Within My Control

Dear blog,

I miss you.

To be completely honest, when I sit down to write, I just haven’t felt overly compelled to do so. I also feel like nothing I write here could even remotely compare to what some of you are going through interstate, and in other parts of the world.

I’ve been watching those all important numbers every day, particularly those affecting my friends in Victoria and NSW. Watching the health response to outbreaks on the East Coast gives me hope that there is a way forward and that we can live safely with this virus. I do feel like more of a health advocate than a diabetes one these days, calling out sick people who aren’t staying at home and judging gatherings where social distancing is not being upheld.

I’m extremely grateful for the freedoms we have here in Western Australia, where we have now surpassed six months since our last locally acquired case. Over these past couple of months, I’ve really thrown myself into looking after myself and maintaining somewhat of a healthy work/study/life balance.

I’ve approached uni in a completely different way this semester. I made the difficult decision to cut my winter break short and start a week early, and have been running a week ahead of schedule. It’s been a massive boost to my mindset, and at the end of each week I’ve been mentally praising my efforts. With an extra week up my sleeve should I need it, I have felt far less pressured.

I’ve been running every 2-3 days since July. It’s nothing particularly impressive. I run the same course, and so far I don’t feel as though I’ve built up any distance, but it still feels good nonetheless. Besides, slow and steady wins the race.

I’m also slowly making my way through TV shows that I’ve fallen behind on in recent years, and that’s been quite fun. I’ve also made my way to the beach more times in the last few months than I have in any other year.

I also hurt my wrist a few weeks ago, and quite honestly I think it was a blessing in disguise. It was a reminder that I come first, and that work and uni will still be there on the other side. Quite honestly, the time I was off resting it was the most relaxing week and a half I’d had in a while. Even if the steroids injected into my wrist wreaked havoc on my blood sugars.

Speaking of, my diabetes has been in what I’d best describe as a semi-autopilot mode. My time in range is decent, but it certainly does not reflect my best effort. There’s probably more variability in my numbers than I’d like. My insulin sensitivity has been all over the place in recent weeks, too. I find myself suspending my pump far too often because I can’t bring myself to eat glucose tabs.

I’m okay with all of that. I’ve adapted as needed. I’ll survive. I know those numbers don’t reflect my worth as a person.

I know that while I can’t control the numbers, or what fates our leaders decide for us, I can control what I do to take care of myself.

‘I Don’t Have Time For That.’

I don’t have time for that!’

This was the answer I received from the doctor I was seeing yesterday, who was seemingly unable to complete my request. After being made to feel rushed and a complete inconvenience during our entire two minutes together, I was abruptly ushered out of the room to finish with the clinic nurse.

I’m having a week. Let me backtrack.

Some soreness crept up on my wrist over the course of last week, and by the end of the week I decided I had to get it checked out. It was the weekend, I couldn’t get in with my own GP, so I made an appointment at a relatively new practice that’s close to home. Plus, I’ve been on the hunt for a good doctor around the place.

The clinic itself was pretty modern. I was easily able to book an appointment online and there were a range of services, delivery options and timeslots available. The premises were relatively new, the decor was fresh and there was even a check in counter that I didn’t register until watching others use it. Oh, and I made a bit of a fool of myself trying to open the automatic door with a wave of my hand over the sensor.

After waiting close to an hour for my appointment, I explained my conundrum to the doctor. After telling me that we need to get on top of this, I was given a referral for an x-ray, the possibility of a needle was mentioned and I was abruptly sent on my way.

I didn’t think much of this place, but then again perhaps there was nothing to discuss until we had a x-ray and ultrasound results to look at. I only really went back to discuss those radiology results yesterday. In hindsight, it would have been better to copy them into my GP instead.

I was really looking for some advice on a course of action, and whether I’d be able to safely go back to work. Radiology had encouraged me to book in for a cortisone shot to ease the inflammation in my wrist, which must have been the needle my doctor had abruptly mentioned. But it felt a bit premature. Especially given that I was sore, but not in pain. I didn’t know a lot about it, either, as well as it’s impact on my diabetes.

But my whole follow up appointment yesterday felt rushed. We discussed another option to the shot, which I learned would ultimately take longer to recover. When I began to discuss a plan for returning to work, I got the message loud and clear that I was wasting this doctor’s time.

To be honest, I wasn’t expecting a lot from a bulk billing clinic. I get that they’re busy, and I get that they’re operating on a quick turnaround.

But I only wanted my ten minutes I had booked to discuss my one issue. I don’t think I was even in there for five. I don’t think it’s a big ask for a healthcare professional to listen to and answer my questions and concerns. I certainly don’t think it’s a big ask to be treated with the same respect that I treated this doctor with, and not like I was wasting someone else’s time.

Language matters. Language bloody matters.

I was left with two courses of action, but unfortunately not a lot of information about them. Thankfully, I went home and talked with my own tribe.

With a bit of consultation with Dr Google, I made a decision.

This doctor definitely won’t be a part of the follow up.

More than a Dexcom Line Could Ever Explain

I spent an intense two weeks buckling down to get two uni assignments done. While they were both due at the same time, it was also a good opportunity to knock them off early in the semester. Once I start something, I get pretty determined to finish. Suffice to say they were finished two weeks ahead of the due date.

I watched my diabetes respond to more evening hours in front of the computer, as well as general feelings of grumpiness as uni ate into my free time. The one symptom that tells me I’m not getting enough rest is a surge in blood glucose the moment my head hits the pillow at night. As well as general feelings of a heavier, groggier kind of sleep.

Before I used an insulin pump, one of the things I often used to complain about was that my basal dose was never consistent. There were times where I felt I needed more, and times where it was too much.

While insulin pumping undoubtedly gives me far superior coverage, my basal requirements are still far from static. Stress is definitely one of those things that affects blood sugar. There are times, just like in the past month, where levels have felt a lot more stubborn to manage. One of my tactics is to simply add a blanket 10% increase to my basal rates until it subsides.

I spent the better part of a week post-assignments looking after myself, binging through the final season of 13 Reasons Why (which was like a really bad movie that I had to see the end of). I wiped my desk clean, vacuumed the floor and got outside again. Sure enough, it didn’t take too long for me to start going low and I wound those basals back again.

All too often when I’m explaining diabetes, it’s easy to oversimplify it. Diabetes is a simple case of taking a shot of insulin to manage blood sugar levels, and hey presto it’s all under control. Basal rates and carb ratios and sensitivity factors just work all the time, and there’s nothing more to think about.

As I sat down at diabetes clinic a few days ago, pouring over my Clarity reports, I said all of the above as I explained what had been happening. Much less cohesively, of course.

I’m not too sure whether a healthcare professional will ever be able to truly ‘get’ all of these little intricacies that only someone living with diabetes day in and day out would get.

However, the one thing I know for sure is that there’s always an explanation that a Dexcom line alone will never be able to explain.

A Review of Dexcom G6

Full disclosure: I have entered into a sponsorship agreement with AMSL Diabetes. AMSL have provided me with a three-month trial of the Dexcom G6 Continuous Glucose Monitoring system, with one of the sponsorship expectations being this blog post. Because AMSL have sponsored me, their regulatory team has reviewed this post for the purpose of ensuring compliance with regulations governing the distribution of medical devices in Australia. All words and opinions expressed here are my own. 

After many months of anticipation, the Dexcom G6 Continuous Glucose Monitoring system has finally hit our shores here in Australia. This newest iteration of the Dexcom features a slimmer profile, 10-day sensor wear and no requirement for calibrations with a finger stick. I’ve been using the system for 20 days now, having recently completed my second sensor. 

Application: There was an important first step where I had to input a code printed on the back of my sensor into the G6 app on my phone, in order for me to proceed without the need for any calibrations. 

The sensors now come encased in a one touch insertion device. I was admittedly a little nervous about this. I prefer manual inserts where I can, as it gives me a lot more confidence that everything has gone in correctly and I haven’t bruised my precious real estate. That being said, insertion was so much simpler and quicker than its predecessor. All I had to do was stick the sensor onto my skin, remove the safety lock and press the orange button. 

What I’d most like to see improved here is the ability to reuse or recycle the large plastic insertion device. 

Transmitter: The G6 transmitter sits on top of the sensor and sends blood glucose readings to the Dexcom G6 app on my phone every five minutes via Bluetooth. The transmitter features a much slimmer profile than the G5, and I definitely noticed an improvement while I was sitting on the couch or laying in bed. Transmitters are a costly component of running a CGM, and I would have liked to see this last longer than three months. 

Sensor wear: I’m always wanting to get more out of my diabetes gear, so it’s good to see that G6 sensors are now approved for 10-day wear. Although as someone who tries to line most of my diabetes tasks up with the weekend, 10 days is admittedly inconvenient. Saturday, next Tuesday, the following Friday… 

The sensors stuck well enough for me over the 10 days. My first sensor showed more signs of wear and became loose around the edges towards the end. I also received one sensor error on days 7, 8, 9 and 10. This occurs when the G6 app stops receiving readings for a short period of time. My second sensor stuck better than the first, and I didn’t receive any sensor errors here. External adhesives can also be used to secure the edges if needed. 

Dexcom G6 app: The G6 app was really easy to set up, with step by step instructions guiding me through pairing my transmitter and inserting and starting my sensor. 

There are the usual alerts which can be customised to notify you when your blood sugar is high or low, rising or falling. My foolproof alert is the tone ‘High.’ As much as I can’t stand that sound in the middle of the night, it never fails to wake me up so that I can correct and avoid waking up high. 

One new feature is the urgent low soon alert, which will give you a 20 minute warning when blood glucose is predicted to fall below 3.1mmol. It feels like your Mum nagging you to do something about it, even though you’ve already been told. Not necessarily a bad thing…

As someone who does often adjust my target ranges at night, another feature I really liked was the alert schedule. In the G6 app, I was able to create a customised schedule between the hours of 11pm and 6am with a tighter target range than my default schedule. I am being a little easier on myself right now, but I’ll definitely try this some point. 

Accuracy: I’m still adjusting to the way that the G6 behaves. The trend arrows feel more immediate than what I was used to on the G5. I feel like I see the impact of a meal or activity more quickly on my CGM graph. I’ve had to adjust my behaviour a little in order to avoid being too reactive to trend arrows. It’s also left me questioning how effective my pre bolusing has been. 

I started checking my blood sugar in the morning and evening, in line with my usual G5 calibration schedule. Almost all of my meter results were within 1mmol of the reading on my G6. I’ll also add that I’m paranoid about checking my blood sugar on clean hands. Generally, I found that my G6 reading was on the higher side of my meter reading. 

Overall, I found the accuracy to be excellent. I’ve only calibrated the system once over the past 20 days, which was in the first 24 hours of a new sensor. For the most part, I didn’t feel the need to calibrate this system because there was rarely a time where it didn’t feel accurate. 

Another time I found accuracy to be superb was when my blood sugar was dropping. In my experience using G5, I expected less accuracy when I was comparing my meter with a diagonal trend arrow. But the G6 was spot on. 

Verdict: I went into this trial sceptical that the Dexcom G5 could be bettered, however the Dexcom G6 has definitely exceeded my expectations. As someone who would be paying for this product out of pocket, I’m still undecided as to whether I would continue using this beyond my trial. However, it is a step in the right direction to see G6 priced considerably lower than G5. 

Dexcom G6 is currently available to purchase in Australia from distributor AMSL Diabetes – www.amsldiabetes.com.au. AMSL are currently working with the government to get G6 listed on the NDSS, however there is no confirmed date as of yet.

Footnote from AMSL: If your glucose alerts and readings from the G6 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions. Always read the label and use only as directed. Read the warnings available on amsldiabetes.com.au/resources before purchasing. Consult your healthcare professional to see if this product is right for you.

Diabetes in The Wild

Last year, one of the units I was studying at uni was, well, really badly organised. The major assignment for the semester was due within a week of the topic it was based on being taught.

I absolutely love studying as a fully online student for the convenience it offers me, but for the most part it’s an isolating experience because you’re left to work largely on your own. Not too dissimilar to living with diabetes. The support often isn’t there in the same way that on campus students get, but I do acknowledge that this is the path I have chosen.

I posted something on the message board for this unit, joining other students who were expressing similar frustrations over this assessment. Later that very night, I received a message from an old friend from high school, asking me how my assignment was going.

How do you know that!?’

As spooky as it sounded, his girlfriend was doing the exact same unit as I was. He must have seen my post on the message board, and he’d probably heard just about every complaint I’d ever had with this particular unit throughout the semester.

We’ve been in touch a bit over the past few months. He’s been asking me about the units I’m doing, how my exams went and those all important results. Pretty similar to our days studying accounting together in year 12, without the rivalry over who got the better test result (it was usually him, with what looked like about half the effort that I put in).

A week or so ago, I ran into this friend in person. He introduced me to his girlfriend, who was doing the same course that I was. As I was expecting to start talking about uni, he said something else.

‘She’s got diabetes, too! he said to me. ‘Go on, show him your pump!’ he gestured to her.

While I thought that was really cool, I told her that she did not have to fish out her pump on my account, as he urged her on.

My friend knows that I have diabetes, and that I do a lot in diabetes advocacy. I just thought it was so cool, that in all those months of messages, his girlfriend’s diabetes hadn’t come up once.

As much as I devote my online life to oversharing about diabetes, as happy as I am to wear diabetes as a badge of honour for the sake of raising awareness, there is so much more that defines us than just living with diabetes.