I woke up this morning to the gentle sound of my sleep cycle alarm. It was a lot darker than usual, because I was waking up a lot earlier than usual today.
My first thought was that I hadn’t stirred during the night. Nor had my CGM gathered my attention for the last eight hours.
I reached for my iPhone and swiped left.
‘Oh, shit!’ I exclaimed at the widget on my home screen as a wave of furiosity instantly hit me.
I’d spent the past three hours riding around the 11 mark. Possibly higher, because I forgot to check my blood sugar for reference which I like to do when I’m high.
I wondered how on earth I was only finding about this now, and unlocked my iPhone with a press of my thumbprint. When I opened up the Dex app, I found the culprit in a high alarm that had been completely turned off.
I have no idea whatsoever how that happened. I distinctly remember opening the app and lowering my high alert from 8mmol to 7mmol last night, like I do every other night before bed.
As I flipped my phone sideways and traced that high back through the night, I was even more furious to find that it had risen from pretty much the minute I rested my head on the pillow at around 10pm.
But it also made complete sense, given I’d consumed a fair few carbs to absorb the dinner I’d over bolused for. I also can’t bring myself to treat hypos with glucose tabs anymore, so there may or may not have been a few raids of the cupboard involved. But I’m making sure I buy some juice today, for a change.
As I bolused super early for my breakfast, got out of bed and jumped into the shower, how that high alert escaped me is still a complete and utter mystery.
I love to drink coffee. But it was never palatable without a good 2 teaspoons of sugar mixed inside. So, I reduced it to one and a half. Then, when I got used to the taste, I reduced it to one. Then half a teaspoon. If you were to put sugar in my coffee today, I’d tell you that I can only taste sugar.
I was feeling exhausted. Far too often. Eventually, I stumbled across an article and realised that I wasn’t eating nearly enough in order to fuel my daily activities. So, I started setting my alarm to wake me half an hour earlier each morning to give me time to scramble two eggs and toast two pieces of bread. I started using my Sunday afternoons to better prepare ahead for weekday lunches. Today, I don’t feel half as exhausted (or deprived) as I once did.
I never used to count carbohydrates. I would just swag my insulin dose, and end up with either crazy highs or intense lows. When I began using an insulin pump, I set an intention with my family that I would weigh my food at dinner time to better count my carbs. That added effort before dinner time has definitely made my insulin dosing more effective.
Managing diabetes does my head in. Like, every single little thing I can think of affects my blood sugar. What I ate, how active I was today, how well I slept last night, where my BG has been sitting overnight, and even what month of the year it is! So, I began making notes. Both on paper, and mentally. Paying closer attention to what was happening with my blood sugars, and learning what I would need to do for next time. Today, I feel far more confident in being able to make those adjustments to keep my blood sugars where I want them to be.
For some time, I’ve been waking up feeling like I haven’t gotten a good night’s sleep. It’s been a real struggle to get up and going throughout the morning. So, at the turn of the new year, I decided to prioritise sleep. I would ‘switch off’ an hour before bed, so that I don’t go to sleep while my mind is still buzzing. Quite honestly, it’s been one of the best changes that I’ve made for myself (more on that one, soon).
Today, I feel pretty happy about where I am at with my diabetes. I’m not perfect, and I don’t always manage to do everything I’ve outlined here religiously each day. There are still things I’m working on improving, too.
However when I think about where I am today, it wasn’t the quick overnight fix I was desperately seeking when I started using an insulin pump four years ago that got me here.
It was the sum of small, gradual changes that I’ve made over the past four years that suited my own needs. This list is certainly not exhaustive, but it’s some of my highlights.
Some of those changes have been directly related to the day to day management of my diabetes. Some of those changes have been more around my routine and habits, which I guess better support me in showing up to manage my diabetes each day. There were equally things that I was happy with, or didn’t want to change (carbs and coffee, to name two).
I don’t believe for a second that there’s only one way to manage diabetes. But I know that I spent years thinking about, and feeling overwhelmed by all of the changes and improvements that I wanted to make.
So I guess the point of this post is that if you are thinking about making changes at the start of a new year, start small. Pick one tiny thing that you could do each day that might further your goal. Above all, be patient.
“It’s one of the best recipes,” he replied enthusiastically. “It’s mostly sugar. Nothing healthy in there.”
“That’s not really good for diabetes!” She remarked, turning towards me and laughing.
“That’s not funny,” I replied.
I’d so been looking forward to this morning tea. I was in the kitchen at 9.00 the night before, making the shortbread that I’d been wanting to make for weeks but hadn’t got the chance to.
Yet that one, ill timed and misinformed comment put a damper on something that I had so been looking forward to. I’m not embarrassed by my diabetes, but it embarrassed me. It reminded me of just how ‘different’ I was.
I was angry at the stigma that had just been perpetuated throughout the room from the attention drawn in from that comment. I’m not saying that as a person with type 1 diabetes, I’m saying that as a person with diabetes.
I know that my reply didn’t suffice. It didn’t make me feel better. It didn’t do anything in the way of correcting the stigma, but it’s the best I could come up with on the spot.
I spent the next hour or so reflecting on how I’d have better responded to that comment if I had my time back. Resisting the urge to approach this person and tell her not to make jokes about diabetes, because she was my friend (and she also puts up with a lot of my grumbling throughout the day…)
As I stood in the kitchen later, eating a banana and feeling rotten after the umpteenth hypo this week (which is a totally different story), I felt well and truly deflated.
I’ve been using the Dexcom G5 CGM for around four months now, and I thought it might be a good opportunity to revisit some of my thoughts on the system now that it’s very much a part of my diabetes kit.
Application: Contrary to popular opinion, I actually like manually inserting the needle via the plunger. Insertion devices tend to bruise my body more easily and don’t leave me feeling confident that the insertion has been a success. The yet to be released G6 iteration will have an insertion device, and I’m not too sure that’s a big selling point for me.
Placement: Like many in the DOC, I love wearing my sensor on my upper arm. It’s out of the way, I can’t see it when I look down at my body and it gives me more real estate for placement of pump sites.
I have personally found the most effective placement to be with the plunger pointing upwards in the direction of my shoulder. I placed one in the opposite direction some weeks ago, and my sensor didn’t last much longer than a week there.
Adhesive: The sensors stick really well on the arms. I can normally go for two weeks before having to apply a bit of reinforcement, such as a Rockadex patch. Although, I don’t do a lot of dedicated exercise or work up a sweat very often…
Sensor life: I’m currently getting three weeks out of a sensor. The first two weeks yield solid results. However, the third week is often a struggle. The readings can get a bit jumpy, movements accentuated, and often those three question marks pop up and I temporarily lose access to blood glucose data.
Last week, my sensor was into week three and I was beginning to experience some really unreliable behaviour. I decided to restart it, clearing the system of any calibrations that may have been sub-optimal. I also drank a few glasses of water, and that has given me my strongest finish to a sensor so far.
Calibration: I prefer to calibrate with clean hands. But I also can’t be bothered washing my hands before I check my blood sugar. Especially first thing in the morning, when the coffee machine is calling me. Which leads to me putting off calibrating. Or checking my blood sugar, second guessing the result because I didn’t wash my hands before checking, and then washing my hands and checking again. For the record, my trusty AccuChek Guide produces almost identical results each time.
I stick to twice a day, ideally when I wake up and just before dinner. But otherwise generally before a meal when my blood sugar is steady and there’s not a lot of bolus insulin on board.
Integration with my t:slim pump: It took me a while until I finally wanted blood sugars on my pump screen. In the beginning when I was still getting used to the system, it was just too much. I also seemed to integrate them at the worst of times, like in week 3 when my sensor was beginning to crap out or a few days before my exam. The only way to take them off is to shut down the pump and then power it back on.
One thing I do not like is having my phone on me all the time for access to my BGs or just to silence an alarm. I only started running BGs on my t:slim for good just before Christmas, and so far I’m loving it for the ability to be phone free.
Affordability: I’m using a rebatteried transmitter obtained through the Diabatteries Down Under community on Facebook. This is not warranted by the manufacturer and is essentially a ‘DIY’ solution that works just as well. This means that the ongoing cost of my system is essentially just the sensors.
In conclusion: Anything that lets me do less while managing my diabetes is a good thing. Having blood glucose readings at the glance of my phone has definitely improved the quality of my life. I do find it far easier to pick up on trends and changes that I need to make than I ever did on finger pricks. I feel as though I have a clearer picture of exactly where my diabetes is at.
I acknowledge just how privileged I am in being able to access this system.
At this point in time, the G5 is meeting my needs perfectly as I continue to manage my diabetes, and I really don’t want anything more from it.
That was largely thanks to overcorrecting before bed, then waking up to a low alarm and eating two glucose tabs, and then suspending my pump on the second low alarm a bit later because I really didn’t want to eat any more glucose tabs.
Not to mention that I only suspended for 30 minutes, telling myself that I’d do a wait-and-see, except that I was well and truly asleep again by the time that 30 minutes was up.
The 4am diabetes brain wants what it wants…
When I looked at my CGM graph the following morning, I must have spent several hours hovering in the 3s.
I spent the remainder of my New Year’s Day paying for it. My brain was foggy, my body felt heavier than usual and my muscles were sore. All thanks to my body being deprived of it’s much needed glucose reserves throughout the night.
Which brings me to my New Year’s resolution.
I really, really, really want to focus on sleeping better this year.
It’s not like I have any trouble sleeping. Or that I’m not getting enough. But when I think about those days where I wake up relatively easily, alert and feeling truly refreshed – it’s hard to think about when the last one was.
When I think about how I feel about living with diabetes of late, I’m really happy with all of the gradual changes I’ve made in my life to support it. I’m really happy with what I’m doing to manage it, and where I’m at.
Yet my sleep would have to be the thing that’s been weighing me down the most. It impairs me physically, it impairs my mood and it impairs on my productivity. It doesn’t make me feel as though I’m managing my diabetes very well at all.
So, there’s one more gradual change that I hope to implement this year.
I’m really making a concentrated effort to switch off in that last hour before I go to bed, reminding myself that whatever I’m doing will still be there to resume tomorrow.
I’ve started turning down the lights at 9pm and closing the blinds. Switching off the WiFi on my devices. Lightly reading, writing or watching the news. I guess you could say that it’s an hour of ‘me time.’
I’ve started using the Sleep Cycle app once again, which tracks my sleep and wakes me up at a time where I’m sleeping lightest.
It’s still really early, but going to bed without a brain that’s still on and buzzing really is making a huge difference when I wake up in the morning.
I’m hoping that this is the difference that will get me off into the New Year on the right foot.