Three Cheers for #doc

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Three cheers for the #DOC

I have to begin with an admission. I thought the internet and land of Twitter was full of busy-bodies and weirdoes. I didn’t understand Twitter, yet after blogging with my friend for @tripility I decided to start tweeting and following people within the #gbdoc (I didn’t know what this referred to, but I now know that #doc is the Diabetic Online Community and #gbdoc doesn’t stand for the Good Bloods Diabetic Online Community!). I can now confirm that the #gbdoc is not full of crazy people, weirdoes or busy-bodies: in fact it is wonderful. Over the past few months I have been lucky enough to have some wonderful experiences that without straying into the land of Twitter I would never have had.

  1. PWDC2015 or the People with Diabetes Conference 2015 where I met @TheTeamBG, @Flipper and @LwSweetpea88. I had a wonderful time at this event and enjoyed meeting so many people who shared a common understanding of life with diabetes. Furthermore it gave me the opportunity to begin new friendships. Somehow within a couple of hours of meeting @LwSweetpea88 we were already organising a night out…!
  2. The Animas Sport Weekend 2015 – without Twitter I would never have known where to apply for the Animas Sport Weekend or who else was going to the weekend. Yet all of sudden a flurry of Tweets with the #ASW2015 hash tag began to populate Twitter. The weekend was fantastic and well worth going on – even if you hate sport. Meeting more like minded people who were so inspiring. Meeting Iron Men, endurance athletes and the friendliest people was wonderful. Made even better by “free” wine on the Saturday night. It is hard to describe how accepting, friendly and easy to chat to everyone was. Once again I met up with @LwSweetpea88…
  3. @LwSweetpea88 knows everyone… therefore a #DOC Birmingham night out was soon planned with @MM640G and @JaivirP. A wild night involving Gay Pride and Jagerbombs followed. Where the only person to have met everyone in the group in ‘real life’ was @LwSweetpea88. Yet somehow through the power of the #GBDOC it didn’t seem strange that we descended on @MM640G’s house and began a game of HeadsUp – which @LwSweetpea88 and I were terrible at. Truly terrible. Once again the shared diabetes meant that in the club everyone did a group blood sugar test. @LwSweetpea88 took on the role of force feeding Glucotabs to anyone who wanted one… Moreover it opened my eyes to how different everyone’s levels are. @JaivirP and I partied in the high teens whilst @MM640G kept it in range. Yet while @MM640G woke up high after a basal rate reduction, I woke up in range with no reduction. Proving once again there are no set rules for diabetes.

Now, it’s time to start planning for the next #GBDOC party / outing and I can’t wait. Fingers crossed for a day trip somewhere and maybe a few more #gbdoc members to join in the fun. Three cheers to the #GBDOC for introducing me to some truly wonderful people who without Twitter I would never have met. Also if I haven’t included your Twitter handle I am sorry, I have enjoyed meeting everyone and can’t wait for the #PWDC2016. Hopefully I will have recovered from #gbdoc Birmingham by the next meet up!

Mid-boogie testing. In order of highest to lowest @gfadventureer, @JaivirP, @LwSweetpea88 and @MM640G (obviously cheating using M640G!)

Mid-boogie testing. In order of highest to lowest @gfadventureer, @JaivirP, @LwSweetpea88 and @MM640G (obviously cheating using M640G!)

I’m not hungry; I’m hypo.

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There are two feelings in my life which I seem to spend a lot of time either thinking about, or doing something about. I love food, I love eating cake and sweets and chocolate, however my enjoyment when eating is not always at the same level.

Hungry – the feeling where you need to eat and know that although you might feel like you could eat a starter, two main courses and two puddings you will be able to continue with your day if you don’t eat straight away. Hypo – knowing that your blood sugar is low and you need to eat / consume sugar in order to bring your blood sugar back up regardless of how full you are, or how recently you have just eaten. Even though they might both involve me eating. It does not mean that I am going to enjoy eating the same amount when I’m hypo.

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My hypos always seem to time themselves badly. In particular I dislike the hypos which occur when I have recently eaten a meal. Moreover I dislike the reaction of people I’m with when I take out a biscuit or small selection of haribo shortly after having finished my meal – “you’ve only just eaten. How can you be hungry?” or “Are you sure you need to eat?”

Yes of course I realise that I have only just eaten quite a huge meal. The feeling of being so full that you can’t squeeze any more food in and then having the sudden feeling of a dropping blood sugar, followed by the confirmation via a finger prick. Hypo. Feeling so sick, yet knowing that you need to eat yet more food which ironically you really don’t want to. Those hypos are the worst. If only I had my crystal ball and had predicted the hypo then maybe I would have been able to adjust my meal time bolus and saved myself from cramming yet more food into my mouth. Avoiding the comments, out of interest, about how can I be eating again. I don’t want to be eating, unfortunately I need to eat the pack of haribo and I’m not even enjoying it as I am cramming in the sugar that quickly.

Living on my own I am used to my hypos at different times during the day or night. I have my supplies ready next to the bed (glucose tablets and lucozade), but occasionally a night time hypo will give me the “eat everything hypo” and those supplies cannot help. I need to venture to the kitchen… I can’t explain why I felt the need to eat three bowls of cereal and two bakewell tarts (this is true) during the night, or why I couldn’t stop eating biscuits after the sixth one. Yet this is what I do. When I have lived with other people they have occasionally come to rescue me from the night time munchies using the skills worthy of a police negotiator to move me away from the food and back to bed. If I wasn’t hypo there is no way I would have eaten so much food, therefore why does a hypo turn me into a champion extreme eater? Surely I can’t be the only one? Recently I stayed with my friend in Newcastle. After a meal and cocktails we returned home, enjoyed some pre-bed Easter egg and then went to bed. My friend has previously been on holiday with me, seen me through two bad hypos and had many sleepover with me since secondary school. She has not however had a sleepover with me, my insulin pump and my Dexcom. The Dexcom will alert to sudden drops and when you are moving towards your low target. My poor friend had a terrible night’s sleep; the Dexcom alerted that I was going low, so I took my glucose tablets from the side of the bed and went back to sleep. This happened twice. Then the Dexcom alerted that I was low again, which involved me having to double check with a finger prick, then find something with a bit more carbohydrate (biscuits of course!) and lucozade. Apparently there was a lot of noise, rustling and bumping around. Quietness is not my forte! Once that hypo had been treated I went back to sleep. My poor friend however had her sleep well and truly disturbed. Something she might not be used to! This made me think. How many times a week do I check my blood sugar in the night? How many nights in a week am I taking glucose tablets during the night? Is it really that unusual to get up in the night and eat? Should I be worried that I am turning into one of those people on secret eaters who go to their fridge in the night? Obviously I am eating because I need to. I am sure the diabetes nurses would hold out their mini cans of fizzy and drink and tell me that is all I need, but sometimes I don’t want that. Sometimes I do need more. Sometimes I have a hypo where I have to eat and eat and eat because nothing will bring me up. Other times my hypo is super easy to treat or can be avoided with a reduced temporary basal rate.

The thing is I don’t know which hypo I am going to get. There are many modes of hypo and I can’t predict which it will be. It could be a night time “eat everything” hypo, or waking up to a “soaked in sweat” hypo and having to spend the rest of my night wearing a poncho towel in bed because everything really is that damp.  Capture3

The “confusion” hypo. Am I going to have a hypo where I just cannot work out what I want to do, or need to do? I know I need to eat, yet I cannot make the decision of what to eat. If anyone asks me a question, then I dread to think what my answer would have been during that time and most of the time it will be accompanied by tears. It could be the “I’m right” hypo, where I am the only person alive on the planet who knows everything and anyone who dares to suggest a different food option, stopping to check my blood sugar or even commenting that I might be hypo will most likely find their head placed on a mental stake in my head because I am the only person on the planet now who is right. Perhaps the “questioner” will be in play, be prepared for questions that have nothing to do with what I am currently doing, be ready to be interrogated on where the tide might be now and how many hours until low time even though I am nowhere near the beach. Or finally will it be a “sabotage” hypo. You know the one… After having prepared like a pro for exercise, reduced my temporary basal rate like an expert, donned my gym kit, done a final blood sugar check to find out somehow in the last few minutes I’ve dropped from the constant 9-10mmol I was aiming for to a rather, at this time, disappointing 3.8 mmol. This list of different hypos is by no means my complete hypo list. However after spending time with my friend I realised how wonderful my friends are when observing my hypos and extreme eating, never batting an eye lid, never questioning and never bringing it up again. My family who are used to being told I’m not hungry; I’m hypo like it is the definitive answer for everything.

Diabetes Blog Week – Day 2. The Cost of Chronic Illness. 

I am luckily enough to live in the United Kingdom. As a result I am very thankful for the NHS and the excellent health care I receive as a result. I am more than aware of the cost of my test strips, it is now printed on my prescription, and am eternally grateful to the NHS for funding my diabetes care. I may be asked every time I go to the doctors to switch to a more cost effective brand of test strips, yet the NHS is paying for my insulin. Recently insulin prices have been increased by Humalog. Luckily, I am unaffected. However what about the crumbling NHS? I am very respectful of the fact I receive free prescriptions. If I can easily buy hay-fever tablets, paracetamol or what ever else is prescribed to me in a chemist then I will. I understand the NHS is under pressure and their spending on Diabetes and other chronic illnesses is increasing. I hope that the NHS will continue to be protected and funding cuts do not have a detrimental effect to those with diabetes.  Living in the U.K. and receiving excellent care as a result, without having to use insurance, or swipe a credit card when I enter a hospital is something that I am truly grateful for. 

However as a Type 1 Diabetic with very good control this does involves additional spending on my behalf. Especially if I want to achieve a level of control which will hopefully prevent long term complications. I spend a minimum of £1200 per year on continuous glucose monitoring. Be it funding the Freestyle Libre or Dexcom. I am self-funding as unfortunately my control is seen as “too good” to qualify for NHS funding. I am in a fortunate position where I have no dependents, work full time and as a result can afford the expenditure. Yes I have to skimp elsewhere. I do not work in a high paid job. Yet I believe that investing in my health instead of a holiday is something that at this moment in time  is a priority for me. 

The monetary cost of chronic illness is easy to calculate – I simply look back through my bank statements. I could use a mileage calculator to work out travel to hospital ( a four hour round trip in a car) but, what about the other costs? Do we ever look at the mental cost? The long term cost to our health? Is it time to consider the other costs? The cost of a chronic illness is always going to be something that impacts upon life. 

Diabetes Blog Week Day 1 – Diabetes and the Unexpected. 

For me, diabetes is continually unexpected. From it’s arrival in your life to the results on my blood glucose machine to the complications that may result. Diabetes is consistently unexpected for me. However this has actually turned out well for preparing me for life as an adult. Even more life as a teacher. 
When the unexpected hits I have learnt over the years to take a deep breath, deal with it and move on. High blood sugar? Correct. Run out of test strips? Pharmacy visit. Not only has diabetes taught me to be highly organised it has taught me to be flexible. It has taught me resilience and it has taught me that the unexpected doesn’t always mean bad news. Equip yourself to deal with the unexpected. Make yourself ‘unflappable’. Soon you’ll be thanking diabetes for all the curve balls it throws at you as you are able to cope with the adult world. Broken washing machine? Implement the dealing with a high blood sugar reaction and suddenly it doesn’t seem so bad. 
However, don’t get me wrong I don’t glide through life with diabetes. I struggle with brushing my teething on a night and then an unexpected low hits and suddenly I’m having lucozade. I plan to go for a run to lose some weight and suddenly I’m low and chugging calories. We can’t plan for the unexpected, but we can learn how to deal with it. Most of all embrace the unexpected. I didn’t expect that the #doc / #gbdoc would provide me with such a wonderful network of people and friends all who I met online and instantly had something in common with. 

What The Basal?

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Before you start reading, worry not, there will be no expletives in the following blog post. There will however be confusion, frustration and unpredictability caused by changing basal insulin rates. For insulin pump users the basal is our background insulin which keeps us ticking along and is delivered every few minutes by an insulin pump. Throughout the day the level of insulin delivered may, most likely will, change. And what’s more throughout the month us women may have more than one basal profile. 

I am used to having two basal profiles which work for me. They keep me in range. I have one which is substantially higher than the other for those tough hormonal weeks. However recently strange going ons have occurred with my basal. 

The first incident occurred at the start of March. Out of the blue I was constantly hypo, I hadn’t changed my exercise, I hadn’t done anything different, yet I was low. I changed my basal and changed it some more. Resulting in a drop of 8 units of insulin for my total basal rate. Quite the reduction. Quite the drop in insulin. My total daily dose (including bolus) is usual around 40 units so I had reduced my weekly insulin by about 1.5days. Still no reason for this. 

Then began the creep about 6 weeks later. I noticed I was stuck in the 8mmols and there came the next change. Gradually adding back in the insulin across the day, particularly in the morning and between 3-6pm. 

Now I’m struggling with my over nights. Each night I’m going to bed around 5mmols, yet my Dexcom is alterting me to high blood sugars at about 2am. So far I’ve increased (and increased again) my basal rate from 11am to 4am. But still I’m spiking to 14mmol over night. Unless I have developed some secret eating I cannot phantom why, despite many theories about how my diabetes is trying to sabotage my Diasend data pre clinic visit. Previously I have always had lows through out the night. Never highs. Each basal increase is making no difference leaving me to think… What The Basal is going on?! The basal struggle is real and I can’t wait to get this sorted and return to some smooth sailing on the Dexcom. 

Pump failure 10,000 miles from home…

I travel a fair bit, whether it is within the U.K., Europe or world wide I enjoy a get away. Packing for my trips, even when I only go to the next city over night, involves quite the ritual and almost a whole extra bag for my diabetes supplies. I have a fear of not having enough, a fear of my pump breaking and me (having had a wine) having to pay for a return taxi journey home so that I can solve the problem. Therefore I always carry spares: cartridges, insulin vials, cannulas, spare blood glucose machine, power cables, spare finger pricked, spare batteries (two incase one doesn’t work), two tubes of test strips in case one is faulty, ketone strips, lancets (really this is a null piece of equipment – obviously I won’t be changing a lancet), spare freestyle libre sensors, spare battery cap for the pump and my pièce de résistance, which I know I am very lucky to have gained funding for, my spare insulin pump. Going away for longer means I take more and more of the essentials. A cannula for every day just in case I sweat them off, or maybe if that’s a possibility then two cannulas for every day and a box of skin tac wipes. A cartridge for every other day in case I get ill and my insulin requirements increase. I know a vial of insulin fills four cartridges, but what if I drop two?! I should take double the insulin because what if I don’t get home on time! Pretty soon I’ve filled a 10kg suitcase with essentials. 

I have travelled through airports with a pump for nearly sixteen years. When I first had my diestronic pumps the advice given to me was to disconnect and put it through the scanner. This is no longer the advice and I would urge people to speak to their pump team before travel to check how to manage airport security. In my sixteen years of pump use I have never had a pump fail me while away from home, until this year. I did finish off a few insulin pumps when lifeguarding before pumps were really waterproof… 

When I was at probably the furthest point from the UK – I was in Melbourne. I took part in a triathlon and during the swim my pump cracked  (it was a waterproof pump). Filling with water, the screen was no longer visible, the buttons didn’t work and it beeped constantly. Furthermore I had made a rookie error. None of my basal levels were written down anywhere, my insulin to carb ratios where gone and I was left flailing. Luckily, after sticking the pump in rice for a bit the screen was visible for short enough periods of time to write down my basal rates while using a wooden spoon and a washing up glove to hold the battery in place. Safety first. 

So what did I do? 

1. Move over to my spare pump and program in the correct data. 

 Sixteen years ago the idea of insulin pumps I was introduced to was that you always had two pumps one which was used and one which was kept. As a result you then cycled the replacements in so that they become your spare and when your ‘day to day’ pump expires you move to the spare and request a new spare. This means that I still have two insulin pumps as I’ve always ‘cycled’ them! Back then the improvements in insulin pumps were few, so ‘cycling’ was much simpler! Then when I began triathlon and didn’t have a waterproof pump I needed to have a pump to wear until the start of a race and a pump to leave in transition. As a result this aided me in gaining funding for two insulin pumps with my CCG. 

2. Ring the insulin pump helpline. 

 Animas have a worldwide free phone number which operates 24 hours a day. I cannot praise Animas enough. They were fantastic. Within 12 hours of breaking my pump a replacement was being shipped from the UK to Melbourne for me! It took four days in total to arrive. Fantastic! Even better I didn’t have to return the faulty pump until I was back in the UK. 

3. Email my consultant to ask for my basal rates and to check that the ones I had retrieved from the severely water damaged pump were correct. Thankfully, he replied straight away with my basal rates. 

4. Find a suitable address to have the insulin pump shipped to as I was travel around the country and hope that it didn’t get held up in customs! 

Yes for a few hours it was stressful when I had no basal rates, but thanks to amazing customer service my holiday wasn’t ruined and I didn’t have to fly 10,000 miles home for an insulin pump replacement. 

If you are going away, then it might be worth contacting your insulin pump provider to see if they offer ‘loaner’ pumps which can be taken away with you and returned to the manufacturer after. 

Post Surgery Diabetes Management.

January of 2017 started in quite a hectic fashion for me. First my flight home from Austrialia was cancelled which led to a panic that I wouldn’t be returning to work in time (luckily I returned to the UK eight hours before work began) then began coping with major jet lag and swinging blood sugar levels while tackling a week of teaching. However this did not phase me, I knew I had my trusty freestyle libre by my side. 

Jet lag made me feel constantly hypo, stopping anti-depressants also made me feel hypo. Therefore I thought – why not do it all at once! Luckily, this plan worked out. My blood sugars however were on the higher side to what I would have preferred, but nothing a few bolus corrections couldn’t help with. It turns out that fluoxetine had a positive effect on lowering my blood sugar levels – which I did remember from when I started them – and coming off it resulted in rising blood sugar levels. Time to use the libre to identify patterns and change my basal rate. An additional four units added to my basal rate across the day. 

Then I had major abdominal surgery. All I wanted to eat post surgery was ice cream, not the best food choice for avoiding blood sugar spikes! Pre-surgery I was nil by mouth for 48 hours. This did not work out well for my blood sugars. By the time I reached hospital I was in desperate need of energy and there I was given a glucose drip. I managed the glucose drip by bolussing for the grams of glucose in the whole drip throughout the time the drip took to finish. This worked well. However in surgery my blood sugar was low, the anaesthetist happily told me that he had given me a glucose drip and given me a good amount of glucose. Firstly, I was surprised that my blood sugars were checked during surgery. I assumed this was just left to tick along. When I came round from surgery I wasn’t quite with it enough to sort out my readings and bolus for it. Thanks to the freestyle libre I checked my blood sugar many times, yet I wasn’t with it enough to do anything apart from look at the numbers! 

Once the drugs had worn off I was back in control. I could read my libre and adjust my basal and bolus as required. Thank goodness for the animas vibe temporary basal rates. Being able to use a basal of up to an extra 200% was perfect as my body tried to recover, fought off infection and I lay inactive for four days in hospital. 

As I write this, I am still at home recovering and able to do slightly more, yet my previous exercise regime is out of the window. This has resulted in a change of basal rates as I realised how insulin sensitive I am post exercise and an increase of my insulin to carbohydrate ratio in the morning. My blood sugars are staying beautifully within the zone without the stress of work, rushing between places and sudden unexpected exercise that daily life brings. Now if I could take my last two weeks data for an HbA1c then I would be truly happy! 

A snapshot of depression. 

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I’m lying awake in the middle of the night writing this blog on my phone because my dreams are that vivid that I don’t want to go back to sleep even though I feel exhausted. Every night I experience surreal dreams which seem more real than life itself and they are not “nice” dreams. So, why the dreams? Depression and antidepressants. 

Depression has become a daily battle: it makes getting out of bed the hardest task I face in a day. Some mornings I can’t move fast enough and feel like I’m wading through treacle. Depression is the little monkey on my shoulder telling me things are going to go wrong, I’m not doing it right, someone will complain. Depression is a complete lack of hunger, until I feel so ill, exhausted even and realise I need to eat. Depression is a numbness from the outside world and feeling like I’m peering through fog to see those around me. It is bursting in to tears while walking to work for no reason, or feeling so exhausted that I have to go to bed. However I still don’t see myself as “depressed”. I don’t feel sad, I don’t think I’m “down” so why is it a word that’s used in creative writing as a synonym for sad? Search google and images of people sitting on their own with their head in their hands, or the typical ‘Eeyore’ will come up. I don’t wander around like a black cloud is following me. I don’t mope like Eeyore, I’m really optimistic, yet the word depression conjures those images. 

Currently, I am trying to reduce my antidepressants and my symptoms are getting worse. On my full dose I feel ‘normal’. I don’t have to force myself out of the house. I want to do things and I am my “usual” self. Those little tablets really are magic. However at the moment I seek the seretonin highs from exercise, yet I can’t bring myself to do it. I’m too tired, too exhausted, I need to rest. Although after exercise, I feel amazing, I feel like me again. My poor chemically imbalanced brain is happy again. Moving forwards I know I need a plan. I need to timetable to force myself out of the house to exercise. Throughout my adult life I’ve always found I have to exercise a lot of make my body “function normally”. Has my brain craved seretonin for that long? 

Mental illness is something which is shunned and kept quiet, but why? Are we all afraid to admit that we are not feeling great? Occasionally I realise how many other people are taking antidepressants. How many other people are struggling through a day, yet because it is your brain it’s not acceptable to admit there is something difficult. Mental illness does not affect my ability to do my job, my ability to be a good friend. It makes things harder for me, but surely that’s ok? A cold makes things harder for you! 

Diabetes and the menopause. 

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This year, at the age of 28, I have experienced the menopause. At the age of 22 I was offered the treatment of an artificial menopause to help with endometriosis, but this year I bit the bullet and took the male doctor’s advice that “it wasn’t so bad” and began an artificial menopause. 
For me the menopause was something old ladies, maybe grannies, experienced. However since going through an artificial menopause I’ve realised that more people are experiencing it than you realise, yet very little is said about it. It is almost a taboo that no one dare speak about. Who wants to know that you’re reaching the end of your periods? Surely we talk about pregnancy and periods but why not the menopause?

The menopause was not easy. I can easily say the best part of my artificial menopause was when I came off the treatment and stopped it. Returning to “normal” made me feel completely different after four menopausal months. 

I was prescribed nafarlen and began with my artificial menopause. To begin with I experienced terrible headaches, nothing touched them. Luckily this stage only lasted a few weeks for me. Then began the hot sweats. Initially, I thought the menopause wasn’t a big deal. It seemed to make my blood sugars exceptionally well controlled. Every morning I woke to a nice flat line on my CGM and for the first month my insulin to carbohydrate ratio decreased dramatically. I didn’t even seem to get post meal spikes. Even towards the end of taking my treatment my diabetes was exceptionally well controlled. Since stopping my treatment my basal rates have all had to be increased. Especially in the morning and over night! There is a lot to be said for hormones. 

Things were going well…

Until the hot sweats. I can only describe a hot sweat as feeling as though your blood is boiling from your feet to your head. Soon colleagues were noticing that I would go from wearing next to nothing with windows open to being cold and wrapped up. Little comments came my way along the lines of if I wasn’t so young they would know what was up! Little did they know! Post eating my sweats were worst. I would have to stand outside to cool down or only eat a small amount. Then getting into bed would result in a flurry of hot sweats. Sheets on, sheets off. I can only imagine watching me in bed would be akin to watching a yoyo! 

Next came the dry eyes. My eyes were constantly dry and itchy. No matter what I did. I wore my glasses, I washed my face, changed mascara. I now know why you can buy eye drops in the supermarket. Along with the dry eyes came itchy skin. I felt as though I was constantly using moisturiser yet the itching could not be kept at bay! 

As if that was not enough a pack of grey hairs erupted on my head – since stopping the artificial menopause I haven’t had one grey – going from zero greys to what felt like a full head was not fun. 

I am now menopause free and although my diabetes control isn’t as good – I think there is some research to be done here – I am definitely enjoying being menopause free. The menopause is hard work. It is exhausting and I’m hoping I can wait at least twenty years before I have to experience it again. However all being said the use of an artificial menopause has given me the benefits and outcome I needed. Not all bad I suppose. Perhaps I need to stop moaning?! 

Taking Control

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Control is a word that many diabetics are used to hearing. If I get through a day, let alone a week, without a discussion about my control then I’m doing very well. No, I am not a control freak. Nor is my boyfriend ordered about by me day and night. However I am in a controlling relationship. This controlling relationship seems to know no boundaries. It’s a relationship with multiple partners – me, food, my insulin, my insulin pump and my testing equipment whether it be finger pricks or a beloved continuous glucose monitor. I exist in a controlling relationship, which many of my magazines have me believe is unhealthy, twenty four seven. 

As soon as I step inside a doctor’s room to state that I am unwell the first question is about my control. Are my blood sugars on target? Do I have good control? The phrase “good control” sometimes confuses me. What do they mean by good control? Is it a different view to that of both myself and my consultant? Oh I must be ill because my control isn’t good… My control is good. I keep myself alive. I keep myself in range and most of all I eat what I want and do what I want. Yes I will occasionally get it wrong, my CGM may show a Himalayan mountain range, but my day to day levels are good. If I limited myself to four tests in a day I am sure they would all be below 7mmol. However I test more than that and see a larger picture of peaks and dips. I test before I eat, exercise, dog walk, drive, when I wake, when I go to sleep. My life is filled with data and carbohydrate counting. However do I achieve control? Is it even possible to achieve perfect control? After all I enjoy living my life, having fun, making my adrenalin cause a spike or two. If someone could please clarify what this illusion of “control” that I search for daily is, then I would be most grateful. 

Adventures on and off the piste…

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As the ski season is coming to an end I thought I would share my experience of skiing with insulin pumps. Having always skiied, without even considering my diabetes, I feel I enjoy my ski first and control my diabetes around that. I have spent a ski season working in a French resort where we skiied both on and off piste. However this isn’t a resume of my ski prowess…. I’m writing this blog to encourage you to take your diabetes skiing. 

The first thing I take into account is the affect that temperature has on my blood sugar, on my insulin pump, my meter and my food. I store my insulin pump in my bra to keep it warm and easily accessible. If it’s not in my bra it is definitely underneath my thermals somewhere! Next I keep my meter in an inside pocket so it doesn’t get cold and not work, I keep a disposable hand warmer in that pocket too for extra safety. Although if your meter is too cold I have found that putting it under my armpit warms it up rather quickly. After that I take an ample amount of food on the mountain with me. I like torq gels, fudge bars and star-burst to allow me to quickly snack on a lift. Moreover temperature doesn’t seem to make those food items inedible! In addition to carrying extras I use High5 powder in my drink so that I can dribble in sugar throughout my ski. Simply using a camelback rucksac allows me to do this. I usually mix 30g of carbohydrate into 1.5 litres of water and take that much skiing with me. 

I know that the harder I ski, the more energy I burn. I know that everyone needs to reduce their basal by different amounts. I find that a 60% reduction in the morning and a 40% reduction in the afternoon followed by a 30% reduction over night works the car for me. I reduce more in the morning as I find when I get hot my blood sugar drops, therefore putting on my equipment and taking lifts up the mountain can cause hypos. I reduce over night as I know that my glycogen stores will be replenishing and I am more likely to hypo post exercise that involves intense muscle usage! 

This year while skiing I used the FreeStyle Libre to help me identify trends and patterns. This ensured that I was able to act before drops / rises occurred. I simply scanned in the lift queues. 

Mountain lunches seem to be quite carbohydrate heavy and I do treat myself to a hot chocolate therefore my afternoon reduction is smaller. I bolus as usual for my lunch. 

Some people have previously expressed concerns about altitude or cold and their insulin pump. I find I need to check more for air bubbles at altitude. Finally… Always ensure you take spares on holiday with you. Spare cannulas especially! The number of times I have ripped a cannula off removing my multiple layers is unreal!  

Leaving the gym in style (in an ambulance)

Many times during a hard exercise class at the gym I’ve worried that I’ve been about to pass out and require an ambulance, oxygen and defibrillator. However this week I did need an ambulance at the gym. Luckily, this was not related to my diabetes. Moreover it was not because I was so unfit I had collapsed doing burpees. Thankfully,  I was still fully able to take care of my diabetes. However due to a back spasm I was left unable to move, in severe pain and requiring an ambulance. This was ten minutes into my session, 40 minutes into a temporary basal rate and suddenly my exercise had stopped. I’m sure you can guess what happened next, with adrenalin included, my blood sugar began to rise. 

I had with me my freestyle libre, a Torq gel and luckily my insulin pump attached to me. The poor ambulance men were very confused by me asking them to “flash me” by this I meant scanning me with my freestyle libre. As I was unable to move my arms my personal trainer had his first experience of using an insulin pump. He has a great understanding of my sugar levels and signs of them dropping, yet asking him to take my pump out of my trousers, cancel a temporary basal rate and scan me was maybe a step too far. Especially when I was rather grumpy and thought it was quite obvious how to cancel a temporary basal rate on the Animas vibe. 

The paramedics had reassured me that they had their own blood glucose testing kit in the ambulance while they were still trying to work out why I wanted them to flash me. Once I was reunited with my freestyle libre the paramedics were so impressed by the trend arrows and how easy it was for them to see and record my levels. They said they wished all diabetics had one. If only NICE / other professionals could hear such feedback and realise the impact that CGM / Flash Glucose Monitors have across the board for diabetics. 

After five hours in hospital, three canisters of gas and air, tramadol, diazepam, paracetamol, ibuprofen and morphine my back stopped spasming and I was able to go home. If I hadn’t have had my freestyle libre and pump on me in the gym I have no idea how I would have coped in hospital as although A and E were beyond amazing, the paramedics were fantastic, there was not one check of my blood sugar. At the time my diabetes was the least of my worries and the paramedic understood that my blood sugar was going up because I hadn’t completed my gym session and the trend arrows had reassured him that I wasn’t at risk of a hypo. However what if my back spasms in a swimming pool next time and my pump is in a locker? Can I rely on the fact it will be brought to me? Fingers crossed my back has had all the attention it requires for the foreseeable future. However after my second blue lights ambulance experience in less than a year I’m beginning to think I should carry an emergency hospital bag around with me at all times. Or maybe that would be taking things a step to far…