Rage Bolus, Baby, Bolus

I’ve been plagued with absolutely stubborn blood sugar levels since Friday morning. I’ve been taking crazy amounts of insulin. I really have no explanation for it, other than being sick.

I probably eat the fewest carbs, and take the least amount of insulin at breakfast time. On Friday, it was a slice of Burgen Low GI toast topped with a boiled egg and a milky coffee. 18g of carbs in total. 4 units of insulin should have been more than enough to cover it. Yet, when I went to check my blood sugar levels 2 hours after breakfast, I was 14.6. I corrected with a very conservative 2 units, which should have brought me back down to the 8-10 mark. An hour and a half later, I was still 14.0, and ready for a rage bolus of 5 units.

This trend continued throughout much of the weekend. By Sunday afternoon, I was injecting around double my normal rapid acting insulin dose for a meal. I would test 2 hours later, with results typically hovering between 14 and 19. I’d rage bolus another 5ish units, which would eventually bring me back down to earth. I was feeling a lot like Basil here…

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I wasn’t staying stable through the night either, so I upped my Lantus dose from my usual 9 units. I started conservatively with a 1 unit increase on Friday night, and 2 units on Saturday.

This was a phenomenon I don’t experience too often. Mind you, I don’t get sick too often. I really had no explanation for it. I could only presume that stress hormones from being unwell were affecting my insulin sensitivity. Thinking about it now, I probably should have checked for ketones and drank more fluids as well.

The scariest part in all of this was the unknown. Normally, I have a good idea of where an insulin dose will take me after a meal. I know how much insulin will correct a high blood sugar. I know how many carbs will correct a hypo. I have a good intuition of where my blood sugar is headed when I test 2 or 3 hours after a meal. But through all of this, I was flying blind.

I was borderline hypo when I was ready for bed on Saturday night. I had no idea whether my blood sugar levels were going to fall further, or whether they were going to start rising again. I had no idea whether my normal hypo fix would be enough, or if it would send my levels skyrocketing. I was dead drowsy from the flu tablets I’d been taking, yet I had no choice but to sit up, test, test, test and wait this sticky situation out.

I’m proudest of the caution I exercised through this situation. I can’t say that I was following a textbook, but I didn’t go too crazy with my corrections either. One of the things on my mind was the fact that I didn’t have the energy to deal with a hypo. The last thing I felt like doing was shoving skittles down my already sore throat and going through the exhaustion and frustration that would inevitably follow. 

I’m not really sure what today holds in store for me, but I am feeling better. I’m heading back to work where I’ll be on my feet, rather than on the couch all day. I’m going to try to go easy on my blood sugar levels, and stick to small simple meals.

One of the hardest things about diabetes is that it’s always changing. Why can’t it just sit quietly on the couch and take the day off with me?

Sick Day

Today, I’ve decided to bite the bullet and take a much needed sick day at home.

I’ve worked through a sore throat and a cough for the last few days, aided by plenty of water and losenges. Mind you, the medicated losenges I’ve been taking are especially conspicuous. The ingredient list is made up of items that don’t make any sense to me. Sugar, or no sugar? Carb count? Your guess is as good as mine.

Today, however, a full blown cold has set in. My nose is running like a tap. Working is extremely uncomfortable when I need tissues every 5 minutes, and I always feel guilty to spread my germs to those around me. As bad as I feel for letting down my team at work, I have to accept that it’s not my problem to worry about for today. I know that I’ll be in a shitty mood if I go to work sick, which reminds me of this post that I don’t particularly want to relive either.

Generally speaking, I don’t find diabetes any more demanding than usual when I’m sick. My blood sugar levels don’t tend to run higher than normal, so I don’t feel the need to test for ketones. Maybe this is more of an issue for pumpers? Although I am being way more cautious with my insulin doses, because I really can’t deal with a hypo at the moment.

Yesterday afternoon, I was reminded of why I hate flu tablets so much. I felt so cloudy, drowsy and almost like my brain was not in sync with the rest of my body. Vicks, however, works wonders on congestion. A small dollop under each nostril helps me sleep so much easier.

On a note completely unrelated to diabetes, check out this hilarious movie trailer about talking food! I hope that your weekend is off to a better start than mine.

Taking a Plunge Into the Diabetes Twitterverse

I was extremely hesitant about taking a plunge into the Twitterverse a year ago. Unlike Facebook, my name, my photo, and everything I posted could be seen by anyone on the internet. When I first joined I would upload a profile photo, Tweet a few things, and then delete everything on my page again. I did this a few times before I eventually had the confidence to stick with it.

I seriously considered Tweeting under an alias for a while. But inspired by others I saw in the diabetes community, I decided to go with a first name and a profile photo. I wanted people to be able to connect with me, and I felt that this did me better justice than an alias.

I also feel that putting my name to my posts on social media makes them more honest and genuine. I think it’s a lot easier to be dishonest and disrespectful on social media when you’re posting behind a mask. If you’re serious about the “a” word (advocacy), then this is definitely something to consider too. I know that when I’m scrolling through my Twitter followers, I’ll follow back genuine people with diabetes rather than the account called “Diabetes Cures.”

It’s fair to say that Twitter has surprised me. I thought that Twitter would be pointless for someone like me, who was relatively unknown and far from the likes of being a celebrity. I never thought that I would make connections, or find any meaning to it. That is, until I began using it with a focus on diabetes. I have discovered a whole new meaning to Twitter since I began using it with a focus on diabetes.

A lot of people with diabetes use Twitter. If your Twitter profile identifies as a person with diabetes, chances are a lot of these friendly folk will follow you back. There’s just something so meaningful about being able to reach out or share with people who just “get it.” Waiting out a hypo at 3am? Support on the other side of the world is just a Tweet away. Have a question? There’s a good chance someone else in your circle has gone through the very same thing. Having access to this kind of support 24 hours a day is very meaningful to me.

I love that Twitter is so short and sharp and to the point. It’s also very stimulating. It’s the first thing I check when I’m sitting at the table with my coffee in the morning. It’s something I relish during a break in the afternoon. I’m always finding something interesting to read, or jumping into a chat such as #OzDOC or #DCDE. It’s the place where I initially became passionate about diabetes (outside of my blog, of course).

I also love my hashtags. Owning a genuine Tweet about diabetes with the hashtag #diabetes is just so empowering. Everytime I use the hashtag, I mentally picture my Tweet thwarting 10 other Tweets in the #diabetes feed promoting cinnamon and weight loss and cures. I’m proud that I’m putting genuine information out there.

I love Twitter. It’s helped me to find a community, become an empowered patient, and feel less alone with my diabetes in general. Although I haven’t met any of these folks in real life, many of them do feel like friends. When you live with something as isolating as diabetes, that’s not a bad thing to have.

Accessing My Diabetes Healthcare in Australia

This post from Diabetes Mine caught my eye over the weekend. I’ve read so many stories from the US about diabetes management tools being tied to health insurance. Patients often go through ordeals with their insurance companies in order to obtain the items that I take for granted every day. Insurance is tied to an individual’s employer, which means that a change of job often comes with a change of insurance. A new insurer won’t necessarily cover the same items that the old one did. And becoming unemployed means that individuals often find themselves without insurance and facing hefty medical costs.

In comparison, I have it so easy here in Australia.

You’ve probably seen me talk about the National Diabetes Services Scheme (NDSS) a fair bit here. In Australia, this is the vehicle through which most diabetes products are delivered through. It’s funded by the government, and delivered through Diabetes Australia and pharmacy outlets.

When I was first diagnosed with type 1 diabetes in hospital, I was signed up to the NDSS straight away. Upon registration, I was able to access consumables like test strips, needles, insulin and pump consumables at a heavily subsidised price. I buy consumables at my local pharmacy, however I can also order through Diabetes Australia and have them delivered to my door. Generally speaking, I’ve never had any major troubles accessing diabetes supplies.

There are a few setbacks. There are limits on quantities that I am able to purchase. As a type 1, I normally get around this by shopping more often and in smaller quantities. If you are a type 2, access is now largely in the hands of a healthcare professional. Continuous Glucose Monitoring consumables are not subsidised on the NDSS. I also feel that there are a lot of barriers to accessing diabetes technology in Australia, too.

Then, there’s private health insurance. I was covered under my parent’s fund until I began working full time, when I then had to take out my own policy. I pay an annual premium to a fund of my choice, which costs me roughly a week’s pay. My package is a comprehensive one, but I can generally tailor them to suit my needs and my budget. Hospital cover ensures that I will be treated straight away if I’m admitted to hospital, and generally most costs associated with hospital care are covered. I can choose services for my plan that I use frequently, such as dental, optical and podiatry, and only pay a small out of pocket cost. Another thing which is pretty sweet for me is that my health insurance will also cover the cost of my pump! An $8,000 device ain’t bad for the small annual premium I pay!

Not everyone in Australia has private health insurance. We also have a system called Medicare, which is funded through taxpayer dollars, and covers emergency hospital procedures and doctor’s visits. But private health insurance offers me peace of mind, and significant financial relief over my medical costs. With a condition as demanding as diabetes, I simply couldn’t live without it.

While I often whinge about the small things, I count myself pretty lucky. It might suck to live with diabetes, but I’m extremely fortunate to live in Australia with it.

An Excellent Example of Patient Centred Care

On Wednesday afternoon, I visited the dentist. I arrived a few minutes prior to my 3.30pm appointment. I greeted the receptionist, whose friendly voice over the phone was instantly recognisable in person. I was fully expecting to be handed a clipboard of tiresome forms to “update” my medical information. Instead, I was invited to take a seat.

I sank into one of the comfortable couches in the air conditioned waiting room. The coffee table wasn’t strewn with ancient magazines, and there was a flatscreen TV playing The Chase on the wall to my right (I hate that nobody ever wins any money!). I could hear my dentist tending to a patient in the surgery as I sat there, waiting. Being the only person in there, I knew that I was up next.

As I was sitting there, I could hear the friendly receptionist tending to some of the admin duties. I heard her place a follow up call to a patient who had seen the dentist recently. She asked the patient if they were still sore, and if everything worked out okay with BUPA (obviously the patient’s health insurer). She also (very smartly) placed a few calls to patients who were due for their 6 month appointments, asking if they would like to make one.

My dentist eventually came out into the waiting room to greet me. She apologised for the wait, before inviting me into the surgery. I was impressed at how well prepared she was to remember my name and the length of time since my last visit in June.

After a lot of poking and prodding and polishing, everything was looking good and it was time to settle the bill. Despite the fact that I did not respond to the recall letter that was sent to me 3 months ago, the receptionist still gave me the 15% discount for being a long time customer. She politely requested my HBF card to process my insurance claim, and then clearly showed me the amount that had been covered and the small gap that I would need to pay. I remembered to pay with EFTPOS this time, after she had to go and find the cash to give me change last time!

I departed with a small clear pencil case complete with toothbrush, floss and a business card, feeling extremely satisfied and valued.

 

This was one of the most amazing, person centred healthcare experiences I’ve had in a long time. It was a big contrast to the diabetes professionals I visit at a public hospital, who are often pressed for time and in high demand. My own general practitioner also lacks the time or the detail I’d often like from him, and I’ve often left feeling disappointed.

Obviously, it’s not fair to compare this experience with my diabetes care. My hospital diabetes clinic falls under public (government funded) healthcare and I pay absolutely nothing for it. However, I know that some people in Australia do pay for costly private diabetes services and still end up feeling dissatisfied. I’ve paid for many healthcare services myself in the past, and was left feeling dissatisfied.

The standard of care I received here was an incredibly refreshing change of scenery. This is what all healthcare providers, and serious business owners, should be aiming for.