Welcome back to our weekly diabetes advice column, Ask D'Mine, hosted by veteran type 1 and diabetes author Wil Dubois in New Mexico. Here, you can ask all the burning questions you may not want to ask your doctor. Speaking of which, have you ever felt like you've needed a dictionary when confronted with all those medical acronyms and abbreviations? Today, Wil has some insights to help make at least some of it a bit easier to understand.

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

 

Ladie, type 3 from Louisiana, writes: My dad was diagnosed with type 2 diabetes about 10 years ago. He has newly been prescribed Toujeo for his high blood sugar. The physician asked my father to go by a sliding scale. 100mpd would equal 40 units, and 80mpd he was told to take 42 units of Toujeo. I am a Medical Assistant and this type of sliding scale is unfamiliar to me. My dad of course has high blood pressure, as well. He also still likes to eat fatty greasy Southern soul food regularly. I’ve substituted some baked for fried foods and Coconut oil instead of Vegetable. I would greatly appreciate your reply and clarification of dosage needed.

 

Wil@Ask D’Mine answers: Here’s the thing: This is almost a medical question. And unfortunately, we’ve been getting a lot of those lately in our inbox here at Ask D’Mine. It can be hard sorting out which questions in the world of patient medical experiences fall into general education and understanding (part of our charter), and which questions run the risk of running aground on the rocky reefs of medical advice. Reminder: I’m no doctor. Questions about “how much to take” and their cousins are questions best put to docs or their staffs, not an advice columnist. Partly this is because I might not know the answer, and the longer I’ve been away from the clinical trenches the less I know and remember, but mostly because any lack of clarity about a therapy plan needs to be addressed right away by the person who has all the facts, so that no one gets hurt.

So this is just a friendly reminder to all our readers: If you want to know the science behind how "SuperShot UltaMax" Insulin works, I’m your man. You want to know how much to take, what to do if you take too much, or what to do if you miss a shot: Call your doctor!!

But like I said, yours was almost a medical question, so while I can't touch the part about “clarification of the dosage needed,” I can talk a bit about sliding scales in general—and the one unexpected way in which they can be superior to more modern methods.

But first... maybe I haven’t had enough coffee yet, or maybe I drank too many beers last night. (I heard on TV that some men like beer.) Or maybe my diabetes has triggered early onset dementia. But I can’t I make heads or tails out of your first question, because I can’t figure out what “mpd” is an abbreviation or acronym for.

In context it would seem to be some sort of unit of measure or range, but it’s not, you know, ringing any bells. So like any good confused citizen, I woke up Uncle Google. 

And he told me, through Wikipedia, that MPD stands for lots of things. Apparently, it can mean meat packing district, managed pressure drilling, multiple personality disorder, memory protection device (I gotta get me one of those), pulse repetition frequency, methylphenidate—a.k.a. Ritalin, the Ecuadorian political party Movimiento Polular Democrático, music play daemon, mesoscale precipitation discussion, and assorted police departments including: the Milwaukee Police Department, the Minneapolis Department, the Memphis Police Department, the Miami Police Department, the DC cops’ Metropolitan Police District, and the Mumbai Police Department. 

That’s not much help. 

Regarding “sliding scales,” there are many out there. All of them strive to create variable dosing that’s adjusted to reflect the environmental conditions at the time of the dose.

Oh my. 

That sounded overly clinical, didn’t it? 

In plain English, a sliding scale is a way of telling people how much insulin to take based—generally—on the level of their blood sugar. The higher the sugar, the higher the dose. Simple pimple. They used to be used in hospitals a lot to ensure that the nurses didn’t make any math errors. I don’t know why. All the nurses I’ve known are pretty sharp cookies when it comes to math.

Anyway, sliding scales are now generally regarded as an old-fashioned and out-of-date approach, but this misses the fact that the slide has one advantage over its sometimes more precise cousin the correction factor, and that’s the fact that the slide can be non-linear. Bear with me. As most people with diabetes can attest, very high sugars are often more stubborn than lower high sugars. A “bad” high can be tenacious, requiring bolus after bolus after bolus to bring the sucker back down again. A savvy physician can easily build a top-heavy sliding scale to deliver a heavier punch to a tougher opponent; while most ratios, factors, and electronic calculators are amazingly dumb in comparison, applying the same math, regardless of the elevation of the numbers being addressed. The only device I can recall that was designed to deliver insulin in a non-linear way was the sadly now-defunct Deltec Cozmo 1800 insulin pump.

There are probably a thousand ways to set up a slide, and slides are almost always used for fast-acting insulin to fix above-target blood sugar. But Toujeo is a long-acting concentrated basal insulin. It’s just super-sized Lantus. So sliding an insulin that works for a full day is… well, novel at the very least. I’ve seen adjust-to-target approaches to basal, where the patient is told to increase the basal by one unit a day until their morning sugars look good. But I don’t recall ever seeing this kind of ongoing adjustment of basal insulin before. It’s also confusing that the scale seems backwards, with more insulin for fewer MPDs, whatever they are. So, please, please, please reach out to this doc and make sure that there’s not some sort of miscommunication going on here.

Now on to food, where I’m on safer ground, advise-wise. First, you need to know that scientific research has proven that changing your eating habits is harder than changing your gender. No offense intended to the gender-challenged, but food carries huge emotional, social, and psychological components that most of us don’t recognize.

So tread lightly. Asking someone to change their diet is asking for deep changes in their life, soul, and personhood. Who they are, and how they relate to the world. My advice? Slow, supportive, baby-step changes that avoid the wholesale “taking away” of beloved foods. To that end, you’re off to a good start by seeking to modify your father’s recipes in changing oils and swapping some baking for frying. I cast around to look for further ideas to help you out and came across two that impressed me.

The cringingly-named Living Chirpy website has gathered ten low-carb solutions to Southern comfort foods, and the experts at Southern Living (who would know better?) have knocked the fat out of some of the fattier Dixie plates. They even used some culinary voodoo to get shrimp and grits down to 235 calories with only two grams of fat! What the….? It’s swamp magic, I tell ya.

Now, recipe modification is only one approach. Sometimes it works great, and folks are happy and heathlier. But other times they’re miserable. I guess it depends on their taste buds. If diet alteration fails, don’t forget that a legitimate alternative to eating right is eating badly, but in smaller portions. Simply put, some people have better luck reducing the portion sizes of the foods they love, rather than changing what they eat.

You can also look at shaking up the elements of a meal so that your dad has one portion of good ol’ Southern soul food with two healthier sides. This way he doesn’t view the changes as pure sacrifice.

So call the doc about that MPD crazy slide, and give yourself a high-five on your good work helping your dad slide into better eating.

 

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.