Author: Frank

Ketones for Christmas

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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…

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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.

Starting Small.

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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 promise you’ll reap the rewards.

The Right Fit

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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.

‘That’s Not Really Good For Diabetes’

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“What’d you bring in?” My friend asked.

“Sticky date pudding,” he replied.

“Oh, yum!”

“It’s one of the best recipes,” he replied enthusiastically. “It’s mostly sugar. Nothing healthy in there.”

“That’s not really good for diabetes!” She remarked, turning towards me and laughing.

“That’s not funny,” I replied.

I’d so been looking forward to this morning tea. I was in the kitchen at 9.00 the night before, making the shortbread that I’d been wanting to make for weeks but hadn’t got the chance to.

Yet that one, ill timed and misinformed comment put a damper on something that I had so been looking forward to. I’m not embarrassed by my diabetes, but it embarrassed me. It reminded me of just how ‘different’ I was.

I was angry at the stigma that had just been perpetuated throughout the room from the attention drawn in from that comment. I’m not saying that as a person with type 1 diabetes, I’m saying that as a person with diabetes.

I know that my reply didn’t suffice. It didn’t make me feel better. It didn’t do anything in the way of correcting the stigma, but it’s the best I could come up with on the spot.

I spent the next hour or so reflecting on how I’d have better responded to that comment if I had my time back. Resisting the urge to approach this person and tell her not to make jokes about diabetes, because she was my friend (and she also puts up with a lot of my grumbling throughout the day…)

As I stood in the kitchen later, eating a banana and feeling rotten after the umpteenth hypo this week (which is a totally different story), I felt well and truly deflated.

Diabetes is not a joke.

Revisiting the Dexcom G5 CGM, Four Months Later

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I’ve been using the Dexcom G5 CGM for around four months now, and I thought it might be a good opportunity to revisit some of my thoughts on the system now that it’s very much a part of my diabetes kit.

Application: Contrary to popular opinion, I actually like manually inserting the needle via the plunger. Insertion devices tend to bruise my body more easily and don’t leave me feeling confident that the insertion has been a success. The yet to be released G6 iteration will have an insertion device, and I’m not too sure that’s a big selling point for me.

Placement: Like many in the DOC, I love wearing my sensor on my upper arm. It’s out of the way, I can’t see it when I look down at my body and it gives me more real estate for placement of pump sites.

I have personally found the most effective placement to be with the plunger pointing upwards in the direction of my shoulder. I placed one in the opposite direction some weeks ago, and my sensor didn’t last much longer than a week there.

Adhesive: The sensors stick really well on the arms. I can normally go for two weeks before having to apply a bit of reinforcement, such as a Rockadex patch. Although, I don’t do a lot of dedicated exercise or work up a sweat very often…

Sensor life: I’m currently getting three weeks out of a sensor. The first two weeks yield solid results. However, the third week is often a struggle. The readings can get a bit jumpy, movements accentuated, and often those three question marks pop up and I temporarily lose access to blood glucose data.

Last week, my sensor was into week three and I was beginning to experience some really unreliable behaviour. I decided to restart it, clearing the system of any calibrations that may have been sub-optimal. I also drank a few glasses of water, and that has given me my strongest finish to a sensor so far.

Calibration: I prefer to calibrate with clean hands. But I also can’t be bothered washing my hands before I check my blood sugar. Especially first thing in the morning, when the coffee machine is calling me. Which leads to me putting off calibrating. Or checking my blood sugar, second guessing the result because I didn’t wash my hands before checking, and then washing my hands and checking again. For the record, my trusty AccuChek Guide produces almost identical results each time.

I stick to twice a day, ideally when I wake up and just before dinner. But otherwise generally before a meal when my blood sugar is steady and there’s not a lot of bolus insulin on board.

Accuracy: Superb. Just stick to twice daily calibrations and don’t over calibrate. For more on the accuracy, check out my last Dexcom post.

Integration with my t:slim pump: It took me a while until I finally wanted blood sugars on my pump screen. In the beginning when I was still getting used to the system, it was just too much. I also seemed to integrate them at the worst of times, like in week 3 when my sensor was beginning to crap out or a few days before my exam. The only way to take them off is to shut down the pump and then power it back on.

One thing I do not like is having my phone on me all the time for access to my BGs or just to silence an alarm. I only started running BGs on my t:slim for good just before Christmas, and so far I’m loving it for the ability to be phone free.

Affordability: I’m using a rebatteried transmitter obtained through the Diabatteries Down Under community on Facebook. This is not warranted by the manufacturer and is essentially a ‘DIY’ solution that works just as well. This means that the ongoing cost of my system is essentially just the sensors.

In conclusion: Anything that lets me do less while managing my diabetes is a good thing. Having blood glucose readings at the glance of my phone has definitely improved the quality of my life. I do find it far easier to pick up on trends and changes that I need to make than I ever did on finger pricks. I feel as though I have a clearer picture of exactly where my diabetes is at.

I acknowledge just how privileged I am in being able to access this system.

At this point in time, the G5 is meeting my needs perfectly as I continue to manage my diabetes, and I really don’t want anything more from it.