Friday, 30 August 2013

Hit with the Sickness

It's come to my attention that I need a new sick day plan.

To be more precise, I need is an actual sick day plan. I haven't really had one before. My plan is the past has been "Don't get sick" and that has worked. I think I've had antibiotics once in ten years. For the most past, infections, the flu and colds usually pass me by.

However, not so much with this recent flu/cold/sinus infection. I've felt terrible and my levels have been going sky high and haywire. When my ketones threw out 0.8 I was panicking a little bit.

Cue: Panic
Physically I was feeling fine (except the head cold and blocked nose). After some food, fluids and insulin the ketones had come down to 0.1 so I took extra Lantus and went to sleep. I made the decision to not go to the Emergency Department for the 0.8 worth of ketones. To me, it made sense to keep hydrated and wait it out a bit. The next morning I woke up at 0.4 indicating that something was still going on in my body. After breakfast they'd come down to 0.1. Since it was working hours I thought I'd call my GP for advice. I've never really had the best of faith in my GPs - see my blog post here. But since that post I'd decided I would try and use my GPs to my advantage. Incorporate them in my medical support team if you will.

The GPs advice was to go to the Emergency Department. I thought this was pretty stupid given they had no idea of my level of ketones or the fact that I was sitting at 0.1 which was in fact within the normal range of ketones. Green even.

It clearly says that reading under 0.6 mmol/L are in normal range....

So, I trusted my gut instinct and didn't seek further medical attention. Reasons why I didn't?
  • I was still in normal range - In the green if you will
  • I wasn't vomiting
  • My levels were high but not super high (10-13mmol/L - am currently running my levels higher to claim back some hypo unawareness)
  • The insulin was working (As evidenced that morning with breakfast and the night before when I was at 0.8)
  • I wasn't feeling like I was in the onset of DKA, I've been there once and the symptoms aren't something I'm likely to forget
Reasons why I would have gone?
  • I had high ketones the night before (0.8) and they showed up the morning after (0.4). That was what was worrying to me. 
So I didn't go and was lucky enough to see this number of ketones later in the day:


It was a scary 24 hours. I've heard a lot of people going into DKA with pump failures and infections/viruses etc. I was terrified that I was coming down with some hideous bug and this was the start of it. 

A couple of days later I emailed my CDE if we could talk sick days at our next appointment and told her about my recent time of it. Her response:

"I think you have managed recent illness superbly well and plan to go to ED if remained ketotic entirely appropriate"

In my own heart I knew that I had acted appropriately, I just felt better when I was reassured that by someone who is a specialist in that area. 

I've never really felt much sympathy to people that have colds and coughs. One of the reasons is that I hardly ever get sick so don't really have empathy to their situation. I think the other is that I manage with this chronic medical condition every day and is that when I get sick, where others might be able to wait it out with chicken soup and ice cream, I'll have to go to the Emergency Department to get better. I'd prefer the chicken soup thanks. Hold the ice cream though, not too much of a fan. 

How does everyone else manage their sick days? Would love to hear about other experiences :)

S xx

Monday, 19 August 2013

GPs versus Diabetes Specialists

I've never really treated my GPs as my primary care physician. I've always felt that since a lot of them don't have a clue about diabetes I shouldn't waste my time with them. After all, every aspect of my life is connected to my Diabetes. Things that are easily treated by a GP become complicated with Diabetes. An eye infection for one patient can  mean much more to a diabetic.

When I began having trouble with numbness in my left hand, I naturally thought of Diabetic Neuropathy and mentioned to to my Diabetes Nurse Educator. Her recommendation was that I should to talk to my GP about it and if necessary get a referral to see an endocrinologist. I'm not sure why but her comment really made me stop and think. I work in a job where I refer people to their GP if they are having issues with other health providers, so I should have confidence in my own GP.

I need to find a GP I like and stick with them. My current Medical Centre makes appointments with the next doctor that's available so I've ended up seeing about 5 or 6 different ones. My latest appointment went fine and I was happy when the Doctor mentioned his friend uses an insulin pump. I thought well, hey here is someone who I know has some form of experience of Diabetes in a real life sense. I made up my mind to ask for this doctor next time.

The numb fingers are most probably not Diabetic Neuropathy which I was happy to hear. The GP I saw reckoned it was a mild form of carpal tunnel syndrome. He sent me off with a few blood tests that included words like a full blood count, thyroid and liver functions. I was happy to do it, mostly because as someone with an autoimmune condition I know I'm likely to get another one. I don't think I've ever had my thyroid checked before? Not sure. In any event, I haven't heard back from the GP which means that nothing has showed up on the bloods. My GP has said that if I am still feeling symptoms to go back and get it checked out again but that he thinks it'll go away. It hasn't but it isn't painful so is something I can wait to mention until my next GP appointment.

I like to think that over time I'll build up trust and confidence in a GP. At least now I am trying to go into appointments with an open mind not some mantra I've carried around with me for years.

Wednesday, 7 August 2013

Sometimes... you just need a cookie

Or in my case, three.

Three.... four, no five Mallow Puffs all in a row.

My oh my it was delicious.

I've been trying to tighten up on my eating and drinking habits lately. I do have a focus on healthy eating, trying to make sure I get enough of the good stuff in my diet. I've been making conscious choices to say no to that beer with dinner or picking a healthier take away option. My nurse educator said when she looked at one of my diet records that there was a little bit too much unhealthy stuff. Fried chicken is okay every now and again as a treat but I think at one point I had it three times in one week.

So I stopped that carry on! I think I've only had fried chicken once in the past month. Tonight would probably be the only time I've eaten that many mallow puffs in one go. It was right before dinner and I included them in my carb count. Two hours late and I'm testing at 6.7 mmol/l. Is this how I should be eating all the time? No.

Is it okay on occasion? Yes, If I ensure I carb count and inject appropriately for them.

Am I going to eat 5 Mallow puffs tomorrow? No and not just because I ran out.

But, in all seriousness, I'm a big believer in taking things as they come, one step at a time. For me, those mallow puffs were like a step sideways. Which is okay every now and again.

Sunday, 4 August 2013

Reflections on the last few months

In some ways I feel like I've got a bit of the old "Diabetes Burn Out" going on. In other ways I know I don't. I'm still taking ten times better care of myself than I was 4 years ago. I'm testing 4-8 times a day, correcting, carb counting, injecting. I'm doing everything I need to.

For me, this feeling of Burnout, of hitting a wall, of smacking my head against said wall stems from trying as hard as possible with my Diabetes management and not getting better results. Cate says I need to stop beating myself up about it. But it's so damn hard. I've really struggled with my feelings. I've struggling to let myself be okay with numbers between 6 and 12 mmol/l (108 and 216 mg/dl). But that's what my body needs right now in order to get back my awareness of low blood sugars,

After the week long trial of the CGM, I was supposed to take diet records for the following week and send them to Cate. But I couldn't bring myself to do it. I'd literally recorded every thing I ate for the previous 20 days and to write everything down again was not something I could face. So I didn't. It felt really great. I was still testing and taking the right amount of insulin. Just the fact of not having to sit down and type it all up into a record sheet made me feel so free and liberated! I think it was my mini "Take that" to Diabetes. The holiday from diet records was one thing I could do that would allow me some of my sanity back without compromising my health.

Looking back on the last 1.5 months since I did the CGM trial I could see in myself a change of mindset with my Diabetes management. I no longer feel hope when I leave appointments with my Diabetes Educator. I've talked about this before, that I used to feel hopeful and inspired that we were together on this Diabetic Jigsaw Puzzle. I used to feel that we were chipping away at it and that things were getting better. I'm sensing she's feeling a bit confused at what to do with me. She took one look at my most recent records from last week and said "Well, we're not winning here are we?" I think she also said exactly what I needed to hear. That I needed to stop beating myself up about it, stop blaming myself for my levels because I am doing everything I should be doing. There's a small part of me, hidden in a back corner of my mind that says I still need to work harder but I think it's okay to have that there. You always need to push yourself.

Our latest development in terms of my management is to take my novorapid at least 15 minutes before eating, not correcting until 3 hours after breakfast novorapid and exercising 40-60 minutes a day. The first two are to target some after breakfast/before lunch blood sugars I've been having. The last is a given and something I've been told for years but I was basically told what I'm currently doing isn't enough. It has inspired me to start a sticker chart and put a sticker on the days where I do more than 40 minutes of exercise. So far for August I have 3 stickers in 4 days so I reckon that's a good go of it.

I think I've wallowed in my own self pity for long enough, I need to change my mindset. Exercising more is bound to help but I need to get that hope and drive back. I think wanting it is a start.

Fingers crossed anyhow.


Friday, 2 August 2013

My Experience With A CGM


I wrote this blog post in June, but then life got in the way and I never quite finished it and got it published. Because of a range of things I'm finding that I really want to start writing again but in order to do that it's better to go back to where I left off... So here we go.

As someone who has a chronic medical condition, I am extremely lucky to be living in a country where health care is subsidised. Each one of my prescriptions costs me $5 for a three month supply, so all in all I probably spend $15-20 every three months. This includes Novorapid, Lantus, Needles, Test Strips etc. I don't have an insurance company breathing down my neck telling me how many times I can test a day. Because of all this, I don't have health insurance. For someone without a lot of expendable income, access to things like Continuous Glucose Monitors and Pumps are hard to come by. Pumps are funded in certain situations but for the most part the majority of New Zealanders are on MDI (This is my own anecdotal view!). I was quite excited to find out that the Health Board in my District actually owns a CGM that they lend out to patients for week long trials. There was a fairly long waiting list but as I was going to be out of the country for 6 weeks it wasn't too much of an issue. The wait time felt like nothing as I was holidaying for it! 

The CGM I used was the Ipro2 - It's unlike most CGMs I read about online in that it doesn't have a real time monitor to go with it. It records data on the sensor which you can then plug in to a computer and have a look at the data. 

I was quite excited about the experience as I'm working toward a better a1c and overall control. I know that when I wake up in the morning and my number is in range I feel better. It's part of a big over haul that I've been working on for the last 12 months.

The results were interesting and in some ways completely expected. In other ways they were completely unexpected. 

The days where I hit 20 were something I completely expected. And I wanted to use this CGM trial to really knuckle down how my insulin works, because sometimes I just feel like it doesn't. Take the light blue line which spikes around lunch time. Why is this? I know there is insulin in there! I thought doing this CGM trial would allow me to get some insight on how my body responds to insulin.

However, all those thoughts surrounding my high numbers went completely out the window when myself and my lovely Diabetes Educator saw that I had prolonged overnight hypoglycaemia. That was something that completely blew me away. It was terrifying. We had a long talk about it and Cate (my Diabetes Educator) knocked back my Lantus and gave me the spiel about making extra sure I was testing before and after driving.

I also got my most recent A1c back and it had gone up 2 points from 72 (8.7%) to 74 (8.9).

In some ways hearing about that increase in A1c was worse than hearing about prolonged overnight lows. I really felt like I have been trying so damn hard. And then having the overnight lows? To me it was a case of 2 steps forward, 10 steps back.