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Posts tagged ‘Seattle’

Highlights from CWD Technology Conference in Seattle

I went to the CWD Focus on Technology conference in Seattle last weekend and floated away in a hazy cloud of hope. It’s true – only smart, hilarious, beautiful people live with T1, and meeting so many in one place at one time was incredible.

Three talks hit on the main issues we struggle with most of all right now: meal spikes, sleep, and sanity.

Strike the spike! 
This was Gary Scheiner’s session on getting mealtime spikes under control (his Type 1 University offers this course online). It was a great sanity check, and using one of the techniques the next morning made breakfast a lot less grisly.

Causes behind meal spikes (i.e. “We’re pre-bolusing big time, so why the f*#& are BGs still screaming sky-high afterwards?”)
* Synthetic insulin still isn’t rapid enough to keep up with most food digestion, except for really low GI foods.
* Type 1 diabetics digest food faster than people with functioning pancreases – so again, the insulin is too slow to keep up. Kids digest food even faster – hence the nasty spikes.
* How cruel is this? – the pancreas in T1 diabetes produces glucagon when it’s least needed, right after meals, adding to the spike.
* Lows before a meal accelerate emptying of the stomach, which means the meal spike will hit even harder.
* Breakfast spikes are the worst, partly due to not having much insulin in circulation from nighttime basals. At lunch and dinner, basals are higher and there’s usually extra insulin in circulation from earlier snacks or corrections.

Recommended post-meal targets:
* Kids under 5: Under 250
* School age kids: Under 220
* Teens: Under 200

We hit these targets less than 10% of time, and a Yale blind study on peaks found the average after breakfast was 293, after lunch was 291, and after dinner 280 (yay, we’re normal!). Doctors, seeing the spikes, often recommend a lower carb ratio – which just causes a crash after the meal.

What to do?
* For older kids, Symlin (off-label) or amylin.
* Bolus for the entire meal up front, but split it and eat the second half an hour or so later. (This worked on Luke – we held off on milk, the worst offender, until he was in the car for the commute to pre-school, and the spike was very gentle.)
* Use physical activity after the meal to speed up insulin absorption and slow digestion (could be something as gentle as walking the dog).
* If a low before the meal is causing a rebound, use a temp basal for 2-3 hours.
* Protein, fat, and fiber help by slowing digestion (low GI foods), as does vinegar. 2t of vinegar have a fatty acid that slows gastric emptying and can lower spikes by 50 points. Sourdough bread, strangely, is low GI due to the this acidity.
* Consider avoiding pure protein, because protein by itself raises blood sugar (on average, half of protein grams turns into carbs, but hard to predict). Having a few carbs with it prevents conversion.

He wasn’t a fan of pre-loading morning basals to blunt the spike, since you’re then locked into a certain time and # of carbs.

Is it Safe to Sleep at Night? (Bruce Buckingham)

The answer, in short (recent JDRF ad aside), was “yes.” Based on many blind studies, it seems it takes 3-5 hours at or below 50 to cause a siezure. So a sensor lag of 5 minutes is not an issue – hypo minimizer trials at Stanford had proven effective and safe without causing hyperglycemia.
I approached Dr. Buckingham after his talk to ask – is it sane for us to be up as much as we are at night, with a T1D 3-year-old? “Oh,” his face fell. “The little ones are so volatile.” Sigh. Which led me to the keeping-your-sanity session –

It’s Not Just a Numbers Game (Joe Solowiejczyk)

This was the first time I’d heard Joe speak, and I laughed so hard I cried through most of his talk. If you haven’t heard him, check out his presentation on CWD!

He talked about finding balance between giving yourself a break (like scheduling “diabetes depression days”)   and making care a non-negotiable with kids.

“What do you say when they say they don’t want to test, because it hurts?” one parent asked. “Of course it hurts!” he bellowed in a thick Long Island accent. “If you enjoy this, you’re sick, and you need help! But they need to do it. They need to test, write down their BGs, and take their boluses.”

“How do you respond to the teenage ‘You just don’t get it?'” another parent asked.  “Don’t make the mistake of treating her as a rational human,” Joe shot back, “She is not! You don’t need her good housekeeping seal of approval! You say, you’re right, my darling, I don’t, and I don’t care.”

He wasn’t a complete hard-ass either, though. Other suggestions for helping kids deal included driving over their (back-up) glucose meter in front of them and saying, “Wow, that felt good!”; praising them for having a meltdown about diabetes (feeling safe enough to do so); and the hardest – ff your kid worries, don’t tell him not to worry. Tell him hoe brave he is, and that sometimes you worry, too. Allow kids to have their feelings, but don’t try to fix it. Just be there for them. That’s the hardest and easiest part of parenting a kid with T1D.


JDRF Seattle Sweden Diabetes Day – Sept. 24

This sounds bland but is a really fantastic opportunity to hear about the latest in T1 research nationally and internationally. If you live in Puget Sound, sign up now!

JDRF puts this on every year and pulls in top researchers, CDEs, pump and CGM reps, and other experts. Last year’s line-up included updates on the artificial pancreas; best practices for diabetes management by Ragnar Hanas (author of Type 1 Diabetes – best book I’ve read on T1 management); a joint US/Sweden epidemiological analysis of T1 increase, prevalence, etc.; future Medtronic plans; a keynote by Jeffrey Brewer (the man is an incredible speaker) on JDRF’s future direction; and I’ll just stop here. It was amazing.

There’s time for Q&A with each talk as well. My favorite question was from a woman who noted that beta cell count increases during pregnancy, so – aside from encouraging her 18 year old daughter to get pregnant, what other options were out there for increasing beta cells…?

Register here.

JDRF NW got a larger room this year so more can attend (it filled up immediately last year) – it’s again at the Microsoft Commons on the Microsoft campus in Redmond.   There will be on-site care (Kids Zone): contact the JDRF Northwest Chapter office at or call 206-838-5153.

A Glimpse of the Future – local Artificial Pancreas study

After hearing about how promising artificial pancreas trials have been, I was very excited to hear a talk here in Seattle by Dr. Mauseth, a Puget Sound pediatric endocrinologist, about results from his trial (with Dr. Carla Greenbaum) using fuzzy logic as the brain behind the dosing decisions. He was turned on to fuzzy logic by a couple of Boeing engineers who instantly saw a parallel between fuzzy logic used to help plans with takeoffs and landings and its potential to help control blood sugar ups and downs. (I’m always amazed at how quickly engineers – whether software or other – grasp the challenges of managing type 1.) Fuzzy logic is promising, because rather than trying to create an absolutely correct, predictable mapping of an individual’s blood sugar variations (which is like trying to predict the weather with complete precision), it treats everything as a matter of degree, as part of a spectrum. Rather than relying on an absolutely precise blood sugar reading from a CGM (nowhere near close yet!), it looks at blood sugar trends and steepness: if blood sugar is falling quickly, fuzzy logic tells the pump to ease up on or suspend insulin, etc. This isn’t too different from what we do now with our CGM – if it’s double arrows straight down, even at 200, we start pulling out the graham crackers.

I’d assumed that these artificial pancreas trials must be using secret Bat Cave prototypes to get results like Dr. Mauseth’s – blood sugar staying in a 100-14o range through the night, spikes in the low 200s after a carb-heavy meal, etc. But no – Dr. Mauseth used an Omnipod and Dexcom 7+ (because they were compatible with the software platform), with the only modification being that the Omnipod was set to give a basal bolus every 5 minutes (like a real pancreas), rather than every half hour like current pumps.

I was floored that they could use the current generation of Dex, which can often be off 100 points off at times. I could understand fuzzy logic compensating for some of that, but surely they must’ve been calibrating the Dex every half hour or so…?

No, was the answer – “We calibrate every 6 hours or if sensor is more than 20% variance from a venous blood sample, which is done every 15 minutes. We have only had to calibrate out of cycle once, and that is when our original calibration was done when the blood sugar was changing.” They did have some glitches with the Dex dropping out of range when a patient went to the bathroom and found it less accurate when patients were sleeping rolled over on the sensor site. All lines up with our Dex experiences as well.

And when could we get that lovely bit of interpretive software, and would it take up an entire harddrive?

It would fit on an iPod, Dr. Mauseth said.

He has only done 3 of 10 (proof of concept) trials – if Luke were over 18, I’d sign him up. I’m sure there’s no shortage of volunteers, but FYI, here’s the site:

There are other intriguing trials going on with JDRF funding, including one using both glucagon and insulin. It’s not a cure, but after 6 months of essentially napping through the night due to ever-shifting toddler blood sugars, it would be a very welcome leap forward!

Beat the Bridge Heroes – Thank You!

This year’s JDRF Beat the Bridge walk in Seattle dawned to torrential rain (1 inch by 8am), a continuation of the nastiest, coldest, least BBQ-friendly spring in the last 75 years. Seriously – would you get up at 5am to go walk in this?

And yet – 0ver 11,000 people did, in running tights, gortex, sandals, shorts, and leis (no kilts spotted). Carly’s Angels, All for Andy, Team Logan – these kids supporting their friends amaze me: are they really in middle school? Some of the same kids had run relays till 8am to raise money for cancer and were just staying up for their next event.

Our friends Ben and Sue came out to walk, which really made my day.

Family gets hijacked into this sort of thing – friends have to walk the plank willingly.

Our team, the A1 Cuties, received even more donations than last year ($10k), thanks to families, friends, colleagues, and people who barely know or have never met us. To all of you who contributed – THANK YOU!  Your contributions will help make Luke’s life safer, bring us closer to a cure, and remind us how lucky we are that so many people care.