Kaleidoscope - what are YOUR priorities?

I've been out of the loop in the last year when it comes to new projects on the diabetes horizon - mainly because there is a socially acceptable level of housework which has to be met in order for your home to be considered habitable; a level which has long been the stuff of legend in our home since the whirlwind arrived.  But last week I had the opportunity to take part in a focus group about a new way or working with Healthcare Professionals (HCPs) when it comes to verbalising what is important to us in managing our diabetes at any given time, whenever we visit the clinic.  That new way of working is called Kaleidoscope.

 

Kaleidoscope is the brainchild of Chartered Health Psychologist Dr Kath Barnard, who recognises that at any one time there can be a multitude of factors affecting how well we are managing our diabetes on any given day.  Those factors (for example, the level of support we have at home, our access to the appropriate technologies, our knowledge of diabetes, or how burnt our we are), are fluid.  They change constantly and our needs change based on how well each aspect of our lives is working with all the others.  And just like a kaleidoscope, if you stopped your life in the middle of the daily whir, the resulting patterns would look wildly different and complex each andevery time.  But trying to communicate what is most important to us in the 15 minutes we have to meet with our diabetes team can be difficult.  And if, like me, visits sometimes happen when I am in the depths of burnout and barely even registering my diabetes, those clinic visits can sometimes involve a very satisfying - but not overly productive - 15 minute rant about diabetes and the general bastard that it can be.

 

The idea behind Kaleidoscope is that a short online (mobile friendly) questionnaire (six minutes to complete in my case) can help identify the top 3 priorities for you at that time.  The questions broadly cover a number of key areas such as environmental, physical and psychological factors and how you are feeling about various aspects of your care/management. The end result is your top three priorities listed for your next clinic visit. This gives a voice to those struggling to find their own, or to those who find it difficult to steer a conversation - or even recognise - what is most important to them.

 

I had the opportunity during the focus group to try the model, and completed it true to what is flipping around my brain about diabetes right now. I imagined that my clinic visit was tomorrow, and that this would be what I aim to cover.

 

"Great," I thought.  "But I know what my priorities are. I don't think I need to know them before I go in. This is probably more for people who struggle to communicate their own needs.  Mine will obviously all be about burnout."

 

Oh, the arrogance.

 

After six short minutes, there they were.  My top three priorities, of which only one related to the psychological aspects of living with diabetes.  It took me a while to work out where the others - knowledge of managing diabetes and another I can't now recall - came into play.  But as I sat and mulled it over, it all made sense.  Since my diagnosis of autoimmune thyroid disease, my feelings towards managing such frustrating conditions have been all over the show.  I have spent hours Googling Graves' Disease, energy levels and diets for thyroid function, feeling helpless, hopeless and hapless at best.  I have tried diets, pills and supplements which have all played a role in changing various aspects of my usual diabetes management - something which played second fiddle to my (stupid) new condition. The ups and downs of trying to solve one problem have left me feeling clueless about the one I thought I had a handle on.

 

Kaleidoscope helped me unmash the muddled-up soup of thoughts in my head and replace it with three places to start a conversation; one which may help me refocus my thoughts and efforts on the most important thing - my health.

 

It turns out that even after 30 years, there is still something you can learn.

Diabetes Soup: Thirty Years at the helm of Type 1

When I first started this blog, almost seven years ago I wrote, "My name is Anna and I am many things. I am a daughter, a sister, a friend, a fiance, a full time worker, a wannabe surfer, an animal lover and a girl. I am also a Type 1 diabetic (insulin dependant, juvenile onset, the beast has many names)... I have been through every stage of adjustment with the condition. I was the child who didn't quite understand it, the teenager who resented and fought it, the adult who started taking it seriously and now I am the girl determined to make it my own."

Thirty years ago on Christmas Eve, my parents brought me home from the hospital in Germany, newly diagnosed and with a challenge beyond anything they could imagine.  The magnitude of their challenge could not yet have been known to them, because only those who have lived through a chronic condition like diabetes could know how every aspect of life could be turned upside down by something as innocuous and seemingly toothless as a pancreas with no ambition.

Thirty years on, with almost a quarter of that time spent writing a blog and regularly exploring the sometimes inexplicable world of my own thoughts, I now know that I was naïve to think I was only one thing at a time. My ongoing states of diabetes  - the child who doesn't understand it, the teenager who fights against it, and the adult who has come to accept it - aren't mutually exclusive.  Sometimes I am a big bowl of diabetes soup (35g carbs, pre-bloused).

This year was the hardest of my thirty years.  With a child of my own now just three years younger than I was when I was diagnosed, I have had little time to focus on myself, but in the most wonderful of ways.  It is hard to care about the highs and lows, the carbs and counts or routines and basal reductions when my daughter's needs seem more urgent and important than my own.  For much of this year I was the mother who ignored it, because my girl was always one notch higher on the to-do list.

As my thyroid packed up shop and the sensor got lost en route to the outside of my leg, I was the adult who resented and once again didn't understand it.  I had a whole new language to learn about thyroid, iodine, overactivity and antibodies, and all those years of acceptance and embrace melted away in the face of the seemingly unmanageable tasks. Every day I worried about the what ifs and could-it-bes of my daughter also being diagnosed one day.  I can't think about that for too long, I have to let those thoughts drift away before the imagining the worst becomes my obsession that day. I found the DOC an overwhelming place to be and carried out a mass exodus of almost all of the diabetes groups I belonged to, sneaking out in the night like a shamed fraudster.  I didn't want to be in the DOC I once loved so much.  I was tired.  I still am tired.

 

But, as the tasks of motherhood became easier to manage and somehow my HbA1c kept steady at 7% (somethingorother in 'new money' mmol), I began to remember what I so loved about blogging. And as I was voted a respectable 62 on the Feedspot Top 100 diabetes blogs worldwide, the recognition flooded back that this is my safe place to say all the garbled junk I have to say, and that being a big bowl of diabetes soup with a million emotions spilling out of me - sometimes all at once - is OK. It's OK to be a diabetes soup sometimes.

I hope that in another 30 years I will be here still, living the life I have been blessed to live, and that diabetes will be a thing of the past.  But if not, I hope I will still have the thoughts to share, the words to write, and the voice to speak about my big old mixed bag of diabetes experience.

 

Happy diaversary to me, and Merry Christmas to all of you. 

ASW2K16 video!

I've posted over and over about the value of knowledge and peer support the Animas Sports Weekend brings and this year was no exception.  As I drove home from the meet in October, the sky blackening as the early autumn nights I so love creeping in, I wondered if the other drivers on the M whateveritwas had enjoyed a weekend as wonderful as mine.

 

Just take a look for yourselves...

 

And don't forget to check out what Sir Steven Redgrave shared when I asked him about the value of Dr Ian Gallen's work.
 

 

Be anything you want to be...

I have very mixed feelings about Theresa May. On the one hand the industry I work in has been decimated on a scale far greater than if she had driven a steam train into Piccadilly Station and set off an atom bomb. Morale is at an all-time low and the derogatory comments and smears she has made of services I treasure, such as the Police, are unforgivable. On the other hand, as a person with type 1 diabetes in a public role, she flies the flag bearing the mark of diabetes. 

I often think about the 'what's ifs' of my daughter one day developing type 1 diabetes. She shouldn't, given that she has just a 2% chance of developing it, but the chance is always there. Raising a child with type 1 can be a tricky business, and in amongst the challenges about self-management, maintaining blood sugars, issues with food and trying to manage a long-term chronic condition, come questions and identity challenges about what you can and can't 'be'. Aviation and emergency services are just two of the careers marred by limits on who can do them, and usually people with diabetes need not apply. 

Had you told me as a girl of just four, hands too small for the cumbersome blood glucose meters of the day, whose life had been irrevocably thrown into a veritable typhoon of diabetes, that she could one day have a job like being the Prime Minister of England, I would beamed from ear to ear.

The fact that the next would-be Prime Minister of England has type 1, is a landmark for people with the condition. People like Halle Berry, still causing merry hell by telling people that she was a type 1 who 'weaned herself off insulin' (God, give me strength) means we may finally have a 'real' face of the condition. Even if that face is one whose political decisions I have disapproved of, deeply. 

The one good thing out of the political turmoil and social unrest in our county is that one day I may have to convince my daughter than she can be anything she sets her mind to, and that can even be the Prime Minister of England.

Dario: The changing face of home glucose testing

I have a confession; for the last few months I have wanted nothing less than to engage with my diabetes.  Burnt out from having a baby and managing thyroid issues on top of diabetes, I've retreated completely to the land of head-burying.  CGM sensors have been stacking up in my paraphernalia cupboard, and my transmitter is lost somewhere in North Wales following a holiday where diabetes was ignored to an impressive extent.  As diabetes week appeared on the horizon I had nothing to say, and thought it had nothing I wanted to pay attention to. Or so I thought, until along came Dario.

 

I was contacted by Dario about their glucose meter and asked to review it.  I agreed, aware that diabetes week was a great deadline to have my thoughts on paper.  Little did I know that inspecting their device would lead to testing more regularly and a hugely positive SHOVE back into the land of looking after myself - slowly, but surely.

 

So here is the detail.

 

The Meter

 

The Dario glucose meter is a palm-sized device which turns your smart phone into a glucose meter*.  Everything needed for the test - strips, pricker and smart-phone adapter - are all contained in the stylish case, which fits comfortably in my handbag giant baby-sack.  This works alongside the Dario app which can be downloaded from your smart phone app store. You can buy the meter from Advanced Therapeutics for £14.95, or ma be able to get one via your diabetes team if they stock them.  The test strips are also NHS approved.

 

The App

 

The Dario app is ridiculously pleasing to use. Rather than the typical 3, 2, 1 countdown, the six-second test shows on the screen in a buffering-style circle, which makes it somehow less ominous than the dreaded countdown.  This might sound ridiculously tiny as a detail (I mean seriously it is), but the first time I used it I was surprised at how pleasing the on-screen detail is.  Even my husband who has no preferences whatsoever when it comes to anything diabetes, perked up and agreed how the design was aesthetically a little bit of a treat (is it totally weird, the things we 'like' about our technology?).  The App itself is self-explanatory in use and has some great features like the ability to log food (fairly standard these days) and exercise (something I missed enormously when One-Touch removed that function from their testers) and a handy counter for hypos and hypers along with the usual average glucose range.  All-in-all, a job well done.

 

The good

 

Self-contained and all-in-one, this meter does what other smart phone-compatible testers have, in my opinion, not done so well.  It is sleek and convenient, and small.

The app is very well designed and extremely easy to use.  I didn't even bother with the manual as the kit was so easy to use.

The size makes this a really good bit of kit for a mother who is already weighed down carrying god-knows-what for my bundle of joy.

 

The bad

 

As a fumbling-bumbling-mum-of-one I often forget to charge my phone.  It's just not really been a priority for the last eight months and I have, on a regular basis, found myself without any battery.  If this happens, the meter is (very obviously) useless.  This only happened to me once while I was testing the device, but it was while I was out and about with my daughter, and I was due to start driving which in the UK comes with a strict caveat that we test before driving.  Luckily I was still packing my other meter so was able to test.  My advice?  If you think this is the meter for you, carry a spare charger for the car. 

 

The only other negative for me was that I use Diasend regularly to share my data with my diabetes team.  I have not found a way to share my Dario data (if you know how, please drop me a line to anna@insulinindependent.com) and for me this is a really key feature and I would love to see Dario introduce this as a feature.  If they did that, along with a spare car charger would make this meter perfect.

 

Would I use this meter?

 

Absolutely, yes.  It is a space-saving well thought out device and a pleasure to use.  My new-mum clumsiness mean I may stick to my regular battery-powered meter until I can get my Megan Trainor on and be sure that I have all the right chargers in all the right places, but this is a really good device.

 

Drop me a line and let me know what you think if you decide to give it a go. Happy Dario-ing!

 

*Boring fine-print - available for iPhone: OS 6.1 or higher: iPhone 4, 4S, 5, 5S, 5C, 6, 6 Plus; iPod touch 3rd & 4th generations; iPad 2, 3 and iPad mini; iPad with Retina display Android (OS 4.1.2 or higher): Samsung Galaxy S2, S3, S4, S5; Samsung Galaxy Note 2, 3; LG/Google Nexus 5

Thyroid issues? The more the merrier.

Having a baby is like setting a bomb off in the centre-most part of your life.  Everything gets blown to smithereens and scattered around, and chaos ensues.  It's marvelous, in the most 'Armageddon' type way you can imagine.

By four months old even during her most sleep-resistant nights baby McP was doing 3-4 hour stints in between wake-ups, and a routine had started to emerge.  I was told it would take about 4 months to start feeling a little more normal by my more experienced baby-mama friends.  Only at four months exactly I started feeling worse.

My self-raising world-exploding  bomb

Just as I had started to figure out her arse from her elbow (and my own, for that matter), and life had begun to become manageable again (meaning I showered once a day and didn't leave the baby in the Supermarket by accident), I was hit with an overwhelming wall of illness.  If Jamie or my mother were around, I would fling baby into their arms and slump into bed for anything from 3-6 extra hours of sleep each day  

My heart was racing all of the time and stairs left me panting and dizzy at the top. My vision was blurry and my blood sugars all over the place, having already jumped from 6.1 - 7.2 HbA1c since the whirlwind arrived. My blog, advocacy work and consulting had all but disappeared. But it was the fact that my daughter was practically raising herself meant I had to get things checked out.  

Symptoms explained and blood drawn the results came back with a bump.  My last thyroid tests taken only six weeks before my symptoms began had been absolutely fine.  My latest ones showed my T3 and T4 to be as much as four times the levels they should.  And the hyperthyroidism diagnosis followed.

The job at hand at the moment is to find out why it happened (in the hope that it may be temporary) and how to manage it alongside the 'normal diabetes' (whatever that may be) and current lack of hypo symptoms (yay!).  Thankfully the beta blockers mean the pounding heart no longer makes it feel and sound as though I have a little man running around in my head, and I am no longer pounding along at 100 miles an hour.

And hey, when it comes  auto-immune disorders, it's the more the merrier, right?

Anyone else living with this and able to give an old tired girl some tips?

Sainsbury's apology

Yesterday I posted about why that card represented all that is wrong with using diabetes as a punch line. Within a matter of hours of a diabetes advocate, Diabetes Power's Angela Allison, posting a picture online of a card she had seen about diabetes and obesity on the shelves of Sainsbury's greeting card section, hundreds of people with diabetes - or those speaking on behalf of someone with diabetes - had launched their complaint with Sainsbury's chief exec, Michael Coupe. 

In a glorious display of the power of social media and a really pissed of bunch of PWDs, Mr Coupe had issued a sincere, warm and humble apology. It went like this: 

"Dear Anna

Thank you for getting in touch.  Firstly let me say how very sorry I am for what has been a lapse in judgment, I completely share your views.

As soon as this was brought to my attention the product was removed from sale across all our stores, and I have this morning asked my team to investigate how this happened.

I pride myself on our values and I do believe our values make us different from other supermarkets, and I know our customers share that view, this is what makes this all the more disappointing.

Thank you again for bringing this to my attention.

Mike"

Hats off to you, Sainsbury's, and thank you for recognising why this card is below the high standards you usually meet. 

Spare a Rose: Save a Life.

There are times in life - when my cannula rips out on a kitchen counter, or my Dexcom itches at my skin from lack of air under the over-used tape - that I find myself feeling less than grateful for the medical technology which keeps me alive. When the clumpy pump won't hide under a slinky top, or my Dexcom sensor protrudes from my leg under my skinny jeans like some kind of bodily 'yuck', I find myself frustrated with diabetes and the cyborg 'kit' that comes with it. But the truth is, that 'kit' - that expensive, wicked clever kit - does more than just keep me alive, it helps me live the life that I want; the life I deserve. 

It's hard to imagine, given my fortunate life in a developed country where it is considered wholly unacceptable for any person to have to die from lack of basic necessities like insulin, that there are children and young people in this very world - the one we share with them - who live on a constant perilous precipice.  Why?  Because they don't know whether or not they will have enough insulin to keep them alive today. 

This situation, which millions of children around the world face on a daily basis, is not only unacceptable, it should be impossible.  No child should die because of lack of access to insulin. Every child deserves to live, and not in constant anguish or fear that today may be their last. Every...single...child.

A group called Partnering for Diabetes Change, came together a while back to see how we, the diabetes community and the wider population of the world, can help.  That's when the 'Spare a Rose: Save a Life' campaign was born.

The Spare a Rose campaign invites people around the world to donate the cost of just one rose on Valentine's Day, just £3, to the International Diabetes Federation's Life for a Child programme which provides insulin to those living in developing countries.  That £3 will keep a child alive for a month.  That romantic bunch of roses, will keep a child alive for a year.

Last year $25,579 was raised, from donors in 684 countries, which kept 426 children alive for a year.

On Valentine's Day, why symbolise your love for someone by buying them something which will whither and die within days, when you could declare your love with a gift which will grow and thrive for a year.  Give life.

Spare a Rose: Save a Child.

Bra shopping and Trainspotting

I've reached the stage in life where my brain is officially full.  Not with useful information or anything which could contribute to a long and happy career, of course.  Quite the contrary; I know nothing of politics, science or history, but ask me the theme tune to 'Captain Planet' circa 1991, or what PSSO means in knitting, and I truly come into my own.  The problem is, due to being full to the brim with theme tunes, lyrics to every Julie Andrews song and the detailed workings of how to make a strawberry smoothie (it's all in the yogurt), in order for new information to enter I have to go through what is officially (not even a little bit officially) called 'brain leakage'.

When I gave birth to the little three months ago, brain leakage of momentous scale took place.  Out went information like how to access my online banking, mathematics and the location of my car keys, and in came how to put on a nappy, the theme tune to Rasta Mouse, and who the hell Macca Pacca is.  As a result of this mass leakage, other key knowledge was lost - like why I had previously always packed spare infusion sets wherever I went.

The thing about people living with diabetes is that we are nothing if not resourceful.

It was shortly after lunch I ripped my cannula out today when a careless trouser waist-band re-adjustment manoeuvre took place.  I was an hour away from home spending a rare few hours with my best friend, buying bras to fit my post-baby body (see also: small refugee family could camp in the cups...).  I was desperate not to go home, but with an abundance of insulin in my possession and no way of administering it, I feared our day together might be coming to the most swift of ends.  Unsure of whether or not I would be successful, we hot-footed it to the local Boots, hoping that our foray into the world of well-fitting bras wasn't the end of our fun today, if we could only secure a hypodermic needle.

I explained my predicament to the pharmacist as she asked me questions about which kind of needle I would need.  Sadly that information was lost in the official (not official) Brain Leakage of 2013, when I got a new job. But between us we managed to establish that 'nothing fancy' would do.

"Would you like one of the drug user kits?" she asked, helpfully.

Slightly taken aback but glad there might be an option, I rummaged through the kits given out free to intravenous drug users in a bid to encourage safer and cleaner ways of using drugs, if they must.  With a veritable Pandora's box of thingameejigees, I eventually came across an individually wrapped  hypodermic needle.

"Perfect!",  I proclaimed as an examination of the needle showed a clear gauge on the side which I could use to draw up insulin to the correct amount.  Sheepishly (but gratefully) I tucked the kit away into my bag, hoping no-one with a knowledge of drug use might see me excitedly fumbling through the kit. 

Luckily, the lady in Boots saved my day, and my diabetes, a great deal of hassle.  On arriving home I was a happy 4.4 mmol, and pleased that I'd found a workaround for not having been prepared. But having learned today that carrying a spare cannula in my bag is absolutely vital, I only dread to think what else has now leaked out of my too-full brain... 

Everybody loves Frio!

If you have type 1 diabetes and need to keep insulin cool, then you will undoubtedly have heard of Frio.  When travelling New Zealand at the beginning of the year my Extra Large Frio case became my best friend for keeping my meds in happy holiday mode.

When Frio UK contacted me to ask me to take a look at some new products I was glad to because, frankly, I heart their products.

Here's what I thought!

Check out their shop here.

If you have any questions about their products feel free to drop me an email at anna@insulinindependent.com.

Lazy Diabetesing / Survival Mode

Two weeks ago we, as a family, welcomed my little girl into our lives. Having seen my unwavering efforts to keep blood sugar hikes and spikes at bay during pregnancy, I was whole-heartedly congratulated on a job well done by my family members (aka, 'the help').  Inside, I congratulated myself too. It was a slog, but I did it.

Throughout pregnancy, my aim was to keep my diabetes as balanced as possible, without becoming a massive control freak and giving birth to one stressed-out neurotic little kiddo. But after 9 months with an HbA1c in the low 6s, healthy squishy bits and a full term pregnancy, it felt like the challenge (war?) had been won. Two weeks on, it has dawned on me that the challenge (war?) is only just starting. 

Immediately after she was born, I smugly looked at my CGM trend thinking how very much I had 'this'. My nice steady line with occasional above 10 mmol spike painted the picture of a mother absolutely nailing post-birth blood sugars. Two weeks on, and even my CGM trend arrow is trying to show me where I went wrong. 

My once 'never away from my side' receiver now shows a sorry trend of gaps and spikes. The gaps telling the story of it having been left in another room, far from anywhere conceivably useful. The spikes sharing its tale of alarms smothered into silence at the bottom of a nappy changing bag - often rummaged around in, but never for the CGM. The weathered tally gear case shows its age, and the precious upper and lower alarm limits set beautifully at 4 and 7.5mmol (target numbers for pregnancy) now stand at 4 and 13mmol, because I had to turn off the alarms which have been the electronic nag in my life since February 2015. The battery uncharged for the third time in this week. A sorry tale it tells. 

Am I lazy diabetesing? Well, no. Right now I'm adjusting to a new normal beyond anything I could have imagined. My kid is amazing, but in a world where only last night Jamie and I celebrated sleeping in the same bed for the first time in two weeks, there is no room for diabetes 'perfection', if there even is such a thing. If there is, it probably holidays with the 'compliant diabetic' and the 'optimal control' gang. 

Right now I'm living day-to-day, in survival mode. And while I thank my situation daily to be able to use a pump and CGM, right now, as I learn tricks of the trade for getting dressed AND having a shower in one day through a fog of sleep deprivation and survival naps, my diabetes has to just tick by on autopilot. My pump means I always have insulin when I leave the house, and my Dexcom is the safetynet of blood sugar mayhem. Anything in between 'way too high' and 'plummeting like fuck' is pretty much OK. 

The time will come when I have the headspace to basal test between breastfeeds, and prepare blood sugar friendly foods between vomitted-on outfit changes. For now, I'll stick with survival mode 

And on we must go. 

Diabetes and Pregnancy: The End Game

Today is the first day of diabetes awareness month, centering around November 14th, World Diabetes Day.  As the days of the month turn over like pages of a book, social media fills up with information, opinion, blog posts, product launches and events.  For me, November has always been about educating, advocating, empowering and de-stigmatising a condition that affects millions around the world.  This year, it represents that little bit more because today, November 1st, 2015, my little girl turns one week old.

November this year represents both a new chapter in my life entitled 'motherhood', and a new chapter in my diabetes life of being a mother, with diabetes.  As I learn about the fun and foibles of being a mother - of breast-feeding and explosive nappies, of pram construction and bedtime routines (or total lack of them, if my little one week old is anything to go by) - I also now have to do so alongside learning how to manage my diabetes with this new beautiful person in my life - one who needs me to be on my game around the clock.  Learning how to prioritise when a hungry baby demands a feed after I've bolused for my dinner, or how to manage the blood sugar drops of breast-feeding or of remembering to check my blood sugars when my CGM alarms rather than treat the hypo it says I'm having because I'm just too tired from a bad night's sleep.  How will I treat a hypo when baby needs a feed?  And how will I keep my HbA1c from drifting as my focus is pulled in a direction other than my diabetes?  Time only will tell.

This year November and beyond is about learning how to do diabetes all over again.  It is about resilience and re-educating.  It is about finding balance, and about using the technology I have at my disposal to make diabetes a big enough priority in my life that the control and quality of life I enjoy so much aren't sacrificed, without leaving my child thinking diabetes is number one.  It isn't. But in many ways diabetes was easier to manage during pregnancy because it was all I had to do.  If my levels were wacky, a short walk could bring them down swiftly, and appointments were no issue to attend because it was just me to worry about.  Now, there is another person - one who cannot reason or wait -  whom I need to think about first.  

Pregnancy was without a doubt the most challenging period in the time I've had diabetes, made up of equal parts determination, joy, frustration and fear.  But the end result of careful planning, resilience and keeping my eye on the pot of gold at the end of the rainbow was a healthy baby girl, all 7 pounds 11 ounce of her.  Only this pot of gold isn't the stuff of myth, she is very much here.

Happy Diabetes Awareness month people.  Let's make this a good one!

Pregnancy and diabetes weeks 13 - 24: Trimester two

When I first fell pregnant it felt as though the magic 12-week mark, when we could more 'safely' announce to the world that we were expecting, was light-years away.  Managing my secret 'pregnancy diabetes' around colleagues and friends was tricky, but strangely exciting, like an affair with none of the sordid details.  By day I carried on in my job, exercise routine and social circle as usual.  By night I would sneak away to hospital appointments to discuss growing babies, bellies and basal rates. Bat-Anna and her new double life were in full swing.

But with the 12 week mark now upon us, we got to announce to the world that we two were to become three, and that the extra tummy 'pooch' (attractive, much?) and enormous(er) cahunas I was lugging around with me came with purpose.  We got to see our little growing bun, now less kidney-bean shaped and looking just like a little person, and were re-assured that we had passed the first round of testing for congenital birth defects.  At this point some of the many clinicians I was seeing would tell me I could stop taking my increased (5mg prescription strength) dose of folic acid.  Some however told me to carry on for a while, so I did, right until 20 weeks.

During the whole pregnancy the first three weeks of the second trimester on the sail into the unknown were the most easy-going.  Insulin sensitivity drifted off, giving a well-earned rest from the 45 minute hypos brought on by the final days of the first trimester, and now knowing there was a healthy kicking baby on board, life seemed to go back to normal.  My new normal, anyway. At about 12 weeks the placenta starts to function for itself, and the change in not only symptoms of pregnancy like spontaneous day-sleeping and ravenous carb-mania, but also the more predictable blood sugars, made for a veritable day off.

At the point we started to tell people was the first time I really started to feel pregnant, seeing as bat-shit crazy blood sugars are often all in a day's work for us D-champions, so even though I knew the hypo marathons were baby-related I had to repeatedly remind myself that's why.  But at week 15 the first flutters started to happen and my growing waistline and pride in becoming a parent was matched  only by the growing insulin resistance which started to hit me at around week 18.

By week 20 I was raising my insulin at certain times of day (between 2am and 5am) three to four times weekly, as my dawn phenomenon (when I am already most resistant to insulin) went into overdrive.  I would often have to notch up my overnight rates every 2-3 days, trying my best to leave a day in between to monitor my efforts.  FYI, if you can resist upping them daily you deserve a medal - one I will personally craft for you, but its worth it when you don't have to deal with monster hypos from over correction.  It was around this time that I truly saw the value of my Animas Vibe pump and Dexcom CGM into their own, because despite being 4.5 months pregnant not once had I had to wake my self up at night to try basal testing (the world's most futile during-pregnancy task) because my beloved Dexcom was all over that shit.  

Yayyyyy, my blood sugar today is perf.....oh. Ok

It was around this time of pregnancy that I also learned to make peace with the odd highs and lows. While traveling with my baby-daddy in New Zealand I had worn out the asphalt in many a campsite by walking at un-Godly hours through the guilt that a blood sugar of 12 or 13 mmol would give me in the pit of my stomach.  But the 20 week 'anomoly scan' had shown me that my body and overall

good control had so far given me a healthy, perfect baby, untouched by the blasted condition I carried around with me.  Some days I nailed blood sugars and insulin resistance, others I 'failed' miserably (or so I felt).  Some days were a bizarre mix of good and bad.  But every day was a day on the countdown.  I earned to tell myself that every day - be it good or bad - was a day I nailed.  And if I wasn't aware of my hard work paying off in the steady HbA1c and healthy scans I was pulling in, then the first true 'kicks' my kid gave me at 22 weeks, were all the sign I needed, because my kid clearly had something to say on the matter.

The second trimester was tough, in ways completely different to those in trimester one.  Instead of  being pro-active in my preparation for pregnancy, keeping secrets, dealing with insulin sensitivity and hoping to reach that 12 week mark safely, I had to learn how to be reactive, flexible, self-forgiving and most of all, to enjoy it.  Any time I needed a reminder of why I was trying so hard in my day-to-day life I just looked at those moving images of Baby McP, and any crappy day was forgiven.

I was now two thirds of the way through baking my bun and my daily mantra of 'test-change-review-repeat' felt a little like an annoying 2013 rave song, but kept me sane when the words 'routine' became a thing of the past, now replaced with 'constant change'.  The second tri certainly did a superb job of keeping me on my toes, but my new normal was somehow, working out just fine, one day at a time.

Pump failure: pregnancy panics and the cocoon of the DOC

It took me a good six months to trust the technology after switching from injections to insulin pump.  And at first there were a great deal of bumbling involuntary midnight cannula changes, kinky moments and at times I was sure my equipment was trying to kill me .  But slowly and surely as my HbA1cs came down, my hours of valuable sleep went up and my quality of life started to soar, it wasn't long before I would have made for the mountains beyond Rio if the NHS had tried to take my pump back.  It was mine: managed by me, and part of me.  

Fast forward five years and with the introduction of Continuous Glucose Monitoring (CGM) into my life and a growing baby in my belly, and the idea of coming off my technology, even briefly, gives me the shivers.  Granted, I dream of the day when I'm no longer tethered and catching my go-go gadget pancreas on door handles or unsuspecting strangers I stand a little too close to, but my choice to remain on a tubed pump indefinitely is based on five good years of a happier, healthier me.  And my choice to use an Animas Vibe which can integrate the Dexcom CGM I use, as well as being waterproof, is a decision I've never looked back on.  

But I still like to moan.  I am British, after all.  Diabetes, particularly during pregnancy, is extremely tiring.  There is no time to burn out because the kicking, wriggling bundle of joy in my belly means there is no taking my eye off my diabetes - well before and beyond the nine months that little hitch-hiker is mooching its free ride.

"I'm almost looking forward to the burnout after baby is born", I joked, bobbing around the swimming pool with my best friend of 22 years.  "I might even take a pump break.  I'm so tired of having to change the reservoir so often now that insulin resistance is in full swing." I said, not so jokingly.

Be careful what you wish for.

Three hours later and with a slightly watery reservoir change having taken place halfway though our spa day, my pump was making some pretty freaky noises.  The kind of noises a distress call from Wall-E might sound like if someone tampered with his electrics.  Noises which I instinctively knew would make for a long and worrisome night.

Driving home I un-hooked my pump, because the semi-permanent not-very-rhythmic vibrating it seemed to be favouring, teamed with the intermittent squawking gave me little faith that I wanted to be connected to a malfunctioning pump with a full reservoir of insulin.  As I reached my home I dashed inside and dialed the number for Animas, knowing that at 5:45pm it would be the support team over the pond in the states I needed to speak with.

While on hold I took a photo snapshot of my basals profiles (which thanks to insulin resistance are barely recognisable and certainly not memorable since the last trimester of pregnancy kicked in), just in case my pump died all together.  This was my best move that night, given that five minutes later while running some checks on the pump, the buttons gave up all together meaning the basal menu was firmly out of bounds. After a few checks and the inevitable diagnosis that my pump was kaput, and the Animas team had fired off an email to the UK office that I would need a replacement ASAP. Awesome.

But that was really the easy part.  Now I just needed - while 7 months pregnant and with diminshing leels of insulin in my system - to figure out how the hell to make the transition back to injections.  I had, of course, ordered in some spares of my pre-pump insulins Lantus and Lispro when I fell pregnant, knowing that this day may come, but remembering what the hell kind of pattern I was in, when to take the background insulin and how long it might take or that insulin to kick in, felt overwhelming. My last (unsuccessful) pump break had been 4 years earlier and had seen me back on my pump within 8 short hours, so my track record for this kind of manouevre was not good.  Ordinarily I would have just fumbled my way through, but with each swift kick to the inside of my abdomen, I was reminded why this would not be the ideal time to experience my first adult diabetes-related hospitalisation. It was not a time for 'winging it' or making mistakes.

I quickly took to social media as fast as my fingers could type, because having called my clinic a good two hours after they had closed their doors I'd found no-one there to speak to for advice, unsurprisingly.  It was then that I started to panic.  And it was then that the cocoon of the Diabetes Online Community came to life.

Within an hour of frantically typing out my garbled requests for advice I had friends from Devon offering me spare pumps and 'strangers' (whom I feel connected to in indescribable ways) wishing me well.    An hour after that diabetes nurses were offering me advice on what to watch out for and when to test.  An hour after that I was tweeting messages to one of the lead specialists at my home clinic.  An hour after that I was texting my very own consultant for help after a fellow blogger offered me their number, having read about my situation online.  And an hour after that I had administered the insulins I needed and was settling in for bed, feeling secure with the advice I'd received, and that the remaining CGM technology I had going strong would help me keep an eye on my levels overnight

I woke up 2-3 hourly during the night, and managed levels of 8-9mmol throughout.  Higher than I would have wanted, but acceptable considering the back-story.  The next morning the inevitable rise started as the Lantus still had to take effect (having learnt on SoMe that it can take up to a week to become truly stable!), and the two-hourly injections weren't quite keeping me where they should.  But, five hours into the day and after a desperate call to Animas were I firmly played the pregnancy 'card' (cheeky, yes.  Shameful, I don't really care...) and begged them to get the replacement to me that day, and my new pump had arrived. Thankfully, they did.  They probably heard from the wobble in my voice that of all days to go the extra mile, today would be one that truly counted to one very tired and frought person.

The next three days were a roller-coaster of results from the initial highs to the eventual too-much-insulin-sticking-around lows, but my pump was back on, and the baby playing bongos on my kidneys was telling me it was worth it.

Without the DOC I would have muddled through somehow.  But that was how I spent my childhood and teen years, before Social Media became a part of the arsenal I use to manage diabetes; I muddled through.  Since the DOC emerged, and at times like this, it helped me feel safe, secure, empowered and in my time of need, cocooned.  And for that it is worth its weight in gold.

Judged.

Blood test measurements, and certainly my reactions to them, are loaded with emotion.  My results are just that - mine; personal, meaningful, emotive, and loaded with context.  And having someone I don't know look over them with a judging eye from their tower of objective reasoning makes those emotions rise up in me.  They shouldn't, because I know as well as the next person that any result I see is 'just a number' and that I should only ever treat them as a snapshot of information at that moment, at that time. But taking a step back is hard when your life is littered with words like 'balance', 'control, 'good' and 'bad'.

 

My 29 years with the condition have taught me that diabetes is one of the most complex science experiments in the world.  Why?  Because our experiment is happening in 'real life' and countless factors are constantly at play.  I know that how much sleep I have, what I ate for dinner last night and how hot or cold the weather is, for example, all play a role in impacting my blood sugars.   And pregnancy has opened up a pandora's box of reasons filed under 'other' which can affect my blood sugar control.  My usual diabetes pump team, who have spent 6 years working with me to help me achieve the level of control I am happy with know this, and are usually the ones reminding me not to concentrate too much on the results above or below where I would like them. They are the masters of patting me on the back and giving me some positive perspective. 

 

A few days ago I attended my first maternity diabetes clinic appointment.  Until now I've been attending usual maternity appointments with my wonderful midwife, and have seen my usual beloved pump team for the rest of my diabetes management every 2-3 weeks.  But now that I have reached the 25 week milestone in my pregnancy, my care is transferred down to what I call the 'warehouse'.  My hospital is a verylarge hospital on the South Coast of England, with an enormous amount of speciailist departments and thousands of women coming from across the county to manage their pregnancies and give birth to their children. Because of these numbers, it can come across as sheer pandemonium when the unit is full of large waddling ladies being hearded from scan department to generic health check areas.  Seeing the same person twice, other than the familiar faces of the diabetes team, is a rarity.

 

As I sat down in the specialist registrar's office having never met her before, and whipped out my weathered and paint-chipped blood glucose meter, placing it on her desk for her to see, I was fairly happy that I had been doing all I could to manage my diabetes during the notorious second trimester of pregnancy, when insulin resistance and reduction in mobility means my blood sugars have been a little more 'rollercoaster' than I would have liked.  

 

As she scrolled through my meter, her eyebrows raising intermittently as she let out little puzzled breaths, asking me what arrows meant and whether or not certain blood sugar results felt a certain way, I was getting little read on what she was thinking, but was starting to feel protective of the numbers she held in her hands.  I was starting to feel judged. 

 

"Are you aware of the targets in pregnancy?" she asked, not looking at me.

 

"Yes.  5.5mmol before a meal and 7.5mmol after." I replied, a little perturbed considering the 5.3mmol currently trending on my CGM.

 

"I often just use the meter at the extremes because my CGM tells me what I am doing the rest of the time." I said, trying to explain myself, my guard now firmly up. She looked at my bag where the CGM was poking out of the top, clearly in such regular use that packing it away in a zip-pocket was pointless.  I could tell she didn’t really understand what a CGM was.

 

As the questions rolled I clocked my husband shifting in his seat, also getting uncomfortable about the loaded questions from the stranger flicking through my numbers .  To add a little context, my baby is currently measuring in the 50th percentile for growth, meaning if you took 100 babies, mine would be perfectly smack bang in the middle for growth; not too big, not too small.  My A1c is still in the mid 6s even with the second trimester mayhem, and my CGM trace shows an 80% in target spectrum of blood sugars. The 'out of range' figures are also neither drastic, nor regular. Baby is kicking away hourly and I've been feeling amazing, diabetically speaking and otherwise.  I do not need to explain myself.

 

With a few more comments fired about being too low a little too often, and trying not to rebound from them, Jamie and I were shuffled back out of the office and seated back in the warehouse for our scan, a moment we'd been both excited and anxious about.  But now we were a little more focussed on whether I really was doing OK or not, considering the registrar had just carried out what felt like brain surgery on my last 2 week's results. 

I've come to learn that being subjective about people's responses to my numbers is not one of my strong points, and that I need to let certain things go.  But as we took our seats and exchanged knowing glances, Jamie managed to sum up how I felt in one word.

 

"Judged", he scoffed.

 

"It's not just me then", I replied, glad that my husband 'gets it' and was ready to jump to my defence given that he has seen first hand how hard a job pregnancy has been at times. I've tried to avoid being the over-sensitive pregnamonster, but picking apart remarks I take the wrong way because of beasty hormones, over ones with genuine carelessness or malice, can be tough. But seeing that Jamie has also picked up on the tone and the questioning made me feel better. Like I wasn't the crazy emotional one.

 

With that, we rolled the comments off our backs and chose to start focusing on seeing the baby again, and on celebrating the excellent blood pressure and clear urine analysis I'd already been told about that day.  But with my blood test meter now firmly back in my bag, locked away for my eyes only, I was reminded of the sharp sense of privacy-invasion that exposing my results for the 'panel' makes me feel.  Everything is under scrutiny when you are pregnant, and those whiley hormones have a habit of making you even more sensitive to anything which looks vaguely like criticism. The fact that in three months there won’t be a team of people ready to assess and evaluate my every blood sugar is an idea I grow more fond of each day.

 

Three months, and counting.

Pregnancy weeks 9-12: kidney-bean babies and leveling out

So at 9 weeks it's finally sunk in; we're having a baby-kid. It's a strange feeling, knowing you are pregnant but not really having tangible proof of that, other than the crazy sore breasts, insane lethargy and incessant crying at TV adverts with mistreated dancing animals.  I've donated a shit lot of money to charity during this stage of pregnancy.  Be warned.

I must have looked at that pregnancy test a millions times, but it wasn't until I saw the kidney-bean-with-ears shape on that first early scan, that I really 'felt' pregnant. There doesn't seem to be a 'standard' approach to scanning mums with D early, but ours was scheduled at 9 weeks, and offered estimated dates of conception and due date, and basic checks that everything looked OK.  Not that I would have had a clue because to me the image on the screen could have been anything, but seeing the flutters of the primitive heart flicking away on the screen was a pretty special moment, and made the many hypos and achey worn-out feet worth every single moment.

After donating more of my best blood cells to the hospital's store of my personal supply, now quite possibly needing its own wing of the hospital, we've been told all looks good with the growing kidney-bean, and that my HbA1c was holding steady just above 6%.  This, along with the fact that I'm learning how to manage the 45-minute hypos, means things have started to feel a little more normal again in life.  I'm packing away the carbs with the gusto of a famished post-hibernation grizzly bear, and if I ever start to waver or feel a little overwhelmed with the task ahead, I look at the photos of the bean, and remember why I'm doing this.

As a result of the first scan and midwife appointment, I'm now also in a regular routine of seeing my diabetes team every 2 weeks for them to look over my results, make suggestions and work with me towards achieving blood sugar levels as close to 5-7mmol as possible.  Some days this feels like a mammoth task, but keeping their email addresses to hand and dropping them a line if I am ever struggling has helped me enormously in feeling like any issues are addressed straight away.

Things I've noticed in the final parts of the first trimester:

~ I've become more sensitive to insulin, and more accepting of carbs.  Rarely rising above 9 mmol even after the most carbilicious meals mean the final parts of this trimester have left me feeling like life is leveling out, just a little.

~ Hypos still take a long time to recover from and some hit in 'stealth-mode', with little warning.  If you don't use CGM, I would highly recommend increasing blood tests if you haven't already, because the tiredness and general overwhelming need to be completely horizontal, if awake at all, in early pregnancy means those hypos-in-cloaking-devices can knock you for six.

~Blood tests still suck.

Pregnancy: weeks 5-8 (boob-ache and bolus-mayhem)

By now if the constant boob-ache and total lethargy hadn't given me reason to suspect I was packin' a baby down there, the five pregnancy tests sealed the deal.  I was one of those horrendous secretly-thrilled people filed under 'lucky bastard' who didn't suffer any sickness (yet), but, before you virtually strike me in the blog-face or permanently unsubscribe from my posts, I have taken to spontaneous day-sleeping.

Spontaneous day-sleeping is a marvellous condition which makes it all but impossible to keep the pregnancy a secret, and works wonders for your relationship when every film we watch together ends in me snoring or falling asleep immediately after the opening credits. Sex, has all but gone into hynernation, because I'm asleep all the time, and there are laws against one-way loving. Jamie, is thrilled.

Diabetes-wise, these weeks weren't too crazy of a time after the first 4 weeks other than some pretty striking hypos which seemed to take 45 minutes or more to recover from. Having been away travelling there was still a whole heap of late-night campsite-tramping and wicked post-meal hypos needing lots of fruit-juice glugging.

During these weeks you may well be going along to your maternity clinic for your first blood tests (these don't get any easier, even with a kiddo on board) and some information on how your care will take shape over the next few months.

Below are some of the things I noticed over these last few weeks.

~I've been religiously using gentle walks to budge down blood sugars when I know I have enough insulin on board but that my post-meal spike is going up just a little faster than I would like.  A quick 15 minute walk around the block once or twice is enough to bring me back into range, and the beauty of walking is that even when lethargy-face hits, it's not such a big ask to go walking for 15 minutes.

~On the plus side, carbs, which I was convinced had reached the end of their sweet life during pregnancy, are back in full force. With some cleverly timed bolusing, I've been enjoying meals with 70, 80 or even 90g carbs.

~ pregnancy gives you 'hunger-rage'. You'll know it when you see it, and you'll probably consider strangling any stray cows eating unattended in a field if hunger-rage strikes. Because you will be THAT hungry. 

~Blood tests still suck arse.

~For some reason my blood sugars have become increasingly more difficult to bring up after a hypo.  Initially I made the horrible mistake of treating hypos twice, because after 30 minutes I was still in the 3s at a stable pace. Be warned, treating twice is a false economy, because you'll most likely spike twice as hard and twice as fast when you recover.

A belated look back at the Animas weekend 2015

Somehow life has run away with me in recent weeks, but finding time to review the Animas weekend which took place back at Loughbourough University in May 2015 and give a little look at the photos from the weekend has been a 'must-do' for quite some time.  

Two years ago Sir Steve Redgrave said this about the journey he had been on since meeting Dr Ian Gallen after his diabetes diagnosis, and then going on to win his fifth Olympic Gold medal after his guidance and advice:

When I was diagnosed with diabetes and thought that my sporting career would have to come to an end I was absolutely devastated.  But with the support of Ian Gallen and his team, I was given the confidence to carry on with rowing and I was able to stay at the same level that I was at before having the condition; going on to win gold at the Sydney Olympics 2000.  I came up with the quote "diabetes has to live with me not me live with diabetes."  And that has stayed with me ever since in whatever I do in life. 
Steve

Want to find out more information for next year, so you can come along and be immersed in a weekend of fun, surrounded by people with type 1 all wanting to learn more about sport and the effect it has on diabetes, then email sportsday@its.jnj.com.

And check out the video montage of this year's exploits.

Enjoy!

Pregnancy: weeks 1 - 4

OK, so we didn't even find out we were having a baby until week 4 of pregnancy, when the hormone HCG was finally at high enough levels in my body to be detected on a pregnancy test but, we'd been planning starting a family for quite a while. And while it may not be time to add safety locks and baby-proof unit edging to all our furniture just yet, there were a number of things I learned can help along the early weeks of pregnancy nicely.

Considering 2 of the 40 weeks we are pregnant aren't even really pregnancy, there wasn't much of a change in anything in the first 4 weeks of pregnancy.  But I had been honing my basal patterns significantly and trying to convince my blood sugars - through diet, exercise and lots of deliberating over insulin dosages - to run a much smoother pattern over that 4 weeks.  You know, just in case.  I basal tested  to within and inch of my life, and re-read my already dog-eared copy of Gary Scheiner's Think Like a Pancreas, now defaced with scribbled notes in the margin and corners of the most important pages folded down.  His chapter on basal testing particularly helped me get much better patterns before we eventually did 'the baby dance'.  This also helped me nudge my recently rising HbA1c from a happy 7.4% to a 6.2% in the first weeks of pregnancy.  The general guidance is people with diabetes should aim to get it below 6.5%.  That may seem impossible, but it's funny how the motivation of a baby can help...

I also started to get back out there and use gentle low-intensity exercise like a stroll to nudge blood sugars down if they started creeping out of my comfort zone. Not only did this bring me down faster, but any gentle exercise is arguably good during pregnancy - although the advice I was given was not to start trying anything too intense if you didn't already do it.  Well...if it's doctor's orders... But by walking to the shop here and there after a meal, I managed in those early days to keep BGs generally under 10mmol after meals (180 mg/dl).

I also took a pre-natal vitamin and an increased (5 milligram - prescription strength) folic acid tablet daily for several months before we tried.  Whether or not the sales pitch of helping with conception is true, I will never know.  Perhaps we were just irritatingly lucky to fall first time.  Perhaps the daily vitamin had something to do with it.  But the folic acid is vital. Folic acid helps reduce the risk of birth defects and the good thing is any extra you don't need the body kicks out - so you don't need to worry about taking 'too much'.

Finally, I also learned that I had to stop freaking out about high blood sugar levels. I spent the first week after finding out we were expecting crying like a total lunatic every time my blood sugars rose too high. This wasn't fun, or necessary. You're partner doesn't want to be looking at you like you're a crazy person having just taken on the beautiful, but HUGE, news about his growing family. The only time high blood sugar levels are dangerous is for PROLONGED, UNTREATED highs. Just do your best to bring them down as soon as possible. And stop freaking out your partner.  Says the crazy lady who writes this blog, now much wrinklier and grey-haired than she was a few short weeks ago.

Weeks 1 - 4 of pregnancy really didn't bring anything more than I was already managing, and even the fabled tell-tale low blood sugars in early pregnancy didn't creep in until after this time.  But there are still 36 to go...who knows what else is around the corner.

D-Blog week: I can...

D-Blog week is the brainchild of Bittersweet Diabetes, and as it turns six years old. it provides another opportunity to hear from blogger voices across the world simultaneously.  I love that two people will see a completely different challenge from the same topic, and today's is sure to be a good 'un.  Today's topic is....I can...

When I was 12 years old I told someone who was asking me about diabetes, "Don't worry about me, there will be a cure in five years." I'd heard it spouted by Diabetes UK and blindly, fell for the line.  At the time very little was known about stem cells or even the causes of type 1, insulin pumps weren't yet routinely used in the UK, and CGM had yet to be invented.  Why I believed this wild claim with so very limited technological support for it ever happening, I will lay firmly at the feet of hope.  I hoped.  My God, I hoped.

 

By 22 that hope was all but lost, as I plunged into months of the worst burnout I have to this day experienced. My DSN, a fantastic woman called Sue Craddock, to whom I owe a great deal as she steered me back on track with careful words and constant support, referred to it as 're-diagnosis', due to the severity with which the reality of diabetes was smacking me in the gut.  "Please take me into hospital, I can't do this." I begged, after testing my blood and discovering I was 22 mmol before even having made it out of my pyjamas.  There was no cure.  It would never happen. It was lies.

 

By 32 another decade on and wiser, older, happily pregnant and still taming the diabetes beast as best I can, things have changed direction yet again.  Now, the technological advances and better understanding of the sheer complexity of diabetes has brought into the diabetes world a new term: Artificial Pancreas (AP).  While the AP isn't a 'cure' at all, if we're honest - it is a new ray of hope. The idea of a closed-loop system which could manage blood sugars on our behalf, and in most situations, is to me a dream come true.  I often ask when is 'good', good enough, because as a community we still hold on hope to stem cell research and islet transplantation, these were the hopes I'd clung to at 12, and those which had let me down by 22.  I still hope they will happen, but I don't let myself dream of days away from this life, quite the way I used to. 

 

But with the AP, tangible evidence is released almost daily in the form of human clinical trials, showing the literal steps which are taking place, bringing us ever closer to one of the most important technological breakthroughs since the discovery of insulin.  And at last, I can see a different future.  I can see that while a 'cure' might not be around the corner, if ever, there will be a time when I can sit with my friends from the diabetes community and enjoy a meal, day out or even just conversation, without our diabetes loudly interrupting our lives.

 

I can.