Type 1 Writes Diabetes Christmas Gift Guide II

We are less than two weeks out from Christmas, and I am yet to do any Christmas shopping whatsoever. If you’re anything like me, you’ve probably spent hours surfing the net with the intention of finding gift inspiration, only to end up finding a whole bunch of new things for yourself. Not to mention my broken pancreas that leaves me on call 24 hours a day…

These are some of the things on my Christmas list this year. Some are related to diabetes, others not so much, because there’s more to me than just my diabetes.

Clockwise from the top left, here we go…

AlCase 3m Lightning USB Cable. I love this iPhone cable for both it’s length, and speed of charge. At 3m long, it reaches my bedside. It charges 10-20% faster than the standard Apple lightning cable, and is compatible with iPads as well (not all lightning cables are). Diabetes quirk: I always read it as the A1C Case, rather than the Alcase every time I glance at it.

Bonds Besties Shorts. In the heat of the Summer, 100% Cotton shorts are what I’m often wearing around the house. They’re soft, breathable and don’t leave me sweating or sticky when I’m sitting behind my desk or on the couch. Plus, lots of pockets for insulin pumps and diabetes crap.

Target iPhone Folio Case. I very rarely buy phone/tech accessories in the shops, because the prices are just a plain rip off. However, I was pleasantly surprised to find this folio case in Target a few weeks ago for just $8. It’s fairly slim, and has two card slots inside. I like it because it can double as a wallet, and when you’re a guy with diabetes, you really need to maximise as much pocket space as possible!

FreeStyle Libre Flash Glucose Monitoring System. I’ve been using the Libre intermittently throughout the year, and it really has provided me with a great deal more convenience and insight into glucose monitoring. Yes, it’s definitely a luxury item, and I’m extremely lucky I’ll be able to wear one during the Christmas season. You can read my initial review here, and my cheat sheet here.

A real Christmas Tree! I must admit I was a little against this idea when we first did it a few years back, but I quickly became a convert. It would be such a cool thing to do with young kids, and I think it’s perfectly suited to Australia’s Summer Christmas. You go to the Christmas Tree Farm, pick your tree, cut it down with a hack saw (they’re fairly easy to cut), and wheel it back to your vehicle. I visit Christmas Trees of Wanneroo in Perth, and judging by the last couple of years, it seems to be growing in popularity.

Dexcom G5 Mobile Continuous Glucose Monitoring System. Although I have never used it, this is definitely on my bucket list for 2017. If you have a compatible mobile device (such as an iPhone) to receive the data, you no longer need to purchase the $650 receiver with your first order. There’s a special offer going at the moment from AMSL Diabetes in Australia that includes a transmitter and 4 sensors for $810. Again, this is definitely a luxury item, but I like the idea of being able to stretch the 7 day sensors to 14 or 21 days.

Gourmet Chocolate Pizza. So, a few years ago, one of my work Mums found this Chocolate Pizza on clearance in Coles after Christmas. It was out of date, and it was the last one left. She bought it into work, and we shared it over our coffee at work one morning. It was honestly one of the best pieces of chocolate I have ever eaten in my life. None of us have ever been able to find it again. I’d love to surprise them with one, but it’s just too expensive to pay the shipping from the UK! One can only dream…

Coffee Club VIP Card. I know, I know, Coffee is a very divisive issue out there in the world (just don’t say Gloria Jeans…) Me and my friend make a pit stop at Coffee Club every morning at work, and the VIP Card gives us 2 coffees for the price of 1. I know most loyalty cards are absolute rubbish, but this one really pays for itself every week, and has turned me into a person who buys a coffee every day.

Merry Christmas, folks, and best of luck to those of you bracing the shops this week!

A New Addition to Team Frank

“What else has happened in your life since diabetes came along?”

“How comfortable are you when you pull out your insulin pump or prick your finger?”

“What concerns you the most about living with diabetes?”

These were just some of the ice breakers as I sat down with a woman who I hoped I would be able to call my new diabetes educator, in a private clinic last week.

After six years of diabetes care in a public hospital, this was a completely different experience. My diabetes clinic-that-wasn’t-technically-a-clinic was situated behind the corner pharmacy store on a quiet inner city street, rather than a bustling hospital campus. My session was in a room on the ground floor, with an open window looking out into the yard behind the building. There was no sense of urgency, nor did I feel that my appointment was being rushed. There were no interruptions throughout the whole hour. I was being spoken to like a person who had diabetes, rather than the diabetes patient. The place certainly didn’t feel super clinic-y, either. Everything just added up to a nice, casual vibe. 

We looked over my diasend uploads, and straight away she picked up on trends of red numbers on weekends. Something my diabetes brain probably should have picked up on sooner. I admitted to cruizy days of weekend eating that were often triggered after a 10am hypo, and she helped me nut out a strategy to continue to cruise through and see a little more green.

I wasn’t really swayed one way or another as I talked through my diabetes management, either, and I wasn’t sure if this was a good or a bad thing. I suppose, like this decision, it was mine. It was diabetes on my terms. No judgement.

As we approached the end of the hour, I was asked how I wanted to proceed after today. I knew how I wanted to proceed. Yet I still hesitated for a moment.

I had spent the whole hour talking over my diabetes management so confidently. The numbers on my diasend report were pretty good, overall. I had reached the hba1c goal I had set myself at the beginning of the year. This session reassured to me how proactive I am in being able to manage my diabetes. Did I need to be here?

After being pushed towards self management for so long at the hospital, it felt strange to have the option there. After all the time constraints of the busy diabetes clinic, it felt super weird to have the choice of when my next appointment would be. I was paying for it, of course. But it still felt strange.

I’ve decided I want a three month catch up with my diabetes educator. As good as I may be, I still need that reassurance. I need that fresh set of eyes that can pick up things that my diabetes brain cannot. I’ll continue to see the endocrinologist at the hospital, and get referrals for all of my important check ups there. Most importantly, I’ve got someone to touch base with inbetween. If the need arises, I’ll be able to call or e-mail, and make appointments inbetween. I already rest a lot easier at night knowing that I have someone reliable at the ready.

Two years ago, I doubt I would’ve had the confidence to be able to identify my needs, to speak up for what I wanted, or to go through with such a big decision.

Today, I’m confident that this is one of the best decisions I’ve made for my diabetes care. With a new addition, Team Frank feels stronger than ever.

Skyrocketing Levels

A couple of weeks ago, I hit a bit of a speedbump with my blood sugar levels. I began skyrocketing after almost everything that I ate. It took several correction doses and hours of temp basal rates to get me out of my mess each time.

This is what I would often witness on my Libre after a meal. My levels would simply climb and climb and climb until they reached the high teens.

My first instinct was that my body was responding to changes in my diet. I have been eating less carbs, and more protein, consistently. If I needed proof, the total daily dose of insulin in my pump history was at its lowest, and most consistent amount day to day. I was still suprised, though. To me, the changes weren’t anything radical. I had been bolusing for my protein. I hadn’t cut out carbohydrates completely, nor was I restricting my food intake.

But it seemed that my insulin was a lot less sensitive than it once was.

My first thought was to revisit my basal rates. I was convinced they might need revising upward. Moreso after reading this article, which told me that the “status quo” for people not on high carbohydrate diets was 50% basal and 50% bolus (mine are skewed in favour of bolus insulin). I was convinced that if I fixed that, my mealtime insulin would do its job properly once again. However after going low during two separate basal tests, I conceded that my basal rates were fine.

My levels were still spiking after meals, so my next thought was my insulin to carb ratios. The spikes were absolutely ridiculous, even with lower carbohydrate meals. I adjusted my insulin:carb ratio from 1:10 to 1:6, and lowered my insulin sensitivity factor by the same proportion.

1:6 was quite a scary ratio to use, because I had such big amounts of insulin on board after eating a meal with only 30g of carbohydrates. The potential to go low from after meal activity was amplified, and pump sites would ultimately need more frequent rotation. Thankfully, it became clear that the 1:6 was sending me too low after meals, and I eventually settled on 1:8.

The 1:8 has been working great, and I have learned a few things about food and my blood sugar spikes since. For instance, on the weekend I ate porridge, which I thought was relatively low GI. Apparently the instant, microwaveable kind, is not. Not even close. And despite accurate carb counting, pre bolusing by half an hour, and a waking BG of 7.9, my levels just climbed. 9.2 an hour later, 14.7 after that, and 15.7 after 2 units of correction. Instantly, bells rang in my head as I recalled occurrences of skyrocketing blood sugar levels after Weet-Bix, potatoes and an overripe Banana.

So, yes, it does seem that less carbohydrates has reduced my insulin sensitivity, or increased my sensitivity to glucose. But it also seems that my insulin to carb ratio is less effective when I eat higher GI foods. And perhaps there were also some stress hormones in play a few weeks back, that were contributing to some of those skyrocketing blood sugar levels.

I absolutely hate that diabetes is forever changing. There’s no guarantee that what’s working today, will work again tomorrow. Or in a month. 

But nonetheless, it does feel good to be somewhat in control once again…and a little wiser…