Diabetes Musings

Skyrocketing Levels

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A couple of weeks ago, I hit a bit of a speedbump with my blood sugar levels. I began skyrocketing after almost everything that I ate. It took several correction doses and hours of temp basal rates to get me out of my mess each time.

This is what I would often witness on my Libre after a meal. My levels would simply climb and climb and climb until they reached the high teens.


My first instinct was that my body was responding to changes in my diet. I have been eating less carbs, and more protein, consistently. If I needed proof, the total daily dose of insulin in my pump history was at its lowest, and most consistent amount day to day. I was still suprised, though. To me, the changes weren’t anything radical. I had been bolusing for my protein. I hadn’t cut out carbohydrates completely, nor was I restricting my food intake.

But it seemed that my insulin was a lot less sensitive than it once was.

My first thought was to revisit my basal rates. I was convinced they might need revising upward. Moreso after reading this article, which told me that the “status quo” for people not on high carbohydrate diets was 50% basal and 50% bolus (mine are skewed in favour of bolus insulin). I was convinced that if I fixed that, my mealtime insulin would do its job properly once again. However after going low during two separate basal tests, I conceded that my basal rates were fine.

My levels were still spiking after meals, so my next thought was my insulin to carb ratios. The spikes were absolutely ridiculous, even with lower carbohydrate meals. I adjusted my insulin:carb ratio from 1:10 to 1:6, and lowered my insulin sensitivity factor by the same proportion.

1:6 was quite a scary ratio to use, because I had such big amounts of insulin on board after eating a meal with only 30g of carbohydrates. The potential to go low from after meal activity was amplified, and pump sites would ultimately need more frequent rotation. Thankfully, it became clear that the 1:6 was sending me too low after meals, and I eventually settled on 1:8.

The 1:8 has been working great, and I have learned a few things about food and my blood sugar spikes since. For instance, on the weekend I ate porridge, which I thought was relatively low GI. Apparently the instant, microwaveable kind, is not. Not even close. And despite accurate carb counting, pre bolusing by half an hour, and a waking BG of 7.9, my levels just climbed. 9.2 an hour later, 14.7 after that, and 15.7 after 2 units of correction. Instantly, bells rang in my head as I recalled occurrences of skyrocketing blood sugar levels after Weet-Bix, potatoes and an overripe Banana.

So, yes, it does seem that less carbohydrates has reduced my insulin sensitivity, or increased my sensitivity to glucose. But it also seems that my insulin to carb ratio is less effective when I eat higher GI foods. And perhaps there were also some stress hormones in play a few weeks back, that were contributing to some of those skyrocketing blood sugar levels.

I absolutely hate that diabetes is forever changing. There’s no guarantee that what’s working today, will work again tomorrow. Or in a month. 

But nonetheless, it does feel good to be somewhat in control once again…and a little wiser…

Libre-less

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It’s no secret that I have continued to use the FreeStyle Libre with much enthusiasm in recent months, albeit intermittently. I frequently talk about it on Twitter, I often refer to trend arrows in my blog posts and it’s a popular subject of messages that arrive in my e-mail inbox. Not to mention how instagrammable that graph is, especially when the line is flat.


Yeah, paying $95 to monitor my blood glucose like this every two weeks absolutely sucks. But overall, it has improved the quality of my life, and I am starting to come around to justifying those costs.

For my needs, it is perfect. I check my blood sugar frequently through the day, so this fits the bill nicely in adding some convenience to that. I like that the hardware is minimal, and that it doesn’t use a lot of real estate on my body. The only upkeep is the round sensor every two weeks, which makes it a cheaper alternative to Continuous Glucose Monitoring.

I guess where I have struggled the most is setting boundaries around the data. I find it easy to become obsessed with the numbers after wearing it for too long.

My behaviour hasn’t been too healthy during the life of my last sensor. I’ve been compulsively checking my levels before I’ve even finished my dinner, and again on the couch in the evenings while I’m watching television. The trend arrows have been really frustrating to see at times, and I find it hard to remind myself that they are only temporary. Against better judgement, I do tend to micro manage data, which sends me low far more often than I should be.

So why haven’t I taken a break from it sooner? Firstly, I wanted to give myself every advantage in getting the best hba1c that I could. Turns out that I was being much too hard on myself, because it exceeded my expectations by a country mile. Then earlier this month, I hit a speedbump where I was literally spiking after everything that I ate. I was too scared to be without it until I had figured the problem out. But I am slowly moving past that issue (more on that, soon).

I’ve been Libre-less for almost a week now, and all that anxiety is gone. I stop to check my blood sugar prior to meals, and one and two hours after meals. I’m forced to think about whether I actually need to check my blood sugar, or whether I’m simply doing it because I can. My head isn’t consumed by numbers so much, and my mood isn’t dependent on trend arrows. In fact, the numbers have been better than they were during the life of my last sensor, and I’m not hypoing so often from micro managing.

The morale of this story is that time away from the tech is equally as valuable as the tech itself. It gives me a chance to actually appreciate the tools I am using, and what I’ve been able to achieve with them.

My life is more than just numbers, and time away from the tech is definitely helping me to realise this once again. 

Do Others See My Diabetes as a Weakness?

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This year, in particular, my diabetes is more apparent than it ever has been before. I started wearing an insulin pump in May, and intermittently use the FreeStyle Libre to monitor my blood glucose. I more actively manage my blood sugar levels than I once did, which means I rarely leave the house without my meter and skittles. I tend to my diabetes quite a lot through the day, and I am very conscious of it.

Which is why the very first question during last week’s OzDOC chat really struck a chord with me. What are the high lights and low lights of being open about my diabetes in real life?

For me, one of the low points is definitely my perception that others might see it as a weakness. It’s stupid, really, because why should I care about what other people think? Yet those thoughts still sit there, on the edge of my subconscious, every time I need to pause and tend to diabetes through the day.

Every time I swipe my FreeStyle Libre up against my arm. Every time I pull out my pump, staring at it for moments on end while deliberating over a correction bolus. Every time I’ve got my phone in hand at the dinner table (and feeling extremely rude for it), calculating carbs or searching through Calorie King. When I spilled my container of skittles on the floor in the shopping centre last week while I was trying to treat a hypo, scrambling to pick them all up (thank goodness I had a spare!).

For the most part, I definitely don’t feel that diabetes as a weakness. When I reflect on my life, I don’t feel that it is significantly weaker because I live with diabetes.

Sure, it’s work. Hard work. It effects every single activity that I undertake. It’s intrusive. It’s frustrating. It doesn’t always go right. It does interrupt my day. I get angry and sweary and pissed off. If I’m lucky, it will even disturb me while I’m asleep. It’s fair to say we have our moments. 

Yet as strange as it might seem, most of the time it is just something that I have to do alongside eating and sleeping and working. Half decent management doesn’t simply come from accepting defeat.

I guess, naturally, people don’t know a lot about diabetes. Neither did I, in the 17 years before I was diagnosed. I don’t really know how I can change that.

The high point of being open about my diabetes would definitely be its conversational value. It does give you something interesting to talk about. And I do feel a little less “weaker” when the people around me know what I’m doing. 

I can only hope that by being open about my diabetes, I am not feeding those perceptions of weakness. I can only hope that by continuing to talk about it, others will see it as the ordinary that I do.

 

What Type 1 Diabetes Is Really Like

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“How’s your diabetes going?” “Are you managing it alright?” “How are your levels?”

These are the questions that I am most often asked about my diabetes. Don’t get my wrong, I love fielding questions about diabetes. However, being asked about my diabetes so generally is so difficult for me to answer. I’m often left lost for words. Speechless.

Diabetes is so much more than just “good” or “not good.” “Pass” or “fail.” It’s never a simple answer. Diabetes in itself, is never simple.

Diabetes is one of the most unpredictable conditions to live with. Trying to mimic a healthy pancreas, while trying to live my life at the same time, is never easy. Two days with diabetes are never the same. Two identical days with diabetes don’t guarantee you the same results.

Everything affects diabetes. Everything and anything.

A good night’s sleep can be the difference between steady, or skyrocketing levels after waking. Physical activity that isn’t carefully planned for will send me low, and then high in the aftermath. Stress, and illness are enough to make my blood sugar levels as stubborn as hell. A plate of pasta is digested at a much slower rate than a plate of mashed potato.

To remain on top of this condition, I have to be on top of my game. Being on top of my game means living in anticipation of all of these things. Second guessing how accurate my carb counting was at dinner. Wondering if I will need a square of chocolate, or a couple of skittles, to keep me steady over the next couple of hours. Anticipating the timing of my insulin dose to match the food I am eating. Stressing about where my blood sugar levels will settle before I go to bed. Wondering whether I am doing enough to keep myself healthy, and free from long term complications.

After six years, diabetes has become somewhat of a second nature. Yeah, it frustrates me. Yeah, I don’t always get it right. Some times are tougher than others. I get burned out from time to time. There are days where I close my eyes, and bury my head in my hands.

But I don’t feel burdened. I don’t spend my days dreaming of a cure, or wishing it away. It hasn’t stopped me from doing whatever I set out to achieve in life. I will have type 1 diabetes for the rest of my life, and I’ve made my peace with that. 

Type 1 diabetes has made me a stronger, healthier, passionate and more confident person. Type 1 diabetes has shaped the person that I am today, and I wouldn’t trade that guy for anything in the world.

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Wishing you a Happy World Diabetes Day.

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There’s a 24 hour chat happening over on Twitter for World Diabetes Day. For those of you in Australia, it kicks off at 1pm WST/4pm EST. All you need is a Twitter account. Join in by following/tweeting with the hashtag #WDDChat16.

I will be hosting the 5am hour, which is 6pm WST/9pm EST for those of you in Australia.

Hope you can join me.

My Desk Says a Lot About My Diabetes

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My blood sugars have decided to go rogue in this past week, and I’ve had a tough time trying to predict what they’re going to do to me next.

You can see it by the mere sight of my desk.


There’s a FreeStyle Libre reader in the white organiser that I have kept within close reach lately. It’s been my saving grace this weekend, while my blood sugar levels have been completely messed up. It provides me with trend arrows the minute my blood sugar levels began skyrocketing, and again as soon as they start plummeting low.

There are test strips strewn across my desk. There have been a few scary moments this weekend where my blood sugar levels were moving quite rapidly. Despite wearing a Libre sensor, during confronting moments like these I need reassurance. There were times where I felt compelled to prick my finger every couple of minutes, just to be sure that my blood sugars were heading in the right direction.

There are blood stains on the beech coloured surface of my desktop that, frankly, don’t look pretty. I’m tempted to clean it, but I know that diabetes won’t allow it to stay clean for very long.

On the left hand side, I’m staring at a notepad that is strewn with numbers. Basal rates, insulin to carb ratios, blood sugar levels, units of insulin taken, carb counts and corresponding times of the day. Notes that I sit and stare at for prolonged moments of time, as I try to make sense of blood sugar levels that aren’t making any sense.

I open my desk drawer and I see a huge party bucket of skittles, that I certainly have no intention of cracking open at any party. Skittles that I carefully divide into portions of 9, and store in empty test strip containers. 9 skittles that add up to 10g of carbs, a perfectly convenient serving that I can easily shove down my throat the moment a hypo strikes.

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I scoop up all of the used test strips into the palm of my hand, and walk over to the rubbish bin. I place my foot on the pedal, and the lid lifts to reveal a vial, half filled with insulin. The vial I threw away last night when my blood sugars were skyrocketing, just to be sure that it hadn’t spoiled.

It’s here in this moment, staring inside a rubbish bin, that I see the bigger picture. Suddenly, I don’t feel like the going is so tough anymore. I don’t feel as crappy as I have been for the past few days. I don’t feel the guilt of awful blood sugar levels so much.

When the going gets tough, I still have the best tools available for me to manage. A script for 25 cartridges of insulin costs me a mere $35. A box of 100 test strips costs me $16. Although my wage is less than glamorous, I can make room for FreeStyle Libre sensors when I need them. I have devices that can be uploaded to a PC, where I can analyse the data. I can call my diabetes educator for assistance, completely free of charge thanks to the public health system in Australia.

I have nothing to complain about. For DOC friends in the US, skyrocketing insulin prices are of real concern. A loss of health insurance coverage is of real concern, because it’s tied to diabetes supplies. Meanwhile people with diabetes in developing countries of the world cannot even afford insulin, supplies, education, treatment – and the ability to merely survive.

T1International are a fantastic organisation based in the UK that advocate for equitable access for people with type 1 diabetes worldwide. You might be familiar with their #Insulin4All movement. This year, T1International are urging us to sign the Type 1 Diabetes Access Charter. The Charter will be used to bolster advocacy efforts worldwide, showing that there are many voices united in support of these rights.

Insulin is a right. Managing your blood sugar is a right. Diabetes education is a right. Healthcare is a right. A life free from diabetes discrimination is a right.

It makes me sad that in this day and age, not everyone in the world is able to access the same standard of diabetes care that I do. Signing the Charter only takes a moment of your time, and you can do so by clicking here. 

Make it the one thing that you do this Diabetes Awareness Month.