With this Lighter Than Air Chocolate Cake, you can have your cake and eat it too.

What’s not to love about a recipe that clicks together, creating a perfect twist of low-carbohydrate and gluten-free ingredients. Birthday cakes are inherently challenging with their traditionally high-carbohydrate loads and glutinous ingredients (just another reason why this cake is amazing).

This entire cake, yes, the whole thing, is approximately 220 carbs.

Don’t be intimidated by the 4 layers this cake contains, your efforts are well worth the finished product (my daughter has made this into a 8-layer cake too). If this is your first rodeo with a multiple-layer cake, be certain that you have 4, 9-inch cake pans on hand and you’ll be good to go!

This is a super light cake as it’s flourless and grain-free. It may look thick in the icing department, but it’s actually mildly sweet, and chock-full of protein and fat. I can’t speak for everyone, but I’ll take the 12 eggs and whipping cream over a ton of carbs.

The post Lighter Than Air Chocolate Cake appeared first on She Sugar.

Cycling or running long-distance may not be your thing, perhaps you’ve thought about dabbling with it. My entry into this landscape goes back 18 years: I was pregnant, on a 6-week stint of bed rest, and had an upcoming 30th birthday. I yearned to move so much that I signed up for my first marathon when I was 8 months pregnant – and literally glued to the couch. (Now you know anything is possible and that I’m a little weird.)

It seemed like it was meant to be. My baby would be 7 months old and the marathon was on my birthday, November 12th. I had to squeeze in the miles, getting most of them before my household was awake and alert. I completed that marathon, with T1D, breastfeeding and all.

Since then, I’ve covered countless miles on foot and bike. My management has morphed over the years too – from injections to pump, from glucometer to a Dexcom CGM, finally landing on the Medtronic 670G.

If you’re entertaining cycling of any distance, I suggest that you look into the JDRF Ride to Cure program. With your commitment to fundraise a certain dollar amount, you receive coaching, transportation, lodging/meals, education, bike support, day of event support, and meet an entirely cool community of welcoming people. This will be my fifth,100-mile ride and the first year that my husband will be joining me. Check out our story on this YouTube video:

What do you Eat?

I often hear people with T1D talking about the struggles they have with managing their blood sugars while they’re exercising. People can easily become frustrated with lows that seem to “cancel out” the benefits of exercise, calorie-wise. It’s never fun to need a picnic mid-workout because of T1D.

I eat on the move. It’s a necessary skill to have when living with T1D and moving for 4-plus hours at a pop.

My goal is about 300 calories an hour. Most long-distance athletes will agree with that calculation. You can’t absorb much more per hour. Otherwise, it will sit in your gut, and – ugh. When you’re done exercising, the blood that has been shunted to your muscles returns to your gut. With T1D, this may create high blood sugars. Digesting what’s been in your tummy, for who knows how long, can create post-exercise havoc.

I personally don’t need to bolus for any food I eat while I’m cycling. This is the only time I don’t tell my 670G when I’m eating and it works like a charm.

I bring what fits in my jersey and my bike pouch. The goal is to never run out.

• Energy chews (Clif Shot Bloks, Honey Stingers)
• Energy Bars (So many to choose from, I always opt for high-calorie)
• Nut Butters (RX, F-Bomb)
• Oven roasted baby potatoes with kosher salt
• Trader Joe’s Nothing but Fruit and Nuts bars
• Banana and Honey Almond butter (Justin’s)
• Fruit Leathers (Stretch Island)
• Other fast-acting carbs to mix things up, if needed

My Approach

I have a handful of things that always help over the long-haul with diabetes management. Some hold true for shorter trips to the gym. Granted, my Medtronic 670G has definitely helped to decrease the amount of lows I experience, but there is still a lot of human intervention.

The whole carb-loading idea does make sense – you want to have full glycogen stores before you exercise. I’ve found that eating big the day prior and having a higher-carb dinner the night before has great pay-offs the next day. I have higher energy levels and my blood sugars are always more cooperative.

I don’t eat a huge breakfast before I ride. I do my typical morning routine: An americano and a piece of gluten-free bread with peanut butter about an hour or so before I ride. About 15 minutes before, I eat a Siggi’s Triple Cream Yogurt. It’s a small container, but it packs a big punch: it has 9% milkfat, 170 calories, 10 grams of fat, and 9 grams of protein. It stabilizes my blood sugar for the first hour of my ride – it’s basically yogurt magic.

I focus on 4 areas for blood sugar maintenance: Calories, Protein, Fat, and Carbs

Ignoring the basics of nutrition and fuel will always result in a fail, especially with T1D. Muscles use glucose for fuel/ energy. Our body stores glucose in the form of glycogen and we break it down into its usable form (glucose) when our muscles need it. Unlike other athletes, we don’t simply eat for fuel. We’re also balancing our blood sugars along the way.

On average, our muscles can sustain our needs for about 90 minutes – the rest comes from foods we eat while exercising. Why carbs? Because they can be broken down easily for quick use. While it may be tempting to go large on fats (as they have almost twice the amount of calories), both fats and proteins are really hard to break down to utilize for energy. In fact, you burn carbs to break down fats, that’s very counter-intuitive. Both fat and protein also slow down digestion making it more difficult to absorb the carbs you’re eating.

Don’t wait for hunger or thirst cues – eat and drink the entire time. Graze all day, or at least every 30 minutes. Practice and find what sits best in your tummy.

I keep my water, electrolytes, and carbs separate. Who wants 2 water bottles full of sugary electrolyte drinks when you get surprised by a high blood sugar? Not me. I’d rather chug water and take a Hammer electrolyte tab instead. If you’re smart about it, you can fix high blood sugars on the fly.

When I’m done, or if I’m having issues sustaining my blood sugars, I personally find that adding real foods like potatoes, energy bars, or fat calories helps me in the blood sugar department – regardless of the fact that they may slow carb digestion. Find what works for YOU and your diabetes.

When you’re through with your adventure, be sure to refill your tank. Long-distance athletes burn a ton of calories and this can create low blood sugars overnight.

Sheri Colberg is my favorite T1D exercise expert. Give her website and research a browse, she’s brilliant. Her research on 10-second sprints effectively raising/stabilizing blood sugars is super informative and it works!

Other She-Sugar Exercise Articles

Crossing the Finish Line With Type 1 Diabetes

The Best Prescription for Diabetes: Exercise

Diabetes and Exercise, Your Arsenal for Safety

Type 1 Diabetes Management by an Exercise Freak

The post Cycling and T1D: Fueling for 100 miles appeared first on She Sugar.

I’ve been working on this Gluten-Free Vegan Chocolate Chip Cookie recipe for some time, adding and deleting ingredients until my healthy-dessert palate was content. I couldn’t resist sharing this recipe with you and hope you will enjoy it as much as we do.

These cookies are fun because they’re easily amenable to your favorite ingredients. I love that they aren’t crumbly without typical gluten-free starches and xanthan gum (which can cause an upset stomach). The delicate balance of liquid and flour ingredients is vital with gluten-free baking. Whether you’re intolerant of gums and starches, or not, these cookies are for you.

Shh! There’s a secret in this gluten free recipe. An entire block of silken tofu is in these bad boys (if you don’t tell your kids they’ll never know). I love stuffing a few of these in my bike jersey to avoid processed bars while cycling.

You’ll also find a tiny jar of organic applesauce in the ingredient list, which gives you good reason to shop in the baby isle – or you can make your own. There’s nothing wrong with having a bonus glass jar to pack snacks in when you’re all done.

The post Gluten-Free Vegan Chocolate Chip Cookies appeared first on She Sugar.

The FreeStyle Libre is now available for purchase in the United States. This system is unique in that it’s the only continuous glucose monitoring (CGM) system that doesn’t need blood sugar numbers to get the system up and running, nor does it need the usual calibrations with blood glucose tests multiple times throughout the day, demanded by other systems (Medtronic and Dexcom).

There is an unfortunate 12-hour warm-up period after insertion of the “Flash System” sensor in order to use this model. The “Next-Gen” model of the FreeStyle Libre system has a 1-hour warm-up period, 14-day sensor life and doesn’t require a presciption. This model is the version that will be used in the Bigfoot Biomedical system that we will – fingers crossed – see by 2019.

Making it Happen

The inserter is quite simple. My only complaint is that it’s a bit clunky and demanded a hard squeeze to release onto the back of the upper arm. This caused a bit of apprehension with the insertion process.

Scanning the sensor for glucose values takes 1 second with the handheld reader and wa-la! On the screen is your current real-time sensor glucose value. It doesn’t provide a constant feed between scans but it does hold data from the past 8 hours.

I’ve heard medical professionals referring to this system as “One for people with Type 2 diabetes.” I’m here to tell you it isn’t. This system has been functioning as well, and sometimes better than, my Medtronic Guardian 3 sensors for use with my Medtronic 670G closed-loop insulin pump.

While I’ve had 2 sensors fail for my 670G in the past 8 days, I remain on the same FreeStyle Libre sensor. No fuss, no muss.

My Positives:

• Continuous glucose monitoring typically requires calibration with a blood glucose result multiple times throughout the day. This system requires NO BLOOD SUGARS or CALIBRATIONS.
• The accuracy has been shocking.

FreeStyle Libre wins again!

• I’m fond of wearing glucose sensors/ transmitters on my arm – they seem to provide the best results in my experience with Dexcom, Medtronic and now Abbott’s products.
• The handheld device/ receiver/ scanner also functions as a glucometer.
• I have no itchiness or skin irritation from the tape, nor have I had to add extra tape to keep the system intact. It’s held up to vigorous exercise, bumps on walls, baths, perspiration and taking clothing off and on my arms for 10 days.
• I haven’t had any issues with the sensor failing, or acting persnickety on a regular basis at all.
• The sensor doesn’t hurt to remove like my 670G does – large pieces of tape can be harmful to our skin, as are adhesive removers.

One point off from each other – so impressive. [Medtronic 670G is on the left, FreeStyle Libre is on the right.]

My Negatives:

• Why every diabetes company is stuck on making their supplies STARK WHITE is beyond me. We don’t wear white band-aids, most ACE bandages are beige, tapes can be found in neutral colors, but if you ask any diabetes company if they have skin color options, their answer will be a firm: “No.”
  I’m very Irish, with fair skin and the color of this sensor bothers me – it screams: “Look at my arm – ask me what this is!” How about a neutral color or even better yet, three skin color range options. Abbott would be a forerunner in this realm. Please, someone consider this.

Please, Abbott, consider color options – no one has WHITE SKIN.

• The receiver is a bit bulky in this day and age. It would be great to have the ability to use a smartphone as the receiver/ scanner. The “Next-Gen” system that will incorporated into Bigfoot Biomedical system will function as a real-time device with alarms and constant feedback monitoring with a smartphone.
• The sensor is quite sensitive to cold.

• It reads “LO” for blood glucose values that I’ve had in the 60’s – that is a bit of a head scratcher.
• I have received 1 error that asked me to scan again in 10 minutes.

I can’t wait to use the Bigfoot biomedical closed loop system that uses the FreeStyle Libre as the CGM. The performance of this CGM was above and beyond what I was expecting. Give it a try – it’s the most affordable on the market too!

The post Freestyle Libre – A Nurse’s Review appeared first on She Sugar.

As many people report, some magic happens between weeks 3 and 5. There was a turning point in which we both became happier with the results and user interface/ demands.

[Our initial experience, one week in, is documented in this piece: A Nurse’s Review: Medtronic 670G Insulin Pump.]

Chew on this: I don’t buy juice anymore.

This is huge, especially in a household that has two very active people under one roof – that both have T1D. I had the habit, on occasion, of pouring my daughter 3 glasses of juice overnight after a big basketball practice or some crazy family adventure in the mountains. I can thankfully report that this behavior is a thing of the past.

Like it or not, midnight picnics are common for those of us living with type 1 diabetes. Our dentists may agree that the 670G may be worth it’s weight in gold with the simple elimination of the sugar bath on our teeth all hours of the day and night.

Hands down, the best feature of this pump/ sensor combo is the near elimination of hypoglycemia (low blood sugar) – particularly overnight when we are at our most vulnerable.

Over the past few months I have put this thing to the test. I trained for and completed a 102 mile bike ride for JDRF Ride to Cure in Loveland, Colorado. I’ve spent a lot of time in the saddle with this sensor and pump over some strenuous miles at higher elevations.

My overall impression is quite positive at this point – I have no desire to go back to my previous pump or a pump/continuous glucose monitor (CGM) that don’t speak to one another.

Do I have high blood sugars? Yes.
Do I get frustrated? Yes
Are there gaps between my blood glucose and sensor glucose readings? Yes.
Is this system the best we’ll see? No.

The Medtronic 670G is a work in progress that will only continue to see improvements – and competition – over the next few years, but for now, it’s king.

My Positives:

• Quality sleep improvements – Because my sugars are normal overnight, as are my daughters, sleeping has seen huge improvements. I’m worried less about her having lows overnight.
  ***I haven’t had 1 overnight low since I started on the 670G.***

• Exercise – I do really love exercising with this system (minus the fact that there isn’t information sharing – so I can’t see my sensor reading on a watch). If I want to see my sensor reading, I have to take an awkward glance at my pump that sits on my waistband – with the updated vertical screen. This may be the death of my neck – so awkward from the user’s perspective. Medtronic would be well served to have a physical therapist on their team analyzing how their new products impact a person’s movements.
  I choose not to use the “temp target” feature for exercise, it always makes my blood sugar creep into the 200 range. I leave my pump as is, and eat free carbs throughout my ride – this is the only time I don’t tell the pump that I’m eating.

• Eating – Eating is a new thing. I’m a thin person and not looking to lose weight, but I lost 7 pounds without trying. I’m actually trying to gain it back – my body, I think, is like – “Hey! Where are all the simple sugars?” I have actually been in bed trying to fall asleep, realized I was hungry and went to the kitchen to eat.
  It’s been an interesting transition for me, after 30 years of diabetes, not having to eat in order to keep my sugars in line. The adjusting micro-basal is so smart. I’m eating more healthy whole foods and larger portions at meals than I used to – I’m also getting more accustomed to this new pattern of “not eating for diabetes.”

• Adjustments – There are only a few things to adjust on the back end with this pump – namely the active insulin time (AIT) and carb ratios (CR). Most people find themselves settling in with a 2 hour AIT or the pump won’t correct a high blood sugar in a timely manner. Carb ratios undergo serious changes for most people – especially those of us that had high basal rates prior to the 670G.
  When bolusing for meals, the micro-basal usually shuts down altogether. I believe this is why we need such tight carb ratios. It’s a bit of a science experiment to find the correct CR’s.

My Negatives:

• Low blood sugars: As I mentioned previously I hardly ever get lows, but that doesn’t mean that the sensor doesn’t give me incorrect warnings.
  When this happens – and I’m not actually low (verified with a BG test), the micro-basal delivery turns off. During this time, if it’s telling me I’m 50 and I’m actually 100, it’s one of those times that you shouldn’t enter your BG or calibrate because the gap in numbers is too wide.
  So, if you leave the pump/sensor “as is,” it will result in a high blood sugar –  rather than leaving you at your excellent BG of 100. Yes, frustrating.
  I choose to revert to manual mode when this occurs or sometimes take insulin and eat carbs without entering a blood sugar and that helps bridge the gap. But ultimately, it means another BG to get things squared away with the sensor – usually 20 minutes later.
  And speaking of alerts, this system took a large step backwards without the communication piece to mobile phones and watches – especially if you are a parent of a child living with T1D. This pump/sensor duo isn’t the end all, it needs parental interventions. Kids need reminders and they really dislike when we have to look on their pump screen to find the data we are looking for. Nightscout has a workaround, but it demands a glucometer be attached to the the users phone. My highschooler would never go for that.

Arrow is pointing at the micro-basal delivery

• Sensor Life: Initially, I had some serious sensor failure issues. I would get the “Updating Sensor” warning which would ultimately end up with a failed sensor, on a regular basis. I have had 3 or 4 sensors last the 7 days they should since I started on this pump (ugh).
  I have figured out that there is some kind of an issue with my 670G and my work in recovery room at the hospital as a nurse. All I can figure is that the “loop” between patient cardiac monitors and vital signs that feeds information to the bedside computer is interfering with my “670G loop.” Medtronic doesn’t have any suggestions other than using manual mode which is unfortunate.
  *Medtronic did send me a new transmitter and that has helped with failing sensors a bit. They have also replaced every failed sensor.*

• Algorithms: It takes a bit for the pump to “get to know you.” If you’re anything like me, I have my regular stuff, but I’m not the most predictable person in the world. Some days I’m working, some days I’m riding my bike 50 miles. I think the more predictable our behaviors are the better results we get from the algorithm.

• A Higher A1C? Well, I’m not sure if I should classify this as a negative, but I know my A1C will be higher. The predictive value on my pump for my next A1C is 6.8 – not bad – but I’m always 5.9 – 6.1.
  Here’s why – there are no lows to bring that value down. It is a solid 6.8 that I’m continuing to make pump adjustments for. This pump rarely keeps me at 120 like it says the target is, I often wish it adjusted me a bit tighter. I often check and I’m 140 when it says 120 on my sensor. I wish it had the option to adjust to 100.
  Rarely do I have sugars in the 80’s and 90’s like I once did. But I also had lows or was averting lows throughout the day.

I think with this tech comes the realization that our once coveted A1C value will change – and so should our perspectives about them.

• “The Loop”: This endearing term (tongue in cheek) stands for one of the most frustrating things that occurs with this pump. The 670G, especially when fed too much information, or information at inappropriate times – freaks out.
  The best solution to this problem is to treat your pump like a 2 year old having a tantrum. Don’t feed into the issue at hand. Be patient, wait and don’t enter information if the BG and SG are more than 30% off, or you will experience the dreaded loop. Is this inconvenient? You betcha.

I realize nothing is perfect. As a parent of a child with the same 24/7 deal, I appreciate some aspects of the 670G, while I’m not so hip on the others. I’ve always said if our kids can have normalized blood sugars overnight, then that’s half of their life within range. That’s pretty impactful – right?

Kids aren’t as attentive as the average adult and this pump isn’t “hands off,” it has it’s odd set of demands – and they can be confusing. I’m most concerned with the negative feedback loop that occurs when the pump is asking for information, but it really doesn’t want you to enter it, or you will confuse the already confused system, and it may result in an aborted sensor.

With kids we are constantly drilling into their heads – “Just do it!” But with the 670G it’s become – “Don’t just do it!”

It requires thought, patience, and sometimes it’s a serious waiting game. But what kid wants to – or will – revisit diabetes 20 minutes later, when it keeps pestering with a beep or vibration to calibrate or enter a BG that the system might not be happy with. This is a serious flaw for a system built for all-ages.

My Daughter’s Positives:

• “No Lows!”
• “I like having the CGM and pump in one unit; when I’m at basketball, I can look and see what my sensor glucose is.”
• “That it’s waterproof.”
• “The sensor/ transmitter is really flat compared to the Dexcom and I like that – it’s less visible under clothes.”
• “You can silence all of the alarms for a period of time for school and sports.”
• “The pump prevents post meal highs when you nail the carb load correctly.”
• “No overnight lows – I sleep better and can sleep in without getting low.”
• “There is a setting to deliver insulin faster – I like that.”
• “My A1C is improving a lot.”
• “I don’t have to eat for diabetes all of the time.”

My Daughter’s Negatives:

• “The red flashing light brings attention to the pump and me.”
• “I have to take the pump off to use it now that it is situated vertically, not horizontally.”
• “You have to count EVERY SINGLE CARB.”
• “I get popped out of auto mode almost every single night – even with calibrating right before bed.”
• “The pump alarms don’t wake me up from my sleep.”
• “I’m still trying to gauge when to use the temp basal for sports or not – I’m not getting consistent results – sometimes the temp basal makes me high.”
• “Sometimes it doesn’t give me one alert, they keep stacking on top of one another and takes time to work through them all.”
• “The pump is bigger and more noticeable.”
• “The battery only lasts 2 weeks and dies quickly – it’s larger – a AA. “
• “When you calibrate it doesn’t give a number right away like my Dexcom did; I miss my Dexcom.”
• “It bugs me that I can’t use my Apple watch or see my pump/ CGM data on my phone. Especially when I’m wearing a dress. You always have to pull your pump out to do anything.”
• “There is a lot of button pushing to do for everything on the pump – much more than previous pump models.”

If you start on this system, I recommend joining one of the 670G Facebook groups. They not only provide a community of support, but it gives us crowd-sourced information from users, outlining the successes, technical issues and workarounds people are using that may not come with our training.

The post Medtronic 670G: Experiences of a Mom + Daughter with T1D appeared first on She Sugar.

Medtronic’s 670 G  hybrid closed loop system is the smartest insulin pump to hit the market, and people living with type 1 diabetes, including my daughter and I, have been gobbling them up.

As we embark into our second week on this new system, the majority of the time I’m all in, thinking: “This is amazing, I haven’t drank juice in days,” “I need to eat something – just to eat, not because I need to balance my diabetes,” “It’s so nice not to have T1D awaken me from sleep,” or “I feel less worried about my daughter.”

All remarkable thoughts.

A minority of the time, I’m thinking: “Why is this pump buzzing at me again?” “This algorithm isn’t really getting me into the 120 range,” “This sensor is frustrating – my Dexcom was so simplistic to use compared to this finicky Guardian 3 sensor,” “I wish I could calibrate anytime; there’s so much button pushing and user demand.”

It’s not all peaches and cream – it’s a work in progress.

Patience, I tell myself. It will get to know me better. Most people report that it takes a month to love the Medtronic 670G. Truth be told: I’m one week in, and I do love it 90% of the time – as does my 15 year old.

Getting Started on the 670G

We personally utilized the “Pathway Program” Medtronic offered through the end of April, 2017, placing us in a virtual line for the Medtronic 670G upgrade. We were fortunate enough to have purchased our pumps less than a year prior, so our out of pocket was expensive, but not unthinkable.

Word has it that 50,000 customers have ordered the Medtronic 670G pump, but customers have faced hurdles along the way with the age of their current pumps and/or lack of insurance coverage for a new pump. Owning a pump that isn’t out of warranty means we’re at the mercy of insurance companies, waiting, or paying out-of-pocket for upgrades that aren’t submittable to the insurance company.

Tweets and Facebook posts have highlighted similar patient plights with this process. Patients in the Pathway Program forced to upgrade to the 630G for the months prior to the 670G roll-out, the spring availability actually meant “we’ll start shipping in mid-July,” sensors not shipping, and/or issues with prompt training dates.

Try staring at the Medtronic 670G package for more than a few days [especially when you’ve already run out of CGM supplies for your Dexcom]. CGM supplies, by the way, can be a cog in the wheel if you order 3-month supplies. Insurance companies won’t let you overlap supply orders, even if you switch to a new system.

Diabetes can be as simplistic as we like or high-tech and high-dollar. We’re always left to break it all down, analyzing the details, deciding what to try on, what might fit us best, and what we can shoulder financially. Mid-process we’re left to hope and wonder: “Will this tech be worth its weight in gold?”

Diabetes is an expensive disease, one that is both financially and mentally draining, fraught with high deductibles, expensive supplies and a lifetime of worry.

I get the cost of healthcare as a nurse and as a patient. We have type 1 diabetes, times two, in our house.

For once, our timing was pretty impeccable with the 670G pump roll-out. We were lucky enough to get trained, and connected, in mid-July.

I try my very best to practice gratitude, not losing sight of what was available when I was diagnosed in 1984: Regular and NPH insulin, syringes, urine strips – and no glucometers. With the ingenuity of the medical and diabetes community at large, DIY closed looping systems, data sharing apps, continuous glucose monitoring, and now – a closed loop pump, we have a lot at our disposal to choose from.

The Guardian 3 Sensor

As a parent, I’m mentally done with witnessing and intervening to this alert:

We have been super fond of our continuous glucose monitoring products Dexcom has offered over the past handful of years. I’m quite honestly going through “Dexcom withdrawl” right now – even being on the 670G.

Kudos to Dexcom: I may have, on rare occasion, knocked my sensor off my arm or gotten the “???” preceding a sensor failure (also at the start of a bike race – ugh), but I was never unable to calibrate, nor did I experience delayed catch-up times, dramatically “off” sensor readings, or question the readings during long athletic pursuits. Dexcom was most always accurate in my experience.

The “Getting to Know You” Phase

The new Guardian 3 Sensors for the 670G insulin pump are reminiscent of my OmniPod experience. I was stoked to start with both, and they work amazing well – until they don’t work at all. It can be finicky with the alarming, failures, high blood sugars and frustrations. Just yesterday, I questioned myself as to why I bought into this, as my CGM said 99, my glucometer said 230, quickly elevating to 415 after a hard training ride. [More on the why’s and how’s below.]

My A1C is usually 5.9 – 6.1 and I never have 400 blood sugars, especially after exercise. It makes me scratch my head. But as the days roll by the gap is closing and I’m becoming happier with the results.

The adjusting basal the 670G offers, in my opinion, tries its hardest to adjust the user to 120, even if that means no micro-basal for over an hour. One thing is for certain – I do have T1D, so I will always need some variation of basal insulin. I appreciate the pump not allowing me to go low during exercise, but I’m finding that it’s also leaving me in a state of insulin deficiency when I’m done pedaling.

I am sort of an outlier as far as exercising goes, which I realize, most people aren’t riding 150 miles a week. However, I do have high expectations that this system can meet my exercise needs. In manual mode, I normally turn my basal down 30%, even on 100 mile bike races. That means I’m getting 70% of my normal basal.

The days of free-carbs are over, even with exercise, I need to bolus for carbs because the basal is so minimal. I think this is key to thwarting my blood sugar issues.

I’m curious to see how this pans out as I wear it over more miles approaching my 100 mile Loveland, Colorado, JDRF Ride to Cure in August. I’ll continue to monitor trends and identify answers.

But as diabetes has always been, every similar situation also has differences. Thirty minutes on the treadmill and the basal adjustments perform fine. Intense high school basketball practice for my daughter has resulted in: Lows during, no lows during but highs after, and also a perfect 670G performance. All the situations were similar.

I’ll chalk it up to the “learning period” for now. Trust me – I am learning.

Two days after starting in the “manual mode” [a setting you must be in for at least 48 hours upon pump start], I cycled in a 70 mile charity event.

Knowing I would be relying on something new and different, finger stick results [not my CGM] were king. When you’re just trying to be an athlete, which I already had dialed with Dexcom, new equipment can be a pain in the @$$.

Five minutes before the start, I peeked at my pump and it said: 278. This ignited my potty mouth, out of pure frustration. I quickly checked with my glucometer, it read: 176. I erroneously chose to calibrate, which resulted in the system not taking the calibration, asking me to wait and renter the number. Super timely.

As an athlete, I was always able to ride and manage my diabetes on the fly – the simplicity was enjoyable. This pump has many bells and whistles, with multiple buttons to be pushed for every task. The system demands an educated and attentive user. It’s not without its regular hiccups. If your blood sugar reading is far off of the CGM reading you can’t calibrate or enter your blood sugar reading or you will be replacing your sensor – this is very different from our Dexcom practices.

Fifteen minutes into my ride the pump is screaming at me while I’m racing. I can only think:

I push the home button through my jersey and it stops screaming for 1 minute. I did this every minute until I couldn’t stand it any longer. Turns out it was ready for a calibration. Really? In manual mode it’s that urgent?!

It took my calibration, but it was off by 100 points [higher than my blood sugar] so at the next stop I turned off my high alerts and and tried my best to ignore the results until I was done. I had these two lovely screens and changed my sensor 4 hours later when I returned home:

The 670G “Screen of Death”

What Was I Expecting – Why Did I Choose This Pump?

• To decrease lows and highs, especially for my teenager.
• To remove some of the continuous management decision making away from us.
• To provide a sense of security for my daughter as she travels with her high school basketball team.
• To have adjustments being made in the background as we exercise and travel.
• To prevent dangerous overnight lows. Even manual mode has suspend on low and suspend approaching low features.

The Pluses:

• The sensors are much less intimidating to insert than a Dexcom sensor. My daughter finally said goodbye to lidocaine cream to numb her skin first.
• The inserter tucks everything inside and with the simultaneous press of 2 buttons, it’s in the skin.
• Dexcom only functions an alarm  – one to be easily ignored by kids and teens. Having the sensor feedback to the pump is a huge safety mechanism and it takes some of the hard minute-to-minute work away from the user.
• You can sleep in! The auto basal adjustments work their best magic when there are no other variables like food, exercise or stress. No more pouring juice down my daughters throat on weekend mornings when she simply wants to sleep longer than usual.
• For chunks of time you can actually “forget” that you have diabetes. Yesterday I had a late start to the health club and errands, finding myself grocery shopping at 1:30 with no lunch after a workout. I would have gotten low without my 670G doing its behind the scenes work.
• You can really see what’s going on with the basal rate by scrolling through the graph screen. I’m amazed at how consistently it gives little/ differing amounts of basal insulin.
• The only things for us to tinker with are: Carb ratios and active insulin time. Many people report needing more insulin for carbs. I notice – especially with a busy day at the hospital – the pump hardly gives me any basal prior to lunch which stops me from going low, but then I approach lunch basal deficient, either going high after the meal or needing more insulin to cover the carbs in the meal.
• I like the profile of the sensor better than the large, boxy Dexcom. It feels comfortable on my stomach, I always wore the Dexcom on my arm because of its dimensions.
• You can temp basal for exercise it’s called a “temp target” where it tries to adjust blood sugars to 150, not 120.

The Minuses:

• There is only one size of the pump available to fit the large reservoir. The size is a bummer for kids and those of us using small amounts of insulin. It also uses a AA battery – both of which make this pump larger, not smaller like many of us wish for.
  
• Guardian 3 Sensors are a bit clunky and cumbersome to get from the package into the skin. For travel, you need the inserter, the charger and the large package the sensor is kept in.
• The sensor requires more tape than I typically use; it may be problematic for the tape-sensitive folks out there.
• I had 2 sensor failures in the first week following cycling, and my daughter had one following basketball practice.
• My daughters blood sugars correlated quite well with her CGM readings, but mine were off by 50 – 100 points from the get-go with the first sensor. The second and third sensors were closer in accuracy.
• Medtronic is very good about replacing the sensors that have issues and they do have replacements in stock – I’ve already received ours.
• There is no remote monitoring available, although the smart people at NightScout do have a fix.
• The pump has needs, and can have them often. It may ask for extra calibrations, blood sugars, bolus doses to fix a high, meal insulin, it will boot you out of auto mode into “safe basal” or manual mode if the sensor isn’t happy or you don’t complete the necessary tasks it asks of you.
• All the button pushing begins with the variating safety screen [picture below]. I’m like of the horizontal screen in models past better. This pump design always has me either: pulling it off my waist, craning my neck to see it correctly – or trying to read it upside down.

The post A Nurses Review: Medtronic 670G Insulin Pump appeared first on She Sugar.

Something magical happens with gluten free flours in these pans, and it all has to do with the metal that protrudes from the center of the pan – seriously. Gluten free baking can be tough. The top of a cake or bread may look finished, but the inside remains gummy, or the bread may look finished [and beautiful] just to drop in the center when it’s pulled from the oven.

I’m apparently not the only one who admires these pans either. I laughed out loud as I read a recipe called: “I like big bundts and I cannot lie.”

I set out to create a recipe without glutinous flours, 2 sticks of butter or 2 cups of sugar [as most bundt recipes contain].

This cake is very adaptable and I’m sure that I’ll be posting different versions in the near future.

Enjoy!

The post Gluten Free Lemon Blueberry Bundt Cake appeared first on She Sugar.

I can’t get enough of these truffles. They are the perfect combination of sophisticated simplicity. Once the truffles are rolled they can be dressed up in anything your heart desires. I have tucked an espresso bean in the center, rolled them in toasted nuts, coconut, powder sugar, and cacao powder.

They are quite easy to make and store nicely in the refrigerator for a few weeks (if they last that long).

Dark Chocolate and Coconut Milk Truffles

Ingredients:

• (2) bags of dark chocolate chunks or chips (12 ounces each)
• 1 small can of coconut milk (5.46 fluid ounces)

Instructions:

• Using a stainless bowl that fits inside a pot or a double boiler, bring a few inches of water to a medium range temperature. Drop chocolate into the bowl, mixing consciously, ensuring no water from below enters the chocolate as you stir or it will ruin your chocolate.

• Blend the coconut milk well, as the fat separates from the water as it sits in a can. I throw mine into a Vitamix for 30 seconds.
• When all of the chocolate is melted nicely, pour the blended coconut milk over the top and place a lid over the pot for 5 minutes.

• Remove the mixing bowl from the pot, and stir the coconut milk into the chocolate until incorporated.

• Using a spatula, pour the mixture into a bowl lined with parchment paper and place in the refrigerator for approximately 1 1/2 hours.

• You’ll know they are ready to roll when a piece can be be scooped off with a spoon and easily rolled into a ball without being too sticky and soft – or too hard (firm) to work with at all.

• Scoop out or cut pieces that are of sizes to your liking. Roll them in your palms until they are formed, and finish by rolling in your favorite toppings!

The post Dark Chocolate and Coconut Milk Truffles appeared first on She Sugar.

Gluten-Free Apple Carrot Banana Muffins
Preheat oven to 375

What’s not to love about a dozen healthy muffins that mix up quickly and you can feel good about feeding your family?

I’ve gotten into the habit of making these gluten-free apple carrot banana muffins on Saturday mornings – when I don’t have to run out of the house in the morning. They are so delicious straight from the warm oven and make the house smell wonderful.

The recipe is adaptable to premixed gluten-free flour blends – just be sure there’s xanthan gum or you’ll need to add it in. With 2 cups of fresh fruit and veggies in these muffins you can’t go wrong. The fresh sweetness offered by the ingredients will keep you and your kids coming back for more.  

Ingredients:

2 eggs (room temp)

1/4 cup melted coconut oil (or another favorite)

1/2 of a ripe medium-sized mashed banana

1/4 cup softened honey (if you add honey to cold ingredients it will harden, be sure it’s warm and soft); agave or maple syrup works as well

1 small apple, peeled + grated

1/2 cup brown sugar or coconut sugar

1/4 tsp sea salt

1.5 tsp baking soda

1 tsp ground cinnamon

1/2 cup vanilla coconut milk (I prefer SO brand)

1 tsp vanilla extract

1 cup grated carrot

2/3 cup gluten-free rolled oats

1/2 cup & 2 tbsp almond meal

2 tbsp flax meal

1 cup gluten free flour: (1/4 cup sorghum flour, 1/4 cup brown rice flour, 1/4 cup sweet rice flour, 1/4 cup quinoa flour, 1/4 cup tapioca starch, 1 tsp xanthan gum)

**{2 Tbsp cold butter, 2 tbsp almond flour, 2 tbsp brown sugar – for topping}**

Mix:

• Grease muffin tin using gluten-free coconut spray

• In a large bowl mix: mashed banana, eggs, honey, coconut oil, brown sugar and vanilla extract until combined.

• Add coconut milk and stir.

• Add grated carrot and apple – mix gently until combined.

• In a second bowl combine oats, salt, cinnamon, baking soda, almond meal, flax meal, gluten-free flour blend and whisk until combined.

• Add dry to wet – mix gently until combined.

• Using an ice cream scooper divide evenly into muffin tins. Mix the 3 items for the topping as mentioned above and sprinkle lightly over the muffins.

• Bake for 20 minutes or until golden brown and set in the middle.

• Remove from oven, let sit for a few minutes and then transfer to a wire rack to cool (you may need to loosen around the edges with a butter knife to separate from the muffin tin) -if there’s any left – store them in a glass container in the fridge.

The post Gluten-Free Apple Carrot Banana Muffins appeared first on She Sugar.

Real estate on a bike is valuable – especially for me. It’s ironic that the distance isn’t the hardest part – wrangling diabetes along the way is.

Type 1 diabetes isn’t going to stop me – I bring it along for the ride.

My daughter and I have a lot in common; I wish type 1 diabetes wasn’t one of them. I was diagnosed at age 13 and Emma at age 5. Looking at her sweet little face, knowing her future included everything I’ve been shouldering for most of my life was heartbreaking.

I’ve ridden my bike over 4,000 miles in the past year.  I look like every other rider, but I’m not – the baggage I carry in my heart and mind is a heavy load.

This fall I’ll be riding 104 miles in the Tour de Tucson for JDRF; we all pedal with a common purpose – to fund a cure for type 1 diabetes.

As the miles pass by, I place distance between the day Emma was diagnosed and now. The road may seem long in front of me, but it’s short in relation to what’s behind me – what our family’s been through.

Cycling and diabetes have a similar rhetoric:
put your head down –  figure things out on the fly- keep spinning – smile.

Type 1 diabetes is 24/7,  making  it one of the most difficult diseases to manage. There are a lot of bumps in the road; crashes, flats, veering off course, things you can’t predict or control. We’re confident that there’s a finish line in sight – but were not there yet.

I ride for you and I ride for me – together- we can turn Type 1 into Type None!

PLEASE, DONATE TO MY RIDE

Thank you for considering a donation to my (Jewels Doskicz) Tour de Tucson century ride with Team JDRF; I’m diligently training for this November JDRF ride.

Our family is committed to finding and funding a cure for Type 1 diabetes – which is the driving force behind this JDRF century ride in Tucson. As a patient advocate and tireless JDRF volunteer, I know that grass root engagement can generate change.

I have been hard at work training while balancing diabetes on my bike in order to achieve this lengthy goal. Please consider a donation on our behalf – your gift today will propel me toward the finish line.

Make your tax deductible contribution online

Watch Jewels 2014 JDRF Fund A Cure Speech

The post Why I Ride | Type 1 Diabetes | JDRF Tour de Tucson appeared first on She Sugar.