A1C Day

“What do you think your hba1c is?”

“Low 6s?” I mused, thinking about the average blood glucose levels I have been running of late.

It was better than my best guess. While it definitely ‘wowed’ me, it wasn’t inconceivable. I hadn’t even really been aiming for that particular number, and yet I had set myself a new personal best without even really trying.

When I think about all of the hba1c results I’ve received over the years, I’ve either been dying to know the result or completely dreading it. I’ve either walked out of clinic literally jumping for joy or feeling bitter disappointment. Every healthcare professional asks me what my last hba1c was the minute I mention that I have type 1 diabetes, and I’ve definitely let myself feel ‘judged’ by that number at some point or another.

But this one was different. I wanted to get my a1c done because it had been over six months since my last one, rather than because I actually wanted to know the number. I’d actually given far more thought to the context leading up to that number as I’d been mentally preparing for this appointment, rather than the number itself.

Things like my average blood glucose levels. Or the standard deviation of my numbers. My time in range, when I’m wearing a Libre. Or the Winter insulin resistance of late. How much I’ve been eating. How well I’ve been sleeping. Just how I’ve been feeling about diabetes in general.

I think my diabetes educator was more pleased for me than I was. We went through my numbers, and she was satisfied that there weren’t a lot of highs and lows. She pulled out my file that impressively documented my history from my diagnosis nine years ago, possibly trying to convince me how well I was doing, and we laughed over a note of me being ‘a lovely 17 year old uni student living with his parents and three siblings.’

“This has been three years of constantly learning about my blood sugars, and learning from experience.” I told her. “I really think that I only get out of these appointments what I’m willing to share with you. If you looked back at some of these appointment notes, you’d probably find that most of them would say that I was doing well. But I know that I wasn’t. I was just too scared to be honest.”

When it comes to living with diabetes, I only spend a fraction of my time in the company of a healthcare professional. For the other chunk of that time, I’m left to make hundreds and hundreds and hundreds of decisions on my own. The only person who I really hear talking back to me is my own subconscious. I’m always thinking about what I haven’t done well. Or what I could be doing better. I’m my own worst critic.

What my subconscious is not good at is giving myself credit for my efforts. I think that’s what my diabetes educator was picking up from me. So it was nice to hear someone else’s voice, rather than my own, telling me that I was doing pretty well.

If that didn’t convince me, white hot chocolate would have to.

Accountability

After two weeks of FreeStyle Libre bliss, finger pricks feel somewhat like disorganised chaos.

Test strips can often be found scattered across my desk, because I’m too lazy to aim for my pencil cup when ejecting test strips from my AccuChek Guide. Blood stains can be found smattered on my desk, because I can never quite find a happy medium between strip fill errors and a bloodbath on my fingers. And then those bloodstains end up on my insulin pump. And my iPhone.

I don’t have the convenience of leaving the house with nothing but my iPhone and a tube of glucose tabs in my pockets. Reaching for my meter, lancet and test strips at 3am feels like hard labour compared to the relative ease of swiping my reader against my arm in the dark.

More than anything, I just don’t feel that same accountability that I do when I’m looking at my Libre reader and seeing that continuous flow of extremely photogenic data. I don’t feel as motivated to keep my blood sugars between the lines when I can’t see them.

I must admit that its been a while since I last properly utilised the Bluetooth capabilities on my blood glucose meters. I did have a valid excuse when I was the owner of a very poorly performing iPhone 6. But that’s no longer an issue since I upgraded to a (refurbished) 7 Plus a few months ago.

At the Diabetes Congress last year, I learned that the mySugr diabetes logbook app could now receive readings from AccuChek blood glucose meters. So, keen to try something new, I downloaded mySugr and connected both of my AccuChek meters.

I have to say, its helped me to rediscover the accountability that I’ve missed when I’m not using the Libre. It’s nice to open up the app and look through my numbers and averages. Those 15 or so finger pricks throughout the day get packaged up into a half decent graph. It gives me a good picture of how I’m tracking along through the day.

One thing that would make a great addition to the app would be the ability to receive data from my insulin pump, and other diabetes devices. Alas, we don’t seem to do interoperability all that well in the diabetes community. I’m also still waiting on a bolus calculator, which would be extremely helpful to MDI-ers.

Yes, mySugr can do a lot of other wonderful things, but for me it’s proven it’s worth in accountability alone. I would like to put more effort into ‘marking’ my readings, which would allow me more ‘filters’ when reviewing my data. But logging data isn’t really my thing.

Quite honestly, I don’t see myself moving beyond my current regime of intermittent FreeStyle Libre and finger pricking in the near future. So, it’s really fantastic to see more options that bring some of those tech benefits to people doing it old-school.

Hypo Hangover.

It was twenty minutes past ten. I knew that I would be stopping for morning tea within the next ten or twenty minutes. A scan of my Libre registered 4.6 and steady, and I gave a pre bolus for the hot cross bun that I was about to eat.

By the time I was seated at the table and buttering my toasted hot cross bun, my insulin pump registered that twenty minutes had passed since my bolus.

As I sat there in my seat, a weakness swept through me. An uncomfortable sweat broke out across the entirety of my upper body. The thought of getting up to wash my plate felt far too difficult, leaving me paralysed in my seat.

I eventually willed myself back up, made my way down the hall and sank into the chair behind my desk. A scan of my Libre registered 2.3 and slipping downwards. I didn’t have the energy to grab the meter that was in arms reach of me to double check. I was tempted to correct with a glucose tab, but I knew that the hot cross bun wouldn’t take long to bring my blood sugar back up.

As I slowly devoured about three quarters of the refreshing cold water in my drink bottle, the weakness began to subside and I began to reassess how I ended up here.

The 4.6 was bordering hypo territory, meaning that I didn’t have as much room for a pre bolus as I normally would. It was also a Libre scan, and a finger prick could have been as much as half or 1mmol lower. Add to that, I hadn’t eaten breakfast earlier because I wasn’t particularly hungry, which could have heightened my insulin sensitivity.

Most of the time, hypos don’t really stop me from what I’m doing. It’s usually nothing more than the odd glucose tab to ward off a downward trend arrow, sometimes more.

But paralysing moments like these? They remind me of just how much weight rests on the decisions that I have to make each and every day.

New Year, New Adventure.

I went back to uni a little over a month ago.

It wasn’t the easiest decision to make as an adult with ‘adult’ responsibilities and a full time job, but ultimately it’s a decision that I hope will be a good investment in my future.

This year I have traded in my evenings to attend ‘virtual’ classes, and my weekends for assignments. It’s been challenging, to say the least. I’m the kind of person who likes to get a good head start on things. The downside to getting ahead is that there have been many fleeting moments when I’ve felt like there’s been nothing more to my existence than study.

I’m studying accounting, which is something I once swore I’d never do because every man and his dog seemed to do it. But it seems to be a profession that’s in demand, and I wasn’t half bad at it when I last did it in high school.

Oh, and my diabetes is still there too. It hasn’t been giving me too much grief. But if there’s one thing that I’ve missed more than anything, it would have to be connecting with others in the diabetes community. While I’ve still been lurking around, I’ve been oddly reminded of what my life was like before I found the DOC four years ago. I know that my wellbeing is far better when I’m an active part of this amazing community.

I submitted my two assignments for the semester this week, and I’m very much looking forward to actually enjoying some of my upcoming weekends. I’m not too sure what will become of my blog this year, but I’m hoping I’ll be able to check in here a little more often than I have been.

So if you’ve made it this far, I guess the morale to this post is that you’re never too old to take a great big leap of faith. And that I’m not going to let diabetes be an excuse for the regrets I might have had down the track.