Diabetes and the Festive Season

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.

[Automatic Reply]: Low Blood Sugar

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24 December 2019 at 9.21am

Good morning and thank you for your e-mail.

Unfortunately I am out of the office on a Christmas break. I can probably be found looking at Christmas lights, playing board games with my family, helping out with Christmas lunch, eating, drinking, getting my festive binge watching on or browsing ebay for some bargains on my own Christmas wish list.

I’m trying not to think about work at all. I will not be tending to any hypos, high blood sugars, bolus calculations, blood sugar checks, infusion set changes, cartridge refills, sensor replacements, meal preparation or physical activity during this time. But I wouldn’t say no to a nice unicorn.

If your matter is urgent, please don’t contact me. Unfortunately my entire team of one will be unavailable over the festive season, as I’ve decided to give them a well earned break for all of their hard work this year. You may appreciate that this team of one works right around the clock, 24/7, 365 days of the year for free to provide you with the very best level of care.

Please bear with me. Your patience is greatly appreciated during this time.

I will get back to you upon my return to the office at a time of my choosing after Christmas.

Last but not least, I would like wish you and your loved ones a very Merry Christmas and a Happy New Year. Thanks for following my adventures this year. You, the diabetes community, mean the world to me and I couldn’t have done this year without you.

Kind regards,

Frank

CEO at Frank’s Diabetes Ltd

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What’s Not on My Christmas Wish List

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Hello, December. The silly season is in full swing, and no doubt almost every place, business or shop window you can think of will be adopting somewhat of a festive theme. In anticipation of all of the newsletters, articles, social media posts, well meaning relatives and other diabetes interactions that I’m likely to encounter over the coming weeks, I can already tell you what’s not on my Christmas wish list this year. Or any other year, for that matter.

I don’t need to be reminded that I have diabetes at this time of the year. That’s pretty much a fact that isn’t going to change until the cure arrives in another five years time. I do diabetes every other day of the year on my own through rain, hail and shine, so I hardly think that Christmas is worthy of any extra attention.

I don’t want to see any ‘helpful’ and highly unsolicited advice on how to manage my diabetes over the Christmas season, no matter how well intended it is. I don’t need suggestions of what I should and shouldn’t be eating throughout the festive season, or advice on how to keep my blood sugars in tow. If I require some assistance in that department, I’m more than capable of asking. Otherwise, please treat me like any other guest.

I don’t need to be shamed for any of the food choices that I may choose to indulge in on Christmas Day (or any other day of the year, for that matter). Please, resist the temptation to ask a person with diabetes how they manage their blood sugars at the dinner table. Rather, an acknowledgement that I do this on the other 364 nights of the year that I’m not eating dinner at your house would go a long, long way.

I don’t need insinuations that just because I tuck into the likes of chocolate, pavlova or potatoes, I’m not taking care of myself. I take a great deal of care in managing my diabetes year round, and to be honest I’m damn proud of those efforts. I refuse to be made to feel that guilty for numbers that may fall outside of my target range during a time where I just want to be Merry. Nor do I need to explain! Besides, what makes you think that a slice of pavlova is any less healthy for me than it is for you?

I really don’t care how the likes of diabetes organisations, diabetes websites, healthcare professionals, other people with diabetes, or support people for that matter, feel that I should be managing my diabetes over the festive season.

The way I choose to manage my diabetes is, quite frankly, nobody’s business but mine.

At the end of a long year, I look forward to Christmas and the ability to wind down after a long year and spend some quality time with my loved ones.

Diabetes is most definitely not the focus of that.

My Wish For the Diabetes Community In 2019

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Let’s have more collaboration and less disconnect. Organisations, healthcare professionals, researchers, pharmaceuticals, industry, people with diabetes and people connected to diabetes. We are all doing amazing things. We all want the same thing, too! Imagine how much more we could achieve if we put our minds together and joined forces?

Let’s respect each other’s differences in the way that we choose to manage our diabetes. Two people will never be exactly the same, so why do we expect two people with diabetes to be? I don’t subscribe to the notion that one size fits all when it comes to managing diabetes. Whether that be pens, pumps, meters, sensors, needles, syringes, Twitter, Facebook, carbs or no carbs, we are all unique and can peacefully co-exist together.

Let’s remember that no one issue is more important than another. Whether that be insulin pricing, insulin for those less fortunate, funding for CGMs, funding for better healthcare services or greater awareness of diabetes. If it’s important to one person, then it’s important. Full stop. But by turning it into an ‘us against them’ scenario, we are marginalising other groups campaigning for equally worthy causes.

While I’m there, let’s put an end to the calls for greater distinction between type 1 and type 2 diabetes. Yes, there are two (well actually, many more) types of diabetes. And yes, it’s important to know the differences between the two. But let’s also remember that nobody asks to get diabetes. This need to separate ourselves from people with other types of diabetes only serves to stigmatise people with different kinds of diabetes than us. We’re all in this together, right?

Let’s bring the voices of more people with diabetes to the table. Let’s see more people with diabetes talking to those in the industry. Let’s see organisations who are representing us, engaging with us. Let’s involve people with diabetes in all aspects of the research and development process, and not just at the launch phase. After all, how can people with diabetes not have a place in discussions that are about us?

Let’s celebrate the small victories (I’m the first to admit to being a glass half empty kind of guy…). Many of us don’t appreciate, for example, the research and development that goes into a product, or the advocacy that goes into securing funding from the government. Good things take time.

Let’s never give up on striving for more. Whether that be talking to your local Member of Parliament to advocate for better outcomes for people with diabetes, or challenging yourself to reach new goals in your own diabetes management. Energy spent complaining (and I’m the first to admit to being a serial whinger) is energy that we could be putting towards something productive.

Let’s never lose sight of why we all joined the diabetes community in the first place. To connect with other people just like us. To raise each other up on the tough days. To bask with us in the glory of our small victories. To know that we are never alone in what we are dealing with. Let’s continue to amplify the peer support that this community does best.

The Silly Season.

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It’s nearly Christmas.

I guess everywhere I look at the moment, I feel like I’m seeing a lot of ‘rules’ that I need to be following as we head into the silly season. Undoubtedly followed by the barrage of New Year, New You stuff.

To be honest, I don’t really have much of a strategy heading into the next couple of days.

It’s Christmas, and to be honest, I want to celebrate Christmas like every other person around me. That will undoubtedly involve food that contains carbs, and drinks that contain alcohol. There will likely be chocolate. And shortbread. And bailey’s. And plenty of other good stuff.

As much as I would love for diabetes to shut up shop over Christmas and New Year, I will have to keep on keeping on. I will be monitoring my blood sugar with a little more ease thanks to the FreeStyle Libre sensor I’m wearing, and giving insulin doses my best guess with the help of my trusty insulin pump. I don’t expect it to turn out perfect, but then again diabetes never is.

The one thing that I will be avoiding when approaching the Christmas dinner table is the food coma that comes after it. Over the years I’ve learned that I don’t need to try everything from the smorgasbord, and would much rather just choose some of my favourites that I might not have so often. Waking up to high blood sugars, insulin resistance, extreme thirst and sweat in the middle of the night is definitely not pretty. This post sums up the experience quite nicely…

I guess one of the more challenging things at this time of the year is being asked questions around how I will manage my diabetes as I sit down to the Christmas dinner I’ve so been looking forward to. Super helpful, right? A few days ago, I was so happy to have a conversation with someone who wasn’t asking me if I had to be careful or if I had to check my blood sugar levels over dinner. Instead, I got to talk about my involvement in the diabetes community.

As I talked about some of the amazing things that have been happening around me this year, I couldn’t help but be reminded of just how much of a highlight continually connecting with people in the diabetes community really is.

To my diabetes family near and far, thanks for sticking around this year.

Merry Christmas, and a Happy New Year.