Diabetes Game Plan: 2016 Edition

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New year, new me.

Kidding! Don’t even get me started on those Facebook statuses…

Ever since I’ve had diabetes, my New Year’s resolution has obviously centred around (wait for it) diabetes. Eat well, get my blood sugar levels down, maintain a good hba1c result without too many hypos and exercise. Scrap that last one, who the hell am I kidding here!

If I’m being honest here, I feel that for the better part of the last five years, my diabetes management has sort of stayed the same. I’ve chalked up good hba1c results, but they’re extremely difficult to sustain inbetween endo visits. Making a dedicated effort that delivers those sustained results is also hard, especially when there are a million other things going on in life.

But I want to do better than okay with my diabetes. I’ve already been at it for five, going on six years. That fraction of my life with diabetes is slowly, but surely growing. I want to look after myself. I want to minimise my risk of future complications. I want to remain hypo aware. I want to remain independent, and in control of my diabetes. I want to live a long, and healthy life.

So instead of that overall improvement this year, I’m going to strive for stable overnight glucose levels.

Night times over the past few months have never been such hard work. I can’t remember the last night where I didn’t have to wake up at 1am, test and give a correction shot. My last full night’s sleep seems like a lifetime ago. And mornings where I have woken up in range without minimal effort overnight have been rare occurrences.

I also know that it’s been a long time since I’ve had a full, uninterrupted night’s sleep. It’s been a long time since I’ve woken up feeling refreshed. It’s been a long time since I’ve woken up feeling pleased with my morning number, and have that sentiment echo positively throughout my day.

So, perhaps this is an argument in favour of switching to the pump. However, until that decision is made next month, I still need to manage with Multiple Daily Injections.

So, in 2016, I’m making a resolution to focus on the back end of the day. Say, from 4pm to 10pm – the 6 hour window before I go to sleep for the night. In these 6 hours, I will focus on doing as much as I can to not spoil my overnight glucose levels. Staying away from high fat foods. Satisfying my desire to graze on junk food with something healthy. Being patient when testing and correcting after dinner.

I know that I can do this.

I hope that I will eventually return to a point where I have some confidence that my overnight glucose levels will remain stable.

I hope that I will be able to return to a point of getting a full, uninterrupted night’s sleep more often.

I hope that if I can get those overnight levels within range, I will have one third of a stellar a1c result up my sleeve and a lot more enthusiasm in my mornings.

Defeated In The Darkness

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I could feel the sweat dripping from my forehead. My favourite red checkered cotton pyjama pants were stuck to my thighs, drenched in sweat. My entire upper body was trembling. I felt like I’d woken up from a bad dream that still felt very real in the dark of my bedroom. I pulled off my blankets, which I usually hid underneath to stop myself from freezing in the air conditioning.

The red numbers 12.40 were glowing back at me in the dark of my bedroom early on this Thursday morning. I reached over to flick on the lamp beside my bed. I pulled back the cap on my tube of test strips, grabbed one and feverishly stuck it into my meter. I pricked my finger and navigated it over to the test strip. 2.1 mmol/L. Just the number I wanted to see at 12.40am on a Thursday morning.

I heaved myself up to reach for the bag of marshmallows on the bed head behind me. Too weak to support this upright state, I leant over to one side. My elbow rested on my pillow, supporting my upper body weight. Marshmallows were in hand.

I opened the zip lock bag and pulled the marshmallows, stuck together from the heat, apart. One, two, three, four, five. I mentally counted to myself as I placed them into my hand, knowing my hypo-muddled brain would lose count of how many I’d eaten midway through.

By the time I was down to that last one, I couldn’t even remember eating the other four. I collapsed back onto the bed, relieved as my head sank back onto the pillow. I felt absolutely exhausted, and too weak to move. I reached over for the remote to the air-con, dialling the temperature down a few degrees. I so badly wanted to close my eyes, but knew I had to stay awake and see this hypo through. I turned and faced my bedside lamp, hoping the bright light would keep my weary eyes distracted.

I’ve always felt very in control of my diabetes. Throughout the day, I’ll test as often as I want. Those tests produce numbers. Numbers that give me a sense of security. Numbers that keep me in the know while I’m riding the wave of an unpredictable disease.

But when night comes and my body switches off, I’m forced to give up all control.

Laying there in that moment, paralysed in front of the lamp, I couldn’t help but feel a little defeated by my diabetes.

I roused again at 2.24am, having dozed off in front of the lamp. I switched it off, rolled over and closed my eyes with a sigh of relief.

(And I’m only now realising why my shoulders were aching the following day!)

“How’s It All Going? Are You Managing It Alright?”

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“Could I talk to you for a minute?”

“Sure.”

“Let’s go over to the desk.”

“I’m going to see my diabetes specialist on the 3rd of February in the afternoon. I wanted to work until 12 and then take the rest of the day as sick leave. I’ve got a letter underneath my form here to say where I’ll be.”

I stood there, waiting. Confident that she would sign my leave form. Sub consciously thinking that this is the second time that I’ve requested leave for my diabetes since November. Knowing that she was pretty understanding. But still half expecting a comment. (And no, this was not the person who told me I Should Be Making My Appointments Outside of Work Hours).

“How’s it all going?”

“What?” I replied, stunned, and a little bit lost for words.

“Are you managing it alright?”

“Um. Yeah, okay, I guess. I can only do the best I can, I suppose. I’ve got the type of diabetes that isn’t caused from being unhealthy.”

“I know. It’s just that your insulin’s not there. My friend has a hard time with it, too.”

“It’s hard. But I’ve only had it for a couple of years. I’m lucky that I got it when I was 17. Some kids get it from a very young age.”

“Yeah, she got it when she was an adult, too.”

“I can only do the best I can” I repeated, almost trying to convince myself of that fact, rather than her.

“Cool. I’ll sign it and payroll can put it through for you.”

Sometimes people can surprise you. That little conversation was enough to make an ordinary day brighter. It’s never a simple question to answer, but it was enough to help me to remember why I do what I do.

Happy Monday!

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.

My Festive Season In 7 Adjectives

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I don’t particularly believe in “rules” or “secret plans” when it comes to diabetes and the festive season. I don’t “prepare” my diabetes management for big events. For me it’s simply about good food, lots of insulin and regular blood glucose testing. After all, it’s only a few days of the year, and I feel better that I’m not missing out on anything because of diabetes. Well, except for the finger pricks, insulin injections and the part where I have to think about those things…

In 7 adjectives, my festive season looked something like this.

No Breakfast. I have breakfast almost every day, and yet I don’t remember having it once inbetween Christmas and New Year. I was eating way too much at lunch and dinner (and desert afterwards, of course!), that I simply wasn’t hungry when morning came around. Correction: breakfast consisted of iced coffee, biscuits, and even leftover desert on one or two occasions.

Lazy. According to the Health App on my iPhone (which isn’t accurate because I don’t always have my phone in my pocket), my average daily step count over the 4 day Christmas long weekend was 1,290 steps. On a normal working day, I would average between 15,000 to 20,000 steps. Lazy.

Night Owl. I can’t remember a single night during the break where I didn’t go to bed after midnight, and wake up after 9am. Which is a stark contrast to my very regimented 10pm bedtime and 5.50am morning alarm (thanks, work!).

Single Digits. According to my meter, my average blood glucose level over the 108 finger pricks in the past fortnight is 9.7. Single digits during Christmas – I’ll take that as a win!

Non-Existent Hypos. I can’t be bothered scrolling through my meter for concrete evidence, but hypos were almost non-existent during the break. This was, of course, because my blood sugar levels were running higher than normal thanks to festive activity! Correction: there was one nasty night of hypos at the movies, story coming soon.

More Insulin. That’s a given, considering what I’ve just described. I’m also a firm believer in upping my Lantus dose when I’m eating more than normal. My Lantus dose hovered between 14-18 units during the break. When I’m active and eating well, it normally sits at around 11 units. Considering I’ve had to use more than 20 units during previous festive seasons, I’ll take this as another win!

Food. And lots of it. From Christmas Day, New Years Day, and various family gatherings. There was prawn skewers, stuffed chicken thighs wrapped in prosciutto, cannelloni, mediterranean baked snapper, pasta bake, roasted veggies, cannoli, biscotti, cheesecake, trifle, panettone, glazed pudding and Baileys Irish Cream. And chocolate. Lots and lots of chocolate.

There was also time spent at the beach, trips to the shops, walks with our adopted dog who was staying with us, a night at the movies and multiple episodes of Downton Abbey and Mr Bean.

 

In a nutshell, it was a break.

I hope you had a great festive season.