Well not exactly... More 'Easter Anxiety' really, bit I'm a sucker for a snappy title, and we've been enjoying some fabulous sunshine over the last few weeks.
I've been really struggling with control for the past three or perhaps four weeks. It started getting wobbly for a week or so, at the end of which it became clear that the insulin stored in our increasingly dodgy fridge had not kept too well and had lost a lot of oomph. Almost immediately afterwards I had a sore throat/cold combo which (unusually for me) wreaked a little BG havoc. And around the same time the Easter holidays came along. As invididual events they would probably have passed with little comment, but in succession they have been very hard work.
My diabetes likes order. My diabetes likes stability. My diabetes likes things to stay the same day after day after day.
Holidays in particular are often a bit of a challenge. When the kids are at school their routine sets a rhythm in the house. We wake at a set time and are careful not to do too much on a 'school night'. It's easy to get to the gym three times a week. Evening meals slot into the regular pattern.
When holidays come along though the regular rhythm of the house changes. We begin to wake up later. Gym visits fall away. Beautiful sunny evenings beckon. Friends call to ask if we'd like to join them for a stroll around the docks, perhaps stopping for a pint at The Cottage on the waterfront. While we are there perhaps we'll decide to stop for some food (I'm sure to have brought my insulin pen). Friends come to visit, what a lovely evening! Let's have a barbecue! All of these events are lovely. They all form an important part of my enjoyment of life.
But they do not make it easy to maintain good control.
It's times like this when I can feel trapped between enthusiasm for these lovely events, and facing the consequences of the BG guesswork they inevitably involve. It's times like this when diabetes seems most in the way. When life is fast-moving and unpredictable. When meals are grabbed outside of the normal, 'old faithful', predictable choices. The choices that we rely on week by week to make life, grocery shopping and carb counting easier. It's times like this when diabetes feels like a weight grinding you down. When a pleasant afternoon stroll followed by a meal out makes you think, "Oh great, that's going to be tricky to count right". It's times like this when diabetes seems determined to suck the joy out of life.
Of course it is not really that bad. Usually with a little effort, and some decent guesswork it is possible to get into 'holiday mode' and make a reasonable attempt at guessing your way through the holiday maze. To reset basal for the lack of gym visits. To adapt to the new 'normal'.
What this last few weeks have shown me (again) though, is how easy it is for one week of uncertainty to roll into another. And before long it's easy to lose confidence in your ability to make good judgements. Even if you know there are good reasons for a string of errant readings, a few short weeks of chaotic BGs can really take the wind out of your sails.
Next time we have a holiday I'm going to make sure that the fridge it in tip top working order, and I'm NOT going to get ill!
Friday, 22 April 2011
Friday, 1 April 2011
Not cool - insulin storage problem
I'm still waiting to write that post extolling the virtues of Colin, my Accu-Chek Expert, but even his shrewd bolus-calculating savvy was not up to coping with the BG craziness of the last seven days.
Things just went bonkers.
And it made me realise that this is not unusual. Since I started putting a lot more effort into my diabetes a year and a bit ago I've noticed a definite repeating pattern in what I previously thought was just diabetes randomness:
1. Finally work out the rules
2. Good numbers for a few days. Yay!
3. Wow that was an AMAZING day. Woo hoo!
4. Errrrr hang on where did that come from
5. Right something's definitely not right here...
6. So the rules have changed again then. Great, thanks for that.
7. Erm... try this?
8. Nope. That was annoying.
9. What about this?
10. Right OK not that either...
11. OK that's looking a bit better
12. Definitely on to something here...
....aaaaand repeat. Given enough trips around the cycle the doses/ratios/splits/timings begin to repeat themselves and off we go again.
But this one wasn't like that. This one was off the scale.
Looking back over recent records I'd had a spectaculatly good patch. Over a fortnight with 75% of readings between 4 and 8 (including several 1hr/2hr post meals). Anything over 10 was a bit of a surprise. I was also having almost no hypos during this period. In short it felt like I was winning. It felt amazing.
I started having a few hypos to tentatively dropped my Lantus by 1u to see if I'd settle just a notch higher up. I only lasted 2 days first with a prefectly acceptable 6.9 average, the second constantly fighting highs and averaging at 10.8.
The next two days, Lantus back up by 1u were not too bad, but the following few days were a complete disaster. Countless corrections were having little or no apparent effect. One morning despite a 2u correction the previous night (at 14.x) I woke to 16.6. I went for broke decided on double my usual breakfast insulin:carb ratio +20% for 'stress', injected 8u and waited for it to come down. 5 hours passed and I still hadn't eaten anything other than a lump of cheese (hoping to trick my liver into cancelling any DP action). BG stayed above 9.0 right up until lunch. The following day saw me needing 10u for a single slice of breakfast toast (that's 5x my usual amount)!
While waiting for our new fridge to be delivered, I posted a moan on a forum describing recent events, and suggesting that the Diabetes Gremlins had perhaps snuck in at night and replaced the Lantus in my cartridge with water. Someone happened to ask if there might be any problem with the way the insulin had been stored. Hang on a minute... "While waiting for our new fridge to be delivered...".
And then it all fell into place. Our fridge has been a bit flaky for some time, maybe even a year. Mostly keeping things cool, sometimes getting a little enthusiastic and getting really cold, other times appearing to warm things up, but never actually completely broken. The light had stopped coming on a week or so ago and we'd decided that enough was enough and ordered a new one. I was down to the last cartridges in the box of both Lantus and Humalog and it seems that the fridge's repeated misbehaviour had substantially affected the insulin's potency. The box of Lantus was the older of the two, so my guess it that it was pretty much shot. The newer Humalog left to fight the BG battle on its own at half-strength. Another one to add to the 'watch list': Count carbs, consider food absorption properties, check basal level, consider level of activity, rotate sites, make sure fridge is working.
I've ditched the suspect cartridges and with nice new fresh ones things have quickly returned to normal. Well today at least.
Things just went bonkers.
And it made me realise that this is not unusual. Since I started putting a lot more effort into my diabetes a year and a bit ago I've noticed a definite repeating pattern in what I previously thought was just diabetes randomness:
1. Finally work out the rules
2. Good numbers for a few days. Yay!
3. Wow that was an AMAZING day. Woo hoo!
4. Errrrr hang on where did that come from
5. Right something's definitely not right here...
6. So the rules have changed again then. Great, thanks for that.
7. Erm... try this?
8. Nope. That was annoying.
9. What about this?
10. Right OK not that either...
11. OK that's looking a bit better
12. Definitely on to something here...
....aaaaand repeat. Given enough trips around the cycle the doses/ratios/splits/timings begin to repeat themselves and off we go again.
But this one wasn't like that. This one was off the scale.
Looking back over recent records I'd had a spectaculatly good patch. Over a fortnight with 75% of readings between 4 and 8 (including several 1hr/2hr post meals). Anything over 10 was a bit of a surprise. I was also having almost no hypos during this period. In short it felt like I was winning. It felt amazing.
I started having a few hypos to tentatively dropped my Lantus by 1u to see if I'd settle just a notch higher up. I only lasted 2 days first with a prefectly acceptable 6.9 average, the second constantly fighting highs and averaging at 10.8.
The next two days, Lantus back up by 1u were not too bad, but the following few days were a complete disaster. Countless corrections were having little or no apparent effect. One morning despite a 2u correction the previous night (at 14.x) I woke to 16.6. I went for broke decided on double my usual breakfast insulin:carb ratio +20% for 'stress', injected 8u and waited for it to come down. 5 hours passed and I still hadn't eaten anything other than a lump of cheese (hoping to trick my liver into cancelling any DP action). BG stayed above 9.0 right up until lunch. The following day saw me needing 10u for a single slice of breakfast toast (that's 5x my usual amount)!
While waiting for our new fridge to be delivered, I posted a moan on a forum describing recent events, and suggesting that the Diabetes Gremlins had perhaps snuck in at night and replaced the Lantus in my cartridge with water. Someone happened to ask if there might be any problem with the way the insulin had been stored. Hang on a minute... "While waiting for our new fridge to be delivered...".
And then it all fell into place. Our fridge has been a bit flaky for some time, maybe even a year. Mostly keeping things cool, sometimes getting a little enthusiastic and getting really cold, other times appearing to warm things up, but never actually completely broken. The light had stopped coming on a week or so ago and we'd decided that enough was enough and ordered a new one. I was down to the last cartridges in the box of both Lantus and Humalog and it seems that the fridge's repeated misbehaviour had substantially affected the insulin's potency. The box of Lantus was the older of the two, so my guess it that it was pretty much shot. The newer Humalog left to fight the BG battle on its own at half-strength. Another one to add to the 'watch list': Count carbs, consider food absorption properties, check basal level, consider level of activity, rotate sites, make sure fridge is working.
I've ditched the suspect cartridges and with nice new fresh ones things have quickly returned to normal. Well today at least.
Tuesday, 29 March 2011
Not always easy
I'm having a slightly difficult time at the moment. Not really, but I've just had a whole load of weeks with almost bewilderingly good control. I have a blog post brewing called something like 'How much I love my Accu-Chek Expert' that I'm hoping to add later this week.
Things never stand still with diabetes though. It's a constant grind of getting it to work OK, then things seeming to change for no readily apparent reason, then working out what these 'new rules' mean while enduring days of chaotic numbers, then getting it to work OK again... and on... and on... and on...
I just read a quotation that someone posted on a forum which so eloquently summed up this feeling that I wanted to share it here:
Things never stand still with diabetes though. It's a constant grind of getting it to work OK, then things seeming to change for no readily apparent reason, then working out what these 'new rules' mean while enduring days of chaotic numbers, then getting it to work OK again... and on... and on... and on...
I just read a quotation that someone posted on a forum which so eloquently summed up this feeling that I wanted to share it here:
“And even the constant need for decisions might be tolerable, if only the results were predictable. Few things generate burnout like the awful frustration of having followed instructions and done everything just right and still to be failing to get the diabetes into control. At those times it seems no use to continue to try.
Think how discouraging it is to fail at something you really wanted to do. Then consider what it must feel like to be failing at something you didn't want to do in the first place.”
Joan Williams Hoover
Friday, 11 March 2011
Owning your targets
I replied to a forum thread today, and only as I was posting did it strike me that I've completely changed the way I view my blood glucose target range in the last year or so. A mother with a teenage type 1 diabetic daughter was expressing concern about the extra fingerstick blood glucose tests, basal testing etc that would be part and parcel of her move to pump therapy. She then said she had to text to remind her daughter to do a test, and text back the results. It made me wonder how that felt for a young person. Whether they would feel that the tests were for them at all.
And then I realised that was exactly how I had felt about these things too.
The recommended levels for adults with type 1 diabetes in the UK are 4-7 mmol/L (72-126mg/dl) before meals and less than 9mmol/L (162mg/dl) by two hours after meals. This is, frankly, a tiny target to try to hit. To be honest the permitted percentage of inaccuracy on a BG meter is 10%. So the meter itself is only accurate to one sixth of the target range some of the time. I've had 20-odd years of consultants telling me that I was 'doing fine', but 'should try to have not quite so many highs and avoid those lows'. I've always just smiled through gritted teeth at such comments. "There speaks a person" I would say to myself, "who has never tried to guestimate the carb load and absorption rate of a meal, and tried to match it precisely with the activity profile of an insulin injection, taking into account any abnormal activity level during the day." If they wanted me to hit their stupid target, they should have made the darned thing a bit bigger.
In a small, but incredibly crucial way though, my mindset has changed. The shift was so slight I only noticed it when trying to look at the same issue from someone else's point of view. The range, is still as tiny, but it is now my range. Whereas before I would grumpily think, "well that's just impossible... I'll aim for 4-10, but for you to ask me to do any more than that is just unreasonable" I now see 4-9 as my target for me.
I've never tested so much in all my 20 years with diabetes as I have over the last 14 months. I've never voluntarily gone without so many meals to check on my basal insulin's activity. In all likelihood I would not be doing so without meeting other diabetics online. Diabetics who hit their own tiny target ranges. Not every day, but often enough to prove that it is at least possible.
Once you understand that the target (whatever you decide that it is) is your own, all the effort required to aim for it, and let's not pretend that is isn't a LOT of effort, somehow becomes much easier.
Edit: Just re-visiting this post after several years and I have realised that in the time in between I have altered and changed my targets on more than one occasion. And this is fine too. Currently I'm finding 4-10 gives me less opportunity to berate myself over high readings with an additional soft lower limit of 5 which I will treat as if low to give myself a little more wiggle room. What's important is that I feel these are what I have decided to do for me. Not some impossible nonsense handed down from on high.
And then I realised that was exactly how I had felt about these things too.
The recommended levels for adults with type 1 diabetes in the UK are 4-7 mmol/L (72-126mg/dl) before meals and less than 9mmol/L (162mg/dl) by two hours after meals. This is, frankly, a tiny target to try to hit. To be honest the permitted percentage of inaccuracy on a BG meter is 10%. So the meter itself is only accurate to one sixth of the target range some of the time. I've had 20-odd years of consultants telling me that I was 'doing fine', but 'should try to have not quite so many highs and avoid those lows'. I've always just smiled through gritted teeth at such comments. "There speaks a person" I would say to myself, "who has never tried to guestimate the carb load and absorption rate of a meal, and tried to match it precisely with the activity profile of an insulin injection, taking into account any abnormal activity level during the day." If they wanted me to hit their stupid target, they should have made the darned thing a bit bigger.
In a small, but incredibly crucial way though, my mindset has changed. The shift was so slight I only noticed it when trying to look at the same issue from someone else's point of view. The range, is still as tiny, but it is now my range. Whereas before I would grumpily think, "well that's just impossible... I'll aim for 4-10, but for you to ask me to do any more than that is just unreasonable" I now see 4-9 as my target for me.
I've never tested so much in all my 20 years with diabetes as I have over the last 14 months. I've never voluntarily gone without so many meals to check on my basal insulin's activity. In all likelihood I would not be doing so without meeting other diabetics online. Diabetics who hit their own tiny target ranges. Not every day, but often enough to prove that it is at least possible.
Once you understand that the target (whatever you decide that it is) is your own, all the effort required to aim for it, and let's not pretend that is isn't a LOT of effort, somehow becomes much easier.
Edit: Just re-visiting this post after several years and I have realised that in the time in between I have altered and changed my targets on more than one occasion. And this is fine too. Currently I'm finding 4-10 gives me less opportunity to berate myself over high readings with an additional soft lower limit of 5 which I will treat as if low to give myself a little more wiggle room. What's important is that I feel these are what I have decided to do for me. Not some impossible nonsense handed down from on high.
Sunday, 27 February 2011
DIABETES V. HOMEWORK
It's school tomorrow so this sudden splurt of blogging is going to stop and a whole load more homework is bound to be rolling in. Oddly enough having a diabetic dad can actually effect my homework. Ish. The other day I was doing some I.T. homework (not for very long admittedly), when I realised I had been working on the file still attached to the email. Oops. So when I discovered this and saved it onto my account the work I had just been doing disappeared. I called Dad to come and help me, but he was all over the place with his levels and consequently very grumpy. This meant when he was trying (and failing) to find my missing homework, he got a bit frustrated. He started hammering at the keyboard and snapping at me. It was quite scary actually. I sort of wanted to get Mum but I was kind of scared Dad would smash my laptop up. Eventually he gave up and I ended up redoing that bit of the homework. Never mind.
THE CONFESSION
I don't actually understand what diabetes is. Dad tries to explain it, but ends up using confusing words like glucose etc. I always nod and pretend I understand when really what I'm thinking is 'I have absolutely no idea what you're talking about'. Why can't he just say 'I don't have the right stuff in my blood and this stuff substitues it' or something. Adults, honestly.
I am now on a mission to discover what on earth diabetes is.
B
THE CONFESSION
I don't actually understand what diabetes is. Dad tries to explain it, but ends up using confusing words like glucose etc. I always nod and pretend I understand when really what I'm thinking is 'I have absolutely no idea what you're talking about'. Why can't he just say 'I don't have the right stuff in my blood and this stuff substitues it' or something. Adults, honestly.
I am now on a mission to discover what on earth diabetes is.
B
Thursday, 24 February 2011
'HbA1c phenomenon' and feeling grumpy
I have an annual review coming up in April. I know this because I called the hospital a while ago to check I was still on their list (I recently transferred back, having been seen at my GPs for a few years).
I also know it because my blood glucose levels have been running stupidly high recently. This seems to happen to me a lot. As soon as I know I'm in the 3 months running up to the test (HbA1c gives an indication of average BG levels over the last 3 months) it all goes to pot. I've come to think of this as 'HbA1c Phenomenon'.
I've been working hard at getting my diabetes under control for around a year now. When I look at monthly average figures during much of that time they are around 6.9 - 7.1 mmol/L. There's a ready reckoner which suggests your HbA1c if you give it an average BG level for 3 months or so, provided the tests include a decent spread of pre- and post-meal results (which mine now are). There are a fair few of these conversion formulae, but the one I use is:
HbA1c = (BG average+2.52)/1.583
Weekly averages recently have been in the mid 8's. I haven't been doing this badly for about 8 months. I was so hoping for a good A1c. Almost as an 'official' affirmation of the work I've been putting in. Secretly I think I was hoping I'd make it into the elusive 5% club (sub-40 in new mmol/mol numbers), but now I think I'll be lucky to match my last one of 7.1%. If I was still pottering along without paying much attention I'd be happy enough with that (as indeed I was), but when you are working much harder at something it's nice to see some sort of results, and a little frustrating to think that you would have seen those results a month or two ago when you didn't have the test scheduled!
In my heart I know that the HbA1c is a pretty poor indicator of control. I've cheated low numbers before by having enough hypos to cancel out all the highs. But it's the badge which defines you as far as the medical profession is concerned. However inaccurate it is, it's still considered the 'gold standard' indicator. I wanted not only to have better control (which I do) but to have a pleasingly low A1c to match.
So I am trying (and largely failing) not to get too grumpy about this. To breathe deeply, take one test at a time and be happy with how far I've come in the last 12 months.
You never know... the test is weighted to the most recent 4 weeks or so. I might still have a chance to knock a bit off if I can keep my head during March.
I also know it because my blood glucose levels have been running stupidly high recently. This seems to happen to me a lot. As soon as I know I'm in the 3 months running up to the test (HbA1c gives an indication of average BG levels over the last 3 months) it all goes to pot. I've come to think of this as 'HbA1c Phenomenon'.
I've been working hard at getting my diabetes under control for around a year now. When I look at monthly average figures during much of that time they are around 6.9 - 7.1 mmol/L. There's a ready reckoner which suggests your HbA1c if you give it an average BG level for 3 months or so, provided the tests include a decent spread of pre- and post-meal results (which mine now are). There are a fair few of these conversion formulae, but the one I use is:
HbA1c = (BG average+2.52)/1.583
Weekly averages recently have been in the mid 8's. I haven't been doing this badly for about 8 months. I was so hoping for a good A1c. Almost as an 'official' affirmation of the work I've been putting in. Secretly I think I was hoping I'd make it into the elusive 5% club (sub-40 in new mmol/mol numbers), but now I think I'll be lucky to match my last one of 7.1%. If I was still pottering along without paying much attention I'd be happy enough with that (as indeed I was), but when you are working much harder at something it's nice to see some sort of results, and a little frustrating to think that you would have seen those results a month or two ago when you didn't have the test scheduled!
In my heart I know that the HbA1c is a pretty poor indicator of control. I've cheated low numbers before by having enough hypos to cancel out all the highs. But it's the badge which defines you as far as the medical profession is concerned. However inaccurate it is, it's still considered the 'gold standard' indicator. I wanted not only to have better control (which I do) but to have a pleasingly low A1c to match.
So I am trying (and largely failing) not to get too grumpy about this. To breathe deeply, take one test at a time and be happy with how far I've come in the last 12 months.
You never know... the test is weighted to the most recent 4 weeks or so. I might still have a chance to knock a bit off if I can keep my head during March.
Wednesday, 18 March 2009
Vegetables that help control blood sugar in Type 2 diabetes.
I have found that some vegetables are very helpful to me in my effort to control blood sugar after meals. Conversely, there are some that are very harmful.
The list of harmful vegetables is not that long. The main culprit is potato. And I used to love potatoes. French fries, baked potatoes,mashed potatoes with gravy. All are absolutely delicious. But I don't eat them anymore. I remember reading an interesting quote from someone that eating steak and potatoes can kill you but, contrary to popular opinion, it is not the steak that kills, its the potato.
Green peas and tomatoes should also be eaten in moderation. A little bit of either vegetable will not hurt the sugar readings.
All green leafy vegetables are excellent. Cauliflower and broccoli top the category of nutrient-rich and glucose-neutral veggies. Lettuce of any kind works well too but I personally prefer Romaine lettuce.
The only vegetable known to actually cut down blood sugar level is bitter melon. It is common in the Indian sub-continent. But not elsewhere. I try to eat it regularly. In spite of its bitter taste. I slice the bitter melon into thin strips and saute them in olive oil with salt and pepper. And down it like I am taking medicine. Which is what it is. It sure beats taking bitter melon supplement pills.
The list of harmful vegetables is not that long. The main culprit is potato. And I used to love potatoes. French fries, baked potatoes,mashed potatoes with gravy. All are absolutely delicious. But I don't eat them anymore. I remember reading an interesting quote from someone that eating steak and potatoes can kill you but, contrary to popular opinion, it is not the steak that kills, its the potato.
Green peas and tomatoes should also be eaten in moderation. A little bit of either vegetable will not hurt the sugar readings.
All green leafy vegetables are excellent. Cauliflower and broccoli top the category of nutrient-rich and glucose-neutral veggies. Lettuce of any kind works well too but I personally prefer Romaine lettuce.
The only vegetable known to actually cut down blood sugar level is bitter melon. It is common in the Indian sub-continent. But not elsewhere. I try to eat it regularly. In spite of its bitter taste. I slice the bitter melon into thin strips and saute them in olive oil with salt and pepper. And down it like I am taking medicine. Which is what it is. It sure beats taking bitter melon supplement pills.
Subscribe to:
Posts (Atom)