Shoot Up or Put Up

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by Alison

Why so low?

13 August, 2012 in Living with diabetes

I’ve been low for days, this means its time for another diabetic brainstorm. I was thinking that through the power of osmosis, the athletes I was watching on the Olympics were absorbing my excess glucose from me via the TV and using it to power their own medal winning performances. But that couldn’t be right, because I was going low, but not getting thin, and surely they couldn’t steal my glucose without me losing a few pounds in the process. Sadly that hasn’t happened.

I reduced my boluses.

Then I wondered if my weekly swimming session had reduced my insulin resistance to a level where I needed to massively reduce my doses. Afterall, I had been watching what the medal winning swimmers did and tried to incorporate some of their techniques into my own amateur style. Given I could barely get out of bed after trying this, I concluded that their method may be more efficient, but mine hurts less. So any potential glucose benefits of swimming a bit harder were definitely offset by not being able to walk for days afterwards.

I reduced my basal rates.

And then I looked at my clothes. I wasn’t wearing many. And haven’t been for a few days. Summer has finally arrived! It’s warm, and insulin requirements are down as a result. If only the weather forecaster had a little syringe symbol to stick on his map when things start to warm up, I wouldn’t need to remember this stuff myself.

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by Alison

A whole new world

13 October, 2011 in Living with diabetes

I’ve decided to learn to play a musical instrument. My family will quickly tell you that this is well outside my current skillset. I’m not renowned for my sense of rhythm or pitch. However, the husband plays the tenor horn in a wind orchestra and in a pub after a recent concert I was bullied/coerced/persuaded/pressured into learning. Lots of enthusiastic cries of “the husband can teach you and then you can practice with us” and a little bit of beer lead to me agreeing to learn to play the baritone.

Baritone

The instrument through which ears are being tortured

I don’t remember my diagnosis with diabetes, but learning a musical instrument has given me some sense of the complete bewilderment that happens when you are dragged into a world you didn’t really know existed. While the new diabetic grapples with basal rates, carb ratios, hypos and hypers I am being told to tighten my embouchure, control my diaphragm (which I’m yet to locate) and to believe that one day I will be able to translate the dots on the page into some form of enjoyable music.  This is like being told at diagnosis that one day you will be able to carb count a whole meal without the aid of a calculator and several reference books. It’s very hard to believe at the time.

There are lots of new things to do. Those who aren’t pancreatically challenged consider it abnormal for someone to stab themselves in the finger to illicit blood or to inject random areas of fat throughout the day. Those of us who aren’t musical are perplexed by the revelation that some people are able to beat a rhythm with their feet, whilst their fingers press down the valves and their mouth blows in the air to create the notes. Changing my first infusion set was not this confusing, I’m sure of it.

The sense of bafflement isn’t helped by the fact that people keep moving the goalposts. Like when you learn to carb count and you learn what insulin you need for 10g of carbs. You start to get confident, this isn’t so hard after all. And then they tell you that actually 10g of carbs from an apple will be absorbed at a different rate to 10g from a pizza, so really it’s a lot harder than it first appears. The same happens in music. You think you’ve got the hang of the counting thing and then they change the rhythm you’ve got to count in. It’s a cruel world.

One of the marvellous things about diabetes is that you get to start again every day. Just because you were a 15 all day yesterday doesn’t mean the same has to happen today. Music appears to be similar. Last night’s rendition of Twinkle Twinkle Little Star was quite frankly an embarrassment to nursery rhymes. Today’s however was a shining example of wonderment, assuming you like your nursery rhymes belted out from a lower brass instrument. Things change quickly in the worlds of diabetes and music.

So, as I blunder into this new musical world it does make me realise how much I take my diabetes knowledge for granted because I have no memory of having to learn all this stuff. I’m quite grateful for that. If I’m not very good at the baritone I can always hide it under the table and forget all about it, sadly the same doesn’t apply to the diabetes.

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by Alison

The diabetic brainstorm

9 December, 2010 in Living with diabetes, The Blog

I’ve been pondering a little mystery over the last few days. My blood sugars have been a bit weird. Not kidney frying, eye blindingly high. Just a bit higher than normal. And I seem to be absorbing carbs by osmosis, I only have to look at a mince pie and I rise. This calls for that fun activity we all love, the diabetic “what the hell’s happening now” brainstorm.

Remember the rules of brainstorm – say what comes into your head, no idea is too stupid. On that basis, my thoughts as to causes of this weirdness include:

  • Hormones – always a good place to point the finger but I don’t think so, the change is too subtle, anything hormone related is more sledgehammer like
  • Stress – not really, I’m pretty happy
  • Dodgy insulin/infusion set – changed both yesterday and saw no difference (not because I’m conscientious, just because the set was due for a change and the bottle was empty)
  • Drugs – I’m clean, other than a spoonful of insulin a day no pharmaceuticals have passed my lips
  • New moon – always a possibility
  • My pancreas has actually been doing a little bit of work for the last 27 years and has finally packed in completely – I wouldn’t put any money on that
  • Sneeky Christmas elves have installed a miniature cannula and are drip feeding me eggnog and mince pies without my knowledge – possible, I do have a cut on my hand that I thought I did making soup but could equally have been a secret miniature infusion set
  • I ran a marathon without realising and my liver is now dumping glucose into my system at a rate of knots – I can still walk so this is unlikely
  • I had pizza a week and a half ago and its still not quite out of my system – you never know with pizza, the extent of its evilness can’t be underestimated
  • Pre Christmas excitement – I admit I was thrilled when we put the tree up the other day but I don’t think I was that thrilled
  • The weather – we have only an inch of snow so I haven’t been doing much shovelling, but equally I haven’t been going out that much because of the ice. Possible.

As the brainstorm led to nothing I took the age old approach of giving up and going to bed. I awoke this morning to the winter sun streaming through the window. I dragged myself out of my warm bed and…drumroll please…I sneezed! I have a cold. Mystery solved.

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by Alison

What made the difference?

22 June, 2010 in Living with diabetes

My HbA1c results show that my pump and CGM are working for me. But they’re not a cure so what is it about using those tools that’s made the difference?

Metronic Paradigm pump & CGM

Doing the research

I read Pumping Insulin: Everything you need for success on a smart insulin pump by John Walsh.  It’s a weighty tome, but it helped me work out how to get the best out of my pump.

Beyond that, I think there are 6 main areas where I’ve seen major improvements:

1. Overnight levels.

Before – nights were a bit of a blood sugar rollercoaster ride of drops at 3am and rises at 5am. This meant I had to go to bed higher than I wanted to avoid hypos and I’d wake up higher than I’d have liked.

After – I can now go to bed at a 5 and wake up at a 5. I have the basal rate on my pump set to decrease at 1.30am, to ward off the 3am low and then increase at 3.30am to stop the 5am high. Looking at the CGM graphs of my overnight blood sugars helps me adjust the basal rates.

The CGM also showed that as soon as I get out of bed in a morning my blood sugar rises, even if I have no food. Now I take 0.5 units as soon as I get up to counter this.

2. Post meal peaks.

Before – I injected when the food was on the table and I could see what I was going to eat. Or sometimes I’d inject afterwards if I wasn’t sure how much I’d eat. If I was being good, I’d do an injection before a meal and then another after, but that wasn’t something I did often.

After – I conservatively guestimate how many carbs I’m going to eat and bolus for that about 30 mins before I eat, more if CGM shows I’m high. It’s no hassle, I just press a button. Then, when the food arrives I’ll put more insulin in if required. Dessert? Press the button again.

The CGM helped me see the impact of not injecting in advance of meals. I’d always known the theory, but nothing brings it home like an upwardly rocketing CGM graph. And nothing is more satisfying than seeing a gentle rise and fall after a meal, rather than a massive peak on a graph.

And then there’s the bolus wizard on the pump – I always thought I had no need for a glorified insulin calculator but I was wrong, when you get it set up right its much better at working out how much insulin I need than my finger in the air guestimates.

3. Dealing with certain foods 

Before – pizza was a nightmare, if I injected for pizza as I ate it I’d be hypo in a couple of hours and then high for about 12 hours after that.

After – I use a dual wave bolus on my pump when I eat pizza. I set it to deliver some insulin as I eat, but then spread the rest of the insulin over the next 5 hours. The CGM lets me track whether I’ve got it right, and take more insulin early if I see I’m rising. Same goes for plenty of other foods too. 

4. Less time spent flying high

Before – I’d only know if I was high when I did a blood test. If I was having a life and didn’t test for a whole afternoon, that would mean I’d be high for 5 hours and not know.

After – I have the CGM set to alarm if I go above 9.5. Plus,  if I look at the CGM and see that I’m rising fast I take more insulin to try and head it off early. That means when I mess up with carb counting or hormones kick in or whatever other reason means I end up high, I spot it early and take action quickly so I don’t rise as high or stay there for as long.

5. The little things

Before – a biscuit during a meeting or a couple of sweets stolen from a friend weren’t worth an injection.

After – I bolus for pretty much everything (assuming I’m not low of course). I’ll take 0.5 units for a small biscuit or a couple of sweets, it’s only the push of a button and it keeps my levels pretty flat.

6. Correcting highs

Before – If I was a 7 I couldn’t really do anything about it – I didn’t need a full unit of insulin so I was stuck with it.

After – Now, if I’m 7 I’ll take 0.3 of a unit to bring it down to around 5.5. A quick glance at the CGM lets me see where I am and whether I’m rising or falling. It puts the number in context – on it’s own a reading of 4 means I need to eat. With the CGM, a reading of 4 that’s been like that for several hours while I’m watching telly and have no plans to move needs no action at all.

So, the pump and CGM haven’t given me the magic bullet to diabetes control, but they’ve let me tweak my control is several key areas that all add up to better overall results. And better quality of life. It took a lot of research and effort to get to this point, but it works for me and importantly, it’s sustainable. I can manage my diabetes like this long term and have a life.

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