Diabetes Musings

30 Grams

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I haven’t been able to stop thinking about a really enlightening article I read at Diatribe in recent weeks. Cherise talked about a glass ceiling that she had for the number of carbs she entered into her pump, and explored why she was hesitant to declare the actual number of carbs that she was eating.

I’ve lost count of the times where I’ve subconsciously entered 30 grams of carbs into my pump, even when I know I’ll probably be eating more.

30 grams is the number I’ve been conditioned into thinking is the ‘right’ amount of carbs for a meal. Many corners of the diabetes community send out messages that less insulin is better, and even worse, demonise food choices.

Today, my mentality has evolved to eat as much as I need to meet my own needs and not some unrealistic ideals of what is right. However, I can’t think of too many times where I will enter more than 30 grams into the bolus calculator of my insulin pump. It’s more of a wait-until-my-blood-sugar-starts-going-up until I’ll top up with more insulin.

30 grams also feels like a safe number. Even moreso after weeks of nasty hypoglycaemic episodes caused by a combination of hot weather and correcting extremely stubborn blood sugars until I’ve over-done it. You know, the ones where I have to stop what I’m doing completely because I can’t concentrate and I feel yucky.

My time in range has been suffering, for a while now. It was definitely a contributing factor to the fatigue that led me to take a pump break over Christmas. But even now that I’m comfortably settled back into pump life, that problem is still glaringly obvious.

50, or 60% at best, does not reflect my best effort. I know that I’m not supposed to judge myself on my numbers, but I feel guilty at seeing so much yellow and red on my Dexcom Clarity reports. Not to mention that my diabetes just feels so much harder to manage.

One of the hardest things about managing diabetes is that the dynamics are always changing. There are times where I need less insulin because it’s hot and I’ve been more active than normal. Then there are times where I need more because I’ve been ‘slacker’ than usual. You always have to stop and think about what’s going on, and what to do to fix the problem.

The lockdown that much of Western Australia was plunged into earlier this month, quite honesty, came at just the right time. It was just the perfect chance to take away some of those distractions – that background noise that comes from the daily grind – and just give my diabetes a little bit more love and attention that I can’t always seem to muster.

I think Cherise’s post couldn’t be more accurate, especially in the context of my own hesitation to go beyond 30 grams – and it will definitely be a focus for me going forward.

The Rule of 10 Percent

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A few days before I was planning on ending my pump break, I pulled my pump out and reviewed my basal profiles. I have, I guess you could call it, a ‘base’ set of basal rates. These are the tried and tested rates that I know work for me most of the time, given that my lifestyle and activity levels have been largely consistent over the past couple of years.

It has also been so hot in recent weeks. I am so sick and tired of this heat. Even after dinner, I end up regretting going for a walk when it’s still 32 degrees outside at 7 o’clock. Yuck.

So yeah, as soon as I resumed pumping, I quickly found myself going low after almost every insulin dose. My insulin sensitivity was epic. Was it due to the heat? Or the fact that I’m feeling far more relaxed after Christmas? Or did my pump break give me a natural reset to my insulin sensitivity? I suspect it was a combination of the three.

Whenever something doesn’t feel right with my diabetes, I go by something I like to call the rule of 10%. In this instance, I simply went through my basal profile and dialled my basal rates back by 10%.

Likewise, I suspect that by late April or May I’ll be upping my base basal rates by 10% as the weather gets cooler and hibernation gets a bit more tempting. Ditto for those periods when I’m feeling a bit more stressed, being less active or facing whatever else is going on in life.

I’m not saying any of this is easy, or that I’m completely on top of all of this. But 10% saves me the stress of having to think about every single basal rate, every single increment, in every single time block of the day. My basals still follow the same pattern, with a typical elevation from 1am, an increase around the time I wake and then a holding pattern for the rest of the day. So it makes sense that an increase across the board will help plug the leaks.

If only there was some kind of golden handbook with answers to navigating sick days, stressful periods, relaxing periods, hot weather, cold weather, active days, lazy days and everything in-between.

Festive Pump Break.

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I never imagined that I’d be spending the festive season detached from my insulin pump, but that’s just how badly I needed this break.

I was fatigued from insulin pumping, both physically and mentally.

I was tired of having that pump attached to me, rolling out of my pocket in bed, slipping down from where I tuck it inside my waistband, or giving those vibrating demands for my attention.

I was also tired of simply pumping insulin. I had tired of pre-bolusing, I was tired of looking basal rates, I was tired of correcting highs and then suspending my way out of subsequent lows. I had simply tired of putting in the effort, and it showed on my time in range.

This break was exactly what I needed.

It was nice not to have a visible reminder of my diabetes on me all the time. Lantus was a really nice set and forget when it came to basal rates, and it kept me relatively steady in the background. It was nice to simply lounge about, or leave the house with a noticeably emptier pocket.

Shorts weather also made it uber convenient to stick needles into my thighs, even under the dinner table while eating out. Although admittedly, I did feel just as reminded of my diabetes every time I was out and had to physically make a point of stopping to give a shot.

In those first few days I often found myself reaching for my pump when my blood sugar was trending low, and this was a good way for me to snap out of suspending my way out of lows, among some other bad habits that had been creeping in.

However, I also found it a lot easier to go high without my pump. Partly because I didn’t have the convenience of being able to efficiently correct when I was on the run. But also partly just…because. I suspect that perhaps I was missing that extra action from the rapid acting basal on my pump.

Once I went high, it took a lot more effort to bring myself back down. It was moments like these, where I was still cruising along at 12 after several correction shots patiently waiting for my blood sugar to budge, that I really missed my pump.

My last pump break was two and a half years ago. During each of those pump breaks I had taken prior, I seriously questioned whether insulin pumping was the best fit for me. I’ve only been pumping for four and a half years, mind you.

This time round, it didn’t take very long at all until I was itching for my pump back. After the first two weeks, I had to convince myself to keep going, knowing that two weeks was not enough of a break.

It kind of reinforced the realisation I’d come to last year, where I had finally reached a point where I was firmly an insulin pumper. Where I has comfy – dare I say liked – the kit that I was using, and that this was the method of insulin delivery that worked best for me.

I’ve been back on my pump for a few days now, feeling a little less fatigued, a little more refreshed and a little more appreciative of the tool I am using to administer insulin.

Ready for another year of diabetes.

Blog-a-ver-sary.

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My blog turns six today.

I’d always been fascinated by blogs. I loved the way they offered a space for writers to share their own daily thoughts, and also the way they offered a space that readers might look forward to visiting every day.

When I first started writing here, I had no real idea what this blog would look like.

There was nothing out there (that I was aware of at the time) that wasn’t medical or professionally geared around diabetes. Especially in Australia. Diabetes just sounded like something that I should write about.

I just wasn’t convinced that anyone would be interested in reading about it.

Joining in Diabetes Blog Week was probably the thing that encouraged me to just write. Not to mention connecting me to so many d-peeps all over the world. I realised it didn’t have to be perfect, it just had to be me.

It’s hard to believe I’ve managed to fill so many of these pages, let alone fill so many of these pages about diabetes.

Honestly, thanks for coming along on this journey with me and for helping to make the great big world around me that little bit smaller.

Finding the Good in 2020.

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It’s been a year. I really should acknowledge my privilege as I write this post in my backyard in Western Australia, where life has been largely back to normal since June. I couldn’t wrap a year that I’ll never forget without looking back on some of the better things that came from it, both diabetes and otherwise.

Webinars and virtual conferences. In a year where I found it difficult to write and participate in the diabetes community, it was events like these and seeing familiar faces on screen that really reminded me of why I love being a part of the DOC.

I really enjoyed Ypsomed’s fortnightly webinar series T1 Connects earlier in the year, bringing together PWD and healthcare professionals sharing different perspectives on insulin pumping and broader diabetes management. These fortnightly Tuesday chats were definitely reminiscent of old OzDOC vibes.

It was also extremely humbling to connect with global advocates during these challenging times through Ascensia’s Diabetes Social Media Summits for some meaningful conversations. I also got a (very brief) taste of the famous Friends for Life conference hosted by US charity Children With Diabetes, even though it was at an extremely unsociable time here in Australia. Diabetes Australia also hosted heaps of Facebook lives to keep us all connected this year, and if I worked in front of a computer I’m sure I would have tuned into more of them.

World Diabetes Day was another highlight for me this year. I spent an unusually wet November morning on the side of the road offering passers by a diabetes risk assessment with my fellow Young Adult Diabetes Committee members. It was such an important thing to be involved in, given just how many people can go undiagnosed because their onset of symptoms may be much slower. I also realise that type 1s aren’t the only PWD in the world, and I absolutely want to participate in spaces which are inclusive of all PWD.

I also came to realise that I would happily continue to pay for my CGM if the government would only expand the subsidy to include the elderly. I had a really humbling conversation with an elderly gentleman who was a fellow t:slim user, with words of wisdom thrown in about diabetes and how far things have come from his wife.

The ABC’s daily Coronavirus live blog, as well as the Coronacast podcast are to blame for my newfound status as a Covid news junkie. I apologise if that has spilled into my blog this year. I can’t say how much I’ve appreciated having these sources of news to keep me informed throughout the year, without the bias of social media ‘experts.’

Receiving a Dexcom G6 in the mail to trial was another highlight of my year. It was hard to imagine anything being able to top G5, but this one definitely did. You can check out my review here. Thanks again to AMSL Diabetes for working with me.

I never imagined that I’d be spending the festive season and ending the year without my pump, but I absolutely needed this. I couldn’t be happier to be sticking needles through my shirts and into my thighs in-between festive eating and drinking.

I don’t think I’ve ever appreciated leaders as much as I have in 2020. In particular West Australian Premier Mark McGowan and our health teams have done an absolutely stellar job in keeping my state free of community transmission since April. I had a lot of uncertainty around restrictions easing earlier this year, however I feel we are in good hands with leaders who will act swiftly and decisively to keep us all safe going forward into 2021.

But I think the one thing I will take away from 2020 is the renewed affinity for home, the people around me and the simpler things in life. As 2020 comes to a close and the media harps on about state border closures, there is absolutely no place I’d rather be than home.

I think we all deserve a pat on the back just for making it to today.

Happy New Year. Here’s hoping that 2021 is only onwards and upwards from here.