Day 31 – Afrezza and Tresiba Post Russia

Here I am, 31 days after leaving for Russia, back in the States for the 4th day. I have many questions, because my use of Afrezza and Tresiba have gone up considerably.

Reduced Tresiba in Russia

My questions come partly from my earlier post, where I noted that I had reduced my basal insulin usage considerably upon arriving in Russia.

When I left the USA for Russia, I was using 46 units of Tresiba a day, for a flat line basal. Total, while in Russia, I had reduced my basal 30% to 32 units a day. I am not sure of why I needed the reduction, but I was thinking it was both exercise and the natural non-GMO food.

Reduced Afrezza in Russia

My bolus insulin usage also decreased significantly while in Russia. My diet had not really changed, other than the type of food eaten – meaning naturally grown, in season, and non-GMO.

In fact, I ate a lot of high carbohydrate items that I normally would not eat in the USA, like baked goods and bread. Diabetic friendly foods and drinks are found in cities like Moscow and St. Petersburg, but not in Crimea.

Total, in 23 days, I used exactly 1 box of Afrezza (60x4u, 30x8u), compared to my normal of 2.5 boxes (135x4u, 90x8u).

I normally use a bolus ratio recommended by one of the Afrezza gang, which is to use 4 units of Afrezza if my carbs are greater than 24, and 8 units if greater than 36. In Russia, I found that 4 units was more than enough for most meals over 36 carbs, and under 60.

Increased Insulin in the USA

On my first day back in the US, July 14, I had wild highs in the afternoon. I attributed it to being tired and potentially a false “dawn phenomenon” since my body thought it was early morning. However, I also went high that night, as well.

I have since adjusted my Tresiba up to 40 units, and I am thinking I need to raise it again in a couple of days. I still get the wild highs in afternoon and early morning.

The Questions to Answer

The questions I have are:

Why did I need such a decrease on arriving in Russia?

This I cannot answer.

Why did I need an increase on returning to the USA?

I cannot answer this one either.

Have I changed the amount of exercise I am getting?

Not really. The first day, maybe, but not since. I still walk 4-5 miles a day. Even when I was not active in Russia, I did not have a rise in glucose levels.

Have I fundamentally changed what I eat?

This is the big question.

My normal (US) diet usually consists of yogurt in the morning, salads for lunch, and a rounded meal of meat, veggies, milk (whole, non-homogenized) and maybe a small amount of carbs. I rarely snack, other than a bagel in my Tuesday staff meetings.

In Moscow, I started the days with eggs, yogurt, meat, veggies, and usually a small parfait. Lunches were a variety of Russian foods (high in potato and cabbage content), and dinner was usually something like beef stroganoff and the normal restaurant accompaniments.

St. Petersburg was pretty stable. We ate at the cafeteria, and the “lunch lady” fed me chicken noodlelunch lady soup soup (2 bowls), beet salad, and chicken cutlets. Lunches and dinners were usually an ice cream, pastry, and some meat product.

Crimea was relatively stable as well. Breakfast was eggs with vegetables, pelmeni (dumplings), and cutlets. Lunch was usually ice cream, and dinner was always chicken cutlets or stew, and salad with a good amount of fresh tomatoes and cucumbers. I also ate one heck of a lot of fresh cherries, almost daily. We were buying a kilo a day, and I ate a good part of them in the evening.

I also drank a heck of a lot of water, and very little soda.

What is the difference in food?

The biggest differences I can see in the food are that the raw foods you buy in Russia are in season, some grown in hot houses, and are (likely) GMO free.

I also find things like yogurt to have less sugar content, dairy products are often raw products (milk, cheese, sour cream, etc.), and foods in general contain less added sugars. People in Russia are more health conscious, and when I would order the occasional “Coke Zero,” I would be encouraged by the waiter or waitress to order water instead.

When eating out, the portions in Russia are smaller, but that does not hold true at my mother-in-law’s meals in Crimea (where 3 servings is “starving” yourself).

I really cannot explain the differences in food, nor why my Tresiba and Afrezza usage are so different.

But one choice seems to stick out to me.

Crimea: Investment Gone Bad?

The building and property in the leading photo was one I was looking at as an investment, in Crimea. Some things just do not work out. Does that make it a bad investment on the Crimean peninsula?

Crimea Investment

This building was originally started as a sanatorium (health clinic) for children. My first information told me that they ran out of money, and it has sat incomplete since.

For me, I would have invested in it just for the brick building on the left side, and some parking spaces. Parking is at a premium in the mountain cities of Crimea, and I looked at it more for myself and my neighbors. Either way, I think the building is cool, and I would have invested in it just to have the property above our apartment.

Original Investment

This was, without a doubt, a bad investment for the original owners. What I found is that the owners were building this sanatorium without a license, while Crimea was under control of Ukraine.

When Ukraine was having its struggles in 2014, the owners quickly sold the building to someone else for almost nothing.

Second Investment

They second owners probably thought they were getting a good buy during the government turmoil. Alas, they ended up with a bad investment too.

The building and property sit under a main power line. In Ukraine, this was not a problem. In Russia, it makes the land unable to be developed. Russia does not allow building underneath power lines.

Building under power lines, especially something like a sanatorium, is forbidden due to health concerns. Add to that this being a facility for children, and you end up with unsuitable property for building.

One of the things I have seen in Russia is that there are many laws that support health concerns which are debated in the United States.

New Crimea Owners

So who ends up being the owners of this unusable property? The Crimean (Russian) Ministry of Health. I do not know if the illegal buildings and property were seized or purchased, but either way it now belongs to the government.

Will the government be able to develop anything there? Only if they move the power lines. Of course, they are about the only ones with the resources and weight to get the lines moved. Is the story all negative, or is there a bright side?

Bright Side of Bad Investments

In the mean time, I look at the bright side. I will not have someone building above our apartment building, blocking our view of Ai-Petri Mountain, or looking into our windows.

The poured concrete on the property has made for a good neighborhood shashlik (BBQ) spot. And yes, neighbors can still park there at this time.

Memorization or Creativity

Yesterday, I posted a story of a boy in Russia. I talked about some of the things I saw as good in the Russian education system. A teacher in the US was quick to disagree with me.  She told me I was wrong thinking memorization is as important as creativity in problem solving. My comment relates to this article, and I will give details of my belief in the following text.

Memorization is the Foundation

I agree that creative problem solving is a good thing. However, I believe the US puts too little focus on the pluses of memorization.Memorization

When I was a primary student in the 1960’s, we also did memorization of multiplication and division tables. We learned basic addition and subtraction. These basics are the foundation of all math going forward. These basics have served me well in my career as an engineer. I am good at calculating, estimating, and fractional equations. My daughter is an example of where this does not work today.

My daughter attended first grade in Russia. In that year, her class studied multiplication tables. When she moved to the US in second grade, she was already 2 years ahead of her classmates in math.

The second grade teacher in the US gave the class calculators at the start of the year. My wife asked the teacher about doing this. The teacher said “we practice new math here” and “creative problem solving is more important than calculating by hand.”

The public school gave up on this math program in favor of another the next year. The school district’s reason was that the earlier math model was a failure.

My daughter is still ahead of her classmates in math, due to her learning the basics in Russia.

Educators must teach the basics along with creative problem solving in order for students to succeed.

Creativity in Creative Problem Solving

We discourage students from using creativity in this “creative problem solving.” We say we encourage students to learn concepts instead of Creativity“getting the right answer,” but our teachers do not practice this .

Teachers still grade students based on getting the right answer. The teachers also grade the specific methods the students use to solve problems. Students who creatively solve problems have points marked off their tests. That in itself is limiting student creativity.

An Example of Discouraging Creativity

For an example, my daughter struggled with solving the algebra equations her teacher was promoting. My daughter sought advice from her mother, a Russian math teacher, and some text books her Russian grandmother brought her. The concepts explained were much simpler for her, and still provided the correct answers to the problems.

The teacher reduced my daughter’s grade for not using the “proper methods,” penalizing her despite having the correct answers.

I learned the same methods in the US, back in the 1960’s, that Russians teach. Quite honestly, I do not understand the new method.

One Extreme or the Other

The issue I see is that Americans go from one extreme to the other. Americans do not seem able to balance on a middle ground. As such, we find it hard to teach creative problem solving skills while also utilizing basic memorization techniques.

Though many US teachers seem against  memorization, many of our basics skills are based on this technique. For example, “i before e, except after c” (ok, it is a mnemonic rule of thumb, but we have to memorize it, yes?) How about quotation mark rules? Keeping Stalin and JFK from being strippers is based on comma rules.

So if memorization is ok in language, why is it so bad in mathematics?

Memorization is the foundation, and creativity is what you can imagine. You need both.

A Story of a Boy – Russian Education

Is there really much of a difference between Russian education and American education? Let me tell you a story about a typical 9-year-old Russian boy. Here, we will call him Ivan (not his real name, to protect his identity).

Russian Education of a Boy

While I have been on the Crimean coast, I have spent time speaking with a 9-year-old boy. Ivan spends the summer with his grandparents in IMG_8727Crimea. He is a typical boy who likes soccer, eating ice cream, playing ball, dogs, mobile phones, his iPad, and making noise.

Ivan studies at a typical State run school in the Ural region of Russia. He has classes in math, Russian grammar, reading, composition, social studies, and physical education. Ivan studies French as a second language at school.

In his spare time, Ivan studies dance and English. He has studied English in a group with other children of his age for 3 years, as a hobby.

Conversing in English

Ivan was afraid to speak with a native English speaker at first. His babushka (grandma) asked if I would speak with him. With a little coaxing, we finally got to the point of exchanging “Hello” and “my name is” between us.

Since then, Ivan has come over to our apartment at least once a day. We spend 30 to 45 minutes together chatting about “boy things,” and I help him with pronunciation and putting sentences together properly. For example: “I am a student” versus “we are students.”  We have discussed boys, girls, time, and clothing items.

Ivan also has workbooks that he brings, and we read texts out loud to each other. He translates them to Russian for me (we both use the services of my wife, a native Russian and English speaker, when needed.)

It has interested me, I have picked up a little Russian from him, and he has expanded on his English pronunciation quite a bit through practice.

Multilingual Russian Education

I guess the thing that strikes me about Russian education is that it is purposefully multi-lingual. Ivan is native in Russian, fluent in French, and very proficient in English. Not only does the school require multiple languages, but parents and grandparents encourage more languages as well. Available languages are English, French, German, and several Asian languages among others.

I compare this to the United States, where a foreign language often is not offered until middle or high school. The number of available languages in American schools are few. I was actually surprised that my daughter’s high school offered French and Russian, while most offer Spanish and French.

Other Strengths of Russian Education

The basic math, science, and (Russian) language aspects of the Russian education system are quite well founded. We can compare that to the United States mathematics, where “new math” and calculators have become king of numeric.

And have you seen a Facebook posting by a teenager lately? It seems US schools quit teaching about capitalization and punctuation.

I have looked at several surveys on educational systems in the world. You can find as many rankings as you can find surveys online. One thing that shows up in most of them is that Russia typically ranks higher in educational excellence than the United States. They spend fewer dollars per head (roughly 3.9% GDP per student in Russia, vs. 5.9% GDP per student in the US.)

I think we should consider areas we can change our educational system, and take some ideas from the Russian system. There are differences, though I disagree with the “rote memorization” characterization. I know most Russian children can calculate circles around me, and I am good at math.

I think we can learn from each other.

Day 13 – Afrezza and Tresiba in Russia

I had a hard time picking the subject of this post. It came down to Afrezza and Tresiba in Russia as they were an easy subject for me.

Afrezza and Tresiba an Easy Subject

Why are Afrezza and Tresiba as easy subject?  It is because life has been simple while in Russia, using these two drugs. I have been able to live a fairly “normal” life as a diabetic with Type 1 diabetes, without worrying about diet and without worrying too much about exercise.

Pros and Cons of Tresiba

Let me be clear: I love Tresiba as a basal insulin. Of current options, I would not change from it nor go back to the pump. One injection a day for the flexibility and control I get is worth it.

The advantages I have seen while traveling are that time zone changes do not affect me. I took my Tresiba a bit late on the day I left the US, and took it at noon the day we arrived in Paris. The switch to Moscow time was easy, as it was only an extra hour. My first dose in Moscow was the morning of the next day.

The con I see with Tresiba is that my basal needed lowering, and it took a good week to find out how far to lower it. With the increased walking I am doing while in Russia, and the healthier food I am eating, I ended up lowering my basal a total of 30%. The problem is that I had lows for several days, while waiting for the dose to adjust. It also meant that I did not know if I had cut it enough, or cut it too much, for several days.

I did take it down in two steps. First, by 20%, then another 10% 3 days later. The result is a flat basal rate when I am not exercising, with a slight rise in the afternoon when I normally am doing a lot of walking.

Pros and Cons of Afrezza

The big advantage I have had with Afrezza is that I can take it with me easily, and dose as needed without having to offend others, or to find a private place to inject.

I find that I use very little Afrezza with the foods I am eating in Russia. Some of it is because I am eating a lot of tasty fruits and vegetables, and I believe a good part of the fruit sugars are eliminated through the extra exercise. However, potatoes are a big part of Russian food, and I do find I use less Afrezza to cover those bolus points.

I am usually taking Afrezza after my meal, and only when my blood glucose hits 130 with a single upswing arrow on my Dexcom. That wins me a puff of 4 units. If I eat ice cream, a large serving of potatoes, or drink some of the deliciously sweet Crimean wine, it wins me an 8 unit puff.

In the US, I average use of about 2.5 boxes of Afrezza per month. That configured as 6 packages of 4 units, and 3 packages of 8 units.

In Russia, over two weeks, I have used exactly 1 pack of 4 units, and under 1/2 pack of 8 units. Average that out to a month, and we get roughly one box.

The cons?

I really have not found any.

Adjusting for the basal anomaly

For the slight rise I have in my basal in the afternoons, I find that the amount of walking I do pretty much offsets that rise. I still have a slight rise in the 6pm timeframe, but my Afrezza dose with dinner usually clears that up right away.

I do think the basal is a couple of units too high, but I need a “no activity” day to really figure that out.

Today is the first day I am actually getting to sit back and do nothing, so we will see how my basal reacts. Thus far I have been fairly flat today, starting at 114 on rising, dropping to 95 just before breakfast, up to 124 after breakfast, and back down to 107 up until now.

I do have a rise to 119 at the moment, with a flat indicator from Dexcom. I did just eat about 200 grams (1 cup) of ice cream, with no Afrezza dose.

Final Notes on Dexcom

Just a couple of notes on Dexcom that I find while I am traveling.

If I stick to the “mobile receiver” (my iPhone) I have had no problems at all with my Dexcom, nor the data uploaded to Dexcom Clarity.

The problem I ran into was when I connected my Dexcom G5 receiver to my laptop today, to upload the missing holes from losing Bluetooth connectivity the past few days.

Because I had not changed the date on the Dexcom receiver, I ended up with some up and down patterns on Clarity. At the same time of the day I have readings that might be 107, with a minute later the readingOdd Dexcom Readings showing 206, then a low one, followed by another high one.

Note to self: Change the date on the receiver if traveling and using it as a backup to the Bluetooth on the phone.

Day 1 – Afrezza and Tresiba in Russia

 On the Way to Russia with Afrezza and Tresiba

Quite a day, and finally in the plane. Heading to Paris first, then Moscow to see how the trip goes with Afrezza and Tresiba in Russia. I have a month and a half of Afrezza with me, and a month and a half of Tresiba. I took extra, just to make sure – better to have too much, than not enough, when you cannot buy the product outside the US.

Airport Saga Begins

We got to the Minneapolis airport and found we left the “bag” of Afrezza at home, in the fridge. I made the return trip home to retrieve it, costing an hour and and extra $80 for the driver, while my wife and daughter went thru Security with our carry on bags.

They had a TSA PreChek appointment, but could not get any help finding the TSA office. They even asked TSA officers where the TSA office was, and they told them “you are done already.” I have PreChek already. However, I found out PreChek is not valid on any Air France flight. I figure we all need a good strip search once in a while, but I sure wish the Afrezza did not get left behind. Fortunately, my trip through security was quick and left plenty of time to get to the flight.

Then my wife and daughter’s passports were flagged as “no proper travel documents” at the gate. You would think they would check this when they scan the passport and visa when you check in. Our daughter got overridden, but my wife… we were the last last passengers on the plane.

Afrezza and Tresiba Seem to Win

Stress total? Brought me to a high of 131. Only 4 units of Afrezza should take care of that.

So, what to expect while we are gone, with Type I Diabetes? Not sure. We will have to see what happens.

To be continued…

Additional Notes: Dexcom vs Medtronic CGM

I have some more thoughts on my earlier Dexcom and Medtronic continuous glucose monitor comparison (CGM) that I did not mention yesterday.

CGM Notifications

The Medtronic 530G can send notifications from the Minimed Connect CGM application to you via text message. They are fairly useless alerts. They simply say “High SG, CHECK BG.”

For a text message notification to be useful, I would at least expect it to tell me the value of the reading. It also will send a new notification every 30 minutes or so, which is an annoyance. If I treated the high, it will take time for my blood glucose to go down. If I do not treat it, I am at least aware of it. Let me set how often I get the notifications, please.

For me, because I set my high level to 140, I get these notifications quite often. Every one of them comes from a different phone number, so I cannot set the name for the number to something like “Medtronic CGM Notification.”

I know the Dexcom G5 Continuous Glucose Monitor can send you text notifications, but I am not aware of how useful they are since I have never used the G5.

CGM on Apple Watch

Apple Watch CGMAnother annoyance for the Medtronic CGM is that they have no Apple Watch app
for their Connect application. That would be handy, too. Dexcom does have an Apple Watch complication on the G4 with Share, and on the G5 CGM. I use my Apple Watch for discrete information many times a day, and would appreciate this ability.

Insurance and CGM

Another plus for Medtronic is that most insurance companies cover the devices. Many do not, or are dropping support for, Dexcom. The problem for users of the Dexcom is that they may have the unit and no longer be able to get sensors and transmitters without paying out-of-pocket. If an insurance company drops Dexcom support shortly after getting the device, I question if they would pay for a replacement Medtronic device, or if they would take the stance that you just got a new CGM device, so you do not need another.

Just something to think about…

Thoughts on God and Stuff

%d bloggers like this: