Insulin Pump and Blood Sugar Obsession Syndrome

For those questions and discussions on the McDougall program that don’t seem to fit in any other forum.

Moderators: JeffN, f1jim, John McDougall, carolve, Heather McDougall

Insulin Pump and Blood Sugar Obsession Syndrome

Postby openmind » Tue Feb 21, 2017 10:56 am

Watching Dr. McDougall's latest talk on diabetes, the Latest Scams from the Diabetic Industry, a lot of the info I've gathered from him on this disease since my wife and I starting following the Starch Solution, finally hit home.

I had never before heard Dr. McDougall express an opinion on the Insulin Pump, but I inferred from his other talks and writings of his that Dr. McDougall would be against it. So I was pleased to see that I understood his position well enough and I was correct- Dr. McDougall apparently dissuades his patients from using it as soon as they enter the 10-day program.

And the scenario describes in this talk- a husband and a wife so obsessed with minute by minute blood sugar readings- is exactly why I have successfully convinced my wife not to get the insulin pump, even though one of her doctor's suggested it. One of my good friend's sons has the insulin pump, and when I heard everything they go through in living with the pump...God it sounds like a nightmare. Who wants to live like that- a minute by minute analysis of blood sugar readings?

Which feeds into the larger issue: at what point do people become overly obsessed with one number, a blood sugar reading, and try to carefully manage that number with the belief that that one single number is a proxy for 'good health'. And in the end, they have become so obsessed with managing the numbers, they've brought themselves into an endless cycle of feeling good/feeling bad about their health.

I have seen that with my wife- she becomes obsessed with her latest reading, and gets upset when it's a little high and alternatively, she is walking on cloud 9 when she gets a reading under 120. Of course, she is a brittle type 1.5, so unless she lives like a Spartan the rest of her life, those high readings will come, and so the 'cloud 9' will never truly last.

Ultimately, my ponderings on this subject boil down to this: at what point do blood sugar readings, and obsession over them as an endpoint, detract from the quality of a diabetic's life, without having significant impact on the quantity of said life?
User avatar
openmind
 
Posts: 682
Joined: Sat Feb 01, 2014 8:13 am

Re: Insulin Pump and Blood Sugar Obsession Syndrome

Postby Kaye » Tue Feb 21, 2017 5:03 pm

Very interesting discussion openmind. My Mum is a diabetic - never sure whether she is classed as Type 1 or Type 2 as she was surgically induced when most of her pancreas (except the tail) was removed by accident during surgery for something else. She takes Repaglinide 3 times daily plus injects with Lantus once daily plus occasionally uses a fast acting insulin if her sugars are too high. She is totally obsessed with checking her blood sugars and has made her fingers so sore. She has just started seeing a new endocrinologist who has told her to stop checking them so much and only to do so before meals - she was checking them after eating as well and then getting in a panic when they were raised.

I'm not sure I totally understand regarding the known complications of diabetes - is Dr McDougall saying they are less likely to occur by eating correctly (this way) than by eating SAD but forcing the sugars down with medications?
Plant-Based Nutrition Certificate, Completed February 2017, T. Colin Campbell Center for Nutrition Studies and eCornell
Kaye
 
Posts: 401
Joined: Mon Aug 08, 2016 4:22 am
Location: South of England.

Re: Insulin Pump and Blood Sugar Obsession Syndrome

Postby Poison Ivy » Tue Feb 21, 2017 5:34 pm

Did your mom sue for the botched surgery? I do agree with becoming too obsessed with the numbers sometimes. That in itself can become a full time job.
Poison Ivy
 
Posts: 578
Joined: Fri Sep 23, 2016 12:05 pm

Re: Insulin Pump and Blood Sugar Obsession Syndrome

Postby Kaye » Tue Feb 21, 2017 6:45 pm

Poison Ivy wrote:Did your mom sue for the botched surgery? I do agree with becoming too obsessed with the numbers sometimes. That in itself can become a full time job.


No she didn't, she is a highly anxious person and could not face going to court. I tried writing a letter of complaint in her behalf but apparently the pancreas looks very similar in colour to the adrenal gland which is what they were trying to remove so the surgeon denied any negligence and my Mum accepted that.
Plant-Based Nutrition Certificate, Completed February 2017, T. Colin Campbell Center for Nutrition Studies and eCornell
Kaye
 
Posts: 401
Joined: Mon Aug 08, 2016 4:22 am
Location: South of England.

Re: Insulin Pump and Blood Sugar Obsession Syndrome

Postby Poison Ivy » Tue Feb 21, 2017 6:50 pm

Had the surgeon not screwed up, your mom would not be diabetic, right?
Poison Ivy
 
Posts: 578
Joined: Fri Sep 23, 2016 12:05 pm

Re: Insulin Pump and Blood Sugar Obsession Syndrome

Postby Kaye » Wed Feb 22, 2017 4:35 am

Poison Ivy wrote:Had the surgeon not screwed up, your mom would not be diabetic, right?


Almost certainly - there were no signs of her being diabetic before and certainly no mention in her notes. This was back in 2007 so the time limit has expired long ago for her to take any legal action.
Plant-Based Nutrition Certificate, Completed February 2017, T. Colin Campbell Center for Nutrition Studies and eCornell
Kaye
 
Posts: 401
Joined: Mon Aug 08, 2016 4:22 am
Location: South of England.

Re: Insulin Pump and Blood Sugar Obsession Syndrome

Postby openmind » Wed Feb 22, 2017 9:59 am

Kaye wrote:Very interesting discussion openmind. My Mum is a diabetic - never sure whether she is classed as Type 1 or Type 2 as she was surgically induced when most of her pancreas (except the tail) was removed by accident during surgery for something else. She takes Repaglinide 3 times daily plus injects with Lantus once daily plus occasionally uses a fast acting insulin if her sugars are too high. She is totally obsessed with checking her blood sugars and has made her fingers so sore. She has just started seeing a new endocrinologist who has told her to stop checking them so much and only to do so before meals - she was checking them after eating as well and then getting in a panic when they were raised.

I'm not sure I totally understand regarding the known complications of diabetes - is Dr McDougall saying they are less likely to occur by eating correctly (this way) than by eating SAD but forcing the sugars down with medications?


Hey Kaye,

Sorry to hear about your Mum. That is terrible.

As far as Dr. McDougall's position, I would hate to mis-characterize his views, especially since your Mum's case is so unique, so I would urge you to read all his free articles and watch all his free videos, and read Jeff Novick's takes on diabetes as well.

Have you seen all his videos on diabetes?
User avatar
openmind
 
Posts: 682
Joined: Sat Feb 01, 2014 8:13 am

Re: Insulin Pump and Blood Sugar Obsession Syndrome

Postby 3kidlets » Wed Feb 22, 2017 11:24 am

An insulin pump gives insulin, it doesn't monitor your blood sugar. A continuous blood glucose meter (CGM) monitors your blood sugar. Speaking as the parent of a child with type 1 diabetes, the CGM is a god send. For her not to have to prick her finger up to 10 times day (and yes, it is absolutely necessary for a type 1 diabetic to do that) is a blessing and a luxury. To not have to worry about her blood sugar dropping dangerously low while she is asleep is a huge relief. To be able to catch a high blood sugar before it goes too high is invaluable. For her to be able to keep her blood sugar in a very tight range so that her a1c is that of a non-type 1 diabetic means everything.
3kidlets
 
Posts: 10
Joined: Mon Jan 30, 2017 6:54 pm

Re: Insulin Pump and Blood Sugar Obsession Syndrome

Postby openmind » Wed Feb 22, 2017 4:31 pm

3kidlets wrote:An insulin pump gives insulin, it doesn't monitor your blood sugar. A continuous blood glucose meter (CGM) monitors your blood sugar. Speaking as the parent of a child with type 1 diabetes, the CGM is a god send. For her not to have to prick her finger up to 10 times day (and yes, it is absolutely necessary for a type 1 diabetic to do that) is a blessing and a luxury. To not have to worry about her blood sugar dropping dangerously low while she is asleep is a huge relief. To be able to catch a high blood sugar before it goes too high is invaluable. For her to be able to keep her blood sugar in a very tight range so that her a1c is that of a non-type 1 diabetic means everything.


My apologies, I was conflating the pump with the CGM.

With a child, it would be nice to have that extra warning at night in case of hypoglycemia.
User avatar
openmind
 
Posts: 682
Joined: Sat Feb 01, 2014 8:13 am

Re: Insulin Pump and Blood Sugar Obsession Syndrome

Postby John McDougall » Wed Feb 22, 2017 5:28 pm

Be careful of what you ask for (patient goals).

Tight control of blood sugars even in critically ill children are of more harm than good.

Feb 23, 2017 NEJM:

Tight Glycemic Control in Critically Ill Children
Michael S.D. Agus, M.D., David Wypij, Ph.D., Eliotte L. Hirshberg, M.D., Vijay Srinivasan, M.D., E. Vincent Faustino, M.D., Peter M. Luckett, M.D., Jamin L. Alexander, B.A., Lisa A. Asaro, M.S., Martha A.Q. Curley, R.N., Ph.D., Garry M. Steil, Ph.D., and Vinay M. Nadkarni, M.D., for the HALF-PINT Study Investigators and the PALISI Network*
N Engl J Med 2017; 376:729-741February 23, 2017DOI: 10.1056/NEJMoa1612348

Share:
BACKGROUND
In multicenter studies, tight glycemic control targeting a normal blood glucose level has not been shown to improve outcomes in critically ill adults or children after cardiac surgery. Studies involving critically ill children who have not undergone cardiac surgery are lacking.
METHODS
In a 35-center trial, we randomly assigned critically ill children with confirmed hyperglycemia (excluding patients who had undergone cardiac surgery) to one of two ranges of glycemic control: 80 to 110 mg per deciliter (4.4 to 6.1 mmol per liter; lower-target group) or 150 to 180 mg per deciliter (8.3 to 10.0 mmol per liter; higher-target group). Clinicians were guided by continuous glucose monitoring and explicit methods for insulin adjustment. The primary outcome was the number of intensive care unit (ICU)–free days to day 28.
RESULTS
The trial was stopped early, on the recommendation of the data and safety monitoring board, owing to a low likelihood of benefit and evidence of the possibility of harm. Of 713 patients, 360 were randomly assigned to the lower-target group and 353 to the higher-target group. In the intention-to-treat analysis, the median number of ICU-free days did not differ significantly between the lower-target group and the higher-target group (19.4 days [interquartile range {IQR}, 0 to 24.2] and 19.4 days [IQR, 6.7 to 23.9], respectively; P=0.58). In per-protocol analyses, the median time-weighted average glucose level was significantly lower in the lower-target group (109 mg per deciliter [IQR, 102 to 118]; 6.1 mmol per liter [IQR, 5.7 to 6.6]) than in the higher-target group (123 mg per deciliter [IQR, 108 to 142]; 6.8 mmol per liter [IQR, 6.0 to 7.9]; P<0.001). Patients in the lower-target group also had higher rates of health care–associated infections than those in the higher-target group (12 of 349 patients [3.4%] vs. 4 of 349 [1.1%], P=0.04), as well as higher rates of severe hypoglycemia, defined as a blood glucose level below 40 mg per deciliter (2.2 mmol per liter) (18 patients [5.2%] vs. 7 [2.0%], P=0.03). No significant differences were observed in mortality, severity of organ dysfunction, or the number of ventilator-free days.
CONCLUSIONS
Critically ill children with hyperglycemia did not benefit from tight glycemic control targeted to a blood glucose level of 80 to 110 mg per deciliter, as compared with a level of 150 to 180 mg per deciliter. (Funded by the National Heart, Lung, and Blood Institute and others; HALF-PINT ClinicalTrials.gov number, NCT01565941.)
User avatar
John McDougall
Site Admin
 
Posts: 575
Joined: Sun Jul 30, 2006 10:08 pm

Re: Insulin Pump and Blood Sugar Obsession Syndrome

Postby Poison Ivy » Thu Feb 23, 2017 9:56 am

3kidlets, how old is your child with the type 1? How long can this thing be left in before you have to repeat by sticking yourself again? Children can be pretty rambunctious sometimes. How do they keep from pulling this thing out during playtime? I googled and watched a guy doing a demo. How long has CGM been available?
Poison Ivy
 
Posts: 578
Joined: Fri Sep 23, 2016 12:05 pm

Re: Insulin Pump and Blood Sugar Obsession Syndrome

Postby 3kidlets » Thu Feb 23, 2017 12:52 pm

Poison Ivy wrote:3kidlets, how old is your child with the type 1? How long can this thing be left in before you have to repeat by sticking yourself again? Children can be pretty rambunctious sometimes. How do they keep from pulling this thing out during playtime? I googled and watched a guy doing a demo. How long has CGM been available?


My daughter is 16. She plays tennis, dances, swims and have never had an issue with the CGM. I think you may be thinking of a tubed insulin pump that can get caught on things and pulled out. But usually, if a child is doing an activity where it can get pulled out, they disconnect from the pump. But they also make tubeless insulin pumps now.

The CGM has been around a while. Don't know for sure but she's had hers 5 years. They've been around longer than that. They are extremely precise. She can wear hers for up to 14 days before having to reinsert a new one.
3kidlets
 
Posts: 10
Joined: Mon Jan 30, 2017 6:54 pm

Re: Insulin Pump and Blood Sugar Obsession Syndrome

Postby Poison Ivy » Thu Feb 23, 2017 3:00 pm

Thanks, how costly is the monitoring?
Poison Ivy
 
Posts: 578
Joined: Fri Sep 23, 2016 12:05 pm

Re: Insulin Pump and Blood Sugar Obsession Syndrome

Postby 3kidlets » Thu Feb 23, 2017 6:42 pm

Poison Ivy wrote:Thanks, how costly is the monitoring?



Our insurance pays for hers. I would say visit dexcom.com. You can get pricing information. One nice feature now is that you don't need a separate device to see her blood sugar. It reads out right to an app on your smart phone.
3kidlets
 
Posts: 10
Joined: Mon Jan 30, 2017 6:54 pm

Re: Insulin Pump and Blood Sugar Obsession Syndrome

Postby 3kidlets » Thu Feb 23, 2017 6:51 pm

John McDougall wrote:Be careful of what you ask for (patient goals).

Tight control of blood sugars even in critically ill children are of more harm than good.

Feb 23, 2017 NEJM:

Tight Glycemic Control in Critically Ill Children
Michael S.D. Agus, M.D., David Wypij, Ph.D., Eliotte L. Hirshberg, M.D., Vijay Srinivasan, M.D., E. Vincent Faustino, M.D., Peter M. Luckett, M.D., Jamin L. Alexander, B.A., Lisa A. Asaro, M.S., Martha A.Q. Curley, R.N., Ph.D., Garry M. Steil, Ph.D., and Vinay M. Nadkarni, M.D., for the HALF-PINT Study Investigators and the PALISI Network*
N Engl J Med 2017; 376:729-741February 23, 2017DOI: 10.1056/NEJMoa1612348

Share:
BACKGROUND
In multicenter studies, tight glycemic control targeting a normal blood glucose level has not been shown to improve outcomes in critically ill adults or children after cardiac surgery. Studies involving critically ill children who have not undergone cardiac surgery are lacking.
METHODS
In a 35-center trial, we randomly assigned critically ill children with confirmed hyperglycemia (excluding patients who had undergone cardiac surgery) to one of two ranges of glycemic control: 80 to 110 mg per deciliter (4.4 to 6.1 mmol per liter; lower-target group) or 150 to 180 mg per deciliter (8.3 to 10.0 mmol per liter; higher-target group). Clinicians were guided by continuous glucose monitoring and explicit methods for insulin adjustment. The primary outcome was the number of intensive care unit (ICU)–free days to day 28.
RESULTS
The trial was stopped early, on the recommendation of the data and safety monitoring board, owing to a low likelihood of benefit and evidence of the possibility of harm. Of 713 patients, 360 were randomly assigned to the lower-target group and 353 to the higher-target group. In the intention-to-treat analysis, the median number of ICU-free days did not differ significantly between the lower-target group and the higher-target group (19.4 days [interquartile range {IQR}, 0 to 24.2] and 19.4 days [IQR, 6.7 to 23.9], respectively; P=0.58). In per-protocol analyses, the median time-weighted average glucose level was significantly lower in the lower-target group (109 mg per deciliter [IQR, 102 to 118]; 6.1 mmol per liter [IQR, 5.7 to 6.6]) than in the higher-target group (123 mg per deciliter [IQR, 108 to 142]; 6.8 mmol per liter [IQR, 6.0 to 7.9]; P<0.001). Patients in the lower-target group also had higher rates of health care–associated infections than those in the higher-target group (12 of 349 patients [3.4%] vs. 4 of 349 [1.1%], P=0.04), as well as higher rates of severe hypoglycemia, defined as a blood glucose level below 40 mg per deciliter (2.2 mmol per liter) (18 patients [5.2%] vs. 7 [2.0%], P=0.03). No significant differences were observed in mortality, severity of organ dysfunction, or the number of ventilator-free days.
CONCLUSIONS
Critically ill children with hyperglycemia did not benefit from tight glycemic control targeted to a blood glucose level of 80 to 110 mg per deciliter, as compared with a level of 150 to 180 mg per deciliter. (Funded by the National Heart, Lung, and Blood Institute and others; HALF-PINT ClinicalTrials.gov number, NCT01565941.)



I can tell you that my daughter can feel when she is 180. She is sluggish and can't focus. Her tennis performance suffers at higher blood sugar. You would never recommend a adult maintain a blood sugar of over 150. Doesn't make sense that a 16 year old should. The beauty of the CGM is it makes this attainable with minimal (as minimal can be with type 1) effort.
3kidlets
 
Posts: 10
Joined: Mon Jan 30, 2017 6:54 pm

Next

Return to The Lounge

Who is online

Users browsing this forum: No registered users and 8 guests


cron

Welcome!

Sign up to receive our regular articles, recipes, and news about upcoming events.