Dex to the Max

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Dr. Ponder makes a few noteworthy points.

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.
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    Buy, read, discuss.
  • 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.

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16 responses to “Dex to the Max

  1. I was lucky enough to attend his seminar and meet the king of sugar surfing. I’m pretty sure my brain exploded that day. I’m contemplating kidnapping him and keeping him in the closet under my stairs, so wise is he.

    I’m totally kidding Internet.

    Right now I can’t even find the time to read the notes that come home from my daughter’s school, but one day when I find some time this book is on my short list.

    Liked by 2 people

  2. I follow Dr. Ponder on FB and am currently reading the book. In some ways I think I totally Sugar Surf. At the same time, my insulin works so slowly that I can bolus when I see a “bend” and I am way too late to influence my BG.

    Liked by 1 person

  3. This sounds great. It’s extremely rare (like not in decades) that I’ve wanted to buy a book about diabetes, but this one sounds like the one to get. I can tell he and I think alike, and I need someone else using these ideas but doing it better and with some solid suggestions! Thanks so much for the recommendation, and for making me laugh too.

    Like

  4. skchrisman

    I can’t wait to read his book and explode my own brain. It makes me excited to learn how my kid can better manage sugar levels by surfing, and so very saaaad that I have to wait until my kid actually “wants” to learn about this and practice it. Your hands are tied when they’re teenagers. Her ears all but fold up when I casually say, “hey, kid…i read this really cool thing last night that might help you blabbity blah.” Having most of the control for a few years and then losing most of that control is rough. Sigh.

    For now, I will ponder Dr. Ponder. And wait. Maybe someday she’ll look at these brilliant people and think of them as rock stars.

    Liked by 2 people

    • skchrisman

      I have to add something here…I feel it’s still important for parents of teens, if they are so inclined, to learn what they can learn about the management of Type 1 because you never know when you’ll draw from that knowledge, or make a new career from it. The possibilities! I have all of our diabetes related books together in the same area, and agree with Karen. Read, learn, bite tongue, hope.

      Liked by 1 person

  5. The book sounds like an interesting read, but it seems like it might over-complicate the concept of giving insulin, bolussing and managing blood sugar levels. Thinking, re-thinking and over-thinking these things is not healthy, and my blood sugar levels have suffered in the past because of this. If he’s volunteering to be my brain then yeah I might consider!

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  6. I have loosely followed this doctor on FB but never delved into the mechanics of what was discussed. The facts that you listed are fascinating!!! Skchrisman makes a great point though. You lose much of your ability to implement these changes when your type 1 kid becomes a teen. I am still tempted to buy the book though and set it on a stack of books in our family room. My son’s curiosity and brainiac tendencies (from his father!) might lead him to read it. Fingers crossed!

    Liked by 1 person

  7. Sounds like a great book and some great ideas! If I could find a way to fully immerse myself in a book about diabetes and how-to directives (something I’ve been unsuccessful, to varying degrees, in the past) I may enjoy it. At least you’ve piqued my curiosity.

    I would question though, if you are talking about surfing your son’s sugar and not your own, then this is may be for him and not for you. Just like with real surfing (which I tried last year), there’s a certain overall “feel” and one-ness between your body and the wave that you need to experience in order to react with the proper precision. It’s why a video screen and a joystick doesn’t do justice to the total experince. OK, maybe my metaphor has gone a bit too far, but my point is that you shouldn’t think of yourself as “an inadequate loser” (or even an adequate one). When you add the step of giving verbal direction for someone else to interpret, you lose the entire sensation of riding the wave.

    But the whole metaphor of joining surfing with maintaing blood sugars is one that I like more and more, the more I think about it.

    Finally, regarding some of your favorite tips– I’m not much of a preboluser, but if I’m waiting to eat because of a high BG, I will wait for the graph to change direction before taking the first bite. And I’m much rather calibrate an hour AFTER I wake up than right away, because I sometimes find a huge lag in my fingerstick readings after my body has been immobile for 8 hours (CGM actually leads it), and if I calibrate too soon, it throws everything off for the day. I’ll wait until the meter and CGM come closer.

    I’m really curious about that book…

    Liked by 1 person

  8. Polina

    OK, I did not know this book existed. Now I may need to get it and read it. It sounds fascinating and overwhelming.

    Liked by 1 person

  9. Jamie Perez

    Great review!! Dr. Ponder is just an amazing man with the simple goal of improving the lives of as many people- children and adults- living with T1D as possible. Thank you for spreading the word!

    Liked by 1 person

  10. Sounds like a lot of helpful info- to be taken with the grain of salt that is your diabetes may vary and that by the time the arrow is heading down, the kid is actually at 50, and now breakfast is stressful. I use the Dexcom, but I am having a hard time not reacting to it constantly. Keep in mind the things you know and use them – carb counts, insulin acting time- bc dexcom trails by however many minutes it trails in your world, and that can be huge. If you have corrected a low, and the dexcom says arrow down, do you still feed the low? Now apply that to arrow down post bolus, pre meal.
    Totally fascinated by his all day basal rate as have just experienced a week of freaky friday altered basal rates- am to pm , pm to am- still trying to wrap my mind around it….. more soon.

    Liked by 1 person

    • When we first started Dexcom I HATED when he’d be high on the Verio but still in range on the Dex (due to the lag time) and I’d treat, and then Dexcom would alarm double arrows up. GEEZE, I KNOW I KNOW I KNOW SHUT UP.

      In the book one parent offers their teen $100 if they can surf in range for 24 hours. This is offered as an example of how you could motivate your person to get in touch with feeling the highs and lows and learning to match those feelings to numbers and actions. My person would probably just need a small Lego set or hour of video game time. But I don’t know how to introduce this idea without seeming like: I blame you if you go out of range because it is totally possible for you to not do so.

      ?

      “More soon” like you’re gonna post?! My heart!

      Like

      • Hi Katy – that parent was me! 🙂 Whatever motivates your kid is the right carrot and the point is definitely not success or failure. I knew what she was capable of doing on her own as a 16 yr old, had t1d since age 2 and is very well adjusted to it as far as a healthy attitude. Definitely still a teen so some days she pays attention and other days she might blow it off but only to a certain extent. The other aspect of the offer was that it was open ended. Days can be crazy and they can get away from you for any number of reasons. It took her about a week to achieve the target of 24 hours in range (60 – 200) and when she did she was so proud of herself. That said, there were 6 days prior that she couldn’t keep her bg in the target range. On those days she committed herself to safely experiment with my oversight (her choices) and learn from the result because she was paying attention. Bottom line is to reward for behaviors and not for outcomes. It is because of her choices that she was eventually able to ‘stay between the lines’. She realized that the power is within her and not in her devices, insulin or food.

        Liked by 1 person

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