A Tumultuous Night

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I’ve never had ketones in the six years I’ve lived with diabetes. Until yesterday, that is.

I performed a routine site change when I arrived home from work – probably around 2.30pm. There was no bruising or bleeding around the old site, which was another confident step away from the occlusion nightmare of three weeks ago. My blood sugar levels were in range, and I was good to go in no time.

By 5pm, I noticed my levels beginning to rise closer to the 10 mark. Dismissing it as a delayed effect of the buttered ham and cheese toastie I’d had for lunch, I gave a correction bolus.

When I sat down to dinner at around 6.30pm, I was 13. I bolussed for what I thought was a pretty accurate carb count of my dinner, with a generous correction. I did my best to eat slowly and pick at the lower carb things on my plate first, so that the bolus would have time to kick in.

After a little OzDOC banter, my levels were edging close to 20 by 8pm. I was obsessively looking at the site I’d changed a few hours ago, but I couldn’t find any reason to rip it out. It looked clean, and the boluses weren’t stinging as they went in.

I added some more carbs to my dinner bolus – this carb count was now extremely generous – and set a temp basal of 100%. I let it run for an hour, while watching my levels continue to soar into the low 20s. With no end in sight to the upward trend arrows on my Libre and feeling the high in my chest, I began to worry.

At 9pm I grabbed the insulin pen from my contingency pack, and injected six units into my stomach. It was my first insulin injection in 7 weeks. I went to check the site once again, and saw small amounts of insulin leaking out of the edges – finally noticeable thanks to the crazy correction boluses and basals of the past hour.

I ripped out the site to discover this.

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The small piece of teflon that sits under my skin was kinked, which meant I’d had little to no insulin in my system since the site change six hours ago.

My BGL was 25, which was honestly the highest I’ve ever seen it.

I checked for ketones, which were present in the mid range of 1.3. At this point, I was very aware of the possibility of having to go to hospital if I became nauseous.

Once I had changed my site, I hastily grabbed my diabetes file from the bookshelf, sending two others flying to the floor in the process. I furiously turned page after page, looking for the cheat sheet my diabetes educator had given to me a few weeks ago. The cheat sheet that I knew had quick instructions for treating ketones in the bottom left corner.

I set a temp basal of 200% to get that basal insulin kicking in my system ASAP (not educator recommended, FYI). As per the handy cheat sheet, I bolussed for correction plus 10% of my total daily insulin dose. I then headed straight for the kitchen, completely filled up my 600ml water bottle, and skulled it down to flush out the ketones. I filled it up again, ready to skull down in another half hour or so.

Slowly, but surely, my BGLs began to decline. When my meter finally rang in with a reading below 20, I breathed a massive sigh of relief.

By 11pm, I was 14, Ketones were down to a negligible 0.3, and I finally felt confident in turning off my temp basal rate.

It was a tumultuous night. By far, the worst scenario that diabetes has ever thrown at me. I crawled into bed at 11.30pm, exhausted.

Only to be woken again by a 4.30am low.

Here’s hoping that tonight diabetes lets me watch Wimbledon in peace.

Macgyvering a Glucose Check

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I was in the middle of a pretty important staff meeting at work the other day. From memory, I believe I had just eaten a few skittles to bring my glucose levels away from edge of hypo territory. I was sitting there, listening intently, but also wondering whether the skittles had done their job.

The looks I get when using my Libre around others are absolutely hilarious. This was a pretty serious discussion, and I didn’t feel like it was the right time to be pulling out an out-of-this-world device and scanning my arm.

I was trying to push the thought of my BGLs to the back of my mind, but I couldn’t. I thought about getting up and leaving, but I didn’t want to miss any of what was being discussed (rare for a staff meeting, right?).

My Libre reader was sitting in my front shirt pocket. I stuck my hand in my pocket and switched it on. I brought my Sensor-bearing arm a little closer to my pocket. I navigated my reader over to the sensor on my arm, and successfully obtained a blood sugar result.


All without the reader ever leaving my pocket.

Happy Wednesday.

Why Matters of Diabetes Ignorance Won’t Bother Me

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I’m posting this with a little nervousness today (please don’t shoot me).

I won’t be bothered by the matters of diabetes ignorance that circulate around the diabetes community.

Am I saying that it’s okay to discriminate against people with diabetes? Absolutely not. 

I just don’t feel compelled to get angry about an offensive sign that was put up on the other side of the world, or a message written on a coffee cup. I wouldn’t personally feel compelled to speak up unless I felt that it directly affected me.

I will point out for those who remember, that I did write an angry post about the CrossFit debacle a year ago – something I am not proud of today. In hindsight, I simply don’t think it was worth my attention.

Being diagnosed at age 17, I see diabetes from both sides of the fence. I didn’t know the first thing about it before I was diagnosed. Thinking back to the days before my blog, I knew very little compared to what I do now. Even today, I’m still very much learning new things about diabetes each and every day. Last week alone, I had two conversations where I had to explain that I did not get diabetes from eating too many lollies (or in my case, chocolate).

These days, I actually love being asked about my diabetes. I feel very confident when talking about diabetes to others. I feel proud of the knowledge and insight that I can offer to help others better understand the condition I live with – something that wasn’t true two years ago. I don’t feel that anger would ever produce the same result.

I simply think that there are greater issues worth my attention. If the e-mails I receive each week are anything to go by, I would hope that my writing here brings to light the realities of life with diabetes. I would hope that others will discover the power of peer support that I did last year, and realise that they are not alone in this.

I guess another thing that bothers me is that lack of respect in each other’s different opinions towards these types of situations. Craig over at Insulin Nation penned this piece in response to one recent matter of ignorance, and to be frank some of the commentary I witnessed in response to his opinions were nasty. 

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My opinion on the issue of diabetes ignorance certainly isn’t the only one, or the right one. It is however, my own, and one which I hope will be respected. If you feel like the matters of ignorance are important to you, I’ll certainly respect that. (So long as you’re not a walker, of course).

FreeStyle Libre: Second Time Round!

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At lunch time on Saturday, my meter came back with a 3.8. Not satisfied with the result, I walked over to the other meter sitting on my desk, which came back with a 4.7. I decided to do a best of 3 with the second meter, which produced an identical 4.7.

As I picked up the collection of discarded test strips strewn on my desk, it occurred to me that I am using test strips like water at the moment. I mean, I do use test strips like water. But I have never relied on them as much as I have now. And it kind of scares me.

I’m still fine tuning my insulin pump. I’ve made a lot of progress in the past week or two, but I’m not quite there just yet. I’m a perfectionist, I suppose. My diabetes educator has even gone on to suggest as much, having taken a step forward with the insulin pump. I can see it myself, in the great attention to detail I apply towards my basal rates and blood glucose monitoring at the moment.

Yet it scares the hell out of me, that somehow, this might become the new normal. I am scared of relying on glucose monitoring so much, instead of having confidence in my own actions. I am scared that I am becoming too compulsive and obsessive with my diabetes. Most of all, I am scared that I might never get this right.

I’ve recently used my second FreeStyle Libre sensor that I received from Abbott at DX2 Sydney, and naturally, I’ve discovered a few things that I didn’t the first time round. You can find out more about what the FreeStyle Libre is in my first review here.

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The Libre has been a life saver for me at work. I don’t need to walk over to my desk to check my blood glucose levels. I don’t need to worry about how dusty my hands are. It takes a lot of the pressure away from basal testing, where I would ideally stop what I’m doing to check my glucose levels every half hour. It offers a level of convenience that glucose monitoring doesn’t. Not to mention some the weird looks I get!

Most of the time, the results have been extremely accurate – to the nearest 1mmol. However, there have also been times where the accuracy has been difficult to trust.

It’s been hard to rely on the Libre’s readings when my glucose levels are moving significantly, particularly in the first 2 hours after meals. At work, I’ve often felt the need to go and double check with a finger prick before making a decision on a reading of 14 after breakfast.

I’ve also found that the Libre pronounces very small movements in glucose levels. For instance, I remember having an espresso with a tiny amount of milk one morning. I watched my Libre trend upwards to 9 or 10mmol, when in reality the movement wasn’t so big. It did eventually “catch up” with my meter, but I had to remember that the drop did not actually represent my blood glucose dropping.

That being said, I really need this extra flexibility with my blood glucose monitoring at the moment. I recently purchased another two sensors, which will hopefully make things a little easier for me over the next couple of weeks.

I’m just hoping that this reliance on heavy glucose monitoring doesn’t become the new normal. I really want to go back to having more confidence in my own diabetes decisions.

An Exclusive Path to Improved A1C Outcomes?

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I was recently e-mailing a blog reader who was investigating a national diabetes management system. As I began to respond to the e-mail, I found myself feeling compelled to add more and more perspective to the question being asked of me.

Diasend is the data management system I use with the team at my diabetes clinic. It allows me to upload the data from all of my diabetes devices – my blood glucose meters, my FreeStyle Libre and my Insulin Pump. I can manage my diabetes data in one place. For instance, I can look at my blood glucose level at 10pm last night, the basal rate of insulin being delivered at the time, and my most recent carb intake and bolus insulin dose.


Even better is the fact that I can choose to share this data with the team at my diabetes clinic. Prior to an appointment with my diabetes educator, I am able to upload all of my devices to Diasend. Gwen can better prepare for our education session, and I don’t need to wing my way through her questions around blank spaces in my logbook with umms and ahhs. It does force me to be more transparent around my results and the context surrounding particular occurrences, but I do have a great deal of trust in most of my team.

The e-mail went on to suggest that a management system such as this one on a larger scale could result in improved A1C outcomes in patients. In some instances, I could envisage this being true. However, I felt compelled to explain that an A1C result is not necessarily the sole indicator of how well an individual or healthcare team is managing diabetes.

How many times have I gone to test my blood glucose, expecting the moon and the stars, only to come back with something completely unexpected? Then I’ve had stellar A1C results in the past that have been praised, when deep down I know that I’ve been having far too many hypos.

There are so many issues surrounding diabetes, that many of us deal with concurrently. Mental health and emotional health, for one. I have a few good connections in the DOC who deal with more than one autoimmune condition, such as rheumatoid arthritis or coeliac disease. Then there’s all the regular checkups we have to maintain. The time and the financial burden we must invest into staying healthy.

The quality of my healthcare team makes all the difference, too. Some healthcare professionals can barely scrape the surface of what’s written in my chart. Others see the whole person behind the condition. They talk to me. They gather the full picture of what’s going on. They are empathetic. They give me their time, and their undivided attention. They go above and beyond their duty to help me succeed.

However on top of all of this, we still do our best to live happy and fulfilling lives. That, in itself, is absolutely amazing.

In my opinion, there is no exclusive path to improved A1C outcomes. But dealing with each of the bricks that cement the final result together definitely helps.