Diabetes Wise

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:

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!

Unbolusable

I love mussels. A big steaming pot of the little critters, cooked in white wine and cream and served with french fries or crusty bread. It's food heaven.

I still remember the very first mussel I ever ate. It was the summer of 1986 in La Rochelle on the west coast of France. They couldn't have been out of the sea more than a few hours when my dad plucked one, steaming, from its shell on his plate and passed it to me. So began a love affair that has lasted  22 years to date.

That summer, six year old me ate platefuls of the things. I can only assume that my twice daily Monotard/Actrapid combination somehow peaked and troughed at just the right times and somehow made all this mussel eating workable. Either that, or both my parents have been dying their hair religiously ever since, having gone grey from the stress of controlling the effects of mussels on my blood sugars.

Mussels are one of those food that no matter how hard I try, I can just never bolus correctly for. I might end up with a perfect blood sugar at two hours, but be sky high hours later. Or I might be low at an hour, but reducing the bolus next time just sends me soaring. And no two times I eat them are ever the same. I tried an endless combination of bolus amounts and durations, all to minimal avail.

So I call them unbolusable.

And mussels aren't the only unbolusable food that I love, either. Cheese fondue is another one.

I don't really like cheese, unless it's cooked. But once it's melted, I could eat the stuff forever. So a big, bubbly pot of swiss cheese and white wine, served with chunks of crusty bread and a leafy green salad... it's food heaven again.

The best meal that I've ever had in my life wasn't at Gordon Ramsay's Claridges, or at any other fancy Michelin starred place. It wasn't even expensive. It was in a little swiss restaurant in Quebec City, Canada. We ate a three course fondue - cheese to start, meat to follow and chocolate for dessert. Ten years later I remember every detail. It was that good.

But every time I eat cheese fondue, I end up with a crashing low or a mountainous high. Only a six -and-a-half hour extended bolus has ever come close to getting it right.

But somehow it doesn't matter. Like mussels, I still love it. Much as I want the best blood glucose control I can get, I'm not prepared to completely give up stuff that I utterly adore. It's a balance. A trade off. Blood glucose control versus the quality of my life.

These foods may be unbolusable, but they're totally worth going high or low for, at least once in a while.

Of course, if anyone has a magic formula for mussels or cheese fondue, I'd love to try it. And I'd love to know what your favourite unbolusable, high/low-worthy foods are.

A Conversation

"Hey, I'm just gonna check my blood sugar, then I'll come help you clean up the kitchen" I yelled to the person who will definitely get a proper introduction very soon.

As I rescued my kit from the dining table it occurred to me how often I'm "just going to check my blood sugar before I...."

"Babe, can I ask you something" I called to the man who was doing things in my kitchen, as I shoved a strip into the meter.

"Of course you can."

Click. Thunk. Blood drop appears on the end of my finger.

"When I say I'm just going to test, do you ever think I'm just saying that to get out of doing something straight away?"  I put the blood drop on the end of my fingertip up to the meter.

"Of course not" he says, coming to stand beside me. "Why would I?"

"I don't know. I just always seem to be saying it before..."

The result flashes up on the screen.

3.2

I glance at the CGM that's at 4.0 and trending down.

"That" he says to me "is why you have to do it first."

One of those frustrating days

Some days are just plain frustrating.

You oversleep, lose your keys and then get stuck in traffic. People are rude to you. Everything seems to take far longer to accomplish than it should.

These kind of days happen whether you have diabetes or not. But throw a frustrating day diabetes-wise in with an other-wise frustrating day an you have a recipe for a violent explosion.

Yesterday was that kind of day.

I ate the same breakfast as the day before, and bolused the same amount. But instead of a steady, smooth line on my CGM, I shot up to 12 (215) and stayed there. I dialled in one correction bolus against the pump's suggestion and still I stayed at 12. I added another only when the pump suggested that I should and crashed down to 3 (54).

What's with that? I break the rules and stay high. I follow the rules and wind up low.

The afternoon was a similar story. Same lunch as the day before, same bolus. But yesterday my blood glucose shot up so fast that the line on my CGM wasn't even a line. Rather it was a splatter of random dots that made no sense. Angry and frustrated, I matched my random readings with a random rage bolus, and paid for it with yet another low.

I surged  from 3 to 18 in the space of half an hour and then tumbled from 18 to 10 in the following thirty minutes.

And that's when I exploded. My head ached and whirled with confusion at the rollercoaster swings. I felt frustrated and out of control. I shouted and tossed things and slammed doors. I swore that I'd never eat anything ever again. I even swore at my (much loved) CGM for making me so overly aware of the constant fluctuations. And despite knowing in my head that the readings were accurate, that the horrible mess of my graph had nothing to do with the sensor, I chose that moment to change it over.

I'd received a brand new box of 10 sensors from Medtronic earlier in the day, so I whanged one in to my belly and connected the transmitter. 20 minutes later the pump, squashed under me on the sofa, began to vibrate. It took me a slit second to realise that this couldn't be yet another high or low alert, since I was in the warm-up period.

"Bad Sensor" read the screen.

I never really believe this error. It pops up if you have two calibration errors in a row, but a third calibration usually sorts it out. I'm not sure I've ever really had a bad sensor, especially not straight out of the box. So I restarted it and then checked the ISIG.

ISIG is, in very simple terms, a measure of the signal strength from the sensor. It peaks to a number in the hundreds at the initial connection, but then settles down to a number than can be more or less directly correlated to the sensor glucose value. Since I work in mmol/l, the ISIG is usually just slightly lower than my sensor glucose value.

In this case my ISIG was 0.00.

And fifteen minutes later, the ISIG was still 0.00.

Which, in other terms, means that I had a truly "Bad Sensor".

Just because I no longer pay out of pocket for these suckers doesn't mean I don't get mad when they don't work. After all, I'm only allowed a certain number per month.

Fortunately today was a new day.

And a less frustrating one.

New Toys!

Yesterday, I had an appointment at my diabetes clinic. In addition to all the normal aspects of a clinic visit, such as getting my A1c, I was expecting to sort out some unresolved details regarding my pump and CGM funding. Chief among these was that I'm still using a loaned pump and need a replacement Real Time pump for the sensor funding to be of continued use in future. What I wasn't expecting was Christmas to come early.

I left the hospital weighed down by boxes including:

A brand new Paradigm Real Time System. I've switched back to a clear 722. The main reason for using a 722 rather than a 522 is because I'm lazy, and I hate filling reservoirs!

To be honest, I was a little taken aback at the ease with which they opened up the cupboard and dished out a new pump from their plentiful stock. Giving away glucose meters is standard practice in the UK, because the manufacturers make their money on the strips. But giving away insulin pumps when the funding for them is still pending? This was a new one on me, and just seemed far too easy. If anything it made me feel even more frustrated about how much of a struggle it was to get considered for funding for CGM in the first place.

I was expecting the next one:

MiniLink CGM transmitter

And then I got one of these:

A Bayer Contour Link blood glucose meter

This is the first blood glucose meter that communicates with the Paradigm pump to be available in the UK. The technogeek in me loves the idea, but my initial impressions actually aren't all that favourable. A proper review will come when I've had more chance to fairly evaluate it, though.

And theeeen.....

Well, no 'and then' really. This one has absolutely nothing to do with diabetes, and I didn't pick it up myself yesterday as that would have been pretty tough to do. I've been desperate to replace my old 18 inch CRT television, that shrinks movies on DVD to the size of a postage stamp in the centre of the screen, and cuts the sides of broadcast programmes because it can't cope with widescreen, for a long time.

So the last one is my present to myself.

Have a great weekend!

GoogleDoodle: I've signed, have you?

You've all seen the little doodles that Google uses in place of the regular logo on certain special dates. You know, these ones .

The guys at Diabetes Daily and Tu Diabetes have joined together to create a petition urging Google to consider a blue doodle on November 14th to mark World Diabetes Day.

Think what a fantastic way this could be to raise awareness. Whilst lots of the Google Doodles are self explanatory, I for one will admit to having had no idea what some of them were commemorating. But the ones I've not known, I've always been intrigued enough to look up. Imagine every Google search on one day coming under a banner highlighting diabetes.

To add your signature to the petition visit www.diabetesdoodle.com

I've already added my name, and persuaded four others to do the same thing.

If you haven't already, please sign up and help towards the goal of 20,000 signatures by November 1st.

Silent Assassin

Diabetes UK have today launched their newest diabetes awareness campaign, entitled 'Silent Assassin'.

The aim behind the campaign is one that I welcome and support whole heartedly. Research carried out by DUK has revealed that many people don't understand the long term risks that diabetes carries, or how serious and deadly it can be. In fact, the overwhelming impression seemed to be that public perceive diabetes as mild and easily managed, perhaps akin to high blood pressure that requires medication to manage.

Of course, the truth is very different. Take a look through my archives if you're yet to be convinced of that fact. Diabetes is not only serious, but also takes a lot of hard work to manage well in order to minimise the risk of complications. So any campaign that attempts to address the public's misconceptions has to be a good thing and should get my backing.To be honest, I think it's long overdue.

The name is a good start. Diabetes is a silent killer, and referring to it as a silent assassin is powerfully emotive.

But then I saw one of the posters:

Diabetes UK had gone so far as to warn their members with diabetes, and particularly parents of children with diabetes, that they may some of the imagery shocking. I agree that this is not the most pleasant image. However, I think it works when you keep the desired impact in mind. I've always thought of diabetes as a bit of a stalker, always on my back, and so personally I quite like the artwork. It also has nothing on an NHS employment campaign a few years back that featured a man having a seizure and falling down a flight of metal steps. I hated that campaign.

They want people to know diabetes is a killer. I think they've achieved that.

What frustrates me about the Diabetes UK campaign, though, is the wording beneath.

Is it just me, or does it imply that you can somehow "beat" diabetes, or make it easier to manage, just by visiting a web link?

And if that is the case, does it not contradict one of the principal aims of the campaign in the first place. It doesn't do anything to make the public more aware how hard those of us who want to control diabetes have to work. Will it not make people assume , even more than they already do, that if we only took our medication like good girls and boys, and never ate sugar again, we'd live long and healthy lives. The campaign website does not even appear to contain robust information about diabetes management and its challenges, just lists of potential complications and lists of different treatments.

It just isn't that simple.

Am I wrong to feel disappointed?