Diabetes Educator

An Indescribable Feeling

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“Can I get my hba1c done?” I asked my diabetes educator, the minute I walked through the door.

“I’ll go get the kit.”

I waited for what felt like forever, my attention shifting from a wall clock identical to those in my high school, to a weary poster from the 90s shouting reduced risks of cardiovascular diseases for every 1% drop in my hba1c.

As I sat there, exhausted after a full on day and a week of rollercoaster blood sugar levels, I wondered what my hba1c might look like. I hadn’t set the bar very high for myself. I was convinced I wouldn’t be anywhere close to my personal goal. I’d be lucky just to clear the 7% mark, at best.

Even though we say all the time that we are more than just numbers, it’s so freaking hard not to feel defined by one. Every day, I wake up to numbers. I make decisions based on numbers. I over-analyse numbers. I feel frustration over numbers. My long term health is dependent on the numbers. Numbers are the very last thing I see, before I go to bed at night.

I’d be lying if I said that my last hba1c hadn’t been hanging over my head since August. I’ve poured my blood, sweat and tears into my numbers over the past few months. But as my diabetes educator made her return to the room, I was about to learn that all of that effort had paid off.

“You’re joking!” I exclaimed.

“I’m not.”

“I can’t believe it!” I said to myself, leaning back and shooting both my arms up into the air in victory.

The feeling was indescribable.

Not only had I bested my personal goal, but I had clocked in over a point lower than August, and had set a new personal best.

I felt a million miles lighter. I felt like a weight had been lifted off of my shoulders. I felt like I was sitting on top of the world. I felt free.

I couldn’t wipe the grin off my face as I stepped out into the mild, sunny November afternoon. As I made my way down Hospital Avenue and back to my car, I kept repeating my new a1c over and over in my head.

I made a pit stop at San Churros on the way home for a Spanish White Hot Chocolate. A big plate of Connoisseur Belgian Chocolate Ice Cream followed when I arrived home, as I eagerly told my family the news.

I felt proud. I had fought a gruelling battle to regain some form of control over my blood sugar levels in the past year, and I had come out on the other side stronger than ever.

In that moment, I had won.

Highs After Exercise

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It’s amazing how something as simple as a conversation has given me some much needed clarity in recent weeks.

For several weeks, I’ve been giving corrections to stubbornly high glucose levels in the afternoons after I’d finished work. Highs that have made afternoon tea difficult to manage. Highs that have made my dinner time insulin dose less effective and pre-bolusing a complete waste of my time. Highs that have often carried through to bedtime and even resulting in a disappointing waking number.

I didn’t think that there could possibly be anything wrong with my afternoon basal rate, because I knew that it was fine on non working days. I thought maybe I was disconnected in the shower for too long. I thought maybe I was eating too much at lunch. I thought maybe it was time to give up the toasted sandwiches slathered with butter, and cheese oozing out of the edges. Maybe buy those addictive donuts from Woolies less often?

When I recently sat down with my new diabetes educator and my Diasend logbook, she instantly pointed out a recurring pattern of red readings in the afternoons. I knew that afternoons had been a problem area. I can see the afternoon ascent in my Ambulatory Glucose Profile.

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Yet in all these weeks, I had never really stopped and thought twice about it.

It took my educator’s small suggestion of increasing my basal rate in the afternoons for me to finally make sense of all of this. Could these afternoon highs possibly be an after-effect of my physical activity at work all day? Could my body be responding with extra glucose as I put my feet up in the afternoons and breathe a sigh of relief that the day is over? A quick google search confirmed that this indeed, could be a possibility.

The most incredible thing is the positive flow on effect that this small change has produced in the past two weeks. Since increasing my afternoon basal rate from 2-5pm on work days, I find that my BGLs stay in range through the afternoon. My dinner time insulin dose is far more effective, and I no longer receive frustrating highs after an accurately carb counted dinner. Overnights have also been looking much healthier, which will ultimately account for a large chunk of the hba1c result I am chasing.

As my educator reminded me, I can easily be doing this at home as well. I have the tech that is capable of uploading my data to the computer. I have Diasend, the software that compiles all of my data into one easy to read report.


Judging by my Diasend report that is now looking a little less red, I really need to be making the time to do this more often.

First hba1c Result Post-Pump

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The very last thing that I was expecting to hear was that my hba1c had gone up after three months on an insulin pump.

I mean, I wasn’t expecting dramatic improvement straight away. I knew full well that my pump is not a magic wand. I knew that my glucose levels were fluctuating far too much pre-pump. When we looked at my Ambulatory Glucose Profile with Gwen back in May, she said just as much to me.

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But I definitely believe that this variance is much tighter today. I feel I don’t peak above 15mmol half as often as I used to. Lows aren’t too bad either, but they are definitely a work in progress. I’ve been putting so much work into my diabetes. More than I used to on injections.

So I guess I went in there, mentally prepared to hear that my a1c result was the same. But definitely not half a point higher than my last one.

For a while now, I’ve stared at half decent a1c results. The doctors have been quick to dismiss me, but I’ve never truly felt satisfied with my results. Deep down, I knew that my levels were fluctuating far too much. I knew that I was peaking way too high after meals, and having far too many lows. I knew that my a1c result was not an accurate representation of what was going on with my levels. But I never had the courage to ask for help. I pushed these thoughts to the back of my mind, telling myself I would fix that problem before my next check up in six months time.

But I never quite got around to it.

So, I guess there was a damn good reason for the rise in my hba1c result last week. For the first time in a long time, I have a clear picture of where my glucose levels actually sit. It definitely means that I have made some progress. But at the same time, my goal post feels a lot further away. I am realising just how much hard work lies ahead of me in order to get that a1c to where I want it to be.

As I made a long drive home in peak hour traffic and pouring rain, it was hard not to feel disappointed. It was really hard not having Gwen, who recently retired, there with me that day. She had been with me all the way through my journey, and I’m sure that she would have understood exactly where I was at. I’m sure she would have known exactly what to say.

I dream of the celebratory dinner I’ll have when I get my a1c to where I want it to be. I dream of the satisfaction I’ll feel. The grin on my face. The sense of achievement. The victory. Feeling somewhat in control of this unpredictable disease. And the cake.

I am motivated. I know that I have made some solid progress in these last three months. I know that I am going make it to that dinner table one day.

Goodbye, Gwen

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A diagnosis with type 1 diabetes back in May 2010 changed my life.

I remember how awkward I felt around my new condition at the time. Carefully finding a spot on my stomach and willing up the courage to insert the needle and administer an insulin injection. Standing in the kitchen eating a white bread sandwich at bedtime, feeling uncomfortable as soon as someone walked in and saw me. The way I tried to carefully follow the very vague instructions I had been given upon my discharge from hospital – 20 units of Lantus at dinnertime, 5-10 units of Novorapid at meal times, and a white bread sandwich at bedtime to stop me from going low.

I remember how “different” I felt at the time. The reality that this condition would be around for the rest of my life was still sinking in. Nervously walking into diabetes clinic for the first time, and seeing other patients there reminded me that I was now a “diabetic” – something I felt very labelled by at the time.

It was there that I first met my diabetes educator, Gwen, a straight talking woman with plenty of diabetes knowledge and experience. My Mum was there with me at my appointments, and Gwen made her feel very much included as well. I’ll never forget her famous diagram of the mouth, the liver and the pancreas, as she demonstrated the role of a functioning pancreas when food entered the body. A diagram that she still uses to this very day.


In the months that followed, Gwen went on with helping me to fine tune my insulin doses, so that I wouldn’t need that white bread sandwich at bedtime. When she saw how complex and spontaneous my meals were, she taught me how to carb count. She always made herself available to me outside of appointments by phone and e-mail, despite how busy she was. When my first endocrinologist told me that I had very poor control, Gwen was the first to see the look of disappointment in my face. She was prepared to go and have a word with him, and she made sure that I didn’t see him again in future.

Gwen often reminded me that the first year was biggest hurdle to get through, in terms of education and clinic appointments. Her job was to make her role as my diabetes educator redundant. After the first year or so, I went on managing my diabetes without regular education sessions.

As I began to consider insulin pumping last year, I felt that it was time to touch base with Gwen again. Nerves after such a long space of time were immediately relieved, as Gwen proceeded as though our last appointment was only yesterday. She approached the matter with the seriousness it deserved. She never sought to influence or sway my decision either way, and respected the decision that I eventually made.

It’s hard to imagine starting out on an insulin pump with anyone other than Gwen. Nerves were eased going into it with someone I was so familiar and comfortable with. It was fantastic to be able to chat with Gwen over the phone every day during that first week. I was very comfortable uploading all of my data to Diasend for her to see.

Last week, I had my final education session with Gwen before she retires at the end of the month. Even though there has been considerable distance between our sessions over the years, I still find it hard to say goodbye to someone who’s been there since the very beginning.

Gwen has been a huge part of my diabetes journey. She is the professional who has the time for me. Who sits down with me, and has my undivided attention for a whole hour. Who knows me, and the very hands on approach I take towards managing my diabetes. My GP, although excellent, doesn’t often have the time for me and is quick to dismiss my concerns. I don’t always see the same endocrinologist on clinic days. Too often, they are quick to sign off on my six monthly checkup and move on to a higher priority patient.

There have been a lot of changes over the past six years.

Back in the beginning, I managed my diabetes with a meter, insulin pens and a paper logbook. Today marks four weeks since I first started using an insulin pump. I also have access to a logbook meter, Diasend software to analyse my data electronically, and a FreeStyle Libre.

Back in the beginning, I was a nervous newly diagnosed teenager who used to shy away from his diabetes. Today I am a confident, passionate and knowledgable person who is empowered to make his own diabetes decisions.

In some ways, I feel as though I am reaching the end of a chapter in my diabetes journey. And it feels nice to have been able to close that chapter with Gwen.

Goodbye, Gwen. Wishing you a very happy and fulfilling retirement that you deserve.

The Healthcare Experience

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It’s Day 4 of Diabetes Blog Week, and so far I’ve managed to make my way through all of Monday and Tuesday’s posts, and comment on a fair chunk of them. Today it’s time to tackle the topic I’m most excited about. Here is today’s prompt:

Most people who live with a chronic illness end up with a lot of experience when it comes to dealing with healthcare. How would you improve or change your healthcare experience? What would you like to see happening during medical visits with your healthcare team? How about when dealing with your health insurance companies? What’s your Healthcare Wish List or Biggest Frustration? Today is the day to share it all!

I’m pretty grateful that I live with diabetes in Australia. I attend a diabetes clinic in a public hospital which is completely free of charge, and hooks me up with any related service I need. Private Health Insurance covers hospital care, and the cost of my brand new $9,000 insulin pump (posts to come next week). Diabetes consumables and insulin are heavily subsidised by the Australian government. All in all, I never need to worry about how I will make ends meet with diabetes here in Australia.


My biggest frustration, however, is that I feel my healthcare professionals don’t often have enough time for me. I was diagnosed as a young adult, which meant that getting a grasp on diabetes education and self management was a lot easier. I was quickly weaned off diabetes education as soon as I could manage on my own. My clinic has a long patient list and waiting times for appointments can often span months. My chart probably looks a lot better compared to most of the other patients in the clinic, which means I am pushed out of the endocrinologist’s office as quickly as possible.

But what about if I’m not happy? What if I don’t want to settle for satisfactory? What if I want to do better with my diabetes? What if I have the potential to do better?

Over the past year or so, I’ve really had to learn to stand up for myself and what I want from my healthcare team. During a time of burnout last year, I had to ring up and chase appointment cancellation slots down at the clinic. I had to do the research, attend the information evenings and tell my diabetes educator that I wanted to go onto an insulin pump. I had to make my goal clear in front of my healthcare team, one that was beyond the “satisfactory” point where I was at.

Nobody else was going to help me, even if there was a benefit to my health. There is simply no time for me in a busy diabetes clinic with a high volume of patients. It’s great that I am a “switched on” patient, but the sad reality is that not every person with diabetes is. Not every person is in a place where they are able to speak up for what they want. It can be hard just to accept and become comfortable with this condition, alone.

One person I would like to praise is my diabetes educator. I know that she is under the pump. Yesterday, she told me that she is under pressure to cut one hour education sessions down to 30 minutes. Yet she always makes herself available to me outside of appointments by both phone and e-mail.

I’m still in uncertain territory at the moment with the insulin pump. I’m testing my basal insulin rates overnight, and checking to see whether they keep my glucose levels steady or not. Being able to talk the adjustments through with Gwen over the phone and by e-mail these past few days is a big relief. I haven’t leaned on this kind of support as much in the past, but I know that I intend on doing so in the next few months.

Technology is also amazing. When I was first diagnosed six years ago, I was given a meter and a logbook. Today I have meters that log my blood sugar levels and calculate my insulin doses. I have devices like the Insulinx and the FreeStyle Libre which are computer friendly. I am using the amazing Diasend software, that allows me to upload the data from my insulin pump, glucose meter and FreeStyle Libre into one place. Gwen can instantly see the reports on the other end.

My biggest takeaway here, is to stand up for what you want. Don’t be afraid to lean on your healthcare team, but also the people around you who can encourage you to do so. Your health is so worth it.

To read other posts related to today’s prompt, click here.