I woke up this morning to the gentle sound of my sleep cycle alarm. It was a lot darker than usual, because I was waking up a lot earlier than usual today.
My first thought was that I hadn’t stirred during the night. Nor had my CGM gathered my attention for the last eight hours.
I reached for my iPhone and swiped left.
‘Oh, shit!’ I exclaimed at the widget on my home screen as a wave of furiosity instantly hit me.
I’d spent the past three hours riding around the 11 mark. Possibly higher, because I forgot to check my blood sugar for reference which I like to do when I’m high.
I wondered how on earth I was only finding about this now, and unlocked my iPhone with a press of my thumbprint. When I opened up the Dex app, I found the culprit in a high alarm that had been completely turned off.
I have no idea whatsoever how that happened. I distinctly remember opening the app and lowering my high alert from 8mmol to 7mmol last night, like I do every other night before bed.
As I flipped my phone sideways and traced that high back through the night, I was even more furious to find that it had risen from pretty much the minute I rested my head on the pillow at around 10pm.
But it also made complete sense, given I’d consumed a fair few carbs to absorb the dinner I’d over bolused for. I also can’t bring myself to treat hypos with glucose tabs anymore, so there may or may not have been a few raids of the cupboard involved. But I’m making sure I buy some juice today, for a change.
As I bolused super early for my breakfast, got out of bed and jumped into the shower, how that high alert escaped me is still a complete and utter mystery.
Yes, Christmas was a month ago. This post has been sitting unfinished in my drafts folder for some time now. I’m sharing today, because I still think its an important one not to forget…
My Christmas Day began in the bathroom at 1.37am, staring into the depths of the toilet basin.
I wasn’t drunk, nor was this the outcome of a good night.
It started on Christmas Eve when I woke up feeling extremely nauseous, extremely dizzy and extremely full. I’m not sure what possessed me to go to work that day, but I did. As I watched my blood sugars creep closer and closer to the 4mmol mark throughout that morning, I knew I absolutely wouldn’t even be able to stomach a glucose tab and suspended my insulin.
I literally collapsed onto the bed the moment I arrived home and slept right up until dinner time. When Mum and Dad asked me if this had anything to do with my diabetes, I thought it would be a good idea to pull my retired meter and expired ketone strips out from the drawer.
If the meter was reliable, and my gut was telling me that it was, I had ketones of 1.2. Which made sense, considering I’d barely eaten all day.
One thing my diabetes educator had drummed into me was that nausea was a warning sign to look out for where ketones were concerned.
After my first bout of sickness that evening, I knew I had to get some glucose and some hydration in me ASAP so that my body would stop burning fat and producing starvation ketones.
The most I could stomach was 50ml of orange juice, diluted with a glass of water. I struggled to sit through dinner, and ended up retiring again soon after.
After another bout of sickness and a few more glasses of diluted juice through the night, ketones were finally down to an 0.4 by Christmas morning and I was starting to feel better.
I’d eaten some roasted lamb at a family get together a couple of days before Christmas. The really rich, really fatty, slow roasted kind that I never have at home.
I only ate a slice that night, but I did indulge in a fair bit for lunch the following day.
Roast meat has given me terrible indigestion two or three times in recent years.
The only problem is, I don’t eat it often enough to remember exactly what it does to me.
It probably took a good 24-48 hours to get it all out of my system, but this bug left me feeling bloated and lacking my appetite. The most I could stomach for several days afterwards was a morning coffee, a very small lunch and an afternoon treat.
One thing I was extremely grateful for throughout all of this was good basal rates. I did have to be really cautious around my insulin thanks to the heightened sensitivity from less food, not to mention the fear of whether I’d be able to keep it all down. I happily ran blood sugars that were higher than I’d normally like. But for the most part I didn’t have to worry about warding off lows and having to eat when I didn’t want to.
This is only the second time I can remember having to navigate ketones since my diagnosis, so it was somewhat unfamiliar territory in managing my diabetes.
If there’s one thing this ordeal has taught me, it’s never to touch a piece of roast meat again.
I love to drink coffee. But it was never palatable without a good 2 teaspoons of sugar mixed inside. So, I reduced it to one and a half. Then, when I got used to the taste, I reduced it to one. Then half a teaspoon. If you were to put sugar in my coffee today, I’d tell you that I can only taste sugar.
I was feeling exhausted. Far too often. Eventually, I stumbled across an article and realised that I wasn’t eating nearly enough in order to fuel my daily activities. So, I started setting my alarm to wake me half an hour earlier each morning to give me time to scramble two eggs and toast two pieces of bread. I started using my Sunday afternoons to better prepare ahead for weekday lunches. Today, I don’t feel half as exhausted (or deprived) as I once did.
I never used to count carbohydrates. I would just swag my insulin dose, and end up with either crazy highs or intense lows. When I began using an insulin pump, I set an intention with my family that I would weigh my food at dinner time to better count my carbs. That added effort before dinner time has definitely made my insulin dosing more effective.
Managing diabetes does my head in. Like, every single little thing I can think of affects my blood sugar. What I ate, how active I was today, how well I slept last night, where my BG has been sitting overnight, and even what month of the year it is! So, I began making notes. Both on paper, and mentally. Paying closer attention to what was happening with my blood sugars, and learning what I would need to do for next time. Today, I feel far more confident in being able to make those adjustments to keep my blood sugars where I want them to be.
For some time, I’ve been waking up feeling like I haven’t gotten a good night’s sleep. It’s been a real struggle to get up and going throughout the morning. So, at the turn of the new year, I decided to prioritise sleep. I would ‘switch off’ an hour before bed, so that I don’t go to sleep while my mind is still buzzing. Quite honestly, it’s been one of the best changes that I’ve made for myself (more on that one, soon).
Today, I feel pretty happy about where I am at with my diabetes. I’m not perfect, and I don’t always manage to do everything I’ve outlined here religiously each day. There are still things I’m working on improving, too.
However when I think about where I am today, it wasn’t the quick overnight fix I was desperately seeking when I started using an insulin pump four years ago that got me here.
It was the sum of small, gradual changes that I’ve made over the past four years that suited my own needs. This list is certainly not exhaustive, but it’s some of my highlights.
Some of those changes have been directly related to the day to day management of my diabetes. Some of those changes have been more around my routine and habits, which I guess better support me in showing up to manage my diabetes each day. There were equally things that I was happy with, or didn’t want to change (carbs and coffee, to name two).
I don’t believe for a second that there’s only one way to manage diabetes. But I know that I spent years thinking about, and feeling overwhelmed by all of the changes and improvements that I wanted to make.
So I guess the point of this post is that if you are thinking about making changes at the start of a new year, start small. Pick one tiny thing that you could do each day that might further your goal. Above all, be patient.
I see an endo. I arrange for my annual checkups to my eyes and feet. I see my GP when I feel unwell, and I also have regular bloodwork done.
But when it comes to the day to day management of my diabetes, I don’t really need a great deal of support.
My first diabetes educator retired shortly after I began pumping, and I hadn’t really found a replacement who was the right fit (there were a few). I do remember feeling pretty disheartened after one session where I was told that it was perfectly okay for my BGLs to be spiking to 15mmol after breakfast. When this person tried to change my basal rates because they didn’t fit the typical 50/50 split, I didn’t make contact again.
That was back in 2016. Since then, I’ve been more actively monitoring my blood sugars and forever learning new things about my diabetes. My confidence is ever growing in being able to pick up on trends and make changes to keep my BGLs where I want them to be. I’ve gradually implemented changes that have brought me to where I am with my diabetes today.
Fast forward to today, and I find myself 18 months into a new healthcare professional relationship. I wasn’t really looking for a diabetes educator 18 months ago, but I needed one if I wanted to get my hands on a t:slim. At the suggestion of my local rep, I unexpectedly met a diabetes educator who was the perfect fit.
I think what I love so much about this relationship is that it’s exactly what I need. Which isn’t a lot. My educator knows that I don’t need a lot of support in the day to day management of my diabetes. She knows that I’m pretty switched on. And most importantly, she can tease me about whether I need to grab a biscuit to treat my borderline blood sugar, and I can tease her about some of the things that I’ve come to know of before she has.
Although I was beaten last week with this insulin pump from the 1980s.
Admittedly, I don’t know this person too well, but I just had a feeling that she was someone who I could be really honest with in terms of what I’m doing with my diabetes. Diabatteried Dexcom transmitter, for instance.
I would never expect a healthcare professional to hold my hand as I do something that’s not textbook or ‘off label’ with my diabetes. But during our session last week, she was completely supportive of exactly where my head was at.
“I need to know, because I need to be able to support you.”
Hearing those parting words as we finished our session last week, I was convinced that she’d been listening to every single comment I’d ever made around why language matters so much when we’re talking about and to people with diabetes.