Diabetes

Diabetes and Mental Health at #DX2Melbourne

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On Monday evening, the attendees at #DX2Melbourne took part in a live webcast discussing the emotional, psychological and mental elements of living with diabetes. The panel was joined by psychologist Lisa Robins, who has experience in diabetes clinical psychology. I was actually thrilled for the opportunity to address this topic at an event of this scale.

Again, I am only relaying what I heard and talked about as honestly as I can recall…

It was quite interesting to hear one member of the panel comment that during earlier times he thought he was doing okay, but looking back on his journey today he has second thoughts. I actually feel the same way. I never thought that it was okay not to be okay, or to consider the impact that type 1 diabetes can have on my mental and emotional wellbeing. Today, I have no hesitation in saying that I felt isolated, emotional, not very well supported and in hiding from my condition.

Who was offered psychological support when they were diagnosed? A quick show of hands from the panel indicated two or three out of eleven. I shared with the panel that I was visited by a social worker in hospital. At the time, I felt relieved to feel normal and energetic once again. I felt that she was pressing for something that wasn’t there. However, how great would it have been if she had:

  1. Taken my word that I was fine.
  2. Highlighted some of the symptoms that I might expect further down the road.
  3. Pointed me to what other people with diabetes are doing to feel well with diabetes – weekly OzDOC chats, Twitter accounts, closed Facebook groups, forums, in person meet ups and peer support.
  4. Left me her card if I did feel that I needed that professional support.

17 year old me would likely have still ignored it, but I digress…

How do we best approach the issue of mental health? It’s something many of us prefer to stay silent about, and treated like its something to be ashamed of. A lot of us like to prove that we are stronger than diabetes, and in doing so we might ignore our vulnerabilities.

The consensus from the panel was that our healthcare professionals don’t take the time to simply ask “how are you going?” in reference to emotional health. The panel suggested that we need to normalise psychological support within diabetes, building it into our annual checklist with our eyes and bloodwork and feet. I’d also add changing the word ‘health’ in mental health to ‘wellbeing’ or ‘wellness.’

I was also thrilled to hear other panel members praising informal peer support. One panel member shared that in the absence of psychological support, it was peer support that had aided her mental wellbeing for so long.

Personally, online communities were the first form of connection I had to anyone else with diabetes. There is so much knowledge out there that helped me to become better engaged in my diabetes management. Those communities were my bridge to finding in person peer support, both of which help me to maintain relatively good emotional wellbeing today.

Touching on the stigma from healthcare professionals associated with online communities, panel members commented that it was more accessible, and no different from going to a coffee shop. One gem was that online communities complement, rather than replace psychological support.

Diabetes burnout was the next topic, and the panel pondered ways of how we identify those triggers that might suggest we need to take a step further.

I did ask Lisa how well she thought our healthcare professionals would be able to pick up those triggers and refer to adequate support. She was very confident, especially in reference to a GP. My personal view is that the right healthcare professional would be able to identify those triggers, so it’s definitely important to shop around and have healthcare professionals on your team that are meeting your needs.

Instead of trying to fix everything, one gem from a panel member was to instead focus on one element that you can fix. When I’m feeling burned out I might turn off my phone for 12 hours, go outside to ease my mind or go to bed early so that I feel more rested. Take small steps.

Another panel member talked about diabetes as extra years thanks to modern medicine, and all of the wonderful things she’s been around to experience.

Without a doubt, this was the highlight of my time at DX2Melbourne, and a topic that really did need to be discussed. The live webcast will be available on demand in a couple of days, once the camera crew (yes, there was a crew filming us) processes it all together. I will keep you posted.

If you’re in Perth and would like to connect with other type 1s and learn more about mental health in a supportive environment, then I highly recommend that you come along to this event on Thursday, August 24.

Disclosures: Abbott covered my travel expenses from Perth to attend #DX2Melbourne. I was put up at The Blackman Hotel on Monday evening, and was fed and watered across the duration of the event. There was a lovely goodie bag with a FreeStyle Libre reader, two sensors and some branded stationery. There was no expectation that I would participate in this webcast if I did not wish to, nor was there any expectation that I would blog about the event at all!

All About That Basal, ‘Bout That Basal

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I remember those inflatable beach balls that I used to get as a kid. The kind that often came in showbags. Inflatable hammers, mascots, and giant fingers for that matter, too.

They were so much fun. I would muck around, and have such a good time with them for a while.

Then they would begin to deflate. They would get these tiny little punctures that you can’t see, and the air began to escape them. Even though I tried to blow them up again, playing with them just didn’t compare to an unpunctured one. No sooner than I had patched up one of those holes, I would discover another. And another.

At the moment, I feel like one of those inflatable beach balls. I feel like I’m trying to patch up these little flaws in my basal rates, and try to stop my blood sugar levels from spiralling out of control.

Since starting out on an insulin pump, I can quite honestly say that my basal requirements in the early hours before waking have been subject to the most fluctuation. I can recall having to make subtle changes every month, or every second month at the very least. It’s been a steady upward trend, which I usually pick up from my FreeStyle Libre, or when my levels stop responding to corrections during the night.

After steady upward adjustments in recent months, I’ve now found myself waking to a few lows in the early hours. Looking over my Diasend history, the downward trend seems to start out at the 4am mark, so I’ve made some subtle changes again.

I am still struggling to grasp the fact that a basal rate that once held me steady through the night, no longer does. One theory that has been hanging over my head in recent days, is the early morning light coming in through my window. Over the past few months, the earlier morning light could have enhanced my dawn phenomenon before waking. But with the mornings now getting darker, could my insulin needs be heading on a downward trend? Time will tell…

I’ve also noticed changes in my morning basal requirements after I wake up. I usually run a higher basal rate for the first 2-3 hours to combat dawn phenomenon, and I’ve had to jack this rate up by 0.1 units per hour. While the new rate gives me much better coverage, this basal rate still needs some more perfecting. Basal testing, particularly morning basal testing, is hard work. There are days where I deviate from my routine, days where my levels might not be ideal for a basal test, days where I can’t handle more failure, and simply days where no coffee is too hard.

Unlike my last problem, I feel like this one has been triggered by a shift in routine. Which brings me to another theory. I think basal rates are a little bit like a cog in a wheel. When you change something here, it might provoke subtle changes somewhere else in the wheel. I don’t know…I’m just thinking aloud here.

My biggest gripe about diabetes is that it is always changing.

But I truly believe that a well tuned basal, and bolus regimen, is the key to success with an insulin pump.

March on…

My Own Worst Critic

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Throughout my childhood, my parents constantly told me that I shouldn’t compare myself to others. Unless I had done poorly on my Year 12 English exam, in which case it was perfectly okay for them to ask me what scores the other guys in my class had obtained…

It’s easier said than done, right?

When it comes to diabetes, I am my own worst critic.

It’s so easy to feel guilty when I wake up to a number that’s out of range.

It’s so easy to place blame for a hypo that was caused by a lapse of better judgement.

It’s so easy to feel anxious about my future during times when my diabetes management might not be so smooth sailing.

Connecting with, and meeting other people with diabetes has been nothing short of amazing. Everyone has their own, unique story to tell. Everyone is passionate about their story, and the way that they manage their diabetes. I drank in the knowledge. I felt inspired, motivated, and dare I even say passionate about diabetes. I no longer felt so isolated, or so alone when it came to living with diabetes.

However after immersing myself in this world for a while, there also comes a point where I might begin comparing myself to other people.

Why aren’t I going for a run every morning?

Why am I not able to wear a CGM without letting it overwhelm me?

Why aren’t I eating clean?

Why don’t I have that hba1c?

Why isn’t my graph as flat as that one?

Why don’t I practice mindfulness?

Why am I not bursting with energy when I woke up this morning?

As amazing as this world is, there also comes a point where I have to put all of these perspectives into a box and focus solely on my own. 

I am not that person who goes running every morning. I am not that person who is reading my latest blood sugar levels from an array of devices. I am not that person who is eating clean, super mindful and bursting with energy either.

I’m no Matt or Joe or Anna or Angela.

I’m just Frank.

And that’s all that really matters.

The Box of Expired Lantus in My Fridge

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I have this box of Lantus that’s just sitting in my fridge at home. It hasn’t been opened. I’m unlikely to open it anytime soon, now that I use an insulin pump. I don’t really have a need for it anymore, considering that I have five fresher boxes of Lantus sitting underneath it. It expired in October last year.

There’s probably nothing particularly wrong with that box of slightly-out-of-date Lantus. The five pens in that box would likely last me a good two months if I were doing multiple daily injections full time.

That one box in a script of five only cost me around $7, thanks to subsidies through Medicare and the Pharmaceutical Benefits Scheme here in Australia.

Yet I still can’t bring myself to throw it away.

As someone with type 1 diabetes, insulin keeps me alive. Insulin keeps me alive today, and every day for the rest of my life.

I am so lucky to live in a country where I have never had to worry about how I will be able to afford the cost of lifesaving, and very expensive products to manage my diabetes. Yet there are people in less fortunate areas of the world who are unable to access life saving insulin, diabetes supplies and basic healthcare.

While I am sitting in my cosy bedroom reading with lust about the newest advancements in diabetes technology, there are people who don’t even know how they will get their hands on their next vial of insulin.

This February, we in the Diabetes Community are encouraged to Spare a Rose. The premise is simple: buy one less rose this Valentine’s Day, and donate the value of that rose (approximately $6 Australian dollars) to the International Diabetes Federation’s Life For a Child program. The cost of that one rose provides life-saving diabetes supplies, medication, and education that children in developing countries need to stay alive. One rose, one month of life to a child with diabetes. A dozen roses, a year of life for a child with diabetes.

Giving the cost of that box of Lantus to Spare a Rose this February is a no brainer.

Will I finally bring myself to throw that box of Lantus away? That’s a much, much more difficult decision for me to make…

Review: The Fast Diet by Dr Michael Mosley

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I picked up the book The Fast Diet after a lousy day last week, and quickly became engrossed in it.


You’ve probably heard of the author, Dr Michael Mosley, from his show Trust Me I’m a Doctor on SBS (which is an excellent alternative to some of the manufactured reality shows on at the moment). Michael has a family history of diabetes, and began to explore intermittent fasting some years ago when his doctor told him he was at risk of developing type 2.

Better known as the 5:2 diet, the basic idea is that you eat 500-600 calories for two days of the week, ideally incorporating a fasting “window” of 12 hours or more on a fasting day. The remainder of the time, you are allowed to eat normally. Many fans observe that it doesn’t feel like a diet, because tomorrow you’ll be able to eat whatever you want. It’s a sustainable way to lose weight and keep it off. Over time, you’ll better recognise hunger and have less of an appetite for large or unhealthy meals.

The book is peppered with plenty of research, facts and statistics supporting the idea of intermittent fasting. Michael explains that people in primitive times did not eat four of five times a day like we do today. They would feast when they came across food, and would often go without for long periods of time inbetween where food was scarce.

I found it remarkable that the average time inbetween ‘eating occasions’ has dropped by an average of an hour in the last 30 years. Thinking about myself alone, I would struggle to last inbetween meals without having something – even if it’s just a coffee. At school and work, I have been engineered to have morning recess and coffee breaks, which inevitably come with the desire for food. Diabetes mags seem to encourage this notion that we have to keep eating to avoid going low. Michael also argues that the idea of eating little and eating often has been partly driven by manufacturers of snack foods.

Michael explains that while we have food digesting in our system, the body is focussed on growth and replenishment. When the body goes without food for 12 hours, it begins to do something different. It enters repair mode, instead focussed on keeping you in reasonable shape until the food returns once more. It begins doing all of the little maintenance tasks that it has put off until now – things such as breaking down or recycling old and tired cells.

For the record, intermittent fasting is not recommended for someone with type 1 diabetes. And obviously, tending to a hypo trumps a fast.

However, some of the concepts in this book really spoke to me. I really liked the idea of a mental challenge not to graze and stack insulin doses as often as I do. I struggle to get through lunch and dinner without having something – even if it’s just a coffee. I have often skipped breakfast if I’ve had a large evening meal and wait until I genuinely feel hungry again. I have found that this is a great way to “resensitise” my insulin after grazing and stacking, and that I appreciate my food more by the time I eat it. When I think about it, my best days do tend to happen when I’m not frequently grazing and insulin stacking.

Overall, the book was both engrossing and easy to read. For a while now, I’ve been keen to do something that might help me to feel a little less lousy and a little more energetic. And, of course, ensure my insulin is working at it’s best. With a commitment of only two days per week – or even just one – it’s definitely something that I’d be inclined to dabble with.