Glucose Monitoring

Dawn Phenomenon, Spring Style.

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My levels have been a bit of a mess over the past couple of weeks.

A few weeks ago, I began to notice my blood sugar levels slowly but steadily rising through the night. I found myself waking up to blood sugars of 8 or 9 at around 2am and giving a correction, only to find it had little effect by the time morning rolled around.

After I had ruled out any after effects of afternoon snacking or evening meals, I began increasing my overnight basal rates until I had curbed that steady rise.

But I still hadn’t quite managed to clean up the spill.

To add to my woes, the FreeStyle Libre sensor I’m wearing at the moment to fine tune those rates has been producing long flat red lines through the night – the kind of ‘LO’ readings that make me a walking talking miracle. Thankfully, multiple finger prick readings quickly confirmed that Libre is at fault, and not me.

I’m usually quite tuned into carb counting, protein and how I bolus for my meals when I’m on my feet at work. Yet morning after morning, I would bolus for my breakfast and find my blood sugar spiking into the teens. Those highs would carry through into my morning tea and lunch.

Eating is something that I can’t really afford to be skipping at the moment. I’m working on packing more into my meals to fuel my active days so that I don’t feel so dreadfully exhausted and limping into bed at night. I’m a better person for it.

As I was setting up the basal profiles on my brand new tslim over the weekend, a mental lightbulb flicked on in my head.

If I had increased my basal rates through the night to cover my dawn phenomenon, why hadn’t I increased them to cover my insulin resistance the moment I wake up?

I have been tinkering my overnight basal rates back and forth since I began pumping insulin two and a half years ago.

I have a theory that the lighter mornings during Spring and Summer enhance that insulin resistance in the wee hours of the morning, compared to the darker days of autumn and winter.

After upping my waking basal rates by 25%, in line with what I had done through the night, I’m hoping I have a better week in store for me.

Review: FreeStyle Insulinx Blood Glucose Meter

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This week, I’m on a mission to deplete my remaining supply of FreeStyle Lite test strips. My calculations tell me that they should be depleted by early Thursday. The one piece of motivation that’s getting me through these final days is the mental promise of a new FreeStyle Libre sensor at the end of it. As part of this final hurrah, I thought I’d take the opportunity to celebrate the ‘life’ of my FreeStyle Insulinx meter over the past two and a half years.

I was first given an Insulinx back in 2015 after I had reconnected with my diabetes educator to discuss insulin pumping. This was a meter with a built in bolus calculator that would help me to become familiar with counting carbohydrates, which is what I’d eventually have to do on an insulin pump.

I had been using the same blood glucose meter since the day I was diagnosed. I didn’t know too much about diabetes back then, or some of the more ‘modern’ options that were on the market. Or the fact that ‘free’ meters were so easy to come across, because companies actually make money from the test strips!

The Insulinx was my first ‘modern’ glucose meter. I loved the test strips that were conveniently stored in capped vials, rather than being wrapped in foil. The USB cable, which meant that I was able to upload the data to my computer for review. There was a backlight for testing in the dark. It also used a much smaller sample of blood, and gave you an additional 60 seconds to apply more blood. No more annoying strip fill errors!

As much as I welcomed these modern features, I didn’t really make much use of the bolus calculator function. Mostly because I wasn’t motivated to count carbs and log insulin doses at the time.

Fast forward to today where I’ve tried many more meters and am generally more switched on to what my blood glucose levels are doing, the FreeStyle Insulinx simply does not meet my needs anymore.

The ‘Lite’ test strips may require a smaller sample of blood (0.3uL), however I feel that it’s easier for any sweat or moisture on my fingers to affect the blood glucose reading. I’ve been trying to combat this by extracting a larger drop of blood from my finger and making more of an effort to wash my hands prior to testing. I also don’t like not being able to physically ‘see’ the blood going onto the strip like other meters do.

The bolus calculator on the Insulinx isn’t as comprehensive as the one you might find on a pump or smartphone apps such as RapidCalc. Little things like being able to adjust carb ratios while I’m on my feet at work are a big deal for me. During pump breaks and even while using the YpsoPump, I haven’t even considered the bolus calculator that’s contained inside my Insulinx.

All of these gripes aside, I simply haven’t found the results to be as consistent or as trustworthy as my AccuChek Guide. Just last week I had something like a 12.7, a 10.1 and then an 11.6 in a row with clean fingers. Alternatively my AccuChek Guide has chalked up impressive consistency, even when throwing some grubby work fingers into the mix!

Due to its bolus calculating capabilities, the FreeStyle Insulinx is only available from a healthcare professional. If you’re using a FreeStyle Libre, the same bolus calculator is also built into the reader. Just make sure to ask for the code to unlock the bolus calculator.

I’m mindful that I’m a huge adopter of diabetes technology. Perhaps that’s why I’ve gravitated towards wireless systems such as Contour Next One or AccuChek Guide that will sync readings to my iPhone via Bluetooth for instant review.

For people who do want something simple and may not have the latest whiz-bang smartphone, this could be the perfect option for you.

AccuChek, MySugr and Eversense at the Diabetes Congress

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At the Diabetes Congress last month, I had the pleasure of reconnecting with the team at Roche Diabetes Care, whose stand had turned a noticeable shade of green. But more on that in a moment…

The AccuChek Guide is currently my blood glucose meter of choice, and for good reason. Not only is it a meter that I can trust, but it’s also a modern one that’s designed for the 21st century. One of my favourite features is its Bluetooth, which wirelessly transmits blood glucose readings to the Accu Chek Connect smartphone app for instant review.

My biggest gripe about most diabetes smartphone apps are their lack of bolus calculators. I can personally see no benefit in logging things like insulin doses or carbohydrates without the essential ingredient that delivers value to me: a bolus calculator.

Despite using an insulin pump, I have found myself in need of a good bolus calculator several times over the past two and a half years. I’ve taken three breaks from my insulin pump during that time, in addition to also using the YpsoPump which does not have a built in bolus calculator itself.

The bolus calculator contained within the AccuChek Connect app has been disabled for over 18 months now, due to a bug that was over estimating insulin doses. I’ve put out calls for help on Twitter and Googled in search of any hacks with very little luck. I’ve been waiting patiently for an update that is yet to surface.

While the Connect app is still available to use, I was told that there are no plans to resurrect the bolus calculator anytime soon, with Roche now focussing their efforts on MySugr.

MySugr is basically a diabetes logbook app with the aim of ‘making diabetes suck less.’ Hence all the green in the stand. I have not personally used it, but I do hear it is quite fun and motivating to use.

The AccuChek Guide will wirelessly transmit blood glucose readings into the MySugr app. I was also pleased to hear that an extension of a bolus calculator to the app is awaiting regulatory approval. Fingers crossed!

Despite Roche’s exit from the insulin pump market in the US last year, AccuChek insulin pumps are still being manufactured in Europe and I have still been reading headlines about new developments in the pipeline. Roche insulin pumps don’t appear to be a popular choice among Aussies, and I did wonder if the lack of insulin pumps on display was a reflection of this or a lack of confidence in their product. Or perhaps I simply didn’t see the pumps on display…

More excitingly, I have heard that Roche has plans in the pipeline to distribute the Eversense implantable CGM system in Australia. I don’t know much more than this, and the system will of course need to receive regulatory approval first. You can have a read of this guest blogger’s review from Europe over at Diabetes Strong.

While Roche may not be the most well known for insulin pumping or CGM systems, they are clearly leading the way in blood glucose monitoring. Given that most people manage their diabetes using standard blood glucose monitoring, that’s not exactly a bad thing.

More enhancements and innovations that will support people in their chosen therapy is always a good thing.

And a cool new coffee mug. Because more excuses for coffee is also a good thing.

Disclosure: Diabetes Australia covered my travel, accommodation and registration costs to attend the Australasian Diabetes Congress. These are my own views, and not those of Diabetes Australia. My time, including the annual leave I took from work to attend, was my own. 

The Diabetes Social Media Summit

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On the Tuesday prior to the Australasian Diabetes Congress, I was lucky enough to be a part of the Oz Diabetes Social Media Summit. Brought together by a company called Ascensia Diabetes Care, the afternoon brought together a group of Aussie diabetes bloggers in Adelaide. You can also check out Renza’s recap of the Summit at Diabetogenic, and also search for #OzDSMS on Twitter to see what was Tweeted through the day.

Prior to being invited to this event, I honestly didn’t know a lot about Ascensia. I knew that these guys were connected to the Contour blood glucose meters many Medtronic insulin pumpers use. The ones that wirelessly Bluetooth blood glucose readings to the pump.

I’ve also seen Ascensia pop up on Twitter over the past couple of months, and much to their credit it is a handle that I would actually want to follow. Their feed is definitely one of those ones that genuinely wants to be a part of the diabetes community, rather than constantly spruiking company culture. I genuinely got the same feel from the team who were present with us in the room (and I’m not just saying that because they supplied a coffee machine!).

Ascensia were formed from the sale of the Bayer Diabetes Care business, and their point of difference is that they’re only focussed on diabetes. Part of the reason for our convention was the launch of their Contour Next One wireless blood glucose meter, which apparently boasts the greatest level of accuracy on the market. Bionic Wookiee David Burren has written more about the meter here.

In a room full of privilege, it was really good to hear standard blood glucose monitoring being given the emphasis it deserved. CDE Cheryl Steele from Victoria presented to us on the importance of having an accurate device to calibrate a CGM, and Bionic Wookiee David is living proof of a backup plan!

Grumpy Pumper hit the nail on the head in highlighting that the majority of people with diabetes actually manage with blood glucose monitors and insulin pens. I still manage on finger pricks for about 50% of the time, and I certainly welcome innovation in blood glucose monitoring as well.

I was happy to hear Ascensia’s vision for interconnected diabetes management, rather than pushing one line or avenue of products. We were told that their aim is to be a calibration partner of choice for insulin pump and CGM systems, as well as having formed partnerships with several data management platforms such as Diasend. All of this gives us more choice in the technologies that we may wish to use around our blood glucose meter. More choice for people with diabetes is always a good thing.

During the afternoon, we also heard from special guest Grumpy Pumper from the UK. Despite the persona he portrays online, Grumps is honestly a really genuine guy. Diagnosed in 1994 with no internet or social media, Grumps was doing the best he could with the limited information he had at the time. His sentiments definitely resonated with me and others in the room, which really says something about how many people with diabetes there are still being left in the dark today.

Grumps also shared with us his movement around encouraging other people with diabetes to talk about diabetes complications. It started with a foot infection and a simple Tweet expressing that he wasn’t ashamed of his diabetes complications, assuming that he wasn’t the only one who had them. He has inspired people to open up about their diabetes complications through a hugely popular series of guest posts on his blog.

To be honest, I was a little quieter than normal during this event. Usually, you can just tell that I want to say something by reading the look on my face. But these conversations were bigger than issues we’ve tackled at previous diabetes events. There were questions left unanswered that I honestly don’t know how to tackle.

I am a really, really privileged person. I don’t represent all people with diabetes. If I’m being honest, I’ve been struggling lately with the idea that perhaps I’m not as ‘identifiable’ as I once was because of the privilege I have.

How do we get the level of engagement that was in that room at OzDSMS, outside the room? How do we make sure that every person with diabetes knows about all of the options available to them in managing their diabetes? As Grumps put it, how many people will actually know that there’s a new blood glucose meter on the market today?

Disclosures: Ascensia Diabetes Care hosted me at the Adelaide Convention Centre, before migrating us to Adelaide Oval for dinner, on the Tuesday prior to the Australasian Diabetes Congress. I was already in Adelaide as a guest of Diabetes Australia.

I was fed and watered across the duration of the afternoon and evening. I also received a goodie bag containing a Contour Next One meter, test strips, information packets and lancets that will likely last me a lifetime.

There was no expectation that I would blog about the event. My opinions and my time, including the annual leave I took from work to attend, are my own.

Do Your Insulin Needs Increase During Winter?

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I could feel my blood boiling.

With every single swipe of my FreeStyle Libre reader against the sensor on my arm, I felt increasingly frustrated.

Despite being pretty confident in what I’d eaten and covered with insulin for dinner, my levels dipped slightly before slowly but steadily ascending once again. A pattern that had become somewhat typical over the past couple of weeks following meals.

Despite correction after correction, my blood sugar levels were yet to budge.

My mind wandered back to the pump break I had taken in late April and May. I thought about how easy blood sugar levels had been to manage with pens and needles. How free my mind had been from frustration.

That pump complacency I felt on the night I disconnected my pump in late April had returned. I didn’t want to be feeling it, but it was there, plaguing my thoughts against my own will.

Then, I just had this sort of ‘epiphany.’

I set a temporary basal rate increase of 10% on my insulin pump, hoping that it would help my correction doses to start working better.

When my insulin still seemed ‘sluggish’ a few hours before bed, I increased it to 20%. After a few more days had passed, I went into my pump settings and permanently adjusted the basal rates upwards by 20%.

I’ve heard it discussed before in the diabetes community. I’ll be the first to admit that I never brought into the whole concept of insulin needs increasing during the Winter. And decreasing during the Summer, for that matter.

I don’t know what causes it. There’s been no significant change in my activity levels. I’m very active during my work day as usual, and don’t go anywhere near the gym or a pair of running shoes when I’m at home. My routine is the same. Admittedly, I probably spend less time outdoors or in the sunlight at the moment. Maybe there’s an increased inclination to drink coffee, eat cannoli and watch Australian Survivor.

More than anything, I think it may be an environmental or physiological factor.

I’m just grateful that my insulin is working again and that I can spend more of my day in range, fighting less of an uphill battle in doing so.

After eight years, I’m still learning new things about my diabetes. I truly believe that the more time and experience I have under my belt, the better equipped I am to live with it.