Diabetes and Healthcare Professionals

A New Addition to Team Frank

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“What else has happened in your life since diabetes came along?”

“How comfortable are you when you pull out your insulin pump or prick your finger?”

“What concerns you the most about living with diabetes?”

These were just some of the ice breakers as I sat down with a woman who I hoped I would be able to call my new diabetes educator, in a private clinic last week.

After six years of diabetes care in a public hospital, this was a completely different experience. My diabetes clinic-that-wasn’t-technically-a-clinic was situated behind the corner pharmacy store on a quiet inner city street, rather than a bustling hospital campus. My session was in a room on the ground floor, with an open window looking out into the yard behind the building. There was no sense of urgency, nor did I feel that my appointment was being rushed. There were no interruptions throughout the whole hour. I was being spoken to like a person who had diabetes, rather than the diabetes patient. The place certainly didn’t feel super clinic-y, either. Everything just added up to a nice, casual vibe. 

We looked over my diasend uploads, and straight away she picked up on trends of red numbers on weekends. Something my diabetes brain probably should have picked up on sooner. I admitted to cruizy days of weekend eating that were often triggered after a 10am hypo, and she helped me nut out a strategy to continue to cruise through and see a little more green.

I wasn’t really swayed one way or another as I talked through my diabetes management, either, and I wasn’t sure if this was a good or a bad thing. I suppose, like this decision, it was mine. It was diabetes on my terms. No judgement.

As we approached the end of the hour, I was asked how I wanted to proceed after today. I knew how I wanted to proceed. Yet I still hesitated for a moment.

I had spent the whole hour talking over my diabetes management so confidently. The numbers on my diasend report were pretty good, overall. I had reached the hba1c goal I had set myself at the beginning of the year. This session reassured to me how proactive I am in being able to manage my diabetes. Did I need to be here?

After being pushed towards self management for so long at the hospital, it felt strange to have the option there. After all the time constraints of the busy diabetes clinic, it felt super weird to have the choice of when my next appointment would be. I was paying for it, of course. But it still felt strange.

I’ve decided I want a three month catch up with my diabetes educator. As good as I may be, I still need that reassurance. I need that fresh set of eyes that can pick up things that my diabetes brain cannot. I’ll continue to see the endocrinologist at the hospital, and get referrals for all of my important check ups there. Most importantly, I’ve got someone to touch base with inbetween. If the need arises, I’ll be able to call or e-mail, and make appointments inbetween. I already rest a lot easier at night knowing that I have someone reliable at the ready.

Two years ago, I doubt I would’ve had the confidence to be able to identify my needs, to speak up for what I wanted, or to go through with such a big decision.

Today, I’m confident that this is one of the best decisions I’ve made for my diabetes care. With a new addition, Team Frank feels stronger than ever.

Making the Leap into Private Diabetes Care

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I am extremely grateful for the diabetes care I have had access to over the past six years. The diabetes clinic at my local public hospital has given me access to every kind of service I could ask for manage my diabetes. All completely free of charge. Unless you count parking. Parking is a pain in the ass.

By far, the most amazing part of that diabetes clinic was my amazing Diabetes Educator, Gwen. Yeah, appointments were often as far as three months apart. Yeah, there was a gap in the middle of those six years where I probably should have kept in touch but didn’t. But Gwen was always there. She was always available by phone and by e-mail. She listened to me. She was someone I could rely on. I wouldn’t have wanted anyone else to support me as I began insulin pump therapy in May.

She retired several months ago.

In the last couple of weeks, I feel like I’ve lost my way. I no longer feel like I can achieve consistency day to day. I mean, I know I’m doing all the right things. Writing things down. Trying to take note of patterns. Checking my basal rates. Eyeing insulin to carb ratios. But none of these things seem to add up to consistent trends in blood sugar levels after eating.

I so wish I could call Gwen right now. All I want is someone to talk this over with. Someone who’s brain isn’t screaming diabetes, diabetes and more diabetes.

The high point of last week was a hba1c result that I had worked damn hard for. The low point was the diabetes education that went with it.

I’m a very hands on person with my diabetes management. Okay, maybe even a little too much of a micro manager. But the advice I received last week was very textbook. I didn’t feel that I was being listened to, nor did I feel that the way I choose to manage my diabetes was supported.

To be fair to this educator, it would have been difficult to give advice to someone who she had only met for the first time. Let alone in the space of a 30 minute appointment on a busy clinic day. Gwen was never replaced after she retired, which has meant a revolving door of whoever’s free to see me on the day I come into clinic.

However at the moment, I need better. I deserve better. I need someone who I can build a relationship with. I need someone who has more time for me than a busy and understaffed clinic in a public hospital allows. I need someone who will listen to me, and be supportive of my approach towards managing my diabetes.

The icing on the cake was being told that it would be okay for me to let my a1c creep back up a little, because that’s all I needed to avoid long term complications.

This is something that has weighed on my mind for some time. I have decided that I want to make the leap into private diabetes education.

An Indescribable Feeling

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“Can I get my hba1c done?” I asked my diabetes educator, the minute I walked through the door.

“I’ll go get the kit.”

I waited for what felt like forever, my attention shifting from a wall clock identical to those in my high school, to a weary poster from the 90s shouting reduced risks of cardiovascular diseases for every 1% drop in my hba1c.

As I sat there, exhausted after a full on day and a week of rollercoaster blood sugar levels, I wondered what my hba1c might look like. I hadn’t set the bar very high for myself. I was convinced I wouldn’t be anywhere close to my personal goal. I’d be lucky just to clear the 7% mark, at best.

Even though we say all the time that we are more than just numbers, it’s so freaking hard not to feel defined by one. Every day, I wake up to numbers. I make decisions based on numbers. I over-analyse numbers. I feel frustration over numbers. My long term health is dependent on the numbers. Numbers are the very last thing I see, before I go to bed at night.

I’d be lying if I said that my last hba1c hadn’t been hanging over my head since August. I’ve poured my blood, sweat and tears into my numbers over the past few months. But as my diabetes educator made her return to the room, I was about to learn that all of that effort had paid off.

“You’re joking!” I exclaimed.

“I’m not.”

“I can’t believe it!” I said to myself, leaning back and shooting both my arms up into the air in victory.

The feeling was indescribable.

Not only had I bested my personal goal, but I had clocked in over a point lower than August, and had set a new personal best.

I felt a million miles lighter. I felt like a weight had been lifted off of my shoulders. I felt like I was sitting on top of the world. I felt free.

I couldn’t wipe the grin off my face as I stepped out into the mild, sunny November afternoon. As I made my way down Hospital Avenue and back to my car, I kept repeating my new a1c over and over in my head.

I made a pit stop at San Churros on the way home for a Spanish White Hot Chocolate. A big plate of Connoisseur Belgian Chocolate Ice Cream followed when I arrived home, as I eagerly told my family the news.

I felt proud. I had fought a gruelling battle to regain some form of control over my blood sugar levels in the past year, and I had come out on the other side stronger than ever.

In that moment, I had won.

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.

First hba1c Result Post-Pump

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The very last thing that I was expecting to hear was that my hba1c had gone up after three months on an insulin pump.

I mean, I wasn’t expecting dramatic improvement straight away. I knew full well that my pump is not a magic wand. I knew that my glucose levels were fluctuating far too much pre-pump. When we looked at my Ambulatory Glucose Profile with Gwen back in May, she said just as much to me.

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But I definitely believe that this variance is much tighter today. I feel I don’t peak above 15mmol half as often as I used to. Lows aren’t too bad either, but they are definitely a work in progress. I’ve been putting so much work into my diabetes. More than I used to on injections.

So I guess I went in there, mentally prepared to hear that my a1c result was the same. But definitely not half a point higher than my last one.

For a while now, I’ve stared at half decent a1c results. The doctors have been quick to dismiss me, but I’ve never truly felt satisfied with my results. Deep down, I knew that my levels were fluctuating far too much. I knew that I was peaking way too high after meals, and having far too many lows. I knew that my a1c result was not an accurate representation of what was going on with my levels. But I never had the courage to ask for help. I pushed these thoughts to the back of my mind, telling myself I would fix that problem before my next check up in six months time.

But I never quite got around to it.

So, I guess there was a damn good reason for the rise in my hba1c result last week. For the first time in a long time, I have a clear picture of where my glucose levels actually sit. It definitely means that I have made some progress. But at the same time, my goal post feels a lot further away. I am realising just how much hard work lies ahead of me in order to get that a1c to where I want it to be.

As I made a long drive home in peak hour traffic and pouring rain, it was hard not to feel disappointed. It was really hard not having Gwen, who recently retired, there with me that day. She had been with me all the way through my journey, and I’m sure that she would have understood exactly where I was at. I’m sure she would have known exactly what to say.

I dream of the celebratory dinner I’ll have when I get my a1c to where I want it to be. I dream of the satisfaction I’ll feel. The grin on my face. The sense of achievement. The victory. Feeling somewhat in control of this unpredictable disease. And the cake.

I am motivated. I know that I have made some solid progress in these last three months. I know that I am going make it to that dinner table one day.