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From Abby: Absolutely Not Medical Advice.

This is NOT medical advice.  Not even close.  But Abby has some opinions that are influenced by her years with type 1 diabetes, her nursing degree, and all the stuff she hears people saying about diabetes, and she wants to share those opinions here.  

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Diabetes is confusing. Sometimes you think you have it figured out, and then - BAM - you do the same thing that worked the last five days but today it doesn't work. I believe that 90% of the time, there is a reason for these disturbances.  I've decided to take my educated little brain and put some myths to rest, and spread some pearls of wisdom. I am a Registered Nurse, but I am still learning about diabetes, and everything that comes along with it, every day.  So this is not medical advice.  This isn't written to influence how you take care of yourself or how you should take care of yourself.  Talk to your doctor before you make any changes to your healthcare.  Seriously.

Welcome to Absolutely Not Medical Advice: Diabetes Hearsay. 

Myth #1: Insulin Makes Me Fat, So I Need To Use Less, Goshdarnit.
Here's the science (it's an abridged regular-people version): Insulin helps you metabolize your food, so that your body can use it (carbohydrates to glucose, specifically). The problem comes in when you eat TOO MUCH of these foods, and your body doesn't need so much of them. Where does it get stored? As FAT! We store excess glucose as fat. We can thank our ancestors for this skill. When they lived in times when food was sparse, they needed to store it in their bodies for later use. So, okay sure, you take more insulin, you gain weight - I can see why you'd think the insulin is the culprit. But really it is all those carbohydrates and, ahem, CALORIES, you're consuming that makes you gain weight. You gain weight when your CALORIE INTAKE EXCEEDS your calorie USE. It really is that simple. I dare you to take a look at calories in your food while you're looking at carbs/protein/fiber whatever else you're looking at. I bet you'll be surprised at what's actually in there.

Myth #2: If I'm going for a run right now I should turn off my basal. RIGHT NOW.
No. Please, no. If you can promise me anything today, it's that you will not do this. Here's the skinny: short acting insulin (Humalog (lispro), Novlog (aspart), and Apidra (glulisine)) lasts approximately four hours in your body. This kind of insulin doesn't even start working for about 15 minutes, and there is also a ginormous peak around 30-60 minutes after administering it. So, it stands to reason that, unless you're going for a four-hour run/hike/bike ride/swim/whatever, changing your insulin now will not help, and could make you high later. What you should do, if you are wary of lows, is make a change to your basal 30-60 minutes before you work out. (This gets really complicated based on food, type of exercise, recent boluses, time of day, how often you exercise, what color shirt you're wearing, etc - talk to your doctor about making ANY and ALL changes to your medication regimen.) In general, however, stopping your pump or skipping a meal bolus right before you work out will not ... ahem ... work out well. [Editor's note:  This doesn't even begin to tap into ketones and how important it is to have insulin on tap at all times, so talk to your doc before disconnecting your pump for exercise!]

Please feel free to email me (abby at sixuntilme dot com) with questions or diabetes myths you'd like to see discussed, or if there is something you have a desire to know more about. I'd love to research and answer any questions. I love to learn, and I am on track towards becoming a CDE, so this is really helping me do my future job better. No question is too random, or issue too insignificant, because trust me - someone else out there has the same question or struggle.

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You should bust 2 myths every Wednesday, Abby! I loved this post.

I am a fan of Anonymous' comment on weekly myth bashing. Do it!

oh my goodness! Myth #2!!!

Thank you!!! I hear people doing this ALL THE TIME and it gives me the twitches! Similarly, I am not sure (well, I am but...) about suspending your pump when you are low.

Second that on exercise. For me, the lows DON'T come during the exercise, but 4-6 hours later. I don't know why, but I'm prepared. Although I'd really like to be able to treat the low BEFORE it gets to the point where I'm confused! LOL!

I take off my pump when I excercise not just to suspend the basal rate but because it is more comfortable to work out without it. If I'm just doing 30 minutes of cardio and my blood sugar is within range when I start it seems pretty harmless to disconnect for 30 minutes. If I am high, I give myself a smaller than usual bolus and then disconnect. I think it depends on what time of day you are exercising also. I tend to be pretty steady in the afternoons so that's my favorite time to exercise. Mornings I get low, too late in the evening and I either get low at night or end up high right before bed.

Kim, I'd love to. feel free to send me more myths, because I tend to be pretty oblivious to things like that. :)

I love the myth-busting! This is fantastic!

I do take off my son's pump when he's swimming, and thought I was just saving the step of programming a -100% temp basal. Now I know: that's dumb. I'm still going to take the pump off though, because somehow this strategy has been working. No doubt not for the reason I have been thinking it works, but through some other mystery of diabetes.

And wouldn't a diabetic person lose a ton of weight with insulin deprivation? Not that it would be at all healthful, but isn't that the mechanics of high blood glucose? The glucose is in the blood and out in the pee instead of being used by cells and stored as chub?

I always wondered about the exercise thing, and I'm glad to see my own analysis turned out to be right! The only thing is, insulin has more than one job. Its MAIN job (and the only job it has that isn't redundant) is bringing glucose from the blood into the cells. The other job it has is aiding in the storage of fat. Insulin has more than just an indirect role in fat storage, it is actually one of the molecules that helps to create fat to be stored.

There is actually a theory that synthetic insulin does better at the secondary role than the original insulin that our bodies make. That explains why some people who use insulin have a harder time losing weight (T1 AND T2).

Abby this will be so so useful/helpful for people with DM. You write so well! Glad you are here, and thanks so much for your input on the "myths"

I agree. I like this!

I love this post, Abby! I totally agree with these! And I will be setting temp basals for excercise ahead of time- which I can do now, thanks to the pump I started using (today :) )Thanks!

LOVE this post! Love the idea behind the post! Lots of love over here.

Also, I would give my eyeteeth for a CDE with T1. All your future patients are lucky!

Please! Continue with the myth busting! And I agree that your shirt colour totally affects all these decisions about diabetes calculations! :P

Hey Abby, love the post, and I love the idea of a weekly myth buster. Have you heard of any myths about diabetes and humidity? I always tend to get lower more quickly when the weather is super humid. I mentioned this to my endo and he looked at me like I need a psych evaluation. Any thoughts.

I would also love to see using suspend when you are low..especially in the morning when I expect dawn phenomenon to take place?

I don't understand the harm in turning off one's pump or disconnecting for exercise. The basic concept of why it doesn't really matter makes sense, but if I'm exercising for 30-45 minutes, I don't want my basal insulin to hit me in the middle of the run, either. So while it's obviously better to make a change 30-60 minutes before exercising, doing it right before will still help keep lows at bay. Also, isn't insulin more effective when you are exercising? Wouldn't that also make it more important to turn off/decrease your basal?

Hi! This isn't a myth, but a truth not widely discussed. My daughter travelled to Jackson Hole WY this summer and was calling me three times a day her bg levels were so crazy. Super highs and then rebound super lows (20's!). Apparently, everything gets screwed up with altitude. We are often in colorado, 5Kabove sea level, WY is 10-12K above and it made a huge difference. I would love to know why and what is affected: insulin sensitivity, insulin potency?

Completely agree on the Exercise Myth.
Its one of my greatest diabetes mysteries that I wish I could resolve.
My endo keeps telling me to just reduce my basal rate, but for me the reaction to exercise seems to change on a weekly basis!

I have to disagree with #2. I run almost every day and disconnect from my pump and have done so for the past 5 years. I've actually had times were I have disconnected for a few hours and my blood stays the same. Crazy,right? Everyone is different but with time and practice you get to know how your body reacts to certain situations.

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