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

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

A horrible hypo

I titled this post at 2 am this morning after a sudden hypo around dinner time. At 2 am I was thinking clearly, taking time to make a note on my phone so I wouldn’t forget. At 7.15 pm things were a whole lot more chaotic. Well not at first….

I was cruising nicely through my evening yoga practice after taking my basal shot (long acting insulin which keeps my blood sugar level over night) about 30 minutes prior. I’ve been playing around with where to take the shot to avoid insulin absorption issues, and decided to inject in the soft fleshy area in the top part of my bum. There was a sting on entry and when I pulled the needle out quite a bit of bleeding so I knew I hit a capillary. I wasn’t concerned. Usually this means the insulin won’t absorb as well and I’ll sustain a higher level overnight.

I hopped on my mat, forgetting all about the shot. It was towards the end of my practice that I noticed some itchy sensations around my waist. This is usually a sign that I am going low but sometimes that itch comes when I’m high. I actually find the itch super annoying. It’s not at all useful in helping me determine whether I should check my level or not. Luckily I checked.

3.4 mmol flashed large on my blood glucose meter. This is NOT a good result. This is a scary result. The last time I had checked I was 5.4 and usually it would stay that number until dinner. This sudden and fast drop could only mean one thing. My long acting insulin had hit my blood stream and was absorbing all at once. If I’d been wearing a CGM ( continuous glucose monitor) I could have seen the trend. Arrow pointing down on an angle means I can treat it with around 8 grams of fast acting carbs and it would come up in 20 minutes. Arrow pointing straight down would mean taking 15 grams and still having to wait 20 minutes.

Sadly I cannot afford a CGM. I had to fly blind.

After cramming two tabs in my mouth at once I sat back down on my mat. By now the itch had turned into a crawl which went from head to toe. My husband who was sitting next to me and in the middle of his own yoga practice reminded me to breathe.

I engaged whats called Ujayii breath a slow whispering breath, which sounds almost like a snore and tried to focus on lengthening my exhalation. It worked and I stayed calm but it did little to budge the numbers on my meter. I took another tab and a half and started raving and ranting This is the point where someone telling me to calm down doesn’t  work.  Me telling me to calm down doesn’t work.

Telling myself, “don’t react, don’t eat more tabs, just be here, it will pass, your blood sugar will come up” is like that feeling on the edge of orgasm when the thought comes “don’t do it… hold off… keep enjoying…” and then you go for it anyway.

Not the best analogy, because sex feels good while hypos are horrible, a total brain melt. 

It took 30 minutes and three and half glucose tabs to come out of the tail spin. The graph on the app which measures my data went straight up. When I pulled out my syringe to take some fast acting insulin for dinner my husband was confused. Why are you taking insulin when insulin just caused the problem? How to explain that if I don’t take some insulin to cover the meal I’ll rebound even higher.

Living with diabetes is a fine and tenuous balancing act between the horror of lows and the haunting of highs. No matter which way you look at it you can’t win. Best not to try. Thankfully I rarely have these testing moments. I chalk this up to a consistent and daily yoga routine. More of which I’ll share with you here during #diabetesawarenessmonth.

Want to learn the ujayii breathing technique I use to calm myself during a low? Watch this short video below and join in.

See you tomorrow

with great respect…

rachel