Month: July 2017

T1 Talk: Food, Exercise and Emotions in Check

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Welcome back to T1 Talk, a series of conversations between myself and Bec of Sweet and Sour Diabetes. The aim of these conversations is to highlight how type 1 diabetes affects two people of a similar age, diagnosed at slightly different stages of life (Bec was a 14 year old high school student, I was a 17 year old freshman uni student).

Haven’t caught up yet?

You can learn more about us in our first post here.

We’ve talked about our management tools here.

Today, we’re tackling the not so technical side of our management – namely food, exercise and emotions. The first half of the chat is here, and the second half follows on Bec’s blog here.

In order to remain healthy, people with and without diabetes often consider food as a fundamental part of maintaining their wellbeing. What are your views on nutrition? How do you include this in your management?

Frank: Food is a really tough one for me. Being Italian, there’s a pretty big emphasis on food. It’s ingrained into our culture. If I don’t eat, my parents notice pretty quickly. If they didn’t see me prepare lunch this morning, they will ask me what I ate. When I go to visit Nonna, it’s almost expected that I’ll have an espresso and biscotti. When we hosted Mum’s family for Easter this year, I spent three days trying to reassure her she had prepared more than enough food.

I love food, and we do have some of the best. Pasta, cannoli, amaretti, cottolette, lasagne….I could go on for days. However, we are talking about diabetes here.

I feel that I eat fairly well. I prepare my own breakfast and lunch most days, and we usually have a cooked meal in the evenings. I drink three milky coffees a day, and usually find myself most peckish in the afternoons and caving in to my sweet tooth.

While nothing is off limits for me, diabetes has certainly made me more mindful of what I’m eating. I’ve cut back on a lot of the sugar laden foods I once ate – cereals, muesli bars, stir through yoghurt pots, and the sugar in my tea and coffee – as well as foods that I realised I didn’t truly enjoy. I am more mindful of the carbs I eat today, and try to balance them out with proteins, fruit and veggies. I would typically eat between 100-150g of carbs a day, which is less than what’s recommended but certainly not low carb.

I feel I have a pretty good idea of what different foods will do to my blood sugars. I’m quite diligent with my carb counting at home, and weigh most of my food on kitchen scales. Even if I don’t know the carb content, simply weighing the cookie and guessing a carb factor of 60% is extremely helpful. I try to pre-bolus by 15-20 minutes if I’m having a higher carb or higher GI meal, but I don’t do this all the time. If I’m having a bit of a cruisier day of eating, I’ll simply set a temp basal rate of 100% on my pump to help me cruise through a little easier.

Bec: I think the idea of tying food into culture is actually lovely, and I definitely don’t experience it. In some ways that’s a good thing considering I’m gluten intolerant and a lot of things would be off the menu if I were Italian!

Eating isn’t my favourite thing. I get a lot of strange looks for this, but I don’t get particularly hungry. I wish I could live off tea and coffee. It’s just a long boring task for me to find something to eat that’s gluten free, work out the carbs, take the insulin and then eat it. That being said there are some foods I actually do enjoy eating, like chocolate, cake, thai food, and risotto.

I think I have the same goal of being a little more organised. I need to increase my carb intake for medical reasons, but it’s hard when you’re not hungry. I also don’t think about food very much in terms of GI and what it does to my sugars. For now though, I’m just focusing on 1) increasing my intake and 2) attempting to count carbs accurately.

Frank: I feel like this gif is relevant in response to eating not being your favourite thing…

(I’m kidding).

Well, I could easily live off coffee (decent coffee, of course), so at least we have some common ground there.

I want to say that maybe you just haven’t found enough of those foods that you enjoy. Keep searching! You don’t need to be European or have a big family to tie food into culture, either. Does your family not have a special dish that brings you together? A meal that you all simply rave about?

Bec: That gif perfectly represents everyone’s thoughts, often followed by measuring the circumference of my wrist…

Well, Mum’s Christmas lunch is pretty great but unfortunately only occurs once a year. My Nan used to make an amazing meal fondly named porcupine rissoles which no one has since replicated to perfection. But hey, I’m always keen to try new food to find something I actually enjoy.

What are your views on exercise?

Frank: I’ve never been the biggest sports person, and that dates back to well before diabetes came along. Our culture has too much of an emphasis on sport and on winning, rather than on just having a good time and doing what makes us happy. I never felt comfortable or encouraged playing sport because I wasn’t the best, while being on the debating team in Year 10 earned me a great deal of sniggers.

Most of my physical activity would be incidental or recreational activity. Fortunately my job as a Warehouse attendant keeps me fairly active. I do dread the day that I get a job sitting behind a desk, because then I’ll probably have to start doing some form of exercise. I also enjoy going for walks in the afternoon, and keeping this little man entertained when he comes to stay with us.

Bec: Ugh. Exercise. I get it to an extent, when I go on walks I do get that adrenalin rush, and it is a good way of staying present. But organised sport is a recipe for disaster. I hated it because I wasn’t perfect at it. You might have gotten sniggers for debating, but I WISH I could have done that at school! It was just so sport focused the only outlet I had was choir (a sequined experience involving dodgy dance moves that I’d rather forget).

I agree we are heavily focused on sport as a culture. I don’t mind it in some ways, after all I do follow the NRL off and on. But it’s not a core part of my life. I also agree that it’s important not to be so focused on winning. It has no appeal to me because I’m too uncoordinated to be perfect at it. Really though, perhaps I should be thinking about shifting the focus off perfect and on to fun.

But taking it back to diabetes, exercise makes me hypo. Very hypo. But I try to keep up the walking in spite of it, because I don’t have as much incidental exercise as I would like. Then again, I make up for it on hospital placements. So. Many. Stairs.

Aw, you certainly have a good motivator there! How can you resist walking that little guy?

Frank: I’ll never truly understand how Australia came to have two different footy codes. Clearly, AFL is where it’s at. I had my hopes up for Freo a few years back, but it’s looking very unlikely nowadays…

Urgh. Exercise hypos. Such a pain, moreso with the insulin pump. You even have to remember to adjust your basal rate for housework!

I’d be keen to hear more about managing diabetes on placement…would make a great blog post.

The second half of this chat moves onto emotions, so head on over to Bec’s blog to continue reading here.

Feeding the D-Tech Frenzy

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Growing up, many of the appliances in our house had longevity. When an item malfunctioned for the first time, there was a pretty good chance that it could be fixed. When the VCR began spitting tape out of our videos, the handyman came out and put some new parts into it. When our second hand Windows 98 computer got stuck in Safe Mode, my Aunty’s computer guy came over and fixed the belt inside the box.

When a beloved household item came the the end of it’s life, I watched Mum and Dad mourn over how well it had served them and how hard it would be to replace. As those items were eventually replaced, we noticed that they all had one thing in common. They never lasted nearly as long as their predecessors. I can’t begin to count how many kettles, washing machines, printers, televisions and computers we’ve gone through since the originals packed up.

We live in a very consumeristic society. Nothing is designed to last anymore. Today’s innovations will likely become enhanced or obsolete in a few year’s time, and the attitude seems to be to throw it away. Everything has to be brand new. Sure, things are far cheaper than they once were, but we probably spend just as much on replacing defunct items.  It’s hard not to feel that we as consumers, have fed this frenzy to a degree.

It’s hard not to feel that diabetes technology is heading this way, as well.

No sooner than the Dexcom G5 Continuous Glucose Monitor was released, I was already reading about plans for a Dexcom G6. No sooner than the Medtronic MiniMed 640G insulin pump had begun rolling out, I was already hearing about plans for the hybrid closed loop 670G. Tandem recently rolled out an upgrade of their t-slim insulin pump. Bigfoot Biomedical, which have a closed loop system in development, recently announced a partnership with Abbott that will utilise data from a “next gen” FreeStyle Libre system. We even have confirmation of Apple entering the market. 

Technology is the hot topic of the town in the diabetes community – and rightfully so. Who doesn’t get excited about all of the advancements in the pipeline that will improve the treatment of diabetes and the quality of our lives? Who wouldn’t get excited about a shiny new device, just like we do with our smartphones and tablets and cars? Diabetes is monotonous, so I’ll certainly appreciate anything that makes it a little more exciting.

Call me a hypocrite writing this, because I am an enthused user of diabetes technology. I am a privileged person. I get excited over a shiny new gadget, and I am grateful that the tech is an option for me.

But I kind of feel that we, as consumers, have fed this technology-focussed frenzy to a degree.

When looking at the bigger picture, it doesn’t feel like an actual cure for type 1 diabetes is even on the horizon. It’s beginning to feel like these advancements are no longer a solution, but rather a pathway to the next enhancement or product.

If my social media feeds are anything to go by, people are crying out over the skyrocketing prices of insulin, and access to basic healthcare. Then I look at all of these advancements, and I wonder just how many people the end product will actually reach.

Dad showed me an article in the paper yesterday, of promising research on insulin producing cells, or something like it. I dismissed it instantly, citing that I’d likely never hear of it again as I have with many other developments that qualify closer to a “cure” status.

I wonder why we aren’t questioning companies on the feasibility of these advancements. I wonder why we aren’t holding companies to greater accountability for their actions. I wonder if we are throwing enough support behind research into potential diabetes cures. I wonder if we, as the consumers, are taking full advantage of our ability to drive the agenda.

I wonder if we have lost sight of curing diabetes.

The Cost of Having Diabetes For a Year

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It’s tax time. I’ve just spent the weekend being a good brother and completing both of my siblings’ tax returns, as well as my own a week ago.

The topic of conversation over dinner on Friday night was annual incomes, and how they stack up against all of our living expenses. Then, as if trying to prove his point, my Dad asked me how much all of my diabetes expenses would add up to.

I guess I’ve never really done the sums before, for a few reasons. My diabetes and broader health are non-negotiable expenses, drummed into me by parents (second only to eating). Obviously here in Australia, we are extremely lucky that most of the essentials are heavily subsidised, and I’ve never genuinely struggled to make ends meet. I’ve also received a great deal of support from my family in terms of meeting the costs associated with my diabetes care.

So, maybe I should count myself lucky that I’m only doing the sums for the first time today.

Test Strips – $918.50

I would go through at least 15 test strips to monitor my blood sugar each day.

That’s 5,475 test strips a year.

Or 55 boxes of 100 test strips a year.

A box of test strips will set me back $16.70, which costs me a beautiful $918.50 each year.

Infusion Sets – $217.10

I would change the infusion set on my insulin pump every three days.

Thats a total of 122 infusion sets each year.

Or 13 boxes of 10 sets per year.

A box of infusion sets will set me back $16.40, which totals a fantastic $217.10 a year.

Insulin Cartridges – $54.50

I replace the insulin cartridge in my pump once a week.

That’s 52 cartridges each year.

Or 5 boxes of 10 cartridges per year.

A box of cartridges sets me back $10.90, which adds up to a cool $54.50 each year.

Insulin – $77.60

A 3ml cartridge of NovoRapid insulin lasts me roughly 7 days.

That’s 52 cartridges a year.

Or two scripts per year, each containing five boxes of five NovoRapid cartridges.

A script of NovoRapid penfill cartridges sets me back $38.80, which is a cheap as chips $77.60 per year.

(Thank you Australia, for making insulin so relatively affordable. Unfortunately the rest of the world doesn’t have the same luxury).

Private Health Insurance – $918

I wouldn’t want to be without a private health insurance policy. It covers the cost of any hospital visits, treatment, as well as rebates on other services such as dental and optical. It’s a small price to pay for the peace of mind, as well as the $9,000 insulin pump that was fully covered under my policy last year!

I renew my policy annually, which set me back an awesome $918 this year.

(Not to worry, it only gets more expensive with every passing year!)

General Practitioner – $16

I would only visit my GP if I need something. Such as an examination, a signature, or a fresh script of insulin inbetween endo visits. Or if I’m dying.

I might visit my GP twice a year.

After a Medicare rebate, I’m usually left to pay $8 out of pocket, which adds up to an awesome $16 per year.

Diabetes Educator Sessions- $100

While I see an endo for free at the hospital, I choose to see a diabetes educator privately. Private education gives me invaluable support and one-on-one time that the public system simply does not allow for.

I would visit my diabetes educator five times annually.

After a Medicare rebate, I am left to pay $20 out of pocket for each session, which totals a cool $100 a year.

Hypo Treatment – $40

My go-to treatment for hypos are Skittles. 

I buy them in party buckets.

I would buy four party buckets a year.

A party bucket sets me back $10, which totals a nice $40 a year.

Grand Total – $2,341.70

It costs me $2,341.70 to live with diabetes for a year. That’s not even factoring in the intangible costs. It’s a fair chunk of my annual income. It saddens me, because it would definitely make a dent in a few bills at home, among other things.

However, I also count myself fairly lucky, because I know that my counterparts overseas might not be as fortunate as me. If I have to live with diabetes, then there’s no place in the world that I’d rather live with it than in Australia.

But seriously, I think it’s time we make these expenses tax deductible.

Better yet, give us a chronic illness tax offset. C’mon, Australia!

Getting the Most Out of a Flash Monitor

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I’ve recently started freelancing for Diabetes Daily, which means that from time to time I’ll be linking to some of my columns over there.

The topic I am most frequently asked about is the FreeStyle Libre. While my experience with the device has been an extremely positive one, I definitely didn’t hit my strides after my first sensor. Any shake up to your diabetes management is going to be an adjustment. In my first column, I wanted to share some of my tips and tricks for a smoother transition from finger sticks to flash monitoring.


Like the fact that getting out of the shower, or going from a dark room to a bright one, can cause momentary changes in the readings. 

Or that higher blood sugars can cause greater variances with a traditional blood glucose meter. 

And that I shouldn’t obsess over the small variances, because two blood glucose meters won’t ever produce an identical reading!

You can check out the full column over at Diabetes Daily right here.

(That being said, Your Diabetes May Vary!)

 

Mixing Up Finger Sticks and Flash Monitoring

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I don’t cope well with the continuous nature of glucose data. After prolonged periods of using my FreeStyle Libre, I tend to get a little fatigued and overwhelmed. I know that I’m not getting the most out of my flash monitor, which I pay a pretty penny for. Perhaps I might feel differently if I were not an insulin pumper as well, and the Libre was the only technical device I had to deal with.

Over the last couple of months, I’ve settled into a routine of wearing a FreeStyle Libre sensor for the first two weeks of the month, and then imposing a break which sees me going back to fingersticks.

Mixing up flash monitoring with fingersticks helps to keep things fresh and exciting for me. These little breaks help me to clear my head from the constant flow of data that’s just a scan away. It helps me to re-evaluate my glucose monitoring habits, and whether I am checking my blood sugar out of necessity or simply for the sake of it. It also keeps me from becoming too reliant on the Libre, considering it is costly and not currently subsidised here in Australia.

However, I have also found fingersticks challenging after using the Libre. Over the past year or so, I’ve been learning a lot about my blood sugars and applying some of these observations towards my diabetes decision making. I usually apply a new sensor with the intent of, for example, analysing my overnight line or basal testing my work day mornings. But with diabetes being diabetes, two weeks is simply not enough to complete all of those little tasks I’ve set out to achieve.

Coming off the Libre has felt a bit like driving somewhere south of the river without directions. I’ve often found myself feeling lost in those little problem spots, anxiously trying to keep my head above water with finger sticks. By the time my self imposed break is up, I’m ready for a new sensor.

However at the moment, I find myself in somewhat unchartered territory.

I’m currently in my longest stretch on fingersticks since I first began using the FreeStyle Libre last year. There are two unopened boxes of Libre sensors on my shelf, and I haven’t felt any desire to put them to use in some time.

I don’t feel like I am struggling without it. I’ve applied what I’ve learned and observed. The problem spots are slowly but surely smoothing out, and starting to feel less problematic. I feel…comfortable.

I guess I have always perceived the Libre as a tool to evaluate elements of my diabetes management, rather than a tool to directly make my decisions from every day.

At the moment, I feel like I am where I have wanted to be for a long time.