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T1 Talk: Food, Exercise and Emotions in Check

July 31, 2017 by Frank Leave a Comment

Welcome back to T1 Talk, a series of conversations between myself and Bec of Sweet and Sour Diabetes. The aim of these conversations is to highlight how type 1 diabetes affects two people of a similar age, diagnosed at slightly different stages of life (Bec was a 14 year old high school student, I was a 17 year old freshman uni student).

Haven’t caught up yet?

You can learn more about us in our first post here.

We’ve talked about our management tools here.

Today, we’re tackling the not so technical side of our management – namely food, exercise and emotions. The first half of the chat is here, and the second half follows on Bec’s blog here.

In order to remain healthy, people with and without diabetes often consider food as a fundamental part of maintaining their wellbeing. What are your views on nutrition? How do you include this in your management?

Frank: Food is a really tough one for me. Being Italian, there’s a pretty big emphasis on food. It’s ingrained into our culture. If I don’t eat, my parents notice pretty quickly. If they didn’t see me prepare lunch this morning, they will ask me what I ate. When I go to visit Nonna, it’s almost expected that I’ll have an espresso and biscotti. When we hosted Mum’s family for Easter this year, I spent three days trying to reassure her she had prepared more than enough food.

I love food, and we do have some of the best. Pasta, cannoli, amaretti, cottolette, lasagne….I could go on for days. However, we are talking about diabetes here.

I feel that I eat fairly well. I prepare my own breakfast and lunch most days, and we usually have a cooked meal in the evenings. I drink three milky coffees a day, and usually find myself most peckish in the afternoons and caving in to my sweet tooth.

While nothing is off limits for me, diabetes has certainly made me more mindful of what I’m eating. I’ve cut back on a lot of the sugar laden foods I once ate – cereals, muesli bars, stir through yoghurt pots, and the sugar in my tea and coffee – as well as foods that I realised I didn’t truly enjoy. I am more mindful of the carbs I eat today, and try to balance them out with proteins, fruit and veggies. I would typically eat between 100-150g of carbs a day, which is less than what’s recommended but certainly not low carb.

I feel I have a pretty good idea of what different foods will do to my blood sugars. I’m quite diligent with my carb counting at home, and weigh most of my food on kitchen scales. Even if I don’t know the carb content, simply weighing the cookie and guessing a carb factor of 60% is extremely helpful. I try to pre-bolus by 15-20 minutes if I’m having a higher carb or higher GI meal, but I don’t do this all the time. If I’m having a bit of a cruisier day of eating, I’ll simply set a temp basal rate of 100% on my pump to help me cruise through a little easier.

Bec: I think the idea of tying food into culture is actually lovely, and I definitely don’t experience it. In some ways that’s a good thing considering I’m gluten intolerant and a lot of things would be off the menu if I were Italian!

Eating isn’t my favourite thing. I get a lot of strange looks for this, but I don’t get particularly hungry. I wish I could live off tea and coffee. It’s just a long boring task for me to find something to eat that’s gluten free, work out the carbs, take the insulin and then eat it. That being said there are some foods I actually do enjoy eating, like chocolate, cake, thai food, and risotto.

I think I have the same goal of being a little more organised. I need to increase my carb intake for medical reasons, but it’s hard when you’re not hungry. I also don’t think about food very much in terms of GI and what it does to my sugars. For now though, I’m just focusing on 1) increasing my intake and 2) attempting to count carbs accurately.

Frank: I feel like this gif is relevant in response to eating not being your favourite thing…

(I’m kidding).

Well, I could easily live off coffee (decent coffee, of course), so at least we have some common ground there.

I want to say that maybe you just haven’t found enough of those foods that you enjoy. Keep searching! You don’t need to be European or have a big family to tie food into culture, either. Does your family not have a special dish that brings you together? A meal that you all simply rave about?

Bec: That gif perfectly represents everyone’s thoughts, often followed by measuring the circumference of my wrist…

Well, Mum’s Christmas lunch is pretty great but unfortunately only occurs once a year. My Nan used to make an amazing meal fondly named porcupine rissoles which no one has since replicated to perfection. But hey, I’m always keen to try new food to find something I actually enjoy.

What are your views on exercise?

Frank: I’ve never been the biggest sports person, and that dates back to well before diabetes came along. Our culture has too much of an emphasis on sport and on winning, rather than on just having a good time and doing what makes us happy. I never felt comfortable or encouraged playing sport because I wasn’t the best, while being on the debating team in Year 10 earned me a great deal of sniggers.

Most of my physical activity would be incidental or recreational activity. Fortunately my job as a Warehouse attendant keeps me fairly active. I do dread the day that I get a job sitting behind a desk, because then I’ll probably have to start doing some form of exercise. I also enjoy going for walks in the afternoon, and keeping this little man entertained when he comes to stay with us.

Bec: Ugh. Exercise. I get it to an extent, when I go on walks I do get that adrenalin rush, and it is a good way of staying present. But organised sport is a recipe for disaster. I hated it because I wasn’t perfect at it. You might have gotten sniggers for debating, but I WISH I could have done that at school! It was just so sport focused the only outlet I had was choir (a sequined experience involving dodgy dance moves that I’d rather forget).

I agree we are heavily focused on sport as a culture. I don’t mind it in some ways, after all I do follow the NRL off and on. But it’s not a core part of my life. I also agree that it’s important not to be so focused on winning. It has no appeal to me because I’m too uncoordinated to be perfect at it. Really though, perhaps I should be thinking about shifting the focus off perfect and on to fun.

But taking it back to diabetes, exercise makes me hypo. Very hypo. But I try to keep up the walking in spite of it, because I don’t have as much incidental exercise as I would like. Then again, I make up for it on hospital placements. So. Many. Stairs.

Aw, you certainly have a good motivator there! How can you resist walking that little guy?

Frank: I’ll never truly understand how Australia came to have two different footy codes. Clearly, AFL is where it’s at. I had my hopes up for Freo a few years back, but it’s looking very unlikely nowadays…

Urgh. Exercise hypos. Such a pain, moreso with the insulin pump. You even have to remember to adjust your basal rate for housework!

I’d be keen to hear more about managing diabetes on placement…would make a great blog post.

The second half of this chat moves onto emotions, so head on over to Bec’s blog to continue reading here.

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Posted in: T1 Talk Tagged: Emotions, Exercise, Food, T1 Talk

Dawn Phenomenon, Breakfast, Physical Activity and Diabetes

September 19, 2016 by Frank 8 Comments

A couple of months ago, I wrote about the relentless hypos I was having at work. There have been days where my blood sugars have been bouncing up and down like a yoyo. The smallest insulin correction would be enough to send me plummeting within half an hour. My Libre would then show me rebounding after a hypo (and I now know that the Libre tends to pronounce movements in my BGLs). I would have the urge to correct it again, only to end up low once again. This seemingly vicious cycle made it impossible to obtain a steady line while I was at work and left me feeling exhausted at the end of the day.

↗️⬆️
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↘️⬇️
?
↗️⬆️
?
↘️⬇️
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???
➡️#diabetes

— Frank (@FrankSita) August 23, 2016

The one thing I genuinely do miss about injections is that insulin sensitivity during physical activity was hardly an issue. I don’t remember having to pay half as much attention to my diabetes at work while I was on injections. I’ve felt very conscious of the number of times I’ve had to tend to diabetes in a day. Unlike a Lantus injection, my pump delivers basal insulin in tiny amounts throughout the day as I’m working. In addition to physical activity, dawn phenomenon and breakfast boluses are also thrown into my morning diabetes equation.

After a lot of trial, error, and notes in my diary, I finally feel as though I’ve got my mornings down pat in recent weeks.

The obvious one has been making sure that my basal rate is right. I cannot stress how difficult morning blood sugar levels are to manage if I do not wake up in range. No amount of correction seems to be able to fix them, and I end up really grumpy at 8am as I see my levels soaring after breakfast.

A couple of weeks ago, I noticed that my levels were climbing at around 3am each morning, warranting a change in overnight basal rates. Until that was fixed, I wasn’t able to properly focus on the mornings. Another thing I’ve learned is that my waking basal rate (when my liver begins dumping extra glucose) needs to run for at least a full hour before I wake up. Even a gap of 15 minutes is enough to screw up my morning basal test. Going on intuition seems to have done the trick in fine tuning the remainder of my morning basal rates.


Breakfast really has been a case of trial and error. I’ve learned that I do not need to subtract any carbohydrates from my breakfast insulin dose. Subtracting 5g from my breakfast dose is the difference between a post prandial result of 9mmol or a post prandial result of 15mmol. My pump will also add a correction dose to my breakfast bolus if my blood sugar level is over 7mmol. 


I’ve learned that I need to ignore it unless my blood sugar level is above 8mmol, and that I need to subtract insulin accordingly if my blood sugar is lower than 6mmol.

Morning coffee at work normally happens anywhere between 8.30 and 9am. My medium cappuccino with no sugar probably has around 15g of carbs, 10g of which I do not need to bolus for. It’s been so hard to wrap my head around these tiny insulin doses, but they are indeed enough! Pre bolusing is also not necessary, as I slowly sip my hot coffee when it first arrives.

Morning tea comes anywhere between 10 and 11am, and is usually a banana which is weighed before I leave home. Again, bolusing for 10g less carbs seems to do the trick, as do the rules for correcting.

Not foregoing what I love in the mornings has been really important to me. It would have been easy to simply forego breakfast or the morning coffee, but I know that would have made me unhappy (and hungry!). I work diabetes around my life and my activity, and not the other way around.

It’s been a lot of hard work, but I do genuinely feel that I have my mornings down pat. Instead of going up and down multiple times in a day, it might happen 2 or 3 times in a week. Levels are also looking great, thanks to continued pre bolusing and my moderate carb approach. I plan on taking a break from my Libre after today, and I’m quite confident that I will be able to manage just fine on finger sticks for a while.

I’ve been nominated for a Wego Health Activist Award. If you enjoy reading my blog, I’d really appreciate your endorsement which you can do by clicking here. 

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Posted in: Diabetes at Work, Diabetes Tech, Hypos, Insulin Pumps Tagged: Banana, Coffee, Diabetes, Exercise, Insulin Pump, Physical Activity, Work

Highs After Exercise

August 29, 2016 by Frank 4 Comments

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.

Screen Shot 2016-08-28 at 5.03.38 PM

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.

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Posted in: Diabetes and Healthcare Professionals, Diabetes at Work, Diabetes Tech, Insulin Pumps Tagged: Basal Rate, CDE, Diabetes, Diabetes Educator, Diasend, Exercise, hba1c, Physical Activity

Logging My First Big Blue Test!

October 23, 2015 by Frank Leave a Comment

I’ve never truly understood the big obsession with Fitbits and step counts and runkeepers. That is, until I opened the Health app on my iPhone about a month ago. That nifty little app has been logging my step count all year long without me even knowing. And looking at the stats, they’re a little embarassing. I can see a huge peak during the month of July, when I was galavanting around Canberra and Sydney having the time of my life (which seems like a lifetime ago, mind you). Then there are some massive slumps on either side while I’ve been back at boring old home.

I’ve been working on getting my step count up over the last month, going for walks most afternoons. Even factoring in the steps that my iPhone doesn’t log while I’m at work (and I would log a lot during my work day), it’s still incredibly hard to reach 10,000 a day!

Which brings me to the Big Blue Test. The Big Blue Test is a program of the Diabetes Hands Foundation, the guys who are also behind the wonderful TuDiabetes community. The Big Blue Test helps to raise money for diabetes charities that provide life saving supplies, services and education to people with diabetes in need.

It’s as simple as testing your blood glucose.

IMG_0564

Getting active for at least 14 minutes of physical activity. If you hate exercise as much as I do, physical activity can be absolutely anything. Also coincidentally wearing blue for Blue Fridays (and being a good diabetic by wearing socks on my feet, of course).

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Testing your blood glucose level again. Hopefully you see a nice drop in your BGLs after exercising like I did in this instance!

IMG_0579

And then logging the details at www.bigbluetest.org or by downloading the Big Blue Test iPhone app. It will literally take a minute of your time, for a series of activities that you probably do already.

Each Big Blue Test that you log between now and November 30 will trigger a $1 donation to diabetes charities. There have been 101,500 Big Blue Tests completed since 2010, this year we are hoping to reach 110,000.

So get testing this weekend.

long

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Posted in: Diabetes Advocacy Tagged: BigBlueTest, Diabetes, Exercise, FitBit, Physical Activity, Step Count, Steps
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