Multiple Daily Injections

Reviewing The Numbers

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I’m due to see my endo next week, and have a long overdue hba1c test.

I don’t feel that my diabetes management has been too great over these last six months. It’s just so much hard work to stick with a consistent regime that seems to produce those good results on Multiple Daily Injections. I’ve been waking myself up almost every night over these past few months to make sure that I won’t wake up out of range in the morning. There’s also been times where I’ve felt like a complete failure because my hard work doesn’t produce the results that I expect.

I’ve purposely avoided opportunities to get my a1c tested over the past six months, because I knew the result would be disappointing. “I know that my a1c has gone up. It’s gotta be half a point higher, at least,” I’ve told myself over and over. 

I’ve been working extra hard at my diabetes since the turn of the new year. Partly because this upcoming appointment has been on my mind, and partly because I am genuinely aiming for long term stability in 2016.

One handy tool I’ve been using is my FreeStyle Insulinx Meter. Gwen gave me this meter in November when I talked to her about insulin pumping. Apparently all newbies in clinics get one these days. It replaces a logbook, meaning that frantically filling in empty pages before an appointment is no more. There’s also no way to forge the numbers, either… If you know how to carb count, it can calculate your insulin dose,mtaking into account any active insulin still on board and corrections. I also love that the test strips are capped, rather than individually wrapped, allowing for quicker access and less mess. The blood sample is heaps smaller, too.

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By far, my favourite thing about this meter is it’s reporting function. Every week I’ve been plugging it into my computer and reviewing the numbers, and the trends. There’s about 6 or 7 different reports you can create, taking into account a week, a month or any other custom range of data. And week by week, I do feel as though I am seeing improvements.

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This is my last 7 days of data. The blue bar is my target threshold, set to 4.0-7.9 mmol/L, and the black line is my average glucose levels throughout the day from morning (left) to evening (right).

I’ve never really been one to sit and review my numbers. I’ve never owned a piece of diabetes technology, and I could never be bothered to write my levels down before that. But numbers are in my head all the time. I deal with them 24/7. They consume me, sometimes. But taking a good, hard look at these numbers lately, I realise that they aren’t as bad as I work them up to be in my head.

I’m waking up in range, which is what I’ve been striving for. Hypos are happening 2-4 times a week which I’m pretty happy with, considering they were quite consuming a year ago. There’s a rise in the afternoon and a surge in the evening, but that’s mostly because I’m home and have more time to pedantically test after meals! And my average is 8.4 mmol/L, without having too many hypos.

Sure, I still have a long way to go in my goal of keeping this effort up in the long run and further improving. But looking at these numbers, I realise that I’m off to a decent start for 2016. I’m ready for whatever hba1c result faces me on Wednesday.

Tennis, With a Serve of Diabetes

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By far, my favourite thing about January is the tennis.

Two weeks ago I went to the Hopman Cup in Perth, one of the tennis tournaments traditionally held in the lead up to the Australian Open this week.

Having seen Andy Murray last year, there wasn’t a doubt in my mind as to who I wanted to see this year – Serena Williams. I was so damn excited to see her play. She is just such an entertaining player to watch. I love her expression and her attitude, which she doesn’t try to hide. I love seeing her come onto the court with a bandage on her leg, seemingly injured, and yet still thrash her opponent. And I love watching her talk down her performance after a killer win.

Needless to say, I was so damn excited to see her play that night.

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When I arrived home after work that day, my blood sugar was 10.4. Which was okay, considering I’d only had my lunch 2 hours ago.

I wasn’t particularly hungry, but I knew I’d be hungry later. Wanting to avoid junk food after all of my festive eating, I packed myself a Burgen Bread sandwich of leftover cutlets from the night before. Even though the Arena had a strict no food policy, I was pretty confident I’d be able to sneak it in. But hey, I could always milk my diabetes for all it was worth, if I had to.

I was still 10.4 as we were getting ready to leave, and I gave myself a generous correction of 2 units.

When we parked the car at the Arena, I dialled up my Lantus dose. It was a little earlier than normal, and I knew that I’d have an hour or so of overlapping insulin. But it would save me the hassle of doing it while I was in there. I knew that the game would be a long one, and I’d likely be eating less than I would at home. I dialled up 10 units, rather than the 11 or 12 that I gave the night prior, and left my pen in the glovebox.

Going past security was a piece of cake. I managed to sneak my sandwich and water bottle through, hidden safely underneath the pile of jackets. Apparently water must be uncapped, in case we decide to launch the cap (rather than the empty bottle) at the court.

Serena came onto court, and it was so damn exciting to see her. She had pulled out of her match the previous day as a precaution, and I was so worried that I wouldn’t get to see her play.

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Unfortunately after the first set, she had to forfeit the match as a precaution for her inflamed knee. It was disappointing, but an hour was still better than no Serena at all.

I was ready to eat that sandwich, and tested my blood sugar. 5.7. I finished it, and quickly went off to the bathroom to bolus 5 units before Lleyton Hewitt came out to play in the Men’s match.

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That night, I was trying so hard to be good. I turned down lollies. I turned down hot chips. I turned down more lollies. Until 8.32pm, when I went hypo.

Not exactly my ideal, carb counted hypo treatment, I really had to give it my best guess. I measured out a handful of lollies into my palm, and began to chew them down. Still feeling shaky and in doubt a few minutes later, I grabbed another handful.

When I headed back to the car at the end of a great night, I was a lovely 19.0. Insert your swear word of choice here.

I had tried so hard to be good that night, and yet one small error with the bolus for my sandwich mucked it up. Yeah, I was bloody annoyed with myself. But it happens. It’s always going to happen, because I’m only human.

But at the end of the day, it’s not the hypo that I’m going to remember about that night.

I’m going to remember one awesome night of tennis that I got to watch.

May The Force of Low Blood Sugars Be With You

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Because I was on holidays, because the fridge was empty and because I’d been wanting one for several weeks, I had a Subway footlong Italian BMT sub for lunch last Wednesday. I dialled up 18 units of insulin, and I was rather pleased with the way the results were tracking in the hours that followed. I was 14.1 at 2.18pm, 8.7 at 3.09pm, 5.7 at 4.04pm and 7.6 at 5.15pm.

At the time of that last test result, I was getting ready to go and see Star Wars. Still feeling full from that Subway, I figured that I would skip dinner (sorry, Mum!). I gave my Lantus dose an hour and a half earlier than normal, and headed out the door. I parked the car at 5.59pm, and a quick test showed I was 5.1. I knew straight away that I was on a downward trend. Definitely a combination of overlapping Lantus doses and skipping dinner that night. Which I should have anticipated, given this just happened a few weeks ago.

We walked in, bought our tickets, and went to sit down in the theatre. I knew that I was hypo, and that I would need some sugar to last me through the movie. For a lack of personal space in the theatre (brother on my left, stranger on the right), I decided to go and test outside. I leaned over to my brother and asked him for my ticket.

A quick test outside the theatre confirmed that I was a borderline hypo 4.0. I headed over to the candy bar, where thankfully, the line was empty.

“Do you have any juice in the fridge?” I asked the attendant, squinting at the drinks fridge behind the counter. I returned to the theatre with a very overpriced bottle of orange juice, noting the 34g of carbs on the label.

I sat back in my seat, reluctant for a few moments to open that bottle of juice in front of the two people I was with who I hadn’t brought anything for. I decided I could excuse myself later, and skulled two thirds of the bottle.

Thankfully the guy on my right had moved down 2 seats, giving me some personal space to test again 15 minutes later. By this point, it was dark. I was relying on the bright scenes on screen in order to see what I was doing. My meter backlight told me I was 2.9, and I quickly skulled the rest of my juice.

Another 15 minutes later I was 7.4, and at last I could finally focus on the movie.

While the force of low blood sugar levels were with me that night, I was pretty proud of how I handled the situation. One year ago, I would have sat that hypo out in the theatre until I truly felt those low symptoms coming on. 

Today, I have the confidence to attend to a hypo in public right away.

Three Hypos in One Night

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It was a cool, breezy Summer evening. That perfect kind of early Summer weather that never seems to last long enough.

We’d had a barbecue lunch that day. Steak, sausages, eggs, onion, salad and cherries. The kind of lunch that left me feeling like it was Christmas Day – stuffed, sleepy and happy.

I wasn’t particularly hungry by dinner time. I wanted to make sure that my blood sugar levels had stabilised before bedtime after that barbecue, and I didn’t want to spoil my appetite for breakfast the next morning. I had some leftover salad and cherries, and gave myself a small correction dose.

14 units of Lantus is what had been keeping me stable those past few nights. 14 units. I figured with that big barbecue lunch, 14 units would do the trick once again.

I sat down outside with my laptop after dinner, catching up on some of my dBlog reading. I started browsing for Christmas gift ideas a little later on, but somehow ended up comparing prices of items on my own Christmas want list.

My blood sugar levels were looking good during the course of that night, clocking in at 7.1 and 6.2. I had the best of intentions to settle in for an early night before the start of another working week. Little did I know, however, that my diabetes had other intentions.

I was 3.8 at 9.18pm. I figured that the majority of my rapid acting insulin had worn off. I thought 3 marshmallows would do the trick, but I gave 4 just to be safe. 20g of carbs, because I was about to go to sleep. I laid in bed, surfing on my phone for a while longer, until it was nearing 10pm. I was a perfect 7.6, but I was convinced that I’d given myself too much for that hypo. I set the alarm for midnight, ready to catch a rebound high in it’s tracks.

That was hypo number one.

I woke up a while later, and my pyjama pants were sticking to the sweat on my thighs. I knew that I didn’t need to test, but I needed to know how low I was. 3.2. I reached for the bag of Marshmallows beside my bed, carefully counting them out in my hand so my hypo induced brain wouldn’t forget how many I’d eaten. One, two, three, four, five. I shoved the 25g of carbs into my mouth and rested my head back on the pillow, feeling instant relief.

I finally noticed that it was 11.53pm, and switched off the midnight alarm on my phone. By this point, I figured that I’d given myself more Lantus than I needed. By this point, I knew that there wouldn’t be any rebound highs to catch that night. By this point, I realised that these hypos were a consequence of skipping dinner. I switched out the light, and went to sleep.

That was hypo number two.

By 4.30am, I was startled awake by my favourite sound in the world. I felt shaky once again. I wasn’t sure if it was another hypo, or if I didn’t have enough blankets on the bed. My meter confirmed that it was the former, clocking in at a very hypo 3.4.

I shuffled into the kitchen, my mouth tasting of dry sugar, and prepared myself the most refreshing thing I could think of. A bowl of Weet Bix, a sliced banana and lots of cold milk.

As I sat there relishing the cold, refreshing milk on my dry throat, I thought about what a great start to a Monday morning it had been.

That was hypo number three.

Revisiting Gwen

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I know that the decision to switch to an insulin pump is not something that I should take lightly. I’ve been deliberating the matter for a while. I wrote about it earlier this week here. I also recently went to see my diabetes educator, Gwen, for some advice.

Gwen is a truly amazing person. You can read about just how amazing she is right here. Gwen’s stated goal was to arm me with the knowledge and skills to manage my diabetes, so that her position as my educator would eventually become redundant. And it sure did. The last time I had a session with Gwen was back in 2010, towards the end of my first year living with diabetes.

I knew that Gwen was always available to me outside of appointments if need be. I had her phone number, e-mail address, and I can even remember her squeezing me in once during her lunch break when I was anxious about too many hypos. I can remember giving Gwen a box of chocolates on the first Christmas after my diagnosis, because she had just been so wonderful during that first year of diabetes. I’ve seen her a few times in passing at the clinic when I go to see my endocrinologist. However, since transitioning from the ‘young adult’ to ‘adult’ diabetes clinic, I’ve seen her less frequently.

I was extremely nervous to go back and see Gwen a few weeks ago, after such a long time. In the car on the way there, I was reciting over and over in my head what I would say to her. Would she take what I needed to say seriously? Would she be supportive of insulin pump therapy? Would I talk to her about my blog, and my involvement in the Diabetes Online Community this year? Would she even remember me?

But walking into her office that day, my nerves were instantly settled. As she began reviewing our last session five years ago, she was so thorough. As she talked through the results of my last endo appointment and hba1c result, she was so familiar and so well prepared for me. As her patient, it felt as though that last session five years ago could have taken place just yesterday.

So, Gwen’s verdict on pumping, in a nutshell?

A pump is a big commitment.

Pumping is not any “easier” than Multiple Daily Injections.

However, a pump can give me more “flexibility.” A pump delivers insulin constantly in order to regulate glucose levels, as opposed to injections which are given at set times of the day. The rate at which a pump delivers insulin can be adjusted throughout the day to factor in activities such as work, physical activity and sleep. The units of insulin delivery on pumps are so precise that you can bolus for something as small as the milk in your coffee!

There are also a few requirements for pumping in Australia.

First up, I must have an appropriate level of Private Health Insurance for a period of at least 12 months, in order for the cost of a pump to be covered. Big tick there.

Second up, I need to show that I qualify for a pump. Translation: I have type 1 diabetes and I’m a good student who will show up to my education sessions. Big tick there.

Third up, a pre education session with Gwen (big tick there), where paperwork is completed and passed onto my endo for sign off (not quite there, yet).

Finally, pump fitting day followed by 3-4 daily sessions with Gwen in order to fine tune the pump. Sadly, there’s a 3 month waiting list at my diabetes clinic for this.

I’m really glad that I did go and get another perspective from Gwen that day. Gwen was plain thorough. She discussed the matter with the seriousness that it deserved, without trying to sway my decision either way.

So, as the session came to an end, I sensibly decided that I would go home and think about it, and come back in the New Year for another check in. Class dismissed!