Month: January 2018

Diabetes Brigades.

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I was trawling through my Facebook feed yesterday when I was distracted by one post in particular. It wasn’t the content that caught my attention however, but rather the brigade of comments that accompanied it.

With many schools going back this week after a leisurely six weeks off (one can only dream), the post was providing some suggestions for school lunchbox snacks.

I didn’t think there was anything particularly bad about the items suggested. Most of the suggestions were only small snack sized portions, and obviously not every item on the list would go into the lunchbox at one time.

I knew that if I were a kid, these would sound like pretty popular options to me. In fact two of these suggestions were in my own lunch box earlier that day, which I had carb counted and given insulin for. I imagine that I would feel very comfortable among my friends in the school yard with suggested snacks such as an apple or a yoghurt.

The aggressive comments, however, told a very different story. People felt the need to begin picking these suggestions apart for a number of different reasons, and linking them to all sorts of horrible diabetes end games. These comments were a pretty poor reflection on the community that I have come to know and cherish.

Yet I couldn’t help but come back to the bit about two of those very suggestions being in my own lunch box earlier that day. Put yourself in the shoes of a parent, or any person with diabetes for that matter, who is packing some of these very typical school food items into their lunchbox. How would you feel, reading a brigade of comments shaming your food choices and your parenting?

Now imagine that the person reading these comments isn’t in as comfortable a place as you are with diabetes. Where could that potentially lead you to? Feelings of guilt? Depression? Diabetes burnout? Disordered eating?

Despite how much of myself I’ve shared with you on these pages, it is not my place to give you advice, tell you how you should be managing your diabetes, or be making you feel guilty if your approach to diabetes doesn’t agree with mine.

Diabetes management is a very individual issue, and I truly believe that the foundation should be built on the needs and preferences of the individual. If that means letting a kid be a kid and eat a muesli bar or a handful of popcorn, then so be it. But hey, that’s only my two cents. 

If the suggestion you see online doesn’t suit your individual needs, then you’re certainly not obliged to take it next time.

P.S. I think Diabetes Australia have done an outstanding job on the resource Mastering Diabetes in Preschools and Schools, and I strongly encourage you to check it out here.

Some Insights into Fat and Protein Bolusing

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One of the most frustrating things that I often read (or hear) is that a low carb diet produces seemingly perfect blood glucose levels.

I certainly don’t have a problem with anyone who chooses to follow a low carb diet, and I can definitely see the benefits to being more mindful of my carbohydrate intake.

However, I find it incredibly frustrating that nobody ever talks about how they manage their blood glucose levels around fat and protein. Because, with the exeption of a few ‘free’ foods (non starchy vegetables, anyone?) the major trade off to carbohydrates is eating more fat and protein.

I’ve sort of conceived this idea that if one chose to contantly fuel their body with fat and protein, you could just offset their effects with a higher basal insulin dose. But what about those who just want to enjoy steak or pizza night without the spike?

Other than monitor your blood sugar levels closely and see how your body responds because everyone is different, Dr Google was very little help in this regard. I get that this topic is very individual in nature, but the information out there is scarce.

My first useful insight into this topic came from Gary Scheiner’s book Think Like a Pancreas. Suggesting that many restaurant and take out meals are naturally higher in fat, he suggests employing a temporary basal rate of 50% as a starting point to combat insulin resistance.

Gary also suggests that protein is only converted to glucose when the carbohydrate content in a meal is insignificant, and therefore only recommends making adjustments for protein when consumed in low or no carb meals. As a starting point, he suggests counting 50% of the protein in a meal as carbohydrate and delivering insulin through either an extended bolus on a pump or a delayed insulin dose when blood glucose starts to rise.

My second valuable insight came from meeting Dr Kirstie Bell, a researcher from the University of Sydney at the ADS-ADEA conference last year. I was absolutely engrossed in her research into fat and protein bolusing, and managed to catch up with her in Perth earlier this month.

Unlike conventional thinking, Dr Bell’s research suggests that fat and protein alone don’t impact blood glucose levels. It’s the lack of sufficient insulin that does. In people without diabetes who produce insulin, the impact of slowly digested fats and proteins is minimal. For people with diabetes who don’t produce insulin however, the impact is quite the opposite.

Ever had one of those nights where you’re correcting a high blood sugar level over and over with very little effect? Dr Bell also suggested that higher fat meals pushed the blood glucose peak of a meal out later, and caused a sustained blood glucose response due to insulin resistance caused by saturated fat.

Protein also produced a noticeable blood glucose response within 2 hours of being consumed. Research findings suggested that protein required adjustments in both mixed and no carbohydrate meals, with mixed meals having a greater degree of impact on blood glucose levels.

The most interesting point for me was hearing the concept of finding a ‘sweet spot’ in insulin dosing for higher fat and protein meals. Research suggested that if insulin was given too early, participants went hypo. But if insulin was given too late and insulin resistance had already set in, finding an optimal blood glucose result was too difficult.

For me, this is one of the things that makes diabetes so difficult to manage. I truly wish that all food was created equal. I wish that I could count the carbs, give insulin and it would produce the same effect on my levels each time.

At the moment I definitely need to put more effort my fat and protein bolusing, because I am definitely seeing a lot of slow and unwanted spikes after my meals.

Want to know more? Check out the resource website www.ibolus4t1d.com, and you can find @drkirstiebell on Twitter.

Review: Myabetic ‘Banting’ Diabetes Wallet

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I’m feeling a bit unsure about the new Myabetic bag that I received for Christmas.

After years of having to decide what to bring with me every time I left the house and walking around with bulky pockets and slipping pants, travelling with a pencil case to house my diabetes gear was a huge relief.

Everything fits in there quite nicely. Meter, test strips, lancing device, spare lancets, spare batteries, insulin, spare needles, an infusion site, spare insulin cartridge, spare pump cap, spare battery cap and my Animas coin to open up my pump. Plus, it looks nice and roomy in there if I need to reach in and grab something.

I carried my pencil case with me everywhere. My only desire was to find something a bit more compact and impact resistant. Which brought me to Myabetic.

When I first opened the parcel containing my new ‘Banting’ Diabetes Wallet, named after the creator of insulin himself, my initial impression was that it looked a lot bigger in real life than it did on the website.

As I began trying to squeeze all of the gear from my pencil case into the little zips, pockets and compartments of the Myabetic, I immediately felt very restricted with what I could carry.

The large velcro envelope housed my meter and test strips. The loop adjacent to the meter pouch was intended for test strip tubes, however the wider oval shape of my Accu Chek guide test strips rendered it unusable. I did manage to squeeze my glucose tabs there, but not without a great deal of effort.

There were two loops equipped to carry insulin pens, and I opted to use the spare loop to carry my lancing device.

There was a removable waste pouch which cleverly housed used test strips and needles. I opted to use it to house my spare (unpackaged) pump site and infusion set. The final mesh pouch was just enough to fit spare needles, lancets and batteries.

I genuinely did like that compared to my pencil case, the Myabetic was a lot more compact and easier to carry around. Not to mention impact resistant. But unfortunately, it was also just a bit too flashy for my liking, even when I carried it with me to a wedding earlier this month. Perhaps in this regard it would be more suited to the girls.

Having to open all of the little zippers and compartments to get to my stuff also felt like a lot of effort when I already have a needy chronic condition to manage. I’m also carrying pump gear on me, so perhaps things would be simpler if I were just on Multiple Daily Injections.

I’ve no doubt that the Myabetic is a clever creation and has won itself legions of fans all over the world. For the time being, though, I think I’ll just keep mine in the spare drawer until a special occasion calls.

The Myabetic collection of diabetes bags can be found here. For those of you in Australia, they are also distributed through Rockadex and One and 2.

Live Beyond.

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After sharing my own diagnosis story during Australian National Diabetes Week last year, I agreed to be the face of a new diabetes awareness initiative run by Beyond Type 1.

Targeted at young adults, posters and tri fold leaflets were produced and distributed to colleges in the US who had shown interest (and yes, it’s a big compliment to still be considered ‘college’ age…)

Unfortunately it didn’t progress into a fully blown campaign for the time being, as Beyond Type 1 continue to focus their awareness efforts on paediatrics.

I did get some pretty cool posters to keep, though! Special thanks to Carolyn for sending them all the way from the States.

And now I can’t get that fictional voice out of my head (hey you, yes you, learn the warning signs of type 1 diabetes…)

Summer Daze.

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After the mad rush of December, frantically attempting to beat the clock in order tie up loose ends for the year, shopping around for Christmas gifts and meeting social obligations of the festive season, January arrives.

The world simply seems to go to sleep in January.

School’s on holidays, some of the lucky ones get to take extended leave from work, and the seemingly endless stretch of sunny 30 degree days just seems to support this quiet, lazy notion in the world.

I’m sitting here at my desk, with a bunch of fresh ideas in my head and seemingly endless time in front of me, plodding along at this slow leisurely pace.

Which might be great for me, but not so great for my diabetes which has decided to hop on my back for the ride.

I don’t exactly have the energy or the enthusiasm at the moment to be pre-bolusing for my peanut butter on toast. I can’t bring myself to correct dropping blood sugars with glucose tabs, when there’s a tin of Shortbread on my bookshelf or chocolates in the fridge. Guesstimates are trumping maths in my insulin dosing more often than not.

It’s harder to get outdoors when it’s hot, and the Australian Open is proving to be a pretty good excuse to crash in front of the TV at 4pm. 

When my FreeStyle Libre is on, I’m motivated to keep those graphs looking pretty. But when it comes off, I can’t see what my blood sugars are doing all the time and I’m not so motivated to keep them between the lines.

I find it harder to accommodate diabetes devices in the warm weather. I’ve briefly contemplated another pump break, but I think my month-long vacation in November was enough to get me over my rut for the time being.

The one symptom that warm weather doesn’t produce for me is hypos. Sure, physical activity without carbs or basal adjustments sends me low. But a hypo just because it’s hot? It simply doesn’t happen.

I’m very much looking forward to this sleepy Summer daze coming to an end, and hopefully finding my diabetes mojo again soon.

Until then, I’ll be spending as much time as I can at the beach.