Dealing with Diabetes

Lantus Adjustment Struggles

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It was the night of Easter Monday four years ago. The very first Easter after my diagnosis. My chocolate haul was proudly spread across my desk, a remarkable feat considering how old I was getting. The fridge at home was full of leftover food and deserts from our family gatherings over the weekend. I’d been pigging out over the past few days and eating more than normal. We were getting new floor coverings in my bedroom tomorrow, and I was sleeping in the spare bed in our games room.

My blood sugar level was somewhere around the 14 or 15 mark before bed. I gave myself three units of correction, knowing that one unit of insulin would bring my BGLs down by 3mmol/L. I tossed and turned, and before I knew it another hour had passed. I tested again, and my BGL hadn’t budged below that 15 mark. I was frustrated, and made an impatience-driven decision to give another 3 units of insulin. I finally drifted off to sleep, and woke up again at around 2am. I tested again. My BGLs had barely budged, and I gave another 3 units of insulin. The same thing happened at 4am. And again at 7am.

I was so angry that my blood sugar levels had been that high for the whole night. I was so frustrated that despite my best efforts, I couldn’t get my blood sugar levels to budge.

Ever since that night, I’ve known that my Lantus dose needs to be adjusted to match the overall amount of food that I eat in a day. Lantus is my long acting, or basal insulin dose that I take once a day to keep my BGLs regulated. On days where I eat more than normal, I know that I need more Lantus in order to keep my BGLs stable through the night. If I’m eating out at a restaurant, pigging out on party food or going crazy at Christmas time, I generally dial up my Lantus dose.

Doctors and other people I talk to have struggled to understand this concept over the years. Most have tried to talk me into giving rapid acting correction and waiting the full four hours for my BGLs to drop. It doesn’t work. That Easter Monday night four years ago was evidence that it doesn’t work. And up until now, I’ve been lost for the words to explain this concept to them.

Multiple Daily Injections are hard. It takes so much fine tuning to get right. There are so many variables that change every day such as food intake and physical activity, which impact on my BGLs and insulin requirements. I was really pleased to hear that my #DOC friend Ally at Very Light No Sugar understood the Lantus adjustment struggle. She offered me a really good analogy to help explain this concept. Lantus, or long acting insulin is like a mitten. And we fine tune this mitten with rapid acting insulin to make it fit like a glove.

At the end of the day, I’m not telling you what to do. I’m just telling you what works for me. Because it’s not anyone else’s diabetes but mine. But I really could use some advice on dealing with Lantus dose adjustments if you’ve ever experienced anything similar. Just putting it out there.

The Day My Insulin Ran Out

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I have two rapid acting insulin pens that I use. The first one sits on my desk at home, beside my blood glucose meter and my phone. I use it with my breakfast, my dinner, my snacks that I shouldn’t be having and for any corrections inbetween. The second one normally accompanies me on my travels. If I’m going to work, it usually sits in my satchel amongst my other clutter. If I’m going out, it’s normally stashed in my jeans or jacket pocket. I use the travel pen less than the home pen, but it probably cops the bigger-than-normal insulin doses from eating out and going overboard at parties.

Every time my home pen runs out, I’ll replace it with my travel pen. And I’ll replace my travel pen with a brand new pen. I swap them so that my insulin pen will always run out at home, where I have a spare stash of insulin sitting in the fridge, rather than on my travels. I know it sounds like a confusing system, but it works for me.

Ever since I returned home from my holidays in July, I’ve only been using the one pen for both home and travel. I’ve had to remember to grab my insulin pen in the morning to take to work, rather than it just already being in my bag. I’ve had to go searching for my insulin pen in my bag or in my jeans when I get home, rather than it already just being on my desk. In all of these weeks, did it ever occur to me that I was making life harder for myself? In all of these weeks, did it ever occur to me that I could just re-employ that second pen? Nope. Or maybe I just couldn’t be bothered doing it.

Last Tuesday night, I noticed that my insulin pen was nearly empty. Too lazy to replace the cartridge then and there, I told myself I’d deal with it tomorrow morning. And I didn’t give it another thought. That was, until after I’d eaten my lunch the following day at work. I was in the locker room, ready to dial up the pen, when I noticed once again that the cartridge was almost empty. My stomach sank. I hoped that there would be enough there to cover my lunch. Even more stupidly, I primed the pen without even thinking about what I was doing. I dialled up my dose of 5 units, stuck it in and pushed. It was cut short. I had managed only 1.5 units of the 5 that I needed.

Thankfully, I’d only had a Burgen bread sandwich and a Muesli bar for lunch. I only had an hour left until knock off time at 3pm. And I live very close to work. Under any other curcumstances, I would have headed home immediately (okay, I probably should have headed home immediately). But under those circumstances, I thought I would be okay to last out the rest of the day. I hadn’t eaten anything ridiculous. And I was just over an hour away from getting my insulin.

My mind was preoccupied for much of my last hour at work. I left at 3pm on the dot, bolted through the door at home and headed straight to the fridge to grab a spare insulin cartridge. It was the first time in five years that anything like this had ever happened. And quite honestly, I was disappointed in myself.

It didn’t take me long to get that second insulin pen out of retirement and back into the workforce at Frank’s diabetes. And I know that I’ll never let it happen again.

Thirteen Truths About Insulin Injectors

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I am not one of the cool kids with an insulin pump or a Continuous Glucose Monitor (CGM). If you start talking to me about basal rates, temp rates, boluses and infusion sites, I’ll probably nod my head without understanding a word of what you’ve just said. And if you tweet me your CGM graphs, you’ll likely put me to sleep because I absolutely hate maths class.

I’ve been on Multiple Daily Injections since I was diagnosed five years ago. What I do understand are words like FlexPen, Penfill and Lantus. If you start talking to me about injection sites, doses, corrections and priming, you’ve probably got my attention. And if you can relate to my thirteen truths about insulin injectors, then you’ve probably got a lot in common with me.

1. Finding a comfortable place in my jeans to stick my insulin pen without squashing it when I go to sit down.

2. Having my insulin pen fall out of my shorts pocket whenever I’m driving, and then having fumble around for it under the driver’s seat.

3. Injecting before dinner, only to realise there’s no carbs on the dinner plate.

4. Trying to pay attention to the conversation at the dinner table when all I’m really thinking about is the carbs that were on my dinner plate.

5. Trying to find a subtle moment at the dinner table to escape to the bathroom without anyone noticing.

6. Dialling up really quietly in the Men’s bathroom so the person in the next cubicle doesn’t think I’m a total weirdo. Or taking drugs.

7. Drawing dots on my stomach to keep track of my injection sites.

8. Frantically putting the cap back on my needle and the lid over my insulin pen the minute I hear someone coming towards the locker room at work.

9. Trying to figure out how much to increase my Lantus dose by after eating more food than usual today.

10. Going hypo in the middle of the night because I ate less than normal today and my Lantus dose was too much.

11. Succumbing to the urge to overcorrect a ridiculously high blood sugar reading, only to end up hypo 2 hours later.

12. Finding a corner to subtly inject because there isn’t a bathroom nearby. Or because I just can’t be bothered going into one.

13. Doing the four touch tap when I leave the house. Wallet. Keys. Phone. And Insulin Pen.

Who says that technology is the only thing that does your head in? Insulin injecting does my head in all the time!

To Disclose, Or Not to Disclose Diabetes?

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Most of the people in my life know that I have diabetes. Although, I think a lot of them forget that I have diabetes because I don’t really talk about it much. I’ll bring it up from time to time, and I’ll get those “oh yeah, that’s right!” exclamations. Then there are those people who offer me way too much food to remember that I have diabetes (and shouldn’t be snacking on chocolate at 8am in the morning!). And then there’ll be those conversations where I’ll be like “how did you know that I had diabetes?” Fun fact: Italian families live to talk about people that they know.

Generally, those who know me well are aware that I have diabetes. I’m happy to talk diabetes with those people who take an interest, but I also realise that some people aren’t interested in hearing me go on about it – and that’s cool with me too! As for strangers, I don’t think it’s necessary to disclose diabetes to everyone I meet. I generally keep my diabetes disclosure on a need-to-know basis with acquaintances, or until I feel I can trust them enough.

My uncle once disclosed diabetes for me in front of one of his friends. Although I had no control over this situation, it’s reminded me of why I’m selective about disclosure ever since. I didn’t know this person very well, but I’ve always found him to be a little weird. I’ve never felt comfortable around him, and he clearly wouldn’t be able to handle that conversation very well (he didn’t). There were lots of insensitive questions and weird looks the whole time. And it made me feel stupid.

The first thing I think about before disclosing my diabetes is how it will affect me. There are a lot of stigmas out there about people with diabetes, and the last thing that I want is for people to think lesser of me. So I think you’ll understand why you’ll never hear me say “I have diabetes, but I hope you will consider me for this job.” And most of the time, I want to be treated just like everyone else. I want to have that piece of cake. I want to do what everyone else is doing. It gives me a feeling of normality. And when you have diabetes, you need as much normality as you can get.

Secondly, a diabetes disclosure inevitably comes with questions. Stupid questions. Like “did you get diabetes because you ate too much sugar?” Or “you can’t eat that, right?” Or “my cousin’s-wife’s-mother has diabetes and she’s found the cinnamon cure!”  There are days where I honestly just can’t be bothered talking about diabetes, or tackling those stupid questions. So sometimes it might be best to save disclosure for a sunnier day.

Thankfully in the online world, disclosure is much easier. Everyone who I interact with in the DOC has diabetes and just “gets” it. I love not having to tackle those stupid questions. I love being able to share my weak moments and know that there will be no judgement or adverse consequences. And I love that there is a never ending source of inspiration, support and #dlove. And that’s refreshing.

Want to chat about more awesome topics like this one? Join the Oz Diabetes Online Community Tonight from 8.30pm AEST (GMT+10) for our weekly chat by following the #OzDOC hashtag on Twitter.

A Marathon of the Diabetes Kind

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I hate running. I absolutely hate it. I can remember dreading sports carnival season when I was in school. Although I never stood a chance in hell of making the cut, I still had to try out and run a lap of that dreaded 800 metre track. Despite how slow I was, every year I dreamt of being able to keep up with my classmates. I would start running. I would enthusiastically try to keep up with the others. I would be able to keep running for the first 100, maybe even 200 metres. Even though I felt like I was killing myself to keep up, my classmates just seemed to effortlessly speed past me.

And I was left behind. Then I would give in to my body’s urge to slow down. I would be puffing and panting. I would be able to feel the pulse in my chest, beating ever so rapidly. I would have to walk some of the distance. And if I was extremely lucky, I’d even get to see some of my classmates overtake me on their second lap. Eventually when I was the last one left on the track, everyone would start cheering me on, more out of pity than anything else. I would start to pick up the pace as best as I could, despite my body telling me otherwise. I would cross that finish line, and collapse to the ground with exhaustion. I could never go the distance.

I feel exactly the same way about my diabetes. Diabetes is like running a marathon every day. Except that a marathon of the diabetes kind has no finish line. I can’t slow down because I’m exhausted, emotional and frustrated. I can’t pull out of the race because I know I won’t get the results I want. And I can’t stop running because I don’t like it anymore.

That finish line keeps moving a little further away the closer that I get to it. There are the obstacles of life that get in the way, and keeping that finish line in sight seems nigh on impossible sometimes. There are so many points where I just want to stop running. There are so many points where I don’t know if I can dig any deeper.

But there is one small difference between that primary school race track and the diabetes one.

In a marathon of the diabetes kind, I am lucky enough to have a whole team of people who are cheering for me. Not out of pity because I’m in last place, but because they genuinely care. My wonderful family, for one. The family who believe, perhaps more than me, in my chances of a relatively normal life. And possibly even a cure at some point down the track. My healthcare team. My diabetes educator and my endocrinologist, who I know are on my side. Who I know I can talk to honestly and without judgement. The people in my life who care enough to ask how my diabetes is going, even though the question annoys the hell out of me! And the wonderful Diabetes Online Community, who are a never ending source of support and encouragement.

Diabetes is always changing. Diabetes is always throwing obstacles onto the track, in the hopes of knocking me sideways. But so long as I have people on the sidelines to cheer me along, that finish line will always be in sight.

Photo: A feeling of achievement while running my diabetes marathon at the Royal Botanic Gardens in Sydney this July.

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