Hey everyone! Happy Saturday! Welcome once again to our weekly advice column, Ask D'Mine, with your host Wil Dubois veteran type 1, author and clinical diabetes educator. Today Wil's tackling sources of quick-acting carbs in case of lows, and whether a certain (acne!) medication is connected to causing diabetes. Great questions, all!

{Need help navigating life with diabetes? Email your questions to AskDMine@diabetesmine.com}


Larry, type 3 from Virginia, writes: My type 1 daughter is 14 years old and an excellent tennis player. Yesterday she was in a very strenuous match which lasted over 2 hours. In anticipation of the match, one hour before she reduced her basal 50% and consumed some complex carbs. Thirty minutes before she suspended her basal completely. She started the match with BG at 185 but it quickly dived into the low 60's. This was a USTA match, so the changeovers are timed and she has to check her blood and consume as many carbs that she can in a very limited amount of time. During the match, she consumed 4 bottles of Gatorade and about 12 tabs of glucose which amounted to approximately 160 grams of carbs. Her BG's stayed in the 60 — 75 area throughout the match. Toward the end she felt bloated by the amount of Gatorade that she had consumed and it certainly impacted her play in the last game. Any comments about managing BG in athletic events would be appreciated, but my specific question revolves around what would be a better source for a high amount of carbs which could be consumed quickly and easily during changeovers?

Wil@Ask D'Mine answers: Short answer to a long question: Dex4 fluid. Why? Because it has 16 grams of very, very, very fast-acting sugar in only two ounces of liquid. Gatorade, by comparison, has less than 2 carbs per ounce. So for getting a lot of sugar into her young hide with a minimum of bloating, the Dex would be the way to go. (Now of course, some Gatorade for the electrolytes is probably a good idea, but not four bottles worth.)

As for how you handled her pump and complex carbs, I think you did great, so I've got nothing to add to that.

Now, I'm feeling the need for a bit of a disclaimer here because I've recommended Dex stuff before.  Once or twice. But, I'm not on their payroll. I'm not a stock holder. In fact, I think the damn stuff is a little pricey. I spend way too much of my limited disposable income on Dex4 products each month as my frickin' insurance company won't cover glucose products. Apparently, it's not a necessary medical expense.

But I love the stuff. It works and it's saved my ass more times than I can count. It's portable, fast, and effective. And most importantly, it keeps me from overdoing it. If I were using some tasty candy I'd eat five times too much, have a rebound excursion, plus all the unneeded calories would make me fat. (Frequent lows can = bigger waistline.)

Oh. One little tip before the first serve: Make sure you have the little Dex4 bottles open for your daughter in advance. Otherwise getting the tricky seals off the top of the bottle will use up her whole changeover!


Michelle, type 3 from Massachusetts, writes: I appreciate your weekly column and look forward to learning more each time I read.  I've been with my fiancé for 3-1/2 years now (we will be getting married next year) and he is a very "keep to himself T1" so it's hard for me to ask him questions and get anything more than a rushed answer or just have the subject changed.  He was diagnosed his senior year of high school and blames Accutane for getting diabetes.  Since we've started dating I've done a lot of research, but really only found one article that briefly mentioned that Accutane could impact blood sugar.  Do you think that Accutane could be to blame, or could there be more to the story?  Thanks again.

Wil@Ask D'Mine answers: Not to blame, no way. Part of the story? Perhaps. But no more than a brief prologue or maybe a foreword from an outsider. But just so everyone's in the loop, Accutane is an acne drug. Well not just any acne drug. Sort of a drug of last resort when all else has failed. It's powerful stuff with a host of side effects.

According to the prescribing information sheet there's a "high risk" that the med can cause miscarriage, still-birth, or birth defects. It can mess with your head, causing depression or psychosis in some people. And suicidal behavior. It can dry out your eyes and rob you of night vision. It can make your skin hyper-sensitive to the sun. Make you more prone to scarring. It can screw up your bones, sometimes making them weak, and other times making them abnormally thick. It can cause nosebleeds, change the color of your skin, slow down healing of wounds, raise your triglycerides, and create unwanted hair growth. It can trigger pancreatitis. Frankly, it's one hell of a scary-sounding drug. No wonder your guy blames his diabetes on it.

And hidden in practically the last line of this long litany of terrifying side effects is the off-hand comment that "some patients receiving Accutane have experienced problems in the control of their blood sugar. In addition, new cases of diabetes have been diagnosed during Accutane therapy, although no causal relationship has been established."

So there you have it. Straight from the Accutane horse's mouth. It can cause blood sugar problems. And it has been associated with new diagnoses of diabetes. But does that mean it caused his diabetes?

That's the 64-million-dollar question, isn't it?

First, consider that Accutane has been prescribed to over 13 million people (the name brand, made by Roche, was pulled from the U.S. market in 2009 under the weight of over 5,000 personal injury lawsuits, but generics still remain available). And there's what? Around 3 million type 1s? If Accutane were a primary cause of type 1 diabetes, I'd expect there'd be a hell of a lot more of us!

Given the wide-ranging side effects of this med, one has to wonder if there's anything that it doesn't cause. But the key thing to consider here is that we really have no clue what causes type 1 in the first place. So that makes it kind of hard to know with any degree of certainty what hand Accutane did, or didn't, have in your guy's diagnosis.

Here's all we really know for sure: in those of us with type 1, the body's immune system goes bonkers and attacks the home team. Our immune system gobbles up our insulin-producing beta cells like they were M&Ms.

And that's about all we know. Period.

Why does it happen? What's the trigger? No one knows. Some people think a virus. Some people think environmental pollution. At least one guy believes it's the Accutane he took for his acne in high school. But it could just as easily be contamination from aluminum in TV dinner trays, preservatives in foods, holes in the ozone layer, global warming, or sunspots. Who the hell knows? I spent almost 30 years working in photographic darkrooms and laboratories and have sometimes wondered if all those toxic chemicals we carelessly dipped our hands into played a part in my health destiny.

But I know a lot of ex-lab people (no more labs, everything went digital) and none of them have diabetes. Still... did the photo chemicals play a role? Even for just a few people like me? Maybe.

But so what?

I'm sure I'll get flamed for this, but I believe that for individuals the cause of our diabetes is meaningless. Hey. We got it now. Time to put on our big boy and big girl pants and deal with it. Now, for the greater good of all the yet-to-get-it folks, I do think science needs to figure this out so we can prevent future cases. The fifth generation to survive since the discovery of insulin is  developing type 1 every day. It would be nice if there wasn't a sixth generation.

But for me, figuring out if there is one cause of type 1 or 100,000 causes—and figuring out what caused mine—really doesn't matter. It won't reset the clock. It won't change what happened to me. I think that spending too much time on "why did this happen" is unhealthy. It's counter-productive. An energy suck. Best to move on.

Controlling... well, ha! Trying to control my diabetes takes all the energy I've got to spare. Worrying about how I got here?

I don't have the oomph for that.


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.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


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.