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    Moving to Diabetes Daily!

    "Ding ding. This blog terminates here. All change please."

    I'm very excited to announce that I've been invited to join the featured bloggers over at Diabetes Daily.

    Diabetes Daily, thanks to the hard work of David and Elizabeth Edelman, has grown in to an awesome resource, and  large and vibrant community of people who have at least one thing in common: an interest in diabetes. Sharing and support amongst the people who understand has always been a primary motive for me as a blogger, so I couldn't refuse the offer to join in. And I'm very honoured to be joining the talented group of people already blogging there.

    My new URL will be https://www.diabetesdaily.com/parker/  Once you've updated your links, head on over and check it out... I'll see you there!

    (And for those who may be wondering about the new name - no I didn't run away and get married!)

    Changing How A1c Values Are Reported

    I'm the kind of person who usually embraces change. But only when that change is clearly beneficial or positive in some way., rather than just the pointless act of change for change's sake. My initial reaction to the news that A1c values in the UK will no longer be reported as percentage values is "why?", and I'm struggling to identify a positive reason for the move.

    The new unit of measurement will be millimoles per mole, or mmol/mol, rather than existing percentage measures. A current result of 6% will equate to 42mmol/mol, 6.5% to 48mmol/mol and 7% to 53mmol/mol. The unit of measurement presents a potential problem to regions of the world that measure blood glucose in mmol/l, which includes the UK. Since the mole is a fairly obscure scientific measure in everyday use, you can bet a lot of people will be confused by mmol/mol and mmol/l. And if your 3 monthly report suggests your average BG has been 48mmol/l, you're going to be a bit worried!

    So why the change? According to the official literature, it will make comparing results from different laboratories easier, but something doesn't add up.

    There is no mention of changing the way in which A1c is actually measured, or the calibration and standardisation of results. In fact, the same piece of loiterature states "It is just a different way of expressing the same thing."  The literature intended for healthcare professionals also says that there is no actual change in calibration methods, just in the units to make comparing results to an existing calibration set easier.

    But why pass confusion and change on to patients who are used to the current system and clear about their goals and targets? If this is a simple conversion between numbers, why not apply the conversion at the time it's needed? Let the scientists and clinicians convert the existing numbers to the units they want to use instead of asking patients to have to convert their new results into a currency they are familiar with.

    Am I missing something?

    Arctic Adventure

    Q. How do you go to the toilet in an outdoor long-drop in the arctic?
    A. Quickly!

    Q. How do you go to the toilet outdoors in the arctic when there is no toilet?
    A. Even more quickly!


    I know this, because last week I, and my diabetes, took on one of our toughest challenges yet spending a week dog sledding and cross country skiing across the arctic wilderness. I experienced both the above situations, but I had the time of my life. It was, without a shadow of a doubt, one of the most amazing things I've ever done.

    Northern Lights We were two hundred miles above the arctic circle in Northern Sweden. For a Brit, unaccustomed to heavy winter snowfall, the landscape is like something out of a fairytale. Several feet of snow and trees dripping with ice crystals that sparkle in the few weak rays of sunlight that make it over the horizon for just a few minutes each day. Rivers and lakes that are frozen solid and topped with deep powder, an endless white expanse stretching further than the eye can see. On our very first evening, as temperatures hovered at minus 25 degrees centigrade we were treated to a glimpse of nature's very own magical light show - the aurora borealis.

    Ian and I in our igloo Accommodation for the week included a wilderness camp with no running water or electricity, and outdoor toilets, a snow hole (also known as an igloo) that we built ourselves, and also a night in the world famous original Icehotel in Jukkasjärvi. The Icehotel is made, as the name implies, entirely from ice with the interior kept at a constant minus 5 degrees to stop the whole thing melting. I've long wanted to visit, but our stay confirmed that amazing as it is, it's a once in a lifetime thing!  We slept in arctic rated sleeping bags atop reindeer skins on an ice bed. Although the bags were warm, this was by far the least comfortable nights sleep of the whole trip, as the sleeping bags were pretty claustrophobic and every time I rolled over I thought I would suffocate. My face was also pretty cold for most of the night. The ice hole, by comparison, was positively cosy. Ian and I even managed a midnight feast.

    Alaskan Huskies Of course, the main reason for being out here was the dogs. As far as dog sledding goes, there is really only one rule - never, ever let go of your sled, or your dogs, unless they are tied down. Otherwise it's the last you'll see of them! These dogs are born to run. As we harnessed our teams up on the first morning, they were going crazy, straining in their harnesses and barking wildly, excited and keen to get out of the trail. You have no control over the throttle (the dogs) just the brakes. The moment you let them off the dogs are away and immediately silent. I can't find the words to describe the magic of the silence of the arctic punctuated by the panting of the dogs and the sushing if the runners over the ice. Weaving through the trees of the forests and then across the open lakes and rivers.

    My team - Queen, Yudis, Dick and X-Ray, worked exceptionally hard for me and I very quickly felt in tune with them. P1270049 X-Ray was the youngest, at just over a year, and brand new to team running. He had a reputation for eating his harness and being a general handful, but somehow he was still totally lovable!

    Of course it isn't all peaceful. It can be hairy at times. Dog sledding is the only form of transport I've come across where you don't brake coming in to a corner, as it's far more stable if you let the dogs take you round at full pelt. Stopping to test my blood sugar and eat was hard work, since you must keep one hand on the sled at all times unless it's properly anchored. I was fortunate not to fall at all, but came close when I was dealing with a CGM calibration alert. I had my snowsuit unzipped and managed to cancel the alarm but as I tried to get the pump back inside the suit, the dogs strained in their harnesses in response to a team ahead of me pulling away. I was momentarily unbalanced, but managed to hold on. I threw the pump clumsily into my suit and managed to get the zip done back up!

    Ice Fishing! We also had the chance to try out cross country skiing and spent the last day hurtling down the frozen Torne River on a snowmobile. At one point the ice beneath us of a small inlet began to break up. What we didn't know at the time was that a snowmobile can travel 30m over water at full throttle. Fortunately we didn't sink, but feet got distinctly wet! We also had a chance to try ice fishing, which revealed the magnificent thickness of the ce on the main lakes. Fortunately we weren't reliant on catching anything for our dinner, or we'd have been hungry. Much of the food was reindeer or moose based, accompanied by delicious Swedish Polar bread.

    Diabetes wise, the trip went great. I'd be lying if I said I wasn't worried before hand. I took a mountain of glucose gels and miniature bags of jelly babies, not to mention cereal bars. I kept my kit in an insulated pocket in my snow suit and tested frequently. I also loaded up the thigh pockets on my suit with glucose and food each day. My control wasn't brilliant, but I avoided any spectacular lows or highs that made me feel unwell. Trading off on my control for this week was entirley worthwhile. It was once in a lifetime, and if I died next week I'd be so glad I got to do it.

    Q. What should you say to anyone who thinks diabetes might limit your lifestyle?
    A. It doesn't have to!

    Me, in the arctic

    Me. with Dick the dog



    How My Pump Ended Up in the Trash

    Wearing an insulin pump, with or without CGM, can be challenging to even the best person's patience. Between incessant alarms, strange bulges under clothing, tubing that pops out at the most inopportune moments, especially when there is a door handle in the vicinity, itchy infusion set adhesive and the pain in the morning after a night of the pump under my back, I'm no exception. Sometimes this device really gets on my nerves.

    But it's fairly easy to tolerate a long list of annoyances when the device in question at the same time makes life so much better. The control I was able to achieve on as many as eight to ten injections a day is nothing to the control I can get with the tiny doses that a pump delivers, and its hour-to-hour variations in basal insulin delivery. When the CGM beeps from under my tunic at work to warn of a low I'm simultaneously embarrassed by the possibility of it being heard by the patient whose wisdom tooth I'm about to pull, and grateful that it has potentially prevented a dangerous situation from occurring. The latter emotion wins out every time, and every good A1c I get whilst using this technology reminds me of that.

    I'm still human though. And I can be a very irritable and obstinate specimen of humanity, not least when my blood sugar is out of range or bouncing around like a rubber ball.

    I've definitely been heading through a bit of a rough patch, diabetes-wise, lately. I'm seeing far too many high numbers and daily low numbers with rapid swings between them. I've been getting deeply frustrated that despite the technology and knowledge I have, I haven't been able to find either the skill or the motivation to turn things around. The messier things have got, the more I'm allowing fear to keep driving it on. I'm eating too many carbs at lunch and under-bolusing for them, fearful of lows. I'm over-correcting highs, in a rage at seeing these big numbers and thinking about the complications they may point to, and I'm over-correcting the resulting lows in a panic.

    On Sunday night, it got a little too much. I'd swung from high to low and back again all weekend and my mood was touchy to say the least. I was fed up of the annoyances of the pump when it didn't seem to be helping me any to reign it all in. The final straw came as I stood up from the sofa and the pump came away from my waistband. The short piece of tubing between the pump itself and the point it was tucked in to my clothes was enough to allow the pump a nice swinging arc, straight in to an open bottle of wine we'd been about to enjoy a glass of, knocking it off balance and on to the floor.

    Something inside me snapped an in a split seconds rage, I'd twisted my infusion set apart and the pump went sailing in to the waste paper bin in the corner with a resounding “fuck you” from me. It wasn't rational or sensible, but at that moment it had all got to much.

    After I'd had a good cry, and Ian had told me it was okay to be mad and angry,after he, recognising my burnout, had tested my blood sugar for me (low, unsurprisingly), he also extracted the pump from the bin for me.

    But I wasn't ready to be friends again that easily. It just felt like all of the hassles of wearing this device just weren't worth it anymore, that I could do almost as well without. I'm a stubborn person, and for some reason, this time I wanted to have a stab at proving the impossible.

    I flounced off to bed without my pump, leaving it lonely on the dining table.

    For two hours it sat there in the dark, while I got engrossed in a good book under a cosy duvet. My blood sugar climbed from it's low to 5.9 (106) and stayed there.

    “Hah” I thought. “I can do this without you.”

    Believing my point sufficiently proved, I reluctantly allowed Ian to reconnect me before I fell asleep.

    Of course, diabetes had the last laugh, as I knew, deep down, that it would. The missing basal, that I didn't bother to replace, ensured that I climbed steadily for the next couple of hours and suffered an interrupted nights sleep.

    From the moment I tossed my pump in to the trash, I knew I was being ridiculous. I knew I couldn't win. But sometimes throwing an enormous strop is the only way I know to deal with the enormity of diabetes.

    I honestly felt better for it.

    Britain's "Diabetes Epidemic" in the News...

    The UK news has been full of figures released today by Diabetes UK stating that one person is diagnosed with diabetes every three minutes in Britain. Last year 150,000 people were diagnosed with the condition, up from 100,000 the year before.

    I may be just a little bit cynical, but I can't help but think that the 50% jump in diagnosis rates, which reports acknowledge is mainly made up of people with Type 2, has a large part to owe to performance related pay for General Practitioners. GP's pay is topped up if they meet a number of different government targets. Diagnosing type 2 diabetes, and putting people on medication to control it, are things which attract reward.

    Don't get me wrong, I believe an increased diagnosis rate is far preferable to having the estimated million people walking around without knowing they have diabetes, whilst elevated blood glucose levels do untold damage to their body systems. Of course diagnosing people with diabetes is a good thing,  if they are accurately  diagnosed. And I'm well aware that there are many people diagnosed with Type 2 who don't fit the profile that is classically portrayed in the media. If the people receiving treatment actually need to take tablets, or insulin, rather than receive proper individualised care and support to modify lifestyle factors that may be contributing to their health, I have no objection.

    I'm sceptical for a reason. My own GP has attempted to get me taking an array of medications from ACE inhibitors to statins, simply because I have diabetes. For the record, I have no other cardiac risk factors, I do not have elevated blood pressure or microalbuminuria. Most of all, I have a cholesterol level well below the recommended safe level and stand only to suffer side effects from taking cholesterol lowering statins. Reading internet message boards and email forums, I know  that I'm far from alone in being a "healthy diabetic" put under pressure to take unnecessary medications in order for the GP to tick a box and claim their extra pay.

    The irony, of course, is that Diabetes UK is using these figures not just for the admirable purpose of urging the Government to put diabetes at the top of the health agenda for 2009, but also to ensure that people diagnosed with diabetes get "the best possible care, information and support". In other words, not just being stuck on medication to tick a box!

    Again, don't get me wrong. Anything which raises the profile of this often devastating condition has the potential to be a very good thing, But yet again I can't help feeling that this news will do nothing to raise profile of Type 1, and has the potential to actually damage the cause for more support and research.

    As usual, we can rely on the Daily Mail to stir thing up. The Daily Mail, for those who don't know, is a UK newspaper that balances precariously in the no-man's-land of journalism. It is not a tabloid paper that supplies those who want it with the latest celebrity gossip and "human interest" stories about tragic death but does little harm to those who choose not to read it. Nor is it a broadsheet paper that may be somewhat biased, but openly so, by political affiliation but at least upholds ethical standards of reporting and attempts at balance, as well as covering "serious" political and financial news. The Daily Mail is gutter press. It switches affiliation depending upon the story and bases reporting on who it can "have a go at". The Daily Mail is legendary for creating more health scares than a hospital full of unqualified doctors. The only thing the Daily Mail truly does well is sensationalism.

    So I wasn't entirely surprised when I read the Daily Mail's reporting of Diabetes UK's research. It is full of vitriolic criticism of "fat people" and clearly lays the blame for diabetes at the feet of those who have it, whilst pointing out how it will contribute to crippling the NHS. The article mentions that the majority of cases are Type 2, but no where does it even mention Type 1, yet alone make clear what the difference is.  The overwhelming message of the article is that diabetes is exclusively caused by obesity. It will do nothing to help move type 1 diabetes up the health agenda if all efforts are solely aimed at lifestyle modification and obesity reduction.

    Diabetes isn't always caused by the people suffering from it. And poor control isn't just down to the patients if they haven't been given the education and resources to manage their condition. Supporting people with Type 1 to live well will reduce complications and enable people to live longer lives whilst working and contributing to society - contributing to funding of the NHS, far from crippling it.

    It is tragic that so many people are being diagnosed with diabetes. But the way the media, the government and so many misinformed people respond to the emotive subject of "diabetes" is equally sad.

    A Year in Review... Introducing Ian

    Finding an adjective to sum up 2008 isn't easy. The first one that came to mind was "roller coaster". But all things considered, it wasn't much of a roller coaster at all, having, as it did, only one real low point. And that was followed hotly by the biggest high of the year.

    They both came in February. My 16 month relationship with Rob came crashing to an abrupt end in the space of a single phone call. As with the breakup of any relationship that has ever really meant something, it was a painful time.

    Two days later, I trekked up to the Castle Climbing Centre in North London where I met a guy called Ian. We were both in need of a regular climbing partner and so began a friendship that grew through regular sessions battling our way up challenging climbing routes and drinks in the pub afterwards to either celebrate or commiserate our respective successes and failures.

    In the meantime, I took a proactive approach to coping with my new single status. For the first time in my adult life, circumstances came together such that I had the heath and physical ability, the time and the finances to do a lot of things that I'd previously not has an opportunity to.

    I had the chance to catch up with relationships that had suffered through my frequent trips to Liverpool. As I said at the time:

    "I'm living a new, different life. I've done a lot of things in the last six weeks. I've spent more nights at the pub than I should. I've gone out with friends and stayed up all all night to watch the sun rise in the morning. I've stayed out in the rain until I was soaked through to the skin, but had a good time anyway. I've had lunch with two amazing women, one in her eighties and the other in her nineties, both of whom were friends with my grandmother when they were younger than I am now. I've drunk more alcohol than I probably should on more than one occasion. I've aggressively pursued my rock climbing, pushing the grades I can climb, free of fear of not measuring up."

    And I tried new things too. I'd been skiing in Italy and France in the earlier part of the year, for the first time since my catastrophic ankle injury in 2004. In March I swapped two slidy things for one and had a go at snowboarding. Ultimately I think I'm definitely a skier at heart, but it was still great fun to learn. I went powerkiting, and got pretty adept at controlling enormous sheets of silk in a fierce wind. I learned to body-fly (or indoor skydive) in a giant wind tunnel. I took dance classes again for the first time in over ten years.

    In April I went speed dating with a friend for the first time and it actually turned out to be a lot of fun, and would have been even had I not "matched" with someone. We actually met up a few times and this turned out to be the catalyst that pushed me in a clear direction.

    When I met Ian, it was far too soon to think about relationships and our friendship developed uncluttered by even the thought of romantic attraction. I got to simply loving spending time with him. He made me laugh. He listened to everything that I had to say, and amazed me with tales of a year spent travelling.

    I don't really know where it started from, but after my speed date experience, I knew the only person I wanted to be dating was Ian.

    Fortunately for me, he felt the same way.

    "Date" is exactly what we did. Exhibitions (Psycho buildings a big favourite), trips to the theatre (Avenue Q the best show I've seen in a long time) and late night museum visits (Ripley's Believe or Not until almost midnight, believe it or not!)

    We have a lot in common, including a love of photography. In May I finally upgraded my camera and we've spent a lot of time jointly improving our skills.

    The latter half of 2008 also saw a bit of travelling.

    In August Ian and I took our first trip away together and I fulfilled a long held dream to visit Marrakech, which stemmed from my arents tales of a visit there in the 1970's and was intensified when I read Esther Freud's Hideous Kinky some 14 years ago. Marrakech didn't disappoint. We shared the unmade streets in the Medina with donkey carts, dogs and throngs of people. Motorcycles weaved through the crowds, sometimes with a whole family of four perched on the back. We dived into the souks and developed our bartering skills and in the evening wandered through the maze of food stalls that spring up each evening in the Djemaa El Fna as the stall holders battled for our business. It would be wrong to say it wasn't a culture shock, but it was a fantastic weekend.

    In September I took my second trip of the year to Italy with a group of twenty ranging in age from 25 to 80. We stayed in an enormous house which, due to a mix up in booking didn't have quite enough beds! It was a wonderful relaxing week with good food, good wine and great company. It also fired me up for the Italian classes I've been taking this autumn.

    At the end of November Ian and I took the Eurostar to Brussels where we spent an enjoyable weekend exploring the city and the Christmas markets. We encountered a lot of people who spoke no English, but my French held up well enough to get us on the correct train and bus to Liege and back again. We drank a lot of Gluwein, and ate waffles, mussels, steak and fondue, as well as managing to buy a lot of unique Christmas gifts.

    The end of the year has come around alarmingly quickly and I'm shocked to find Ian and I have been together for eight months. As well as all the fun times, he's learned all about lows and highs, pump malfunctions and what it means to live with diabetes. He knows how to check my blood sugar, and seems to know better than me when I'm low.

    Over a meal on New Year's Eve as I fiddled and calculated and was bothered by both my pump and CGM I commented "It's fun this, being with a diabetic, isn't it?".

    Ian shrugged his shoulders and said "It just is."

    There isn't a lot more I can say to that.

    So finally... Whirlwind. This year's been a whirlwind, in terms of how busy it's been. It's also been a whirlwind because this amazing guy walked in to my life.

    Dumb Diabetes Mistake

    Sometimes I'm just a dumb diabetic.

    I've been feeling lousy with a really sore throat and no voice for the last couple of days. I've also had no CGM for the last 12 or so hours - new sensor is waring up as I speak. It didn't come as much surprise, then, to find my blood sugar was high when I finished work this evening.

    But 2 hours later, when I was still only 0.5mmol/l lower, I decided that changing my two-and-a-half day old infusion set was in order.

    So I did.

    I whacked a new Quickset in my opposite hip.

    I did a fixed prime to fill the space left in the cannula after withdrawing the insertion needle.

    I gave myself another correction bolus. And...

    An hour and a half later I'm still high.

    The reason?

    I forgot to disconnect the tubing from the old infusion set and attach it to the brand new one.

    Another reason NOT to keep re-using my tubing!

    Falling Out With My Pump

    As a dentist, I often joke that I need to get on well with my assistants since we spend more time working closely together in the same room each day than most people spend with their partners.

    Given that I spend virtually twenty four hours a day, give or take a shower or two, attached to my pump and CGM, it's obviously pretty important that we get on well too.

    Fortunately I have a great relationship with all the girls at work, which makes my working environment more fun and less stressful than it easily could be. And most of the time I have a great relationship with my pump. Together we do a good job at keeping my blood sugars in check as much as possible. But for the last few days I've been suppressing a strong urge to hurl it at wall.

    Mostly it's been minor annoyances. A bunch of CAL ERROR alarms that were my fault anyway, for trying to calibrate on the rise or fall. My pump frequently leaping out of the pocket of a particular pair of trousers that I love. Peeling adhesive around the edge of a-day-and-a-half old Quickset that caused itchiness that drove me to distraction.

    These are all little quirks of living with a pump. They irritated me more because we spent this weekend away in Brussels, and I didn't want diabetes, or my pump, spoiling the fun. A bunch of little quirks together also lowered my tolerance or any further problems, and yesterday they came.

    We spent an hour or so on the outdoor ice rink in Brussels. Towards the end of the session, the CGM alarmed to tell me I was low. You can imagine my surprise, then, when I tested and the meter said: "Hi".

    That most unfriendly of greetings when it's coming from a blood glucose meter. I checked again.

    "Hi"

    Damn. We'd eaten Tartiflette with an unguessable number of carbs, and drunk Gluhwein that is sweetened differently in every recipe. I could have got it way wrong. I dialled in an enormous correction as we began to snake our way through the crowded Christmas Market.

    As we walked, I couldn't  help but wonder how I got so high. I hadn't eaten or drunk much and I'd been very active.. Something wasn't adding up.

    I'd taken a big tumble on the ice where my pump had flown from my pocket and hit the ice with an audible crack. I'd been too busy getting back the wind that had been knocked out of my to check it over properly. As I pulled it out of my pocket to look again, I noticed what wasn't right. The tubing was coming away from the reservoir. Again.

    This was the second time in two months. And I was really, really angry. I put the previous episode down to re-used tubing, but this tubing was brand new. I started a new reservoir, with new tubing and a new infusion set before we left home on Friday morning. That was only just over 48 hours earlier. Tubing is meant to last at least three days. And here I was faced with the prospect of changing the whole thing in the middle of a freezing market. I was unsure if any of the huge correction had got in to me and I definitely didn't want to overdo it so I'd end up with a massive low blood sugar whilst on the Eurostar back to London. Not to mention that the CGM had been telling me I was low just minutes before I tested Hi. I've never had a discrepancy so ridiculous before.

    I was angry enough that I felt like tossing the pump into the nearest garbage bin and leaving it there.

    I didn't, of course. The CGM aligned itself only a short while later and fortunately I came down gently and we made it back to London without further catastrophe. But the pump and CGM were definitely in the dog house.

    I might have forgotten all about it though, had the CGM not decided to try and make amends for the missed high. In the middle of the night I was woken by a high alert that said "Above 22.2 mmol/l"

    Come again?

    That was the actual text of the alert. I hadn't had a previous alert which put it into snooze mode, which meant I'd jumped from below my high threshold to this level in one go.

    Sure enough, the reading 5 minutes earlier was 4.8.

    Blood sugars can move fast, but 4.8 to 22.2 (86 to 400) in five minutes? I don't think so.

    When I tested, I was actually 4.1.

    I have no idea what caused the silly spike, because when I checked the ISIG it was around six. From experience, I know high numbers don't have ISIG values that low, and more confusingly the ISIG didn't drop when it fell back in to line, which it did without re-calibration. The sensor spiked two more "Above 22.2" alerts today and in both cases the ISIG did not change from where it was shortly before.

    I'm concluding that I have a temperamental sensor, and I have terminated my relationship with it, much as I terminated the relationship with the dodgy tubing.

    The pump has been given a second chance, without its naughty sidekicks, but it's been warned to be on its best behaviour otherwise it may just be meeting that wall.

    The Day for D-Blogging

    Dblog_08 Today is the fourth annual D-Blog Day. The day to blog about diabetes, and support others who blog about it too.

    In November 2005, the first D-Blog day, I'd discovered and begun to read many of the blogs that were around back then. But I was yet to even post a comment on one of those blogs, let alone think about starting my own D-Blog. Despite that fact that I didn't respond to the call to de-lurk on -Blog day, seeing how the community came together was certainly a factor that played a big part in drawing me in to this fantastic community.

    I started this blog less than two months later, but in November 2006, I missed D-Blog Day, wrapped up in depression and burnout, it took me several more days to be reminded that this is just what this community of people with diabetes is here for: to help us not feel so overwhelmed and alone.

    Last year, I gave thanks to the community for getting me out of that funk. For understanding me. For inspiring me.

    And I urge you to go back and read that post because, ultimately, I still feel the same way a year on.

    Sometimes, though, I feel disconnected from the community. I don't always have the time that I'd like to read other blogs and post comments. I don't even have the time to write all that I'd like to here. I'm in a minority being outside of North America and sometimes the issues I face, especially with respect to insurance, are vastly different to those that others in the community experience. My two year fight for CGM coverage, as a prime example, was not the same as that faced by others. I don't always understand all of the issues others share, and I'm not sure that all my own issues are understood either.

    But despite this, despite the number of times that I'm unable to offer support and feedback to others and the many times I don't directly get given it myself, the community remains very special to me.

    To be able to open a browser window and connect myself instantly to so many places where I can read the personal day-to-day stories - struggles and triumphs - of others who live with diabetes, and who I can identify with, is priceless.

    It's so far from anything that could have been imagined at my diagnosis 25 years ago, that I'd go so far as to call it magic.

    Happy D-Blog Day!

    The Pizza Effect in Pictures

    Last Saturday I had pizza for dinner.

    For a reason best known to the gremlins that take over my brain on occasion (i.e. whenever I do something unquestionably dumb) I took a regular old bolus, rather than my normal dual-wave extended over 4 or 5 hours. Then the gremlins kept up their occupancy, and led me to not even realise what I'd done when I was low two hours out from the meal.

    I certainly realised in the middle of the night though. And they say a picture is worth a thousand words:

    A Pizza Mountain

    It's a pizza mountain!

    Pizza isn't  unbolusable. I just need to make sure I give an appropriately extended bolus to stop that peak from appearing.

    I'm just thankful for CGM (again!). Without it this high would certainly have escalated unchecked until morning. Which would have been more of a pizza mountain-range, than a single peak!


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