Bzzzzzz. Bzzzzzz. Bzzzzzz.

I woke to the sound of my insulin pump vibrating a few nights ago, alerting my that my blood sugar had dipped below my low threshold of 4.4. I didn’t have much insulin on board, and hoped I could just suspend my way out of it. If there’s one time of day where, more than ever, I don’t want to treat a hypo, it would have to be in the middle of the night.

Bzzzzzz. Bzzzzzz. Bzzzzzz.

In-between having just nodded off, but not yet being peacefully asleep, my pump woke me up 30 minutes later to remind me that my blood sugar still hadn’t risen above 4.4.

I fumbled for my bedside lamp, switched it on and reached for my meter, curious to see whether there was any lag from my pump’s reading of 3.6. 3.1. Yikes. I was too tired to worry about how clean my hands were and whether it was accurate. I’d have to do exactly what I did not want to do.

I reached for my tube of glucose tabs, popped two out and instantly felt the horrid orange chalkiness invade my mouth. Made worse by the fact that I’d be left with a horrid aftertaste stuck to the walls of my mouth and my tongue.

Bzzzzzz. Bzzzzzz. Bzzzzzz.

An hour or two had passed. As I reached to silence my pump for the third time, I registered the steady descent after the bump from the glucose tabs that had ended at this 4.4.

I popped another glucose tab in my mouth, even getting some of that orange chalkiness caught in my throat this time. I set a temp rate of 90% for another four hours, which would hopefully steady me until I woke up.

As I eventually woke up and went about my day, with the orange taste that would not escape my tongue, I was left with a lasting reminder of the night that had gone.

Hypos happen. I laugh every time a doctor asks me how many hypos I’m having, because after a decade of living with diabetes it’s not something that I can easily count on the palm of my hand. They’re just something I deal with, in exactly the same way that I check my blood sugar, count my carbs or give insulin.

After living through a decade of lows, it’s no longer the physical feeling of going low that bothers me so much any more.

It’s the fact that I need to find the urgency to treat them every time I register a downward trend arrow. It’s the need to mentally convince myself to pop a disgustingly orange glucose tab into my mouth every time I clock in at 4.4. Or being disturbed in the middle of the night or right after I’ve brushed my teeth.

If I had to describe how I feel about living with lows in just one word, it would have to be inconvenient.

Building Resilience

‘Tell me what you can’t get?”

That conversation with my panicked Mum when toilet paper began flying off the shelves back in March is a far cry from the person who would today be able to tell you the numbers and developments around COVID right across Australia.

2020 has exacerbated a lot of strong opinions. I’ve even found myself sharing a lot of strong opinions which I might not have had if it were not for the pandemic. Namely around COVID complacency, people’s need to travel in the midst of a pandemic, and Western Australia’s hard border closure (which is unfortunately, but inevitably, coming to an end).

Photo credit: Ascensia Diabetes Care (@ascensiaglobal).

In the context of being part of the DOC, where I share and look for trusted health information every day, I’ve struggled to find it this year. I’ve struggled to share it. To a degree, I’ve even stopped looking for it.

I really struggled with the whole notion of being classed as a ‘vulnerable’ or ‘high risk’ person from the very beginning. I tired quickly of seeing many corners of the diabetes community try to editorialise the pandemic, ‘helpfully’ telling me how to optimise my diabetes management for Coronavirus. My diabetes was just fine, thank you.

All I have been interested in, all along, was following the health advice. Which is just common sense. Nothing more.

During Ascensia Diabetes Care’s OzDSMS summit a few weeks ago, we talked about building resilience. It was quite a complex question.

Resilience looks like being more accepting of different points of view to our own. Again, its been harder to share in a year full of exacerbated opinions, and often its felt easier to stay silent.

Resilience looks like embracing choice. We might all have diabetes in common, but we are all still very different and what works for one is not the solution for everyone. It’s still really frustrating to see corners of the community where choice is not embraced and we are pushing what we think is best onto others.

Most importantly, resilience means looking after yourself ahead of others. For me, this year has definitely been about the little things. Finding the lightest room in the house as I while away hours studying over the weekends. Making time to get outside, and even run, because it feels good. My afternoon coffee and biscuit break. Doing things that I enjoy – whether it be a walk by the beach, time in the kitchen, getting into a good TV show, or a scroll through Gumtree and Marketplace.

I think we all deserve a pat on the back just for getting through 2020. We’re all the more resilient for it.

Back to G5

Late last Thursday afternoon, as I pulled my car up at a local reserve to take the dog for a walk, the life of my final Dexcom G6 sensor came to an end.

I absolutely loved my time using Dexcom G6. Not having to prick my fingers after ten and a half years of living with diabetes was nothing short of amazing. It’s a reality that I haven’t quite shaken myself of every morning when my G5 pings me for a calibration, and I have to reluctantly delay my coffee to wash my hands and prick my finger.

The one thing I truly missed was having blood glucose readings on my insulin pump. I truly love not being tethered to my phone, particularly for things like runs or lounging around the house. Of course, this would have been rectified had I chosen to update my t:slim to Basal IQ. This would bring low glucose suspend functionality to my pump, with the promise of a fully automated system hopefully not too far away.

That was even harder to walk away from, than G6 itself.

The update to Basal IQ was really, really tempting. I think CGM/Flash is definitely something that is worth spending some of my money on, and something that I know I want to live with. However, I just couldn’t justify spending that much money on the G6 when I have other priorities in my life right now and there are cheaper options available. Plus, there’d be no going back if I changed my mind on the update.

I do think the subscription plan and price reduction from G5 is a step in the right direction from distributor AMSL Diabetes – to the extent that this was genuinely something I could consider. However, the $400 bond does add a further barrier and cost to the subscription plan, which could surely be replaced by a credit check.

At the end of the day, I knew this is where I would find myself when I was weighing up my decision to commit to another four years on the t:slim earlier this year. I have absolutely no regrets with that decision, because the Tandem/Dexcom G5 is still the system that works best for me and burdens me the least.

So for the foreseeable future, I’m back using my rebatteried Dexcom G5. Given that G6 is yet to be listed on the NDSS, I’d expect that G5 won’t be going anywhere for at least 12 months.

I’m super grateful to AMSL for the opportunity to trial the G6.

Hopefully this is a ‘not now,’ rather than a ‘not ever.’

Full disclosure: AMSL Diabetes provided me with a three month trial of the Dexcom G6 Continuous Glucose Monitoring system. I previously wrote about the system as part of my now ended sponsorship agreement here. This post does not form part of that agreement and is, as always, my own.

For the Long Haul.

Hello, November. We meet again.

That one month of the year where my social media feeds turn blue and light up with diabetes awareness.

Much like Halloween, Diabetes Awareness Month isn’t really a thing here in Australia. Aside from marking World Diabetes Day on the 14th of November, our National Diabetes Week takes place in July. Even though I’m just about ready to hang up the Christmas lights and put my feet up for the Summer, it will undoubtedly be hard not to feel obligated to join in and reconnect with the DOC.

One of the first things I was told when I was diagnosed was that I’d have diabetes for the rest of my life. And that it would be a pretty normal life, because it was manageable.

But the one thing that nobody ever told me, and the one thing that nobody ever readied me for, was the fact that diabetes is for the long haul.

Nobody ever stressed to me the monotony of doing those same tasks day in and day out, forever. Whoops, I mean until the cure arrives in five years time. Those annoying little tasks that I know I should do, but really don’t want to. Just like the thought of brushing my teeth at night when all I really want to do is turn the lights off and go to bed. Sure, there are shiny new toys that occasionally pep things up, but the gloss eventually fades.

Nobody ever told me how much mental energy I’d have to devote to this thing. How every single thing I want to do today revolves around numbers and insulin and goodness knows what else. Sometimes, when the going gets tough, it might distract away from the energy I have to put towards the other aspects of my life.

Nobody ever told me that I’d still be explaining diabetes all these years later, to those same people who asked me those same questions eleven years ago. Being your own advocate is exhausting.

Nobody ever prepared me for the fact that there’s never really a finish line. I mean, sure, there are diaversaries. There are decades. There is cake. There are victories. Like a great A1C, or news of an all clear diabetes screening for another year.

But nobody ever prepared me for just how ordinary and unremarkable these things would feel after I’d marked them over and over again. When all I have to look forward to is doing it all over again on the long road ahead.

Happy diabetes awareness month.

Loosening the Reins.

As I opened up my Dexcom Clarity app last night, I wasn’t all too surprised at what I saw.

My time in range wasn’t too shabby, but it was down on prior periods. The variability in my blood glucose readings was considerably larger than what I would usually see. My average blood sugar was sitting at the upper end of my own target range.

Overall, it wasn’t too shabby. But I also knew that it didn’t reflect my best effort.

I know that I haven’t been as diligent as I’d like with pre bolusing insulin before I eat. Case in point yesterday, when I had a muffin and an iced latte on top of a blood sugar level of 12. (It’s been a loooong week). I’ve tolerated longer blocks of time where my blood glucose levels have been flatlining outside of my target range, and I’m not too bothered by it. And I’ve found myself suspending my pump increasingly, because I just can’t bring myself to treat a low (especially after I’ve brushed my teeth).

I’ve made some very lazy changes – like increasing my basal rate to combat the insulin resistance that has crept up in recent weeks. But I’m reluctant to put any effort into making more permanent changes – like revising basal rates of ratios – because I know there are reasons behind what’s happening. Diabetes, or my diabetes at least, is definitely cyclical. I know at some point things will probably go back to where they were.

I’ve definitely loosened the reins, within reason, when it comes to my diabetes over the last several weeks. Quite honestly, it’s freed up mental energy and it’s definitely helped me to realise increased focus in other aspects of my life. Namely, my studies and my mental wellbeing. I also know that this wouldn’t be possible without my own tools of the trade, namely my t:slim pump and Dexcom CGM, which just seamlessly integrate into my own life without being a burden.

I don’t particularly feel like I see enough stories of imperfection when I look online. Sometimes, and in some corners of the internet, it definitely feels like everyone is just perfect and healthy and doesn’t have a crease in their shirt.

So, I’m just going to continue with this somewhat ‘lazy’ but acceptable approach to my diabetes for the time being, because sometimes there’s more to my own self worth than numbers alone.