Diabetes Musings

It’s been a scorcher of a week in Perth. I’ve switched my milky coffees for iced, and it feels like the last ‘normal’ day of the year before we lose all sense of what day it is and what we’re supposed to be doing.

Unlike all of the emails I’ve been receiving prompting me of prolonged Christmas closures and the inability to get anything done for two weeks, diabetes won’t be taking any time off for Christmas. In fact, it will be open for business on Christmas Day, right through until New Years and beyond. Jealous.

Which is why, I think taking some time out and lessening the load at this point of the year is more important than ever.

I’m so looking forward to a break, made even better by the fact that Christmas falls nicely next to a weekend this year. Four whole days off, with another three to follow in a week. For me, that’s definitely going to look like sleeping in, having my feet up, spending time with family and of course lots of food and drink.

My pump break is definitely going to be one of those ways that I’ll be lessening the load on diabetes this festive season. It feels so freeing to not be reliant on maintaining a constant attachment to my pump for infusion of insulin, and I imagine it will be some time until I am ready to return. I’m literally picturing myself running through beach sand, a million miles away from my pump knowing that the long acting inside of me has my back.

I’m also cutting myself some slack for numbers which I might not usually tolerate. Like yesterday, when I was riding a little high after breakfast at work. It was a busy morning, my long acting wasn’t quite right and I didn’t have the convenience of being able to pull out my pump and swiftly correct. But in all honesty, I didn’t care less. I felt great. I rode it out, and got to it when I could.

My final feeling is that Christmas Day with diabetes doesn’t really need to be any different than another day with diabetes. Everyone around you likes to make you feel like it’s daunting and that it must be some mammoth task. But I know what works for me, and I know what doesn’t work for me. I’ll be doing exactly the same thing on Christmas Day that I’ve been doing during the other 364 days of the year to manage.

Merry Christmas. Thanks for reading my extremely sporadic posts over these past few months. Special thoughts to those in New South Wales, particularly in Greater Sydney and the Northern Beaches. A massive thank you to everyone who has played their part over the course of this year in keeping us all safe here in Australia. We’ve got this.

When I was first diagnosed with diabetes, I thought that I would arrive at the day where I everything would be under control. I specifically remember explaining to a friend that while I was pricking my finger quite a bit, eventually the day would come where I wouldn’t have to do it so often.

Over the years, I’ve come to realise that diabetes ebbs and it flows. There are periods where things are just moving along in a nice rhythm, and then there are times where things just…aren’t. There are times where things are working for me, and times where they just…don’t.

I think I’ve definitely felt in a bit of a rut in recent weeks. Several weeks. I haven’t felt that nice rhythm as I’ve been going about the daily grind, day in and day out. I’ve felt more effort, with less return. My foot has definitely eased from the pedal for quite some time, and I don’t feel particularly compelled to hit accelerate once again.

I’ve been itching for change over the past few weeks. Perhaps not the best time for it, on the verge of Christmas, but diabetes wants what it wants. The only real thing that’s been stopping me has been the 02-2020 expiration date on the box of insulin stashed in my fridge.

Over the weekend, I finally bit the bullet and went down to my local Chemist, with a script for some long acting insulin in hand. A few hours later, I’d happily stashed my pump away in a drawer and I finally felt some freedom. Like the weight of my past several weeks in diabetes had been lifted from my shoulders.

Diabetes ebbs and it flows. I’ve been attached to my pump continuously for the past two and a half years. The longest period of time since I began pumping insulin four and a half years ago. I had finally reached a point earlier this year where I knew that I was firmly an insulin pumper. That this is what works for me. I was finally at the point of saying that I couldn’t imagine being without my pump.

However, diabetes ebbs and it flows. Today, I find myself looking forward to a break for searching for suitable infusion sites on my tummy. A break from fumbling for my pump which has flown out of the pockets of my pyjama pants in bed. And a break from having to accommodate said pump alongside my keys and wallet and phone while out and about on Summer days.

Most of all, I look forward to not being so ‘reminded’ of my diabetes for a while with a noticeably emptier left hand pocket.

Bzzzzzz. Bzzzzzz. Bzzzzzz.

I woke to the sound of my insulin pump vibrating a few nights ago, alerting my that my blood sugar had dipped below my low threshold of 4.4. I didn’t have much insulin on board, and hoped I could just suspend my way out of it. If there’s one time of day where, more than ever, I don’t want to treat a hypo, it would have to be in the middle of the night.

Bzzzzzz. Bzzzzzz. Bzzzzzz.

In-between having just nodded off, but not yet being peacefully asleep, my pump woke me up 30 minutes later to remind me that my blood sugar still hadn’t risen above 4.4.

I fumbled for my bedside lamp, switched it on and reached for my meter, curious to see whether there was any lag from my pump’s reading of 3.6. 3.1. Yikes. I was too tired to worry about how clean my hands were and whether it was accurate. I’d have to do exactly what I did not want to do.

I reached for my tube of glucose tabs, popped two out and instantly felt the horrid orange chalkiness invade my mouth. Made worse by the fact that I’d be left with a horrid aftertaste stuck to the walls of my mouth and my tongue.

Bzzzzzz. Bzzzzzz. Bzzzzzz.

An hour or two had passed. As I reached to silence my pump for the third time, I registered the steady descent after the bump from the glucose tabs that had ended at this 4.4.

I popped another glucose tab in my mouth, even getting some of that orange chalkiness caught in my throat this time. I set a temp rate of 90% for another four hours, which would hopefully steady me until I woke up.

As I eventually woke up and went about my day, with the orange taste that would not escape my tongue, I was left with a lasting reminder of the night that had gone.

Hypos happen. I laugh every time a doctor asks me how many hypos I’m having, because after a decade of living with diabetes it’s not something that I can easily count on the palm of my hand. They’re just something I deal with, in exactly the same way that I check my blood sugar, count my carbs or give insulin.

After living through a decade of lows, it’s no longer the physical feeling of going low that bothers me so much any more.

It’s the fact that I need to find the urgency to treat them every time I register a downward trend arrow. It’s the need to mentally convince myself to pop a disgustingly orange glucose tab into my mouth every time I clock in at 4.4. Or being disturbed in the middle of the night or right after I’ve brushed my teeth.

If I had to describe how I feel about living with lows in just one word, it would have to be inconvenient.

‘Tell me what you can’t get?”

That conversation with my panicked Mum when toilet paper began flying off the shelves back in March is a far cry from the person who would today be able to tell you the numbers and developments around COVID right across Australia.

2020 has exacerbated a lot of strong opinions. I’ve even found myself sharing a lot of strong opinions which I might not have had if it were not for the pandemic. Namely around COVID complacency, people’s need to travel in the midst of a pandemic, and Western Australia’s hard border closure (which is unfortunately, but inevitably, coming to an end).

In the context of being part of the DOC, where I share and look for trusted health information every day, I’ve struggled to find it this year. I’ve struggled to share it. To a degree, I’ve even stopped looking for it.

I really struggled with the whole notion of being classed as a ‘vulnerable’ or ‘high risk’ person from the very beginning. I tired quickly of seeing many corners of the diabetes community try to editorialise the pandemic, ‘helpfully’ telling me how to optimise my diabetes management for Coronavirus. My diabetes was just fine, thank you.

All I have been interested in, all along, was following the health advice. Which is just common sense. Nothing more.

During Ascensia Diabetes Care’s OzDSMS summit a few weeks ago, we talked about building resilience. It was quite a complex question.

Resilience looks like being more accepting of different points of view to our own. Again, its been harder to share in a year full of exacerbated opinions, and often its felt easier to stay silent.

Resilience looks like embracing choice. We might all have diabetes in common, but we are all still very different and what works for one is not the solution for everyone. It’s still really frustrating to see corners of the community where choice is not embraced and we are pushing what we think is best onto others.

Most importantly, resilience means looking after yourself ahead of others. For me, this year has definitely been about the little things. Finding the lightest room in the house as I while away hours studying over the weekends. Making time to get outside, and even run, because it feels good. My afternoon coffee and biscuit break. Doing things that I enjoy – whether it be a walk by the beach, time in the kitchen, getting into a good TV show, or a scroll through Gumtree and Marketplace.

I think we all deserve a pat on the back just for getting through 2020. We’re all the more resilient for it.

Late last Thursday afternoon, as I pulled my car up at a local reserve to take the dog for a walk, the life of my final Dexcom G6 sensor came to an end.

I absolutely loved my time using Dexcom G6. Not having to prick my fingers after ten and a half years of living with diabetes was nothing short of amazing. It’s a reality that I haven’t quite shaken myself of every morning when my G5 pings me for a calibration, and I have to reluctantly delay my coffee to wash my hands and prick my finger.

The one thing I truly missed was having blood glucose readings on my insulin pump. I truly love not being tethered to my phone, particularly for things like runs or lounging around the house. Of course, this would have been rectified had I chosen to update my t:slim to Basal IQ. This would bring low glucose suspend functionality to my pump, with the promise of a fully automated system hopefully not too far away.

That was even harder to walk away from, than G6 itself.

The update to Basal IQ was really, really tempting. I think CGM/Flash is definitely something that is worth spending some of my money on, and something that I know I want to live with. However, I just couldn’t justify spending that much money on the G6 when I have other priorities in my life right now and there are cheaper options available. Plus, there’d be no going back if I changed my mind on the update.

I do think the subscription plan and price reduction from G5 is a step in the right direction from distributor AMSL Diabetes – to the extent that this was genuinely something I could consider. However, the $400 bond does add a further barrier and cost to the subscription plan, which could surely be replaced by a credit check.

At the end of the day, I knew this is where I would find myself when I was weighing up my decision to commit to another four years on the t:slim earlier this year. I have absolutely no regrets with that decision, because the Tandem/Dexcom G5 is still the system that works best for me and burdens me the least.

So for the foreseeable future, I’m back using my rebatteried Dexcom G5. Given that G6 is yet to be listed on the NDSS, I’d expect that G5 won’t be going anywhere for at least 12 months.

I’m super grateful to AMSL for the opportunity to trial the G6.

Hopefully this is a ‘not now,’ rather than a ‘not ever.’

Full disclosure: AMSL Diabetes provided me with a three month trial of the Dexcom G6 Continuous Glucose Monitoring system. I previously wrote about the system as part of my now ended sponsorship agreement here. This post does not form part of that agreement and is, as always, my own.