Diabetes blog week 2011: Diabetes bloopers!

Diabetes bloopers - Wednesday 5/11: Whether you or your loved one are newly diagnosed or have been dealing with diabetes for a while, you probably realize that things can (and will) go wrong. But sometimes the things that go wrong aren’t stressful - instead sometimes they are downright funny! Go ahead and share your Diabetes Blooper - your “I can’t believe I did that" moment - your big “D-oh” - and let’s all have a good laugh together!!

Bloopers. Well, there have been many of them (and many more to come, I'm sure!)

There was the time I went to bolus for breakfast, dialed up the dose, realised there wasn't enough insulin left in the cartridge, and dutifully went off and changed it. And then had breakfast. Without actually *taking* the insulin. I only realised when it wasn't even coffee time in work and I'd been to the toilet three times and was gasping for a drink. A quick check on my meter showed a BG of 27.7, and realisation dawned...

Then there have been the times when I've been hypo and done silly things, like the time I was sitting balling up socks on the floor of my room when I felt a bit hot and a bit weird. I decided I felt weird because I was hot, so kept stripping of layers while I continued to ball up the socks. I was down to my underwear before it occurred to me to check my BG. I still felt that it was Very Important that I finish balling up the socks before I did though (hypo logic, worse than dunk logic...). And that's not including the times where I've woken up low in the middle of the night having one of those OMG MUST EAT EVERYTHING!!! hypos, where I've ended up sitting on the kitchen floor with the remnants of a carb fest around me...

Then we get to the pump. I've lost count of the number of times I've managed to put in a new infusion set only to discover I've somehow managed to get the tubing under the sticky bit. Then there was the time I was filling up the cartridge at work, managed to pull the plunger out of the end of the cartridge, spilling insulin all over my legs (mmm...that hospital smell). I've also managed to smack Stuart on the head with my pump (it was an accident I swear, any claims he makes that I was wielding it like a flailing mace are completely fictional...)

Ahh, diabetes! You've got to laugh... ;)

Diabetes blog week 2011: Letter writing day

Letter writing day - Tuesday 5/10: In February the Wego Blog Carnival asked participants to write letters to their condition. You can write a letter to diabetes if you’d like, but we can also take it one step further. How about writing a letter to a fictional (or not so fictional) endocrinologist telling the doctor what you love (or not) about them. How about a letter to a pretend (or again, not so pretend) meter or pump company telling them of the device of your dreams? Maybe you’d like to write a letter to your child with diabetes. Or a letter from your adult self to the d-child you were. Whomever you choose as a recipient, today is the day to tell them what you are feeling.

This is a letter that I keep thinking I should write but I never actually have. Maybe now I've written it I might actually send it one day.

Dear Dr C.

You probably won't remember me, because I'm sure I'm just one of thousands of patients you've seen in your career, but you made a huge difference to my life, and I wanted to thank you.

I began seeing you when I was about 14, when I was still attending the diabetes clinic in the childrens' hospital. There were a couple of different reasons you became my endo at that point. I was due to transfer to the adult hospital when I turned 15, and this was part of the preparation for moving to the big scary world of the adult clinic. The other reason was that my control wasn't very good at that time. In fact, it was pretty damn awful, I have to be honest. I was on two injections of mixtard at the time, blood testing meters weren't quite at the same level as they are now, and I was going through a fairly extended period of burnout. I was always high in the mornings, no matter what I did, I always seemed to be high whenever I tested, I had no idea about how to adjust insulin (in fact, it wasn't even a subject that was ever broached, so I didn't know it was an option!), and it just seemed like it didn't seem to matter what I did, I'd always be high and I'd get yelled at when I went to the clinic. It wasn't rebellion, because it wasn't like I was deliberately not doing my insulin or eating things I knew were 'bad' for me. I just couldn't see any way for me to make things better, and that crushed what little motivation I had. It just didn't seem worth the effort if the effort gave nothing in return.

You were the first endo I've ever had who recognised what was going on. You set up regular meetings with me, you and a DSN where I went along for an hour once a fortnight and you taught me about managing my diabetes. I knew a lot of the science behind it, but you were able to fill in the gaps, like how I was probably high in the mornings due to hormones. You didn't judge me for things that had gone wrong, or high numbers. You were the first person to tell me that diabetes was *my* disease, that I was the one who'd have to live with it, and that I should be the once managing it. No-one had ever said that to me before, and it was kind of a revelation.

It wasn't all sunshine and lollipops. Burnout doesn't just disappear overnight, and although you encouraged me to keep going with the regular meetings at the adult clinic, when I got there they weren't interested. My appointments were once a year for maybe five minutes, I never saw the same endo twice, there was no continuity of care, and it seemed like the only thing they were particularly interested in was making sure I didn't get pregnant! I fell through the cracks, and I reverted back to the way I was before.

But you planted a seed, which meant that when I moved to Cambridge and attended the diabetes clinic here I *believed* my new endo when he told me I could do better. When they encouraged me to get back on my feet and start managing my diabetes properly, they built on that message that it was *my* diabetes, and that I was the best person to manage it. They helped me learn the tools to do that, put me on courses, got me a pump, and I began to see my results improve.

I don't think that would be possible without the help you gave me. You changed my attitude towards my diabetes, and that has changed my life, and for that you have my immense gratitude.

Diabetes Blog Week 2011 : Admiring our differences

I've decided to take part in Diabetes blog week this year, since I think it's a really cool idea, and I think it'll be a great way to get see lots of different perspectives on the subjects, and get introduced to some new diabetes blogs at the same time! :)

Admiring our differences - Monday 5/9: We are all diabetes bloggers, but we come from many different perspectives. Last year, Diabetes Blog Week opened my eyes to all of the different kinds of blogs (and bloggers) out there – Type 1s, Type 2s, LADAs, parents of kids with diabetes, spouses of adults with diabetes and so on. Today let’s talk about how great it is to learn from the perspectives of those unlike us! Have you learned new things from your T2 friends? Are D-Parents your heroes? Do LADA blogs give you insight to another diagnosis story? Do T1s who’ve lived well with diabetes since childhood give you hope? Pick a type of blogger who is different from you and tell us why they inspire you - why you admire them - why it’s great that we are all the same but different!!

I have to say, since joining the DOC and reading many other diabetic blogs, I have learned so much about the different types of diabetes and the people who live with it. I've learned more about type 2, which I knew a bit about, I've learned about the various type 1.5's, which I knew very little about, I 've read about what it's like to be on the other side of this diabetes shindig and deal with someone you love living with it.

But the thing that's got to me the most has been reading the stories of the parents of diabetic children.

See, I was four when I was diagnosed with diabetes. I don't remember *not* being diabetic. I've grown up with this condition. I have no memory of diagnosis, or the weeks in hospital, or those first few months while my parents had to deal with their world being turned upside down. My mum says that when I was diagnosed she was quite calm at first. It was a relief to get a diagnosis after she's been passed over by one doctor as being a paranoid mother. I'd been diagnosed with juvenile rheumatoid arthritis a couple of years before, and that had taken months and months to diagnose. In comparison, the diabetes diagnosis was relatively straightforward. The treatment, however, not so much. She says I used to run and hide and fight them when they had to do my injections, until I realised that they were making me feel better and I stopped fighting them, and even then there was all the other bits and pieces to learn, and this was 23 years ago when treatment solutions weren't quite as advanced as they are now.

I always used to think "well, at least I was four, at least I wasn't a baby." And then my little cousin turned four, and all I could think about was how tiny she was. I can't imagine what it's like to have to inject your child just to keep them alive. To test their little fingers, to watch every morsel of food that goes in their mouths, to try and figure out if they're hypo, or hyper, and deal with that. Not to mention sick days, holidays, school and a hundred other things these wonderful people deal with every day, taking responsibility for treating a disease that does not in any way play fair.

To the parents of diabetic kids in this community, I salute you. You are all amazing, wonderful people who have shown me what it's like to be on the other side of diabetes. You have made me appreciate what my parents did for me as a small child when I was too young to even be aware of the sacrifices they made to keep me healthy. I know what it's like to just get on with it, because diabetes is not going anywhere. It's not always an easy task, but at least I'm doing it with all the information relative to me at hand. To do it on behalf of a child, who may not always be able to explain how they're feeling, or what's wrong, or even simple things like how much exercise they may have gotten while out playing with friends? That's incredible, and you have my complete admiration for it.

Exercise!

I've started cycling into work again, after a break of over a year, which has led to some interesting things diabetes-wise.

I decided to start cycling again for a few reasons. Mainly, I really missed it. I used to cycle all the time, but then when I was writing up I was just too tired, and then I was ill, and it fell by the wayside. Since we moved to our new place I've been getting the bus, but it's bugged me that I'm then dependent on bus timetables to get anywhere, not to mention the expense. I also need to lose some weight. I'm about a stone heavier than I'd like to be, and I've started making some changes (omg, I love the kinect fitness!), but I figured that cycling eight miles a day has got to be a good addition! I also know that exercise helps my diabetes control. I used to see differences when I wasn't cycling, and I generally used to run with less highs, and needing less insulin when I was cycling.

So, putting all of those things together, and inspired by the lovely weather we've had recently, I finally got my backside in gear, got my bike serviced, figured out the route to work (but still managed to get lost. Twice...), and started cycling again.

I wasn't sure what effect to expect on my BG and insulin levels. I was already cycling when I went onto MDI, and I'd hadn't cycled for a few months when I started on the pump. The upshot being that I knew how to manage cycling on MDI, but that was when I was trying to make lantus work for me when it really didn't match my basal needs. I had no idea how to do it on the pump. In addition, I tend to find that the first few days of any new exercise tends to hit me quite hard, in that I drop through the floor, but then my body adjusts and things even out.

And this is what I saw for the first few days. Even with using 50% basal rates, for up to an hour before the cycle, during, and after, and free carbs, I was still hypoing more often that I'd like. I had a look at my results, and set up a new basal profile (imaginatively entitled 'exercise') which was pretty much just a 25% reduction of my previous basal. That worked, for a day or two, and then my body got over the shock of the cycling, and I started to run high again, so I switched back to the old profile.

At the moment, I'm tending to find that I don't have to change my basal at all to go cycling, which was a surprise. What is an even bigger surprise is what to do about my breakfast bolus. On MDI, I used to reduce my breakfast bolus by 30%, and that seemed to work quite nicely. If I try that on the pump, it keeps me steady during the cycle, but then I rise a couple of hours later. It seems that I need the full bolus, just not all at once. I've been playing about with the extended bolus, and so far 70% up front with the rest over an hour seems to be best. I'm dropping a little before lunch, but I'm starting to suspect that's a basal issue.

The interesting thing is that if I screw up the extension on the bolus (like I did this morning - I tried reducing the bolus by 10%, but then didn't increase the percent up front to keep me steady, so I was high after two hours), and I end up high at the two hour mark, they seem to be fairly stubborn highs. They're not too high - mainly 10/11, but they seem to need more insulin to come down, whereas the same amount of insulin, but given in the right proportions seems to keep me steady. It's been fascinating to see how much being high at that point has an effect on my insulin resistance.

Of course, the other thing is that there are several points in the day now where I'm dropping, and I think I'm now seeing the general effect of consistent exercise on my insulin sensitivity. You know what that means: basal testing. Roll on the sugar free jelly!