Eating Whatever I Want

My eating has been lacking lately.

Most afternoons of late, I’ve been coming home and sinking my teeth into something sweet. Like the Ice Cream Pannettone sitting in the freezer, that we made with one of our leftover Panettone from Christmas.

The leftover Pancakes I made for breakfast last weekend. A bowl of ice cream. The stash of Woolies choc chip Hot Cross Buns sitting in the freezer. Or, the block of Kit Kats that was on sale last week.

This is rather different to burnouts I’ve experienced in the past, because I’m still diligently covering my carbs with insulin. Dare I say, I’m covering my carbs with insulin quite well. The Calorie King app is my lifeline for things like the pancakes, or the choc chip hot cross buns. If I’m guessing for that Panettone ice cream, I weigh it first and estimate that it’s got at least 50-60% carbohydrate content. My insulin to carb ratio seems spot on most of the time. My levels honestly aren’t bouncing around all over the place, that I sort of feel like I can get away with it. 

I’m also in the midst of what I refer to as the lazy time of year. It’s been a warm start to March. There’s little motivation to go outside, or doing something more productive after work. The heat sucks all the energy out of me, that crashing in front of the air con is the most tempting option at the end of the day. The mornings haven’t been the most comfortable to wake up to either, lacking that cool, crisp and fresh feeling. Thankfully, it seems to be coming to an end…

The energy spike and crash from these carbs isn’t helping my cause. I have felt pretty damn lousy this past week or two as a result. I feel exhausted. I have observed noticeable changes in my mood. I shouldn’t feel like I am limping toward the finish line on Friday, despite a stressful week. 

I know what I need to be doing. Cutting back on the sugar laden foods. Swapping some of the carbs out for fruit, veggies and proteins. Being more organised with meals and snacks. Swapping the spontaneity with more set times to eat.

This is different to burnouts I have experienced in the past, because I don’t feel particularly burned out. I am still actively managing my blood sugar levels and counting carbs. I know I have a lot going on at the moment. Perhaps taking my foot off the pedal and eating whatever I want, is simply a way for me to cope the demands of diabetes and life at the moment.

T1 Talk: Back To The Beginning

Today’s post begins a series of conversations between myself and Bec of Sweet and Sour Diabetes. We first connected through our blogs, and our mutual friend type 1 diabetes. Despite our three year age difference, we have discovered that we both have quite a lot in common. Starting with the fact that we were both diagnosed with type 1 diabetes in May 2010, only a couple of days apart. We’ve started these conversations with the aim of highlighting how type 1 diabetes impacts two people of a similar age, who were diagnosed at slightly different stages of life. Although this is our own unique series of T1 Talks, we would like to give credit to Laddie and Kate for the inspiration from their Type 1/Type 2 Conversations series.

Our first T1 Talk is titled Back to the Beginning. This isn’t your typical diagnosis story.  We aren’t specifically revisiting diagnosis, DKA, or the signs and symptoms of type 1. I guess we’re focussing more on the people who were dealing with a type 1 diagnosis thrown into their lives, and some of the issues they faced.

There are two parts to this T1 Talk. The first half is right here in this blog post. The second half follows over on Bec’s blog, so make sure you head on over once you’re finished here.

Tell us a little about yourself

Frank: I’m Frank from Perth, the most boring city in Western Australia the world. My first foray into the diabetes community was when I began writing my blog Type 1 Writes in 2015, and diabetes has become my passion ever since. Some relatively uninteresting things about me: I’ve been a university graduate for four years. I have a degree in Marketing and Public Relations, but the job market in Australia is a tough one to crack. I hate exercise, but somehow I ended up working in a Warehouse. I love drinking coffee, and I would happily eat Toast at any time of the day. I prefer TV shows over movies. I like music from Good Charlotte and The Fray. My most frequently used word would be “honestly.”


Bec: I’m Bec from Sydney, Australia. For the past few years I’ve been part of the diabetes online community through my blog Sweet and Sour, and now as a reasonably regular contributor to OzDOC on twitter. Outside of my online diabetes life I am a student speech pathologist commencing my final year of study. I’m a pianist, 80’s music and film connoisseur, Harry Potter enthusiast, and TV series binge watcher. I also enjoy reminding Frank of Sydney’s superiority based solely on our fancy coat hanger. I do approve of your music choice Frank, so you’ve got that going for you.

Frank: You’re so lucky. You can just climb the bridge or walk over and have a Cannoli at Rossini’s on the Harbour whenever you feel like it!

Bec: I still haven’t climbed that thing! One day. When I’m no longer a poor uni student.

Frank: You haven’t climbed it? I’ve done it twice and I don’t even live there…

How did you first connect with each other?

Frank: I remember leaving a comment on Bec’s blog on the final day of Diabetes Blog Week in 2015. Most of the blogs I had read at the time were from the US and abroad, so obviously the first thing I noticed was that she was an Aussie! Over the year she left a few comments on my blog, and eventually sent me an e-mail. I’m still not sure whether my reply actually went through, because I later discovered that my outgoing messages weren’t reaching their recipients. I think we connected a lot more once we became Facebook friends, and Bec began joining in weekly OzDOC chats on Twitter (you’re welcome).

Bec: Thankfully I wasn’t shunned by Frank’s dodgy email account; your reply did work. I have no idea when I found Frank’s blog but I’m going to say it was probably around the same time. I had the same response “Look! Another Aussie in the DOC!”. Plus he had a cool graphic/logo for his blog so looked ultra-professional. I became a regular reader/blog stalker and we had a comment exchange happening across our posts. I like to think we’ve become friends over the years. You can be smug about getting me into OzDOC, but I think the real privilege is having access to my bad jokes/film references/cat gifs on a regular basis. You’re welcome.

Tell us a little about what was happening in your life when you were diagnosed?

Frank: I’m one of the privileged few who got to join the diagnosed-a-few-weeks-before-turning-18 club. I was in the midst of a big transitional change in my life. I had newfound independence. I was midway into my first semester at uni, enthusiastically working my first real job, and had only recently gotten my license. It was very “different” to going to school, having the same routine and seeing the same people every day. I also remember spending a lot of time in front of the computer working on uni assignments, which are very different to high school ones! I’m not one of those people who can simply belt out an essay the night before it’s due.

Bec: I can’t imagine being diagnosed at that time. That’s a major transition stage to have T1 thrown in the mix. I was 14 when I was diagnosed in Year 9 at school. The most exciting thing going for me was being a week from getting my braces off. I remember it being a stressful time. I still have my school diary from 2010 and it listed a lot of half-yearly exams and assignments due shortly after my diagnosis. I was busy at school, taking piano lessons, choir, and going to weekly Scout meetings. Quite a bit for a 14-year-old.

Frank: Well, you had to deal with that while you were in High School. And you were doing a lot more than I was at 14. When I think about the amount of time I spent on Homework and exam study, I couldn’t imagine having to deal with type 1 on top of it. Although, it would have been a good excuse to get out of Phys Ed class…

Frank: Your stalking obviously worked, because we’re now diabuddies. But I think the real privilege is being in the circle of cool kids with a Twitter account. You’re welcome.

How much did you know about diabetes prior to being diagnosed?

Frank: I always thought diabetes was caused by being unhealthy. Poor diet, lack of exercise, blah blah blah. I couldn’t distinguish between types, either. I recall the type 1 in my Primary School writing about having to give herself needles in the annual school newspaper. I simply cringed at this thought, and suddenly felt very conscious about the junk food I was eating after school. Meanwhile the type 1 in my High School came as a total shock. He played heaps of sport. I remember he had an insulin pump, and often told our Maths teacher that he had to leave to get some sugar. I think he was just wanted to get out of class…

Bec: Haha dodgy type 1 excuses. I don’t know how he did it, I felt guilty for using it to get out of sport once!

I knew precious little too. I saw 1 person with type 1 in primary school and all I knew was that she could eat jellybeans in class sometimes and had injections. Back then I split type 1 and type 2 into “the needle type” and “the food type”. The morning I was taken to hospital I kept asking my Mum whether I had “the needle type”. She (not knowing anything about it either) believed I didn’t. Woops…

She raided our cupboards that morning throwing out junk food because she didn’t know what else to do. I remember mourning the Milo (thankfully I got it back once we realised excess Milo consumption did not cause my diabetes or anyone else’s for that matter).

Frank: Your Mum throwing away the Milo…hahaha! Seems like you had a greater insight into diabetes than I did. I never genuinely considered what having diabetes meant, or what those people in school had to do to manage.

Bec: She was on a mission! I didn’t consider what they had to manage in any way. I look back and wonder if I said something stupid at some point as a kid. Probably not, was a bit of a wallflower.

How did you react to learning that you had diabetes?

Frank: When I learned I had diabetes in the midst of DKA, I was devastated. I thought I had done something wrong. I asked my Dad if I would have it forever.

I’m usually more of a glass half empty kind of person. But post DKA, I was so relieved to have saliva back in my mouth and my energy back, that I wasn’t really pissed off about having diabetes at all! The extra attention in the beginning was kind of nice, too…

I remember telling people that once my diabetes was controlled, I wouldn’t have to check my blood sugar so often. Ha ha ha!

Bec: The feeling of having done something wrong is a hard one, I’m glad you got through that. I remember that feeling of not being thirsty anymore. It was the greatest thing ever.

I love the blood checking hypothesis. If only!

By all appearances I handled it remarkably well. I was very attentive and wanted to understand everything about it. I felt a little relieved that I could name what was happening to me.

A few days post diagnosis I remember going into my parent’s room one evening and asking them “why me?” Other than that, I was firmly denying any emotion about it because I was too busy learning how to live with it. In hindsight, that’s not the best way to go about it, and it was followed by a pretty deep denial. Oddly, despite the denial, I was an “over-manager”. I just held on to the idea that it was temporary/an inaccurate diagnosis for a good year or so. Almost 7 years on and I’m only recently starting to properly react to it, and that’s okay.

Frank: I’m so touched hearing your “why me” story. I’m instantly reminded of our age difference, and I can’t imagine how you must have felt dealing with it 3 years earlier than I did. Also, you’re not alone. Seven years in and I’ve only just started to actively manage it in the past year.

Bec: Now now, you’re not that much older thank you. But yes, at the time of diagnosis we were definitely in different stages. I was still more naïve kid than adult. I guess that changed pretty fast once I was diagnosed. You took more ownership of it by asking what you had done wrong. Nothing, of course.

What were you told by your healthcare professionals when you were diagnosed?

Frank: That I would be able to live a normal life. Which my parents constantly reinforced to me whenever I made a comment about having a leg chopped off. There’ll definitely be a cure in your lifetime, my Dad constantly remarked.

My first diabetes educator was amazing. She pulled out her famous diagram of the mouth, and the path that food takes when it enters the body and is eventually transformed into glucose to supply the body with energy (I hope I got that right, G). She remarked that I was quite a spontaneous eater, and suggested that most people have a cycle of 10-15 meals that they eat to help better take note of insulin needs. Mum and I still laugh about that idea to this very day…

Unfortunately, I also had an encounter with an endo who told me I had very poor control just months after being diagnosed. Said educator went in and stuck up for me, and made sure that I was never scheduled to see him again on a clinic day. Thanks, G.

Bec: Oh I get in so much trouble for the dark humour/sarcasm, but I’m glad you’ve been supported by your family and G. G is an absolute legend and that endo needed to read their file notes a little more carefully.

My diagnosis confused me at first because it took a while for someone to tell me what it was. An endocrinologist (not mine) came into Emergency and introduced herself. I had no idea what an endocrinologist was. She told us a diabetes educator would be coming down to take me to the hospital’s “Diabetes Day Care”. Ah… so I’m diabetic?

Once I found out I had type 1, I was told there is no cure, but there are remarkable advancements being made in treatment and technology. I’m also pretty sure the cure in ten years was mentioned as a possibility. Most importantly I was told I could live a normal life. I agree with this, but it’s a new normal.

A few weeks afterwards I was told that I “definitely have type 1” after the antibodies test. This was the trigger for my denial. What did they mean? There was a question about it? They can get that wrong? The educators had no idea that one phrase set off a conviction that my diagnosis would change to something “better” in time.

Frank: Wow, such different experiences. I wasn’t “all there” the first 24 hours of having diabetes. I’m not sure how I would have reacted if I had to start learning about diabetes that day.

Bec: I think whilst my sugar was insanely high my ketones were actually not horrific (3.6). I was lucky in that sense. So I was pretty good to go once they injected me with insulin. I can’t imagine NOT learning about it on the first day. I was an information addict!

The second half of this T1 Talk follows on Bec’s blog. We’ll delve into how we each handled type 1 in the initial time after our diagnosis, and some of the initial challenges that we each faced. Head on over to Bec’s blog to read the second half of our conversation here.

P.S. Thanks for floating this idea, Bec, and for being an awesome co-host and friend.

NDSS Debacle

Late last week, I finally received the infusion sets for my insulin pump, that I had been chasing down since December. I was down to my last box, and had even resorted to reusing the sets to make sure they lasted.

I didn’t really have much of a stockpile of sets at home. I’ve been pretty mindful of my ordering, particularly since I had changed infusion sets only a few months ago. Plus, we’ve been told not to over order in ‘fear’ of the recent changes to the delivery of NDSS products. My local diabetes orgs and diabetes educator have told me that there are no issues affecting supply.

This debacle began when I placed a regular order for my diabetes consumables on December 12 through my local Pharmacy. I figured that this order would arrive in time to cover me through Christmas and New Year. When my order arrived only partially filled, I was told that my infusion sets were on back order – but that I would still get them. I waited a week. Two weeks. I was continually reassured that the stock was still coming my way, and that the hold up was due to the NDSS changes.

When the New Year rolled around, I went back and had a chat with my Pharmacy. After a few phone calls, I was told that the manufacturer claimed that it had delivered the stock to my Pharmacy’s wholesaler. Meanwhile, the wholesaler claimed that it hasn’t received the stock. Who do you believe? Who takes responsibility?

I am really grateful for the relationship I do have with my Pharmacy, because otherwise I would have run out of stock much sooner. They told me that Diabetes WA had three boxes of my infusion sets in stock, and advised me to place an order through them while I waited. Diabetes WA still sell NDSS products online, without the free postage option that was available prior to the changes. Thanks, Y.

So, the initial order from Diabetes WA arrived within a few days, and I had two boxes of infusion sets sitting on the shelf. But when I placed my next order in early February, it arrived partially returned, with a note on my receipt stating that the infusion sets were on “back order.” Again.

Diabetes WA only had three boxes in stock in January. I had purchased two, and the final box was likely sold to someone else during the month. I was also still waiting on my order from December. So, I think it was reasonable for me to assume that perhaps there were shortages. I then phoned the manufacturer, AMSL, who told me that they had plenty of stock in Sydney and that there was no reason for shortages.

When my order finally arrived last week, my Pharmacist told me that Diabetes Australia purge all orders after one month, despite the fact that mine had not yet been completed. That was, apparently the hold up.

When my order from Diabetes WA arrived a few days later and I suggested this reason, I was told that it was the manufacturer who purges all orders after one month.

To add to this, I’ve also heard another rumour that Animas Comfort infusion sets are being discontinued and these last four boxes had to be specially ordered for me.

Who do I believe?

There are two morals to this story. And well done if you’ve made it this far into my rant…

  1. Have a good relationship with your Pharmacist – they will be your friend and advocate and can give you advice.
  2. Get on the phone with your Pharmacist, the NDSS, the manufacturer, and keep reminding them that you haven’t received your orders. Don’t wait too long for them to call you back, because there’s a good chance they’ll forget.

A massive thank you to everyone who helped me chase down my orders through this long ordeal.

I now have four boxes of infusion sets sitting on my shelf at home. Hopefully my next order will arrive before they are depleted.

How I Manage My Blood Sugar During Exercise

I’ve learned a fair bit about physical activity, and how to manage my diabetes around it in the past year. I guess having my job and my income depend on it, is a big motivation.

I am physically active at work every day, which means that I am more sensitive to insulin and more prone to going low through the day. Combine this with trying to offset dawn phenomenon when I wake up each morning, and you’re left with one very tricky equation.

One positive of combining work and exercise, is that every day is Groundhog Day. There is no shortage of opportunities to experiment. And when something does go wrong, I get to repeat it the following day in almost identical conditions. Not to mention that I don’t need to feel guilty about telling my doctor that I don’t go to the gym!

The negative is that at times, diabetes has felt very gruelling to manage while I am at work. The motivation to basal test, or to conduct experiments, isn’t always there. There have been days where I’ve literally been juggling highs and lows with insulin and food, respectively. There have been weeks where I felt like I haven’t gotten anywhere, and it’s often hard to pick myself back up and carry on.

Your diabetes, and the kind of physical activity that you undertake, will likely be different to mine. However, here are a few of the strategies that have worked for me while I have been physically active in recent months.

I would class my level of activity as mild – being on my feet, lots of walking around, some climbing up and down ladders and lifting. There are some days where it is more intense than usual – particularly if we are busy. But I find that most days, my level of activity is identical.

I find that for this mild level of physical activity, I need 30% less basal insulin compared to when I am vegging out at home. The 30% reduction in basal insulin needs a lead time of around half an hour before I start work. Most would suggest an hour’s lead time, however I don’t feel that my level of activity is at full speed until half an hour into my work day. I.e. I’m spending too much time chatting to people in the morning!

Mealtime boluses are still a work in progress. I’m currently sitting on 1 unit for every 8 grams of carbohydrate. At breakfast, my full insulin dose does its job, as I’m not on my feet for another hour and there’s probably some dawn phenomenon in play. I’ve tried reducing my insulin dose for meals during my work day with mixed results. At morning coffee time, I’m dosing insulin or snacking while I’m on my feet. Whereas at lunch time, I’m dosing insulin at the start of my break and not going back out to work for another hour. I’m working with a 30% bolus reduction with morning tea, and 15% with lunch.

I’m probably about two thirds of the way there. My overnight, and morning BGLs are looking fantastic. I just need to focus on getting some more green numbers into the afternoons, so that I’m not going home and snacking or eating dinner on higher numbers. It’s been an ongoing issue.

Work has been a gruelling journey, but I have finally began seeing results in recent months. Putting the hard work into fine tuning my basal rates and mealtime boluses has been invaluable towards a productive day, free from the stress of highs and lows.

I’m not so terrified of going to work without wearing a Libre sensor anymore, and I can comfortably go for two or three hours without needing to check my blood sugar. When I uploaded my meter data to Diasend on the weekend, I realised that I had only had three lows in the last fortnight. Freaking awesome. I finally feel a level of confidence in what I’m doing. 

Another piece of advice that I never gave myself: give yourself a break. When I was on injections I would often come home with exhausting lows, crash on the couch and eat my way out of it with junk food. I failed. Constantly. The task of fine tuning insulin felt overwhelming, and the motivation was never there. After my pump start, I was under the illusion that I’d have everything down pat in a number of weeks. In hindsight that was such an unrealistic goal. Give yourself some room to breathe. Maybe basal test every second day. Or have a few days off from your experiments if they’re feeling overwhelming. Set small goals.

As with any element of managing diabetes, it takes a lot of time and patience. You won’t necessarily get it right the first time. Or even the tenth. Goal posts are always moving, because diabetes is always changing. You’re always learning, and putting two and two together.

But with time, you pick up these valuable little skills that will make fine tuning your next diabetes scenario a little easier.

Clinic Days

Clinic days always feel a little extra special to me.

It starts with anticipation. I feel like I’m going in for a job interview of sorts, rehearsing in my head what I’m going to say when I’m in there. I’ve got a list of notes on my desk that I add to in the days leading up to my appointment, of all the things I want to bring up when I’m in there.

There’s almost always a period of erratic blood sugars in the lead up to the appointment. It doesn’t matter how good my numbers have been in recent weeks or months, it always happens without fail. Entering into evidence yesterday arvo…

And of course, those most recent numbers are the ones that appear first on a Diasend report!

I get to leave work a little earlier than normal, which is always a bonus. I head onto the Freeway and drive towards the city, which is usually a breeze. I remember to bring my satchel with me, after having to walk with full arms and some very weighty pockets last time. Wallet, keys, phone, pump, wifi hotspot, meter, skittles, appointment letter, water bottle…you know the drill.

I search for free 2 hour parking on the street, rather than having to pay $6.60 in the hospital carpark. Weather permitting, of course. I cross the busy road, and follow the pathway adjacent to some beautiful green gardens.

By the time my appointment is done, I’m usually feeling pretty good about myself. I walk back to my car and begin the journey home, by which time I usually get stuck in traffic. When I finally get to Leederville, I pull into the carpark and grab a free one hour ticket. I walk through the alleyway and cross the road, where I arrive at Chocolateria San Churro. I usually order a regular takeaway White Hot Chocolate, which costs me roughly the same amount I saved on parking.

I have to manage type 1 diabetes every single minute, of every single hour, of every single day, for the rest of my life. I check my blood sugar, count my carbs, dose my insulin, eat my food and get on with my day. Until I have to do it again. I put a lot of work into keeping my blood sugar levels between 4 and 8 as often as possible. Yet I hardly ever stop and give myself some credit for my self management efforts. That’s not necessarily a bad thing. It’s just that I’m more focussed on trying to live my life at the same time.

Results pertaining to my diabetes management aren’t the only special thing about a Clinic Day. Clinic Day gives me a chance to stop and reflect on my diabetes management efforts, and give myself some credit where it’s due.

A White Hot Chocolate is my reward for getting through another few months with diabetes.

Here’s to many more…