This post is all about Sugar Surfing, the new book from Dr. Stephen Ponder. This book is so good, I used up almost an entire pad of treasured jellyfish page markers marking passages I need to re-read. Sugar Surfing is so good, it made me feel like an inadequate loser. It is so good, when I saw Bubs eating a piece of a rice cake that had fallen on to the counter, my brain imploded.
Is this book controversial at all? It shouldn’t be. It’s a distilled version of the things people notice once they’ve used a Dexcom for a while. But smartened up and codified. The codification makes everything feel different. This is because, when surfing the sugar, you are glancing at your Dexcom graph two or three or more times an hour, and micro-adjusting your blood with a glucose tab or a temp basal or a deliberate decision to do nothing. When sugar surfing, you are in the moment, but you are also an encyclopedia for past details and a crackerjack personal assistant for the future. Everything means something. And you are synthesizing all of these memories and anticipations with the moment’s data, using the mental agility of a Damiano algorithm.
So instead of feeling clever for noticing a 110 mg/dL with a straight arrow but a slight downward slope and then turning the basal down (“applying the brakes” in Dr. Ponder lingo) to avoid a future low, this feels more—now, post-book—like something I am failing to do. Because Sugar Surfing tells you how to be on the ball all of the time. That means I could be on it all of the time, instead of once or twice a month when I’m an amazing superstar.
The book is also full of annotated Dexcom graphs. That’s a lot of fun.
My favorite concept in the book is waiting to eat until the bolus insulin says ahem, I am now working. That means you bolus and wait for the Dexcom line to start heading downhill before eating. I love this. A tip from the book (to make “waiting for the bend” easier) is to take the bolus and then find someone interesting to talk to. I’d add that if the waiting person is a hungry child, you could distract them with a video game. More ideas & concepts from Sugar Surfing (to think about more later or discuss amongst myself):
- “Estimated Food Impact.” Instead of using super-accurate carb count to calculate a dose, take a bunch of factors into consideration: the approximate carbs, the glycemic index, the BG, the arrow, the whole situation. (p. 70.)
- Children might fake a BG reading by getting a sample from the family dog. (p. 78.)
- Dr. Ponder has the same basal rate in his pump ALL DAY LONG. Studies have shown that fewer basal rates leads to clinically significant improvements in outcomes. (p. 80.)
- An alcohol wipe only moves dirt and sugar around on the finger. You really ought to wash your hands with soap and water before you test your BG. (p. 86.) I’m pretty sure I’ve known and conveniently forgotten this fact at least ten times. Doesn’t an alcohol swipe just seem so perfect? Like you should get extra credit for using it, even? Also convenient. And I love the fragrance. Alas.
- Some users report simply re-entering the BG value displayed on the sensor unit at the time the device requests a calibration sample. IS DR. PONDER WATCHING ME? I can’t believe there are other dumdums doing this. (p. 93.)
- Don’t wait for the blood drop prompt. You might as well calibrate when you wake up in the morning, before you start eating and exercising and complicating things. (p. 117.)
- If you want to pre-empt a high or low by tweaking basal, keep in mind it takes two hours to see the effect of a basal rate change. (p. 113.) Such a bummer.
- Dr. P. changes his Dexcom high and low thresholds throughout the day, and his rates of rise and fall too. (p. 121.) I have wished I could do this, but have never considered doing it. It is not hard to do, but since there’s no “alternate program” feature giving me permission to do it, I never really considered it possible.
- Reassurance on hypoglycemia and death. There is a pervasive notion…that if you had not caught it the child would have died…in my 30 plus years working with thousands of children with diabetes I’ve seen many hypoglycemic kids and adults below 40 mg/dL…many had no symptoms and easily recovered. Others passed out or had a seizure…and fully recovered. (p. 154.)
- “Hollow Highs”: highs from stress shouldn’t be treated like highs from foods. (p. 185.) Go halvesies.
- Fear of insulin stacking is a relic from the time before CGM. (p. 201.)
Throughout the course of this book, Dr. Ponder eats cereal and fried chicken and soft-shell crabs and rice, explains how he figured out how to bolus for each, and illustrates these with Dexcom graphs. It is at once simple and mind-boggling. He is an amazing doctor and diabetes educator. But am I an adequate vessel for this knowledge? Reading this book was exhausting, and left me feeling sorry that Dr. Ponder isn’t my…mom. Or my brain. It wouldn’t be enough to have him as a doctor.