Shoot Up or Put Up

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.

So old you have to pee on them

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!

Urgh. Ugly

One of the many wonderful features of diabetes is the sheer, damned boredom of it all. Diabetes is generally about the day to day uneventful plod of checking our blood glucose and balancing carbohydrate and insulin intake. While there are sometimes the exciting peaks and troughs of extreme hypoglycemia and hyperglycemia – which do, admittedly, add a certain frisson of excitement to the daily toil – generally not much of any interest happens.

The one glimmer of interest that appears briefly through the fog of general boredom is the gadgets. In my limited experience, it’s common among diabetics, especially of those within a certain demographic (I’m essentially talking men in their 20-30s here), to have an ongoing obsession in the latest shiny stuff marketed to the pancreatically-challenged hoards by our favourite friendly pharmaceutical conglomerates.

A great example of this is the hype concerning the new Bayer Contour USB glucose meter within the blogosphere (I really hate that word – it creates an air of an important, unified community of useful social commentators; which, of course, we all know doesn’t actually exist; most blogs – especially this one – are made up of an ill-informed, soupy conglomeration of poorly written rants and miss-enlightened opinions that no sane person cares about. But I digress).

Anyway, lots of people have been burbling on about how they’re looking forward to Bayer’s new funky colour screened wondrousness arriving on the market for our joyous consumption. All this goes to prove my point – us diabetics love our gadgets and shiny things.

So, with this in mind, why are the insulin pens us pump-challenged people depend on so damned ugly?

For example, I was idly examining my lantus-enabled AutoPen 24 earlier today and noted its vile, tacky cheap plastic feel. It really is a horrible pen – like something you would win in a disappointing set of Christmas crackers. Similarly, my Lilly HumaPen “Luxura” which I use on a daily basis to squirt humalog into my stomach is hardly as luxurious as the name implies. If, to use an tenuous analogy here, luxury is defined as the Presidential Suite of the five star Balmoral hotel in the heart of Edinburgh then the so-called “Luxura” pen is a threadbare, slightly sticky carpeted, one star Travel Tavern situated near a busy junction on the Norwich bypass. Not so good.

Over the next ten years I’ll stick in just under 15,000 injections (unless I finally get my pump, but that’s another story). So please, beloved pharmaceutical companies, please can you come up with a pen which looks great, works well and helps to stave away the horrendous boredom of diabetes!

And lo! the scales fell from my eyes

During the summer last year we went round to some friends of ours for a dinner party. Yes, a dinner party – now that I have reached my thirties, I no longer have the desire to frequent sweaty nightclubs of a Saturday night, downing expensive, sticky drinks and being much, much too close to the dripping unwashed masses.

So being unrelenting and incurably middle class, I now spend Saturday nights with friends, supping fine wines and discussing the issues of the day (I say that, but this particular dinner party ended up being somewhat rowdy, with broken glasses and minor chaos – we eventually left our host in the early hours with an uncontrollable bout of booze-induced hiccups).

Anyway, I digress. I bring up the whole dinner-party thing because I noticed on that particular evening that our host had a rather fancy-pants set of scales which gave you the various nutritional values of whatever you happened to be weighing. I saw that it did carbohydrates and duly lodged this diabetic-friendly piece of information away in the recesses of my brain.

So it came to pass that when our crappy set of TESCO scales gave up the ghost (thanks TESCO – that was £12 well spent, I think not) I finally fulfilled my ambition and purchased a set of said fancy-pants scales.

As I think I’ve mentioned before, I religiously carb count. I mean religiously in that I strictly carb count about as frequently as I attend church (once on Christmas Eve and the occasional wedding). Most of the time I fly solo and make an educated guess for carb contents and insulin doses. But every once in a while I properly check and log everything for a week or so – sort of like a diabetes refresher course – to check I’m doing things well.

It’s therefore when I’m doing a periodic refresher that these scales really come into their own. Can’t be bothered to work out the carb content of your glass of breakfast orange juice? Easy – just bung the glass on the fancy scales, hit 878 (the code for orange juice), fill up with orange and hey presto! up comes the carb content for that exact amount of fruity juicy goodness. Yum!

Using the internal memory, you can quickly tot up the total carb content of your entire breakfast (which is usually, for me, a pint of heavy claret and a whole roast pheasant and trimmings) and log and inject accordingly.

So while not entirely world-shattering, my new fancy-pants scales are actually quite good with helping me to carb count. More importantly, they look really cool. So – in summary – they’re probably a worthwhile spend of £36. If you care, my Salter “Nutri-weigh Slim” electronic scale can be found on the John Lewis web site; if you don’t care, what technology-of-the-future do you use to help carb count?

Just out of reach

By Samantha

Today, I go into battle. Excuse me while I suit up…and the somewhat serious nature of this post…

Since deciding that an Insulin Pump would be the best option for me, I seem to have had nothing but trouble from various people in the diabetes specialist world. As some you may know from reading my own blog, I have recently come out of a few years of huge diabetes rebellion which has culminated in the onset of peripheral nueropathy. Not very nice I can tell you. And since getting my backside into gear, my blood sugar levels have been all over the place. We’re talking constant hypos (three or four a day usually), which I don’t often feel, as well as huge highs. And all of this is despite carb counting.

I have been arguing with specialists for months now about getting a pump. And my fantastic nursing team have been brilliant about it, pushing my notes forward to various professors and big cheeses.

Then the phone call this morning came. It was my nurse, and she told me that the big cheese had said under no circumstance would I be eligable for a pump. He reckons my latest HbA1C is too good, and I’m too well controlled. Funny that…despite phoning up my nurses in a panic because of various factors and them knowing the factors that have contributed to my wanting a pump. Funny, that despite having massive blood sugar issues, and massive problems with the restrictions of MDI’s, that they still feel it necessary to refuse this flat out.

HbA1C is not the be all and end all of starting on insulin pump therapy surely? Surely there are other factors involved such as the way the diabetes affects the person in question’s lifestyle? Such as, oh I don’t know? Deblitating hypos? It just seems funny that a supposedly brilliant team has immediately jumped on the HbA1C thing, rather than considering all the options.

A total kick in the teeth. And one I’m not going to give up easily I can tell you. Someone fetch me a giant stick so I can keep hitting my specialist with it til he relents!

My fight starts now. It’s going to be a long and hard battle, and many lives may be lost along the way. But I’m certainly not going to give up on this one. The emails to various people in the know have been started, and a full on daily diary of blood sugar issues and whatnot has been started too. My weapon of choice? One fully loaded novopen 4…kapow! Take that specialist team!

But my question for you guys is thus: have any of you had to put up with such things getting hold of a pump? And also, do you have any advice?

—————

Samantha is Type One and regularly blogs at http://www.talkingbloodglucose.com/

Me vs my grandad. Yesterday

Christmas. It’s a time for family, a time for sharing things, a time for complete overindulgence. But in my family its also time for the dreaded blood sugar wars. You see, both of my grandparents are diabetic. They’re Type II, both on insulin (and my grandmother with an insulin pump) and I have to say, my grandfather absolutely adores to try and beat me in the blood sugar stakes! And usually he wins.

“What’s your sugars Sam?” he asks every morning, only for me to look at him and say something along the lines of “7.2…” or “6.3” or as it was the other morning, “15.2…” And every morning I get a grin, “I beat you. Mine is x.x”. And every single morning I growl at him and tell him how much I dislike him and his good blood sugar levels.

It usually ends up with a lot of stick beating, handbags at dawn and of course the age old favourite of a renactment of the battle of Hastings. I kid you not, it’s that bad. It happens every Christmas without fail. The blood sugar wars, whereupon I lose in a not-so-valiant way, give up and end up eating chocolate cake. The only problem with this however is that the sugars go through the roof, and I end up being laughed at by granddad, who has a much better level than me. Never mind, eh?

I have to say, I had the last laugh after Christmas dinner, when granddad’s sugars were higher than mine. I was a humble 5.6 whereas he was up at 8.something or other. Excellent! It’s all in good fun though. It wouldn’t be Christmas without a bit of friendly diabeticesque rivalry in the Morris household! It has to be done, when the majority of people in said house are pancreatically challenged!

Although I have to say, it gets rather confusing when my grandmother has the same blood glucose machine as me…I wondered why my levels were coming out reading 100 or more. Silly French system!

Though this got me wondering, do any of you have blood sugar wars? Or play swap the numberwang? Maybe that’s just me then…

I hope you all had a fantastic Christmas and have a brilliant New Year!!!!!

Meters, meters everywhere

It’s fast approaching the end of 2009 and every form of media is crammed with lazy, poorly composed “end of the year” reviews. And, of course, your soaraway Shoot Up is no exception.

But forget those boring articles, TV clip shows or back-slapping awards ceremonies you see on the television. Who cares about comedy awards, or Baftas or even the Oscars, when you have Shoot Up’s soaraway Blood Glucose Meter of the Year award? Yes, I’ve poured myself into my dinner suit to write this article live from the glitzy surroundings of our kitchen table! Woo!

2009 has been a controversial year for blood glucose meters (actually, it hasn’t; I’m just trying – without much success – to add a tiny degree of dramatic tension to the proceedings…) with a whole range of new meters coming on the market, some of which I’ve bothered to test.

Anyway, the first that must have a mention (if only a dishonourable one) is of course Menarini’s GlucoMen LX, which was almost universally despised by anyone who’s had the misfortune to use one. Nasty, tacky and cheap, the GlucoMen LX inspired nothing but revolted disdain in this reviewer. Hopefully Menarini will try harder next time and I hope they forgive me for getting my horrible review to be the second result in Google’s search results for their product.

Moving swiftly on, the Accu-Chek Aviva Nano is certainly worthy of mention for its sexy, sleek looks and useful functions. However, it was badly let down by Accu-Chek’s crappy looking test strip that just makes the whole lot look ugly. Don’t get me wrong – it’s a perfectly good test strip – but it needs a serious redesign to sex it up.

But, in my view, this year’s winner is the pretty wonderful Abbott Freestyle Lite. It looks pretty sexy, has some of the best test strips on the market and two great features. The first is the ability to add more blood to a sample if you don’t squeeze out enough first time around, which saves wasting a strip. And also stops the utter, utter misery having to repeat a test after you’ve spent 5 minutes trying to get blood out of freezing cold fingers. The second worthy feature is a little LED that lights up the test strip when you’re testing in the dark. A simple addition – but one that’s bloody marvellous.

So there we have it – congratulations to Abbott and their joyful Freestyle Lite. Here’s to 2010 – cheers!

You can see all our blood glucose meter reviews here.

The Portaloo. My new best friend

By Samantha

So on Thursday of last week, after dragging myself out of bed at 5.30 in the am and chilling out with a nice few (four!) coffees to get myself ready for the day, I inadvertently found myself rushing like a lunatic to get everything ready and get my backside out of the door at 7.15.

Now of course, usually I’m alright at doing this and if I forget anything usually realise within moments of getting out of the door. Except on this particular Thursday, I was almost twenty minutes down the road when I realised that I had forgotten a few very important things.

First of all, the pills I take for my so called foot issues and then I realised with horror as I was nearing work that I had forgotten to put a new pot of test strips into my kit bag. I honestly wanted to slap myself across the face and yell obscenities at myself for doing so, but of course, wandering down the road in the middle of Southampton muttering to yourself isn’t exactly going to go down well is it? And I didn’t particularly fancy being carted off in a white van.

So instead I phone my other half and moan down the phone at him about how stupid I am and end up bursting into tears. It’s a scary thought, being at work without test strips or the pills that mean my feet will actually function without shooting pains. But I guess I had to deal with it. I was too far away to walk home as that would have meant being late for work, so I told myself I’d get on with it.

And I really wish I had gone home and gotten these supplies.

Up until lunch, things were relatively fine. I had enough test strips to see me through till lunch but of course, me being me I was wandering around this busy, hellish archaeological/building site having a right mooey all day. And in the end I got so fed up I went to the shop and brought myself the biggest chocolate bar I could find for my lunch. Except, lunch was my last test strip. And I was getting really concerned that I hadn’t taken this tablet too, searching frantically in my bag for anything resembling a strong painkiller. Thankfully I had something with me, and by lunchtime I needed it because I was seriously feeling the cold (thank you poor circulation) and nasty shooting pains in my feet matched up with numb toes (thank you transient peripheral neuropathy…not!).

And then, I think the hyper started. The thirst kicked in and I kept running backwards and forwards to the horrible plastic portaloo. Except I couldn’t test my blood because I had run out of test strips. Cue panic. And by this stage I had been sent to the office to do paperwork, so instead of sitting there doing ‘very important work’, I was pacing backwards and forwards trying to work out a solution to the tiny little problem in front of me.

It’s worth noting too, that this ‘neuropathy’ really sinks its teeth in when the bloods are high. And even if it looks amusing when I’m hopping around yelling obscenities, it’s really not.

Forgetting stuff. It’s something I do a lot. It’s assumed everything is always where it should be when I run out of the door, and when it’s not it feels as if that carefully built word of diabetes is slowly starting to crumble. And it’s even worse when you get out and realise that you should have changed your insulin, because now you’ve run out. But let’s be honest, I’m sure we’ve all done it and all felt like muppets when we realise. And spending the day hungry due to being forgetful isn’t very nice. I guess it happens though, we all do it.

It just makes you feel really stupid when things happen that could be avoided. And playing a guessing game with the blood sugars is just silly. I had no idea what I was running at and spent most of the afternoon feeling horrific, yet I could have been running low and have no idea about it. So one thing’s for sure, I certainly won’t be leaving the house without this stuff again in the near future. Yet saying that, what’s the betting that come next week, something else will be forgotten. Although saying that, I walked out of the house without my trowel this morning – my archaeology soul right there…and also my lunch. But that’s a different story for a different day!

—————

Samantha is Type One and regularly blogs at http://www.talkingbloodglucose.com/

I recently did an interview for a diabetes magazine (yes, another magazine – we’re getting really big now in diabetes celebrity circles; such as they are). And I was asked what single development would make life easier for me as a member of the pancreatically-challenged hoard.

I did think about a new pancreas grown from stem cells, but I just don’t think science is advanced enough to come up with a proper cure for diabetes in my lifetime (or what I expect my lifetime to be – obviously even I don’t know how long I’m going to live). When you think about it, science has had 90-odd years since Banting & Best successfully stopped killing dogs and discovered insulin to come up with a complete cure. Although there have been leaps and bounds forward since then, science hasn’t even yet managed to come up with a long acting insulin that actually delivers consistently and smoothly for a full 24 hours (yes, we’re talking about you lantus). So I’m afraid that I think cures are still a long way off.

So I side-stepped the question by answering that incremental improvements to existing systems actually make life a lot easier for people with wonky pancreases. Take for example blood glucose meters. I’m a huge fan of Abbott’s FreeStyle Lite as it uses a tiny sample, is stupidly quick to process your result and is just generally well designed and thought out.

When you compare this to the medieval instruments of torture that were used not that long ago for measuring BG you can see that the world has moved on enormously and checking your BG is now ludicrously easy and relatively pain free. Given that a Good Diabetic will check their BG 4, 5 or 6 (or more) times a day such seemingly small changes to meters make a huge difference to the quality of our lives.

Similarly, faster acting insulins would be hugely beneficial. Humalog is pretty good stuff, but I still have to stick it in about 20 minutes before breakfast to avoid a massive post-port and pheasant peak (there’s nothing like a good, well-matured roast pheasant and a flagon of port for a good start to the day. The sort of breakfast empires were built upon, God be my witness!).

Anyway, so that’s what I’m hoping for the future – not a cure – but lots of little incremental improvements. Each one might not be wildly noticeable by itself, but cumulatively they’ll make a huge difference to our everyday, mundane, shuffling lives.

Not a Maserati GranTurismo. Oh no.

I recently got my hands on Accu-Chek’s newish Compact Plus GT and took it out for a test drive. The “test drive” thing is relatively apt as, for some reason, Accu-Chek have added the suffix “GT” to the meter’s name. I always understood that GT referred to cars and stood for Grand Tourer (or Gran Turismo if you want to go for the Italian – like the Maserati GranTurismo – which is still high on my Christmas wish list). Unfortunately, if the Compact Plus GT were a car it would be big clunky ugly minibus and not the sprightly Maserati above.

The Compact Plus GT is designed to be an all-in-one meter – with finger pricker, test strips and said meter all rolled into one. The meter element isn’t particularly exciting in itself; it has all the features you’ve come to know and love on any modern meter – a 500 test memory, a pretty straightforward user interface and a bright display for night-time use.

Of slightly greater interest is the relatively innovative test strip drum. Rather than sticking in a strip every time you want to test, you put a drum of 17 tiny strips into the machine in one go. A handy dial round the back of the meter tells you how many strips you have left in the meter and the drum incorporates a bar code which automatically calibrates each new set of strips. A switch on the front of the meter then spits out a test strip whenever one is needed. The strips themselves are tiny, very slurpy but require a positively vampiric sample size of 1.5 µL. The attached finger pricker uses an air-pump instead of the usual spring to fire the lancet into your finger. But, as I’ve mentioned before, I’ve not noticed any difference between this and a normal finger pricker. Buy, hey, ten out of ten for effort in trying to reduce wear and tear on our ravaged, pepper pot fingers.

All in all, the Compact Plus is made up of some good components – the meter’s okay (but nothing world-shattering), the finger pricker is acceptable and the strip system is very good. However, combined, they form a pretty ugly, clunky bit of kit; which doesn’t take up any less space than my usual meter and assorted kit and just doesn’t really offer anything greater than I have already.

Some people might like the all-in-one nature of the Compact Plus which makes it very easy to grab and shove in a bag as you leave the house; but sadly I just don’t think the sum of the parts makes it a better system than anything else out there. Pity really.

So, in summary:

Sample size – 1/5
1.5 µL – vampiric

Test time – 2/5
Five seconds – not wildly quick, but not disastrous

Test strip calibration – 5/5
No calibration by user required

Test strip slurpiness – 4/5
Pretty damned slurpy!

Memory – 4/5
500 readings – which isn’t too bad

Sexiness – 1/5
I would say it’s an ugly duckling; but “duckling” implies small and cute.

Beeping – 5/5
Can be turned off. Thankfully.

4am test – 3/5
Bright, easy to read display makes it a bearable meter at 4am. But no light on the test strip – boo!

TOTAL – 25/40

Check out our other blood glucose meter reviews or have a look at the manufacturer’s web site.