BGLs

Feeling Tired With Type 1 Diabetes

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The final stretch of last year was a pretty challenging time for me, physically.

I felt tired. All. The. Damn. Time.

I would often find myself crawling into bed at the end of the day, feeling utterly exhausted. I was no longer waking up to my 1am alarms, and my blood sugars definitely suffered for it. I would wake up after a solid eight hours of sleep feeling bleary eyed, wanting nothing more than to close my eyes and go back to sleep again.

I honestly could not find an explanation for the way that I was feeling. Although the management of my blood sugar levels had slipped a little since achieving a personal best hba1c in July, my ability to manage them was still far better than they had ever been in my pre-pumping era. My bloodwork from July was also really good, and I had seen my endo in August.

I probably should have made an appointment with my GP, but I honestly didn’t feel that he would have been very helpful to me.

I felt more burdened than I had felt in a long time. in fact, I’d go as far as to say I felt equally or more burdened than I did during my start on insulin pump therapy. These feelings affected my work, my attitude around others and my overall quality of life. Part of me was ready to accept that these symptoms were simply a tradeoff of living with a demanding chronic condition like diabetes.

Living with type 1 diabetes creates somewhat of a complex relationship with food. We need food to fuel our bodies, but at the same time food spikes our blood sugar levels – and we want to avoid out of range glucose levels at all costs.

What’s the best nutrition advice for a person with diabetes? From my experience, It depends on what you’re reading and who you’re talking to. While I absolutely love my diabetes community, the overwhelming messages that seep into my brain is to avoid this food group or cut back on that one that and stop the spikes from happening.

I don’t want to single out any particular way of eating, but diabetes has distorted my relationship with food without me even realising.

The average male needs to consume about 8,000 kilojoules of energy per day to fuel his body so that it can function properly and match energy expended through activity. I don’t think I was even coming close to that. Not to mention having an active job where I’m on my feet all day expending even more energy by the minute.

I honestly cannot ever recall being taught to eat to fuel my body and meet my daily energy needs – from healthcare professionals and diabetes websites alike. Or perhaps I wasn’t listening carefully enough.

The past month or so has been a bit of a learning curve for me. Let me just say that it is pretty challenging to eat 8,000 kilojoules of quality food every day, and I have slacked a little at keeping tabs on this at times.

Of course, as with anything you make a major change to in life, diabetes management also demands attention and there have been a few tweaks to basal rates. I’ll share more specifics in time. 

But I’m sitting here in the sunshine typing this today, feeling far better than I have in quite some time.

Curse of the One Touch Verio IQ

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I first received a One Touch Verio IQ glucose meter when I started on my insulin pump in May 2016. As most diabetes sales reps do, I received a rave review about how it was one of the most accurate blood glucose meters on the market.

I was using the FreeStyle Insulinx at the time, which I absolutely loved for it’s ‘Lite’ test strips that only required a tiny sample of blood and weren’t wrapped in that annoying foil. Although I had no intention of switching from the Insulinx, I decided to place this meter in my travel case and use it as my spare.

To give it credit, the Verio is actually quite an attractive meter. It has a colour screen and a backlight that automatically comes on when inserting a test strip. The meter is a refreshing white colour, rather than the dull greys and blacks that I’m accustomed to. By far, my favourite thing about this meter was the plastic shell that holds the meter, test strips and lancing device, which makes it super easy to carry.

Unlike any other meter I’ve used, its also rechargeable. This is good in the sense that you don’t need to keep on buying batteries (which are expensive, mind you!), but also not so good in the sense that you need to remember to keep your meter charged up before leaving the house. As a travel meter, the battery life held up well and would typically last me a month.

Testing with this meter was tricky to get my head around. Unlike FreeStyle and AccuChek meters, the test strip port was situated at the top of the meter. Additionally, blood had to be placed on the side of the strip, rather than at the bottom.

My pet hate was getting strip fill errors if I didn’t get sufficient blood on the strip in one go. I had a lot of these in the beginning as I was getting used to placing blood on the side of the strip. This was extremely wasteful compared to FreeStyle meters, which would give me ample time to apply additional blood.

I also didn’t like the fact that the capped test strip vials only stored 25 strips rather than 50, and that boxes came with 50 strips instead of the usual 100. This was an unnecessary waste of packaging materials, and meant that I needed to buy double the number of boxes to get the same amount of test strips. Although the price was comparable to other brands, Pharmacies didn’t necessarily stock more boxes of Verio strips on their shelves.

However, the biggest dealbreaker for me was the accuracy of this meter. I have consistently found that the Verio reads 0.5 to 1mmol higher than each of my other blood glucose meters.

Of course when I raised this issue with Aussie distributor AMSL diabetes at the ADS-ADEA conference last year, I was basically told that it was the other meters that were wrong. The accuracy of this meter fell within the acceptable Mean Average Relative Distance (MARD) from laboratory glucose readings. It had also been recommended for calibrating readings with Dexcom, which is the golden child of Continuous Glucose Monitoring.

I’ve done a little experiment with some of my leftover test strips, comparing the Verio with my FreeStyle Insulinx, Accu Chek Guide and FreeStyle Libre. I washed and dried my hands prior to each test, as I’m well aware that any moisture or dirt on my hands can impact glucose readings.

To be fair, all meter readings are only accurate to the nearest 1mmol of a laboratory result. Two simultaneous blood glucose readings will likely produce different results. So how do I know which of these readings I can trust?

I’ve found myself feeling hypo on several occasions, only to test with the Verio and receive a reading in the 4s. Patterns as exhibited above are a regular occurrence.

I’m exercising my own judgement here, in saying that I simply cannot trust this meter.

Why I Choose Not to Share My A1C Online

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My latest column for Diabetes Daily is up, and this time I’m respectfully talking about why I’m not a fan of seeing hba1cs in bios and Facebook statuses. 

“A couple of weeks ago, I saw a photo posted into a closed diabetes Facebook group. This photo showed an individual’s pathology report, displaying their latest A1C result. It was an amazing, amazing result. I tip my hat. People were expressing their amazement in the comments. The moderator kindly congratulated the individual, before expressing that everyone is different and that onlookers shouldn’t compare.

I thought that the moderator’s response was impeccable. More so, because it reminded me of why I am reluctant to post my A1c result online.”

You can read the full column over at Diabetes Daily right here.

Libre-less

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It’s no secret that I have continued to use the FreeStyle Libre with much enthusiasm in recent months, albeit intermittently. I frequently talk about it on Twitter, I often refer to trend arrows in my blog posts and it’s a popular subject of messages that arrive in my e-mail inbox. Not to mention how instagrammable that graph is, especially when the line is flat.


Yeah, paying $95 to monitor my blood glucose like this every two weeks absolutely sucks. But overall, it has improved the quality of my life, and I am starting to come around to justifying those costs.

For my needs, it is perfect. I check my blood sugar frequently through the day, so this fits the bill nicely in adding some convenience to that. I like that the hardware is minimal, and that it doesn’t use a lot of real estate on my body. The only upkeep is the round sensor every two weeks, which makes it a cheaper alternative to Continuous Glucose Monitoring.

I guess where I have struggled the most is setting boundaries around the data. I find it easy to become obsessed with the numbers after wearing it for too long.

My behaviour hasn’t been too healthy during the life of my last sensor. I’ve been compulsively checking my levels before I’ve even finished my dinner, and again on the couch in the evenings while I’m watching television. The trend arrows have been really frustrating to see at times, and I find it hard to remind myself that they are only temporary. Against better judgement, I do tend to micro manage data, which sends me low far more often than I should be.

So why haven’t I taken a break from it sooner? Firstly, I wanted to give myself every advantage in getting the best hba1c that I could. Turns out that I was being much too hard on myself, because it exceeded my expectations by a country mile. Then earlier this month, I hit a speedbump where I was literally spiking after everything that I ate. I was too scared to be without it until I had figured the problem out. But I am slowly moving past that issue (more on that, soon).

I’ve been Libre-less for almost a week now, and all that anxiety is gone. I stop to check my blood sugar prior to meals, and one and two hours after meals. I’m forced to think about whether I actually need to check my blood sugar, or whether I’m simply doing it because I can. My head isn’t consumed by numbers so much, and my mood isn’t dependent on trend arrows. In fact, the numbers have been better than they were during the life of my last sensor, and I’m not hypoing so often from micro managing.

The morale of this story is that time away from the tech is equally as valuable as the tech itself. It gives me a chance to actually appreciate the tools I am using, and what I’ve been able to achieve with them.

My life is more than just numbers, and time away from the tech is definitely helping me to realise this once again. 

Eating Some Carbs, and Moderate Protein

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A few months ago, I wrote about some of the changes I was making towards my carbohydrate intake, and I think it’s time for a bit of a follow up.

I’m quite a spontaneous eater. For a long time, I’ve struggled with trying to curb my snacking and be diligent inbetween meals. I would have weeks where I would be super diligent, have excellent blood sugars, but was super hungry and fidgety. Those good spells rarely lasted beyond a week or two, and I would eventually end up rebounding with more carbs.

I was also eating a lot of fast acting carbohydrates and empty foods that left me hungry soon after. Some days I would snack mindlessly in the afternoons, and I never felt great or super energetic at the end of the day.

I knew all of this, but never resolved to do anything about it until recently. In my mind, I never set out on this with the intention of going extreme low carb. Life is too short not to eat cake or drink coffee. For me, this was more of a way to try and improve my eating habits, incorporate more sustaining energy sources into my diet, and to feel better overall. Maybe, just maybe, that would be the key to making my glucose levels a little more manageable.

I now try to have at least one protein source with either breakfast or lunch. For breakfast, I’ve thrown eggs on toast into my rotation alongside Oats or Weetbix and Banana. For lunch, I’ve thrown steak sandwiches and tuna sandwiches into my rotation, rather than having toasted ham and cheese every day. Dinner is usually a cooked meal, and would likely include a protein source at least 4 times a week.

Significant protein meals do need a bolus. I’m still experimenting with this, but I’m finding that setting an extended bolus for 50% of the protein over 2 hours is too much. I would like to give this theory a go, where I would bolus for 100% of the protein amount over 20g.

On good days, I try to keep my snacks inbetween meals very low carb. I usually snack on nuts and cheese, and often have a milky coffee with it, which is about 8g of carbs.

There are still plenty of moments where I indulge. But it doesn’t necessarily happen every day like it used to. Treating myself is more of my choice now, not simply because I’m feeling empty and craving something sweet. If I’m guessing for a piece of cake, I do try to look at it and think about the carb count. It really does make all the difference. The Calorie King app on my iPhone is also really handy for finding carb counts on the go.

https://www.instagram.com/p/BMgOvS9DCjw/?taken-by=franksita

I don’t have a strict number of carbs that I hold myself to each day. As a ballpark figure, I would say that I would eat an average of 30g per meal. But it really does depend on the meal. A low day might be 70-80g of carbs. A high day might be 120g. I think I would rarely go near 150g in a day.

What’s surprising me the most is how much I have unconsciously reduced the amount of carbs I have eaten. For instance, there are days where I glance at my pump and realise that I’ve only eaten something like 75g without even noticing. My blood sugars are more manageable, in part because I have reduced my carb intake, but moreso because I don’t have that urge to snack mindlessly anymore. There is definitely more of a variety and satisfaction in my diet, which translates to less of a desire for junk food. I think I have brought my lunch once in the last month, as opposed to every Friday. Unless you count coffee.

I definitely don’t view carbs as the enemy, so long as I go about them sensibly, carb count and pre bolus insulin appropriately. Carbohydrates that I do eat regularly include nutritious lower carb bread, such as Baker’s Delight Cape Seed loaf or Burgen varieties. Greek style vanilla yoghurt, fruit, vegetables, milk and oats. I eat pasta and rice in moderation if they are a part of the evening meal. I also have a block of chocolate handy for a treat if I’m craving something sweet. 

I often receive e-mails and messages asking me if I would consider going on a genuine low carb high fat, or ketogenic diet. For me, what I am doing at the moment is realistic. That 30g per meal is a number that doesn’t send me rebounding on more carbohydrates. Super high fat or greasy meals don’t particularly appeal to me, either. And to be honest, I’m never going to be the kind of person who converts to low carb as a way of life.

As always, diet is a very individual choice, and I have come across a variety of different perspectives in the DOC. There’s no right or wrong approach. In my mind, the right diet is the one that is realistic, that you can sustain, and that will make you happy.

At the moment, I’m confident that this is the approach that I want to continue with going forward, and the one that will send me toward the a1c I am aiming for.