Shoot Up or Put Up

People who read this blog for a long time (you poor souls) may dimly recall that in September 2009 I wrote an article where I mentioned I would be getting a pump (it’s here, if you don’t remember it).

You may also dimly recall that I was a bit eggy about having to wait eighteen months (or 2.8% of my lifetime, I cleverly calculated at the time) to get the damned thing. I swore blue murder and mentioned that I would write to all concerned to remedy this crappy state of affairs.

Well, months passed, and I did indeed write to my MSP (health is a devolved matter and so is handled by the Scottish Parliament rather than Westminster) and the chief big cheese of my health board. I’m pleased to report that I achieved absolutely nothing and, in fact, I hear ugly rumours that since writing my original article the waiting list for pump therapy in the Lothians has now increased from 18 months to three years. Very not so good.

Anyway, time has now elapsed and I’ve been given an approximate start date for my lovely new pump – sometime in November. So that’s something to look forward to, an early Christmas present of sorts.

I’ve also been given a choice of pump. The decision of which pump to go for was, in the end, a pretty easy one as I was given a choice of *drum roll please* one. The Medtronic Veo or the Medtronic Veo. Fortunately I hear it’s not actually a bad pump and I suppose it does cut down on training costs – apparently the reason for the long waiting list. The probable fact that apparent difficulties relating to training is an excuse for rationing and limiting the supply of expensive pumps is, of course, neither here nor there.

As we all know, pumps aren’t a magic wand for good diabetes care. I’m not expecting it to magic my diabetical problems away in an instant (and anyone that does is somewhat deranged). However, I do think pumps are a more subtle and versatile tool for trying to manually replicate what your pancreas does automatically (well, it would if it worked!) which is, after all, what we diabetics are trying to do day in day out.

So there we have it – the end of the pump saga is gradually hoving into sight. No doubt I’ll keep you all updated with further developments as and when they eventually happen.

Nearly five years after my diagnosis of Type One, I’ve finally got around to getting myself some medical alert jewellery. I thought it was time that should I be found collapsed in an Edinburgh gutter late one night then the ambulance men might have a chance of identifying what the problem might be. The fact that I’m more likely to be in that state because of too much Scottish wine than anything diabetes-related is, of course, neither here nor there.

The reason I’ve put it off for so long is that I don’t really wear jewellery, aside from my wedding ring which never leaves my finger (resulting in it nearly being lost down drains, in rivers, inside cows, etc.)  I’ve just never been one for wrist bands, signet rings or medallions (thank God). I’ve never really felt the need for any bodily adornments, so in addition to jewellery, the prospects of getting a diabetes tattoo also seem pretty limited.

So what changed my mind? I suppose I just thought it was a sensible thing to do. Now that I am inexorably advancing into the twilight years of the early thirties, I suppose I’m gradually getting more sensible and wise. Long gone are the days of all night Scrabble sessions and drinking Horlicks ’til dawn. Sigh, happy days; happy days.

The other thing that changed my mind was actually finding some medical alert jewellery that was actually quite nice. The general rule that seems to apply to such jewellery is a) discrete; b) practical; c) stylish – pick two. However, over on www.icegems.co.uk I did manage to find a pendent and a wrist band that did actually fit all these criteria. I then arranged to have them engraved with my name, date of birth, diabeticness and my wife’s mobile number. And very nice there are too. I actually now wear one or other of them most of the time.

This means that, much like a family pet, I can be let out on my own to wander and can be returned to my owner if found lost or collapsed in a hypoglycemic heap. Comforting for all concerned, I guess.

Well chaps, after nearly 18 months of thinking about it I’ve finally gone and done a video blog. It’s a review of Bayer’s Contour USB meter and it’s almost unbearably  brilliant. In my view.

Anyway, watch and enjoy; and do let me know if you like the video blog format and I’ll do some more – we actually rather enjoyed doing it! Huzzah!

A couple of weeks ago I mentioned that I was getting some new software for recording my diabetic data to replace my old Accu-Chek Compass software.  Compass was created in Microsoft Access and was not so much outdated as positively prehistoric!  As I’m in the lucky position of using one of the biggest, blackest, butchest and best BG meters in existence, the excellent Accu-Chek Compact Plus from Roche Diagnostics (pfft, hardly – Tim], it’s pretty obvious the software was from the same source to allow PC and meter to communicate.  As always, there is no communications standard to allow any meter to access any software, manufacturers are far too proprietorial for that!

The software comes with a new USB cable to replace the old one that hooked into the serial port.  Shaped a little like a cloverleaf it has an electric blue flashing light designed to induce seizures in anyone unfortunate enough to be epileptic as well as diabetic.  I’ve not yet found a way to switch this light off; if I do I’ll let you know.  What this light signifies though is that by placing your meter with its infra-red port pointing towards it, switching the meter to communication mode will automatically start the download.  The downside is that this pops up a window requiring input from the user, but it pops up in the background rather than on top of all other open windows, so unless you know about it you’re left wondering what’s going on.  Apart from that, the communication between meter and PC is easy and quick.

Once you’ve downloaded some data, the differences in the software quickly become apparent.  Installing it and setting it up is frightfully easy, especially if you’ve been using Compass as you can port all your data across into 360°, making the transition pretty much seamless.  The Main Menu page is still a little on the clunky side, but attractive enough and easily navigable.  Where this software really scores over its predecessor though, is the amount of data that can be stored and the additional information that can be input by the user.  As well as all the downloaded data from the meter it’s possible to input insulin doses, events, and comments on the diary entries, as well as recording a wealth of other information such as HbA1c, blood pressure, three types of cholesterol, height, weight and a list of medications amongst other things.  Almost everything can be printed out, emailed, or faxed directly from the current screen with relative ease.

Reporting from the system is also pretty comprehensive, though the reports are only customisable to a certain extent and there doesn’t appear to be any way to create new custom reports.  Having said that though, data is exportable to Excel or Open Office with little bother, so custom reports are available for the geekier geeks.

Over and above the reports available such as the log book and diary, the standard graphical reports are perfectly adequate and make communication with diabetes professionals pretty straight forward.  Personally I use the Trend Graph more than any other, though the Target Chart is quite useful too.  In all cases a raft of statistics are also available to keep track of your lifestyle.  The program now offers three reports for pump users as well; though not being a pumper I was unable to try these with live data, so I have absolutely no idea of how useful they are.

In conclusion then; Accu-Chek 360° is easy to set up, easy to use and provides all the information you could wish for in a clear and reportable format.  The ability to add data to diary/log book entries makes it eminently suitable for both T1 and T2 diabetics (Roche must have read all those emails I sent them!)  The whole package is easy to use, though not perfect of course, but generally head and shoulders above its predecessor.  The biggest drawback of course, is that it’s tied solely to Accu-Chek meters, a minor point I know, but a more open system would be so much better.

Like all of us I’m slowly advancing towards my twilight years and the inevitability of a cold, unforgiving grave; the rictus grin of Death himself the only certainty. Life is but a mere spark of light between two endless eternities of darkness.

But, hey, it’s not all misery and despond. Through age comes wisdom and I can now more closely empathise with the elderly – soon I will be an elderly myself, after all. So I think I’ve come to know what old people like and don’t like.

On the “like” list comes beige overcoats, tea cakes and pretending to be deaf. While high entries on the “don’t like” list include disrespectful teenagers, harsh winters and Dr. Harold Shipman.

Also on this list of likes must surely come Abbott’s FreeStyle Freedom Lite. Essentially this meter is the brother of my current favourite meter – the Freestyle Lite. It’s perhaps the slightly more backward, ugly, socially shunned brother, but a brother all the same.

Your first impression of the Freedom is that it’s much bigger than the standard Lite and features only two buttons instead of the three. The screen is about twice the size of the Lite and so the readings can be read from the other side of the room –ideal for those with crappy eyesight.

The Freedom uses Abbott’s newish test strips, with their slightly odd “ZipWik” nodules, which are easily the best and slurpiest on the market at the minute. They don’t require coding, use a nice small 0.3µL sample and take 5 seconds to spit out a result. For our outside-UK readers, I’ve no idea how much they cost per packet; given they’re free on the NHS they could cost more than unicorn’s blood for all I care. Anyway, they’re wonderful little test strips which allow you to top up the sample if you don’t put enough on first time round – absolutely great if you’re trying desperately to get blood out of freezing cold hands.

Alert readers will have noted that I mentioned above the Freedom has one fewer button than the standard Lite. I’m afraid to say that this button relates to the wonderful LED which lights up the strip on the Lite which appears to have been abandoned. Speaking of lights, the Freedom doesn’t even have a backlight for Heaven’s sake. The test strip light was easily the best feature of the Lite, so quite why Abbott haven’t included it on this meter I’m not sure. As a result the Freedom fails the 4am test miserably. Bah!

The meter can store 400 results, has 7, 14 and 30 day averages and has four reminder alarms. In terms of sexiness, the Freedom isn’t as petite as the standard Lite but it’s still a good looking meter. It’s slim and sleek but still has a massively huge display which is great. The test result beeps can be turned off or, indeed, turned up so they are deafeningly loud, which is ideal if you like to annoy people at the theatre.

So, in summary, the FreeStyle Freedom Lite is quite a good meter and is ideal for those of us with poor sight. Quite why Abbott didn’t give it a light is anyone’s guess and it drops points for this idiotic oversight.

Anyway, hope you enjoyed the review, I’m off – there’s some guy with scythe hanging around behind me…

Sample size > 4/5
0.3µL – fine.

Test time > 3/5
Five seconds – we can live with it

Test strip calibration > 5/5
No calibration required – huzzah!

Test strip slurpiness > 5/5
Excellent – the best strips out there.

Memory > 3/5
Fine, nothing to get too thrilling about

Sexiness > 3/5
Big but sexy

Beeping > 5/5
Can be turned off or turned up to irritate the neighbours

4am test > 0/5
No light! No light? What were they thinking?

Grand total: 28/40

Have a look at all our meter reviews here.

Think back to the wonderful day you were diagnosed with Type One. Ah, what lovely memories. The smell of hospital detergent, the sinking feeling in your belly as you realised with a dread chill that your life would never be the same; the moderately caring but slightly detached consultant; wondering what the hell diabetes was and how long you had to live. Such happy days.

After the initial shock you would – hopefully – be given a crash-course to teach you how to stand in for your pancreas, now that the stupid bloody thing had decided to conk out on you.

Weighted down with leaflets about driving with diabetes, drinking with diabetes, eating with diabetes and booklets detailing the thrills and spills of peripheral neuropathy you would have probably be issued with one of these little beauties, the almost completely ubiquitous Optium Xceed.

The Optium Xceed is the AK47 assault rifle of the blood-glucose meter world. Simple to use, easily available, known all the world round and standard issue to the newly-diagnosed. While quite a lot of us gadget-obsessed geeks have moved on to something slightly more sophisticated, I bet pretty much all of us have one of these in a bottom-drawer somewhere if they’re not in actual active use.

The main reason for the Xceed still hanging around is that it’s one of the very few meters that can check for ketones. I’m probably a negligent diabetic but I never, ever, ever, ever check my ketones. I know I’m diabetic (obviously), I know sometimes my blood glucose goes high (obviously) and I know that, as sure as day follows breakfast, that I will sometimes produce ketones when I’m high. I don’t really need a meter to tell me something so strikingly obvious aside the occasional exceptional emergency.

Though saying that, I do own an Oregon weather station that tells me it’s raining outside (it does a lot of that in Scotland) when I could simply look out of the window. I didn’t need that meter to tell me that but I still have it. So maybe, the whole ketone measuring thing does have a place after all. Or maybe they’re just pandering to the lunatics who adhere to the late, lamentable Atkins’ diet; who calculate the diet isn’t working unless they’re producing ketones. Nutters.

Anyway, getting down to blood glucose measuring itself, the meter needs to be calibrated with each new set of test strips, which is a bit of pain. The test strips themselves come individually foil-wrapped, which I’m sure is great for something but the extra unwrapping just annoyingly adds another step to the tedium of testing. Also your bag also soon fills up with a tonne more crap compared to other meters.

The strips themselves are relatively slurpy, require quite a small sample of 0.3µL and tests take 5 seconds. All in all not world class, but acceptable. Just. Moving on down the specifications list, it has a 450-test memory and 7, 14 and 30 day averaging. You can also download your results to your computer, should you choose too.

So, if it wasn’t for the ketone measuring thing, this meter would be consigned to the bin. But because of the ketone-thing and the fact I once saw this model on an episode of BBC’s Casualty when they had some poor bloke falling into a diabetic coma, or something, on an episode – I nudged my wife excitedly, “I’ve got one of them!” So for that reason alone it deserves to remain in the drawer with some out of date test strips for emergency use.

So to summarise:

Sample size > 5/5
0.3µL

Test time > 2/5
5 seconds

Test strip calibration > 2/5
Yes, each batch needs calibrating

Test strip slurpiness > 2/5
Perhaps slightly waterproof compared to other strips

Memory > 2/5
450 tests

Sexiness > 2/5
Too ubiquitous to be sexy – a victim of it’s own success

Beeping > 5/5
Yes, can be turned off

4am test > 3/5
Comes complete with backlight and is relatively straightforward to use

Grand total: 23/40

Read our other meter reviews

The other week I ran out of needles in the easy-reach box in our under-stairs cupboard. I have a couple of nicely painted IKEA boxes there where I keep my day-to-day diabetic supplies. Pretty thrilling stuff, I think you’ll agree.

I went upstairs to my diabetic warehouse and was horrified (well, not really horrified at all; more mildly surprised – I’m trying to build tension here) to discover that my pharmacist had given me the wrong needles. Now, in the interests of professional courtesy said pharmacist should remain nameless. But he won’t, he’s called Simon and his pharmacy is on the Dalry Road in Edinburgh. Anyway, that aside, I noted the only actual difference from my normal needles was the size.

Since diagnosis I’ve used teeny-tiny 5mm needles which are so small that even my most needle-phobic friends take no notice of them. However, these brutes were 8mm – shock, horror! But bravely shrugging aside the extra 3mm I started using them.

Lo and behold! 8mm is actually a much better needle for me. I get much less “insulin ooze” post injection – where insulin that should stay in your body leaks out, making your t-shirt smell of disinfectant all evening. Never ideal. Additionally the extra 3mm has made no difference in terms of pain or bruising which is, in turn, ideal.

I think this whole wrong sized needle-thing was caused by the fact that when I was diagnosed five years ago I was as skinny as anything – for obvious non-diagnosed-Type-One-diabetes reasons. Now that I’ve got my insulin management nicely under control I’m back to being fat. In fact I’m now much like the hideously grotesque guy who portrays “Gluttony” in psychopathic chucklefest Se7en. Well, sort of.

So there we have it, when it comes to needles its obvious that biggest is best! Bring on the 50mm horse-needles I say!

Caroline’s forum post  about the volume of diabetes junk she lugs around every day made me wonder if I’m a bit of a lightweight. I have a graduated approach to the amount I carry, which increases disproportionately depending on whether or not pyjamas are involved. In brief, my theory is pj=3dj. That is to say, a pair of pyjamas (pj) leads to a minimum threefold increase in the amount of diabetes junk (dj) carried.

If I’m popping out for a couple of hours I take my pump and fruit pastilles. That’s it. Although if I’m in the car there will always be more fruit pastilles, a spare syringe and a decrepit cereal bar tucked away somewhere just in case.

If I have my handbag with me, there’ll be more fruit pastilles plus a syringe tucked away inside in case of emergencies and a spare battery in my purse. If I’m lucky there might also be another bruised and battered cereal bar somewhere.

If I’m going out for the day, I’ll have my blood meter too. Despite previous experiences  proving that life can be a bit of a nightmare when you pull your infusion set out hundreds of miles from home, I still don’t carry a spare (I know, I know, but it happens so rarely and as long as I’ll be home before bed I can cope with a syringe).

Now, here’s where it gets a bit strange. My minimalist approach to daytime trips disappears completely if I’m sleeping anywhere other than in my own bed. If I pack my pyjamas, I also pack my diabetes junk bag with all the diabetes goodies you could ever wish for:

• 2 x infusion sets & infusion set inserter
• Pump reservoir
• Pump batteries
• CGM sensor, inserter & transmitter
• Stickies to keep the CGM transmitter attached to my back
• Insulin
• Spare blood test strips
• Spare lancets – I have no idea why when I only change them on bank holidays and very special occasions.
• Glucagon (although until recently it was out of date)
• Glucogel
• Syringes

At our first ShootUp meetup I discovered that I seem to travel very light during the day compared to others. But what I really want to know is does the pj/dj formula work for everyone, or is it unusual to have such a large swing in diabete junk volume depending on whether pyjamas are involved?

I recently had cause to look at my fingers. Not a high octane thrilling experience, I’m sure you’ll all agree. But I did notice the array of tiny dots caused by the last zillion, or so, blood tests that my poor, ravaged fingers have had to endure. While I can never take a break from diabetes, I thought that my mangled fingers could do with a rest and so I decided to give alternate site testing a go.

My first meter, along with the myriad that I’ve used since, came with the obligatory finger poker. Said finger poker came with an alternate clear bit to shove on the end for what the guidebook described as “alternate site testing”. “How thrilling”, I thought, as I chucked the apparently useless bit into the bin.

However, last week I dug through the rancid, rotting fish bones in the bottom of my bin and pulled out said clear finger poker bit and gave it a go. Incidentally I’m not really sure why finger pokers have a clear end bit for alternate site testing. Answers below if you have any idea.

Anyway, back to the article; with my poker ready to poke I started with my palm. The first thing I noticed, pretty quickly, was that it hurt. Quite a lot. Maybe my crusted fingertips are so covered in scar tissue that I can no longer feel anything through them – not even a sharpened piece of metal being thrust into them. (Bang goes a career in delicate eye surgery). But, whatever, it seemed more painful than the fingertips.

I also noticed that a bleeding palm is quite difficult to give a squeeze to get that little extra bit of blood out as you do with your fingertips. As a result I failed to fill up three test strips and my meter moodily displayed its nagging “You haven’t put enough blood on, eejit!” message (I have a very rude meter).

The palm being a failure, I then moved on to inflict some misery on my forearms. The fatal flaw with my arms is that they’re quite hairy. Not exactly the matted fur of a gorilla, but certainly enough hair to be going on with. Said hair just made things trickier but, bravely, I persisted.

Much like the palm, the arm isn’t very squeezable and so getting that all important extra drop of blood out was quite difficult. So I increased the depth gauge on the poker until I could swear I could hear the lancet scraping against bone every time I attacked myself.

Finally the mission was accomplished and I managed an alternate site reading. However, I then observed, with mild revulsion, how much your arms actually bleed after being stabbed with a full-depth lancet. After my five or six attempts I looked like I had enjoyed a jolly evening of self-harm but, hey, at least I had my reading.

So will I continue to alternate site test? Probably not. It generally seemed like a pain in the arse and wasn’t very successful. However, because of the post-test self-harming-look I might save the arm-tests for Hallowe’en parties.

Recently I suffered an unwelcome visit from a mild throat infection. I mention this not to get sympathy (because I know I’ll get Sweet FA from you lot) but because it really messed up my blood glucose levels.

Despite being hobbled by MDI, I tend to keep my blood glucose in the single figures (go me!) but with the introduction to my throat of a whole bunch of bacteria or virii (or whatever the plural of virus is) I just couldn’t maintain this happy medium. So I spent a good part of last week testing and injecting, testing and injecting. It got so bad that over a morning I had to shove in 14 units to cover off a small bowl of cereal and glass of orange juice. The Diabetic Gods were not smiling on me that day.

Anyway, with all this testing of my highly-sugary blood my faithful meter kept reminding to “CHECK KETONES”. Usually whenever my meter orders me to “CHECK KETONES” I ignore it. Firstly, I don’t take orders from no one, see; and secondly I’ve never really understood the point in checking for ketones.

If, say, my BG is particularly high I know this because my meter tells me so (and I feel crap, of course). I then duly correct the high by shoving in an appropriate amount of humalog. My BG then comes back down to normal and I get back to humdrum day-to-day stuff – like organising coups in backward African states and international jewel theft, that sort of thing.

If, however, my BG was high and I checked my ketones and I discovered I was indeed producing a low level of ketonic-goodness I would, uhm, do exactly what I was going to do anyway and shove in some humalog and wait for normality to return. Given I’m just doing the same thing, why bother testing for ketones? As an aside, it’s obvious though that if things go really out of goose and my BG is high for days on end, then perhaps ketones, DKA and all that stuff are much more important and work testing for.

Anyway, getting to the subject of this article, after being prompted by my meter 300-or-so times to “CHECK KETONES” I thought, just this once, I would treat myself and check them. It was clearly a quiet evening.

So I dug out my faithful Abbott Optium Xceed, found some ketone strips in the very back of diabetic supplies drawer and prepared to test. Imagine my crushing disappointment when the meter reported an error, prompting me to check the “use by” date on the strips. June 2007. Oops!

Given I was diagnosed at the end of 2005, this packet must have been at most two years old at their expiry date (I suspect they were younger than that as they were the new type of ketone strip that Abbott now do). I understand that strips and what-not will, in time, degrade and it’s probably best not to use them after that time; but a shelf life of only two years or so for something that must be pretty stable? Surely that’s a little suspect? (Please note, I haven’t actually done the slightest bit of research on this fact; it might be the case that test strips are more volatile and unstable than a dodgy nuclear warhead and that Big Pharma has struggled valiantly for years to tame test strip chemicals to last as incredibly long as two years. But I suspect not).

Anyway, in conclusion, this all meant I couldn’t test my ketones the other night. I could blame Big Pharma for evilly building obsolescence into its products; but, really, I blame myself for not checking the use by dates on my spare strips for the last two years. D’oh!