Sugar Surfing: How to manage type 1 diabetes in a modern world, by Stephen Ponder, Kevin McMahon
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Sugar Surfing: How to manage type 1 diabetes in a modern world, by Stephen Ponder, Kevin McMahon
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We aim to replace static diabetes management with a dynamic in the moment method. An excerpt from Chapter 4 – A Force For Change “… In the grand scheme of diabetes self-management, I explain to patients and families that I (the doctor) don’t “manage” anyone’s diabetes. My role is more like that of a coach, occasional cheerleader, mentor, and at times role model I suppose. It truly is the sum of your choices; not mine or your doctor’s. Simply receiving diabetes education is often not enough. I see a three step process at work, and often times we barely get past the frst step. What we call “diabetes education” is intended to result in understanding on the part of the person(s) receiving it. But that is not the fnal element. Understanding should translate into behavior or actions for the education “loop” to be intact. There are many highly intelligent and understanding individuals in the criminal justice system who are well educated and understand all too well their actions, even the illegal ones. So what does all this have to do with using a CGM? In my opinion, it means all the difference in the world. It morphs a CGM device from a simple high or low blood alarm system (not a bad thing by itself) into the key for unlocking a vast new universe of diabetes self-realization that could once only be dreamed about. Basic diabetes self-care can be drawn as a decision loop. This loop is actually being executed daily by most persons with diabetes albeit often in a mindless fashion. Turning this chore into a more mindful action loop transforms this into an incredible tool for attaining the best blood sugar control possible for you. Like any loop, Sugar Surfing has no beginning or end. I tend to jump in at the point I call “monitoring”. This embodies many inputs both measurable and subjective. Most of us think of the act of measuring a blood sugar level with a meter or CGM device. But it’s more than that. It’s also being “in the moment”. That means being aware of recent, current and impending actions that are known to affect the ebb and fow of blood sugar levels in the body. Since blood sugar levels can be unpredictable, staying “in the moment” is a about the only approach that works for anticipating, or at least quickly reacting to unexpected shifts in BG. Once the status of the system (your body) has been sized up, either through the act of measuring a glucose level or glancing at the screen of your CGM device (or both), the next step is to analyze what is going on. This involves pulling in memories of recent actions (last insulin dose, most recent bout of exercise, what and how much was eaten (or will be soon) and more. The analysis step is where all of the little inputs come together for a final determination which is the next step: decision- making. Deciding is prioritizing one or more actions based on all the possible actions. The one that seems to be the best option is placed at the top of the list to be acted upon. Back up options are most likely numerous, but an initial action is required. The fnal part of our loop is execution: the act of following through on our decision. Immediately afterwards we are moving back into monitoring to determine the effect of our action and then modifying it as needed. You are probably saying “I already do this” and you would be right. But as has been written about by many authors, many of our decisions are mindless as opposed to mindful. This loop is a skill as much as it is a process. And as such, skills are practicable and can improve over time, or grow rusty with disuse. For example, if you use an insulin pump, when was the last time you validated all of your built-in static ratios? This is what I call the cardinal sin of set it and forget it. If you fnd yourself simply acting on what your bolus wizard says then you are acting in a mindless state. Rather, be mindful and consider the pump’s suggested bolus as simply another input to your decision...
Sugar Surfing: How to manage type 1 diabetes in a modern world, by Stephen Ponder, Kevin McMahon- Amazon Sales Rank: #56107 in eBooks
- Published on: 2015-10-30
- Released on: 2015-10-30
- Format: Kindle eBook
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Most helpful customer reviews
44 of 44 people found the following review helpful. Mom with two T1D kids By Andromeda Before you start reading this review, you may want to sit down and make yourself comfortable. I have a lot to say, most of it complimentary.Let's start with my background. As of this review, my daughter has been a type 1 diabetic for 9 years (she's 11) and my son has been a T1D for 2 years (he's 13.) It would be fair to say that I spend a decent chunk of time as a pancreas. Well, pancreata, actually, if one can be plural. Anyhow, I have spent years learning about diabetes. We've done MDI and pumps, been through surgeries, illnesses and the diagnosis of additional auto immunes. I make all changes, evaluate all Dexcom reading, manage foods, oversee carb counting, change sites, wake up sleeping kids to feed them, stay up late to watch a temp basal kick in and then spend my free time researching ways to do it even better.I first heard of Dr. Ponder on Facebook. I became a follower because I liked his tips/posts. At some point, I realized he was writing a book about his approach to diabetes and when he started to raise funding, I contributed. Going in, I expected to like the book. But, please note that I was not GIVEN this book - there is no giveaway and this isn't a review based on a freebie. I paid my money and I'm very happy to have done so.So on to the book. Basically, I loved it. In 9 years, I have tried many, many things. People that don't live with T1D have no idea how hard diabetes is. It's 24/7/365 and there are no days off. Ever. There is no afternoon off. Most parents of T1Ds are just happy when the stars align and they are able to sleep through an entire night without an alarm. We don't have the disease but we have to have the knowledge because we feel this pressure to make sure our kids are given every opportunity to have healthy, complication-free adult lives without being constantly in their faces about diabetes.I remember when my daughter was diagnosed and I found carb factors in my research...and then had to explain it to the CNP at the next four endo visits. And implementing the TAG idea in meal planning so that fats and proteins were covered appropriately...and then explain it to the CNP. As you can imagine, I decided to do my own thing fairly early on and the habit has stuck. I see the endo as a prescription source and like to figure out things on my own.And then along came this book! And I realized that I wasn't alone. That there is an endo out there (who is a multi-decade T1D himself) that gets this. That experiments and tests and keeps an open mind. That takes his results, figures out WHY they happened and then figures out how to repeat it. And then SHARES it with the world.I'm going to touch on a few topics that might help reviewers determine if this is a book for them.First, basal rates. Dr. Ponder is a bit pushy about the idea of a single basal rate, or at least a small number of them. It's not a rule but it's something he appears to value. I have varied basals greatly over the years but I've never used a single basal rate. Perhaps it's because we did split dosing on long-acting insulins and I timed the overlap to cover dawn effects and bedtime growth hormones...so we never really had "one flat line" even on MDI. But I have learned over time that I gradually add basal rates until I become overwhelmed by them, at which point I scrap them all and start minimal again. With both kids in puberty and a son that is that teenage stage where kids 'forget' to bolus, one rate isn't right for them...but I have really given some thought to it. My son has three different levels - lower at night, really high in the morning, and high all day - and it's working well, so point to Dr. Ponder. My daughter's basal rates have been incredibly detailed before so while it's not three, I have reduced them by 3. Again, it's working well and it's easier to remember, so another point to Dr. Ponder.Second, I needed a good reminder that a flat line means a basal rate is right, and that it means the other details need changed. I had been struggling with nights and had been changing them so often...and it was completely the wrong approach. I changed my mindset and the results have been wonderful.He slept 12 hours last night and was between 75 and 100 the entire time with no eating, no temping, no bolusing. Thank you, Dr. Ponder.
12 of 12 people found the following review helpful. A Great Addition to my Diabetes Management Toolbox By B. Friedhoff Dr. Ponder's "Sugar Surfing" has become another important tool in my diabetic management toolbox. I had been using a continuous glucose monitor (CGM) for about a year with some success in keeping my blood sugars more stable, but Ponder's matter-of-fact guidance in other proactive ways to manage your blood sugar really got me hooked on keeping my blood sugar "between the lines" (my high and low alerts on my CGM). I think any person or family wanting to better their management of diabetes will find several tips in these pages worth much more than the cost of the book. His tools can be used regardless of whether you use a pump or MDI or a CGM. It's really about using your blood sugar readings along with what you know about the past, present and future to make real-time decisions regarding insulin dosing or glucose intake. I also sent a copy to my endocrinologist and nurse practitioner who both loved the book!
10 of 10 people found the following review helpful. Don't do diabetes without this book! By Angie A must-read book for anyone with type one diabetes, packed with real-life examples and detailed CGM charts. Sugar Surfing has Surfing dropped my 8 yr old son's A1c by nearly a full point, and we've maintained that for a year, due largely to following Dr Ponder's methods. The future of diabetes management is here - it's Sugar Surfing!
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