Sugar Surfing

[tim2000s]

If anyone was at the JDRF discovery day on May 23rd, they will have seen Stephen Ponder speaking about Sugar Surfing. I cam across this approach to managing diabetes after I found myself inadvertantly doing it due to the diet that I consume, acquiring the Libre and doing a bit of digging.

An overview can be found at this link: http://www.slideshare.net/mobile/St...with-a-continuous-glucose-monitor-may-11-2014

It's generally a by-product of CGM and a pump as delivery mechanism, due to the way it works, but I've also had some success taking this approach with MDI, which is why I have started down the line of Injection ports. To me it seems a sensible approach, and one that I would expect the algorithm in a bionic pancreas is essentially approximating in order to maintain an in target blood glucose range (indeed, when I've been looking at how one might code such an algo, this is the approach that i have come back to on a regular basis).

It's worth working your way through the 93 slides in the deck because he points out a lot of useful info relating to how different foods react with insulin and on blood glucose and how to manage them. I also think it is a great selling point for my hypothesis that CGM should be given to all insulin dependent diabetics to improve their level of overall optimisation.

Has anyone else used or attempted to use this method of bg control? What do you think of it? I think it works incredibly well.

 

[Spiker]

While I did do something like this with CGM, I've done it a lot more just using the IOB function on the Vibe Pump and a 2 hr post bolus alarm. So correcting every 2 hrs. Does that also count as 'sugar surfing', do you think?

 

[tim2000s]

@Spiker I guess the question is whether you are reacting to bg levels as well?

 

[Spiker]

Gah. Hard to read that slideshow for me. I can't get it to fit on one screen. I am technologically challenged. Spent too long in the IT industry.

 

[tim2000s]

Lol

Gah. Hard to read that slideshow for me. I can't get it to fit on one screen. I am technologically challenged. Spent too long in the IT industry.

Do it on your phone/tablet! It seems to work well in the app.

 

[Spiker]

@Spiker I guess the question is whether you are reacting to bg levels as well?

Well I am reacting to them in the sense of correcting, but I could probably do more in the sense of learning trends and adapting my (eating and dosing) behaviour. The slideshow does look interesting. It's a whole philosophy and argument around the technique, not just the technique itself. Cool stuff.

 

[tim2000s]

It's a whole philosophy and argument around the technique, not just the technique itself. Cool stuff.

Yes. What I liked about it was that it was how I had found myself managing bg following getting the libre. I had always had the notion that managing it dynamically like this was the right way to do it (feels like how a pancreas would do it!!!) and used to get very frustrated with the point in time-ness of finger pricks.

His documentation of it described what I was doing almost to a tee. I should have jumped on the CGM bandwagon a long time back. I'm also coming to the conclusion that in spite of apps, meters, etc, the best bionic pancreas algorithm I have found so far is the one in my head that is reacting to the CGM data (but should I class that as an Organic Pancreas Algorithm??? ). Can't wait for it to get transcribed onto a little bit of hardware that requires less thinking from me!

 

[lizdeluz]

Yes. What I liked about it was that it was how I had found myself managing bg following getting the libre. I had always had the notion that managing it dynamically like this was the right way to do it (feels like how a pancreas would do it!!!) and used to get very frustrated with the point in time-ness of finger pricks.

His documentation of it described what I was doing almost to a tee. I should have jumped on the CGM bandwagon a long time back. I'm also coming to the conclusion that in spite of apps, meters, etc, the best bionic pancreas algorithm I have found so far is the one in my head that is reacting to the CGM data (but should I class that as an Organic Pancreas Algorithm??? ). Can't wait for it to get transcribed onto a little bit of hardware that requires less thinking from me!

Thank you for this link. Lots of useful food for thought.

 

[pinewood]

Tim, I'm interested in your comment about injection ports. Are you using them currently? How do you get started with this - via your DSN/diabetes team? I've always wondered if they are really a good idea as presumably it's not good for insulin to be going in at the same location each time whilst a particular port is in use?

As to sugar surfing, I completely agree and have been following this method myself. The Libre has been invaluable.

 

[tim2000s]

Tim, I'm interested in your comment about injection ports. Are you using them currently? How do you get started with this - via your DSN/diabetes team? I've always wondered if they are really a good idea as presumably it's not good for insulin to be going in at the same location each time whilst a particular port is in use?

As to sugar surfing, I completely agree and have been following this method myself. The Libre has been invaluable.

Hi @pinewood, I've been keeping a running commentary of the injection ports here: http://www.diabetes.co.uk/forum/thr...alternative-injection-mechanism-on-mdi.77896/

I got started thanks to a link from on here. I followed up with AMT and had a call with my DSN to convince her it was worth giving a shot. She provided the necessary approval, and I'm currently trialling the different types.

Essentially all they are is a pump set that you inject into. As there is no issue in keeping a pump set in place for a few days, I can't see why there would be an issue with injecting via a port for a similar period of time.

They aren't currently prescription available so I will have to pay for them when I go ahead and use them longer term.

 

[pinewood]

Hi @pinewood, I've been keeping a running commentary of the injection ports here: http://www.diabetes.co.uk/forum/thr...alternative-injection-mechanism-on-mdi.77896/

I got started thanks to a link from on here. I followed up with AMT and had a call with my DSN to convince her it was worth giving a shot. She provided the necessary approval, and I'm currently trialling the different types.

Essentially all they are is a pump set that you inject into. As there is no issue in keeping a pump set in place for a few days, I can't see why there would be an issue with injecting via a port for a similar period of time.

They aren't currently prescription available so I will have to pay for them when I go ahead and use them longer term.

Thanks! Very interesting. Given my reaction to the Libre adhesive I expect they wouldn't be a great idea for me (and I don't really like the idea of having something else permanently stuck to me) but I will definitely follow your commentary and can see how the port could be useful if you've been injecting for many years. Is there a reason you haven't pursued a pump?

 

[tim2000s]

Is there a reason you haven't pursued a pump?

I've never fallen in the right bucket for a pump. My Hba1Cs haven't been bad enough to qualify, I've historically not had an issue with injections and I've not really suffered from too many hypos (and overnight ones when on Lantus, if I've had them, haven't been bad enough to warrant calling out ambulances or left me incapacitated). The first time a pump was raised for me was when I changed clinics earlier this year, and there is still the issue of "Structured Education", which I feel is a waste of time, but is a box ticking exercise.

For the month prior to the clinic this time, I'm documenting everything I'm eating, in terms of carb content and protein content, all my insulin shots, blood tests/scans and giving the clinic a raft of documentation on the meet up that demonstrates:

1. I know what I'm doing with carb (and protein) counting and;
2. I don't need to spend five days on DAFNE learning how to do this - the time is better spend on someone else.

I'm sure I'll be greeted with "You manage so well on MDI you don't need a pump" when what would be the right response would be "You are so responsible that you're an ideal candidate for the pump".

The fact that I've taken my own responsibility for monitoring (with Libre) and managing my injection sites (with injection ports) seems to not be a factor and if anything, seems to go against me. That I'm interested in participating in early trials for Bionic Pancreas type technology as someone who thinks they can probably contribute something useful also seems to be ignored (or I am not talking to the right people).

[RANT]Due to the ludicrous way the NHS works, I can't get a form of medical insurance to pay for a pump. There's not really enough money in the system, but if I want one outside of the system, I have to go to a private GP to get the approval and then pay for all the supplies, and while I can cope with £150 per month for Libre and Injection ports, a pump is more like £1,000 with all the required supplies, which I can't do. This is why i think there is an issue with the way the NHS funding works.[/RANT]

Sorry about the rant, but it does frustrate me rather that if I was to compromise my care and condition, I'd be more likely to accelerate onto better therapy!

 

[pinewood]

I've never fallen in the right bucket for a pump. My Hba1Cs haven't been bad enough to qualify, I've historically not had an issue with injections and I've not really suffered from too many hypos (and overnight ones when on Lantus, if I've had them, haven't been bad enough to warrant calling out ambulances or left me incapacitated). The first time a pump was raised for me was when I changed clinics earlier this year, and there is still the issue of "Structured Education", which I feel is a waste of time, but is a box ticking exercise.

For the month prior to the clinic this time, I'm documenting everything I'm eating, in terms of carb content and protein content, all my insulin shots, blood tests/scans and giving the clinic a raft of documentation on the meet up that demonstrates:

1. I know what I'm doing with carb (and protein) counting and;
2. I don't need to spend five days on DAFNE learning how to do this - the time is better spend on someone else.

I'm sure I'll be greeted with "You manage so well on MDI you don't need a pump" when what would be the right response would be "You are so responsible that you're an ideal candidate for the pump".

The fact that I've taken my own responsibility for monitoring (with Libre) and managing my injection sites (with injection ports) seems to not be a factor and if anything, seems to go against me. That I'm interested in participating in early trials for Bionic Pancreas type technology as someone who thinks they can probably contribute something useful also seems to be ignored (or I am not talking to the right people).

[RANT]Due to the ludicrous way the NHS works, I can't get a form of medical insurance to pay for a pump. There's not really enough money in the system, but if I want one outside of the system, I have to go to a private GP to get the approval and then pay for all the supplies, and while I can cope with £150 per month for Libre and Injection ports, a pump is more like £1,000 with all the required supplies, which I can't do. This is why i think there is an issue with the way the NHS funding works.[/RANT]

Sorry about the rant, but it does frustrate me rather that if I was to compromise my care and condition, I'd be more likely to accelerate onto better therapy!

Wow, sorry to hear about that. Where do you live? I'm in London and I've had COMPLETELY the opposite experience. Maybe it's because my consultant is a pump specialist and is super keen on pumping, but I got told word for word what you indicate would be the right response ("you are so responsible that you're an ideal candidate for a pump"). He was extremely keen to get me on to a pump this summer (and "certainly before your one year diabetes-anniversary") but I mentioned that I was not interested in having a pump right now but may wish to consider it in the future. I left with the impression it would never be a problem, as "there is always a way to tick the boxes for eligibility" according to my consultant. Same impression from my DSN - she said if I ever change my mind there won't be any problem arranging it (she is T1 herself). Maybe I'm being naïve and it's really not as straightforward as they make out - but now I'm wondering if I should have taken up the opportunity when they mentioned it in case it won't come round again in the future. Maybe it's different for the newly diagnosed? Who knows.

As for private medical insurance, I've found it's a complete waste of time for diabetes. Mine doesn't cover anything.

 

[tim2000s]

Where do you live?

In London. When I was at St George's, they were so uninterested that I ended up going under my GP, however Guys and St Thomas's seem to be a lot better, so we'll see where we get to.

Yes, Private Medical insurance in the UK is rubbish in relation to Diabetes. Sorry if I didn't make it clear. I have it, but due to the way the NHS works, it's a little useless in this respect.

 

[Spiker]

Are you talking about insurance to pay for your pump Tim, or just to cover it against loss?

 

[tim2000s]

Are you talking about insurance to pay for your pump Tim, or just to cover it against loss?

To pay for the pump @Spiker.

 

[Spiker]

I am sure Tim's experience is typical of a well controlled diabetic. Back of the queue if you're lucky, or more likely not in the queue at all. That after all is NICE policy.

 

[Spiker]

Tim I would encourage you to go to DAFNE if only for the educational effect you will have on the medical team and other participants. And because it is always useful to talk with T1 peers. But I realise a week off work is a very big ask.

Maybe they would let you do online BDEC to meet the structured education criterion?

 

[tim2000s]

Tim I would encourage you to go to DAFNE if only for the educational effect you will have on the medical team and other participants. And because it is always useful to talk with T1 peers. But I realise a week off work is a very big ask.

Maybe they would let you do online BDEC to meet the structured education criterion?

Funny you should mention BDEC. I was told this doesn't count! I elected to do it six or seven years ago when I met one of the better registrars at St George's.

 

[-Artemis-]

I was at the talk and have the book... Looking forward to experimenting with the techniques once I have my pump & cgm