BGLs

Glucose Testing Behind The Wheel

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One of the topics that really spoke to me while completing the yourSAY survey was the issue of glucose monitoring before getting behind the wheel of a vehicle.

To be honest, having to go to a doctor every two years to have my “assessment to drive” completed is a bit demoralising. I don’t like having my “medical condition” branded on my drivers license. I don’t often ask for special considerations because of my diabetes, and I hate that I have to ask my doctor for it every two years in order to operate a vehicle.

I get that operating a vehicle, or machinery is a pretty serious responsibility. For anybody. With or without diabetes. I get that I have a condition that could potentially put others at risk on the road if not managed properly. But I also know that I am a responsible driver. A responsible driver of my own vehicle, and of my own diabetes management. Both of which I take very seriously.

I do not test every time that I am about to get behind the wheel of a vehicle. Not because it’s inconvenient, not because I don’t like to and not because I don’t carry my testing supplies on hand. I don’t test every time that I get behind the wheel simply because I don’t feel that it is necessary to do so.

I am the designated driver in the vehicle of my diabetes management. And it’s my right to make that decision of whether or not it will be necessary for me to test before getting behind the wheel today. It’s my ability to judge a hypo, or hyper coming on. They’re my blood sugar levels that I place the confidence in to remain stable while on the road. Not yours. Not the government’s. Not my doctor’s. And not anybody else’s.

Every day in the news we hear of drunk drivers, traffic offenders and criminals endangering our roads, and the individuals on them. I am not suggesting it is, but I would hate to think that mandatory glucose testing in a vehicle would somehow be legally enforced here in Australia ahead of these other more serious issues.

I realise that this is probably easier for me to say compared to someone who is not as confident with their diabetes management. But at the end of the day we must empower, and give this responsibility to the individual.

I will be guest moderating tonight’s Oz Diabetes Online Community chat. Join me by following the #OzDOC hashtag on Twitter from 8.30pm AEDT/5.30pm AWST.

Diabetes Pressures Without CGM Subsidies

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I was rather touched by an awesome type 1 Mum who spoke out about Continuous Glucose Monitors here in Australia on last night’s episode of Q and A.

Aussie Type 1 Mum Catherine asked Ken Wyatt, our Minister for Health, when Continuous Glucose Monitors would be subsidised by the Australian Government and hence bringing us into line with other countries.

She noted that the cost of a Continuous Glucose Monitor here in Australia was $5,000 per year, which was considerably less than the costs of looking after people with diabetes who are hospitalised. During a one week trial last year, a Continuous Glucose Monitor saved Catherine’s daughter in three instances where her blood glucose levels were dangerously low and could have resulted in hospitalisation.

Catherine told us that she checked her daughter’s blood glucose levels every two hours. She was often sleep deprived from managing her daughter’s type 1 diabetes throughout the night. Diabetes kept her awake for eight hours last week, in an instance where she was unable to get her daughter’s blood glucose to rise above 4mmol/L.

As a single parent, Catherine feels the financial pressures of type 1 diabetes. She cannot afford to work part time, or to stay at home with her daughter. A Continuous Glucose Monitor would allow Catherine to keep an eye on her daughter’s blood sugar levels remotely, and reduce a lot of the stress in her life.

As for the reponse given by the politician on the program, it was the typical response given by a politician. Wishy washy xtatements implying concern and high regard for the issue, but nothing committal.

I can relate to wanting to keep a close eye on blood glucose levels. I will test up to 10 times on most days, just to make sure I’m not having too many nasty hypos or being too high. There are nights where I so badly want to test in the middle of the night to make sure I don’t end up too high. And I often hate myself the next morning for succumbing to my exhaustion and not doing so when I see a high blood glucose level. And I don’t earn a lot of money, either. At the moment, a Continuous Glucose Monitor is a luxury that I simply cannot afford. When I’m paying the bill at the Chemist, I often think of all the other things that I would rather have spent that money on.

Catherine, you’re not alone. Thankyou for sharing your story, and for bringing this issue in front of our leaders, and the Australian public. Well done, type 1 Mum.

Night Time Blood Glucose Monitoring Mishaps

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It was 10pm on Tuesday night, and I was getting ready to go to bed. We had Pasta for dinner, a family favourite in our house. Pasta usually produces really good blood sugar levels by bedtime. However, being a low glycemic index food, Pasta also tends to have somewhat of a delayed effect on my glucose levels. Once I fall asleep and the majority of my rapid acting insulin wears off, my blood sugar levels tend to creep up. And I’ll wake up the next morning with something crazy like 15.

I was a perfect 7.3 at bedtime that night, but I wasn’t confident that my blood sugar levels would settle there. So I decided to set the alarm on my phone for 12.50am, so that I could test and correct later on. I turned out the light, and went to sleep.

The next thing I knew, I began to stir as my Dad came and opened the door to my room. I could see light streaming in from behind the closed vertical blinds, and the clock on the side of my bed read 6.38am. I was convinced it was Saturday. I was still lying in bed at 6.38 in the morning because it was Saturday. Until Dad asked me if I was going to work that morning. And I realised that it was, in fact, Wednesday.

What the hell had happened? My mind was foggy, and for the life of me I couldn’t even remember hearing the alarm go off. Which was unusual. I hate my alarm. It’s one of those awful buzzer-like sounds that startles me awake in the morning. It’s so startling on a sleepy brain that I usually scramble to silence it each morning. But I also love it for the fact that it has never failed me. Until now.

I didn’t even hear that alarm go off at 12.50am. Well, at least I couldn’t remember hearing that alarm go off at 12.50am. As I tried to put the pieces together, the only reasonable explanation that I could come up with was that I had hit snooze at 12.50am. And in doing so, I hadn’t been able to re-set the alarm for the morning.

I angrily got up out of bed to test my blood sugar. I knew it would be high, but I was hoping for a miracle. The last thing I wanted to deal with that morning was a high blood sugar and the shitty mood that would inevitably go with it. But, as expected, diabetes gave me a lovely 15.6.

I furiously threw the covers on top of the bed and got dressed. I began swearing, and throwing every curse word I could think of at diabetes. I jabbed in 8 units of insulin. A couple of units to cover my usual morning requirements, and a couple to combat that stubborn 15 that I’d been sitting at for the past 8 hours.

I was so furious with myself that I decided I would go straight to work. I didn’t deserve breakfast with such a high blood sugar level. I didn’t deserve that coffee that I so enjoy relishing in the morning either. And the last thing I wanted was to go into work later and let diabetes take my afternoon away from me.

I clocked on at work at 6.58am, just in the nick of time.

And I added a second alarm to my iPhone, to ensure that this would never happen again.

How Can We Change Attitudes to Glucose Monitoring With Limited Subsidies?

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I recently completed the yourSAY (Self-management And You) study, where I was invited to give my insights into diabetes self management and glucose monitoring behaviour here in Australia. As I was answering the questions, it became evident to me that the survey was trying to hone in on people’s attitudes and behaviour towards blood glucose monitoring.

One of the survey questions asked me to identify when I would check my blood glucose levels. Would I check when I wake up? Before meals? 2 hours after meals? Before bed? When I feel unwell? When I feel my blood glucose might be high or low? Before I drive a motor vehicle? Before I exercise? During the night? Or “just to check?” Naturally, I ticked all of the boxes.

If you’re a long time reader of this blog, you’ll know how strongly I feel about blood glucose monitoring. How it helps me to feel grounded and in control over my diabetes. How it gives me a sense of certainty, and peace of mind over this rollercoaster of a disease. And how lost I would feel about it. I have never, ever needed any motivation to check my blood glucose levels in the years that I have been living with diabetes. But as I was completing this survey, it became apparent to me that many people might not be as motivated to do so (no judgement either way).

I might be wrong, but it seemed to me that this survey might have an end view of encouraging people with diabetes to check their blood glucose levels more often. And when I think of this issue, one thing comes to mind. 

How am I supposed to check my blood sugar levels that often when our test strip subsidies here in Australia are so limited? How am I supposed to check my blood sugar levels when I get behind the wheel, when I exercise, when I feel unwell, before a meal, after a meal, when I feel low, when I feel high, when I’m unsure and during the night – when our National Diabetes Services Scheme only subsidises 5 blood glucose tests a day? How am I supposed to check my blood sugar levels when I am being told that I consume too many diabetes supplies? (You can read more about this in the column I wrote for Insulin Nation in July).

If this is indeed the end game that our diabetes regulatory bodies are seeking, then surely the sensible approach would be to re-evaluate our healthcare policies.

I must say that completing the yourSAY survey was rather stimulating. It certainly made me reflect on my diabetes management strategies here in Australia, and I’ll be sharing some more of my thoughts here in the days to come.

If you are a person with diabetes living in Australia, you can complete the yourSAY survey by visiting yoursay.org.au.

A Marathon of the Diabetes Kind

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I hate running. I absolutely hate it. I can remember dreading sports carnival season when I was in school. Although I never stood a chance in hell of making the cut, I still had to try out and run a lap of that dreaded 800 metre track. Despite how slow I was, every year I dreamt of being able to keep up with my classmates. I would start running. I would enthusiastically try to keep up with the others. I would be able to keep running for the first 100, maybe even 200 metres. Even though I felt like I was killing myself to keep up, my classmates just seemed to effortlessly speed past me.

And I was left behind. Then I would give in to my body’s urge to slow down. I would be puffing and panting. I would be able to feel the pulse in my chest, beating ever so rapidly. I would have to walk some of the distance. And if I was extremely lucky, I’d even get to see some of my classmates overtake me on their second lap. Eventually when I was the last one left on the track, everyone would start cheering me on, more out of pity than anything else. I would start to pick up the pace as best as I could, despite my body telling me otherwise. I would cross that finish line, and collapse to the ground with exhaustion. I could never go the distance.

I feel exactly the same way about my diabetes. Diabetes is like running a marathon every day. Except that a marathon of the diabetes kind has no finish line. I can’t slow down because I’m exhausted, emotional and frustrated. I can’t pull out of the race because I know I won’t get the results I want. And I can’t stop running because I don’t like it anymore.

That finish line keeps moving a little further away the closer that I get to it. There are the obstacles of life that get in the way, and keeping that finish line in sight seems nigh on impossible sometimes. There are so many points where I just want to stop running. There are so many points where I don’t know if I can dig any deeper.

But there is one small difference between that primary school race track and the diabetes one.

In a marathon of the diabetes kind, I am lucky enough to have a whole team of people who are cheering for me. Not out of pity because I’m in last place, but because they genuinely care. My wonderful family, for one. The family who believe, perhaps more than me, in my chances of a relatively normal life. And possibly even a cure at some point down the track. My healthcare team. My diabetes educator and my endocrinologist, who I know are on my side. Who I know I can talk to honestly and without judgement. The people in my life who care enough to ask how my diabetes is going, even though the question annoys the hell out of me! And the wonderful Diabetes Online Community, who are a never ending source of support and encouragement.

Diabetes is always changing. Diabetes is always throwing obstacles onto the track, in the hopes of knocking me sideways. But so long as I have people on the sidelines to cheer me along, that finish line will always be in sight.

Photo: A feeling of achievement while running my diabetes marathon at the Royal Botanic Gardens in Sydney this July.

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