Month: April 2018

Insulin Gone Bad.

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I couldn’t help but notice the reading of 14.1. Is that high? My friend asked me from across the table as I was demonstrating my FreeStyle Libre.

Yeah, I obviously haven’t given enough insulin for the banana bread, I replied, pulling my pump out of my pocket and bolusing for another 30 grams of carbs ever so casually.

I had already bolused a very generous 60 grams of carbs for the slice of banana bread and iced coffee I had ordered at the local cafe, but I wasn’t overly surprised to see the upward trend arrow on my Libre.

My blood sugar was still skyrocketing by the time I arrived home an hour later, with my Libre clocking in at a lovely 17.4. I bolused for another 10g of carbs, bringing the total for my mid morning coffee catch up to an overly generous 100g of carbs. I was certain that all of this insulin was bound to kick in any minute now.

After another hour had passed and my Libre clocked in at 25, I had figured that banana bread was the devil. After a prick of the finger came in at 20.4, I ignored all insulin I had on board and gave a full 4 unit correction. I also set a temporary basal rate of 100% to help get things moving in the right direction.

After a bucketful of insulin, my blood sugars slowly but surely began moving in the right direction over the course of the afternoon.

When dinner time rolled around and I was back in range, I bolused for the 50 grams of carbs on my plate. I drank a glass of water. I stepped outside and turned the sprinklers on. I washed some strawberries that I planned on having post dinner. I drank yet another glass of water. I stepped outside again, and switched the reticulation off. After distracting myself for a good 20 minutes or so for the bolus to kick in, I finally tucked into my dinner with the hope of avoiding another blood sugar rollercoaster.

Fast forward to me in front of the television 2 hours later, and my blood sugar clocked in at 16.1 with an upward trend arrow on my Libre.

I scrolled back through my pump history, noting that my last prime was four and a half days ago. As I swapped out the infusion site, my brain began to cotton on to other moments of particularly difficult-to-manage post meal blood sugars in recent days.

The lone milky coffee that sent my blood sugar upwards of 10. The hot cross bun that I’d carefully pre bolused for, but landed me close to 20. Rising blood sugars, despite a long walk fuelled by 10g of chocolate beforehand. Even a pasta meal had been extremely difficult to manage.

As I connected all of these recent occurrences together, I eventually recalled another occurrence of skyrocketing levels when my insulin had spoiled 2 years ago.

My insulin had spoiled! There was my answer! 

So, maybe Banana bread wasn’t the devil after all.

How to Get Active Without Entering a Gym

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I don’t do running. I don’t do workouts. I do, however, believe that physical activity should not be confined to these two things alone.

“Over the years, I haven’t had the best relationship with exercise.

I’ve tried to get into a routine of jogging, but usually expect too much of myself and feel poorly afterwards. I’ve previously used casual gym passes, but ultimately they are costly and aren’t geared to someone who might go once or twice a week. During my school years I was never really taught how to play sports, and usually tried to stay as far away from the ball as possible!

It has only been in more recent years that I’ve embraced other forms of exercise beyond the conventional gym or running. There are so many activities that qualify as exercise, making it possible to burn calories while doing something that you actually enjoy!”

You can read more in this week’s column for Diabetes Daily here. 

Perspective.

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It was a glorious Friday afternoon. I so badly wished I’d been able to get to the surgery earlier so that I could bask in that golden late afternoon autumn sun. I parked my car on the side of the road adjacent to the building, collected my belongings, locked up and made my way toward my doctor’s surgery.

I stepped inside the green waiting room, announced my name and appointment time to the receptionist before being gestured to take a seat. I made my way towards the corner of the room, taking a seat beside the ottoman stacked with dated magazines. I placed my trusty diabetes case, keys, pocket wifi and pocket tissue pack down beside me, and settled in for the long wait.

I had the flu. I had copped the brunt of it the day prior and was feeling somewhat better, but decided to take advantage of a sick day and pay my doctor a visit for another matter that I’d been putting off for a while.

I buried my head into my phone – something I’ve actually been making a conscious effort to do less of lately – and caught up on some of the news in my feeds.

I did a quick scan of the room. After grouping people together, I figured that there were five or six people waiting to see the doctor late on that Friday. I continuously glanced through the sliding glass door, watching the sunlight disappear from the street corner as the darkness set in.

As I watched the clock slowly move past six and closer to six thirty, the wait wasn’t even particularly bothering me. I wasn’t even thinking about how lousy I felt anymore. I was beginning to feel plagued with sympathy over this hour of day that I was demanding my doctor.

I thought about what I would normally be doing at this time on a Friday. I’d probably be well caffeinated, sweetened, showered and in clean clothes, capping off another working week. I’d probably be sitting down to a nice dinner with my family after grocery shop day. Yet here was my doctor, who had probably started his work day at the same time as me, still shouting out patients names from down the hall before appearing at the reception desk.

My doc could have made his last appointment at 5 instead of 5.30. He could have allocated longer appointment times so that he didn’t fall behind schedule and might get home on time. But he didn’t.

Although he was understandably hurrying things along, my doctor didn’t complain once as he called me in and prepared for me what I had asked for. I was in and out in less than five minutes. 

Our healthcare system is far from perfect. I’m the first person to complain about anything and everything. But this particular visit, at this particular hour of the day, came with a nice little lens that put things into a different perspective.

I’m certainly glad that there are people out there in the world, like my doctor, going above and beyond to help sick people get better.

(Although, as always some more resources to help people like my doc would always be greatly appreciated).

Guest Post: Behind the Scenes of Diabetes Research

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Today I’m handing over the reins to Caroline Rudnicka, a diabetes research officer who also lives with type 1. I first connected with Caroline after hearing her speak at a local event hosted by Diabetes Research Western Australia, and today she shares with me a little about her connection to diabetes and an upcoming event to support diabetes research. 

I must admit that I don’t think too often about an end game when it comes to diabetes, so I really appreciate hearing from people like Caroline and the team at Diabetes Research WA who share such a passion for research. 

***

Frank: Hi Caroline. Can you tell us a little about your connection to diabetes? 

Caroline: Hi Frank and thank you for the invitation to guest blog on Type 1 Writes.

I was diagnosed with Type 1 Diabetes in 1989 while my parents and I were holidaying in Europe. My diagnosis was a horrible shock for my parents, who had mistakenly attributed my mood swings, weight loss and lethargy down to my young age and traveling. Furthermore, with no family history of T1D, my ‘spontaneous’ diagnosis really astounded my parents, who were previously completely unaware of the condition.

My diagnosis drove me to pursue a T1D-orientated honors project through the University of Western Australia. Currently, I work for Royal Perth Hospital as a research officer, and I have been fortunate to work in a lab group, supervised by Professor Vance Matthews, that is dedicated to type 2 diabetes research (although we are starting to investigate T1D complications too).

I feel lucky to be in the position where my work environment encourages me to constantly reflect on the potential mechanisms which promote diabetes development, and provides me with unlimited access to read high quality diabetes journals.

Frank: We first connected through your work with Diabetes Research WA. Can you tell us a little about that? 

Caroline: It was actually through my boss Vance that I was introduced to Sherl Westlund and Nat Caudle from Diabetes Research WA (DRWA) in late 2017. At the time, Sherl and her great team were organising their information night, “Diabetes, where is the cure?” when Sherl contacted me and asked me if I would like to present a talk about my experiences with T1D and diabetes research.

I must admit, I was initially apprehensive as I wasn’t certain that the audience would find me or my experiences very engaging. I was always under the impression that only diabetics cared about diabetes. However, having worked with Vance previously on a DRWA funded project, I felt flattered to do something for DRWA, a local organisation that strongly supports diabetes research. Hence I accepted their invitation.

I was surprised to receive a lot of positive feedback following my talk that night, and I was humbled that the experiences which I discussed managed to move many people in the audience. When I was driving home that night with my husband, he commented that my talk really opened his eyes to what I go through living with T1D, and this is despite the fact that we had been living together for years!

This made me realise the importance of openly discussing T1D and sharing experiences, to link T1D patients with each other and non-diabetics to raise diabetes awareness. As such, I was delighted to act as that link between DRWA and their audience on that particular night, and I hope to do more events with DRWA in future.

Frank: Your husband Joey is going to be participating in a charity fundraiser for Diabetes Research WA later this month. Could you tell us a little about the event, and how we could get involved? 

Caroline: My husband Joey is literally putting his body on the line as he participates in the “100 Fights in 100 Minutes Charity Benefit” on April 28th.

This is an event being hosted by the fantastic owners Noah Greenstone and Ron Amram from Leederville’s Combat Arts Institute of Australia (CAIA), a self defence facility where my husband trains. Noah and Ron are the masters of technique, and it is going to be so enjoyable watching all the competitors on the day.

The charity benefit is essentially a test of endurance, as each competitor participates in 100 friendly rounds of sparring (kick boxing or jiu jitsu) at one minute long each. Funds are raised by sponsoring a fighter for each round they are able to fight. The Institute is hoping to reach its $6,000 target through sponsorship of the fighters.

My husband, being previously motivated by my DRWA talk to support diabetes research, liaised with the owners of CAIA, and I am extremely grateful to Noah and Ron for selecting DRWA as the beneficiary for this fundraiser.

Their decision really excites me, because diabetes research relies on community support to continue. Working in a diabetes research lab, I can see that funds are necessary to promote and develop scientific ideas, and donations from the community are the key to unlock the dream of a diabetes cure into a reality.

So please sponsor my husband Joey Balczer as he literally “fights for a diabetes cure” using this link: http://combatartsinstitute.com.au/100fights2018sponsors/view/form

The event is free to watch, and there will be delicious food trucks on site, so I encourage everybody to attend.

What:
100 Fights in 100 Minutes – Charity Benefit for Diabetes Research WA
Hosted by Combat Arts Institute of Australia

When:
Saturday April 28, 2018, 5.30pm

Where:
341 Oxford Street
Leederville WA 6007

http://combatartsinstitute.com.au/component/k2/item/76-100-fights-100-minutes-2018-perth

Frank: Do you see a cure for type 1 diabetes coming from a particular form of diabetes research? 

Simply answered, the end goal as a diabetes researcher is to find the cure, and as a diabetes patient it is to be cured.

When I was diagnosed in 1989, the Dr told my family that a cure was only “10-15 years away”. As a T1D patient, such claims anger and frustrate me because almost 30 years later, I still have T1D.

However as a diabetes researcher, I see what goes on behind the scenes- the long hours that are put in, the numerous experiments, the lack of funds, government imposed restrictions, the endless paperwork, lengthy clinical trials, etc. Therefore I can appreciate that finding a diabetes cure is a long, tedious, difficult and frustrating process. It literally takes years and years to turn a “lab bench idea” into a clinical trial, and then there is no guarantee that the initial idea will eventuate into a marketable good or service.

It is also crucial to highlight that in order to cure something, we need to fundamentally understand it better. Through research, our grasp on diabetes is constantly improving (just not always at the pace us diabetes patients would like). Incidentally, as technology advances, this will provide researchers and clinicians better ways to test, analyze and understand diabetes, and to use that diabetes knowledge to formulate potential cures.

Consequently, I dont classify one area of research as being more promising than another. It is important to distinguish that given the complexity of diabetes, including multiple environmental and genetic factors, age of diagnosis, and length of disease duration, a future T1D cure may take on many forms. I personally do not believe it will be a “one solution fits all” scenario, but rather, a cure will need to be somewhat personalised, similarly to how we approach current diabetes management options. What works for one person, may not be suitable for another.

I would like to add that finding a way to prevent T1D from developing is as important as ridding the condition entirely once it has developed and I think that this is also an exciting area of diabetes to explore.

Of course, it is difficult to convey these notions with diabetic patients who do not work in the scientific or medical industry, and are exasperated that “nothing is being done”.

Believe me readers, something is definitely being done. Don’t lose hope.

Learning to Fuel My Body with Type 1 Diabetes.

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Trying to stick to a diet of 8,000 kilojoules a day is hard work.

I know that when I do eat enough to sufficiently fuel my very active body, I don’t feel lousy, exhale air or yawn half as often as I’m used to. I have more energy, focus and enthusiasm to pour into my day. In fact, I’m so focussed on getting those kilojoules into my body that I don’t think think about chocolate or even coffee half as often (no, I am not kidding).

I also know that this 8,000 kilojoules a day business is hard work (have I said that already?). Organising meals and snacks takes time out of my day, even though I am more than capable in the kitchen. It’s been very easy for me to slip back into my old habits of existing on rabbit food until dinner time when I haven’t organised myself in the mornings.

I embarked on this new eating-to-fuel-my-body kick at the end of February, rebounded for some part of March after I got sick and the Cadbury Choc Chip Hot Cross Buns kicked in, and am only just getting back on track in the past week or so.

I first learned about eating to meet my daily energy needs after reading The CSIRO Total Wellbeing Diet and The CSIRO Low Carb Diet last year. Despite it all making perfect sense, putting kilojoule counting into practice on top of carb counting, checking blood sugars and all of those other diabetes tasks felt extremely overwhelming. Thankfully, the smartphone app My Fitness Pal made tracking my kilojoule intake really easy.

The biggest change since I’ve began eating more is increased insulin sensitivity. Which I guess is a good thing, right? It started with unusually easy to manage blood sugars in the evenings after dinner. I would then wake up low during the night, have a glucose tab or two, only to wake up low again a few hours later. Fun times, right?

I’ve dropped my basal rates by about 10% overall, and so far, so good. My biggest challenge is continuing to eat this way so that I can maintain the same sensitivity to insulin.

I’m not really focussed on skewing a particular way with protein, fat or carbohydrate, but do find myself eating more protein than I was before. At the moment I’m honestly just focussing on eating enough, eating well and getting a balance of everything in there.

I find myself eating more significant meals for breakfast and lunch, rather than a slice of toast or a toasted ham and cheese sandwich. Like this amazing Sunday roast of pistachio stuffed chicken breast wrapped in prosciutto that has doubled as Monday lunch.

I embarked on this way of eating for more physical reasons, but the benefits seem to have extended into my diabetes as well.

I have more energy and focus in the short term, and I’m hoping that this will only replicate further in the long run (if I can keep it up!). The increased insulin sensitivity is making blood sugar levels much easier to manage. In the past I’d correct stubborn highs with little or no effect, and override the suggested correction on my pump with a larger bolus. Now, a correction seems far more effective than before.

I get that balancing food and blood sugar levels is no easy feat, but I don’t think I ever truly appreciated just why it is so important to eat.