“Can I Tempt You With a Sugar Fix?”

Can I tempt you with a sugar fix, Frank?

I could see snakes, chewies, sour worms, chocolates and other party mix lollies in the bowl my boss was holding in front of me, as she asked ever so nicely.

No thanks, I’m fine.

Oh!  She replied with a small gasp, presumably recalling the fact that I have diabetes. Sorry!

There it was.

That presumption that just because I have diabetes, I couldn’t dip my hand into that jar of lollies. Even though I was certain I’d had this conversation before, and hundreds of others like it.

I felt cornered. Defined. I hated seeing someone else make presumptions about what was best for me. And I felt this rising urge to explain.

It’s not that I can’t have them, I just don’t want any at the moment.

The truth is, I’m not a big fan of lollies. Sure, I like them. Sure, I’ve been known to eat them from time to time. But they’re not my absolute favourite sugar laden treat food in the world.

Sure, I could of grabbed a piece of chocolate. But I’d just had my morning tea, and no longer felt particularly hungry. I was also physically working, and wasn’t keen to screw up a steady blood sugar with something spontaneous in this moment. I’ve also been eating far too much junk lately, to the point where I’ve even been treating hypos with Easter eggs. So I am definitely making a conscious effort to be more prepared with my eating behaviours and scale back on the chocolate.

Just like any other person out there in the world, I will politely turn down food from time to time.

All I ask is that you don’t assume that my diabetes is the reason.

That Damn Clip

What’s the worst thing about wearing an insulin pump?

It’s not the feeling of attachment all the time.

It’s not the constant attention required towards infusion sites, batteries, pump lines and insulin cartridges.

I’m not even bothered that the pump is still not a freaking cure for diabetes.

What bothers me the most about my pump is that damn clip.

It wobbles. All. The. Bloody. Time.

Despite my many repeated attempts to tighten that tiny screw that holds both parts of the clip together, I’m lucky if I’m rewarded with a week free from wobbliness.

It doesn’t stay clipped to my clothes properly unless I actually thread the fabric inbetween those two bits of plastic.

It’s a bloody pain to pull apart from my clothes when I want to have a glance at it. Which, let me tell you, is quite a lot. Not to mention having to thread it back on again when I’m finished.

My affection for this delightful clip escalated yesterday when the two parts of my clip, held together by a screw, snapped apart.

When I called the Animas helpline to see about getting it replaced, I learned that this clip is only covered under warranty for six months. Yet the $9,000 pump is covered for four years, despite it already looking quite tired after one.

I can’t say I’m keen to waste another 30 or more dollars on a new clip that I don’t like, and which I know won’t last.

I’d love to buy one of those awesome clips on eBay that I could simply stick to the back of the pump. But of course then I’d be blocking the little infrared patch, which I need access to when I upload my pump data to diasend.

So last night, I went out to the shed and attempted a little DIY repair on my pump clip.

I’ve put the clip back together with a putty called Knead It, that dries like cement.

Cement will hold better than screws, right?

Giving Context to a Hba1c Result

I really want to get my hba1c done. I have a referral to pathology sitting in my diabetes file at home, to tide me over until my next endo appointment. But I know it’s still a bit too soon. 

I have a pretty good idea of where I’ll be sitting. Yet my deepest, darkest desires are still chasing sight of a number. A scorecard. That stamp of validation, that will tell me how well or not-so-well I have been doing with my diabetes over the past couple of months.

It’s silly, really.

A hba1c is just a number. It’s only one small element in the scope of managing diabetes. In fact, it’s not even the most accurate measure of how I am managing. Although it’s supposed to be a 3 month ‘average,’ around 50% of that result is drawn from the past four weeks worth of blood sugar levels. If there are big variances in my levels, then the result is likely to be less accurate. I was even told that clinic results can vary by as much as 0.5% from pathology!

With holidays and Easter in the rearview mirror, I definitely felt that it was time to sit down and review my data. So over the weekend, I gathered all of my diabetes devices and uploaded their data to Diasend.

Diasend is a brilliant tool for reviewing my diabetes data at home. It’s a web-based software platform, where I can upload the data from my insulin pump, blood glucose meters and FreeStyle Libre. It generates the data from all these devices into one, easy to read report. So for instance, I can see what my reading was at 12pm, the carbs I ate with lunch, the insulin dose I gave for lunch, and the basal rate I had running at the time.

When I review my data, there are five things I like to look at besides from my hba1c, which give me an indication of how I am doing with my d-management.

Obviously, the first thing I want to know is my average blood sugar level over the past 2-4 weeks. I then use this handy tool to convert my average blood sugar level to an estimated hba1c.

The second thing I think about is how often I am checking my blood sugar. I’ve always been in a pretty good habit of checking my levels before and after meals, and before and after significant activity. I also try to check once during the night, if I don’t sleep over my 1am alarm! Checking my blood sugar more than four times a day means that I’m getting a bigger picture of where my levels are sitting through the day, and that my average blood sugar level is accurate.

The third thing I look at is the Standard Deviation in my blood glucose readings. In other words, how high or how low are my blood sugar levels going? How often are these kinds of swings happening? How big is the variability between these kinds of swings? Before I started using an insulin pump and more actively managing my levels, there were big swings. For several years, I was able to scrape together half decent a1c results, but I always knew that they weren’t accurate because of the large deviation. Ideally, my standard deviation should be less than 3 for the hba1c result to be a reliable one.

My fourth consideration is to any significant events that might have influenced my levels lately. I know that I’ve been travelling and eating a lot over Easter. The increased physical activity has produced a few more lows, while the excess of food has produced a few stubborn highs. There’s usually a good reason for everything, and I simply feel so much better about a disappointing couple of days when it can be explained.

Finally, I try to focus on the progress I’ve made since last time. Whether it’s a lower standard deviation, a problem area I’ve been able to fix, or whether I’m simply feeling more comfortable with my management since last time. I constantly remind myself of these victories, to motivate myself going forward.

A hba1c result is an important number. But there is so much more context that needs to be given due consideration, before we begin popping the champagne bottle, or smashing it to pieces.

Review: Think Like a Pancreas by Gary Scheiner

Think Like a Pancreas. My first diabetes educator often reminded me of the job that I was ultimately trying to replicate.

It was also the title of a very useful book that she recommended to me, if I were ever able to get my hands on a copy of it.

I only wish it hadn’t taken me six years to finally shell out and order it from eBay.

For me, this book ultimately reflected much of what I had gone through in my journey with diabetes. From my diagnosis, to getting my head around diabetes, to getting a bit more active in my management with basal and bolus calculations, to finally learning to navigate my way through the daily diabetes challenges a little more smoothly.

Many of the little intricacies and quirky things I’ve learned about my diabetes over the past six years are covered in this book.

Several of the lightbulb moments I’ve had since I started pumping insulin last year can also be found in this book.

Answers to the many questions or musings I randomly have about my diabetes are also tucked away in these pages.

Ultimately, this book would have saved me so much time and frustration in the last year or so!

Think Like a Pancreas is a book for anyone with diabetes who uses insulin, whether on multiple daily injections or an insulin pump. Author Gary Scheiner is a longtime type 1, diagnosed back in 1985 at the age of 18. Gary starts his book with the very basics of what diabetes is, and talks us through many of the common insulins and insulin regimens. I felt that in this regard, the book would also be easy for a family member or loved one without diabetes to read.

Gary talks us through some of our common motivations for reading this book, and some of the advantages we can expect to see from seeking out better control. He also highlights some of the tools that we will need in order to succeed in our quest for better blood sugar levels – our healthcare professionals, our diabetes tools, glucose monitoring, record keeping, data analysis, and the right mindset, to name a few.

As we head into the meatier part of the book, Gary highlights the importance of setting a well tuned background rate of insulin. I know that a well tuned basal rate will keep my blood sugar levels steady while I’m fasting, and generally easier to manage the remainder of the time. A not-so-well tuned basal rate will leave me feeling like I’m walking through quicksand.

Gary gives practical, actionable tips for setting a background rate of insulin – a chapter I feel would be highly advantageous to a new insulin pumper trying to figure out basal rates. There’s a very useful table in this chapter where Gary gives suggestions for tweaking basal rates based on the current rate, and the magnitude of the rise or fall while fasting. For those on multiple daily injections, Gary sets out the conditions for conducting an overnight fasting basal test, and advises how to go about adjusting long acting insulin doses.

Gary then proceeds to talk about calculating bolus, or mealtime insulin to cover carbohydrates, and insulin to correct blood sugar levels. Ever correct a high blood sugar level during the night, only to wake up low soon after? One of my lightbulb moments in this chapter was the confirmation of greater insulin sensitivity that seems to occur in the wee hours. There are more useful tables in this chapter giving tips for bolus timing to minimise post meal spikes in blood sugar, and adjustments for post-meal exercise. 

Welcome to the real world. Gary proceeds to talk through the many other elements that tend to affect blood sugar levels. Caffeine, stress, illness, travel and pregnancy, to name a few – with tips for dealing with them. There are also tips for dealing with protein when consumed in the absence of carbohydrate. And have you ever gone out for dinner, only to find yourself correcting resilient blood sugar levels well into the night? One of the lightbulb moments for me in this section of the book, was Gary’s suggestion of using a temporary basal rate for several hours to combat the insulin resistance that typically follows a larger, restaurant, or higher fat meal.

This is the best book I’ve read about diabetes, ever.

I loved that it didn’t tell me that I was doing anything wrong, or that I needed to change something about myself. It simply helped me to better utilise my insulin regime, so that I would be able to get more out of it.

It went so much further than simply talking about diabetes. It gave me practical, actionable tips to better navigate my way through the daily diabetes challenges, helping me to ultimately see more in range blood sugar levels.

Today, Think Like a Pancreas sits within reach on my bookshelf, for easy reference. It’s kind of like having my diabetes educator’s advice handy when I can’t get to her. Whenever I sense that something’s a little bit off, I’ll pick it up and revisit the relevant sections of the book.

A must read.

P.S. I’m more of a hard-copy kind of guy, but if that sort of thing doesn’t bother you, you can grab a digital copy from Amazon and start reading on your iPad/tablet/device today. I swear I wasn’t paid to say any of this – it’s just a really good book!