Glucose Monitoring

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.

Replicating the Good Days

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At the moment, I’m trying to replicate days like these.

Rather than these.

I have whole weeks where my carb counting is spot on, insulin just ‘works’ and blood sugars are simply effortless to manage. There are less highs, and less lows. The stream of good blood sugars seem to have somewhat of a flow on effect, so long as I can keep the train on course.

Then there are the weeks where blood sugars simply do not want to co-operate with the maths. Blood sugars feel like a lot of effort to manage, because naturally the insulin doesn’t work as well when levels are out of range. The urge to rage bolus is real, ultimately leading to more lows, and more rebound highs. It feels much more difficult to get the train back onto the course, rather than simply keeping it on the course.

In the midst of trying to pinpoint things, this was yesterday’s discovery.

11.1 was the greeting that I received from my FreeStyle Libre sensor after breakfast yesterday. It’s not what I was expecting, given that I had woken up to a blood sugar of 6.2 and carb counted my eggs on toast and milky coffee.

I gave an additional unit of insulin, and decided against reducing my basal rate for a day on my feet at work until that stubborn high started to come down.

Normally, a one unit correction while ripping open pallets of bulky furniture would send me plummeting. Yesterday, I was lucky to nudge the top edge of my target range.

As I recalled the day prior, my blood sugar had also remained stubbornly in the 8s despite repeated corrections. After increasing my basal rate in the evening and avoiding every urge in my body to rage bolus, I slowly but surely landed back into range by bedtime. Only to find that the ascent had begun once again when I checked at 1am.

By this point, I knew what had happened. In fact, I was feeling like an idiot that I had not picked up on this sooner.

Perhaps not as terrible as the banana bread highs that spoiled insulin had given me last time, but spoiled enough to make my blood sugars noticeably more stubborn to manage than usual.

Tools and technologies are only as smart as the people using them.

By sharing some more bits of the daily grind here, I’m hoping to make myself a bit more accountable to replicate more of those good days.

Red Light.

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I glance at the watch on my wrist. I know that it will only take me a minute, but it’s 4 o’clock and I really want to get out of here already.

I make the trek outside, where my car is conveniently parked in its usual spot at the end closest to the centre door. It’s a longer walk in the morning, when I have to come in through the back entrance, but completely worth it at the end of the day.

I hop inside my car, and place my belongings on the vacant seat beside me. I know that it will only take me a minute, but I really just want to start making my way home where afternoon coffee is calling my name.

I place my keys in the ignition, lock my doors and wind down my windows. I reverse out of my spot and make my way out of the carpark, cutting through some of the quieter residential areas in order to avoid the pile up of traffic on my way out of the centre. I make one final right, which takes me back out onto the main road and in a far better position traffic wise.

Finally, I have what I’ve been waiting for as I begin to apply my brakes, slide my gears back into neutral and cars begin to bank up in front of me. A red light.

I only have a minute, but I know I can do it.

I dive into my bag, pull out my travel case and grab my meter, strips and lancing device. I quickly pop open the cap on my test strip vial and slide out a fresh strip, sticking it into my blood glucose meter. I prick my finger with the lancing device, and squeeze my fingertip. A little drop of blood appears on my fingertip, but I know its not enough. I squeeze again, harder, like I’m holding on tightly for dear life.

Part of me knows I don’t have enough blood, but the other hasty part of my brain watching the traffic light tells me I can do this. I bring the meter closer to my fingertip, and let the blood slide onto the end of the test strip.

A shrill BEEEEEEP! Sounds from my meter as a strip fill error appears on the screen. My absolute pet hate when it comes to living with diabetes.

I furiously rip out the useless test strip, pop open the cap on my vial of strips and slide out a new one. I stick it onto the end of my meter, shove my lancing device right up against the tip of my finger and prick again. This time, blood flows more freely. Satisfied, the test strip laps it up and decides to give me a blood glucose reading.

I quickly wipe the excess blood on my fingertip against the side of the test strip as the light changes to green and traffic begins to move. I fling everything on the passenger seat beside me, which I’ll clean up during the next red light.

Hypo in the Diabetes Clinic.

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“Are you still using the Animas?”

“Actually, I have the new YpsoPump.” I replied to the nurse, pulling it out of my pocket.

“Would you like to use your own lancet?”

“Good idea,” I replied, pulling it out of my pencil case and avoiding a bloodbath on my fingers.

“Oh, you’re 3.8,” the nurse said to me after I had applied some blood onto the test strip. “Have you got some hypo treatment on you?”

Before I was even given any time to answer, she had poured me a glass of sugary fluid to drink and handed it to me. Encouragingly, it was an appropriate sized amount that wouldn’t send me rebounding.

“Are you able to feel your hypos?”

“If it’s a steady 3.8, like this one, I feel fine. But if it were a 3.8 and dropping rapidly, I would.” She was lovely, and I didn’t feel that I was being judged.

Another nurse walked in, also wanting to have a look at my new YpsoPump. “Of course, you should treat your hypo first!” She exclaimed to me in a motherly way, after being reminded by nurse one that I was hypo.

“Are you sure I can’t get you some biscuits or anything?” the nurse asked me, as I made my way towards the door.

“No, I’ll be fine. The tea will probably bring me up as well,” I said as I grabbed the Styrofoam cup that I had been given in the hallway earlier.

I made my way back toward the end of the corridor, took a seat and buried my head into my iPhone, grateful for the warm drink on my sore throat. I wasn’t worried.

Some time later, the nurse returned. She hovered for a moment, but I didn’t really notice until she spoke.

“Frank, would you like to check your blood sugar again?”

Knowing it had been sufficiently treated, I had completely forgotten about my hypo. I pulled out my FreeStyle Libre, registering the 3.7. I wasn’t convinced that I needed anything further, and pulled out my meter.

“I’m happy to leave it,” I said, holding up my meter that was displaying a 4.4. “I don’t want to overtreat it, and the tea will probably bring me up a bit more as well.”

“Are you sure I can’t get you any biscuits or something?”

“No, I’m fine. Thank you.”

I get that this comes from a good place. A really good place.

Perhaps if hypos hadn’t interrupted many of my work days, bed times, socialising, housework, walks and errands over the years, I might just treat them with the same response as that nurse.

Hypos are not a scary thing, provided I know how to manage them. They are a part of living with diabetes, just like checking my blood sugar or injecting some insulin. Last year at the Roche Educator’s Day, I made a big point of stating that two hypos per week was an unrealistic expectation from my healthcare professionals. Moreso as my skills in managing blood sugars improved and I was spending more time in range.

I get that hypos are not good for me in the long run. I get that hypos can impair my cognitive function. I also get that hypos can be life threatening – and maybe I’m just lucky that I’ve never had one where I’ve needed help. Believe me, I don’t like having hypos anymore than a healthcare professional likes seeing them appear on a blood glucose meter.

However I feel it’s more important that I’m dosing insulin responsibly, checking my blood sugar often enough, travelling with glucose tabs on hand and am able to sufficiently treat a low.

Some healthcare professionals condemn people with diabetes for having too many lows, and this is where we need to reshape our attitudes toward hypos.

Making me feel any lesser for the number of hypos I have will only make it more difficult for me to share openly in front of a healthcare professional, ultimately jeopardising the provision of any support I may need.

FreeStyle LibreLink: First Impressions!

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I must admit that I couldn’t get too excited at the news of FreeStyle LibreLink hitting our shoes Down Under. However I was really blown away by the response to my vlog last week, which suggests that perhaps I am in the minority on this new smartphone app.

FreeStyle LibreLink is a smartphone app that can either complement or replace the fundamental role of a FreeStyle Libre reader. So if you are thinking about trialling or getting started with a FreeStyle Libre system, you will no longer need to invest in a $95 reader. I also thought that LibreLink may be advantageous to parents or loved ones, who could have their own access to the data provided they scan the sensor with their respective devices (devices don’t share data).

Abbott told us that while LibreLink was originally due in August, they have fast tracked the launch as a show of their commitment to get their technology into the hands of as many people as possible.

The FreeStyle Libre system utilises Near Field Communication (NFC) technology in order to scan the sensor and obtain a blood glucose reading. In order to use the FreeStyle LibreLink app, your phone must have these same NFC capabilities as the FreeStyle Libre system, and this is the reason for limitations on compatible phone models.

So, blame Apple. Or Samsung. Or whoever else you feel like blaming.

Apple users will need an iPhone 7 or higher, running on iOS 11 or higher. Android users will need a phone with NFC, running on Android 5.0 (Lollipop) or higher.

If you wish to use your reader in conjunction with the LibreLink app, you must activate a new FreeStyle Libre sensor with your reader, followed by the LibreLink app during the 60 minute warmup period. If you do not activate with both devices during the warmup period, then you will only be able to read data with the one device you activated with.

Why can LibreLink only be used with a new sensor, and not an existing one? I am told this is purely for security reasons, otherwise I could theoretically approach anyone wearing a sensor and scan it.

My loaner iPhone seemed to scan my FreeStyle Libre sensor just as well as my reader did. A reading is best taken by pointing the top end of your iPhone, where your ear rests, over the sensor.

One noteworthy feature is the text to voice, which will voice your blood glucose level and trend following a scan. This may prove useful when you’re in bed and don’t want to open your eyes, or if you’re wanting to interrupt someone else’s presentation and show off your reading of 6.6 and steady to the rest of the group (sorry, Kim!).

I also think that the app will be really valuable for accessing blood glucose reports without the need to upload to a computer. I must admit I can’t remember the last time I uploaded my pump or my meters to the computer. In the whole scope of managing diabetes, little tasks like these often slip and features like this really do make a big difference.

LibreLink does not have the capability to transmit blood glucose data to another device. Nor can data be shared between a phone and a reader. You know how you can click on that little forward button when browsing your iPhone to share a link or a photo? That’s basically how you can share things like screenshots or reports from inside the LibreLink app with others.

Everything else that you’re used to seeing in the reader is there, with a bit of an expanded view.

      

Also on the horizon is Libreview, a cloud based software designed as a companion to LibreLink that provides a way to share data with healthcare professionals.

I don’t have any plans to upgrade my old iPhone 6 anytime soon to use the LibreLink at home. I’m also not sure that I view carrying my Libre reader around as a hassle. Having my iPhone on me all the time can be equally distracting. Another reservation I have is the increased demand placed on my iPhone’s resources from the introduction of two new mobile apps in the space of a week (YpsoPump app and LibreLink).

That being said, I have definitely underestimated LibreLink. It’s fantastic that FreeStyle Libre users will have more ways to access and engage with their blood glucose data. More choice for people with diabetes is always a good thing.

The FreeStyle LibreLink app launches in Australia tomorrow, and is available as a free download from your Apple or Google Play store on a compatible device.

Disclosures: Abbott Diabetes Care covered my travel and accommodation costs to attend DX2Sydney. I was fed and watered across the duration of the event. I was also provided with a FreeStyle Libre sensor and a loaner phone if I wished to trial the FreeStyle LibreLink app during the event. There was no expectation that I would blog about anything covered at the event. My opinions and my time, including the annual leave I took from work to be there, are my own.