Friday, 30 April 2010

Switch it off an on again!

I have now done two full days on the Minimed Paradigm Real Time CGM system, and boy has it been a roller coaster! In my previous post, I talked about how it was an eye opener to have constant access to information about your blood sugars at the touch of a button. It truly has been a 'journey' so far, but one that took me to new realms of obsession, even I thought impossible.

For me, the reason for my interest in CGM is two-fold. Firstly, I want to be able to see what is going on at times when I wouldn't normally test, such as during the night, in a film, or after a meal. They often tell you not to take a BG reading straight after a meal, because your sugars will always spike giving you an incorrect picture of the overall effect of your last decision - but, to have information about how quickly your sugars go up and how long after you inject it rises, can offer extremely useful tools which can aid in making informed decisions about ways to manage this disease in the future. Secondly, I would like the opportunity to do less blood tests. On some days, if an ill-informed onlooker saw how many times a day I test (15 is nothing out of the ordinary), they may conclude that this was a hobby of mine. It isn't.

At the end of the last post, I commented on how there seemed to be a degree of variation in the blood sugar readings and the sensor readings, but that this was likely to be because the sensor needed time to 'bed in' and formulate the correct algorithm. Well, today got a whole lot worse.

I woke up this morning and keenly pulled the pump up to my sleepy, drowsy eyes to see what was happening in this body of mine overnight. To my delight, there was a practically straight line staring back from the graph on the pump screen. very often in life, we like to see graphs which either climb, or descend. The crime line goes down, good work folks! Performance line goes up, perhaps I'll make bonus this year. On the pump, you really want to see the flattest line possible, like an ocean horizon or perfect spirit level. So to my delight, I woke up this morning to find a spirit level even the most respected architect would be proud of!

I calibrated the sensor with my blood sugar readings (which was still about 3mmol out) and went on my way to work, feeling very good indeed. That's when things got a little weird. About an hour after I arrived I checked the graph, which was starting to climb at a pretty speedy rate. The figure on the pump was telling me I was 12.2, and the little upward pointing arrow next to that, told me I was doing it quickly. I tested my sugar because I hadn't eaten and was a bit surprised at the jump and threatening arrow. My blood sugar reading, again surprisingly, told me I was 6mmol, after having been 7 when I woke up! Now I'm am no mathematician, but that tells me it was heading down, and I would imagine it had a little downward facing arrow next to it.

The weirdness and inaccurary continued from here. The distance between sensor and glucose readings got gradually further and further apart, as the blood glucose reading seemed to stay steady, while the sensor reading got as far as 8mmol away from the blood readings, and the arrow cloned itself so I had two threatening upward facing arrows, meaning my sugars are 'catapulting' themselves toward ketone-ville!

Eventually, I got so sick of staring at confusing figures, and having done 31 glucose tests in the 16 hours I was awake yesterday, I switched it off. I literally just turned it off and decided not to care for a bit.

Being the obsessive I am, it lasted abut 2 hours before I decided that some sort of graph was better than none at all. I also contacted my rep in the meantime to ask what I could have done wrong. Although I was confident that I hadn't done anything wrong, due to the nature of my job meaning I have very busy Wednesday's, I had to do my initial calibrations at funny times. For example, after a meal or when the pump wanted me to do one, but actually it looked as though my sugars were changing a little too quickly.

So I turned the sensor on again at around 2.30pm today. I calibrated it even though my sugars were a little high, because they had been a little high most of the day, so I figured that must count as a 'stable' trend.

Well, since then, I could not have asked for more precise, up to date and informative information! My sugar compared to sensor glucose readings for the past 6 hours have looked like this:

The figure on the left is the blood glucose reading, the one on the right is the sensor reading and the readings are around an hour apart

11.8 13.1
9.8 9.5
7.0 7.5
5.7 6.4
7.3 7.8

Bearing in mind that the sensor reading is always around 10-15 minutes behind the glucose reading, because the information is not taken directly from the blood, which is the most up to date information, I call that pretty precise! It is certainly precise enough to base decisions on, and to feel confident that it is at least giving you information based on what is really going on, rather than the lottery system from this morning!

It is still early days and because I don't yet 'trust' the sensor enough to 'go it alone', I am still doing as many (if not more) tests than before, but this afternoon has been the closest I have gotten to seeing why this tool could be so beneficial. I am hoping that by the time I come to the end of my trial, I will have gained enough confidence to go from testing every hour, or every time my 'sixth sense' kicks in to allow me just to do the two calibration tests I need to do every day, rather than the obsessive and in all honestly, tiresome testing I am doing right now.

Maybe the answer was in the age old cliche of 'turn it off and on again', maybe Bill Gates should copy write that phrase, seeing as it seems no matter how small then computer, it still obeys the rules. Maybe I was so keen to get the sensor going that I didn't calibrate at the best times, or didn't realise that my sugars were changing too rapidly for science to understand. I guess we'll see.

For now, I am just glad to see it's working. But nervous that this might mean I have to find the money to fund buying a CGM of my own.

Whatever happens, straight lines are a new hobby of mine. Here's hoping it stays that way.

Wednesday, 28 April 2010

The CGM begins!

After blogging on numerous occasions about the benefits and convenience of Continuous Glucose Monitoring (CGM) and after managing to secure a free 12 day trial with Medtronic's Minimed Paradigm Real Time system, the time has arrived for me to sample the world of CGM! The folks at Medtronic were kind enough to offer me a free trial, which I gladly accepted. I did try to get a free trial with Dexcom (the other CGM system which I feel is at the forefront of the market), but unfortunately they made me no such offer, so although my future blogging will hopefully give you an idea of what CGM can offer, it won't be a comprehensive comparison of the differences between the systems currently available. But here goes as far as the Medtronic system works....

I arrived excited and ready to go this morning, keen to get going on something I'd been avidly researching for months! I was met by the Medtronic rep who was kind enough to fit me in around my work pattern and had arrived nice and early to meet me. Thankfully my DSN was also there, which turned out to be a blessing as she often asked questions about the system which probably wouldn't have occurred to me. I'm sure she was asking for my benefit, so I didn't make any silly mistakes, but she hid it well under the guise of not knowing too much about it herself.

My initial impression of the equipment was that the whole sensor and tramsitter was smaller than I was expecting. It was around the size of a fifty pence piece, and although it is 'bulkier' than the infusion set for the pump, I didn't expect it to be quite as small as it was. The equipment to get the thing in though, was HUGE! It looked like some sort of industrial piston - and looked like it would be pretty painful to insert! In fact it didn't hurt at all. It felt a little like someone had flicked my stomach with their fingers, but I couldn't feel the needle at all, which is always a bonus as far as I'm concerned.

As for setting it up and inserting it, it's definitely more fiddly than putting the pump in. There are a number of tags and flaps you have to pull off, and in the right order, all the while being careful not to jolt the sensor too much, because apparently this can 'upset' the enzymes in the sensor, causing it fail. But I imagine that's just something you have to get used to. I remember when I put my first infusion in I was all fingers and thumbs, convinced that if I did anything wrong something drastic would happen! I'm pretty sure that after a few times doing it, you become a dab hand and the whole process is over in seconds!

Once the sensor is in, you need to wait around 15 minutes before attaching the transmitter (the bit which sends the results wirelessly to the pump),because the enzymes in the sensor need to become wet. I tried several times to attach the transmitter but every time I tried the sensor wouldn't 'flash', meaning it wasn't quite ready! The rep advised me this could mean I was dehydrated, so I had a drink of water and carried on trying until it worked. It actually took 2 and a half hours before the sensor was wet enough to start 'sensing' under the skin. I was surprised it took this long seeing as I was advised that 15 minutes normally does it, but still, I was doing my normal blood tests anyway so it wasn't really a big deal.

The first time I saw the light flash, I then pressed 'link to sensor' on the pump menu and got the ball rolling. After this point you have to wait two hours in order for the sensor to 'bed in'. When it first asks you for a reading, you have to do a blood test and enter it on the pump in order to calibrate the sensor with your blood glucose. This is so that the sensor can 'learn' about your sugar levels, and when there is a change, the calibrations should mean it is as exact as possible.

After the initial calibration, within no time at all I was receiving real time information about what my blood sugars were doing. At first it was excellent. My sensor glucose was 11.2 at one point while my blood glucose was 10.5. As the sensor reading is approximately 15 minutes behind the glucose reading, I was pretty happy with this result. It would certainly be precise enough to react accordingly, which is the whole point, right?

I have run into problems slightly later in the day, after I narrowly avoided a hypo earlier, thanks to the hypo alarm on the pump. The pump alarmed to let me know that I was 4.4mmol. I tested my sugars via blood and got a 4.7 reading. Close enough! However, I later re calibrated the sensor when my blood glucose was back up to 6. It was around 5 hours since my last calibration and I hadn't eaten, meaning it was a good time to calibrate again. I was warned that in the first 24 hours you get a few odd readings, because until the sensor has been calibrated a number of times, it won't be as precise.

The problem is, the sensor has been alarming for about 3 hours now and currently thinks I'm 2.2mmol! I have checked and double checked, and haven't gone below 5.6mmol so far. But, it could be because after avoiding the low and eating some fruit, my sugars were rising a little too quickly. It's not ideal to calibrate when your sugars are changing rapidly, so the sensor probably thinks I haven't recovered from the low yet. Really, it's just doing its job and seeing as it has only been calibrated twice, it is just going to take a little longer to get set up!

That being said, while it was good, it was fantastic to look at the pump and with the touch of a button, be able to see a reading, as well as trend information and a graph showing what my sugars had been up to for the last 3, 6, 12 or 24 hour period.

So far, apart from the current issue, I can definitely see the benefits of wearing a sensor. I will recalibrate in another couple of hours and hopefully the sensor and my body will begin to agree! I will post again in a couple of days to chart my progress and how I think it's going.

Over and out.

Tuesday, 27 April 2010

Too much, too quickly

Ok, so about a month ago I decided to go on a detox to give myself a boost and kick start my system a little. As a sideline I was hoping that my newfound respect for all things green and natural would have a positive impact on the diabetes. So, I threw myself into a non-wheat, non-dairy, non-meat, non-fish, non-gluten, non-processed food, non-alcohol.... OK, the list goes on and on so I may as well stop there before you (and I) fall asleep! It was fundamentally non-everything except fruit and veg. Yum!

The instant effect was that for the ten days I was on it, my sugars acted like I wasn't even diabetic! I had fantastic skin, lost half a stone in weight, slept like a log and felt great. Never have I seen such good control with such little ease or felt so incredibly 'on top' of things. The problem was, there was no room for anything - no enjoyment, no eating out, no treats and no choice. It was so restrictive I started craving whole chunks of chicken. The bizarre thing is, I'm not even that keen on chicken! I was craving protein in the way I imagine a crack addict craves a hit! It wasn't pretty that's for sure! So, slowly but surely I crashed and burned on the detox and before I knew it I'd put on the half a stone I so proudly bragged about losing, my skin was back to normal, I was tired again and the biggest problem, my sugars were haywire. Haywire is an understatement.

I've gone from being in target 89% of the time (thanks to the pump and some hard work on my part), to my current which is 59% out of control. It's not the pumps fault, in fact, the way my sugars were so perfect during the detox shows that my basal levels are practically perfect. The problem was, messing around with my metabolism and changing all my rates so quickly, meant that my insulin needs were changing so quickly and drastically, that I had to pretty much start from the beginning when it came to adjusting the pump to react to my needs. I need to figure out all over again what level I need when and for some reason I need more insulin now than I did before the detox. I'm not sure why and maybe I'll never know, but the one thing I have realised is that you have to do things a little slower when you are diabetic. A non-diabetic would probably have needed to adjust things one step at a time, but a diabetic has to do things slowly enough to allow time for you to see where and when your new routine might be affecting your sugars. You need time to adjust your doses one at a time so that you can really 'know' what's going on.

So with the CGM trial starting tomorrow, and with a new understanding of how much I can demand from my body at once, the next couple of weeks will be all about making it up to my body and re-discovering that diabetes means doing things at a different pace!

I will keep posting about the CGM trial specifically as I have promised several of you that I will, but it will also be interesting to see what effect the CGM will have on figuring out what I need and when!

Thats it for now

Sunday, 18 April 2010


About two months ago I wrote a post all about Continuous Glucose Monitoring (CGM), which is a way of monitoring your glucose levels 24/7 by wearing a small sensor in the skin which feeds information wirelessly to my pump. It then provides me with trend information about whether my sugars are stable, heading up or plummeting down. In theory, this should mean I can make better informed decisions about what action I need to take in order to avoid the highs and lows which can take you by surprise. Since embarking on life as a pump user, I have been increasingly interested in this, as for the first time in my life 'prefect' control is within reach. The reason I put the apostrophes around the word perfect, is that every diabetic knows there is no such thing, but there is something close enough which is achievable.

While the pump has become my new best friend, I have (and I have no idea why), had a very unstable couple of weeks. First, around two weeks ago, I rocketed into the twenties every day for about 3 days. I had to almost double my basal rates to see even the smallest improvement. I went from having predictable 4-7mmol sugars when I woke up, to mid teens one day, 3 the next and even a 17mmol - which was exactly the kind of number I thought I had put behind me when I joined the pump club! Then I started experiencing lows at strange times of day (no doubt because of the double basal rates - which I can see now were perhaps a little heavy handed!). In the last couple of days it has settled down somewhat, although I still hit 24.9mmol today after a carb counted lunch! I even had cheese and biscuits instead of sticky toffee pudding because the diabetes 'angel' who sits on one shoulder, managed to shout down the diabetes 'devil' who sits on the other!

The one thing which has come out of this episode, is that it would have been extremely helpful to see what was going on all the time, rather than the snapshots in time which the blood glucose monitor I currently use can offer. It is really hard to make decisions during the day when you have no idea what was going on overnight, or you have no idea whether the perfect 6mmol you just had, was sitting on an upward or downward trend. For example, if I had a low during the night, but didn't wake up, I will have a rebound during the day, so being wary of what I eat and how much I inject would be wise. But if I didn't wake up - how can I know this and therefore act on it? A frustrating situation I'm sure you will agree.

So, in the midst of my frustrations about my erratic and angry blood sugars, I contacted my rep from Medtronic who has agreed to offer me a trial on the Paradigm VEO Real Time CGM system. I have discussed this one in the past, as in my opinion, this one and the Dexcom 7+ are on a parr with one another in terms of the benefits they offer. As well as the benefits I previously raved about, Medtronic have managed to secure FDA approval for wearing the sensor for 6 days, making it even more tempting, seeing as the biggest benefit of the Dexcom 7+ was that the sensor could be worn for 7 days, while the Medtronic CGM only had FDA approval for 3 days.

One distinct benefit of the Medtronic CGM system is that it will feed information directly to my pump, rather than other systems, which require you to have a hand held receiver, to which the information from the sensor is fed. This means you can only be a matter of feet away from the receiver, otherwise the information feed will stop.

The only drawback I could see at the moment is that this is the CGM which reportedly 'flops' about on the surface as it is not fixed very well to the skin. This still freaks me out a bit as I'm not keen on the idea of catching it on things. That being said, I used to be freaked out by the idea of a pump - and now I would never look back. I plan on spending my forthcoming trial looking at ways and means of sticking the sensor to the skin a bit better, if I even need to. I may find that it seems perfectly fixed - we'll have to wait and see.

After looking at how much it benefits me, the one remaining decision will be about cost, while the Medtronic seems distinctly more affordable than others, it can still cost in the region of £180 per month for continuous use. By no means can I afford this, so unless I can get away with using the sensors for longer (which has been purported as extremely common by most users of the Medtronic system), it will have to be a now and then thing. For sure, having CGM as an option would have been a God-send during the last two weeks!

For the meantime, I will be very interested to see how well this benefits me and the benefits and drawbacks of the system, and will be keenly blogging about my experiences of using a CGM.

I will keep you posted and will include pictures, so that you can see what you make of it yourselves.

Over and out


Saturday, 17 April 2010

In memory of Louis Austin - RIP

Diabetes treatment in 2010 has surpassed the treatment available for almost any other disease - FACT. We can monitor our glucose continuously, we can take tablets, we can use pumps, injections, exercise, eye surgery and even amptuations if it means saving our lives. The cold hard truth is that without diagnosis and treatment, diabetics will die. Had I been alive one hundred years ago, when diabetes was known about but only as a killer, because no treatment yet existed, I would have never made it passed the age of four. I would have been long gone for 23 years, just a memory to my parents now, who will forever remember me as the four year old girl they had to say goodbye to in the hospital bed that night. I would exist only in photos and memories. I would be an educational story, used to try and teach others about the devastation that diabetes can cause.

I often talk about the way I rely on insulin because I still find it incredible that even though I feel wonderful now, without insulin, I would have only hours before I would be in serious trouble. Without it, my body would begin to die and within days, if not hours, I could no longer be here. I simply can't survive without insulin. The thing is, in this day and age no-one needs to die from undiagnosed or untreated diabetes, right?


In July 2009, Louis Austin, an 8 year old school boy from Manchester, was complaining of devastating headaches, was vomitting, had lost almost 2 stone in weight over a matter of days, was hot, was restless and was tired beyond comprehension. He was taken to an out of hours Dr Surgery on Saturday, where he was misdiagnosed as having been struck by the Swine Flu. He was prescribed Tamiflu and was sent home.

By Sunday night, Louis Austin was no longer alive. He passed away that night, despite his parents having called an ambulance twice as well as contacting the out of hours Doctor service. According to the paramedic, he was 'not a priority'. In the midst of the swine flu craze, Louis Austin was failed by a number of people. Failed, is the only word for it.

It saddens me that a disease like diabetes still takes the lives of people who never even knew what was coming. It saddens me that those parents had to say goodbye to a son they never should have lost, and it saddens me that so little is still known about diabetes. It saddens me that any child who had lost that amount of weight, and was clearly showing all the signs of Diabetic Ketoacidosis, was misdiagnosed as having swine flu, because there happened to be an 'epidemic' around.

With a general election looming, and the promise of so many changes being spouted by over condfident politicians, I truly hope that more wil be done to educate about diabetes. To explain how incredibly dangerous a condition it is, no matter how good your control is. The fact remains that without treatment, diabetics cannot survive. Although the doctor now admits that she was wrong, and although this (hopefully) is a rare incident, it was one incident too many.

Even though diabetes is a life sentence, it is still better than a death sentence.

RIP Louis Austin.

Wednesday, 14 April 2010

False hopes and paper dreams

Picture the scene...

I am a newly diagnosed type 1 diabetic. I've been told I will have to change the way I do pretty much everything. The experts tell me I will do OK if I keep my sugars under tight control, but I don't really know what that will take yet. I know that I will need to inject myself for the rest of my life on a daily basis. I will have to test my blood sugars every few hours I'm awake, and sometimes during the night. I know that if I don't keep good control, the list of things which could happen is almost endless. Will I meet someone who will understand why some days I won't be at my best? Can I do the job I always wanted to do? Can I eat out with friends? Will I have kids and live to see them grow up? I have so many questions.

Whether you are a newly diagnosed diabetic, or someone whose had it 30 years and just wishes it would cut you some slack. Sometimes, things just get too much. You want a way out, or even just a way to make it easier. A rope to cling on to, or even a straw.

So you do a little searching on the Internet.

"Cure diabetes"

That's what the advert reads.

"Reverse diabetes with this simple natural rememdy just discovered".

The website looks smart - it talks intelligently about all the natural remedies which can cure diabetes, in fact it talks about things I've never even heard of! Maybe it's worth a go? I've tried doing things the medicinal way, maybe herbal remedies are the way forward. Maybe the big wig companies who have the money to invest in this just don't because diabetes is a big money industry. At least if I'm still hooked on insulin, I'm giving them some money! I'll just take a look what it costs.

Oooh, it is a bit more expensive than I would have hoped. Plus I have to buy a whole load of pills. Hmm.

Now, don't get me wrong. I spend a lot of time trawling through the Internet looking for updates on stem cell research, on islet cell transplantation, on ways of using the most up to date technology to make my life a bit easier. I am also a big believer in supplements and alternative therapy. I believe our modern diets don't allow for as many combinations of weird and wonderful food types as it used to, and in some cases, beneficial supplements would never have feature in our diet originally, so we need to think outside the box. I believe the answer to diabetes could be a simple as an ingredient found in nature in a simple plant in Outer Mongolia. I have been thinking about acupuncture, I believe in foot massage, I am willing to entertain many ideas. I do believe that there are a multitude of ways to improve the condition and the prognosis, and not just by the conventional means. I try not to rule anything out.

BUT! And it's a big but - I get so frustrated by adverts which feature all over the Internet, claiming to reverse diabetes once and for all. They often word themselves extremely well giving them an air of credibility and believability. The truth is, there are people in labs all over the world, testing those simple plants from Outer Mongolia. There are those who claim hemp oil can make conditions better. And yes, for those people who are AT RISK of diabetes, perhaps due to weight or other lifestyle issues, there ARE ways of having an influence over your future. There are ways of making things easier on your body and avoiding type 2. But to claim that you can 'cure' diabetes using a product which probably hasn't even been through basic safety testing - is in my opinion, plain and simple fraud.

To make promises of taking away this condition, a condition which comes with no guarantees as to how your body will cope with it. One which will set you apart from others, and which no matter how well controlled you are, may well limit your life in some manner - is simply cruel.

No doubt aimed at those who are desperate or still don't understand the physical processes which took place when they were diagnosed. I for one know that my body doesn't do what it is supposed to and won't, for the indefinite future. I understand that the insulin producing beta cells in my pancreas were destroyed or permanently damaged by my very own body. I understand that any insulin I may produce is not enough to keep me alive and certainly not enough to keep my sugar levels in control.

To someone who is still daunted by the awful task of injecting every day or having to watch what they eat, the promise of 'herbal remedies' which will cure - not improve - but cure their diabetes, this promise must be tempting. I mean it must look so unbelievably good.

When I see those adverts I often wonder how many people have been convinced that this is the product that could change their life. How many have parted with money in the hope that maybe, in time, this remedy will free them of this disease.

I really hope there aren't too many. I hope that people haven't been ripped off. I hope they haven't parted with their own money. I hope they haven't waited in for the post to arrive. I hope they didn't peel back the lid of the bottle and peer over the rim with hope in their heart. I hope they didn't set their hopes and dreams on being cured of their sentence. And most of all, I hope it didn't hurt too much when they realised it was just another money maker. That was a long way to fall and I really hope it didn't hurt too much.

Friday, 9 April 2010

Politically incorrect

The first time I was offered an insulin pump must have been around 4 years ago, in early 2006. I had been off work for 6 weeks, because I was going through a period of what the pros referred to a 're-diagnosis'. You see, the problem was, I was diagnosed at four years old. At such a tiny age, I had very few (indeed, if any!) memories of what life was like before I was 'taken over'. I lived out my child years being closely monitored by my parents, who, despite the challenges they faced, managed to keep my BS well in check.

During my teens, as I got too old to be 'monitored' and became more independent, the control started to twindle. I rarely did blood tests and if I could help it, avoided all appointments where I was constantly reminded about the gravity of the disease. So when I hit my twenties and wanted to think career, children and travel, I decided I needed to pay far more attention to what was going on. I emerged from my cave of ignorance and tried to change everything at once. I excercised every day, tested more often than anyone could ask, changed my diet and made enough appointments keep me busy for months. Only there was one problem; for the first time in my life, I really learned how much diabetes takes to control. Before I knew it, I was obsessively testing, achieving awful results and becoming so stressed, I had to go off work on long-term sick. In total, the six weeks I was off held more desperation and devastation than I had ever known. I would test first thing in the morning and staring back at me from the BS reader, the angry screen would shout "21.7mmol!". How could this be? I haven't even eaten yet and had only just woken up, and still I felt like I could drink non-stop from the kitchen tap for six hours, and would still need more water thereafter.

For the first time in my life I was terrified about my future, and couldn's see a point or reason to try. This was the first time I was offered a pump.

"Are you serious?"

I was at my lowest point in life. I felt trapped by a disease I didn't deserve, and had convinced myself that I wouldn't last long. Yes, as a diabetic, I COULDN'T last long. The thought of living out whatever short life I had, attached to a pump with wires trailing from places I didn't want to think about was to me, too much.

The next time I was offered a pump was about a year ago. I attended a course which was designed to provide diabetics with the tools they needed to be able to achieve better control. At the end of the course, although it was informative, it didn't seem to make a difference. My A1c was still 9.5% and I didn't feel any more in control.

All I had to do was say that I was interested. I was given a start date, an idea of how many other people would be on the course with me, and got to see what the pump looked like.

That was it. A year later I've been on it two months, can't believe some of the results I am getting, am happy, in control and shocked at how much more I am getting for the effort I put in.

The pump was offered to me with enthusiasm and an 'of course you can' attitude.

So why is it that while I read the comments on the diabetes UK website, so many people are being told flat out that they can't have a pump. "There is a two year waiting list", "Your control isn't bad enough". How can this be the way the world works in 2010! There are desperate mothers and fathers trying to find a way to extend their lives and make themselves healthier for the sake of their kids.

The insulin pump has been available in the UK since the turn of the century. How is it possible that people still have to 'prove' they are poorly enough controlled to warrant a pump. It seems to me that it comes down to a postcode lottery. Some people, like me, are able get a pump even after turning their nose up at it, while others, who are asking to go on it at every opportunity, are still refused on the basis of funding - surely the cost of dialysis, sight problems and amputations outweighs the cost of pump therapy?

It makes perfect sense to me now, why injections didn't work for me. By body needs changes in insulin between one hour and the next, as little as 0.1u/h. So during the night I need 1.4u between 9pm and midnight, then between midnight and 7 I need 1.3u/h. How I ever survived on one injection every 24 hours, where I injected 24 units and waited for it to slowly 'wear off', I will never understand.

By no means is my control perfect now, but the fact that 87% of my sugars are in single figures, where I only used to have sugars in target 13% of the time (yes I admit it, the control was awful!), shows that injections could never have worked. It baffles me that despite the overwhelming evidence that pump therapy benefits most diabetics (pump therapy is a lifestyle choice - that much is true), the NHS still struggle to find the funding for people who are willing to make that choice. I know it isn't the fault of the professionals, or at least that's what I hope, but as a diabetic and a pump user (and a happy one at that!), I feel a sense of guilt when people ask me how I got a pump. I feel embarrassed that I turned it down. But I guess I know that for me, it wasn't right four years ago. The effort I have put in to testing, monitoring and experimenting, means that in the midst of my 'breakdown', I simply couldn't have taken any more. My time was now.

I truly hope that things begin to change and that others will be able to go on the pump. After all, why should wanting to look after yourself be stopped by funding. To me, that is just politically incorrect!

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!

Predicting the unpredictable

Since I began venturing into the world of e-diabetes, I have read many comments posted by people on websites, blogs and e-diaries. I have met people who age between 16 and 57 and have for the first time in my life felt like there really are other people out there going into daily battle with this disease. I have read things I have agreed with, read things I didn't and read things I couldn't even comprehend. But perhaps the most striking thing about diabetes, is that everyone has a different kind. Not a different kind per se (as in type 1, 2 or MODY), but a kind that reacts very differently to similar triggers.

Just this morning I was at my monthly pump-review meeting with the two people who I joined the insulin pump 'club' with. The most interesting thing that comes out of our meetings is that each and every time we hook our glucose monitors up to the PC, so that we can download and analyse our reading in the hope of finding a pattern, it is completely different for each person. One of the guys, we'll call him Jack (I don't think people would appreciate me naming them all over the net!) struggles immensely with high sugars over night and first thing in the morning. I on the other hand, find my waking sugar the most predictable of the day. The third person, Mike (name changed for privacy reasons!), has blood sugar readings which look to me as though he isn't even diabetic. Yes, he has highs and lows, but the highest Mike had were around the lowest that Jack and I had! So this disease appears to be completely unpredictable....

Or maybe not so.

Last week, my partner contracted a cold. We now know all too well that living together means you invariably 'contract' anything the other person has. Be it a simple cold or full blown flu. So when he gets a cold, we immediately remind ourselves to be wary, because I'm likely to struck down by whatever it is too. So, towards the end of the week, the sugars started going up to over 10mmol and would not, despite a vast amount of effort and frustration, come down again. Looking at the factors, I should have seen it coming a mile off. The fact that the other half was ill, the fact the sugars were going up, the fact that I needed about 10 hours sleep a night just to function. But I still missed it.


Sunday night - funny tummy, sore throat and immense tiredness. Yup, I got a nice dose of man flu. The funny thing is, I say "Bam", but really, my diabetes (for once)was giving me the warning signs about 5 days before the disease set in! I know from the past that if I'm fighting something off (and losing) I develop insulin resistance and the sugars don't like to come down.

So perhaps diabetes isn't as unpredictable as I thought. Really, if I tune in more to what my body is trying to tell me, I coulde probably plan ahead and take those days off! Then again, maybe it's just my body's way of telling me to slow down and repair itself. Anyway the sugars are behaving once again and I now know why 15 was last weeks magic number.

Maybe next time I will take heed of my body's warnings!

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.


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.

Customize your pump!

OK, so I'm pretty certain that the idea of pump skins (a cover you can get for your pump to make it more 'funky') is mainly aimed at children and young people, to help them feel more excited about wearing one. But when I first got the pump I experienced the whole "will I look like a science experiment" phase. As soon as I reached my first few goals I got over this, but wearing it 24 hours a day or thereabouts still takes some getting used to. Not as much as I'd initally anticipated, but there was still a degree of adjusting which had to be done.

When I first got my Paradigm VEO, I wrote to Medtronic and asked how I could get a 'skin'. At this point I was still in the early stages, and probably still trying to find a way of fitting the pump around my life and personality in a way that suited me. I completely forgot about the skins until when this morning in the post, I received a whole bundle of skins! Not only does everyone love a freebie, but the range of colours and size was surprising, and it didn't take long for me to get all excited again!

I mean, check out how pretty she is! I should probably explain that in order to personify my pump enough to make it feel part of me, I have given her a gender....

So I've sexed up my pump with a dark pink and white skin, which is no more than a sticky plastic cover which can be removed when my mood changes.

Whether these are aimed at kids or whether I can legitimately get away with finding them so pelasing I don't know, but every little win is another positive in this change.

Anna, in a dark pink and white mood today.

Bumbling clumsiness

This week, I have been less successful at all things diabetes than Most Haunted is at impersonating reality. But not in terms of my control, granted, there have been major ups and downs this week, but I mean successful in terms of the manipulating the equipment which comes with the pump. Two days ago it took me three attempts to insert the cannula and needle, because every time I tried to use the quick inserter, the adhesive pad which sticks to the skin kept getting stuck to the side of the quick-serter, meaning the needle would go half way in and the cannula would get stuck!

Finally I switched to the other arm and managed to successfully get it to attach. Don't get me wrong, this whole process is far less painful and far less of a faff than MDIs were. BUT, the last three days I appear to be about as coordinated as a heroin addict going cold turkey.

I woke up today as normal and busied myself getting ready for my last day at work before my three weeks off (in case I hadn't mentioned it yet!). I knew it would be a busy day, so was keen to get to work asap. Only something happened.

Anna happened.

I may have mentioned before that I have the ability to fall off stuff when I am lying down. Today proved that. While moving around the house a little too quickly, I somehow managed to fall into the door frame and whack my right arm with what must have equated to the momentum of a drunk and out of control rhino. And where was my site today? On my right arm. Yup, I scraped and bashed my arm so hard, that as I checked for the site to make sure it had survived, it was gone all together! I ripped the damned thing straight out of my arm!

This is how the slightly worse for wear cannula looked after I was finished with it!

The funny thing is, the pulling out of the cannula (which takes some doing I can assure you!) didn't hurt at all. It was the pounding my arm received that did all the hurting. There was no blood, no after pain, and my arm felt absolutely fine! The 'cringe factor' fears I had before getting the pump were all about how weird it would be wearing a cannula and a needle that were permanenly attached to me. But in fact, it's all a lot less cringey than I'd have imagined.

After getting over the shock of having managed to pull the whole cannula out, I disconnected the tubing and stared at disbelief at the worlds tiniest knot, which I had somehow managed to 'tie' in the tubing. I have no idea how I managed it, or more to the point when?? Seeing as my sugars were fine, I can only assume that the insulin was still getting through, but still, how I did it I have no idea. I mean, look how tiny it is!

Anyway. I have now managed to not only attach a cannula which appears to be doing something but I also haven't ripped anything out, dropped anything or tied knots in anything for at least the last two hours.

Long may it continue! Tomorrow is another day...

My robo-organ

On the month anniversary of getting my new robo-organ and after a month of seeing more single figures per day than I can remember for years (and I truly mean YEARS), I started off knowing today would be a good day. I was 4.2 when I woke up, had a great nights sleep and was looking forward to the forthcoming holiday I'd been counting down the days until.

I arrived at work nice and early but was feeling a little on the low side. Not a major low, not the kind where you start shaking and feel like you could manage several sittings of an all you can eat buffet before you would be even slightly satisfied, but I was a touch flustered and feeling a little 'wonky', shall we say. Tested again, 4.1. OK, it doesn't class as a full blown hypo and it seems to be stable but it was enough for me to want to have something to eat make sure I didn't dip down any further. So I got myself a nice bacon and cheese turnover and a coffee. For some reason (seeing as I was nice and stable) I decided it would be a 'good' idea to have a teaspoon of sugar in my coffee, rather than my usual sweetener. I also decided that as the bacon and cheese turnover would have a high fat content, and as such would take longer for the carbs to get into my system, I would inject after the meal.

It must have been about forty five minutes later that an all too familiar feeling crept in. I started to feel a little spaced out, my thigh muscles were starting to ache when I stood up from a sitting position, a little as if I had been a done a full body workout at the gym - only I hadn't. Suddenly I realise how thirsty I was. Man, is it on hot in here or just me. Then the light bulb went on.

"Shoot! I didn't give myself the dose after my meal! I better do a blood test."

5, 4, 3, 2, 1 - 17.2!

Turns out, I enjoyed the cheese and bacon turnover and coffee that much, I happily dove into my work after the last tasty bite, satisfied and ready for the day! So the sugar, the processed super-quick acting pastry and even the milk in the coffee hit my system like runaway steam train!

After happily swanning around for a month so happy with my sugars I would happily regail the beginning of my pump journey to anyone who would listen, I hit a major fail! Granted, within a couple of hours I was back down in the 'good' numbers again and was certainly the wiser for it, but it just goes to show that with this disease there is no such thing as a free meal and there are no days off. Forgetting a dose isn't something which we can be blasé about. There's no cheating the system in this game.

It also shows how reliant we are on that little dose of transparent liquid. It never fails to surprise me how such a tiny dose of liquid can have such a huge impact on our day. Missing that dose took me from 'perfect' to 'better act quick' in the space of an hour. Even this was a jump which surprised me, but brought me back to the fact that this little device is probably the closest thing I have to a guardian angel. Although this guardian angel has a computer in it and comes in a range of funky colours!

I have no doubt there will be many more occasions when I forget myself for just a moment. And despite the blip, the rest of the day my BG was right in target, it just makes me remember that with this disease you can't take your eye off the ball, or off the cheese and bacon turnover for that matter.

Anna - just eaten dinner - bolus given. And relax!

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!

Thought train of a pre-holiday diabetic (Armageddon is nigh!)

So, in just six little days my fiance and I will be setting off for a two week holiday in Thailand, to celebrate the marriage of two of our dear friends. Granted, at the moment those six days feel like FOREVER, but as we all know, it won't be long until we are saying "my, didn't that go quick!" To a non-diabetic, the main concern at the moment would simply be how many sets of bikinis or board shorts to take and do I need factor 20 or 30 suncream? Hmm, dilemma indeed.

For those of you who are diabetic, it is a somewhat different story. After sorting out the logistics of the non-diabetic side of things such as, have we booked the flights, are we confirmed at the hotel, have we arranged transfers and so on, the diabetic plans have to be made and the calculations must begin!

Having never holidayed in Malaysia before, there are a number of things to consider and knowing what hot weather does to my blood sugars, there are various safeguards we have to put in place to make sure I'm 'OK' if my sugars take an unexpected dive. The hot weather thing always mystified me, as some people would report extreme highs, while others, including myself, always experience more lows. I recently found out why - and it explained a lot. The reason hot weather affects a diabetic's blood glucose (BG), is because hot weather makes the capillaries in the body expand, in order to cool us down. As such, the insulin gets around the body much quicker, meaning you can have unexpected lows. And what do we know about lows? They are always followed by a high. So depending on when you are testing, your experience may be that you could be seeing all the highs or all the lows. Chances are you are having both but may not be testing (or sometimes even realising) at the same time.

So now that I know I can be the subject of a number of wobblies, I have to make plans.

First up, insurance. Not only am I the proud owner of a marvellous (but costly) new insulin pump but I also have to cater for the fact that knowing what I know about hot weather, I need to be prepared for a major wobblie. One that could mean hospital treatment or even just a visit from a medic. Insurance is an area where many diabetics fall short, because apparently we are far more risky for anyone to invest in. I would disagree, but only out of principle- I can see why they err on the side of caution with something that can take even its host by surprise. But this means a lot of searching for a reasonable and fair deal, seeing as most companies whack up the price of your policy as soon as you mention diabetes, let alone type one. They always ask those ridiculous questions, such as "have you had a low in the last year". Erm, yes, seeing as if I hadn't, chances would be that I wasn't diabetic, and was in fact filling this out in error! As soon as you answer "Yes", up goes the price! After searching high and low and getting quotes for well over £100, I finally found an insurer who didn't think it was necessary to chase me off with a rottweiler of a quote. Tokio-Marine offered to insure both my partner and I, diabetes considered, for an annual worldwide policy for only £62. Pretty good considering somehow we managed to wangle (yes I know it's not a word, but it works!) 3 holidays this year, spanning the globe and various continents! The only problem was we took out the insurance on 17th March last year and the holiday was reshceduled to end on the 18th! So the last 2 days have been spent haggling (yes, we British are able to, when needs be) in the hope that they would extend the cover by 2 days. Normally this wouldn't be an issue, but thanks to the insulin pump, I am back in the high risk category, because they like you to have been on a new regime for 3 months before they consider you less likely to spring a claim on them! Thankfully, the nice people at Tokio-Marine saw sense (and no doubt did some google searching on the term "Insulin Pump") and agreed to extend the cover. And yes, we will be using them again!

Now, we need to consider the supplies! You've already seen a picture of my cupboard supplies, well holiday supplies get even worse! Because you pretty much have to cater for Armageddon and make sure that in the event of ANY emergency, you are prepared. So, each cannula (the tubing with flexible needle which attaches to the skin and pump) lasts me three days. I am away for a total of 16 days, so I need 6 cannulas to ensure I am covered for the basics. However, if Armageddon is imminent, or my bags get lost, flight gets cancelled, tropical bear climbs through the window and uses them as a chew toy, I need to double this really. Ok, 12 cannulas and I'm happy.

Now for reservoirs (the part that fits into the pump and stores the insulin I will use). Each one seems to hold around 270 units, which will last me around 4 days, seeing as 70 units per day would be at the higher end. I'm going to be there 16 days, so need a minimum of 4, keeping in mind that my insulin requirements will change. Ah, but what about a freak snow storm (if you've seen the Day after Tomorrow, you'll stop snickering now!), or perhaps another bag loss, or another tropical bear..... I'll take ten. Sorted.

Testing strips for my BG meter. Well, at the moment I am averaging around 10 tests a day, so will need 160. What?? That sounds dreadful, but realistic. I may well do more on holiday, keeping in mind the change in temperature, activity levels food and of course, running from a tropical bear or snow storms. I better take 200. That's 4 boxes of strips. A lot, but necessary.

Ok - now for weapons against lows. First, juice. Now I know they will have juice there, it's not the arctic after all. But I like to go well equipped, so will squeeze a bundle of boxes of juice in my luggage, just for peace of mind. Glucagon (a HUGE injection which has a glucose tablet and saline in it which my partner can inject me with if I completely conk out), now this is a must. Do we still have one? Check. Phew, one less thing to cater for.

Batteries. OK this one sounds strange, but the pump runs on a triple A battery, and although it goes for a month, I like to change it as soon as it says it's running out. It's been in about 2 weeks, so I definitely need a replacement. Plus I hear the world is coming to an end, better take 2.

Insulin! Yup, I can take all the supplies I want, but without this, I don't stand a chance. Now, each vial contains 10ml. I get through about 3ml per sitting, which lasts 4 days. So 1 vial should last me 12 days. But, in the event of me dropping one, losing one, breaking one, or a total freeze out in a freak snow storm, I have to take at least 2. You know what, make it three, it IS the most important part. Right, prescription request for another bottle coming up.

Injections. Well, while I hope not to ever have to use one of those blighters again, I have to plan for anything. If my pump conks out, breaks or gets eaten by a tropical bear or goes overboard while we evacuate the plane after the emergency water landing, I need to prepare myself for that emergency. So I need the pens (both of them, seeing as I was on two types every day), the needles (need to be changed every time, better take ten) and the prefilled insulin cartridges. OK, that's sorted.

Next, antiseptic wipes. Now, I use these anyway on the recommendations of the pros, because the pump 'site' where the needle goes in is there for 3 days at a time. But it is worth bearing in mind that I will no doubt be sweating more (it's currently 8 degrees here and 36 in Thailand!), and there will be a whole new set of bacteria and air born critters over there. Better take a box of them!

Right, are we done. Oh! Hang on! I need to prove that I am not a terrorist and am not in fact transporting doses of killer weapons of mass destruction in the form of liquid! I need a letter from my doctor explaining why I need so much liquid and needles and tubes and why I'm connected to something which looks a bit like a pager, but appears to be going into my body. Yup, need one of those bad boys to get through customs. And they are a steal at only £12. I thought it was ridiculous too.

Well, I think I have reached the end of this ridiculously long post. And hopefully the end of my planning for the holiday. Now I get to pack my clothes and do my 'other list'. The non-diabetic one.

My advice - plan early. In fact, I may be going away next spring, I think I need some..........

Seeing the wood for the trees

These days, there are so many tools available to a diabetic, it would seem almost impossible not to know what you sugars are doing all day long. From insulin pumps, to continuous glucose monitoring (CGM) and to glucose testing machines which come with free software in order for you to create charts, tables, diagrams and histograms, or full blood work which give you information about things your didn't even know you had in your body! What are electocytes and why do I have them??

So why can it be so difficult to see the wood for the trees? By this what I mean is why can it be so difficult to see the trends, blips and anomalous results which would help you obtain excellent control, if you could see them.

As a 'newbie' to the insulin pump, I am attending weekly specialist appointments at the moment so that my diabetes specialist nurses can look at my OneTouch Ultra software to see the patterns which may be occurring due to very small alterations in the amount of insulin my body requires. I have the same software at home, which I regularly look at and ponder, sometimes even pretending to have clarity on what's going on 'in there'. But most of the time, it looks to me as though a five year old has taken a biro, scribbled all over a chart and handed it to me in the form of a nicely packed histogram. My charts usually look more to be like a black and white picture of the alps than a clear and useful tool to consult and base my changes on

So this week, I sat down and counted how many of my sugars were under 15 mmol, under 12 mmol and under 10mmol, so that I could go to my appointment equipped with something useful to say when asked the question, "How did you get on this week". Imagine my surprise when I found out that 62% of my sugars are under 10, 85% were under 12 and 91% were under 15. Granted, 12 and 15 are not ideal. 12mmol is still leaning too high, especially if part of an upward trent. And 15 is by no means 'good'. But coming from someone who used to only test as little as possible because my sugars were over 15 so often that each test would eat away at me inside this is a good - no, A GREAT - result!

But had you asked me what my sugars were that week, I could only have answered "19.9" and "16". You know why? I do. Because as diabetics we have to strive to achieve the best results possible. Where possible, only 4-7mmol is good, everything else is 'bad', or 'wrong'. But in reality, any diabetic will know this is extremely hard, if not impossible. I know it. For years I've known it. The reasons I had no idea about that 85%, is that when I get a good result, I don't pat myself on the back, I don't say "well done, good going". Instead I say "right, when do I test again to check I've stayed there". I say "ok, it's good, but how long will it last". Why when I get a 19mmol, do I not say the same thing to myself. Why do I not say, "Right, that's fine, as long as I don't stay there". Or why do I not let myself off the back lashing and say, "You know what, it's still better than 25". Because I can't that's why. If I, or any of us, are going to whip this diabetes into shape, we never get to have a day off and we never get to say it's 'ok'.

That being said, it has only been 3 weeks on this new pump, and when I looked back at my results from 6 months ago, only 38% of my sugars were under 10mmol. That's an improvement of 24% in 3 weeks! I mean talk about progress!. And I haven't changed anything else. If I want to eat a giant burger or piece of pie, I still am, so the effort is minimal on the diet front. In fact, I had an extremely tasty piece of lemon meringue pie for lunch today. Do I regret it? Not in the slightest. Should I? Not in the slightest.

I will carry on being vigilant and giving as good a fight as I can, but next time I hit a 20mmol, I'm not gonna give myself such a hard time. Why? Because 85% is damn good in my opinion. Next week, I'm aiming for 86% and the week after 87%. I just need to keep reminding myself that 20mmol is not the norm. I don't sit there for days or even hours. I usually hit 20 and come right back down before the next test. It's just that I have to remind myself that the rest of the time, I'm still hitting 85%.


Part of Something

When I was diagnosed, I was the only person I knew with the disease. Not just within my family, but out of all the people we had ever known. At school, my teachers embraced it and I never felt weird or abnormal. My friends took delight in being the ones who knew about diabetes and knew how to recognise when I was getting a bit wonky.

As a teenager I admit that I felt alone sometimes, and extremely hard done by. Why me? Why not that woman, or that man (aimed at any stranger I walked past in the street)? Sometimes, just why?

As a teenager I never met any other diabetics until I started a part time job whilst studying at college. Funnily enough, we had worked together for weeks, without knowing. It was when we went to lunch together one day that of course it cropped up. Immediately I felt a sense of connection to this person. She was fun, friendly, great to work with, and all of a sudden, she knew better than anyone what it was like to be me, in part anyway.

For the next few years in my early twenties, I met one or two other diabetics, but none who seemed to struggle with the condition. By struggle I mean that I still hated 'it', but had come around to thinking that if I was gonna have this, I might as well make the most of it.

About 3 years ago, I went one step further. I embraced it. I started asking questions. I started reading more, making sense of it and putting the pieces of this muddled up illness together, to try and make a more pleasant picture. So much so that I used my diabetes to write my dissertation, which to this day, is the work I am most proud of having created.

About 8 months ago, I started thinking about the pump. This, as a child and youngster, had been my idea of hell.

"Having something attached to me all the time, I can't imagine diabetes controlling me more in any other way."

I still remember saying it, who I was with how out of control my sugars were at the time.

Two months ago, I started reading blogs. I started realising that I was not the exception to the rule. I was not alone and by no means was I struggling to maintain control any more than anyone else. I started realising that using the Internet was the key to reaching other diabetics from all over the world. People who in their own countries faced all sorts of challenges with their own treatment. In the US, you either pay or get insured, if you want any kind of treatment. In the UK, care is free at the point of contact, but not everything you want gets funded.

A week ago I joined the Diabetes UK website, and since then I have become a web-maniac! In fact, I feel like I am stalking the site, checking every couple of hours for more posts from people asking for help or advice, or checking in case someone has asked a question I have asked myself, just not out loud.

I have made new friends, I have written to people I feel more connected to than many people I have known fleetingly in my own time on this planet. I have talked about things which have infuriated me in the past, but never had the right ears to listen. My family and friends could not be any more supportive if they tried. I always tell my fiance that he has diabetes too, because he has to carb count, he has to get up in the night when I'm wondering around, too low to make sense of why I'm in the kitchen. He will have to help me through the future, because god knows, there will be many challenges to come. But when you read a post about someone being 25 mmol and feeling like they could sleep for a week, you know exactly how that feels. You don't need to know their hobbies, their friends, their taste in music, or even their name. You know how they feel.

I have never felt so connected, never felt so in touch with people, and probably most importantly, never felt like diabetes has brought me so much that is good.

It has put me in touch with people who truly understand what it's like to be high, low, frustrated, sometimes a little scared and often misunderstood.

It has made me realise - diabetes doesn't make you alone, it makes you part of something. Something which can bring people together, something which can make you connect with people all over the world, and something which up until now, I never thought would have a positive side

Anna - part of something for 23 years .....and counting.

Is honesty always the best policy?

When you read some of the blogs out there you wonder if anyone, anywhere, has ever, even once, had a blood sugar over ten. You wouldn't be wrong to think so, at least, not if you take people on their word. There are many many blogs out there, but I can only connect with a handful, for that exact reason. These are the ones that say it how it is. That today, something changed, and it all went kaput! When I read comments all about how "I like never to go above ten", or "my sugars soared up to the early teens", I get that feeling in the pit of my stomach. The guilt creeps in and I lose hope that anyone out there has ever had the same experience as me. Have they ever felt so tired they could fall asleep at their desk? And not because they had a night on the tiles, or because they stayed up until 4am watching films. But simply because they are diabetic. And if you have diabetes which is anything like mine, it sometimes just happens!

Since I started my blog only a few weeks ago, I have found myself talking a great deal about all the good points. The pump and the sophisticated settings which claim will eventually make my life a bit easier. The CGM and the hope that one day we, as a whole portion of society, might only have to inject ourselves a couple of times a week and blood test even less. I have talked about how we must spread the message that we are not at fault, and even how your breasts finally have a purpose (other than the obvious) - they make a great hiding place for the pump.

On looking back, I have failed to mention some of the pains in the backside I have faced. This wasn't intentional, but I think when you write something that people may read, it can be easy to highlight all the good points, the mood-boosting things and the sometimes clinging at straws anecdotes. This is because that's the bit that people want to hear. But what can become lost along the way, is when you get frustrated and when no matter how hard you try, 2 + 2 make 21 (mmol).

So the rest of this post is about my experience today. A day when that diabetic tantrum (not mine, but the disease's) reared it's grouchy head and yelled its way through my afternoon, with a vengeance!

Today had all the makings of a perfect day.

Great nights sleep - good start

First sugar of the day - 5.2, "Ok, feeling pretty good about that"

Post breakfast sugar - 8.7 - "Oh yes! Carb counted correctly - good girl"

End of the morning - 6.2 - "Damn! I'm getting good at this!"

Just to check - 5.8 - "I could write the diabetes manual with these babies!"

Before lunch - 4.6 - "Ok, I'm drifting down, but that's fine, just means I get a to eat lunch now"

And then this

19.9! Achieved somehow without even the slightest of effort. I can quite easily manage that, if I pick, snack or have an impromptu meal (as I often do).

It's moments like these that I suspect some people don't write about. Maybe because there is an element of public embarrassment. I mean, the blogs I read are all about inspiring me, about making me feel strong and connected. When everyone else is 'stable', you don't want to advertise numbers like these. But you know what, these happen to me all the time. I'm back down now, under ten, where I 'like' to be. But like doesn't mean 'always am'. Something I don't think always comes across when you focus on only the good bits. It will happen again, and again, and guess what, again. As long as I'm diabetic, Mr Hyde will always find a way to creep in.

I know that I did something different today but I'm loathed to use the word 'wrong'. It leaves a bitter taste in my mouth seeing as 'right' would be not being diabetic. There is no right and wrong with this disease. Some of us will go on to have complications, some will not. Some people will find good control just by staying positive and putting the minimum in, some will fight against high sugars on a daily basis (I am definitely in the latter camp!). So you know what, if I get sugars like this but I am trying my best, striving as much as I can and finding my way back down again at some point, I'm not going to let it get to me. It may do momentarily, but any more than a couple of minutes spent regretting any decision I made, is a couple of minutes longer than this disease should take from me.

So tomorrow I'll start again. If it starts as well as today, then I'm on to a winner. If it goes the same way as today, I'll have another think and try something different.

That's just the name of this 'game'.

Is honesty the best policy? Yes, even if it means admitting you got it wro...... I mean, when you did something different.


CGMs - Continuous Glucose Monitoring is something I rambled about a few posts ago. The idea is you wear a small sensor which is attached to your skin with adhesive plaster material. This will then feed information through to your pump or a hand held receiver (much like a blood glucose monitor), and this will give you 24 hour coverage of what your glucose levels are up to. It won't replace glucose fingerstick testing, as the machine needs to be calibrated, to ensure that it is still working correctly, but the constant information at your fingertips (or not, as the case may be!) means total peace of mind. It seems to me to be a little like having one of those baby monitors which listens to what your kids are up to in the other room. Because let's face it, sometimes your sugars act like they raided the sugar supply, sometimes they seem to 'tire' out drop on you with little warning and sometimes, no matter how hard you try, they just will not behave!

So I've been doing some research and it seems to me that there are two clear front runners for CGMs. This is of course, just my opinion, but each and every diabetic will need to reach their own conclusions about their diabetes management. This might just give you something on which to base your own research. There are indeed many more options, but these two have struck me as the two biggest contenders for my personal needs/desires:

These two options are:

The Guardian RealTime system
The Dexcom 7+.

Perhaps the Guardian Realtime appeals to me because it is manufactured by Medtronic (the makers of my pump), and therefore the information the Realtime will pick up, will be fed straight to my pump. It won't control my sugars, but from what I can tell will mean that I wouldn't need carry around much more machinery with me And let's face it, when you cupboard looks like this...... need to try and lighten your own load a little!

The Guardian Real Time system can also shut off insulin supply from the pump if you ask it to. So if you suffer from debilitating hypos, or you just want to play it safe, the pump will automatically shut off the supply when your sugars drop to the level you dictate, meaning during hypos, you will no longer be receiving insulin. You will of course still have insulin in your system, but you won't be adding to the problem.

The sensor looks like this:

Pretty smart looking I think. According to the Internet library, the sensor can be worn for 3 days. After doing some research it seems many people use theirs for longer than this, seeing as the approval just means this is how long they can guarantee you can wear it before infection or less reliable readings can occur. My experience is that many people choose to wear them for longer. Reliability will checked every day in order to calibrate the machine, so once it does start to get a bit hazy, it can be changed.

The major drawback to this system is the expense. Four sensors cost £160. Even if each sensor manages to last 7 days, that is still a pretty substantial amount to pay. I have no doubt that CGM will one day find its way into the NHS, but for the meantime, while glucose testing is so cheap and reliable, self-funding would be the way forward. The initial cost is £750, which includes the software, transceiver, 10 sensors and the instructions. This price would drop to £450 if purchased at the time of the pump. But either way, it is A LOT to pay in my opinion, unless the results were dramatic!

Drawbacks I have found so far is that apparently the sensor is not completely affixed to the skin, so it kind of 'flops' about on the surface. Hmm, one thing I like about the pump, is that the needle site is very subtle and can't be noticed. The fact that it is described as 'flopping about' puts me off.

There are also many reviews saying that sometimes putting the sensor in can cause a lot of bleeding if you hit a blood vessel. There is a suggestion that a 'bloody' sensor works better - still, doesn't sound great does it!

I am hoping that I will be able to trial the Guardian Real Time at some time in the future, but after asking the people at Medtronic about how long the initial kit lasted, the company went a little this space.

The second one, and in my opinion the one which has a little more going for it than the GRT, is the Dexcom 7+.

Dexcom has been a long standing favourite of many in the US. Many diabetics rave about the Dexcom systems but until recently, there was no distributor in the UK. Well, after writing to Dexcom and asking them how to order from their American distributor, they advise me that they now have a distributor over this side of the water!

The Dexcom 7+ looks like this....

While the sensor doesn't look quite as sophisticated as the other Real-Time, it sits completely attached to the skin, much like a pump, so there is no 'flopping about' and in my opinion it is less likely to catch on anything.

But perhaps the biggest advantage is that as the name suggests, it is a seven-day sensor. If, as mentioned before, the sensor continues to work for more than seven days, then it will mean even less jabbing yourself with needles and even more information.

I have also written to Dexcom, who I am advised are sending me through some information about costs, how it works etc, so I will be able to fill you in more in the near future.

The biggest difference (other than the sensor lifespan) with these two options is that the information isn't sent to your pump. Instead you have a handheld monitor which needs to be within 5 or 6 feet in order to take a reading. However, if you carry a blood glucose meter, they are similar in size, and mine is rarely more than 5 feet away!

As with the real time I am hoping I will be able to trial one, and in the end, it may all come down to price. I haven't had the information through from Dexcom yet, but my research onto chat rooms and forums seems to show that the Dexcom may be as much as half the price of the real time - see why I'm leaning toward that?

The main thing to remember is that the CGM systems don't offer exact like for like readings, seeing as fingerstick tests take their results directly from the blood, which is the most up to date and accurate readings. The CGMs will take reading from the fluid in the muscles. That is the purpose of the fingerstick tests twice a day to calibrate with the machine. The CGMs will provide you with trend information to show the habits of your glucose levels. The main thing is you would have total information about what your body is doing. Half the battle I have found with diabetes is knowing what is going on. Are you having overnight hypos, did you inject enough for the last meal, do you suddenly go up or down during exercise?
This may be the answer, and seeing as I would never be able to achieve this level of control through any other means, I believe it is well worth a little nosey research!

Whatever the outcome, I am very interested in finding out the benefits of this new technology and the practical help it may provide.

I'll keep you posted and write a little more once I have heard back from everyone, and maybe been given the chance to trial them!

Thank God for breasts!

"I agree!" I hear the boys cry!

After many serious posts about blood sugars, CGM, spreading the diabetes message and so on and so forth, I thought it was time for a more light hearted post. About breasts. Well, not breasts exactly, but about how being a girl has certain advantages when it comes to the insulin pump.

One of the biggest eye openers for me has been the ingenious ways people dress up or disguise their pumps. For children, there are all sorts of companies who come up with funky and flashy pump case designs, so that kids can add a bit of fun and individuality to their pumps ( - great stuff!). For adults, it may not always be that you want to have a pump on display, or when you move the needle to a new area, it can mean a new system of where you put the tubing and the pump itself.

I have found one thing with the pump. It loves a good bra. No one can notice it, it nestles nicely between 'them' and it can be clipped on. It's relatively easy to remove to give yourself a bolus, as long as you are subtle.

I for one am not bothered by people seeing my pump. Considering it is now an integral part of my life, as well as my diabetes management and diabetic 'identity'. But I don't like it when I bump it on things. I am not known for my grace, or for my ability to walk in a straight line without walking into things - so my pump can take a battering if I am rushing around. For those that know me personally, I am always rushing around (and talking too quickly!).

So for me, the bra is an ideal place to put it. No one can see it, I can easily access it, it doesn't fall out or get knocked into things (there's a pun in there somewhere) and the wire just traces down your stomach, without drawing attention to itself.

Somehow I don't think boys have it so easy. Whipping it out (the pump, for those of you who were thinking otherwise) from your pants is never going to be an appropriate and I would imagine is likely to draw some stares!

All I have to say is - thank God for breasts!

Searching for perfection

I used to be someone who was grateful if they just had one sugar under 10 per day or sometimes, per week. I remember days of waking up with sugars of 21 and knowing that today would be another day lost to a disease I couldn't control. I remember spending those days gulping my hours away on endless cups of water, diet coke and sugar free juice, because no matter how many gallons I swallowed, barely allowing it to touch the sides of my mouth, I would still be thirsty. I remember being tired, sluggish, emotional and feeling guilty. Guilty about the fact I wasn't doing it 'right'. Guilty that I was risking having complications, even though I was trying as hard as I could. Any diabetic knows that if you run high for a couple of days, you feel too tired to muster the strength to go for a walk, or even stay awake. Imagine that for two weeks, two months, or for some people, 2 years.

Each day since I have been on the pump, my sugars have improved. Steadily and slowly, but surely. The first week was a nightmare. More hypos than I could shake a carton of juice at and more highs that I could face without the guilt and worry creeping back in. But then, week 2 saw the era of the magic number 7. Throughout the morning I would be seven. Throughout the afternoon, I would still have high sugars, but over time these too have subsided. I now have not had a hypo for 2 weeks and I haven't had a sugar near the twenties for 4 days. Instead of praying for sugars under 10, I am now surprised when they nudge their way over. And most of those ones that are creeping up are admittedly down to my own miscalculation or under-bolusing. Not that even that is my fault. After all, I'm not a mind- (or body-) reader. I'm still mostly human, apart from the robot attached to my hip.

But the main thing is I am now, for the first time in as long as I can remember, starting to strive to have every sugar below 10mmol. I have gone from having 66% of my sugars in the 'red' according to my glucose software. Now I am hitting my target or below 58% of the time. It's not perfect yet, but in the past 3 days, I have not even approached 15. Something that seemed to come naturally for many years. Each day I nudge my way down that little bit further. Today, I was 10 when I woke up, and that has been the highest. I've had 6's, 8's and 5's, but no twenties. And I try to remind myself whenever Mr Hyde tries to nudge those sugars up, that it's only been three weeks.

There is still a long way to go, but being able to test my sugar and know that a ten is now the higher end of the scale rather than the ray of light it once was, makes me feel hopeful and perhaps most importantly - more in control. Eventually I aim to be at 6 as often as possible. But for now, I'll be happy to take anything under 10. The 6's will come, of that I'm sure. But baby steps suit me just fine.

Anna, 9.5

Get your facts straight....

Until recently, it never bothered me that people didn't always seem to understand what type 1 diabetes was all about. It never bothered me that people would say "that's when you can't have sugar isn't it?" It didn't even bother me when I would start to answer, giving them the watered down, appropriate for the masses 'dummies guide' to diabetes and they would jump in with "no, I'm sure you're definitely not allowed sugar". I would chuckle under my breath and let them make up their own mind, seeing as my 23 years of experience didn't appear to give me any clout as an 'expert' in the field.

But just lately, it has begun to bother me a little and I felt the need to blog it out! Maybe it is because I'm going through such a big change in my diabetes management, maybe because I am trying twice as hard as normal to gain control over this condition. I was speaking to a colleague a little while ago all about diabetes, when she commented that a neighbour of hers had been a diabetic for years, and how he still had really bad hypos.

"I've always wondered why, after so many years, does he still have bad hypos. I mean, why doesn't he have better control?" She explained quizzically.

My mind goes blank.

For the first time, I realised that there are many people out there who think it's our fault. That we don't look after ourselves well enough. That hypos are about bad planning or because we don't know enough because we're too lazy to take better care. I didn't quite know how to answer. I was so surprised by the comment, it took me a few seconds to muster an answer.

"It's not quite like that. It's not like after you've had it a while you don't get highs or lows anymore. Every day is a balancing act. For some people, even a bad night's sleep can affect their sugars and make their sugars swing either way".

I look over.


I don't think my answer met with any sort of acceptance. It felt as though she believed I giving her an apathetic answer. One to stifle her criticism, which would still exist. I am also still having highs and lows highs and lows, after 23 years. Laziness most likely.

There is always a huge amount of publicity out there all about Type 2 and how it is avoidable. There always seem to be undertones about how 'these' people could have avoided the consequences. The fact is, some type 2s just develop it because of their age. My grandmother has it and she was neither fat, nor lazy. She can't help getting older - I would love to find ANYONE who can! And in the defence of type 2s, never has the been so much fast food in so many places across the world. In any given high street, fast food chains sit alongside one another, beckoning people in with cheap deals and buy one get one frees. You can almost taste the salt and MSG as you try to walk past! You may get past one, but there will be another. If not next door, then at least within a stones throw. I know this isn't an excuse, but as a self-confessed junk food addict, it takes all I have not to swing by Subway when I walk past, and settle for my home made salad instead! I get that people are more over weight than ever, and as impactive as the word 'epidemic' is, it's exctly what it is. It, being type 2 as a result of being overweight.

But type 1 isn't about that. I was four years old. I wasn't overweight. I exercised every day the way children do. Type one is genetic. It has nothing to do with weight, lifestyle or what day of the week it is. For all that is known about what causes it, it could be down to when your birthday falls! So why then, in this day and age is it still so hard to find non-diabetics who are able to understand the difference between the two. I know it isn't their fault, that it is the fault of under-education of the masses, but it still frustrates me.

Being diabetic, whether type 1 or 2, you fight enough battles every day. You battle with blood sugars, with injections, carb ratios, adjustments, need I go on. But it seems we also have another battle on our hands. This battle is all about making people aware. Teaching them, as those who are best in the know, that diabetes comes in many shapes and sizes. Even those who have had the same condition for the same number of years, are the same age and the same gender, will never experience diabetes in the same way. Different challenges or every day occurrences will have surprisingly different effects on someone with seemingly 'the same' condition.

So it has become a pain of mine that we also have the challenge of letting the entire world (except for those in the 21st century!) that diabetes is full of the highs and lows. Admittedly these can be reduced with A LOT of effort, but they will always happen. Whether it is giving people the beginners guide or the constantly developing lesson, I feel the challenge is just beginning.

Let's get their facts straight!

Anna (currently a little high)