I’m back…

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My blood sugar hit 11.7 mmol today. It’s been a while. I mean a long while. Since starting Insulin in 2014 and simultaneously going low carb I’ve had excellent control. A high for me was about 9 mmol. In the last two years, even that was pretty rare.

The control I’ve had over my numbers has been directly related to a huge amount of food restriction. A.K.A living on eggs, non-starchy vegetables and avocados and olive oil for the last 6 years. When my husband would ask, “How is your dinner?” my standard reply was, “the same.” I could make breakfast, lunch or dinner in 15 minutes tops. Eating to live, and fine with that. Worth the sacrifice if it meant staying healthy.

Don’t get me wrong low carb works. It totally works. The question is… is it healthy and sustainable? I have been low carb for 6 years so it’s doable but healthy?anna-pelzer-IGfIGP5ONV0-unsplashHealthy is having a rainbow in your diet. Healthy is as much emotional satisfaction as physical satiation. Healthy is enjoying food, being social, being able to go out and pick something off the menu without guilt or fear. Healthy is putting the meal together and then trusting that what you inject will do the job. I’m not talking eat whatever you want and cover, rather eat whole foods that please the eye and the pallet. Know you are taking in life sustaining nutrients and that your body can take it in, digest it and distribute the energy accordingly.

This is the basis of a yoga practice, absorbing prana from food, the atmosphere, anything you consume. If our own energy is scattered, stuck or overly dogmatic, we can’t absorb prana which in turn builds Ojas, the basis of our immune system.

In Ayurveda diet should be mitahari, which means balanced. Eating whole grains, legumes, fruits, vegetables etc. Everything according to your type incorporating the six tastes of sour, salty, sweet, bitter, pungent and astringent.JMFO1826Before my diagnosis I was able to follow an Ayurvedic vegetarian diet ad infinitum. After diagnosis I found myself narrowing my diet according to what I felt sensitive to or what I thought wouldn’t cause a high blood sugar. Eventually I was so afraid of going low I stopped trying. I told myself I couldn’t have mung beans or quinoa because it was too confusing to dose for. I couldn’t have fruit because I would spike. My list of excuses was long. My openness and availability to try something new was zero.

In the last few years I’ve started each year with a diabetes goal. In 2018 it was braving meal time insulin (up until then I managed on a split dose of basal with severe carb restriction). In 2019 I worked on healing my gut. My 2020 goal came out of months of feeling helpless around the situation we are facing on the planet and watching two documentaries Cowspiracy and The Game Changers. Discovering that animal agriculture is one of the main contributing factors to climate change and seeing how athletes were able to maintain a vegan diet and increase their performance, made me question what I was eating and why.

To be honest wanting to go vegan was a total heart longing. I’ve never liked the feeling of eating animals (as a kid, I used to pretend to eat my pork chop and when no one was looking I’d push it into a napkin and then excuse myself and flush it down the toilet) so it made sense to stop.pexels-photo-3669638The big question for me was how. How could I make the transition from keto to vegan smoothly? Was it even possible? While I was mulling over the what and how, a T1D friend sent me a PM about a new program she was on which was high carb, low fat and and how successful it had been. She suggested I try it.

I balked at the idea. Then another T1D I follow on Instagram shared his story of going from keto to vegan.  His story was inspiring and confronting. I had to ask myself, what was my excuse really? Was I going to be terrified of carbs and insulin for the rest of my life? What was holding me back?

Doing some deep soul searching around these fundamental questions forced me to take stock of the times in my life where I’d faced a seemingly insurmountable hurdle. I reflected on giving birth. That was terrifying, yet I did it. I thought about how I managed during 9/11. How when I thought I couldn’t handle the shock I actually rose above it and made it through. Even after my diagnosis I was able to eventually find a way to acceptance. I also thought about the beach. Here in South Africa the water is beyond cold. Going in takes a certain kind of bravado.IMG_0674That’s how I decided to approach this new and exciting chapter in my diabetes management. If I didn’t jump in, I might regret it. If I did, hopefully I’d feel refreshed and invigorated.

Five weeks on from transitioning to a plant-based diet. I’ve introduced a huge range of foods, with hardly a hitch in my digestion. The big challenge has been to experiment with insulin to carb ratios to find what works best when. I’ve also had way more highs and lows then before. I’ve had to be courageous while watching that straight down arrow on my freestyle libre. Patient when I see a spike.

My insulin needs have completely changed. I need less basal; more bolus and I am becoming more and more sensitive to insulin. I’ve also had to slowly build my daily carb intake working my way up to about 250 carbs per day. That’s been hard, but I’m getting there. I’ve also rekindled my passion for creating recipes. I’ve made hummus, nori rolls, veggie burgers. I’ve been eating heaven in a bowl for breakfast. Smoothie bowls with dates and figs, bananas and papaya. I now look forward to eating and cooking. I’m excited to try things like beets, leeks, peppers again. I feel like every meal is a party. One I get to have for myself.

The best side effect of my new diet is increased energy and decreased aches and pains. When I step on my mat I feel open, balanced and clean from the inside out. It feels like I’m back.IMG_1095If you’d like to find out more about a plant based whole food diet check out this brilliant new book, Mastering Diabetes

If you’d like to have more one on one support to make the transition I highly recommend Drew Harrisberg from www.drewsdailydose.com

Sick with Diabetes

Usually I can fly 30,000 miles without a hitch but not this time. I’ve been hit by some sort of bug. Could be an allergy, could be my body trying to eliminate all the toxicity from breathing in smoke from the Australian bushfires or could be I actually picked up a bug. One thing I’ve consistently noticed about myself since diagnosis is that I hardly ever get sick. I know others have mentioned this too. It’s like diabetes gives us some sort of immune super power, where we are chronically ill but never sick. Weird!

I try to avoid exposure to bugs as much as I can. It can make me antisocial.  I won’t go to hangout with someone when they have the flu. Getting sick can wreak havoc on blood sugars. Fighting off a bug can raise levels, and having to take extra herbs or medications can lower levels. Even something supportive like Vitamin C can affect the accuracy of the readings on a continuous glucose monitor. Basically a cold or flu is a minefield I’d rather avoid.

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When I travel I wear a mask. It’s not pretty and I’m often the only one on the plane who wears one, but it seems to help. If nothing else it gives me a feeling of security.  Insecurity rears its ugly head when I am tired, sick and feeling irrational. Same as one of those out of control hypo moments. Brain offline, body shaking, must get glucose now kind of stuff.

Obviously this time the mask was no match for the super bug. Now I’m in that lovely cycle of watching and waiting. Watching how it progresses from excruciating pain at back of nose, to yellow phlegm, to sore throat, waking up every hour during the night, to loss of  voice. Where to next? No idea… Such fun!

Meanwhile my blood sugar seems to be staying in range for once. Go figureIMG_7258

And it’s a beautiful day in Africa! Nature is in full force in spite of my gluggy head. A little bird is building its nest in the rafters, the lion down the road is roaring, the natural bush around us is filled with cheeps and chirps and there is a presence and stillness in the surrounding forest and mountain scape that can’t really be described.

Yep, it’s definitely annoying to get sick when you live with diabetes, but it’s also a good opportunity to rest, reflect and appreciate one’s health.

Happy Thanksgiving!

See you tomorrow #NDAM #DiabetesAwarenessMonth

with great respect…

rachel

Staying in range

I’m feeling motivated to get my levels back to where I want them. Not that their not in a good range, its just I know I can do better. At the beginning of the year I worked with the Diabetic Health Journal. It’s a great way to stay accountable, set goals and track patterns. When I was using it my Hba1c went from over 6% to 5.5%. For anyone living with diabetes that’s a perfect number, but really hard to maintain. As much as I know that time in range (keeping my levels between 4-8 mmol) is ideal, there have been a few too many peaks and troughs for my liking. So when I opened the journal and set my goal for the week, I thought I’d try some intermittent fasting.

Intermittent fasting is different to a regular fast. I’m still eating, just spacing out when I eat. The last two days I had my last meal at 7.30 pm and broke the fast with lunch at 1.00 pm. That’s 18 hours between meals. The idea with IF is that it increases insulin sensitivity. It means I assimilate the insulin I am injecting better and blood sugar levels are lower. When I’m really sensitive to insulin I can even reduce the amount of insulin I’m taking which means less low blood sugars events. It’s a win win.

Intermittent fastin concept - empty plate on blue background

The only issue for me is I am a huge fan of my avocado and egg breakfast. Day 1 was easy because I distracted myself by going to yoga. Day 2 (today) was harder. I was pretty hungry from about 10.00 am onwards.  I also haven’t seen any concrete results yet. I.e lower levels and increased sensitivity. Patience Rachel Patience…

After I started taking insulin in 2014, I came across a book by Ginger Vieira called Your Diabetes Science Experiment. I read it from cover to cover and learned a lot about the variables that affect diabetes. I learned that even though there are  guidelines and formulas for managing diabetes, it’s not one size fits all. Flexibility and a willingness to experiment are key assets. I’ve been using my yoga practice for years as my personal laboratory to see what my body is capable of. Having diabetes has made things tricky. Sometimes I’m not sure what’s affecting what. Is the sequence or practice supporting what I am doing or is a day of higher or lower levels affecting my practice?

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I feel like I am drawing a giant question mark on a blackboard.

Not having all the answers is something I’ve grown accustomed to.  I was the child that had to be ‘right’ or else. I thrived on competition. That’s why having diabetes has been a bonus in my life. It’s taught me to stop comparing, be kinder to myself and take a gentle approach.  So even though I’ve set a goal for myself to get back to the numbers I feel healthiest at I’m also open to the possibility that where I’m at now is absolutely fine.

See you tomorrow #NDAM #DiabetesAwarenessMonth

with great respect…

rachel

The number of tests?

“How many times do you test per day?” this was the question put to me this morning by the Accuchek Guide rep while I was trying to replace my meter. “About twenty,” I replied adding that my blood sugar can tend to be volatile. The rep murmured a sympathetic sound. But I wondered what she really thought.

I know what my Endo thinks. He’s mentioned to me on more than one occasion that I am obsessed with checking.  Do I really need to wake up throughout the night to check? Ummm…YES!  It’s not like I set an alarm or anything, I seem to naturally wake up between 1-3 times per night anyway so why not check?

Overnight lows are the worst. In the days before I had the whole diet thing mastered I’d wake up and have to eat at 2 am. Nothing worse than sitting by myself in the kitchen watching the clock tick over while I wait for my blood sugar to rise.

midnight snack

And what about in the day? Do I really need to check every hour? I actually don’t check every hour, it depends on whether I’m insulin resistant or have had some sort of injection blunder. Most mornings I can go from breakfast to lunch without even checking. I know my liver is doing its thing, dumping some extra glycogen into my system so it’s rare for me to drop. It’s usually between 12-5 pm that I like to be vigilant. I can never seem to get my lunchtime bolus right, and then there might be some extra exercise thrown in the mix around 4 pm.

Checking vigilantly when you live with Type 1 Diabetes is a make or break situation. Especially if you can’t tell when your low. Its called hypo unawareness, it happens when you have too many lows and the body stops recognising the feeling of being low. Like my horrible hypo two weeks ago, before I knew it I’d dropped to 3.2 mmol. Scary!

It was also after that horrible hypo and sharing it here that some friends encouraged me to use a CGM (continuous glucose monitor). This is something I would love to have but sadly here in Australia there is no subsidy for someone like me. To be eligible for the Dexcom or Medtronic CGM you have to be hypo unaware and admitted to hospital more than once or under the age of 21.

The Freestyle libre flash glucose system is also on offer here, but this has no subsidy at all. I have written before on the blog about how much I love this product. Sleek, discreet and accurate using it has increased my peace of mind and saved my finger tips. I’ve attended  product launches and #dx2Melbourne and can honestly share the company, its ethos and care are palpable. I’ve even lobbied the government to make access affordable for people like me and had a small feature in the Noosa News. In spite of my passion and efforts, I still can’t justify spending $100 every fortnight.

But wait ho… my wonderful parents, after reading my blog, gave me the best early christmas gift ever! A 6 months supply of the freestyle libre. I am touched and grateful.

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Here I am ready to launch. So excited to have some time off from the drudgery of test strips and the ability to see whats actually happening minute by minute with the food I am eating, the insulin I am taking and the sleep I’m sleeping. I’ll probably put one in starting next week so stay tuned…

See you tomorrow #NDAM #DiabetesAwarenessMonth

with great respect…

rachel

The humble test strip

Something that bears the brunt of many jokes in the diabetes community is the test strip. If you haven’t a clue what that is. No worries, I’ll explain.

The test strip is a very small yet essential item for anyone living with diabetes. In order to keep blood glucose levels in check you have to take regular measurements with a blood sugar measuring device called a glucometer.  Even if I wear a CGM (continuous blood glucose monitor) which measures blood sugar through an implanted device, I still need to calibrate my CGM or double check that the reading I’m getting is accurate. Especially in an emergency. Nothing worse than getting a false reading on my CGM and treating it with either insulin or glucose and then having either a low or high. Sound complicated? Not even the half of it.

Anyway I digress…

The test strip is inserted into the Glucometer, I prick my finger with a lancing device, place a minute amount of blood on the test strip and within 5 seconds I see the reading on a screen. Then I take the test strip out and supposedly dispose of it. The big question is where? One lone strip usually lands in the side pocket of my meter case, eventually 1 becomes 50 or 100 and before I know it little tiny test strips covered in droplets of red blood are literally falling out of my meter every time I open it. Too lazy to throw them in the rubbish I put them back in the side pocket only for them to fall out again the next time I go to test my blood sugar.


Stray test strips end up in car seat crevices, on the floor, in the bed, in the toilet, on the pavement, in my hair. I’ve even found a test strip in my soup. Yuk!

Getting the test strip out of the little round container in the middle of the night in the dark is also a total drag. It’s bad enough having to get up to test my blood sugar but then when I waste a strip putting it in upside down and back to front… total headache! Plus if I don’t get enough blood on the strip the machine tells me I have to test again. That’s another waste of a strip.

Strips are made of plastic and as far as I know non recyclable. In fact most of what we  use to manage diabetes is non recyclable. Talk about feeling guilty every time I test or inject. I just wish someone could invent a recyclable paper, bamboo or hemp test strip. In fact why not invent insulin pens, needle cases, devices out of hemp plastic or some other compostable equivalent. Anyone want to start a movement ?

The test strip is also a conversation piece. ” What’s that? My aunt has diabetes. How many times do you test? Does it hurt?”

The test strip is certainly not something to be undervalued or ignored. Before the test strip made its appearance on the world stage, the only way to know what your blood sugar reading was was to use a special solution mixed with urine then boiled to get a rough sense of the levels. Eventually  a urine test strip was used and by the 80’s there were home test kits like the one pictured below, but it took 5 minutes to get a reading.

Screen Shot 2019-11-08 at 5.13.53 PMThink about it, before the invention of insulin and diabetes technology we didn’t know what we had. how to manage it or even how to stay alive. The humble test strip for all its foibles, annoyances and character flaws is an absolute life saver.

I for one will never leave home without it!

See you tomorrow for #NDAM #DiabetesAwarenessMonth

With great respect…

rachel

P.S. Check out the amazing Miss Diabetes and her latest cartoon about how to test your blood sugar here

7 Things or thereabouts

There are a lot of things that influence blood sugar.  42 to be exact, according to Adam Brown from diatribe.org . If you’re keen to know what those are you can check out his handy chart here.

In the spirit of Diabetes Awareness Month and to share more about what its like to live with diabetes, I’ve put together my own short list based on personal trial and error. For those who don’t have diabetes and are just coming along for the ride, your blood sugar levels might also be influenced by these ‘things’ the only difference between you and someone with diabetes is. When your blood sugar rises your pancreas produces insulin to lower your blood sugar level, mine doesn’t. So unless I inject insulin or do something else to lower my level like exercise, I can’t just kick back and let my body do the work. When blood sugar levels go low in a non-diabetic , the liver kicks in with a drip feed of glycogen, to bring them back to homeostasis. My liver kicks in too, but as there is no insulin to meet the liver dump my blood sugar goes up again, hence the need for more insulin and round and round I go. Fun, fun fun…NOT!

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So here’s my list in no particular order.

  1. The Sun. Every time I lie in the sun for more than 20 minutes, I have higher levels for 24-48 hours afterwards. Apparently its the oxidative stress. It’s a double edged sword because if I avoid the sun I don’t get enough Vitamin D. I’ve worked out that if I limit exposure to 15-20 min and only sunbathe every two days I stay in range.
  2. High Fat Foods. I absolutely love my avocados and olive oil. I also love Haloumi and Feta cheese. My blood sugar however is very fussy when it comes to what I eat when. I’ve learned to avoid fatty dairy products before bed because I go high over  night and for 24 hours after. Avocados are a little more friendly, they actually help me keep my blood sugar from tanking while I sleep. So I load up on a hefty avocado with my dinner. But sometimes it backfires and I am still high when I wake up. I’m still trying to work out how to dose for fat. I feel like if I could figure it out I’d eat pizza again.
  3. Not enough sleep affects everything. Sleeping less than 7 hours a night for me definitely messes with my levels. I wake up about 1-2 times a night too so not sure what would happen to my levels if I was able to sleep through the night. I’d probably have lower levels in general.
  4.  A Daily Walk can either reduce my blood sugar level, which can be a bonus when I’m high, or raise my blood sugar level which is not ideal. When I walk, for how long and at what pace is also a factor. Walking directly uses the thigh muscles which burn glucose for fuel. It’s suggested that when levels are higher, or you’ve had a carb heavy meal, a walk will help insulin to work more effectively and reduce blood sugar. In my case a long walk (over an hour) on flat terrain  raises my blood sugar whereas a short 20 minutes hike up and down hills reduces my levels.
  5. Cleaning definitely drops my blood sugar in spades. All I have to do is look at the vacuum and I’m low. No joke!
  6. Travel. This is also very specific to the type of travel. When we travel by car anywhere over long distances I have lows. When we fly I usually have lows and then struggle with a stubborn high when we land. Jet lag is included in travel and wreaks havoc.
  7. Any kind of stressor like unexpected news, seeing a snake on the path, (that  happened yesterday) a loud noise, change in routine, fears, emotions, frustrations. So that covers the gamut right? All of this always gives me higher levels. Especially emotional outbursts.

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The one thing that doesn’t affect my levels is my yoga practice. That includes postural yoga, breathing and meditation as well as adhering to an ayurvedic daily regime. No matter how often, or how intense the practice my levels stay steady. In fact they flat line. That’s why I personally use yoga as my goto when I’m getting stressed out about my blood sugar levels. It’s like pushing the reset button.

It may not lower a stubborn high or fix a scary low, but it will calm me down enough to handle it.

See you tomorrow

with great respect…

rachel

6 tips to bounce back from a rebound high

The first time it happened I was clueless. People living with diabetes often talk about blood sugar roller coasters but I thought that just meant highs and lows in a short period of time. What I didn’t understand was that when I go low I also go high and not just right after correcting a low blood sugar. The high lasts for days. My body starts resisting the insulin I’m injecting and I need more insulin to manage the highs which means more risk of lows. When I was a kid I hated rollercoasters and for good reason. They made me feel sick, scared the begeezus out of me and I’d come off the dang thing with a sore throat from screaming my lungs out.

It took quite a few hypo’s for me to work out that the high’s that followed were to do with the lows. At first I just thought there was something wrong with the insulin, or maybe I hadn’t dosed enough. I even speculated that maybe my pancreas had finally hit the dirt and I really didn’t have an ounce of beta cell function left. Because I live with LADA ( latent autoimmune diabetes in adults) I still produce a minute amount of  insulin, this means that sometimes my body squirts out a tiny amount when I first start eating. It also means that if I am already low when I start eating I could go even lower and have a hypo. Not having the recipe as to what my pancreas will do when means there’s a lot of guessing going on. So when I’m high for days on end and doing everything exactly as I did it the days, weeks and months before it feels like I’m in the middle of a crap shoot. Lucky me!

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When people meet someone living with diabetes, the decision making and daily micromanagement is largely invisible. You might see a CGM or an insulin pump, but on the whole it seems as though the whole process runs smoothly.

Here’s what actually goes on most days for me. I wake up, inject. I eat, inject. Go a little below range, take a glucose tab. Go high, take some insulin.  I check my blood sugar every hour to be on the safe side except for at night where I place my faith in morpheus, the god of sleep trusting that the amount I take for my long acting insulin will keep me in range all night. 20 fingerpricks and up to 6 shots a day of insulin is not easy or seamless no matter how doable it is.

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What do I do to deal with the physical and mental blood sugar challenges during a rebound high? Here’s 6 things that have really helped me.

  1. Do some physical exercise which I know increases insulin sensitivity, like a walk with some hills,
  2. Do a yoga practice which works with the larger muscles of the body and includes standing hip openers and balancing postures
  3. Talk to myself in a positive and supportive way when I see a high number on my meter. I.e. This too shall pass, this is a normal response to a low blood sugar, everybody goes through this
  4. Do things in my day that give me joy, like writing, yoga, connecting with a friend or have some hang out time with my husband
  5. Go to bed early, there’s nothing more healing then a good nights sleep
  6. Reach out in the #DOC ( diabetes online community) to find out how my diabuddies deal with the same situation

And if you live with diabetes I’d love to know… How do you deal with a rebound high? Lets start a conversation in the comments below!

See you tomorrow #NDAM #DiabetesAwarenessMonth

with great respect…

rachel