Diabetes at Work

Snap Lockdown.

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Yesterday was probably the most anxious I have felt since March or April last year. I acknowledge my privilege in writing this, because I’m sure many of you reading this have experienced a lot more than this.

I’d only just come home and finished my lunch when the phone rang, with my sister telling me to turn on the TV as West Australian Premier Mark McGowan had called an emergency COVID19 press conference. I knew it could only mean one thing.

For anyone who has been listening to the Premier over the past year, yesterday’s snap lockdown announcement in response to a positive COVID19 case in the community would come as no surprise. Looking to recent outbreaks in Queensland and South Australia, I had a fair idea of how this would be managed.

Yet still, nothing could prepare me for the shock of learning that there had been a positive COVID19 case out in our community for the first time in ten months. Hearing suburbs and extensive venues visited by this positive case that I not only recognised, but were so close to home, really hit home. As well as realising just how terrible the situation is overseas that this virus was able to escape Australia’s strict quarantine hotels.

So, we are being asked to stay at home for the next five days. Limiting our movements gives the contact tracers some breathing space to isolate close contacts of this positive case, as well as close contacts of close contacts. Hopefully this quick, decisive action will allow us to quickly stamp out the virus and we can go back to how things were much sooner.

Back in March, I think I was definitely a little more blasé about the whole thing. I didn’t mind going to work, given I can’t work from home. I thought people were overreacting by wearing a mask in the supermarkets. I definitely didn’t think back then, that we would still be living with this virus today.

I spent some time yesterday debating whether to message my boss. This time around, I really didn’t feel comfortable leaving the house. At least not until I know how much further this has spread, and whether this positive case was carrying the more infectious UK strain.

Fortunately, I had plenty of personal leave accrued and my boss was extremely understanding. While this might not completely come from a place of living with diabetes, that is definitely the reason I have used not to go to work.

Stay home, and stay safe this week, WA. We’ve got this.

Overflowing.

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Being diagnosed with diabetes as a young adult came with its own, unique set of challenges. I had lived a ‘normal’ life for 17 years, and then all of a sudden I had this new condition that I had to find a place for in my life.

Nobody around me knew that I had diabetes, and it was difficult to explain such a complex condition to the people around me. In some ways, it was just easier to deal with my diabetes in private rather than having to try and explain what I was doing in the middle of another frustrating high blood sugar.

Today, I think my diabetes is pretty visible. Whether I’m talking with the pump in my hand, checking my blood sugar in the inventory office at work as someone comes to interrupt me, or walking back out again crunching down glucose tabs.

It’s fair to say that I have a pretty big interest in diabetes today. I spend a lot of my spare time writing here, freelancing over at Diabetes Daily, posting about diabetes on my social media, attending community events, as well as being part of a diabetes Committee here in Perth.

“Are you going with the diabetes group?” is now a fairly standard response from colleagues when they hear that I’m taking annual leave from work.

“What are you doing?”

“What’s that?”

I spent so long imagining people’s reactions to a finger prick or an insulin injection. Today, it often feels like they simply don’t take any notice. Those explanations of the condition that I live with don’t seem to have any effect when the same questions pop up again and again. Perhaps others are just sparing my feelings by not asking me what I am doing.

However after National Diabetes Week, it finally began to feel like those messages of awareness were getting through to the people who needed to hear them the most.

The response to my diagnosis story that was shared on Diabetes WA’s Facebook page last Sunday was phenomenal. The story that appeared in The West Australian on Thursday was absolutely huge.

Despite my repeated arguments of just how terrible that photo was, two colleagues at work pulled the newspaper out of my hands on Thursday morning, took it over to the photocopier and stuck it on the staff room wall at work. “It’s a really important issue that could affect the people you work with!”

Doing media is a really big thing, even for an over sharer like myself, but I couldn’t be prouder of the outcome.

After a big week spent raising awareness of diabetes, and hearing stories shared from fellow people with diabetes, my cup is well and truly overflowing.

This is what National Diabetes Week is all about.

itsabouttime.org.au.

Kicking off Diabetes Week with some of my tribe last weekend.

How I Manage My Blood Sugar During Exercise

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I’ve learned a fair bit about physical activity, and how to manage my diabetes around it in the past year. I guess having my job and my income depend on it, is a big motivation.

I am physically active at work every day, which means that I am more sensitive to insulin and more prone to going low through the day. Combine this with trying to offset dawn phenomenon when I wake up each morning, and you’re left with one very tricky equation.

One positive of combining work and exercise, is that every day is Groundhog Day. There is no shortage of opportunities to experiment. And when something does go wrong, I get to repeat it the following day in almost identical conditions. Not to mention that I don’t need to feel guilty about telling my doctor that I don’t go to the gym!

The negative is that at times, diabetes has felt very gruelling to manage while I am at work. The motivation to basal test, or to conduct experiments, isn’t always there. There have been days where I’ve literally been juggling highs and lows with insulin and food, respectively. There have been weeks where I felt like I haven’t gotten anywhere, and it’s often hard to pick myself back up and carry on.

Your diabetes, and the kind of physical activity that you undertake, will likely be different to mine. However, here are a few of the strategies that have worked for me while I have been physically active in recent months.

I would class my level of activity as mild – being on my feet, lots of walking around, some climbing up and down ladders and lifting. There are some days where it is more intense than usual – particularly if we are busy. But I find that most days, my level of activity is identical.

I find that for this mild level of physical activity, I need 30% less basal insulin compared to when I am vegging out at home. The 30% reduction in basal insulin needs a lead time of around half an hour before I start work. Most would suggest an hour’s lead time, however I don’t feel that my level of activity is at full speed until half an hour into my work day. I.e. I’m spending too much time chatting to people in the morning!

Mealtime boluses are still a work in progress. I’m currently sitting on 1 unit for every 8 grams of carbohydrate. At breakfast, my full insulin dose does its job, as I’m not on my feet for another hour and there’s probably some dawn phenomenon in play. I’ve tried reducing my insulin dose for meals during my work day with mixed results. At morning coffee time, I’m dosing insulin or snacking while I’m on my feet. Whereas at lunch time, I’m dosing insulin at the start of my break and not going back out to work for another hour. I’m working with a 30% bolus reduction with morning tea, and 15% with lunch.

I’m probably about two thirds of the way there. My overnight, and morning BGLs are looking fantastic. I just need to focus on getting some more green numbers into the afternoons, so that I’m not going home and snacking or eating dinner on higher numbers. It’s been an ongoing issue.

Work has been a gruelling journey, but I have finally began seeing results in recent months. Putting the hard work into fine tuning my basal rates and mealtime boluses has been invaluable towards a productive day, free from the stress of highs and lows.

I’m not so terrified of going to work without wearing a Libre sensor anymore, and I can comfortably go for two or three hours without needing to check my blood sugar. When I uploaded my meter data to Diasend on the weekend, I realised that I had only had three lows in the last fortnight. Freaking awesome. I finally feel a level of confidence in what I’m doing. 

Another piece of advice that I never gave myself: give yourself a break. When I was on injections I would often come home with exhausting lows, crash on the couch and eat my way out of it with junk food. I failed. Constantly. The task of fine tuning insulin felt overwhelming, and the motivation was never there. After my pump start, I was under the illusion that I’d have everything down pat in a number of weeks. In hindsight that was such an unrealistic goal. Give yourself some room to breathe. Maybe basal test every second day. Or have a few days off from your experiments if they’re feeling overwhelming. Set small goals.

As with any element of managing diabetes, it takes a lot of time and patience. You won’t necessarily get it right the first time. Or even the tenth. Goal posts are always moving, because diabetes is always changing. You’re always learning, and putting two and two together.

But with time, you pick up these valuable little skills that will make fine tuning your next diabetes scenario a little easier.

“Are You On a Diet?”

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I can’t begin to describe some of the funny looks I’ve been getting when I sit down with my bag of almonds at morning tea time. Those looks that just scream of “is that all you’re eating?” or “are you on a diet?” or “are you not feeling well?”

The young guy in the fluoro shirt who should be skulling choc milk and having a Woolies donut, eating almonds? Yep, I get it. While my diabetes is pretty transparent, people still forget or don’t realise it’s there.

Last week, one of my work Mums brought in a tray of leftover sweets to share from her weekend. As usual, I got the typical Nonna treatment. “Go on. Take it!” I politely said that I was trying to be good, and asked her to save me something for later. “Why?”

Last week, we had a bake sale in the staff room at work. I felt guilty for not buying anything. As I sat down in front of all of the tempting cake with my bag of almonds, someone remarked to me “you’re being good today, are you?”

I don’t put a lot of things off limits when it comes to diabetes and food. So long as I feel that I truly do enjoy eating something, then it is worth the effort. But I absolutely hate to perpetuate the myth that someone with diabetes can’t eat whatever they choose. I felt compelled to explain my choice not to indulge in cake at 10am on a work day to the staff room table.

After six months of experimenting and fine tuning, I am finally starting to see some consistency in the mornings while I am physically active at work. I am starting to feel that sweets are just not worth the effort while I am working. I will be guessing the carbs. I will be giving a generous dose of insulin. That insulin is more sensitive while I am physically active, and I am more likely to go low. What tends to follow is a day where I am trying to juggle highs and lows. I don’t feel very motivated to manage my diabetes well after days like this, and it’s just not fun. 

I eat a satisfying breakfast when I wake up. My treat in the morning is my Coffee Club Cappuccino with no sugar, enjoyed with my team mates. It’s 12g of slowly digested carbs, and I can handle that just fine.

But at 10am, I eat almonds. Almonds have minimal impact on my blood glucose while I am working. They don’t send me into a vicious cycle where I am correcting highs and warding off lows. Turning down cake is a small price to pay for the juggling act I so badly want to avoid while I am at work.

Plus, the cake will still be there to enjoy later, right?

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Dawn Phenomenon, Breakfast, Physical Activity and Diabetes

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A couple of months ago, I wrote about the relentless hypos I was having at work. There have been days where my blood sugars have been bouncing up and down like a yoyo. The smallest insulin correction would be enough to send me plummeting within half an hour. My Libre would then show me rebounding after a hypo (and I now know that the Libre tends to pronounce movements in my BGLs). I would have the urge to correct it again, only to end up low once again. This seemingly vicious cycle made it impossible to obtain a steady line while I was at work and left me feeling exhausted at the end of the day.

The one thing I genuinely do miss about injections is that insulin sensitivity during physical activity was hardly an issue. I don’t remember having to pay half as much attention to my diabetes at work while I was on injections. I’ve felt very conscious of the number of times I’ve had to tend to diabetes in a day. Unlike a Lantus injection, my pump delivers basal insulin in tiny amounts throughout the day as I’m working. In addition to physical activity, dawn phenomenon and breakfast boluses are also thrown into my morning diabetes equation.

After a lot of trial, error, and notes in my diary, I finally feel as though I’ve got my mornings down pat in recent weeks.

The obvious one has been making sure that my basal rate is right. I cannot stress how difficult morning blood sugar levels are to manage if I do not wake up in range. No amount of correction seems to be able to fix them, and I end up really grumpy at 8am as I see my levels soaring after breakfast.

A couple of weeks ago, I noticed that my levels were climbing at around 3am each morning, warranting a change in overnight basal rates. Until that was fixed, I wasn’t able to properly focus on the mornings. Another thing I’ve learned is that my waking basal rate (when my liver begins dumping extra glucose) needs to run for at least a full hour before I wake up. Even a gap of 15 minutes is enough to screw up my morning basal test. Going on intuition seems to have done the trick in fine tuning the remainder of my morning basal rates.


Breakfast really has been a case of trial and error. I’ve learned that I do not need to subtract any carbohydrates from my breakfast insulin dose. Subtracting 5g from my breakfast dose is the difference between a post prandial result of 9mmol or a post prandial result of 15mmol. My pump will also add a correction dose to my breakfast bolus if my blood sugar level is over 7mmol. 


I’ve learned that I need to ignore it unless my blood sugar level is above 8mmol, and that I need to subtract insulin accordingly if my blood sugar is lower than 6mmol.

Morning coffee at work normally happens anywhere between 8.30 and 9am. My medium cappuccino with no sugar probably has around 15g of carbs, 10g of which I do not need to bolus for. It’s been so hard to wrap my head around these tiny insulin doses, but they are indeed enough! Pre bolusing is also not necessary, as I slowly sip my hot coffee when it first arrives.

Morning tea comes anywhere between 10 and 11am, and is usually a banana which is weighed before I leave home. Again, bolusing for 10g less carbs seems to do the trick, as do the rules for correcting.

Not foregoing what I love in the mornings has been really important to me. It would have been easy to simply forego breakfast or the morning coffee, but I know that would have made me unhappy (and hungry!). I work diabetes around my life and my activity, and not the other way around.

It’s been a lot of hard work, but I do genuinely feel that I have my mornings down pat. Instead of going up and down multiple times in a day, it might happen 2 or 3 times in a week. Levels are also looking great, thanks to continued pre bolusing and my moderate carb approach. I plan on taking a break from my Libre after today, and I’m quite confident that I will be able to manage just fine on finger sticks for a while.

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