Diabetes Musings

As I was sitting in bed the other night, surrounded by the amazing speakers on my new MacBook Pro, my blood sugar began to dip. Treading cautiously, I treated with small amounts. A square of coconut slice from the kitchen bench. A bit of the pink icing that I’d cautiously left to one side. Then a glucose tab.

By the time I was ready for bed, my CGM was showing 3.5 and a finger prick was 4.0. ‘I could have covered it with a juicebox,’ I thought to myself as I could feel my very unclean mouth. There was just shy of 1 unit of insulin on board. My head was telling me I only needed one more glucose tab, but after the evening’s trend I played it safe and ate two.

Unsurprisingly, around an hour later, my CGM began alarming me. As I picked up my phone and stared at my graph (which I am so grateful to have), I saw a trend upwards that had begun from the minute my head had hit the pillow. I corrected, and fell asleep again.

2 hours later, I was alerted and woken once again by my CGM. It was a little before 2am – and I was still high. I mentally begin to retrace every decision I’d made earlier that evening in the lead up to bed. Then I backtracked to the past couple of nights, and weeks. I felt frustration. That frustration eventually turned to guilt. Finally, I began doubting how well I was actually taking care of myself.

I was wide awake now, and try as I might I just couldn’t get back to sleep.

Now here’s the thing. If this was happening during the day, I wouldn’t have thought twice about it. This afternoon, I was riding at the 12-13 mark for well over 2 hours. I corrected, and thought nothing more of it. It’s rare that I do question how well I’m taking care of myself.

But in the middle of the night, when it’s dead silent and there’s nothing else other than diabetes to occupy my mind? These highs keep me up well past 2am, to the point that my frustration won’t let me get back to sleep.

When I can’t get back to sleep, I’ll grab a glass of water and navigate to the couch. TV, particularly something funny, quickly takes my mind away from it all. If I’m lucky, it might just put me back to sleep.

I have to admit I’ve been wanting to try Genteel since the minute I laid my eyes on it. There was something so endearing about its vacuum seal that promised a virtually painless drop of blood on my fingertips. However, with a price tag that’s traditionally been around the $200 mark, it’s not something I would ever even consider spending on a lancing device.

This is the Genteel. It’s a bit fatter and a little more complex than your typical lancing device. It was gifted to me earlier this year from a friend who did not want theirs, which brings me to this long overdue post.

There’s six different sized ‘contact tips’ that sit on the tip of the Genteel, varying in depth settings. Genteel’s point of difference is that it is designed for drawing blood from other parts of the body, such as your palm or your arm (eek!).

My box also included a small handful of Genteel’s ‘butterfly touch’ lancets, which is nowhere near enough given the price tag. Genteel promises that these will result in 100% less pain than regular lancing devices. Ordinary lancets can also be used in the Genteel, which promises 27% less pain than a regular lancing device.

I initially found it cumbersome. After trying it out a couple of times, I found myself reaching for my AccuChek FastClix more often than not (I’m a creature of habit). Eventually, I bit the bullet and threw my FastClix into a drawer.

The process of drawing blood is somewhat of a technique. You’ll need to make sure that your contact tip forms an airtight seal around your finger (or any other body part) from where you’re drawing blood. Otherwise it doesn’t work. Then you’ll need to press and hold the activation button for six seconds. This ‘hold’ time following the prick essentially activates the vacuum which draws out the blood.

I settled on contact tip number 2, with number 1 being ‘gentlest’ and number 6 being least gentlest. At times, I did struggle to draw a sufficient amount of blood with the 2 and found myself squeezing my fingers for more. But as the user of an AccuChek Guide that wants sufficient blood in one application (hello, strip fill errors), I’m always a bit paranoid about not having enough. Stepping up to the 3 was a little too painful and bloody for my liking.

I also found that when I drew too much blood, it was prone to splattering inside the nozzle when I released my activation button and broke my airtight seal. It’s a fine balance.

I don’t think I could ever associate pricking my finger with the word painless. But I will say that Genteel was the least painful of any lancing device I have used – with one caveat.

You’ve got to change your lancet.

I would suggest every day. Otherwise, Genteel begins to feel like any other lancing device. Although I was skeptical, Genteel’s butterfly touch lancets also lived up to their word of offering superior comfort. Lancing was noticeably more painful when I used my own lancets. I’d recommend adjusting the contact tip here, but I’m yet to experiment with my own lancets.

I pricked my palm once, and I did get a nice drop of blood there too. But that just grosses me out in general, so I think I’ll be sticking to my fingers.

After several weeks of regular use, Genteel has definitely grown on me. The process of drawing blood feels more natural to me today, and I’m not ‘trying’ so hard with my technique. At the end of this review, I confidently say that I intend to continue using the Genteel as my main lancing device at home – and might even consider picking up some more of the butterfly touch lancets.

Before I started using CGM last year, I was pricking my fingers at least 15 times per day. That’s a lot. Genteel’s price point of approximately AU$150 (for the model reviewed) is still going to be a barrier for many – especially for a lancing device. However if finger pricking still forms a major part of your diabetes management, then Genteel might be a worthy investment.

Genteel’s Australian website has vanished in recent months, so I’m not sure who distributes them locally. However, they do ship internationally from mygenteel.com.

Disclosure: I received my Genteel from a friend. I wasn’t asked to write about it, but they probably knew that I would. Thank you so much, L.

There was a time where the low alert on my CGM, or the mental indicator in brain, was set at 3.9. That was when I’d reach for some glucose tabs and do something to fix my low.

When my blood sugar was sitting in the low 4s, I’d be tempted to ride it out more often than not to see if I could avoid glucose tabs. Because honestly, does anyone really like eating glucose tabs? That strategy almost never worked, often leading to my hypo brain emptying the kitchen cupboards.

Let me say this. Lows are fatiguing. The longer I’m low, and the lower my low is, the more depleted I feel. It’s a link I’ve drawn this year, as I’ve been continuing to focus on sleeping well and feeling energised enough to get through my day. My lows definitely needed more attention than I was giving them. The attention that I can best describe with one number and one number alone.

4.4.

That’s the low threshold which I have set for my CGM to alert me that my blood sugar is trending low. I’m ultimately setting myself up for more annoying alerts than what I’d like. But I can live with those extra alerts, because it’s a tactic that’s helped me massively in more promptly addressing my lows and reducing my time below target.

4.4 is like a cushion. A buffer. It buys me time to treat that low while I’m still feeling good, and technically not yet ‘below target.’

For reporting purposes, my low threshold is different to that on my CGM. In Dexcom Clarity, I’ve defined my low threshold as 3.9. That’s what I was educated with, and that’s also the consensus I’ve heard from CDE Jenny Smith on the Juicebox Podcast (which is well worth a listen).

At the end of last year, I’d typically be looking at least 4-5% below target. During rougher diabetes periods, that could even be as high as 8%. It was never something easy for me to bring down. But today, my most recent 30 days look like this.

I’ve rolled my eyes in the past at healthcare professionals and their ‘edginess’ around lows. I’ve had a plastic cup of hypo fluid thrust in front of me as soon I produce a 4.0 on the clinic meter. I still think that lows are not as scary when you actually have to live with them. But I’ve come to agree with my clinic nurses on treating them with urgency.

While I don’t treat my lows with a fear of collapsing at the forefront of my mind, I treat them for me.

Less time below target = greater energy and greater happiness.

The moment that I had been longing for, for so many weeks, finally rolled around on Friday afternoon. After I hit the ‘submit’ button on my final exam for the semester, I could finally log out of Blackboard and turn off my laptop with a sunny weekend and six weeks of freedom to look forward to.

On around Tuesday or Wednesday last week, as I was completely zoned out of the conversations that were happening around me, I knew I had well and truly depleted myself.

In some ways, I haven’t really had much of a chance to slow down since this whole pandemic began. I acknowledge just how lucky I am to have a job, and to continue receiving an education. I’m also extremely lucky to be in Western Australia, where our relative isolation and hard border closures against interstate travellers have left us with next to no locally acquired cases in the community.

But this whole situation distracted me big time, nonetheless. Namely reading the news and keeping tabs on what’s happening here, the rest of Australia, and the world. There have been days where I haven’t had it in me to spend time studying in the evenings like I should.

This has ultimately led to me feeling as though I’ve been cooped up inside more than ever during these final weeks of semester, playing catch up and furiously revising for exams. I work indoors for eight hours a day, and then I’ve had to come home and confine myself to my desk for a few more hours revising for my exams. During the shortest days of the year, that feeling of being cooped up is definitely amplified.

During Ascensia’s Social Media Summit I participated in last week, it was suggested that self care and wellness are often promoted as something we should aspire to throughout those picture perfect Instagram feeds. However, the reality is that people with diabetes are often made to feel lesser for looking after themselves – namely during a pandemic.

American advocates shared stories of being ridiculed for choosing to wear masks outside of the house, while in Australia some of us are not feeling ready to venture out as Coronavirus restrictions are being eased.

Life is slowly getting back to normal here in Western Australia, albeit with continued hygiene, social distancing measures and (hopefully) a continued hard border restriction against travel. One way that I’m taking care of myself is reminding myself to slow down.

I’ve got to admit since this whole pandemic began, I’ve envied all of the free time that people around me have seemingly found. I’ve also wanted nothing more than to sleep in, go outside in the middle of the day and watch the midday movie. Well, not the midday movie specifically, but you get my gist.

So, that’s exactly what I plan on making time for in the weeks ahead.

On a rather gloomy Saturday afternoon, I was sitting at the dining table at home and making good progress in revising for my Financial Reporting exam this week. My pump began to vibrate and I pulled it out, thinking it might be a high alarm.

After 18 months of using a t:slim (and another two and a half years using a reliable Animas Vibe before that), a pump malfunction was the very last thing that I was expecting.

Admittedly, the first thing I did was type bits of my error message into the Tandem Australia Facebook group to see if anyone else had the same problem – and it seemed there had been a few.

After a chat and a bit of troubleshooting with AMSL Diabetes over the phone, we eventually concluded that the Bluetooth on my pump had carked it and a replacement would be sent my way this week.

So, no big deal. The pump was still useable for insulin delivery, it just wouldn’t be able to connect to my Dexcom. All good.

Before bed, I noticed that my pump battery was hovering around the 50% mark. Thinking nothing of it after the earlier troubleshooting, I played it safe and charged it back up before going to bed.

Then at around 4am the next morning, I was woken by my pump, alarming me that my battery was down to 20%. It soon became clear that this malfunction was now causing my battery to drain quite rapidly and the pump was no longer usable.

Which brings me to the backup plan I’ve unexpectedly had to fall back onto.

One of the reasons I wanted to upgrade my pump last month was for the sake of having a spare. After four years of insulin pumping, I’ve reached a point where I have very little desire to manage my diabetes in any other way. For now, at least. With my old t:slim now sitting in my wardrobe, I was able to simply pull it out and seamlessly continue using the pump I know and love.

Obviously, the other part of the backup plan is having an in-warranty pump. One of the best things about distributor AMSL Diabetes is that I can call them any time of the day or night and speak to someone local – and within the space of a few days I’ve already got a replacement pump in my hands.

Of course, if that failed, I did have some long acting insulin in the fridge, as well as friends who I know would be able to help me out with a spare pump if I needed it.

I often find myself thinking about how I would manage my diabetes should the unexpected happen, but I never really think that I’ll need to.

I guess that’s what’s backup plans are for.