Author: Frank

A New Member of the D-Club

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“Doesn’t your sugar levels go high if you eat too many sweets?”

This was a question that was posed to me over the weekend, as I reached over and grabbed a sweet from the table. 

“I’m low at the moment” were the first words I could get out of my mouth, resisting the urge to add more words until the sugar was sitting safely in my belly.

“I have type 1 diabetes. My body doesn’t produce any insulin.”

I pulled my pump out of my pocket, thankful for my newfound prop that keeps my flailing hand gestures at bay.

“This delivers all of my insulin for me. Technically speaking I can eat anything I want, so long as I give insulin to cover it. Obviously it is better for my blood sugar levels if I eat healthier foods, though.”

This person then went on to tell me that she had been recently diagnosed with early signs of type 2 diabetes, and that the lifestyle changes suggested by her doctor were easier said than done. That she wasn’t sure how changes to her diet would fit in with the rest of her family at home. As she questioned her need for the medication prescribed to her, I could see just how hard it was for her to accept her condition. It brought back my own memories of hiding my diabetes, unable to accept my new ordinary.

I curiously asked if she was testing her blood sugars at home, or whether she had seen a diabetes educator yet. As she told me ‘no,’ I nodded my head. The last thing I wanted to do was to try to give advice. The last thing I wanted to do was to act like I knew what she was going through, or what was best for her. Type 2 diabetes is completely different to type 1. Heck, one person’s diabetes is completely different to another’s.

Yet at the same time, I felt like I should have done more to help her out. I felt sorry for her, because her doctor didn’t seem very helpful or supportive. I hope I said the right things.

“I know it’s hard. It’s taken me ages to make changes that have lasted. I’ve had diabetes for six years, and I still have days where I don’t feel like I’ve got it right.”

All I really wanted to do was to give her a big hug and tell her everything was going to be okay.

Hopefully she sees in me that it will be.

Navigating Diabetes Through a High Carb Breakfast

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I have always found diabetes extra challenging to manage around big meals. I’m the kind of person who likes to try a bit of everything at a party. I try not to let diabetes get in the way of enjoying myself on special occasions like birthdays or Christmases, because they only come around once a year. Often the consequence of this has been high blood sugar levels that are tricky to bring down in the hours that follow.

One of the biggest advantages of having an insulin pump is the extra flexibility that it gives me to work around high blood sugar levels. With tricks like temporary basal insulin rates, the pump has definitely saved me hours of frustration in trying to bring my blood sugar levels down in the aftermath.

Yesterday my pump got it’s first taste of a high carb meal, as I took the wheels out for a spin over breakfast. I had been craving pancakes all week, so my order was going to be a no brainer.

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In anticipation of the extra carb load, I set a temporary basal rate of +100% to ensure that my mealtime insulin did its job effectively. I did this before I left home, so that the basal rate would kick in by the time I sat down to breakfast.

The cafe looked pretty busy, and I wondered how long I would be waiting for my pancakes. I guessed that I would probably need insulin to cover somewhere in the vicinity of 60-80g of carbohydrates, but I didn’t know for sure how big the serving would be. I decided to play it safe, and pre bolused half my insulin when I placed my order, and the other half when my meal arrived.

When I left the cafe, my blood sugar was 13 mmol. When I checked again at home half an hour later, I was 13 mmol once again. I noticed my blood sugar begin to creep up again at around the 3 hour mark, as I would expect for a higher loaded meal. I entered my blood sugar reading into the pump, overrode the insulin on board subtraction, and gave a correction dose. I kept the temp basal running, anticipating that I would need it to cover the delayed fat/protein spikes.

By around 2pm, my blood sugar was almost back in range at 8.3.

The majority of my numbers throughout the morning were around the 12-13 mmol mark, save for one brief peak at 15.7 mmol. To put that into perspective, a loaded meal like that has the potential to send me well above 20 mmol. 

Safe to say I was pretty damn pleased with my handy work.

Take that, food police.

In the Line of Questioning

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I went down to my local pharmacy yesterday to order some consumables for my insulin pump. Specifically, I had chosen a box of Comfort infusion sets (thanks for the suggestion, Laddie) in response to some of my recent site failures. I pointed out to the Pharmacist that I had not purchased this item before, because I knew that the computer would notify her of this.

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“Why do you need a different one?” She asked me.

I explained that I wanted to try a different kind of infusion set, because I had been having some site failures recently.

“Have you spoken to a diabetes educator? You’re not really supposed to be changing without their advice.”

I found this line of questioning rather bizarre, because prior to the recent NDSS changes in Australia I could easily jump onto the computer and order whatever I liked with no questions asked. Besides, would you really expect me to call my educator if I wanted to change the colour, or length of my infusion site? Do you really expect that the needs of my diabetes aren’t going to change ever again?

I think she was only trying to make sure that I was ordering a product that would be compatible with my pump, and that I understood that I would not be able to bring it back.

There is a lot of uncertainty at the moment while the delivery of diabetes consumables is shifting from online to pharmacies, and she was probably making sure I wasn’t being wasteful. There is a lot of fear and sensationalism being spread around on social media. Many are over ordering in response, leading to shortages in the supply of diabetes consumables.

I made it clear that I had done my research prior to selecting the product, and that I was only purchasing the one box because I wasn’t sure if I will like using this type of infusion set.

Pharmacist questions always make me uncomfortable. Even when I walk in there with the flu requesting Demazin tablets, they always question me about the symptoms I am experiencing.

I just try to remind myself that it’s a Pharmacist’s job to ask the hard questions. It’s their job to make sure that we are ordering the correct medications for ourselves. It’s their job to make sure that we are not being wasteful.

I’ve been buying diabetes consumables from my local pharmacy since I was diagnosed. Having a good relationship with them over the years has really paid off. They’ve given me insulin when I presented an expired prescription once. They eventually gave me the test strips after I was told I had purchased too many last year (I wrote about this here). They know that I have diabetes and they understand what I need.

If there’s one golden piece of advice I would give to Australians affected by changes to the delivery of diabetes consumables, it would be to find a local pharmacy and build a good relationship with them.

Answering to people that I’ve known for well over six years makes those hard questions a little less uncomfortable.

Sidenote: You can read more about the NDSS changes here.

FreeStyle Libre Not Working?

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I’m appealing to the search engines with the title of my post today, because this is what I was hoping to find when I turned to Google for help with my FreeStyle Libre a few weeks back.

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I was about halfway into a sensor that I had purchased, when suddenly my reader stopped working. The screen wouldn’t start up when I hit the home button. There had been a few instances in the days leading up to this where my screen had blacked out for five or ten minutes at a time, but it always came back to life. I might also mention that this culminated on a Saturday morning, and I soon learned that I wouldn’t have access to customer service until 8am on the Monday.

When my reader still wasn’t responding well after an hour, I was frustrated. I reached out to @FreeStyleDiabet on Twitter with no reply (I’m not too sure where in the world this account is based).

I tried charging the battery with no success. I got an idea from the instruction manual that the device might be temperature sensitive, and kept it in my pocket while I was sleeping one night with no luck either.

I had no idea where I would stand in getting replacements for my reader and the $95 sensor I couldn’t make use of. Abbott were a little coy at the blogger event in Sydney regarding faulty sensors, and we were told that it would depend on individual circumstances.

When I got in touch with Customer Service on the Monday, they shipped me a new reader and replacement sensor on the condition that I send the faulty one back via supplied packaging. The replacements arrived via express delivery two days later, and I started the sensor up once again.

The replacement sensor, however, was wildly out of range. Most of the time, the readings on the Libre were far higher than what I actually was. I was constantly seeing numbers in the mid to high teens (and even 20s) after meals, and this really took a bit of a mental toll on me. I was pricking my fingers almost as much as I would without it, because I couldn’t trust the numbers. I was driving myself crazy, thinking about the prior two sensors I had used and whether the readings were this far out (and it didn’t only happen when glucose was high!)

I gave customer service a call once again, explaining my problem. I was reminded to factor in the 5-10 minute lag time, which I was confident I had. I was then asked to provide three Libre readings and their respective finger stick readings, and I was put on hold to do a control test. The customer service rep then came back and told me that he would send me a replacement sensor free of charge because I was reporting readings higher than the acceptable difference of 1-2mmol.

I was really impressed at how quickly I was issued with a replacement sensor over the phone. I had meter reports prepared prior to calling, almost expecting that I would have to send through evidence of inaccurate readings. Both times, my replacement products were shipped by overnight express to my doorstep instead of the usual 6-9 day delivery window.

However, I would have expected customer service available to me on weekends, even if just for a couple of hours. I also think that Abbott need to be more realistic about their products developing faults. The returns policy, which you can read here, is rather brief and doesn’t give the customer a feeling of confidence or support when the tech fails.

That being said, I am super grateful that Abbott resolved both of my problems with very minimal hassles.

To Carb, or Not to Carb?

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I’ve read so many articles about low carb eating lately, that it’s left me wondering if there are any people with diabetes out there who still eat them. I’m not about to start telling you what’s right or what’s wrong, because I believe that diabetes management is a very individual issue. But I would like to weigh in with my own perspective on the age old question. I stress, these are my personal opinions only.

Quite honestly, I’ve never been a fan of low carb. The mere sound of the word makes me cringe, simply because it makes me think of restriction. I also think that eating low carb requires a greater level of commitment in the kitchen all through the day, rather than having just one cooked meal in the evening as I do.

The main reason I do not like low carb eating is because the trade off is usually foods that are higher in fat. Foods that are higher in fat tend to produce spikes in blood sugar levels several hours after a meal. I find that protein and fat spikes are very hard to bolus for, and high blood sugar levels are very resilient to insulin corrections. Personally, I do not like chasing highs several hours after meals and would much rather bolus my insulin just once. If there are any low carb people reading this, I’d be interested to hear how you work your way around this.

I am happy to put the work into the carbohydrates I eat. As I wrote last week, pre-bolussing for meals helps me to avoid the post meal spikes. Carbohydrate counting does work when I’ve got my ratios and basal rates right.

That being said, I definitely have changed my thinking around the way I approach carbohydrate foods. Over time I have slowly made gradual changes to the carbohydrates I eat.

I definitely try not to overload on the carbs at mealtimes. On the weekend, we had Turkish bread rolls for lunch, which were 70g. I cut mine in half, simply because I consider 70g way too much to be eating in one sitting. Ditto for the thick slice Cafe-style raisin toast that I have as an afternoon treat sometimes. I also make sure to weigh out my portions when I have foods like rice and pasta, to make sure I don’t overload on the carbs.

I only eat bread as either toast or sandwiches now, and not as a side or appetiser for my dinner plate. I always opt for lower carb, seeded bread, which also tends to carry greater nutritional value with it. Burgen Pumpkin Seed is a real winner for me, with just 11g carbs per slice. Baker’s Delight Cape Seed loaf is another good one.

I have also cut out a lot of the high sugar foods in my diet. Over one very painful year, I gradually cut the two sugars out of my coffee and tea completely. I no longer eat breakfast cereals, because even some of the better ones are still loaded with at least 20g of sugar per 100g. Ditto for muesli bars, which have been replaced by bananas. I often have microwaveable Oats sachets for breakfast, and I have recently switched from the sugar laden fruit flavours to Original.

My approach to eating has definitely centred around eliminating the carbs that I deem unnecessary or unenjoyable. I would much rather put these carbs saved towards foods that I do want to eat. For instance, those yoghurt pots with the stir through fruit jelly? I would much rather have that sugar in a plate of ice cream instead.

When I look at my Dad, who eats bread with anything and everything, I definitely feel that I eat far fewer carbohydrates than I once did. Would I identify myself as a low carbohydrate eater? I still eat the foods that I want to eat. I don’t feel as though I am depriving myself of anything. I’m simply eating a diet with far more balance compared to life prior to diabetes.

With lots of coffee, and the occasional cannoli or cake thrown in.

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