Starting the Conversation

A few weeks ago, my friend Bec over at Sweet and Sour Diabetes wrote this post about starting the conversation around mental health. To quote Bec’s words:

“Mental health is a touchy subject. Despite increased awareness we still whisper about it. We still pretend it doesn’t exist. We hide it, and treat it like it’s something wrong to discuss. Fact is, you or someone you love have likely experienced some form of mental illness/disorder. The word sounds scary doesn’t it? Like it means you’re crazy, or unstable in some way. Interesting when you consider that earlier fact. If everyone has been touched by mental illness, why are we so touchy about it?”

I’ve been mulling over how to best put this into words in the context of myself. While I may not have a mental health condition, having diabetes certainly does have a big impact on my mental health and wellbeing.

Sometimes, I can be a real micro manager.

There, I said it.

Carefully weighing and precisely calculating every gram of carbohydrate in my coffee and slice of toast. Carefully adding up every gram of protein in that milky coffee, slice of toast, ham and hard boiled egg. On days like these, I really strive for perfection. Yet my blood sugar level doesn’t always translate to perfection in the hours that follow. I get frustrated. I scrutinise over what I did and where I went wrong. So much so that I can’t concentrate on the TV show I’m watching in the evening. Sometimes this is enough of an excuse to throw in the towel for the rest of the day.

In the complete opposite of situations, I can still be a real micro manager.

Yesterday, for instance, was just one of those days where I couldn’t be bothered bringing my lunch from home. I ended up buying a Pizza from Bakers Delight and a slice of Apple Strudel from Miss Maud next door. I swag bolused, and of course became obsessed with the graph on my Libre as I watched my blood sugar levels climb. The higher they rose, the more compulsive I became. Checking every 5 or 10 minutes. Compulsively shovelling in insulin doses of 5 or 10 units every hour because my blood sugar level simply wouldn’t come down. When they finally did begin falling at dinnertime, I had a very scary 20-something units of insulin on board that sent me into a panic. 

It’s easy to feel different, alone or isolated when I’m living with an often invisible condition that nobody else around me has. There are days where I feel like an absolute basket case, or a roller coaster of emotions. It’s easy to tell myself that those around me won’t care or understand.

So, how does one deal with all of this?

Try to lean on the people around you. This won’t automatically happen overnight, but I’ve slowly learned to lean on my family where my diabetes is concerned. I feel like I can occasionally say that I’ve had a shit night or that my blood sugars are really high, and sometimes that just makes all the difference. I find that this has given me a great deal more confidence when dealing with diabetes around others. I no longer hesitate to pull out my pump or check my blood sugar for fear of diabetes questions. I have found my voice, which helps me to get what I want for my diabetes each and every day.

Thinking about how I can relieve the frustration and anxiety. For me, taking breaks from the technology has been invaluable. Taking time out for myself. Getting some rest, going for walks, watching a good tv show, and simply taking the time to breathe. It’s easy to forget the simple things.

Trying not to sound too cliche here, but trying not to think of an unfavourable outcome as a failure. Think about what I can do differently next time. Remembering that I don’t want to eat my way out of 20 units of insulin next time my blood sugar is frustratingly high. Remembering that a string of other things could have affected my post meal blood sugar, rather than my carb counting skills. 

I’m not sure if any of this is serious enough to qualify as mental health, or if any of it makes any sense. But all of the above has been in my head at some point or another in the past six years of life with diabetes. I’m hoping that by sharing some of my deepest thoughts, someone else reading this won’t feel so alone or afraid.

It’s okay to talk about mental health.

An E-Mail To My Electoral Candidate

To my Electoral Candidate,

Just a quick response to the e-mail you sent about your campaign for the upcoming State Election. 

I wanted to tell you about something special happening in my life. Something so special, it happens every single minute, of every single hour, of every single day. In fact, it’s so special, that I get to keep it for the rest of my life. 

Exciting, right?

Six years ago, my pancreas did something unprecedented. Something very grassroots. It decided to call it quits, and handed over the reigns to me. A commoner, would you believe it? All of a sudden, I was in charge of trying to mimic a working pancreas. This meant giving insulin to match the foods I eat. Adjusting insulin delivery based on the carbohydrate, fat, protein or glycemic index of my meal. Matching insulin delivery to any physical activity I undertake throughout the day. Keeping my blood sugar level above 4 mmol/L, in order to keep my brain functioning and remain conscious. Keeping my blood sugar below 8 mmol/L for as much of the time as possible, so that I can maximise my chances of living a long and healthy life. 

Sounds like a tough gig with extremely high stakes, right?

I live with a condition called type 1 diabetes. A condition that is often unpredictable, operating with a mind of its own. To stay on top of this, I can often be found pricking my finger. Sometimes, as often as 20 times per day.

Sounds intrusive, right? 

I’ve received care through a public hospital diabetes clinic for many years, but it’s hardly been adequate. Patient numbers continue to grow, while resources continue to be stretched thin. I reached a point where I felt I was no longer getting the personalised support I deserve to help me manage my chronic condition to the best of my ability. This means forking out my hard earned money to receive the support I deserve.

I sometimes wear a device that continuously monitors my blood sugar. A device that keeps me safe from the lows and the highs. A device that gives me a great deal of convenience, allowing me to more quickly respond to the lows and the highs. I’d like to wear it full time. I’d like to try other Continuous Glucose Monitoring devices that are on the market. Yet this device, and others like it, are not currently subsidised in Australia. It costs me a fortune to wear. This is on top of all of the other life challenges facing young adults in Australia, that I am sure you would be well aware of.

You are campaigning for a man who will be a Premier for every West Australian. In my books, a man who truly is a premier for every West Australian, would not let me live through such injustices.

Warmest regards from the bottom of my broken pancreas,


Sticky Stuff

Is it coming unstuck?

That’s the million dollar question that plagues me through the day. I often find myself prodding my arm, just to make sure that my FreeStyle Libre sensor is still there.

It’s pretty hard to tell whether that sensor is coming unstuck once those edges begin to fray. Sometimes it really is coming unstuck, while other times the edges are frayed but the adhesive game underneath the sensor is still going strong.

The warmer months of the year have definitely tested my sensors. I remember coming home from work after a warm day and the sensor literally fell off as I got dressed. Thankfully, FreeStyle customer service replaced the sensor for me with no hassles.

Without the security of winter thermals and jumpers, I’ve also found that I’ve got to take A LOT of extra caution not to knock that sensor as I go about my day.

I definitely find that getting the best position on my arm makes a huge difference, both in adhesive power and in sensor accuracy. Ideally I want to pick a flat space on my arm, as far up and out of the way as possible. 

This week, I’ve also been rocking my Rockadex Penguin patch. It’s a sticker that simply sits over the Libre sensor on my arm (or any other Continuous Glucose Monitoring device), holding it into place.

Honestly, it’s a lifesaver, especially during the warmer months of the year while I’m more active. As someone who always opts for the plainest or most invisible of colours, this is really saying something!

Yet what’s even better is the story behind it. Rockadex is an Australian business based in my hometown of Perth. It’s run by the mother of a young child with type 1 diabetes. The patches and diabetes accessories are sold solely for the purpose of funding a young girl’s Continuous Glucose Monitoring costs, which is not currently subsidised here in Australia. Anything more is given away. 

I’ve also splashed out on a silicone case for my Libre reader, which often slips out of my shirt pocket when I bend down.

 They’ve also got a bunch of international distributors for those outside of Australia. 

There’s stickers, patches and accessories available to match almost any diabetes device you might use. At the end of the day, anything that adds a bit of extra excitement to the monotony of diabetes is surely a good thing in my book.

Multiple Daily Injections, a Second Time Round

I definitely felt hesitant about going back to Multiple Daily Injections when I was contemplating a pump break.

I didn’t really have too many fond memories of managing diabetes prior to insulin pumping. Lantus was very uneven and inconsistent the last time I used it. I felt I could never get the dose quite right. I remember lots of carb guesstimates, and the wildly fluctuating levels that followed.

But at the same time I knew that I was armed with a lot more knowledge, and motivation compared to when I last did injections. I was actually curious as to whether I could apply these newfound skills into Multiple Daily Injections a second time round.

I gave 9 units of Lantus at around 9pm on the first night of my pump break, which was the sum of the 24 hour basal profile on my pump. I was pretty pleased to see that it did keep me fairly stable when I woke up the next morning.

I was definitely contemplating splitting my Lantus dose, but I wasn’t sure how best to go about it. The general consensus in forums seemed to be that Lantus lasted around 18 hours at best. After running high during the first two afternoons, I decided to experiment with a smaller second dose at 1pm to cover the final third of my day. 3 units seemed to be enough to cover, without sending me low overnight.

After months of diligent carb counting, I knew I definitely wouldn’t be able to survive without a bolus calculator. Although there were plenty of flashy diabetes apps to choose from in the App Store, many of them lacked a bolus calculator. I eventually found RapidCalc for $12.99. Although it didn’t have the flashiest interface, it fitted my needs nicely. I was able to set up my insulin to carb ratios, correction factors, insulin usage profile, and reminders for my Lantus doses.

This break definitely reinforced that to me that you tend to use less insulin on the pump. On the pump, I was using a carb ratio of 1:10g and a correction factor of 1:2.6mmol. On injections, I needed a ratio of 1:6g and a correction factor of 1:1.6mmol. Being off by even half a unit of insulin had a big impact on my blood sugar levels after meals.

What I loved most about injections was the simplicity of it all. There was instant relief from the lows, and far less thinking about where my blood sugar was heading. Small activities around the house had minimal effect on my blood sugar levels. I witnessed steady trend arrows on my Libre during afternoon walks, rather than downward ones. Using Lantus for my basal, rather than rapid acting insulin on the pump, made a BIG difference here. The only time I had to think about lows was when I had mealtime insulin on board.

Gotta say, it was also just awesome to sprawl out on the couch or in bed and not feel that chunk there in my pocket. And I loved having a little less weight in my pockets every time I left the house.

Overall, my blood sugar levels were just as good on injections as they were when I was pumping.

But shots were definitely a LOT of work. Although I carried my pen around with me in my pocket everywhere, I don’t shoot up in front of others. So I really had to make a point of finding a quiet corner to do so when I wanted to eat or correct a high blood sugar level. Speaking of, morning blood sugars were a LOT harder to manage. I didnt have the flexibility of increasing my basal insulin to cover the morning rise after I woke up. I often found myself giving at least 3 corrections after breakfast to bring me back into range. If I had stuck with injections for longer, I would definitely basal test with a few extra units of rapid acting insulin to cover the morning rise.

My pump break definitely reminded of something that Ginger at Diabetes Daily wrote recently. She says that neither pens or pumps were perfect, and that we were choosing between the flaws that bothered us the least. I couldn’t agree more.

For me personally, an insulin pump is a LOT more work than injections. Keeping on top of site changes, dying batteries and insulin cartridges, and having to be on my game in setting basal rates around my activity. It’s more careful thinking about what you’re doing. Not to mention the extra chunk in my pockets pulling my shorts down!

But a pump also offers me more convenience when I’m on the go, more precision in my basal rates and greater flexibility with insulin dosing to cover different kinds of meals.

For the time being, those benefits outweigh the flaws when managing my diabetes.