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

Adventure D launch weekend!

On Friday morning 12th September 2014, after a night of minimal winks and maximum anticipation, my brother, Chris, and I made our way to CYE sailing center in Chidham West Sussex, for the inaugural Adventure D kayaking weekend!  The two day event in impossibly beautiful surroundings, would see eight fabulous people with diabetes, including Claire Pesterfield, a type one herself and diabetes specialist nurse to boot, along with a team of volunteers and instructors, take the attendees from 'never been in a kayak' to having advanced skills and being equipped with the knowledge of how to kayak safely.  

As the group started to arrive, any fears or nerves we had about the weekend slipped away as the smiling, keen faces of the fabulous group getting to know one another showed us that this was going to be a great weekend.  The weather was idyllic, the harbour was still and the gentle murmur or friendships being made set the relaxed pace for the weekend. We settled after our carb-counted meal and learned from Claire how we might adapt insulin and food intake for the water-based sessions the next day.

Saturday saw the group take to the water, starting off in practically unsinkable 'sit-on-top' kayaks, to learn about strokes, boats and safety.  Throughout the day were relaxed but regular breaks to allow for blood testing and tweaks to insulin or carb intakes here and there, and grow in confidence on the water.  The sessions ended with games - transforming the once-cautious sit-on-top users to competitive kayakers, losing any inhibitions they had in order to smash the other team out of the game, all the while donning fully-fledged Pyranha kayaks, and pulling out some professional moves in order to win the ball, catch the 'robber', or make it through the finish line first.   The laughter resounded through the harbour we called our own. Watching from the sidelines, this was the Adventure D dream come true, playing out in front of us.

After a delicious home-prepared and carb-counted curry, the group made for the local pub to share a drink with their new-found friends and to re-tell their favourite moments of the day. It was without doubt one of my favourite moments of the weekend; watching budding kayakers become friends and for some of the group, mix with fellow people with diabetes for the very first time.

Sunday saw the group of kayakers, now confident on the water and ready to put their new-found diabetes knowledge to the test, take to the water, keen and excited.  As we journeyed through Chichester harbour to the beautiful sights of Bosham, the instructors gushed about what a delight it was to teach this group. The Adventure D group.

As the Sunday came to a close and the Adventurers told us how they wanted to buy kayaks, had grown in confidence or didn't want to go home, we knew they had enjoyed it as much as we had. Every. Single.  Moment.

When I think about the first time I tried kayaking, a smile creeps across my face, and I can almost feel the warmth of the sun and the spray of the saltwater on my skin.  It was a clear day in late summer, there was no wind to speak of and the water in the harbour glistened as the rays bounced off the gentle undulating waves as the water ebbed and flowed.  That day was good.  This weekend, was perfect. 

Thank you to the wonderful people who joined us for the weekend, and made the event such a success.  Here are your best bits :)

Finger sticks and spurting capillaries....becoming obsolete?

When I was 9 years old, I punctured the tip of my middle finger for a routine-as-rain blood test.  But this one was a little different.  Rather than the usual prick-squeeze-apply, I had managed to pierce a capillary and when squeezing the finger to produce my tiny drop of blood, managed to inadvertently spatter blood right across my face, Tarantino style.  As I looked in the mirror, horrified, I couldn't yet have known that one day, while watching the film Kill Bill, Uma Thurman's face would remind me of my nine year-old, freaked out own.  Looking back now I see the humour in that.  At nine years old, that 'funny side' escaped me.

In my diabetic lifetime I've done an average of 70,262 blood tests, and as Kerri Sparling's recent post about why she now changes her lancet regularly demonstrates, this takes its toll on the nerve endings and circulation in my fingers.  The beauty of my Dexcom is that only needing two calibration tests a day, this number has rapidly dropped off.  But nevertheless, I always dreamed that one day there might be a different way of doing things.  A less, 'spurty' way.  Well, Abbott have found a way with the Freestyle Libre Flash Glucose Monitoring System!

The Libre works by inserting a small coin-sized sensor into the skin on the upper arm, and placing the receiver next to the sensor for just 1 second, allowing it to pick up the current reading glucose reading from your interstitial fluid.  It's not strictly 'CGM', in that there is no continuous reading, and there are no alarms to alert for highs or lows, but there are trend arrows to indicate the direction of glucose travel. The growing buzz on the internet forums however, is that this would allow users to gain so much more information in a much less invasive way, and that it is very much the next best thing.  Sadly it won't completely remove the need for testing as tests should still be done to confirm lows and highs, but even that is an enormous step forward to permanent bloodless testing.

Early (unconfirmed) reports suggest the system will retail at £150, with sensors costing £50 for 14 day wear, although this has yet to be confirmed by Abbott themselves.  But InPuT have reported that CE marking has been achieved and they have been invited to a release event, so rather than being one of the 'blue sky dreams' we read about as being 'just around the corner', the Libre system seems to be set for public use, very soon.  All that is awaited is release of the MARD (Mean Actual Relative Difference) data to show the accuracy of the device. MARD is calculated by comparing BG meter readings with laborartory standards. A lower MARD value indicates smaller difference between meter value and the reference value. Higher MARD value indicates larger difference between meter value and the reference value.

The only downside at the moment is that it will only be licensed for those over 18 meaning the hopes of parents that they will one day be able to stop puncturing their children's fingers, is yet to come.  I would have no doubt however, that Abbott are aware of how much this product will appeal to parents, and that bringing it to market for paediatric use is a goldmine waiting to be blown open out of the mountainside.

Check out the Freestyle Libre video below.

All in all, it looks a promising signs for fingertips!

MyStar Extra: The first home HbA1c device in the UK

When Menarini stopped manufacturing their home HbA1c testing kits at the end of 2012, I was gutted.  I deal with blood tests the way a cat deals with the hoover: through a mixture of hiding, hissing, and eventual submission.  So being able to check my HbA1c every few months by simply squishing a large drop of blood onto a piece of gauze and sending it off for a lab-standard result, meant it wasn't so naughty of me to put off my annual blood tests until the 'tow the line, Presswell' letters started arriving from my clinic.

When I was invited to attend a symposium for Sanofi's new Blood glucose monitor, the MyStar Extra, which claimed to have an on-board A1C calculator, I was just a little bit excited.  As well as offering a swish looking machine, the on-board A1c calculator can be done by following a few simple steps.

1) Set up a profile day.  

This is the process of taking a full profile of seven blood tests throughout the day, at certain times. These are before 11:00 'fasting' test, followed by a further post-breakfast test by 11:00 (so it's a good idea to make your fasting test before 09:00 to give time for the post-meal test).  Then a pre-lunch and post-lunch test between 11:00 and 15:59 (again, a pre-lunch test of before 13:00 gives time for the second test). The pre-dinner and post dinner between 16:00 and 20:59 (again, a pre-dinner test of around 18:00 allows time for the post-dinner test).  Finally the bedtime test of 21:00 - 23:59.  This is called your 'profile day', and by selecting the 'tick' button on the machine, you have now set up your profile.

2)  Fasting blood results.

Once your profile day is up and running, conduct six more fasting blood test results and BAM! You're done.  You're estimated HbA1c result is ready to be viewed!

So, the big question is, how accurate is it?  

Conveniently, two weeks before my MyStar Extra glucose arrived I had my yearly hissy-fit blood
panel done, so now would be a great time to test-drive the system.  I was convinced my result would have gone up after a chaotic few months, but the lab result was the same as last year - 6.6% (49mmol in 'new money').

I eagerly awaited the result of first MyStar A1c test.  

3...

2...

1...

...6.8% (51 mmol, in new money). Pretty darn close, if you take into account the two-week gap and the fact I did the profile day on the same day I went to my local legendary high tea parlour, giving slightly skewed results.  And plenty good enough to help me keep a monthly eye on my A1c along the way.  

As with many things, there is one small down side: the limited A1c calculator range. As someone aiming for pregnancy-perfect A1cs so that Jamie and I might bring our own nappy-factory into this world, I need to aim to get my A1c under 6% to ensure my risk of complications during pregnancy are reduced.  Having scoured through the guidance manual, it seems that the A1c calculator will only go as low as 6%, until you just get the warning 'A4'.  On the plus side, a result of A4 will tell me my A1c is now below 6% (or above 10!) but still, it is this level of accuracy I need to aim for in the next year or so, so it is somewhat disappointing that levels lower than 6% won't be reported. Of course, it hasn't been tested on pregnant people yet so using it so would be entirely off-label.

That said, to have an at-my-fingertips chance to get an estimated A1c in between visits to the clinic is a god-send. It means I have that extra tool in the diabetes arsenal and means I have another way to feel empowered over, and in control of, my condition.

All in all, a big thumbs up!

Off-label CGM use: words of caution from my consultant

I spent most of today thinking my 24 day-old sensor was 'way off', because the calibrations were rarely within 1 mmol; something I have come to expect from my trusty companion.  When I wasn't scoffing at the result, I was resigning myself to pulling it - something I hate doing when I've managed to get almost a month out of it.  For some reason I become attached to a sensor the longer it lasts and the better it performs.  But I thought that this might be a good opportunity to test out a word of caution my consultant had given me in clinic some months ago.

When my consultant found out that I was using my Dexcom G4 sensors for waaaaaay longer than the 7 days they have CE approval for, he offered me a word of caution.  Two, in fact.  Firstly, doc was worried about the damage I might be causing to my might-be-needed-one-day cannula sites, as I was regularly getting 21-28 days out of sensors - up to four times longer than advised.  The second concern he had was that over time, the peaks and troughs the trace would show me would be less sharp as the sensors response to glucose in the body becomes blunted, meaning you won't get the precision you are looking for and could even miss the highs or lows you bought CGM to catch in the first place

As I downloaded the data I was writing the 'watch out for this, folks' post in my head already. But as I looked at the picture, this is what I found:

The red dots are my blood glucose calibrations today, while the purple trace is the results my sensor was providing.  I felt surprise as I looked at it, having been convinced this was 'the risky bit' my consultant had warned me of.  But even though the calibrations felt 'way off', when you look at it though the objective eyes of hindsight (and some kick-ass software), the valuable trend information (that we have so banged into us is more important that the 'exact number') is still there.  At my highest point the sensor was spot on, and at my lowest it was still reflecting the changes in my glucose trends.  In fact when you really look at it, the CGM still appeared to be picking up a few more peaks and troughs than my BGs did, as it should.

Perhaps it felt that way because this is the kind of data you see would normally see on day 5 of week 1, when the sensor has had a chance to be calibrated numerous times but is still a 'fresh' sensor, in the long run:

This day was generally filed under 'not so great'.  Any BG of 18mmol at 3am is always filed under 'not so great' (unless you are normally 24mmol at that time of night, in which case, go you!), but despite the crazy roller-coaster day, the only two calibrations I did (unusual, for me) were both absolutely spot on.  Perhaps it is because of this kind of precision that I have become so accustomed to that threw me off when the calibrations seemed so 'far off' today. 

But having seen the data from today and realised that the sensor was not as AWOL as I felt it was, I'm going to keep hanging on.  Despite being 24 days in I've yet to see more than one set of ??? marks, meaning communication-wise the sensor is still going strong and speaking to the received without any problems - something that can falter in an older sensor.  And although my calibrations are a little off bulls-eye, the trend data is still more valuable than finger sticks alone, so I will plough on until this one gives up the ghost for good.

Hopefully sometime in 2015.

Surfing with diabetes: Face-planting and packing the right kit.

When you start dating, you could choose to put on your best clothes, douse yourself in perfume and dine at the most expensive restaurant in town.  That, is a great way to get to know each other.  The other option of course is that you could, as Jamie and I did, drive to Cornwall, squeeze into a frighteningly tight wet-suit not designed for someone with a chocolate habit and throw yourselves repeatedly into the powerful battering waves of the North Atlantic Ocean.  While doing so, you will of course also face-plant the water over and over again with blind optimism, sheer determination and in an attempt to 'impress' the other.

We first caught the surfing bug when we stumbled across  Escape Surf School, back in 2007. Based under St Christopher's Inn Hostel, Newquay and overlooking Towan beach, it was a beautiful place to be for our first date.  On the first morning we immediately clicked with the instructors, Mike (pro-surfer, coach to the British Surf Team and possibly the most friendly man alive) and Will (awesome guy who's won countless competitions, coached the British Junior Surf Team and can even surf without a surfboard.  Show off.).

Wet-suit unfriendly
diabetes paraphernalia.  

Surfing is a challenging business: not in the least for a person with Type one diabetes. Let's put aside the issue of blood testing in the water (extreme aqua blood testing?) and think about where the hell you keep your glucose tabs, insulin, blood test meter and insulin pump when wearing, well, little more than a skin-tight neoprene wet-suit. Considering there is barely space for my ample rear-end, finding space for my diabetes paraphernalia is even more of a challenge.                   

                                                   

This September Jamie and I made our way back to Cornwall for our annual anniversary trip, and what better way to celebrate than to head back to our favourite surf school, catch some waves and work on our surfing style (see also: face-planting).  

Before heading into the water on day one my blood glucose was a fantastic 9.0 mmol: a great number pre-surf.  With a swig of Lucozade and the removal of my insulin pump, I surfed for the whole session with no problems, and as we got back to Escape's welcoming warm showers and Belushi's legendary burgers, I was rocking a perfect 10.0 (mmol).  It was a resounding success, by anyone's standards.  As was my face-pl...I mean, surfing.  My husband on the other hand, rocked it.

Jamie, who tells me that he is expecting O'Neill's call any day...

Day 2 however told a different story.  My pre-surf BG test revealed a 4.0 mmol and as 3.9 mmol is technically already a hypo, I devoured most of my first bottle of Lucozade before we'd even left for the beach.  I put the remainder of the bottle and my blood test kit into Escape's first aid bag, and headed in the direction of the waves. Why it didn't occur to me to take my second (full) bottle of Lucozade I will never know, but one hour in and after a monster wipe out, I felt the tell-tale signs of a hypo arrive.  I told Will I was heading in, enrolled the help of Jamie to babysit my board while I tried my hand at extreme aqua blood testing, and made for the beach.  Escape instructor Sarah had already spotted me wandering in, dragging my board behind me in a less than cool-looking way, and came to check things out. Calm but attentive, she jogged off to get my testing kit, like it was no big deal. There is nothing worse than a panicker when you are feeling hypo, so Sarah's chilled-out attitude was a breath of fresh air.   

Thank you to the photographer, for the photos...
...and the shorts!

Luckily for me the photographer, there to catch our most impressive surfing attempts (see also: watery face-plants), let me to dry my hands on his shorts because I forgot to pack any tissue to dry my fingers (worst prepared diabetic ever award?).  But then what better way is there to get to know someone than to wipe your salty, water-wrinkled hands all over their shorts?

As it dawned on me that my second bottle of Lucozade was at the top of the hill in the changing rooms, I prayed I was just tired from the surfing (see also: sea-bed face-planting). I watched nervously as the meter counted down.

5, 4, 3, 2, 1.

3.2 mmol.  

"Shit."

I looked back up at the hill I might need to climb, wishing that the last mouthful of Lucozade I just finished would be enough to raise my BGs.  I knew it wouldn't be.  

"Hey", I heard from over my shoulder.  "Here you go, have these."

As I turned around Sarah placed in my hand a full packet of glucose tablets and smiled. And just like that, her eyes were back on the surf watching the surfers get acquainted with the sea-bed (see also: beachy face-planting).

I let out a sigh of relief.  

It had never occurred to me that the surf school I learn with might need to be diabetes-savvy. I have always been fiercely independent in my management of diabetes, so other than the mandatory 'type one diabetes' on the medical form, I don't really demand the help of others, or expect them to be prepared.  But as I discovered this year sometimes, they need to be. Because even someone with 26 years of diabetes experience can mess it up sometimes.  

Wild dolphins, who swam amongst us for over an hour

My own complacency after just one successful surf could have brought me crashing to my knees and ruined a fantastic surf (see also: every kind of face-planting there is), but thankfully for me Escape Surf School were totally prepared.  Not just in the amount of instructors they have watching over our inexplicably comical efforts to walk on water, but also in the supplies they took to the beach and the speed at which they calmly dealt with my efforts to derail their lesson.

Escape, thank you. Not just for a weekend where I experienced wild dolphins playing in the harbour while we surfed, but also for being prepared for all eventualities: especially unprepared people with type 1 diabetes.

Can you guarantee the surf company you chose have supplies if you need them to?  I can tell you first hand that Escape do. 

See you next year! 

Me, apparently trying to kill Sarah

Day off. Seriously?

I've already raved about the CWD weekend.  The message is; it rocks, so GO! But while I hope I have covered the weekend in general enough to give you a thirst for more and hopefully come along to the Glasgow weekend, there were some lightbulb moments that I thought deserved a post all to themselves. Having a day off, is one of them.

The 'Avoiding Burnout' talk by Jill Weissberg-Benchell (awesome name alert!) and Korey Hood, brought together a group of people who by all accounts either were, had been or might be on their way to, burnout.  If you have never been through burnout before, it isn't a fun place to be.  It's when diabetes, technically a chronic condition, becomes emotionally acute.  The pressures of walking the tighrope between the upper and lower target range build up over weeks, months or years and end in, quite literally, total burn out. 

During the CWD session we explored ways parents can have a rest without going out of their minds with worry and how to hand over control to teenagers, without losing tracks of whose role it is to do what.  One suggestion was for parents to be in charge of everything when they were around their child but hand that control over, when apart.  Great idea, if you are a parent.  For the PWDs, who can't ever truly get away from the condition, it isn't quite so easy. Or….is it?

That discussion seemed to start a fire in the mind of InPuT's Lesley Jordan, who announced that she would be asking her husband to give her a day off when she got home from the conference.  He would be taking over the reigns for one day and allow her to just be Lesley.  Not, Lesley with diabetes. 

Honestly I thought she was crazy.  How would that work? Wouldn't she worry more?  How will she know everything is being done right, or even just, OK? 

Without realising it I was turning into my own concerned parent, saying all the same things a parent at the beginning stages of burnout says?  The lack of faith that things will be OK.  The need to know what was going on.  The inability to let go of control, but needing to in order to self preserve.  Placing demands on myself to handle it.  Those are exactly the demands I want to to have a break from, too.

After teasing me that this fitted well into his master plan of exerting total control over me (he's kidding.  I wear the trousers, of course) Jamie agreed that it seemed like a great idea.  What's to lose, right?

So tomorrow, for the first time since in 18 years since my parents handed over the reigns in my early teens, my Jamie will be allowing me my first day off. Tomorrow is mine; Anna's, not Anna with diabetes.  I won't be consulted. I won't have to make decisions about when to test or what to eat or how much to bolus. Jamie, is taking my diabetes for the day. And he's welcome to it!

Now to decide how to spend my day off...

Have you had a day off lately?

Each little victory: spinning

With all eyes on the London 2012 Olympics, exercise and personal achievement are hot topics of discussion.  Watching our celebrated British rower Sir Steve Redgrave with his own lazy pancreas issues carry in our Olympic torch was certainly a moment to celebrate.  A couple of years ago a moment to celebrate for me was getting out of bed in one motion, eating a bumper portion of fried chicken or getting out of a chair without making that noise.  You know, the one that kinda goes  'oooourgghhhhh', followed by a sharp outlet of breath.  But over the last two years things have changed for me; something shifted.  I got tired of always feeling tired.  I missed the figure I once had and I realised how much I missed being active.  Outdoors had become a place I no longer had the energy or desire for.  

I'm not sure where it was I took a wrong turn in the road, but I hazard a guess that it was a mixture of going to university, where gym memberships and healthy food were a thing of the past and drinking was all the rage, starting a full time job and being exceedingly happy in my relationship.  Damn that happiness. *shakes fist in air*

In the last year however I have been clawing back whatever residual fitness I had left and could force our of hiding, and started exploring a different way of eating and exercising. But while my diet and attitude started to improve, I made no secret of the fact that managing blood sugars during exercise was a challenge I had no idea how to handle.  Failure happened frequently in even my best-laid plans.  Gentle walks in the country led to serious and embarrassing hypos and gym classes led to kidney-bashing blood sugars I could have achieved by saving myself the effort and sweat and chowing down on a bag of sweets instead.  I reached the point where I would go to an exercise session armed with insulin in case I went high, lucozade in case I went low, bananas in case I needed a littler something before exercise, and protein shakes to try and keep sugars stable (again, deludedly) both during and after exercise.

It was on the sports weekend run by Animas that I was given the tools I needed to start understanding what was happening in my body during my exercise sessions.  I learnt to abandon the bananas, get more confident when reducing basals and exercise as regularly as possible to reap the full benefits of more balanced blood sugar levels.

Piece by piece things started to come together.  The kidney bashing reduced, hypos happened far less frequently and eventually I was even happy to try new exercises, having grown in both confidence and skill at managing that beast called Mr Hyde.  I went from being the girl who hid at the back of the class, dressed head-to-toe in hideous black baggy clothes, hovering somewhere between the water-cooler and the exit (or 'escape' as I called it), to picking new classes, actually saying 'thanks' to the instructor afterwards and even bought myself some shockingly skin-tight running trousers.  And I mean spray-on kind of tight!

On the Saturday just gone however, the spray-on tights, tireless pre-, during- and post-exercise blood-testing and the trying to be as patient and scientific as possible, finally paid off.  I had my first real break thorough.   I arrived at the gym, having been hovering around 5-6 all morning and having lowered my basals to 50% an hour before exercise.  I'd eaten a healthy omelette for breakfast and tuna salad for lunch, so I knew I had some protein in board and that I wasn't likely to have any crazy highs.  I tested my sugars and a 5.6 was staring back at me.  A year ago I would never have dreamed of exercising at 5.6.  If I'm honest, I wouldn't have even 3 months ago. 

'Oh hell', I thought.  'Let's just go for it, what's the worst that could happen?' 

Well, contrary to the Dr Pepper adverts, I didn't run into any problems after asking that, somewhat dangerous, rhetorical question.  Halfway through my spin class I tested.  5.1. 

'OK, OK, I'm happy with that, let's keep going and see what happens.' 

I reached the end of the class and nervously tested again.  There's no way I will have scored a hatrick.   But there it was, a perfect 5.2.  The elated and somewhat unhinged grin on my face must have scared the living daylights out of the other spin goers that day, but it would have made a difference even if I'd noticed, or cared.  That was my first great success. The next two hours were made up of 6s and 7s, settling at 7.4, three hours later.

JACKPOT.

The moral? Keep at it.  The grass on the other side really is as green as it gets...

The Microsoft way of thinking

It's no secret to anyone who reads my blog (or is 'friends' with me on Facebook) that I have been having a 'blip' diabetes wise lately. No big deal, everyone has them, right?

Well for me the odd blip here and there is normal. There will always be the days of miscalculated dinners, the biscuit which had more carbs than you thought, the stressful day at the office which renders your insulin all but useless and those days when you just can't figure out what went wrong. But this latest blip of mine seems to have not only lasted longer than normal and for the life of me, I have been simply unable to fathom it. My diet hasn't changed, my weight hasn't changed, my routine hasn't changed. Nada!

So for the past two weeks I have been stumbling from one frustrating blood test to the next, becoming more baffled and more irritated with each test, exercising my right to swear at random and sometimes inopportune moments (mainly at my desk with my boss in earshot). One minute I seem to be in the major hypos, the next I am having 'highs' even the most hardened drug addict would be phased by.

I guess the most frustrating thing about this last couple of weeks is that it was all too reminiscent of a life I thought I had left behind. A life which involved nothing but fear of the blood test machine, fear of complications and fear of my own body. Deep down I suppose I always knew that it wouldn't last forever, but being grown up about it and being able to see the wood for the trees can sometimes be hard, particularly when it is my body and my health at stake.

So this weekend I decided enough was enough; it was time for some drastic action. Not only to save my own sanity, but that of my poor facebook friends and family members who no doubt have barred me from ever being allowed to comment on their wall again, following my many desperate and harassed sounding status updates. I wonder how many people can delete you in one weekend, before you get an official warning about the content of your updates.

So, I decided if it was good enough for Bill Gates it was good enough for me. I quite literally turned it all off and on again.

That is, I unplugged my pump, dusted off my insulin pens and needles (having found a stash at the back of the diabetes cupboard) and brought it back to basics : I minimised my carbs to a very basic amount so that I could make fewer mistakes when it came to boluses, I didn't do any stressful exercise, I made sure I got a perfect amount of sleep, ate healthily and tried to stop testing my bloods so fanatically.

It must have been about 3 hours before I started to miss the pump; noticing that only being able to inject full units at a time is very difficult when you are eating low carb and sometimes a meal consists of 15 grams of carbs. Do you inject one or two units? With the pump it isn't an issue. With pens, it is.

Hello and [un]welcome back injecting in public! I had forgotten all about this beast of a task for a diabetic. I had never realised what a pain this was when I had to do it, but having joined the pumping club, I had obviously adjusted to the much easier way of life that was whipping out your pump or better still, notching up a couple of units on the remote control that is all possible on the pump. But it was not so on my 'days off'. Back with a vengeance was the 'do I go to the loo or inject in front of that woman who won't quit staring' dilemma. I had forgotten what a pain that was. And I think I have a new found appreciation of the ease of just tapping a few buttons.

Another thing I was reminded of very quickly, was that on a pump, you have exact knowledge of how much insulin you have in your system in any one time. When you first programme it, you tell the pump just how long your insulin takes to wear off (based on your own experiments). So if you test your blood glucose and find a nice big fat double digit staring at you, on a pump you can check to see how much 'active insulin' you still have in your system. Sometimes I ignore what the pump tells me, because if my sugars are up near the 20s, then it is pretty obvious that I need a whole bunch more. But if you are 12 or 13mmol, you really need to know how much active insulin you still have. If you have 5 units, it would be kind of silly to inject seeing as the active insulin will still be taking effect. It wasn't long after taking the pump off that I realised how useful this function is, and how much I must rely on it! Ever noticed how much you miss the clock on your kitchen wall when you have to take it down to get more batteries for it? Well it was a lot like that.

I'm sure that had I stayed off the pump for much longer I would have found a million things to 'miss'. But the fact is, 48 hours off the pump was enough for me. I got to spend a weekend without wires, batteries and a beeping chest and I got to have a couple of nights without having to wear my pump to bed. I got to feel 'normal' for a little while.

But it was never going to last. Within a couple of days I noticed even bigger swings than before, and not having the sound knowledge that I have with the pump, I re-connected yesterday and plugged back in to the Matrix. It's much nicer in 'there'. Safer, I guess.

Today I have somehow managed sugars between 4.1 and 8.4 mmol. I'm not sure what made the difference. Perhaps it was the low carb, perhaps it was cutting myself some slack and having some time without the pump, perhaps it was the natural end to the blip.

I have no idea - and knowing type 1 diabetes as well as I do, I don't think I ever will.

But what this little exercise did teach me is that I do like my pump, even when it can't solve all of my diabetic hassles.

I missed it, I needed it and I remembered why I like it.

Perhaps when it comes down to it, that's what I needed; to be reminded of why I do this on a daily basis.

Anna (7.7 and trying not to rock the boat!)

A rest is as good as a change

I consider myself to be someone who is normally pretty much on target when it comes to my diabetes. I manage to walk the fine line between paying close attention and obsession on a daily basis with relative ease, which helps me to achieve reasonable control of this confusing and sometimes almost comical condition. I have done this for 24 years now and it almost seems normal to me. As normal as type one diabetes can be anyway!


I haven't been sectioned yet (I must stress the word 'yet', it can't be far off these days), despite the constant calculations, second-guessing and sometimes sheer frustration that diabetes can throw at you, especially when it feels like Freddie Flintoff has just bowled a 90 mile an hourer at you while someone else distracts you with a giant Krispy Kreme. I am not someone who claims to have 'perfect' control, whatever that really is is. And I am not someone who says control is easy - because frankly - those people drive me crazy. Either they are lying or they are very, very, very, VERY lucky. I am not sure which of those I prefer to believe, but part of me hopes they are just lying. At least that way I may not be perfect, but my honesty is something I can be proud of, even if it means admitting that sometimes I get it wrong. Very, very wrong.


I have rambled on in the past about how I can have a bit of a Jeckyl and Hyde thing going on at times and unfortunately this week was one of those weeks. More so than ever. I have been managing blood sugar swings I imagine similar to that of an out of control sugar-crazed Oompa Loompa at Mister Wonkas factory. Before I went onto an insulin pump, I could see blood sugar swings in any one day ranging from 2 mmol to 32 mmol and spent most of my time terrified of the blood glucose meter. I would never know what it was going to tell me. Occasionally it would be in range, sometimes it was spot on but most of the time it would be wildly uncontrolled. Leaving me emotionally drained, frustrated beyond belief and scared of my future.

As soon as I started on the pump things got a whole lot better. Blood tests became more predictable and a whole lot less scary. For the first time I was able to expect more from my control and diabetes became something I could understand more clearly and dare I say it, embrace.

Over the last week, there have certainly been a few moments when I could have punched my pancreas in the imaginary head or stamped on my pump. Don't get me wrong, my pump is still doing just what I ask it to and I know that despite being a lazy-ass semi-useless organ only one step up from an appendix, too much time has gone by for me to really blame my pancreas anymore. I can admit that I'm still moderately bitter seeing as I didn't do anything to warrant it going on an extended holiday, but what's the point now, other than having the odd moment of blame?

Whatever the cause, I have decided to just unplug for a couple of days. I love my pump, and I love the freedom and quality or life it has given me. But 'it' isn't nice; it is not attractive or even easy to live with. It took a lot of adjusting to and there are moments when I tug in the wire or notice it protruding from under my clothing when I am reminded of just how much it takes to be prepared to do this forever. So when things are all up the shoot and I have no idea why, I feel the need to give myself a day off.

I know that when I am off the pump, I need to follow a much stricter low carb diet, have to keep a closer eye and that it is only a matter of 48 hours before I am desperate to get back on it again, because my sugars will have gone from bad to worse. But in my experience, sometimes you need a little reminder of why you reached this decision in the first place. I will be glad to get that tubey robot back plugged back in after two days, so maybe that is what this little episode is all about; learning to love my pump again.

Anyway, I will post again in a few days when I have no doubt thrown my testing kit at the wall [again] and will be gasping to get off the injections and back on the pumping way of life.

God knows I need a reminder of why at the moment!

Anna - tubeless for the first time in 11 months.

Looking back: A year with a pump at my side

There are many things which will change your life. Literally. Choices you make and experiences you encounter can be both the making of you and the breaking of you. Perhaps these milestones are different for all of us, or perhpas we share many of the same. For those who have children the moment you conceived was no doubt a moment that changed the path of your life forever. For those who travelled, maybe the things you experienced while emersed in another culture will be the motivation that underpins some of your most crucial decisions in life. Perhaps a particularly good - or bad - relationship has changed the way you view your life and the expectations you hold because of what you learnt about yourself. But whether we all share the same 'moments' or not, one thing is for sure: For each and every one of us there are moments - not just one - but many, that change your life somehow, be it for better or worse.

For me, one such decision began to emerge in my mind in 2009. A seed - tiny and barely nurtured - was planted in my head while I was on a JIGSAW (Juggling Insulin for Goal Success and Well-being) course and involved something about an insulin pump and how useful they could be when you suffered with poorly controlled diabetes. Something which at the time, I rejected without a second thought. But this one little idea began to gather momentum and cause the curious button in my head to need pushing. At first, the thought of an insulin pump with its crude wires and constant glaring presence was something which repulsed me. Even disgusted me, dare I say it. How, when diabetes had already drained so much of my life could this BOX (!) solve any of my problems?

But that's the funny thing about a seed; even in the most harsh and hostile landscape a seed can flourish and develop into the the most breath-taking of plants.

That seed, nestled in my hostile head surrounded by negative thoughts and stubborn ignorance began to flourish. With the wonder of the internet at my fingertips, I nervously started looking up images of insulin pumps and finding forums to piggy-back on and see what people were saying about these pumps. Pretty soon, I stumbled across a blog which would water that seed in my head. This blog was written by a lady I could really associate with. She was my age, she was also diagnosed in 1986 and she was pregnant, which when it came down to it was the only reason I was willing to give this contraption a go. Because one day I wanted to bring a child into the world with the man I had come to love. This blog, was Six Until Me.

This blog was honest, open, beautifully written but most of all, real. The stories Kerri told were not about the horror of wearing a pump or the restrictions it placed on her life. In fact it didn't sound at all like she was mourning the loss of a former life, which was the way I felt when I thought about the pump. It talked of fashion, friends, the diabetic community (something I too was about to stumble on), the promise of a future and of the creation of a new healthy life - one her readers came to know as BSparl (her kiddo!).

It wasn't long before that button in my head began to throb again.

Push me, PUSH ME!

I'd estimate it was about a week after that I first emailed my DSN with a million pump-related questions in my head. My new found fascination with an insulin pump had begun. And once the idea was there - I wasn't about to forget it.

On the 25th January 2010, my life changed forever.

Attaching the pump initially was - I imagine - like watching a monkey use tools for the first time. I was 'all fingers and thumbs', shaking a little and convinced I was doing it all wrong. For the next 24 hours I had this immense awareness of my new pump, almost like when you get a new phone which barely leaves your hand - let alone your handbag - for the first few days after you get it. I started to navigate my way around the menu learning at the speed of light about boluses, basals, daily totals and carb ratios. I imagine you would learn slower if you joined NASA or MI5! But nevertheless, something which only 6 months before had terrified and repulsed me, became interesting and engaging. I started talking to my friends and family about the pump, tricking them into guessing where it was hidden today, because unlike my mistakenly ignorant first impression, the pump can be hidden, isn't a monstrosity and doesn't take over your life.

But no one can go through this alone and surrounded by my team of supporters, I began to explain the pump to anyone around me who would listen. My fiance, who had to earn his degree at the University of Insulin Pumping pretty darn quick, took this challenge in his stride, learning terminology like cannula, bolus and "Darn, I didn't re-fill before we came out!", quicker than you can say 'I love ya'. My mother, who for years held me up when I couldn't manage myself, took delight in hearing that I was reaching my pre-pump goals for the first time in 20 years. My friends, who I have no doubt were intially freaked out by the idea (mostly because their faces told me just that), could not have been more supportive or accepting, when it came to me whipping an insulin pump out from my chesty area!

Before long my own blog, one which began as a project to help me negotiate the psychological and emotional adaption that life on a pump requires, began to connect me with my own diabetic community. It led me to the Diabetes UK facebook site, which in turn led me to some of the most talented, creative, positive and go-getter type people you could imagine. Some shared my story, some had a whole different perspective on things. Either way, I went from being someone terrified and beaten down by my own condition, to someone feeling more in control than in the previous 23 years of having diabetes. I began to learn that blood glucose testing didn't have to be about pot luck. I began to learn that waking up in the morning having had a good night's sleep without hypos, hypers, loo visits and fridge raiding, was something everyone - even me - could expect. No, could demand!

I also began to learn that I was allowed to have far higher expectations of what my range of blood sugars could be. When people used to tell me that us diabetics should be aiming for 4-7mmol (80 -120 mg/dl) I would have laughed (and cried a little, inside), because in my whole adult life I had never had a day, let alone a week when I had acheived those kinds of numbers. At my very best clawing at 'control' with every last shred of energy I could muster, I had never achieved an HbA1c of less than 9.6%. Within 6 months, this had fallen to 8.2%. And I use the word 'fallen' because I wasn't doing any more than normal. Granted, I had begun doing more tests, but tests alone won't change anything. This, had happened simply as a result of my pump. My last A1c was 7.9%, and with the kind of readings I have been having in the last 2 months thanks to adapting my diet to a lower carb system, I have every confidence in the world that my next A1c will be in target.

The last year of my life has been a roller coaster. I have learned about the triumphs of conquering goals I thought were impossible to reach and how it feels to give diabetes a swift kick in the stomach, just as it did to me for all those years. I have learned about the pitfalls of kinked cannulas and packing for holiday with what feels like the worlds biggest collection of diabetes supplies, just in case armageddon comes a knocking.

But the greatest and most significant lesson I've learned, is that there is a vast community out there experiencing all of those highs and lows that kept me in a dark and isolated place for so many years. The friends I have made in the last year and those relationships strengthened by people's acceptance and even interest in this pump and how it has changed my life is a lesson that has changed my life forever. And for the better, much, much better.

I can only hope that the next few years of my life, as I plan my own family and move on into new and daunting challenges, will bring me even half as much knowledge and excitement as the last year has. I can only hope that my circles of friendship will expand beyond those I have already found. I can only hope that this disease which for the first time in my life I feel I have conquered, will bring me as much as it has in the last year.

I am thankful that I no longer feel like the pump is a contraption, a box or a hindrance. Quite the opposite in fact, it is part of me. It is a significant part of me, as it has helped me have the quality of life I deserve and has allowed me to grow, flourish and enjoy life again. I am also thankful that having just passed two enormous milestones, those being 24 years of having diabetes and of having celebrated my first anniversary of joining the 'pumping club', I can honestly say that the latter came from one of the best decisions I ever made.

I am thankful for what I have discovered, conquered and experienced - even in the face of the adversity that comes with this condition.

My condition.

Our condition.

What would you do on your day off?

Every week there are a few days we all look forward to. Whether they fall at the weekend, whether they are nestled between Tuesday and Friday or even when they are dotted here and there, we all look forward to them. We make plans for them; we plan for a lie in, we plan to see friends, we go the the movies, we rest, we play, we enjoy.

But there is one thing that we as diabetics can never look forward to: A day off.

We may be allowed a day off from work, college or school. And we may enjoy all of the things that others can enjoy, no matter what our idea of fun is. But from the moment we wake, when our tired eyes open and take in the first snapshot of the day, we are planning.

The first blood test falls about a minute after waking. We pull back the covers, sleepy and a little unsteady. We reach for the light, flick the switch and begin our search. We find our blood testing kit and nervously prick our finger for the first, but certainly not the last time that day. The result of this test will tell us a lot about whether our bodies are going to be in a bad mood today. If the test is high, we have some damage limitation to plan. We must correct, we must hang back on breakfast, we must hazard a guess at what happened last night, we must wait. For this reason, the first test of the day is usually a nervous affair. Mine usually involves looking at the test with one eye closed - similar to how you would watch a horror film when you know you don't necessarily want to see the gruesome result.

5

4

3

2

1

The rest of the day trundles on; test after test, dose after dose. My food has to be weighed at every meal, my sugars analysed after each test. If I feel thirsty, I have to wonder why; did I bolus right at my last sitting, do I have a kink in my cannula, is my pump working.

There is no such thing as a 'day off' from diabetes. The closest we can get is not testing our blood for the day. Irresponsible and dangerous - it's but a break, if all else has failed and we just need a break. I think the last time I didn't test for a day was about 3 months ago, when I ran out of strips from testing too much the day before. Technically it was a forced holiday, but a holiday nonetheless.

But I often wonder about how things would be if there was a cure or even something close. How would my first minute of each day compare. When my sleepy eyes crack open, would I look forward to a morning run? One without the pre-jog blood test, sip of juice and portable supply of glucose tablets?

Maybe after I could tuck into a pancakes with syrup breakfast (even saying the word 'syrup' makes my sugars go up at the moment - God forbid some should ever touch my lips). But after tucking into that blood sugar-tastic breakfast for a king, what would be next?

I try not to dwell on these things too much, mainly because 'they' have been talking about a cure since I was diagnosed, all those 24 years ago. Quarter of a decade domineered by a disease which dictates many of my every day decisions.

I still don't know how I would choose to spend my first day off if they cured this disease.

How about you?

Compromise? If I must.

There are many things I have had to accept as a diabetic.

I have had to accept that until there is a cure, I will need to inject or wear an insulin pump to help me control my blood sugar levels. I have had to accept that blood testing, insulin pumps, injections and carb counting are going to have to be part of my daily routine, if I am to conquer this challenge. I have had to accept that no matter how small a part of me I once wished it would be, diabetes is a big part of my life, and indeed of who I am.

But there is one aspect of diabetes I have always struggled with: Food.

In truth I have never been the kind of person who takes instruction easily. In fact, if dictionary entries had faces of people who are a 'good example' next to them, I would no doubt be picked for several; stubborn, argumentative, opinionated and always right(!) spring to mind. And I'm sure my friends and family would most definitely be those who vote me in! If I could successfully argue that red was not red, I would give it a damned good try. The truth is I hate boxes. Not the kind my cats hide in, using them as some sort of feline fortress from which to attack passers by, but the kind that are often referred to as pigeon holes. You are this, you are that. You are diabetic.

But the fact is, while I always knew that I had to inject and had to carry out blood tests, food has always been the thorn in my side - because I love it. I have never felt hard done by when it comes to injecting. I have never felt as though blood tests were hard or unfair. They were just 'there'. Something which I show a bit of contempt for, each and every time my skin is pierced in the interest of the condition, but which don't really detract anything from my life. It is the only way I know.

But when it comes to food, and having to accept that sometimes you just have to say 'no', I have always swum against the current.

One of my biggest pet peeves is when people say to me, "are you allowed that?" I am not a violent person, but now and then some bright spark has caught me at a bad moment, and in the midst of my annoyance, which was being subdued somewhat by the fact that I was indulging in a much needed treat, I could have clean taken them straight off this planet!

But yesterday morning I had the final installment of my insulin pump trial assessment, with my wonderful but long-suffering DSN (Diabetes Specialist Nurse). I have been attending these sessions on a monthly basis since January, in order to review my success with the insulin pump. Something us Brits have to do if we want to successfully make the move onto the pump.

At the beginning of the trial, I had to work with the specialist team to set myself the targets I wanted to achieve by the end of the trial. Now some of these were personal targets, primarily set as a way of taking some emotional control over my diabetes. But some were physiological targets, such as lower my A1c and have less than one BS of more than 20mmol per month.

I have now successfully achieved 4 of my 5 targets. Excellent!

The problem is, that last little blighter always gets the better of me. It is always JUST out of reach. I have managed to lower the frequency of BS levels in the 20s by about 60%, which incidentally I am very proud of. But, on a monthly basis, there are always 2 or 3 which fall on exactly 20. No higher, but high enough.

Well, I tracked them back this month, and much to my horror (mainly because I had to accept that I was wrong - I know, can you believe it?), they were ALL on days when I had eaten something 'I shouldn't'. I'm loathed to say it, mainly because I want to prove all the judgmental onlookers who dare to ask me that question wrong, but I guess there are times when I really shouldn't have that.

Don't get me wrong, by no means am I planning on never having a treat again, and I certainly don't plan on allowing this revelation to change who I am. I will still argue that red is not red. I will still stand firm when I am asked what I think. I am still Anna.

But the fact is, if I wanted to get those sugars well and truly conquered, I think I now see that it isn't the end of the world if now and then, I let the diabetes win, and just say no.

I need to learn that treats are fine, but I have to experiment only now and then, so that I can find out exactly what and when I need to bolus, without sabotaging my monthly targets.

I guess you learn something new everyday.

I guess I can't win 'em all.

I guess it'll make the next time even sweeter - no pun intended!

Hitting those high notes !

I am still only 2 months into my pump trial, but have already seen such a marked improvement on my sugars that I know it is worth it. I don't need the HbA1c result to tell me at the end of the six months, I simply know it.

Before starting on the pump, the diabetes team set goals with me which were designed to provide both practical and political targets to strive for. From a political perspective, the specialists need to see that the pump therapy, which is expensive, still relatively new to the NHS and requires total commitment, is worth them investing in for me. If my a1c goes up after going on it, then there lacks justification for me to be on such expensive treatment. This would also most likely also mean that surely, if your results are still constantly high or low, the law of averages would suggest that I can't be feeling much better about it either! On a personal note, people who go on the pump in the UK are usually struggling with the condition and with controlling it. Each day is a struggle - a gamble of whether you will be high today, low today or both today. The drip, drip, dripping of the nagging threats about loss of limbs, kidney failure and blindness have worn away so much at most of us to the point of hating our body, for putting us through this every day. So the point of the personal targets is to give you a chance to demand something from the pump. Make it work for YOU, so to speak.

My poli-targets were as follows:

1)To reduce my a1c by 1% - The overall aim is to achieve 6.5% or less. But as a 9.5% girl at the moment, even an 8 to begin with would be just peachy!

2)A reduction of 50% of hyperglycaemic episodes - well, my BG meter shows that I have had one sugar at 20 in the last month (not including holiday - everyone knows holiday doesn't count)! To me, that is such an enormous achievement. I used to get sugars over 25 at least twice a week, for reasons I never understood or could even hazard a guess at! Now, my highest sugar was 20mmol, and it was another one of those mysterious ones. Whatever it was, one doesn't matter - and it feels pretty great to be on the right side of 10mmol everyday, I can tell you!

3)A 20% reduction in glucose variability - at the time that was written, I had 66% of my sugars outside of my target range (5-10mmol). Now, I have a whopping 71% of my sugars within target! Even though this is one the DSN came up with, to see it happen is just incredible. The only word to describe it is ELATED!

The next two were mine, 'silly' things really, but both equally as important as the poli-targets, because these are what I want, or even expect, from making the decision to wear this pump, which when it comes right down to it, is still a mini computerized box attached to me 24/7.

4) To feel less worried about the future when I experience high sugars - hey, with 71% in target and that number rising, whose worried???

5) To eat a take away and not feel ill with high sugars for the next day - ok, so this one may seem weird to you, because most people probably chow down on a pizza, curry or fish and chips without a second thought. For me, this has NEVER happened. Take away involves trying to calculate how many ingredients there are which might increase BS levels. When you get most take aways, they are a mish mash of all kinds of foods and you have no idea where to start! There is no such thing as a 'good' take away for me. It usually involves an initial estimation, followed by hours of blood testing, a night swigging water and nipping to the loo, and when it has gone really wrong, even a sick day through lack of sleep and general exhaustion.

This one I am still working on, mainly because getting in a habit of having a take away is never wise. From any perspective. But at least the pump gives me the tools to try different times for giving a dose (ie, before or after a meal), split doses, lengthened doses, or even numerous doses (without the numerous jabs), with ease.

The fact that of my 5 targets, I have achieved 3 within 2 months of being on the pup, is astonishing. To me anyway. I just hope more people can have the opportunity I have had to give this a go. There is no looking back, and that comes with a lifetime guarantee!

Holiday highs and lows

Well, Thailand is perhaps one of the most breathtaking places I have experienced. Until now, the hottest places I have been were Florida and Spain. Being hot and dusty places, I wasn't quite expecting the unbelievable and unparalleled beauty of the landscape, the limestone cliffs, the stunning coral reefs surrounding each of the hundreds if islands or the tireless hospitality of the locals. Crystal clear water, cloudless skies and beaches only movie sets could mirror.

But enough about the perfection, this blog is about one thing. Diabetes and how to cope with it. In the past, holidays have been something which have brought a mixture of both good and bad. Great to get away from the grind and enjoy some peace and quiet, an opportunity to let my body reset and get back to a healthy state. On the other hand, the minute I am eating food which isn't perfectly weighed and carbohydrate calculated, those sugars start having a party. Mix that with a time difference, hot temperatures, alcohol and even sleeping in, and you have yourself the perfect concoction of trouble. A mix of trouble which would make even the most well behaved diabetes would fall off the wagon. So many variables that the diabetes runs off like a spooked horse which has no intention of stopping!

There were certainly some challenges which arose with the pump. Of which I will concentrate on only one. Mainly because this was the biggest problem, and because it would be quite a long blog if I listed all the challenges.

For those who read my previous blog about the planning which goes into packing for holiday from a diabetic's point of view, you will know that I planned for every possible eventuality, including tropical bears (!) when I calculated how many cannulas I would need for holiday. Well, it turns out I forgot one. The fact that I would be in the pool or ocean everyday and would be sweating more than normal. For those reasons, my first cannula fell out, or rather tugged out with ease after just one day of wear. Now, I took 10 cannulas, which was enough for one month. I figured that this was enough before I left, but in my new knowledge about the wear that water could cause to the sticking plaster, if I continued to lose them at one a day, I would run out after 10 days! I decided to try my hand back at injections, because I knew I had enough insulin and needles to last.

BIG MISTAKE.

After just two days, I had had more sugars over 20 than I could remember, lost a whole day to sleeping because my BG (blood glucose) and was so out of control that my body gave up. So I got myself back on the pump quick smart, having never been so grateful of being attached to it. And guess what happened? At 11pm when I re-attached the pump I was 23.2mmol, by 9 am, once back on it, I was 5.6mmol.
So I decided to stick with the pump but to try and keep the site as dry as possible, which meant checking it a lot and having a little tug now and then, just to make sure it wouldn’t pull out in the middle of a trip or god forbid, the middle of my friend’s wedding! Now it was still a challenge, especially on days when we went snorkeling, because of the constant water contact to the cannula. But somehow it all came together ok. I just had to ensure that I was mindful of the time so that I didn’t stay in the water much over an hour. Those who are on a pump should only ever be off it for around 30 minutes – 1 hour. This may sound like a lot, but when you have some of the best snorkeling Thailand has to offer, 1 hour is not enough. But I’m still here and despite some ups and downs, I obviously made it through the holiday, so no harm done. And even though I hit some high highs, and some low lows, my sugars were still nothing like they were when I was on MDIs. I would still wake up with sugars of around 5mmol everyday, and I didn’t worry nearly as much as I used to. Perhaps that one dodgy cannula at the beginning was a fluke, or a faulty, or perhaps I had knocked it on something and caused it to become a bit loose. Whatever it was, I eacked them out to the very end and they lasted. Phew.

The moral of this story (blog)……it may still be rough, but the pump makes it a damned sight easier.

Taming the [carbohydrate] beast!

Well, after a few posts all about general life as a diabetic, it's back to some features of the pump I am starting to discover. And I think this is perhaps the best function yet! So much so that I had to write about it one day one!

One of the biggest challenges to a diabetic, is conquering the the art of working out how quickly or slowly the carbohydrate you have eaten will work off. Now, how quickly the insulin works will depend on each person, but for me it is generally around 3-4 hours. The pain about carbohydrates is that some work quicker whilst others work slower. For example, complex carbohydrates found in pasta, will take longer to burn off than simple carbs, such as sugar or glucose (or in fact, any of the 'oses' you find in foods). So in theory, if you have one type of carbs, you can inject according to how quickly or slowly your body will use them.

BUT, and it is a big [pain the the] but[t], when these carbs are mixed, you need to adjust your insulin in order to cater for carbs which will release quickly and those which will take longer. The best example I know of is a Korma Indian curry, for which the knowledge of calculation of insulin has completely baffled and evaded me for years. A Korma is very sweet (simple carbs which release very quikcly) but also has rice with it (which has complex carbs which take longer to work). The problem is, in order to manage this meal on multiple daily injections (MDIs), you would undoubtedly have to inject several times just for one meal in order to counteract the effect of the slow and fast acting carbs. Yeah, pain in the butt! And when you alreayd inject 4 or 5 times a day, injecting another 3 for one meal is just not worth it. So much so that for the past 3 years my partner and I have had to eat a Korma on a Friday or Saturday night. Why? Because the effect it would have on my sugars would be so huge, the whole of that night I would be almost drowning in beakers of water and visiting the loo every five minutes, thanks to the 20+ BG readings I would have throughout the night. In turn, this would leave me feeling hideous the day after. In fact, I even had to call in sick at work on one occasion (the first occasion) that I ate a Korma, because of the effect the night before had made. That was when 'the rule' was put in place.

Two of the fantastic benefits the pump offers are something called dual-wave bolusing or square-wave bolusing. Now, a bolus is the name for the dose of insulin you give yourself before a meal. This would be used if you are eating a meal which contains carbs that you think will take around the time to burn off that your insulin will be effective for. The meal is probably one which has a source of steady releasing carbohydrates, but which remain active for longer than your insulin normally takes to burn off.

The square wave bolus is designed to release insulin steadily over a time you specify. Therefore, if you are eating a meal like a jacket potato with beans, the potato (due to the way it's cooked) will get into your system quickly and therefore will require insulin to go in straight away. The beans however release slowly and are likely to continue releasing energy longer than the insulin I take. Before this would have mean I would have needed to inject in the middle of the meal (yeah, I didn't exactly go for that either!). Instead, square wave-bolus means that I can set the total amount of units I will need for the meal, only I can tell the pump to continue releasing this insulin over say, 5 hours. This will mean I won't need to worry about my insulin running out and my blood sugars going up, after the 3-4 hours it normally takes me to run out. Awesome!!!!

The square-wave bolus function is similar, but instead of releasing it steadily, you can use it for a meal such as the dreaded (loved) Korma. The instant effect of a Korma is that your sugars will fly up, due to the sweetness, meaning you need an immediate dose of insulin to counteract that. But later, the rice will continue to release energy. Thanks to this function, I can work out how many units I need for the rice, and set the pump to carry on working for several hours afterwards! I haven't tried a Korma yet (mainly because I don't have total confidence in how long to set the dose for and how many units I need in total), BUT, for the past week I have been trying to figure out how much to inject for my lunch, which was a sandwich and a chocolate bar. For the past week, I've been battling with it and coming out with any range of numbers, but all over 15. Today, my sugars were a little on the high side anyway (10mmol), but I decided to give it a go, as I had a good night and a stable morning, meaning an 'experiment' had less variables than the usual 12 I can find at any one time!

So, today I gave the dual-wave bolusing a go! My thinking was that chocolate isn't too bad in itself, but it was honeycomb which was sweet would kick in quickly. The sandwich on the other hand was wholegrain bread, meaning it would work much slower and would last longer. So, in total I needed 10 units overall. So I decided to inject 5 units straight away, as that was for the honeycomb which would kick in quick and work off quick, while the bread would start to work almost immediately and continue releasing. The rest of the dose I asked it to release over the space of two hours.

What happened? It worked perfectly. Well, almost. My sugars are now at 4.3mmol, which is a little on the low side, but for the first time in two weeks, I didn't have my horrible high which I was expecting. Meaning something must have gone right! It may be that I needed to ask it to release over one hour, seeing as that would then mean that I still had active insulin for around 5 hours, and it is fairly unlikely the few seeds in the bread were still releasing energy 6 hours after the meal. BUT, it was the first time I have eaten that meal with success.

Over the next few weeks I will continue to play with the pump and ask them team at the hospital about how to use these functions properly, but it has finally opened the doors for me to eat the meals I enjoy without the nasty after effect that I know so well!

Anna - about to eat a curry!