Pulling everything together

Nick Hutchins
Apr 14, 2017 · 6 min read

Stepping off a small plane in Portland, Maine on April 5th, 2017, I arrived to find an anxiously awaiting mother who was happy to see me. The last time I had visited Maine was in early November, 2016 when my younger brother’s daughter Kelsey was born.

I brought a few pieces of knowledge on diabetes management I picked up through my own research and from my friends who have experience working with diabetes.

A special thank you goes out to my great friend Dave Korsunsky for the knowledge dump over a few glasses of bourbon before my departure from San Francisco.

Detour bars work for replacing meals in a pinch
Getting the flu becomes particularly dangerous
High fat, low carb diets work
Time to take a blood glucose measurement: pre-prandial after awaking from sleep, and 1,2,3 hours post-prandial
Keeping your blood glucose levels under 120 millimoles per litre will give your pancreas a vacation and allow your body to regain its sensitivity to insulin, in turn allowing your body to deal with the glucose in your blood
Extreme cases need intermittent fasting
The Bayer Contour monitor is a good model

Establishing a platform

After several attempts at trying to gain [authorized] access to my mom’s electronic medical record via a patient portal, the latest token her doctor’s office gave us still doesn’t work. We went down to the office so I could sign the medical record release forms as an authorized care team member. I have the entire record printed on several reams of paper and have started to pore through the information to piece together a complete picture of her health. Twofailed tokens and a paper stack later I realize this will be an on going task as we continue to look for a new doctor who is willing to take a more proactive approach to my mother’s health and well-being.

Monitoring blood glucose levels is an essential task while learning how to best manage diabetes. We’re first focusing on dietary improvements. My mom picked up the FreeStyle Freedom Lite monitor and we set a regular monitoring schedule: after waking up in the morning (fasting) and 2 hours after eating each meal (postprandial). With four readings each day, this should give us enough data to learn how certain foods impact her blood glucose levels.

Blood glucose monitoring 4 times every day

We decided to use the Fitbit Alta HR activity, sleep and heart rate monitor to measure steps, rest and cardiovascular health. We chose the Fitbit Aria scale to capture my mom’s weight and body fat percentage. The Alta data is captured in real-time while the Aria scale captures body weight and body fat percentage once a day.

Activity, heart rate, sleep, weight and body fat percentage — catpured

Where does all the data go?

Thanks again to my good friend Dave, founder and CEO of Heads Up Health, for providing my mom with a platform for integrating all her health data into a centralized, shareable record. By having just one online record we can quickly and easily document health data, analyze trends and open up access to members of her care team. My mom enters her blood glucose levels and what she ate into the dashboard while the Fitbit Alta and Aria data flow into the platform automatically.

Weight, glucose, steps, sleep — my mom’s customized dashboard I can access from my own account

Patients who are better informed are more empowered to take control of their health.

Shifting the diet

A grocery store run was in order.

Quinoa
Greek Yogurt
Hummus
Blueberries
Cold Pressed Juice
Kale Chips
Tofu
Bananas
Salad
Feta Cheese

A few healthy food items

We started collecting blood glucose levels April 3rd through the 8th and the results were discouraging. Our target range is between 90 and 130 mg/dL and we were between 115 and 252 with an average of 169.5 mg/dL. What was more alarming was her upward glucose trend despite strong dietary adjustments.

We sat together on Saturday evening to analyze the data to understand how the nutrition impacted her glucose levels. What we found was upsetting. Her homemade rice mixture was the primary culprit for her blood glucose spikes. Asking a native Korean to give up rice was heartbreaking. But based on the data we collected, the high protein, low-carb meals were keeping her in a lower glucose range. A lower overall range is what’s going to give her pancreas the break it needs.

Here comes the sun

Coming off a snow storm last week, temps in Jay, Maine hit 60 degrees on April 9th and continued to rise into the 80’s the following two days.

With a warm weather tailwind we continued to make dietary changes that focused on low carbohydrates, high protein and natural sugars from fruits and vegetables. As a show of solidarity and moral support, I’ve started committing myself to my mom’s diet. I’ve been testing my own blood glucose to further validate our dietary experiments. Good news —I’m not living with diabetes.

Meal-matching with my mom — salmon, sweet potato fries, tomatoes and cucumbers with light dressing

Because my mom’s glucose range continued to escalate we decided to start taking Metformin with breakfast and dinner as prescribed by her physician. Metformin is a common first-line medication used to treat type 2 diabetes. The medication reduces the amount of glucose your liver produces by up to 33%.

A type 2 diabetic has three times the liver glucose production rate as a healthy individual.

The new diet combined with Metformin has already shown promising results. From April 9th through the 14th her blood glucose levels were between 80 and 189 with an average of 120.1 mg/dL. It’s clear the medication has a significant impact on the volume of glucose in her blood. With reduced glucose levels her pancreas can finally take a vacation and her body can slowly begin to rebuild the invaluable insulin sensitivity she desperately needs to live the happy, healthy life she deserves.

Upward glucose trend before Metformin, downward trend afterwards

Now that progress is being made and we’re on the right dietary and medication track we’re starting to narrow down specific foods that bump up glucose levels. The goal is to stay in the 90 to 130 range consistently for the next few weeks.

Zeroing in…on a banana

My mother has already realized significant weight loss from adjusting her diet. We’ll be focusing on increasing activity levels in the next phase of our program.

Weight and activity

Long days and late nights with my best friend

🍅 TOMATOES!

With Love,
Nick

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