How I went from an A1C of 81 (9.6%) to 62 (7.8%)

From this...

I wish I could tell you guys a magic cure for this. It didn't happen overnight. In fact, this drop in A1C took just under two years. Part of it I can attribute to switching to an insulin pump but on it's own an insulin pump isn't a magic cure. I would like to highlight that before this happened I made a 10point drop on my own. The pump is great but you do have to be prepared to put the work in. 

Pre Pump

I've talked about this before here but I found my diabetes managed to be like one big giant jigsaw puzzle, you try one piece and if it doesn't work you try another. That is what I was doing to start with. The first step came from wanting to have an active role in my health care. I had gone through the last 5-6 years, floating through as a passive participant in my health. I had terrible habits but not so terrible that it was unmanageable. My blood sugar levels were dangerous in the long run because they were contributing to a high A1c but in the moment I was able to live. The only point in which I needed medical intervention was when I ran out of insulin one weekend and I thought I would be okay till my doctors appointment on Monday. I wasn't and this showed my lack of knowledge about how intrinsically important insulin is. I went into DKA at the end of 2010 and came out of it being prescribed lantus which evened out my blood sugar levels. In any event, I was still running higher BSLs than I should have been and  I was consistently tired, grumpy and struggling to get out of bed in the morning. I put this down to stress and a heavy work load. I also continued to blame myself for these high levels.

And then halfway through 2011 I got sick. I rarely get sick and this one just completely wore me down. It was a combination of being run down, having the flu and a chest infection. I started paying a bit more attention to my levels and found that they weren't making sense even when my sickness go better. I emailed the Diabetes Nurse Educator and the hospital and organised an appointment to see her. From there we started working on the jigsaw puzzle. We adjusted my nightly lantus dose, my insulin to carb ratio, my correction factor, my insulin sites (I was asked to stay away from the left side of my stomach), and it felt like everything else under the sun. I even wore a CGM for a week (loaned to me by my local hospital) I was trying so many different things and trying to keep a brave face of it. Blogging helped but it did get me down to not see a better result than a 71 (8.6%).  Eventually the idea of a pump was brought and I was slightly hesitant at first. And then I had to go through an approval process with Pharmac which was terrifying. I did all this research on pumps and it made me really really want one!

Post Pump and becoming an active participant in my health care!

I've talked a little bit about my experience with my Animas Vibe here but one of the positives of a pump was my acceptance of my freaking enormous dawn phenomena. I now know that I need 3 times as much insulin during the hours of 2am and 6am compared to what I use during the day. When I discovered that it lessened off some of the intense blame I had been carrying for the past few years. With a dawn phenomena like that I was never going to be able to manage on injections. And that brings us to August 2014 where my latest A1c is 62. I know that I have a way to go before I am in a safer range but after 8 years of sitting in the 8 and 9 % range. I think that a 7.8% (or 62) is a pretty good sign. There was something amazing at looking at it and realising it was my lowest number since I moved to Dunedin in 2006. 

I can attribute my better levels to my discovery of the Online Diabetic Community. Diabetes is so isolating that it is damn great to have someone to share it with. 

Diabetes Blog Week 2014 - Snapshots Saturday

Back for another year, let’s show everyone what life with diabetes looks like!  With a nod to the Diabetes 365 project, let’s grab our cameras again and share some more d-related pictures.  Post as many or as few as you’d like.  Feel free to blog your thoughts on or explanations of your pictures, or leave out the written words and let the pictures speak for themselves.

Click for the Saturday Snapshots - Saturday 5/17 Link List. 

Apologies for the delay of this!! I was originally going to turn this post into a photo journey of my Saturday but that didn't work out. Instead I spent the day in the kitchen cooking and hanging out with my other half. So instead I sourced my photos from the gallery on my phone - the first one is from June 2013.. so without further a do .. Here is my snapshot!

My experience with a CGM  - June 2013

Current basal rates! This is the reason why I love my pump - so great to be able to change these.

His name is Eddie. Not exactly D Related but belongs to the other half 

Micro dosing - Another reason I love the pump

Always connected

Difficult to see but my fingers show years of pricking. 

And here I am - May 19th 2014 :)

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.


S

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.