my standard deviation is 48.
That means that this week, my rate of the kind of hyperglycemia that gets you warned about ketones- numbers above 240- has fallen from being something I experience for an average of 45 minutes per day, to none. My rate of real hypoglycemia (below 55, say), fell from being something I experience for an average of half an hour per day, to none. The amount of time I spend in the 80-200 range went from 80% to 91%. My average fell ten points.
Did I do anything differently? Nope.
By the way, the title says "these kinds of weeks" but the last one as good as this was probably September 2011.
Over the last three months, I've spent only 90% of the time below 200, and have been above 200 about 5 days per week. My average is 134, I spend 3% of the time above 240, I go below 55 on the majority of days, and my standard deviation is 48.
That means that this week, my rate of the kind of hyperglycemia that gets you warned about ketones- numbers above 240- has fallen from being something I experience for an average of 45 minutes per day, to none. My rate of real hypoglycemia (below 55, say), fell from being something I experience for an average of half an hour per day, to none. The amount of time I spend in the 80-200 range went from 80% to 91%. My average fell ten points.
Did I do anything differently? Nope.
By the way, the title says "these kinds of weeks" but the last one as good as this was probably September 2011.
Sunday, September 16, 2012
Complete (if vague) 1 week food log (does not include water)
Sunday, breakfast:
1 1/2 cups soymilk (365 brand, "normal", sweetened)
1 tbsp Brewer's yeast
1 cup honey bunches of oats, honey roasted flavor (cereal)
1 small banana (I estimated it at 15 grams of carbs)
Sunday, midmorning:
25 jelly beans
Sunday, lunch:
pizza bread (basically white bread with tomato sauce, onions, mushrooms, and olives)
Sunday, while out walking:
granola bar (Nature Valley, Oats n' Honey flavor)
Sunday, supper:
Garlic bread (three types of bread with lots of garlic and some oil)
more jelly beans
Monday, breakfast
lentils with bits of sweet potato, onion
spelt noodles
little bit of bread
Monday, early lunch
lentils with bits of sweet potato, onion,
spelt noodles
Monday, later lunch
1 cup unsweetened Edensoy (this is actually the stuff Bernstein recommends drinking but I drank it even before I read his book, because my mother likes it)
2 tbsp Brewer's Yeast
extremely thin slice of pizza bread, with hummus
Monday, hypotime
1/3 cup applesauce
1 dum dum
Monday, still not suppertime
1/2 cup tomato juice, RubyKist brand
Monday, suppertime
1 large white potato (boiled) with lentil dish
Monday, bedtime
2 dum dums
Tuesday breakfast
1 microwaved red potato (raw weight 120 grams)
1 cup unsweetened soy milk
Tuesday lunch
1 packet of instant oatmeal- raisin and walnut flavor
Tuesday afternoon
1 big gulp honey
1 dum dum
Tuesday on the way home
1 dum dum
Tuesday late afternoon snack
1 bowl stir fried vegetables- onion, eggplant, zucchini, cauliflour with soy sauce
about 1/4 cup sticky rice
boiled cabbage
Tuesday suppertime
Roasted and salted sunflower seeds
More stir fry- onion, eggplant, zuchhini, cauliflour with Brewer's Yeast
1 cup rice
1 cup soymilk- vanilla slightly sweetened (365 brand)
1/8 cup cereal- granola
handful of popcorn, no toppings
Tuesday bedtime
one baked potato, larger than the morning's
honey
2 dum dums
Tuesday later
honey
Wednesday pre-prayers
unsweetened Silk with tomato juice
Wednesday breakfast
vanilla soymilk with shredded wheat and BreKewer's Yeast
roasted unsalted, already shelled, sunflower seeds
Wednesday on the way to work (roughly lunchtime):
16 tea biscuits (3 grams CHO each)
1 sandwich (2 pieces of 1/2 whole wheat bread, about 1 tbsp peanut butter- the kind that's nothing but roasted peanuts, and 1 small tomato)
Wednesday when I got home:
soymilk with multigrain cheerios
Wednesday supper:
soymilk with Kellogg's Crunchy Nut Golden Honey Nut cereal (it tasted like peanut brittle)
stir fry (cauliflower, eggplant, onion, and zucchini) with rice and with Newman's tomato sauce
Thursday before prayers:
1/4 cup vanilla soymilk (I mixed it with water)
Thursday brunch:
grits with raisins (a lot of it)
Thursday early afternoon:
chocolate wafers
Thursday late afternoon:
Stew- eggplant, flax, zucchini, carrot, onion, garbanzo beans
Thursday evening:
Cooking water and some lentils left over after cooking a pot of lentils for a house of mourning.
2 dried apricots
Friday breakfast:
Unsweetened Silk Soymilk, Brewer's yeast, and toasted oats cereal
Friday at work:
gulp of honey
Friday lunch:
one packet instant oatmeal, raisins and walnut flavor
2 rice cakes
Friday afternoon snack:
2 rice cakes
chocolate wafers
Sometime on the sabbath:
three types of soymilk, flaxmilk
boiled potatoes
some kind of stew with lentils and spinach
borsht- mostly beets but also some celery and onions
tea biscuits
2 medjool dates (these are supposed to raise blood sugar really fast but I have never noticed them actually doing this)
bread
broccoli
hummus
soy hotdogs
wheat germ
half of a zucchini muffin
two types of breakfast cereal
breaded eggplant sticks (they look like fishsticks)
semi sweet chocolate chips
apple juice (we somehow forgot to buy grape juice)
roasted sunflower seeds
one pear (juicy and ripe)
soy "sour cream" (this tastes absolutely nothing like I remember sour cream but my mother makes it from tofu about once a month and claims it's sour cream. It tastes more like kefir.)
Saturday evening:
one dum dum
one small baked potato
three rice cakes
another small baked potato
1 1/2 cups soymilk (365 brand, "normal", sweetened)
1 tbsp Brewer's yeast
1 cup honey bunches of oats, honey roasted flavor (cereal)
1 small banana (I estimated it at 15 grams of carbs)
Sunday, midmorning:
25 jelly beans
Sunday, lunch:
pizza bread (basically white bread with tomato sauce, onions, mushrooms, and olives)
Sunday, while out walking:
granola bar (Nature Valley, Oats n' Honey flavor)
Sunday, supper:
Garlic bread (three types of bread with lots of garlic and some oil)
more jelly beans
Monday, breakfast
lentils with bits of sweet potato, onion
spelt noodles
little bit of bread
Monday, early lunch
lentils with bits of sweet potato, onion,
spelt noodles
Monday, later lunch
1 cup unsweetened Edensoy (this is actually the stuff Bernstein recommends drinking but I drank it even before I read his book, because my mother likes it)
2 tbsp Brewer's Yeast
extremely thin slice of pizza bread, with hummus
Monday, hypotime
1/3 cup applesauce
1 dum dum
Monday, still not suppertime
1/2 cup tomato juice, RubyKist brand
Monday, suppertime
1 large white potato (boiled) with lentil dish
Monday, bedtime
2 dum dums
Tuesday breakfast
1 microwaved red potato (raw weight 120 grams)
1 cup unsweetened soy milk
Tuesday lunch
1 packet of instant oatmeal- raisin and walnut flavor
Tuesday afternoon
1 big gulp honey
1 dum dum
Tuesday on the way home
1 dum dum
Tuesday late afternoon snack
1 bowl stir fried vegetables- onion, eggplant, zucchini, cauliflour with soy sauce
about 1/4 cup sticky rice
boiled cabbage
Tuesday suppertime
Roasted and salted sunflower seeds
More stir fry- onion, eggplant, zuchhini, cauliflour with Brewer's Yeast
1 cup rice
1 cup soymilk- vanilla slightly sweetened (365 brand)
1/8 cup cereal- granola
handful of popcorn, no toppings
Tuesday bedtime
one baked potato, larger than the morning's
honey
2 dum dums
Tuesday later
honey
Wednesday pre-prayers
unsweetened Silk with tomato juice
Wednesday breakfast
vanilla soymilk with shredded wheat and BreKewer's Yeast
roasted unsalted, already shelled, sunflower seeds
Wednesday on the way to work (roughly lunchtime):
16 tea biscuits (3 grams CHO each)
1 sandwich (2 pieces of 1/2 whole wheat bread, about 1 tbsp peanut butter- the kind that's nothing but roasted peanuts, and 1 small tomato)
Wednesday when I got home:
soymilk with multigrain cheerios
Wednesday supper:
soymilk with Kellogg's Crunchy Nut Golden Honey Nut cereal (it tasted like peanut brittle)
stir fry (cauliflower, eggplant, onion, and zucchini) with rice and with Newman's tomato sauce
Thursday before prayers:
1/4 cup vanilla soymilk (I mixed it with water)
Thursday brunch:
grits with raisins (a lot of it)
Thursday early afternoon:
chocolate wafers
Thursday late afternoon:
Stew- eggplant, flax, zucchini, carrot, onion, garbanzo beans
Thursday evening:
Cooking water and some lentils left over after cooking a pot of lentils for a house of mourning.
2 dried apricots
Friday breakfast:
Unsweetened Silk Soymilk, Brewer's yeast, and toasted oats cereal
Friday at work:
gulp of honey
Friday lunch:
one packet instant oatmeal, raisins and walnut flavor
2 rice cakes
Friday afternoon snack:
2 rice cakes
chocolate wafers
Sometime on the sabbath:
three types of soymilk, flaxmilk
boiled potatoes
some kind of stew with lentils and spinach
borsht- mostly beets but also some celery and onions
tea biscuits
2 medjool dates (these are supposed to raise blood sugar really fast but I have never noticed them actually doing this)
bread
broccoli
hummus
soy hotdogs
wheat germ
half of a zucchini muffin
two types of breakfast cereal
breaded eggplant sticks (they look like fishsticks)
semi sweet chocolate chips
apple juice (we somehow forgot to buy grape juice)
roasted sunflower seeds
one pear (juicy and ripe)
soy "sour cream" (this tastes absolutely nothing like I remember sour cream but my mother makes it from tofu about once a month and claims it's sour cream. It tastes more like kefir.)
Saturday evening:
one dum dum
one small baked potato
three rice cakes
another small baked potato
Wednesday, September 05, 2012
Research idea
I've been thinking for a while about the internet being a vast source of information, but how a lot of the information that I want isn't available. And I keep thinking, what if a hundred or two hundred diabetics decided to get together and submit their own questions and data to each other and monitor it for years and then share it.
I think the project would go like this:
First of all, the people I want data on are people who are or have been on insulin for a significant amount of time. I'm going to say 10% of your life. I also want people who are going to be available for follow up, so people participating have to be volunteering their own data, not their kids'. And they have to commit to continuing to participate, and that means also giving me or somebody else their name to find an obituary if they die. So that's the inclusion criteria.
I then would need a whole lot of people to volunteer, in order to collect much meaningful data. Like I said, I'm thinking at least 100. Each person joining would need to submit their contact information, some statement to the effect that they want to join, and if they want to, would have the option of submitting the question(s) that they want the other people to be asked. The questions should be quantifiable type questions- not, "How did you feel?" but "Have you seen a therapist?" or "Have you been depressed?" not, how does your skin look, but "Do you have scar tissue at your injection sites?"
Then at some point we'd start the study, and probably for anonymity, assign or ask for a code name or number for each participant. Send out all the questions that everybody's submitted. Everybody returns the survey, with somebody badgering them until they do. Publically shared is the percentage answering each question in different ways, and maybe some large analysis; private to the members are any linkages that anybody asks for. For example, a participant might ask, of people who answered X1 to question number 14, how many answered Z1 to question 23? Of people who answered X2 to question number 14, how many answered Z1 to question 23?s
We would send out the same group of questions to the participants every year, except for questions like when did you go on insulin and how old are you. Participants would continue to be able to ask for linkage on past questions. For example, of people who answered Z2 to question 23 in the first year, but answered Z1 later, how many answered question 14 with X1 the first year?
Some questions I'd hope a study like this might answer are: what factors change the risk of lipodystrophy? What factors change the risk of scarring? How prevalent is lipodystrophy?
What questions would you want answered?
I think the project would go like this:
First of all, the people I want data on are people who are or have been on insulin for a significant amount of time. I'm going to say 10% of your life. I also want people who are going to be available for follow up, so people participating have to be volunteering their own data, not their kids'. And they have to commit to continuing to participate, and that means also giving me or somebody else their name to find an obituary if they die. So that's the inclusion criteria.
I then would need a whole lot of people to volunteer, in order to collect much meaningful data. Like I said, I'm thinking at least 100. Each person joining would need to submit their contact information, some statement to the effect that they want to join, and if they want to, would have the option of submitting the question(s) that they want the other people to be asked. The questions should be quantifiable type questions- not, "How did you feel?" but "Have you seen a therapist?" or "Have you been depressed?" not, how does your skin look, but "Do you have scar tissue at your injection sites?"
Then at some point we'd start the study, and probably for anonymity, assign or ask for a code name or number for each participant. Send out all the questions that everybody's submitted. Everybody returns the survey, with somebody badgering them until they do. Publically shared is the percentage answering each question in different ways, and maybe some large analysis; private to the members are any linkages that anybody asks for. For example, a participant might ask, of people who answered X1 to question number 14, how many answered Z1 to question 23? Of people who answered X2 to question number 14, how many answered Z1 to question 23?s
We would send out the same group of questions to the participants every year, except for questions like when did you go on insulin and how old are you. Participants would continue to be able to ask for linkage on past questions. For example, of people who answered Z2 to question 23 in the first year, but answered Z1 later, how many answered question 14 with X1 the first year?
Some questions I'd hope a study like this might answer are: what factors change the risk of lipodystrophy? What factors change the risk of scarring? How prevalent is lipodystrophy?
What questions would you want answered?
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