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?

emily-morter-8xAA0f9yQnE-unsplash

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.

IMG_7205

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!

glenn-carstens-peters-RLw-UC03Gwc-unsplash

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.

_YNG6316

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!

shooting-craps

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.

IMG_2253

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