Tuesday, 30 November 2010

All the small things

As the title says there is more to life with diabetes than just checking your BG and taking insulin and whatever other types of medication you may be on. First there are the mental aspects of it which I don't want to go into at the moment. Here I want to talk about all the small things, the little innocuous things that to someone without diabetes would have no consequence but to folk like me they can become a little bit more sinister.
Needing to go for a wee. Well as innocent as it may sound this can mean one thing for a diabetic, that they have a high BG, generally over 10 mmol/l. This is caused by the kidneys dumping excess glucose into the urine when BG exceeds 10 mmol/l, this is called the renal threshold. So then, waking up in the middle of the night or in the small hours with a desperate urge to use the toilet usually results in a BG. Sometimes it comes back to be in the right range of numbers. Sometimes it comes back to be just over what I want to be so I correct. Sometimes it comes out as being far from where I want it to be. For insulin pumpers such as me this can mean a variety of things. Chief amongst these things is a cannula fail which is a right nasty bugger to deal with but somehow it's even worse at night when you've just woken up and it's the kind of time you're a little groggy from being woken up and you're in that twilight zone between fully functional awake and the fine state of slumber you were in previously. This makes everything that little bit harder. The resulting cannula change becomes more complex for what was once a relatively simple procedure. There are other reasons for waking up high in the small hours and one of them is being human. We can carb count to a very high degree of accuracy but sometimes it just doesn't work and you get it wrong. Simple but hugely irritating.
Being thirsty. Normal solution drink. If diabetic reach for testing kit, insert strip into meter, prick finger with finger stabber and apply blood then wait for the score. If you're lucky it comes back fine so you then go and grab a drink of your choice. If you're unlucky and the BG's come back high well, the reason you're thirsty is because of the renal threshold trying to wash glucose out of your body in the urine. Once again a usually small and innocent thing becoming somewhat more sinister.
Being tired. Yes. Another symptom of hyperglycaemia. If it's completely inexplicable after a restful night's sleep then it precipitates a blood test. Normally fatigue is a symptom of hyperglycaemia or sometimes it can be related to a hypo.
Shaky legs. It may well be that you've just been for a fine jog but when you've got up off the sofa if you're a bit of a slob at the moment like I am it can mean one thing only to me. A hypo and then comes the resulting blood test. Granted each diabetic has a variety of hypo symptoms that make it patently clear to that induvidual that they are hypo but they do follow broad guidelines.

That's the end of a somewhat disjointed blog post. I suppose what I wanted to get across is that any day to day thing which means nothing more than what it first appears to be to someone who doesn't have diabetes.

Sunday, 28 November 2010

The joys of basal testing.

Basal testing.

Two words that strike fear into the hearts of most pumpers. Especially me. Generally these mean forgoing all food and subsisting on water for a period of several hours and testing at least on the hour every hour. For me I test every half hour. This is just for in the day. Should you wish to do the same at night an alarm clock is needed and the results can be interpreted the next day once the jaded tiredness has worn off.
Not so for me. Give that yesterday I wanted to basal test in the small hours I thought it'd be a simple matter of setting a few alarms on my phone and waking up and testing when they went off. No such luck. Diabetes never makes anything easy nor does my body it seems.
So, the original plan was to start at three in the morning and work my way forward until about seven testing every hour. The three o'clock test went fine. The trouble came after it. The trouble was in the form of me not being able to get back to sleep after the first test. After half an hour of tossing and turning in my pit I decided to abandon any notion that sleep was going to come. After that decision was made I then decided to stay up and test every half hour. I managed to do so until half past ten, some seven and a half hours later on. The results were wonderful and highlighted an interesting pattern as you will see now:
03:00 - 6.5
03:30 - 6.2
04:00 - 5.2
04:30 - 5.2
05:00 - 4.9 Note, this is where it starts to get interesting. How long can I last until I hypo?
05:30 - 4.7
06:00 - 4.7
06:30 - 5.1 Doth the dawn phenomenon rear it's ugly head? I think so!
07:00 - 5.7
07:30 - 6.3
08:00 - 5.8
08:30 - 5.9
09:00 - 5.6
09:30 - 6.4
10:00 - 6.1
10:30 - 6.4

Now I know I can be a bit of a perfectionist but the drop that occurs between 03:00 and 05:30 is a little worrying. Having had a few hypos at about the 05:00 mark that have woken me up this seems to fit the pattern should I have gone to bed on a slightly low BG of about 5 mmol/L the night before. Then there's the rise that happens between 05:30 and 07:30. I do suspect that there is a little bit of dawn phenomenon occuring there. On that note, I have made changes to suit both of the trends that came up in my basal test. Tomorrow I intend to have a repeat performance to see if the changes have been to my good. I also intend to basal test until about midday to see if there is any rise after 09:00 until 12:00 as I've had a fair few days when I've tested pre lunch (usually between 12:00 and 13:30) and have been above ten.

Fingers crossed about tomorrow's basal test. I'll do a post after I've done it. I also need to basal test in the late afternoon/early evening to see what effect the early darkness has had on me.

Friday, 26 November 2010

Two for the price of one...

Like it says, two issues for the price of one tonight.

As winter has arrived the nights draw in early and by about four it's darker. Now to anyone else this probably wouldn't have much of an impact on their life. For me as a diabetic the effects are quite interesting.
What I've noticed is that at about three or four in the afternoon of an ordinary my BG's have started to rise resulting in higher than average post meal BG's and higher than average pre meal BG's. What is wrong? Personally I think it's that I'm not getting enough basal. This is because I reckon that my body is getting tricked into thinking that it's night This may sound silly but given that it's pitch black by five o'clock. This seems to make my body think it's night and I should be asleep. I'd very much like to spend alot of my time in bed but that's besides the point. The answer is a basal test tomorrow from about two in the afternoon to about six in the evening. I will post the results tomorrow if I remember to do that!

Now the second issue. Given that my partner is also diabetic but under the care of Selly Oak hospital in Birmingham and is going for a pump which her consultant has now said he'll reccommend that she be given funding for it. This means that I've done a little travelling to and from Birmingham as I was at the appointment where she was told she'd be given funding. Ultimately it needs a three and a half hour journey either way. This has the lovely effect of raising my BG's. The worst part for raising the BG's is the part of the journey that I need to make on the London Underground. On my usual basal I find that I can't get my BG's below ten or so. Fortunately they don't go dramatically high. So it seems that I now have to put a temporary basal onto my pump for the length of the journey. It seems that journeying is a stressful event for me. Next time I travel I think I'll be popping on a temporary basal of about a hundred and twenty five percent.

Wednesday, 17 November 2010

A spin off!

Having read a somewhat moving blog by a good acquaintance about doing night time blood glucose checks on his two sons I feel that I should say a little on that subject.
As a young adult with type one (young adult, damn it I hate that term, rant aside let me proceed) night time tests are a necessary evil that can range from a minor inconvenience to a full blown shit storm.
When I do a night time test it's usually at the classic hour of three in the morning. Classic in the fact that this is the time of night at which your blood glucose is lowest. Or so goes the theory. On the lowest level it is a minor irritation as you have to wake up to what seems to be a klaxon going off next to my bed then fumble around looking for the BG kit and going through the motions. Then there's the ensuing result. If it's a nice one that's in range and hasn't budged too much since I went to bed a few hours previously then all is well and I may return to my slumbers without any worries.
The next scenario is if it's a little bit higher then I'd like. Normally I'm woken up by the need to go for a pee the moment my numbers start to go above ten millimoles per litre (the renal threshold for glucose, in English that's the level above which the kidneys throw glucose into the urine to get rid of it). My other half is exceptionally good at spotting this and is very easily woken so I can't get out of bed and do what's necessary without waking her up. If this is following an evening long doughnut binge then I know fullwell that it's self inflicted because as usual, I'll have got the carbs in my doughnuts wrong. Note to self; look at Collins Gem Carb Counter from time to time.
Then there's the final scenario. I'm in the late teens/ early twenties. Then I become decidedly displeased as I wake up with a deep urge to go to the toilet and paradoxically I also awake with a raging thirst. Damned if you do, damned if you don't. Throw in the appropriate correction and hope that the next three or four hours is enough time for the blood glucose to drop in until you wake up.
When I do do my night time tests as a routine at three in the morning it's usually over about a week or as long as I need to spot any trends at that time. If needs be I do tests at different times to help sort things out or to make the image clearer.
There's also another type of night time test. The just got into bed hypo type of test. Normally this can be just enough to wake me at say a three point five millimoles per litre result. From the sublime unto the rediculous in the low twos or even ones which come out of the wood work once in a blue moon. It's not the hypo that bothers me so much more the bout of the munchies that follows the hypo. Sometimes twenty grammes of glucose is enough to sate me and make me feel good enough to head back to sleep. Sometimes I feel the need to eat everything within sight. This goes to such an extent that I have at times been found eating sugar sandwhiches in the small hours. Then there is the realisation that I will then need to bolus for this hypo related binge. That gets me even more than the hypo as I've then got to retrospectively work out the carbs and then the appropriate insulin dose for that. Fortunately I use one unit of Novorapid for every ten grammes of carbohydrate that I eat but even simple division is one hell of an ask in the small hours or a few hours after I've got into bed.
How to round this off then I must ask. Ultimately then night time blood glucose tests are a hassle. The amount of grief they can cause depends on the result that I get or quite often if I do the test or not as I have been well known to turn the alarm off and go back to sleep without doing the test. Damn unpleasant to do at times but a necessary evil. It's a catch twenty two situation as you know you need to do it at times but there are times when it's such a fine balance that it could easily go either way. So then, mixed feelings on my part about night testing. In typically English fashion I must end on an understatement; it's a bit of a bugger.

Sunday, 7 November 2010

Heavens! A review that might be diabetes related...

Well, I have been getting more of the free stuff and exploiting it. This week's free thing is an Accu Chek Mobile blood glucose meter courtesy of my fabulous DSN.
Firstly a little bit of an overview. The Mobile is a blood glucose monitoring system that does not have strips. Yes you heard. It doesn't have strips. It has a cassette thingy inside with what I suppose is the equivalent of the strips on it. The reagents are also in there.
What's good about this is that there isn't any faffing about with the handling of test strips and popping them into a meter then jabbing your finger with a lancet.
This is fantastic. I love the concept.
Now the downsides.
Firstly the noise made by the meter when you fire it up is quite phenomenal. No good if you're trying to sneak a stealth test in there and need it to go unnoticed.
Secondly the size. This is quite something to look at really. When you line it up against my Contour USB in it's pouch with strips and lancets it's roughly the same size. However what can't be done is when I need to break the black USB pouch down into its component parts and stash them in various pockets. That can't be done with the Mobile which makes it rather hard to conceal unless you have rather capacious pockets. I suppose I'd best get my bum bag from my early teens back. That carried everything in it with the one downside of looking like an utter tit. This Mobile is a housebrick and a rather unweildy piece of kit. Not liked.
The Screen is rather large which is a nice thing but then it's only a single colour and is rather lack lustre when compared to the Contour USB.
Then there are the flag options that you get on both the Contour USB and the Mobile. Firstly there is a much wider range of flags on the Contour USB. The Mobile's ones are somewhat limited in comparison.
Turning off. Something that may be trivial but I don't appreciate having to physically turn off the meter after testing. I love the fact that if I take the strip out of a USB then it just turns off. Simple. Not so in the Mobile. You need to manually shut it down after testing or setting the flag on a BG result. Not helpful.
So, in conclusion then I don't really like it. It's a large and bulk meter that isn't as accurate as my own Contour USB. There isn't any software such as the simplistic and easy to understand Glucofacts that comes with the Contour USB. Ultimately it's good for the novelty value that it's a unique concept and the only one of it's kind but when it comes down to using it day in day out in the way that I do it just doesn't cut the mustard really.

Tuesday, 2 November 2010

Friends For Life 2010

Well, from sod all blog related antics over the past few months to quite an explosion now.

Where to begin? Well, Friends For Life is a gathering of diabetic kids and their families. All type one kids. For the kids there was a series of activities depending on their age. For the old and boring adults like me there was a series of lectures/talks about the best ways to deal with diabetes from many folks.

The talks, well, I would have attended Gary Scheiner's "Strike The Spike" talk. Note the would have. I missed out as both my other half and I had failed cannulas. Then Siobhan went two up on me as she had three failed cannulas in one morning. We were looked after by the wonderful Jo Soloweicyzk, a fellow type one who's been type one for forty nine years and is still relatively sane despite that! His talks that we went to were quite something, I even won a quid off him for being able to tell him who discovered insulin.
There was Fiona Campbell who as the Paediatric consultant at Leeds, gave a fascinating talk on hypos.
Gary Scheiner gave several great talks, only one of which I could attend owing to cannula fails and a lack of space in the other.

What was the best thing was being around so many kids and being able to help their parents with the questions that only a yound adult (I hate that term!) with type one could answer.

That and the amounts of free stuff I got my hands on was quite something. The rep from Medtronic who set me up on my pump was there. Despite her being a bit rude it was nice to catch up with her. The Animas folk were brilliant. I got hold of a couple of reservoirs and sets from them that are compatible with my Medtronic Veo. From the Roche folks I got a belt and a pump case usually meant for their Spirit pump but seems to accomodate my pump rather nicely. Then there is the amounts of hypo treatment I've got my hands on. Seriously, I won't need to buy glucose tablets for a long, long time. I warn ye, should you get the option of buying Hypo Fit stuff made by Arctic Medical I wouldn't touch it as it had the habit of attempting to summon the chunks with me last night. I'd also avoid the glucoshots that the folks who organised it had left out for us to help ourselves to. I still have many of them. Pens too. Many, many free pens.