Shoot Up or Put Up

The OneTouch, not shagging other meters

Lifescan’s OneTouch Ultra2 is my current meter of choice and I don’t really know why.

Like a long-term relationship between partners who don’t love each any more, yet can’t be bothered to go to the effort of breaking up, I’m almost completely ambivalent about it. My Ultra2 isn’t really too bad, certainly isn’t abusive and hasn’t been sleeping around with other meters, so I just trundle along with it every day. There’s just no need to get another meter.

On paper at least the Ultra2 is perfectly fine, at 5ul the sample size is okay, but not exactly market-leading. The test time of five seconds is bearable but, again, nothing spectacular. It has a back-light, the colour of which – through lots of association – I instantly associate with night-time hypos (very odd that – a colour being associated with a physiological action; I guess it’s like ersatz synesthesia . Possibly.)

Anyhoo, it’s quite nice to look at, is relatively small and is pretty simple to use. The infernal beeping can be turned off and it does pass the 4am hypo test pretty well. It’s got a pretty big memory for your readings and can be hooked up to the obligatory PC software for further analysis, which is nice, but something even I (as a dedicated computer geek) can never, ever be bothered to do.

So there we have it – the Ultra2 is a perfectly fine meter, it’ll never set the world alight but it does what it’s supposed to.

However, having written this review, I’ve realised it’s a relationship I no longer want to be in, so as soon as I’ve updated my prescription I’m leaving the Ultra2 forever and running off with the sexy, young thing that is the Abott Freestyle Lite – wish me luck!

Sample size – 3/5
0.5μL – fine, I guess.

Test time – 2/5
5 seconds – meh.

Test strip calibration – 0/5
Nope, no automatic calibration

Test strip slurpiness – 5/5
Equal with the best on the market

Memory – 4/5
500 readings – not too shabby

Sexiness – 3/5
A little plain-Jane but bearable

Beeping – 5/5
Can be turned off

4am test – 3/5
No worse than any other meter without a test strip light

Total – 30/40

Check out the manufacturer’s web site or read about our reviews.

I went to London for work yesterday. Not a major event really, I go a few times a month and it’s only a couple of hours by train. For some reason though the world was against me yesterday.

- 0630: Leave the house.

- 0635: Return to the house having remembered that I haven’t picked up my meter.

- 0705: Get to the station and ladder my tights getting out of the car.

- 0715: Get on the train and spill my hot coffee on my leg, luckily though I haven’t changed the laddered tights yet, so at least that’s something.

- 0800: Go to the bathroom to change my tights. Somehow during this escapade I manage to pull my infusion set out.

- Because I’m a bit of an idiot and am allergic to carrying lots of junk around I don’t carry a spare infusion set when I’m only out for the day – bad diabetic!

- Because I’m not a complete idiot, I do carry a syringe so that I can get insulin out of the pump should I accidentally remove an infusion set on a train.

- 0805: Stop muttering about the infusion set nightmare and get on with dealing with it.

- 0806: Realise I’ve forgotten what it’s like to use a syringe in public – the man opposite me looks at me a bit strangely as I disassemble my pump and use the syringe to draw insulin out of the reservoir.

- 0807: Wimp out of starting a diabetes education session with the man opposite as my brain is occupied with calculating how much to inject to compensate for the basal I’m going to miss, conscious that I have an important meeting at 1100 that I don’t want to hypo in.

-  0808: Realise that my diary is back-to-back with meetings pretty much all day which will make injecting every couple of hours a bit of a nightmare. Decide to keep an eye on CGMS, aim to inject every 2 hours and deal with problems as they arise.

- 0820: Realise that for all the time I’ve been dealing with the infusion set issue and wondering how I’m going to keep myself alive for the next 12 hours the woman across the aisle has been doing her make up. Why can’t my life be that simple?

- 1127: CGMS alarms to tell me I’m high. Normally I’d press a button for a quick bolus of insulin and no one would notice, but my only way of getting insulin is to take my pump apart and use a syringe. I decide that my kidneys won’t fry from sitting in excessive glucose for the 30mins it’ll take to finish this meeting.

- 1200: Most important meeting of the day is over and CGMS shows 14.6. I resist the instinct to just press a button on my pump and get the syringe out again for a splash of insulin to correct the high and some more basal to cover the next few hours.

- 1405: Why can I smell insulin? So that I can keep track of how much insulin I’ve injected, I’ve been bolusing the same amount on the pump every time I inject. This info is incredibly helpful but as the infusion set isn’t actually in my skin all this insulin is running down my leg and my tights smell of insulin. Nice!

The day continues – check CGMS; thank the god of diabetes tech for CGMS which makes this whole palaver slightly easier; inject; do my job; repeat.

- 2000: Arrive home and insert new infusion set, I feel whole again! Blood sugar is 13.8 which isn’t at all bad after a busy day of managing with only fast acting insulin and a syringe.

- 2245: Jump out of bed to put a couple of new syringes in my handbag for any future emergencies.

- 0257: Remember that I know someone in the London office who also has a pump and who could probably have given me an infusion set. Idiot!

I start with a word that sounds like I’m about to stop living
My middle is a wager I might make on a horse
I end with a flea-like creature

That’s right; I’m a Di-a-be-tic. Or am I?

When I was a child I was a diabetic. Later the trend changed and I morphed into being a person with diabetes. Since I’ve started blogging I’ve also added pancreatically challenged to my list of labels. And that’s without even starting on the good diabetic/bad diabetic debate. But does it really matter what we’re called?

My initial reaction was that it didn’t matter either way. It was only when I heard other people try to label me that I suddenly became interested.

My attitude really shifted when I heard a group of healthcare professionals talking. There was a lot of talk of “What you find with diabetics is that…” and “Diabetics don’t respond well to…”.  

I hate being referred to as part of a group like that. While I know I have a lot in common with – and learn a lot from – the people reading this blog, I know that we’re also completely different. While its lovely to know that I share a disease with Tim, CALpumper, Sam, Ckoei, Mark, Scott and all our other readers, I expect my healthcare team to recognise that my attitude, needs, quirks and expectations are unique. We can’t all be treated the same.

As an aside, perhaps we could prove that we’re all different by all taking 5 units of fast acting insulin at 1700 BST today and eating a cheese sandwich made with 2 slices of wholemeal bread. Two hours later we can all record our glucose levels. If you are unconscious due to a hypo at this time or battling with high blood sugars you are permitted to record your result once you’ve regained consciousness. That should show just how different we all are. (For the record, because you can never be too careful where medicine and sarcasm are concerned, this is a joke, please don’t do it, I’m being facetious to prove a point not trying to set up a mass international hypo-athon!)

If I’m talking to other people with diabetes, I tend to say I’m diabetic because they know that I’m a person too, I don’t need to spell it out. Other than that I usually say that I have diabetes, it seems to infer that it isn’t the only thing about me. So what am I? I’ll probably just settle for being Alison, that seems to sum it up.

I’m Alison’s pump. She talks about me a lot so I’ve hi-jacked the blog to tell my side of the story. I don’t have long because we’re not apart often so I’ll get straight to it.

I’ve been with Alison for over 2 years now and overall I’d say we get on well. She’s a very enthusiastic owner, she makes me blush at times the way she raves about how fantastic I am. And so she should, I have integrated CGMS, I’m at the forefront of diabetes tech. Personally I don’t think she uses all of my capabilities – I’m sure she could spend more time downloading and analysing all the data I collect for her but apparently she has a life she wants to live.

Most of the time I get to sit in pride of place on her waistband, although don’t think I haven’t noticed that for parties that involve a posh frock I’m relegated to the bra, out of sight. That doesn’t do a lot for my ego.

This job has some good perks. She’s taken me white water rafting, sailing and on safari. I like it that she never leaves me behind although it was a little embarrassing when she spotted one of my friends in the middle of the Costa Rican jungle. Despite it’s owner speaking no English I had to endure the shame of her and Alison attempting to compare pumps via the medium of mime. I was willing my battery to run out so I didn’t have to witness the humiliating spectacle any longer.

I don’t want to sound ungrateful, Alison’s a good owner, but she can be a little hard to live with at times.  

She has a tendency to shoot the messenger. I can’t predict how she’s going to react when I have to tell her that her blood sugar is too high, it’s like Russian roulette. If we’re in public I’m generally safe, she’ll acknowledge the high and put some more insulin in quickly and discretely. If we’re alone it’s a more hit and miss affair. Sometimes its fine, other times there’s furious muttering and occasional violence. Thankfully she’s only thrown me on the bed so far but she does talk about pitching me out of the window which I think is an unnecessary over-reaction. At times like this I fear for my safety.

There’s one thing though that hurts above all else. She thinks I don’t know, but I’ve seen her looking round at other pumps, seeing if there’s anything better on the market, eyeing up my replacement. I know I’ve got less than 2 years until I’m out of warranty and then what? I need to start planning for my future.

The things I know about Alison you wouldn’t believe. We’re rarely apart; I know everything about her, what I’ve told you so far is just a taster. If you want the more salubrious bits, please send money. I have to fund my retirement somehow.

A Royal Infirmary, yesterday

Last week, I missed my first ever diabetes-related appointment at my local hospital. Prior to this mishap I tutted angrily to myself when I read about people who were too lazy to bother turning up for appointments – wasting valuable medical staff’s time and costing the NHS. But now, sadly, I join the serried ranks of Bad People.

<rant>

In my defence, such as it is, the appointment was for an eye check-up during which they spend ten minutes taking a high-resolution (and surprisingly interesting) picture of the back of my eyes. The appointment is generally very quick and is usually included as part of my usual annual review up at the Royal Infirmary.

However, for some utterly inexplicable reason the eye check up is now done separately from everything else – the A1C, foot check and all that jazz that we know and love. This means more trips up to hospital each year.

If you are not familiar with Edinburgh (and you should be, it’s a lovely city), the Royal Infirmary is a newly-built hospital on the very outskirts of the city and is a complete and utter pain to get to. I usually take a morning off work to bus / taxi there for appointments and it costs both me and my employers time and money to get there.

Like a considerable number of Type Ones, I’m in full time professional employment and hold a responsible position acting for clients all around the world (no, really, I do); continually dropping everything and spending mornings up at the hospital is just not practical or sensible.

So which hair-brained dolt thought that it was a good idea to split the various care-functions into different appointments throughout the year? The moron who put this into place should be nailed into a barrel with two pissed-off starving jackals and rolled down a bloody steep hill.

We’re continually told that we shouldn’t let diabetes rule our lives and how we should allow diabetes to work around us. However, if our own health service is apparently conspiring to make life as difficult as possible for us pancreatically-challenged masses, then this will remain a hopeless pipe dream.

</rant>

If you’re reading this up at the ERI – sorry I missed my appointment.

My fair city of Edinburgh is currently in the grip of the Edinburgh International Festival and Fringe. For those that don’t know, the city plays host to the world’s largest arts festival. Each August a bewildering number of plays, dance routines, comedy shows, musical extravaganzas, street performances are put on in a warren of tiny, damp, uncomfortable venues scattered around town.

Every year we’re subject to a vast range of performances, ranging from the truly brilliant and inspired to the truly awful and downright bizarre. And not being one to miss out on anything, I thought we could all club together, hire a venue and put on:

Diabetes: The Musical!

It would be brilliant and would chart the daily highs and lows of being diabetic in the modern world through the medium of cheery song and dance. And I’ll think you’ll agree, there’s no better medium for broadcasting information about life-threatening chronic conditions than cheery song and dance.

I expect some of us can carry a tune (though actually being able to sing is probably just an optional extra); I did a bit of theatre lighting and sound at school; and my wife is very handy with a sewing machine and could knock-up colourful costumes. So we’re sorted – all we need now are lyrics.

It’s early days yet, but here are a few rhyming couplets I’ve knocked out so far that could form the basis of some songs:

It’s morning and I’m feeling low
I’ve got a busy day and I hope I don’t hypo

My friends just say I’m just sweet
But without insulin I’m incomplete

It’s true that on the blog we’re sometimes outspoken
But that’s just because our pancreases are broken

Some people think it’s just an affection
But we’re dead without our daily injection

When I was high I used to be a grump
But that’s a thing of the past now I have my pump

So there we have it – further suggestions below in the usual place. I think with only a tiny bit more work we’re only one step away from a sure-fire five-star Festival hit!

Bad diabetic?

When I meet other people with diabetes or even just people who think they know a bit about it, they often make a judgement about my diabetes. “Oh, you’re such a good diabetic” or “you’re such a bad diabetic because you’re eating that”. Whilst my overwhelming urge is to tell them it’s my diabetes and they are only allowed to make judgements about it if they take it away from me and live with it for a day, it did get me thinking.

What kind of diabetic am I?

• My HbA1c is great and has been ever since I got my pump – good diabetic
  
• I use a pump – in some peoples’ eyes this makes me a bad diabetic because they’re expensive so I’m a drain on resources. I’m often tempted to poke these people in the eye whilst gently explaining that I’m worth it.
• I change my lancets on bank holidays and when the clocks go forward and back. Other than that I only change them when I realise they’re hurting – bad diabetic
  
• I always change my infusion sets every 3 days and I rotate them round my body lots to avoid under the skin scarring – good diabetic
  
• I attend all my annual check ups for eyes, feet, kidneys etc – good diabetic
  
• I do like to whinge about having to attend all these annual check ups and about having to sort out my regular prescriptions – bad diabetic
  
• Despite occasional whinging, I do try and look on the positive side of diabetes - good diabetic
  


Good diabetic?

• I spend a lot of time in bare feet and have just spent 2 weeks sailing when I barely went near a pair of shoes – bad diabetic
  
• I don’t keep a log book; I know it’s sensible I just hate doing it. As a child I really hated it when my Dr would look through my log book and say “Why do you think you were a 17 a week last Thursday?” I’ve been rebelling against keeping a log book since my late teens – bad diabetic
  
• I like chocolate but I know how to eat it in moderation and adjust my insulin to cope with it. Some people think this makes me a bad diabetic. A man at a conference once told me I’d go blind because I was eating a chocolate brownie. I shut him up by telling him my HbAlc and was very tempted to eat a second brownie just to irritate him.
• I blog about diabetes – thus improving my own emotional state and hopefully occasionally helping others – good diabetic

I (modestly) think I’m a good diabetic with just enough bad diabetic tendencies to make me tolerable. I do the important stuff and get the right results, but I’m very impatient with the amount of fuss involved and only do things I can see a real benefit in doing.

What about you, good or bad?

Do I really believe that?

When I was a child my mother used to carry an uncooked baking potato in her handbag. She knew that potato contained 30g of carbs. When my meal arrived in the restaurant she’d get the raw potato out of her bag and compare it with the one on my plate. Ta-da, a very early version of carb guestimating technology.

Now, I will admit that it isn’t practical to carry in your bag a ready weighed version of all the food you intend to eat. I’m the woman who whinges about the amount of diabetes junk I have to take on holiday, a life size specimen of all foods I may encounter certainly isn’t going in my hand luggage.

Over the years lots of people (ok, more than 10, less than 100) have said to me that we should campaign for all restaurants to publish carb counts of their food. Sounds sensible.

However, I’m a big fan of self sufficiency. I don’t want to be dependent on someone else publishing carb counts when I go out. Surely it’s better to learn the skill of guestimating carbs with the help of a good book and some trial and error rather than rely slavishly on companies to publish the data? That way, you can go anywhere.

I’ve already recounted the Chinese dumpling banquet debacle. A label on each dumpling wouldn’t have helped, there’s no way I would have believed they contained so many carbs and I wouldn’t have been brave enough to put in the full bucket of insulin required.

McDonalds do publish carb counts and if I inject according to their carb count I’m on the floor within 2 hours begging for sugar. I’m sure it’s factually correct; it’s just that the fat content is so high it slows the absorption of the carbs. It doesn’t tell you that on the box.

I’m all for a bit of help to make life easier. However, I also like to pick my battles. Getting CGMS funded by the NHS? I’ll fight til I drop. Getting insulin pen needles on prescription when the Govt refused in the early 1990’s? Done it. Campaigning to ensure that all people with diabetes have access to decent patient education and support? Oh yes. Pushing water up hill to get all restaurants to publish carb counts? Nice to have but if I put my efforts into getting decent education and support for people with diabetes, this one almost becomes an irrelevance.

We’re just back from a fantastic fortnight sailing around the beautiful Aegean Sea. We were around the islands where Mamma Mia was filmed so the poor husband is still recovering from being tunelessly serenaded with Abba tunes most days by yours truly! Reading through the comments it looks like Tim’s had plenty of company while I’ve been away but I know that you must have been waiting impatiently for me to answer the questions I posed before I went away.

The wait is over, here we go.

• Disappointingly Greek beer has a greater impact on blood sugars than Croatian beer. I don’t know what the Croatians do to their beer to make it so diabetes friendly but I needed about a unit a glass to cope with the Greek stuff.
• I’m proud (and slightly surprised) to say there was no full on diabetes tantrum prior to departure, but I did allow myself the luxury of a little diabetes grumble whilst packing the seven tonnes of junk needed for a fortnight’s diabetes care.
• And the answer you’ve all been waiting for, how many pump related sailing injuries did I endure? Drum roll please…just the one bruised knee from catching the pump on the rope that hoists the main sail and one infusion set ripped out whilst mooring one evening. Other injuries included a bit of a rash on my back from using extra strong sticking plaster to keep my sensor attached amidst salt water, sweat and sun block and a nasty bruised toe from a slight collision with the anchor. Other than that, I’m remarkably unscathed.

The pump provided hours of entertainment when people spotted it clipped to my bikini. Guesses as to what it was ranged from a personal GPS system so that I could be located if I fell overboard to a camera; a compass; a portable VHF radio and a pedometer! I almost felt like I was disappointing them when I told them it was a boring old insulin pump.

Lancets, photographed artily, yesterday

I’ve just had a brilliant idea that will, without any doubt, benefit the entire international diabetic community! It’s so good, in fact, that if I wasn’t so dedicated to the good of the common weal, I would be heading down to the UK Patent Office right now to claim exclusive 20-year rights.

There are two parts to my idea. Part one – diabetics frequently refer to themselves as being members of a giant club, a brotherhood if you will, of pancreatically challenged hoards who share a common bond of insulin dependency.

Part two – the outward-bound freaks amongst you may have heard of GeoCaching. Basically, people hide Tupperware boxes of trinkets around the countryside and publish the latitude and longitude of said boxes on the Intermaweb. Armed with your trusty GPS, you can then head out into the wilds, find said box, add a trinket, take a trinket and move on.

It sounds a rubbish waste of time, but it’s actually quite fun (honestly). Through it you can find new places you might not have visited before and there are a huge number of caches around the world.

So, here’s the idea – we combine Part One and Part Two! As a local diabetic you firstly bury a box of spares – needles, Fruit Pastilles, lancets, a few test strips – under a tree, or behind a loose brick in a city wall. You then log on to a special website only diabetics can access. Allowing access would be simple, you would just have password challenge question like “What was your last Hb1AC?” Diabetics will instantly know the answer, while non-diabetics will be left bemused. Once on the website you would log the position of your cache.

Now, imagine another diabetic comes to visit your town and, shock, they run out of lancets. They simply dial into the website using their mobile phone and are directed to the nearest cache of spares via GPS. Everyone’s got Internet and GPS-enabled phones, yeah?

With this system in place, worries about running out of cannulas, strips and needles would become a thing of the past and the world would thus become a happier, better, utopian place.

So to kick off, I’ve just left a cache of lancets behind the statue of Robert Dundas, 2nd Viscount Melville, in the street outside my office; anyone visiting Edinburgh at the minute for the International Festival can help themselves.

I think you’ll all agree it’s a scheme that is completely and utterly without any feasible flaws or problems at all. Go me – I await my knighthood from a grateful world.