Happy Saturday, and welcome back to our weekly advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and educatoAsk-DMine_buttonr Wil Dubois.

This week, Wil tackles "The Great Diabetes Coffee Debate" and also chimes in on the issue of how insulin pump calculations can be confusing to users. Ya think?

Read on...

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

Mandy, type 1 from West Virginia, asks: Can coffee raise my blood sugar?

News nuggets from around the diabetes community

NEWSFLASH: FDA Clears Dexcom Share Direct
Dexcom gets regulatory approval of its 'on-the-go' mobile apps for CGM data-sharing.
Snail Uses Insulin to Poison Fish
New study shows these slow-moving creatures use toxic form of insulin to capture prey.
A New Square Patch Insulin Pump
TouchéMedical's new Bluetooth-enabled patch pump is supposedly the world's smallest and cheapest.

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Wil@Ask D'Mine answers: OK, let me pour myself a cup of java before I set out to explain this one. Short answer: You bet it can, for a number of different reasons, and plenty of T1s need to bolus for their Morning Joe. Of course, if you use sugar, milk, cream, or creamer, you just carbed up your morning jolt; but even pure-straight "black" coffee will raise many people's blood sugar.

The culprit in the coffee is caffeine, a naturally occurring stimulant used by some plants as an insecticide. For what it's worth, caffeine is the world's number one psychoactive drug, meaning it can cross the blood-brain barrier and directly affect the central nervous system. Like any drug it can be addictive, and like any drug, an overdose will do some bad shit to your body. Still, 90% of adults in the States consume it daily. (The other 10% overslept.)

Because caffeine is a mild stimulant, it comes as no surprise that consuming it might bump-up your BGL. That's what stimulants do. They ramp up your system.

How? When the body gets stressed, it releases extra glucagon for fuel to deal with the emergency at hand. To illustrate the concept let's say you are strolling through the Everglades when you come across a hungry human-eating crocodile. (OK, I know it's alligators, not crocs, in the Everglades, but just go with the flow here.) When you see that big mouth full of four-inStrip in DMine Coffee Mugch razor-sharp teeth headed your way fast, your body cuts lose with a flood of cortisol, adrenaline, and the rest of it—raising your blood sugar—to give you the energy to run like you've never run before.

Caffeine stimulates the same body systems, but to a lesser degree. If the croc's head-on assault opens the adrenaline faucet full-bore, then your Starbucks is more like a dripping faucet. Of course, how much your blood sugar will upsurge depends on how "stimulated" you become.

(OK, get your mind out of the gutter, and we'll move on.)

This physiological explanation makes perfect sense to me, but the effects of caffeine on the body may be even more complex. Recent research suggests that caffeine might lower insulin sensitivity, thus raising blood sugar. And this change in resistance means that the insulin in your blood won't function as well.

Either way, the fix for your morning fix is a simple one. (Say that 5 times fast without any coffee!) Whether your blood sugar goes up because that Morning Joe unleashed your adrenaline, or whether it spiked because your insulin sensitivity tanked, the cure is the same: Just add insulin.

Oh yes, one last thing: in addition to being present in coffee and charging crocodile scares, caffeine is also found in many varieties of tea (both hot and cold), sodas (both diet and regular), and in chocolate (more in dark than milk)—in fact, some chocolate has as much caffeine as a cup of coffee!

So, whether you're sipping java at home or fleeing from a wild animal, just be prepared to dose insulin whenever caffeine's in the game!

 

Steve, type 1 from Connecticut, writes: I get that insulin pump companies make different devices and each has their own way of doing things, but why can't all the pumps calculate IOB (insulin on board) the same way? Or why do they have different delivery speeds? Can't there be standards to make them all be on the same playing field so that those of us on the consumer side don't have to read dozens of manual pages to figure out the differences?

Wil@Ask D'Mine answers: They could, but what would be the fun in that? Oh. Wait. No they can't. Medtronic famously (and successfully) sued their rival Smiths Medical (which made the now-defunct Deltec Cozmo pump) back in the day over the whole concept of a bolus calculator. Smiths ended up paying royalties to MedT on each Cozmo sold. To me, it was rather like taking out a patent on sliced bread. Our friends at Close Concerns said it best at the time: "We didn't realize it was possible to patent division."

Had MedT also taken out a patent on NOT having a bolus calculator, I guess all pumps would be MedT.

So no one in pump manufacturing will fess up to it, but the fact is, if you are a pump company, doing things differently keeps you from getting sued. That is, doing things differently raises the odds you will win if dragged into court. Litigation probably gets more attention than marketing in this industry, and some folks in the biz seem more lawsuit-happy than others.

I guess when you have all those expensive attorneys on retainer, you need to keep them busy.

Of course this whole patent-protection obsession is framed in terms of customer choice, of giving you options. Options are good, at least in theory, because everyone's diabetes varies. A worthless feature to you may be the best thing since Saran Wrap to me, and vice versa. And while many of the so-called "features" strike me as hair-splitting to the point of pointlessness, there are other cases where the best and brightest in the field can't agree on what really is best, and you mentioned one of them yourself: Insulin on Board (IOB), a.k.a. active insulin (note: we've been asked about this before).

There are two ways to track IOB, linear (simply dividing the amount of insulin by the action time) and curvilinear (using a complex curve-shaped algorithm where the insulin is assumed to have more effect early on and less later on)Digested read - The News: A User's Manual by Alain de Botton, and experts disagree about which method is more accurate for mimicking what insulin really does in the body. It would seem on the surface that the more sophisticated curvilinear would be better, but for me at least, I found that pumps using the simpler math did a better job of keeping me out of trouble than the fancy-math models. Yet I'll bet half the readers who have used both kinds of pumps would say exactly the opposite.

As to the issue with the manuals, I don't think standards in gear would really help all that much. The problem with manuals for prescription devices is that they are written (or at least edited) by lawyers. In this case, they aren't worried about being sued by the other guys, they are worried about being sued by your family if you use the pump wrong and accidentally kill yourself.

Because the priority is CYA over education, I find most medical gear manuals to be insomnia-inducing in the extreme. That's a crime in itself because any explanation can be written either well or poorly, and given the deep pockets of the medical device builders, there's no excuse for poor writing.

Every time I read a manual on a new piece of gear, I get so pissed off that I'm tempted to start authoring "unauthorized" insulin pump and CGM users' guides that are fun, well-organized, informative, and entertaining—so that folks will actually read them and get the most out of their gear.

But then I remember that I don't have any attorneys on retainer, and I don't want to get my ass sued off.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

 
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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.