Partying with the pump

Englebert is a complete star
Englebert is a complete star

Hello beloved Shoot Up readers and a belated happy New Year to you all! I hope you had an enjoyable winter festival and, if you use the Gregorian calendar, a wonderful New Year.

Being pseudo-Scottish, I don’t do New Year. Instead I do Hogmanay, which is pretty much the same as New Year celebrations but with considerably more whisky and puking. For a change this year Katie and I decided to avoid the hideous scrum that is the centre of Edinburgh on 31st and instead hired a cottage in the foothills of the Highlands for the week over Hogmanay. For company we also invited our good chums Sheena and Stephan to ring in the New Year with us.

While I might like to say that the four of us used our time together to discuss the issues of the day, visit cultural attractions or enjoy poetry recitals*, we didn’t. Essentially we had a traditional Scottish (though three of us are English) three days of trying to eat and drink as much as possible. This aim we achieved with some degree of success.

As we all know, eating and drinking a lot of stuff at irregular times can be a diabetic nightmare. However I think me and my new best mate – Englebert Pumperdinck – tackled it all with gusto.

A typical day in the cottage involved eating a late, high carb dinner (use square wave bolus to iron out highs and lows); dancing round hi-fi (match booze intake with energy used, check BG regularly); late night and late rising (different pre-programmed basal levels through night took care of dawn phenomena problems); walking to pub (temporarily reduced basal for two hours); pint of Guinness (slip in 1.3 units); another pint of Guinness (another 1.3 units); walk home from pub (another temporary basal); rinse and repeat ad infinitum.

As a result of the flexibility which Englebert afforded me, I managed a week of difficult potential diabetic issues with only one hypo and not that many highs. (I have chosen to ignore the Boxing Day Trifle Incident in this article, which saw me struggling with a BG of 20+ for six hours. The less said about that the better).

While pumps are definitely not a wonderful panacea and are certainly hard work to set up, I was seriously impressed with the flexibility it gave me during my first holiday and non-routine days since being on it. Good old Englebert! It was worth the wait.

* we did actually have a poetry recital, in that I read aloud from my new copy of William McGonagall’s collected works. If you’re not familiar with his work, check out his wonderful poem The Tay Bridge Disaster (http://www.mcgonagall-online.org.uk/poems/pgdisaster.htm)

Kangaroos and armadillos – a story of HbA1cs

Beware, what follows has somehow turned into a slightly bizarre piece using animals to illustrate HbA1c result variations. I don’t know where in my mind this came from but bear with me, the real point is that my pump and CGM have made a real difference to my long term diabetes control.

A year ago I graphed my HbA1c results for the first timeand was pleasantly surprised (read absolutely gobsmacked and delighted) with the results my pump and CGM had helped me to achieve.

Pre-pump the graph looks like the results of an Alison vs kangaroo wrestling match. If I tried really hard I could tie that kangaroo down and get my HbA1c around 6.5. Once, I managed a particularly brilliant left hook and floored it to 6.2. Sadly, as kangaroos and HbA1cs are apt to do, the damn thing always bounced back up to around 7 whenever I took my eye off the metaphorical kangaroo.

Then I got the pump and CGM and the graph looks like I taught the kangaroo to ski (yes, I am starting to regret this bouncing kangaroo analogy but its too late now). The downhill ski slope 4 months after starting on the pump was the last significant gradient. From then on the kangaroo lost it’s bounce and became more of an armadillo, wandering gently through the meandering flatlands that made up the next 2 years. My HbA1c flatlined, the slight twitch as it varied between 5.5 and 5.8 the only real sign of life in the graph.

Recent forum debates about whether anyone had graphed the impact of pumps on HbA1c prompted me to carry out my first annual graph update. The result leaves me feeling a bit like Mary – just a little contrary.

I’m delighted to see that there’s been no change; I’ve flatlined for another year with HbA1cs between 5.6 and 5.8 and no significant hypo issues. If I didn’t know better I’d swear I must be dead, such HbA1c consistency is not something I’ve been used to over the last 27 years of diabetes. I still have bad days, random blood sugars, hypos, times when I forget to bolus and times when I’ve had enough of the whole thing, but they’re much rarer now. I’ve found the tool that lets me manage my diabetes as I want to and the kangaroo, if not quite dead, is certainly enjoying a long hibernation period.

So why do I feel so contrary? It leaves me with little more to say on the subject than I said a year ago. What use is that when I’ve got a blog to populate?

Review – LifeScan OneTouch UltraEasy

The teeny-tiny UltraEasy
The teeny-tiny UltraEasy

Received opinion says that good things come in small packages.

This is clearly not true, I can think of loads of things that come in small packages which are simultaneously small and completely rubbish.

Chief amongst these would be a certain ex-girlfriend of mine who was somewhat height-challenged. She was a small package but she most certainly was not good. Think of a ball of seething, dwarfish spite and misery. A hateful being who sapped the joy out of every situation whatever the circumstances. An absolute delight in other words.

Other small things that leap to mind are wasps (hateful little bastards), midges (a source of misery for me and my apparently oh-so-tasty flesh) and jockeys (nasty people who whip horses – the best of all the animals).

So it was with unmitigated surprise that I actually quite liked LifeScan’s teeny-weeny OneTouch UltraEasy blood glucose meter.

In terms of features, it doesn’t really do all that much. Essentially, it sucks your blood and spits out a blood glucose reading. It doesn’t come with the usual useless back-light, but it can give you average readings over a few weeks or so, which is quite handy when you want to be smug about how good your averages are.

The main feature, attribute and benefit for the LifeScan OneTouch UltraEasy (do they not believe in spaces between words?) is therefore its size. It’s very, very small and so can be easily concealed; much like the hidden handgun and swordstick you carry to guard yourself against ambush by rival cartels. So that’s handy.

Not being the leader of an international drug gang (mores the pity) I actually keep my UltraEasy in my cycling backpack, which I keep constantly ready with a meter and a stock of sweets and Lucozade, etc. Just in case I want to sit in the garage looking at my bike. In a deckchair. With a glass of wine.

The meter uses LifeScan’s standard test strips, which require a fairly small sample and suck up your precious life-gore very easily. The finger-pricking device is small, looks quite funky and is also nice and compact.

But it gets better – the UltraEasy comes in different colours! You might think I’m being sarcastic (for once) but this is actually quite a good feature. I test my blood glucose four, five or six times a day and, frankly, I get bored to tears looking at the same meter over and over again. That’s probably why I use so many meters – sheer, unadulterated boredom.

While you can get the UltraEasy in standard primary colours, I think there would be a huge market for clip-on fascias for all meters – just like you get for mobile phones. So sign me up for a Union Jack cover for mine! Oh yeah, baby!

So in summary:

Sample size > 3/5

1.0μL

Test time > 3/5
5 seconds

Test strip calibration > 2/5
Yes, it’s required with each batch

Test strip slurpiness > 4/5
Very good

Memory > 3/5

500 tests

Sexiness > 4/5
Small and sleek

Beeping > 5/5
Yes, can be turned off

4am test > 2/5
No backlight

Grand total: 26/40

Read about our tests and criteria.

In defence of multiple daily injections

As we all know there are a few choices when it comes to managing Type One diabetes. We can rely on multiple daily injections (MDI), using a pump or other solutions – such as homoeopathy. The latter option usualy results in a slow, lingering death and other answers, such as inhaled insulin are just rubbish. So it’s basically down to MDI or pumps.

For the last wee while, pumps seem to be given as the must-have diabetic accessory. Without one you’re seen as a throwback to the early 20th century, having little progressed from the days of Banting and Best. Essentially you’re the diabetic equivalent of the caveman (or, of course, cavewoman) – a drooling, half-mad imbecile pitied by the pump-wearing community.

Well, the tide has turned my friends as I’m coming out in support of MDI!

“For God’s sake, why?” You may ask. Well, in my view MDI has a lot going for it. No, it really does.

The main benefit of MDI is its simplicity. There’s no complicated machinery for one thing. I haven’t been able to set the timer on any video player or DVD recorder I’ve owned for the last ten years. That I might be put in control of a complex device on which my life wholly depends is frankly terrifying. If I had a pump I would end up with the diabetic equivalent of my favourite program being recorded over by a repeat of Masterchef – as happens with monotonous regularity with my video (whatever the diabetic equivalent of that could possibly be…)

Second; MDI is extremely portable, robust and virtually indestructible. Should I choose to go out hoola-dancing in a grass skirt on a tropical island (now that’s going to be a hard image to shift…) then I can do that without the slightest difficulty. A quick squirt of humalog and I’m away. There are no problems wondering where I’m going hide my pump in my grassy skirts or whether the mile of tubing I have attached is going to pop out during the wild equatorial festivities.

It’s also worth remembering that contrary to popular belief you can actually maintain very good control with MDI. I don’t like to brag (well, actually I do) but my last five A1C’s have all been 6.5% or below – all achieved by just using simple old humalog and basic lantus. By carefully adjusting the long and short term injections you can get a really good balance that’s just right for you. If you can do this with basic equipment then why bother with the expense and complications of pumps?

So there we have it – MDI rules and pumps suck! Comments below please – bring it on!

Comatose and rotting toes – the lighter side of insulin dependency