Taking a Plunge

The shimmering blue water slowly began to emerge as I made my way up the highway, perfectly contrasted and coordinated at the same time with the bright blue sky above.

I manoeuvred into the right turn lane and made my way into the carpark, which was almost deserted on a Thursday afternoon. I grabbed my blue and white AMSL drawstring bag containing a towel, bottle of sunscreen, a dry shirt and glucose tabs.

My insulin pump was clipped to the inside of the pocket in my swim shorts, still running as per normal. My blood sugar was 9.3 before I left home. With 2 units of insulin left to act from lunch and some protein in play, I felt fairly confident to let it ride.

My comfy brown thongs with blue and red striped cotton straps came off as I buried my feet in the soft, white sand. I made my way closer to the shore line and perched my bag in the sand, setting up ship.

I disconnected my pump from the infusion site on my stomach and wrapped it up in the beach towel in my bag, not overly worried about insulin spoiling on that breezy thirty degree day. I slapped a load of sunscreen over my pale skin, recalling sore throbbing red marks of sunburn that were a painful reminder of previous non-compliant days in the sun.

The gentle wind whipped through my hair and burst onto my face. I could feel the refreshingly cold water hit my toes as I began to wade my way into the water. The salty sea spray hit my face as the waves crashed over the water and the bottom half of my body became submerged underneath it.

With the top half of my body feeling the cold of the sea spray, I took a plunge beneath the water.

As the waves pushed their way over me, crashed and then receded, with the sun shining brightly over the clear blue sky, I wasn’t thinking about diabetes. I wasn’t thinking about work. I wasn’t thinking about life.

I was drifting there, savouring the moment.

It felt good.

In and Around the DOC of Late V

Hello, February! In amongst the long Sunny days and balmy nights, there’s been a few things that have crossed my radar of late. So grab a coffee and settle in!

I’ve noticed a lot of conflicting information circulating in Facebook groups recently surrounding the new Cellnovo insulin pump being withdrawn from the Australian market, with suggestions that the parafin wax was unable to withstand the Australian Summer heat.

With no official communication from either Cellnovo or the NDSS, I can only assume that the product has not actually been recalled, but rather just that new Cellnovo units are no longer for sale. I have since learned that an upgraded Cellnovo system is expected in the next month, which will be swapped out with all existing Cellnovo units before becoming available to new customers on the waiting list.

Speaking of pump choice, there’s been a lot of speculation about AMSL Diabetes acquiring a new pump to distribute following the demise of Animas. While Tandem’s t-slim touch screen insulin pump with Dexcom integration would feel like a natural successor for AMSL, it is not currently listed on the Australian Register of Therapeutic Goods (ARTG) and cannot be lawfully be distributed in Australia. Given that approval can take a number of years, I’d be inclined to say that it’s unlikely at this stage.

What has received approval, however, is the Omnipod tubeless pump as well as the tubed Ypsopump from distributor Ypsomed Australia. More recently infusion sets, software and the starter box have been submitted. Time will tell…

The Oz Diabetes Online Community lives on! David @davidburren can be found hanging out under the #OzDOC hashtag on Twitter every Tuesday night from 8.30 to 9.30pm for anyone in the community seeking out peer support in the slot recently vacated by moderator Kim. There’s also a new Twitter account @OzDOC_host, where weekly chats are being run from.

Here in Australia, it’s a given that most of us wouldn’t think too hard about the cost of our insulin thanks to generous government subsidies. What you might not be aware of, however, is that the full cost of a script of insulin is several hundred dollars. In other parts of the world, this insulin is far less accessible and a lot less affordable.

February marks the annual Spare a Rose campaign in the diabetes community. The idea is to spare a rose on Valentine’s Day, and donate the cost of that rose (roughly $6 AUD) to a child with diabetes in need of insulin. Sparing just one rose will provide a child with life for a month in the form of insulin. You can find out more and donate at sparearose.org.

Finally, the Young Adult Diabetes Committee here in Perth are hosting their first event for the year on Thursday February 22. Dr Kirstie Bell will be sharing some insights from her research into fat and protein’s effect on blood glucose levels (you can read more about Dr Bell’s research here). If you live in Perth or you know of anyone who does, please pass this on. You do need to register through Eventbrite, however.

After starting my work week on Sunday this week, I’m fuelling myself purely on caffeine and on the countdown to a three and a half day weekend. Happy hump day!

Embracing Minimalism.

My bedroom, which doubles as my workspace, is one of the more poorly lit rooms in the house.

A few years ago, I painted the white, dishevelled walls with a refreshing coat of sky blue. The great creaky brown wardrobe was replaced in favour of a more built in style with great white sliding mirror doors. Last year I purchased an attractive white floor lamp which now overlooks my desk and does a super job at flooding the room with some much needed warm light.

Despite all of these changes, it still hasn’t felt like a place where I might feel focussed. If I have any hope of achieving my resolution of ‘less is more’ this year, than I damn well need my focus. As I was searching the interwebs for ideas to make a room look brighter, I came across a suggestion of embracing a more minimalist style.

As I began to clear the many surfaces, shelves and walls in my room, I realised just how many visible signs of diabetes there are scattered everywhere.

The dry blood stains left on my desktop, from every used test strip that I’ve lazily discarded there.

The empty vials of glucose tabs scattered across my bedhead at the most inconvenient of times, that I’ve been simply too lazy to throw away.

The open packets of infusion sets that I leave on my chest of drawers after a site change, just in case I’ve chosen a bad site and require the needle to re-apply it.

The silver box of Nurofen Zavance capsules, that I take on the occasionally bad days where diabetes makes dealing with the normal person stuff a lot harder.

The pencil case full of my diabetes travel gear, that I lazily fling atop my chest of drawers the moment I walk in the door.

The meter, test strips and lancing device that sit within easy reach of my bedside at night, but are nothing more than a hindrance to my work vibes during the day.

The notepad on my desktop, filled with some of the most undecipherable diabetes scribble.

The handful of meter batteries on the corner of my bedhead, that I haven’t yet found the time to sort into piles of ones that work and ones that don’t.

The USB wall chargers and bright yellow cables used to charge up diabetes devices, that are then left creeping across the floor for several days to come.

The sight of my hoard of diabetes supplies in my wardrobe, because I’m often too lazy to slide the door back across.

As I look around staring at more wall space, surface space and shelf space, my room suddenly feels so much brighter.

I realise just how suffocating all of those small but visible signs of diabetes made me feel, and I’m vowing to make more of an effort to keep them behind closed doors.

Diabetes Brigades.

I was trawling through my Facebook feed yesterday when I was distracted by one post in particular. It wasn’t the content that caught my attention however, but rather the brigade of comments that accompanied it.

With many schools going back this week after a leisurely six weeks off (one can only dream), the post was providing some suggestions for school lunchbox snacks.

I didn’t think there was anything particularly bad about the items suggested. Most of the suggestions were only small snack sized portions, and obviously not every item on the list would go into the lunchbox at one time.

I knew that if I were a kid, these would sound like pretty popular options to me. In fact two of these suggestions were in my own lunch box earlier that day, which I had carb counted and given insulin for. I imagine that I would feel very comfortable among my friends in the school yard with suggested snacks such as an apple or a yoghurt.

The aggressive comments, however, told a very different story. People felt the need to begin picking these suggestions apart for a number of different reasons, and linking them to all sorts of horrible diabetes end games. These comments were a pretty poor reflection on the community that I have come to know and cherish.

Yet I couldn’t help but come back to the bit about two of those very suggestions being in my own lunch box earlier that day. Put yourself in the shoes of a parent, or any person with diabetes for that matter, who is packing some of these very typical school food items into their lunchbox. How would you feel, reading a brigade of comments shaming your food choices and your parenting?

Now imagine that the person reading these comments isn’t in as comfortable a place as you are with diabetes. Where could that potentially lead you to? Feelings of guilt? Depression? Diabetes burnout? Disordered eating?

Despite how much of myself I’ve shared with you on these pages, it is not my place to give you advice, tell you how you should be managing your diabetes, or be making you feel guilty if your approach to diabetes doesn’t agree with mine.

Diabetes management is a very individual issue, and I truly believe that the foundation should be built on the needs and preferences of the individual. If that means letting a kid be a kid and eat a muesli bar or a handful of popcorn, then so be it. But hey, that’s only my two cents. 

If the suggestion you see online doesn’t suit your individual needs, then you’re certainly not obliged to take it next time.

P.S. I think Diabetes Australia have done an outstanding job on the resource Mastering Diabetes in Preschools and Schools, and I strongly encourage you to check it out here.

Some Insights into Fat and Protein Bolusing

One of the most frustrating things that I often read (or hear) is that a low carb diet produces seemingly perfect blood glucose levels.

I certainly don’t have a problem with anyone who chooses to follow a low carb diet, and I can definitely see the benefits to being more mindful of my carbohydrate intake.

However, I find it incredibly frustrating that nobody ever talks about how they manage their blood glucose levels around fat and protein. Because, with the exeption of a few ‘free’ foods (non starchy vegetables, anyone?) the major trade off to carbohydrates is eating more fat and protein.

I’ve sort of conceived this idea that if one chose to contantly fuel their body with fat and protein, you could just offset their effects with a higher basal insulin dose. But what about those who just want to enjoy steak or pizza night without the spike?

Other than monitor your blood sugar levels closely and see how your body responds because everyone is different, Dr Google was very little help in this regard. I get that this topic is very individual in nature, but the information out there is scarce.

My first useful insight into this topic came from Gary Scheiner’s book Think Like a Pancreas. Suggesting that many restaurant and take out meals are naturally higher in fat, he suggests employing a temporary basal rate of 50% as a starting point to combat insulin resistance.

Gary also suggests that protein is only converted to glucose when the carbohydrate content in a meal is insignificant, and therefore only recommends making adjustments for protein when consumed in low or no carb meals. As a starting point, he suggests counting 50% of the protein in a meal as carbohydrate and delivering insulin through either an extended bolus on a pump or a delayed insulin dose when blood glucose starts to rise.

My second valuable insight came from meeting Dr Kirstie Bell, a researcher from the University of Sydney at the ADS-ADEA conference last year. I was absolutely engrossed in her research into fat and protein bolusing, and managed to catch up with her in Perth earlier this month.

Unlike conventional thinking, Dr Bell’s research suggests that fat and protein alone don’t impact blood glucose levels. It’s the lack of sufficient insulin that does. In people without diabetes who produce insulin, the impact of slowly digested fats and proteins is minimal. For people with diabetes who don’t produce insulin however, the impact is quite the opposite.

Ever had one of those nights where you’re correcting a high blood sugar level over and over with very little effect? Dr Bell also suggested that higher fat meals pushed the blood glucose peak of a meal out later, and caused a sustained blood glucose response due to insulin resistance caused by saturated fat.

Protein also produced a noticeable blood glucose response within 2 hours of being consumed. Research findings suggested that protein required adjustments in both mixed and no carbohydrate meals, with mixed meals having a greater degree of impact on blood glucose levels.

The most interesting point for me was hearing the concept of finding a ‘sweet spot’ in insulin dosing for higher fat and protein meals. Research suggested that if insulin was given too early, participants went hypo. But if insulin was given too late and insulin resistance had already set in, finding an optimal blood glucose result was too difficult.

For me, this is one of the things that makes diabetes so difficult to manage. I truly wish that all food was created equal. I wish that I could count the carbs, give insulin and it would produce the same effect on my levels each time.

At the moment I definitely need to put more effort my fat and protein bolusing, because I am definitely seeing a lot of slow and unwanted spikes after my meals.

Want to know more? Check out the resource website www.ibolus4t1d.com, and you can find @drkirstiebell on Twitter.