Author: Frank

Burnout Is In The Air

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Don’t even get me started on those Spring has Sprung statuses…

I’ve been very much burned out these past couple of days. Surprisingly, nothing insulin pump related, either.

The truth is, I’ve had diabetes on the brain these past couple of weeks. I am striving to bring my A1C down by the end of the year. I’ve been stalking my glucose levels around the clock, demanding perfection. Carb counting. Weighing portions. Pre bolusing mealtime insulin. I’ve even heard the words remember to pre bolus escape from under my breath occasionally when I’ve been in the shower. I’m not kidding, either.

Last week, this constant diligence finally caught up with me.

I had two identical mornings, where I woke up slightly out of range on each. On Tuesday morning, my breakfast bolus failed to do it’s job of bringing me back into range. When I woke up slightly out of range again on Wednesday morning, I added another 10g worth of insulin to my identical breakfast, only to end up with an even higher blood sugar level than the day prior.

It got to me. It really got to me. Despite my best efforts, despite the constant monitoring and adjustments, I had still failed myself. Two identical days should be easier to manage, and yet they still produced completely different results. Diabetes is so damn unpredictable.

So I dropped the diligence. I didn’t feel like carb counting. I didn’t feel like weighing portions. I couldn’t be bothered pre bolusing insulin. I ate Croissants and chunky Kit Kats for lunch, because that’s what I felt like. Upward trend arrows on my Libre were compensated for with wild insulin boluses and temporary basal rates. Having access to unlimited glucose monitoring through my FreeStyle Libre sensor definitely made me feel I could get away with this downright shameful behaviour.

What scared me the most, however, was that this behaviour often mirrored my attitude towards diabetes prior to getting the pump. Lazy eating. Guesstimates. Rollercoaster swings in glucose levels. I lacked that sustained motivation. I didn’t really feel very much in control of my diabetes at all.

If this old reality has become “burnout” behaviour today, then I feel I’ve made a great deal of progress in the past couple of months.

A Basket Case?

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I’m sitting here, typing this, with a blood sugar level of 18.8. My FreeStyle Libre graph for the past 8 hours looks absolutely dreadful. I had to override the maximum insulin delivery limits on my pump so that I could give higher insulin boluses, and run higher basal rates to bring my blood sugar levels down.

I feel like crap. I feel ridden with guilt. I feel sick and tired of all the discipline that diabetes involves. I feel like I really don’t give a shit about diabetes today.

Rewind back to yesterday morning, when I woke up to a 9.1. Nothing too terrible, but far enough out of range to make my breakfast bolus less sensitive. Which, despite an added bolus for 10 grams worth of insulin with breakfast, still led to a reading of 15.0 afterwards. Which led to an I-don’t-give-a-shit slice of black forrest cake with lunch. Which led to an I-couldn’t-give-a-flying-f*** about being diligent attitude for the remainder of the day.

Diabetes demands so much discipline. Checking my blood sugar. Counting my carbs. Weighing my portions. Delivering my insulin. Pre bolusing that insulin 30 minutes prior for a optimal post-prandial result. Setting the alarm to check my blood sugar at 2am to ensure that I won’t wake up high the next morning. Foregoing so much temptation, for the sake of better blood sugar levels.

Diabetes already demands so much of me, and yet it never seems to be enough. It never seems to be enough, and that’s where the cracks begin to show. 

Yesterday afternoon, I was curled up in front of the couch with a coffee and an almost-finished (not by me) packet of melting moments biscuits. I had eaten one, and was sitting there staring at the last one in the packet for what must have been 10 or 15 minutes. Should I eat it? Or I should put the packet away?

I eventually ate the second one, and of course watched my blood sugar rise in the aftermath. As I gave corrections that couldn’t quite catch up to my rising blood sugar, I began to murmur to myself “you’ve got problem, mate.” “You need help.”

The funny thing being that if I didn’t have diabetes, this would hardly have been a problem. I would have eaten the second biscuit and enjoyed the hell out of it, instead of feeling guilty. I might have bragged to the next person I saw about eating those two whole biscuits, instead of feeling ashamed. I might have complained about feeling ready for bed after satisfying my stomach, instead of cursing my rising blood sugar levels.

If I didn’t have diabetes, this would hardly have been a problem.

If I didn’t have diabetes, I wouldn’t be talking to myself like I were a basket case because I ate two damn biscuits.

In and Around the DOC of Late II

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I feel I’ve been quiet in the DOC chatter while diligently working on my own blood sugar levels and stalking my glucose meter, so here are a few items that have caught my interest lately.

Allison at The Blood Sugar Whisperer is sharing a unique perspective into preparing to conceive a child with diabetes. I’m working diligently towards bringing my A1C down, so I can relate a lot to that aspect of Allison’s writing.

Speaking of A1C, being able to look beyond the less than ideal number that I wrote about last week was crucial. This post from Mike at Diabetes Mine really hit home, and it’s great to see that there’s conversations happening in the US around re-evaluating the A1C as the sole assessment of diabetes therapy.

I frequent Facebook, Twitter and a lot of diabetes blogs for my dose of DOC. One blogger who is doing it differently is Drew of Drew’s Daily Dose. Drew is an exercise physiologist and diabetes educator who lives with type 1. I first met him in Sydney this May, and he primarily runs a popular Instagram account focussed on his passion for exercise, fitness and type 1 diabetes. Check it out here.

Steptember. The idea is that you take 10,000 steps a day for 28 days and get people to sponsor you along the way. Although this is a fundraiser for Cerebral Palsy, I still think it’s a great idea for diabetes and getting active. steptember.org.au explains what it’s all about.

One of my favourite writers on the other side of the world is Sarah of Coffee and Insulin, and some of her recent posts have been exceptional. Sarah’s writing is just so captivating, and her lust for travel, adventure and life shines through in her writing. Happy 11th Diaversary, Sarah!

Back on the home turf, the Australian Diabetes Society and Australian Diabetes Educators Association held their annual scientific meeting last week. Tweets were rolling out from some of the passionate advocates in attendance, and you can catch up by following #adsadea2016 on Twitter.

Congratulations to Kelley at Below Seven and Kerri at Six Until Me on the recent arrival of their newborn boys. Maria at My Life: A Long Trip With T1D is also expecting, although I’m not sure her new employer realised straight away!

Tuesday night is OzDOC night. Follow @OzDiabetesOC and #OzDOC on Twitter to connect with other people with diabetes.

Last but not least, I must have missed the memo that Friday was National Dog Day. This little man has been holidaying at my house for the past two weeks, and he absolutely hates the camera. Although he did promise that he would guest blog again soon to make up for it…

 

Highs After Exercise

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It’s amazing how something as simple as a conversation has given me some much needed clarity in recent weeks.

For several weeks, I’ve been giving corrections to stubbornly high glucose levels in the afternoons after I’d finished work. Highs that have made afternoon tea difficult to manage. Highs that have made my dinner time insulin dose less effective and pre-bolusing a complete waste of my time. Highs that have often carried through to bedtime and even resulting in a disappointing waking number.

I didn’t think that there could possibly be anything wrong with my afternoon basal rate, because I knew that it was fine on non working days. I thought maybe I was disconnected in the shower for too long. I thought maybe I was eating too much at lunch. I thought maybe it was time to give up the toasted sandwiches slathered with butter, and cheese oozing out of the edges. Maybe buy those addictive donuts from Woolies less often?

When I recently sat down with my new diabetes educator and my Diasend logbook, she instantly pointed out a recurring pattern of red readings in the afternoons. I knew that afternoons had been a problem area. I can see the afternoon ascent in my Ambulatory Glucose Profile.

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Yet in all these weeks, I had never really stopped and thought twice about it.

It took my educator’s small suggestion of increasing my basal rate in the afternoons for me to finally make sense of all of this. Could these afternoon highs possibly be an after-effect of my physical activity at work all day? Could my body be responding with extra glucose as I put my feet up in the afternoons and breathe a sigh of relief that the day is over? A quick google search confirmed that this indeed, could be a possibility.

The most incredible thing is the positive flow on effect that this small change has produced in the past two weeks. Since increasing my afternoon basal rate from 2-5pm on work days, I find that my BGLs stay in range through the afternoon. My dinner time insulin dose is far more effective, and I no longer receive frustrating highs after an accurately carb counted dinner. Overnights have also been looking much healthier, which will ultimately account for a large chunk of the hba1c result I am chasing.

As my educator reminded me, I can easily be doing this at home as well. I have the tech that is capable of uploading my data to the computer. I have Diasend, the software that compiles all of my data into one easy to read report.


Judging by my Diasend report that is now looking a little less red, I really need to be making the time to do this more often.