The Daily Bingo Game

This snapshot of the last few months of morning fasting blood sugar measurements shows my dramatic descent into normal. Was it the diet, supplements, acupuncture, meditation, solar flares, or some combination thereof?

Diabetes is a numbers game. Some people test throughout the day. Some never do. After a year and a half of only sporadic checking, I began consistent morning fasting blood glucose testing last February. The danger with even that frequency is that you obsess... but, I needed some way to gauge the effect of all the lifestyle, diet, exercise, and medication changes my healthcare team and I are trying. Over time patterns emerge. Combined with the details of what I eat, stress events, and activity levels, we've found what works for me. For those that like numbers and graphs, here's the Dropbox link to my daily tracking excel file.

http://dl.dropbox.com/u/11169890/RS%20BS%20Data.xls

If You'd Rather Have a Daily Shot in the Stomach Than Give Up Beer...

Then you'll want to find another story.

Mine won’t be the only recipe for success in the fight against diabetes. But a recipe to follow isn’t the hardest part. You’ve got to rearrange your head to find a sustainable solution. As in forever. Can I eat grilled chicken and quinoa wrap-type things for the foreseeable? Probably. I can definitely eat fruit and nuts every day until I die. But it’s going to be different for everyone. Just how critical is the caffeine? When that chocolate crave hits, will granola suffice? Can you change your job and your life as necessary to jettison stress? Is it worth it? To Live? Hard for me to fathom a NO answer. But I’ve had a good life and wouldn’t mind adding to it. But not as a martyr. I have to believe this is the best thing that ever happened to me.

Not all will make the choice to live as a nutritional ascetic. Some will opt for the shot, an excuse not to go whole hog (pardon the pun). They’ll keep drinking, and they’ll rationalize the cookies and soda and the rest. “And the rest.” Those three words encompass the hardest bits. Figuring out who you are, actually going around and beyond those things we say about ourselves to others, and to ourselves. And we say it for enough years that we believe it, because it’s never tested.

All the comfortable, known, bedrock assumptions, actions, stunts, anecdotes, hobby specialties (rum, beer, Mexican food), philosophical positions, assessments of strengths and vulnerabilities, affiliations, bigotries, pipe dreams... it’s quite a “put your money where your mouth is” experience if you undertake such a tear down and re-build.

Diabetes 101

For those not already experts on the flavors of diabetes, let me provide a quick primer. Type 1 and Type 2 are really two different diseases. They both have the result of abnormally high levels of blood glucose. That causes lots of problems that can kill you either sooner or later. There are 2 ways those levels can get high and that pretty much defines the difference between Type 1 and 2. Your pancreas creates the insulin that allows your body to use the glucose. This action happens in cells that can become resistant to insulin. A Type 1 has a pancreas that's not producing enough insulin. A Type 2 has cells that are resistant to insulin. Either way blood sugar(glucose) goes up.

Type 2 is far more common. It can be acquired through unhealthy lifestyle. And it can be controlled with medications or often reversed by discontinuing the eating of crap. Type 1 is genetic. It's an autoimmune disease that has the body attacking it's own pancreas, killing the production of insulin. It's universally believed to be irreversible. People with Type 1 inject insulin constantly to prevent deadly blood glucose levels. The majority of Type 1's are kids, who at a certain age, quickly lose their capacity to produce insulin. A recent development is the emergence of a variation of Type 1 that affects adults over 35. It's thought to be genetic, but possibly triggered by stress and lousy diet and exercise. This variation is being called Latent (or Late-onset) Autoimmune Diabetes in Adults. LADA takes longer to kill the pancreas than the juvenile version of Type 1. It can be 6 years between onset and when the insulin producing beta cells of the pancreas are so far gone that shots of insulin (or a pump) are necessary. Diet, exercise, medications, and everything that works for a Type 2 will work for a while with LADA, but with diminishing returns.

That's all terribly over-simplified. But it will suffice as a set of terms to help decipher my story.

My LADA: A Bird's Eye Perspective on a Misdiagnosed Piece of the Diabetes Epidemic

It's time to share. Much of the focus here will pivot to the story of my fight against Latent Autoimmune Diabetes in Adults (LADA). My choice to bare, publicly, the details of this personal journey is not lightly decided. For my first 51 years, I've been quite private. But I've discovered a few things that may help others. I'll now post my body of evidence (pun intended) and findings to give anyone with diabetes or other chronic autoimmune/inflammatory diseases another perspective.


For my first 50 years, I guzzled beer, ate anything I chose, and was reasonably healthy and slim. Then I was told I had an irreversible autoimmune disease, a form of Type 1 diabetes called LADA. And the only road led to insulin, a daily shot in the stomach.

I said "Hell No. I'll find another way."
And I have. It's required a complete tear down and re-build to change the deep roots of stress and habit. But the result, besides normal blood sugar, is feeling better than I have for years, a whole different outlook, and expanded vs. restricted plans and dreams for my next 50 years.

This site will become the repository of what I call the evidence, including any documentation or results of my curation of the science around diabetes, autoimmune disorders, diet, exercise, and stress. For now, check out my Delicious bookmarks for a raw collection of my online interests. The "type 1" or "type 2" tags will filter for the diabetes links.

It's in daily conversations at work or at play that I most commonly find myself telling this story. Online, it's either in comments here, or via my twitter feed (@russellstamets), or on Google + (Russell Stamets) that the day to day thread will be spooled. If something I relate sparks a question, please ask, or comment.

As for disclaimers, is it not obvious? I'm no doc. I'm not offering a specific formula or recipe. Anyone who does is dishonest of deluded. Your solution, particularly resolving the stress component, will be utterly unique to you. You've got to build your own body of evidence. If you decide you trust my voice, it may help steer you to your goal.

CME Outcome Measurement: Irrational Expectations

More on this later... My staff and I are consumed this month jousting with a particularly quixotic windmill. Every four years, we draft a self-study report as part of our re-accreditation survey to be able to offer continuing medical education to physicians. The piece that has to do with planning is reasonable. Identify a gap in knowledge and practice, and design an activity to meet the specific needs and changes desired. Keeping an eye on that process helps us consistently produce evidence-based education. Where we morph into Don Quixote, though, is when we attempt to measure a specific change in a physician’s practice or in patient outcomes as a result of a one hour CME presentation.

Geeks For Geezers

In about 10 days we’ll know if our IN Touch proposal (iPads for transitional care) has been accepted. Odds are we’ll make it work one way or another even if we’re not awarded the grant. It makes too much sense. See the 4/3/11 post if you want details of the project. One idea I’ve been playing with while we wait I’m calling Geeks For Geezers. The volunteer activities my high school junior participates in prompted me to realize many of these kids would be the perfect tech support to help the IN Touch program’s iPad carrying patients. What a cool intergenerational interaction.

iPads For Old Folks

Well, we’ve done it. Our ad-hoc team of three (RN, aging specialist, and techie educator) completed our grant proposal before deadline. We’re going to lend iPads to sick old people to improve their health and quality of life. Even if we don’t get the money, we’ll still find some way to implement this plan. It makes too much sense. The reductions in readmissions alone will pay for the iPads and the hours of the nurse coordinator.

Various initiatives around the country are already looking at care transitions for long term care patients. Our project could be used to boost the efficacy of any of them. I’ve written previously (on 3/9 and 3/21) about the goals and strategies of idea. Our final proposal for the grant from our parent patient-centered care organization fleshes out those general descriptions and weaves in some specifics: community partnerships, details of the metrics of outcome evaluation, and even some anecdotal evidence to support the success of use of iPads by the elderly. This widely viewed you-tube clip of 100 year old Virginia Campbell and her iPad is compelling.