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    Nineteen

    The steady line on my CGM is very pretty. It's very, very flat.

    It's just a shame it isn't 14mmol/l (250mg/dL) lower down.

    My blood sugar has been sitting steadfastly at 19mmol/l (342mg/dL) for the last nine hours. Nineteen for nine hours.

    The recipe for (attempted) correction has included:

    • Two correction boluses - a rational 3.7 units (as per Bolus Wizard suggestion) and a rageful additional 5 units when I hadn't budged 90 minutes later.
    • Another 5 units via a syringe, plunged angrily into the fleshy bit of my backside where infusion sets never go, as I don't relish sitting on my infusion set for 3 days. Since insulin never goes there, I figured I have no absorption problems.
    • A new infusion set, a new reservoir and new insulin, from a brand new bottle.
    • A few more correction boluses. Total units delivered since first testing at 19mmol/l = 22units. That's over two thirds of my usual total daily dose.
    • Total carbs eaten since that time = 30g. That was my (small) lunch. I haven't eaten dinner, for fear of ending up higher.
    • A 200% basal rate for the last 3 hours. So I'm getting double basals right now.

    But I'm still 19mmol/l. 19.3mmol/l to be precise.

    There has been:

    • A lot of water drunk and a lot of trips to the bathroom.
    • An awful lot of test strips used.
    • A lot of priming and checking of my pump.
    • A lot of cursing and getting angry.
    • One (but only one) incident of hurling my testing kit across the room in a rage.
    • Some double checking with other (two other) meters...

    Yep... still at 19mmol/l.

    The good thing?

    No ketones.

    Every cloud, and all that...

    In One Piece... Just

    I'm back in England after my week on the Italian slopes, and have finally crawled out from beneath the mountain of dirty ski clothes that needed laundering! Fortunately I'm all in one piece, if only just!Img_0534

    I was pleased to discover that I can still ski, although my leg strength isn't quite what it was prior to my ankle injuries, which has clearly had some effect on my technique and ability. I also earned a reputation as a cautious skier, since fear of further injury dented my confidence somewhat and I wasn't quite as keen as they guys in the group to hurl myself down any old black run at the highest speed possible!

    It turns out that caution doesn't always pay, though, as I still managed to have two accidents. On the very first afternoon we set off to ski back down to the village. Unbeknown to me, someone had evidently taped a luminous "Snowboarders aim here" sign to the back of my jacket as I was hit by out of control snowboarders not once, not twice, but THREE times on the way down. The third time, just around the corner from the final drop into Sauze, a snowboarder turned across me and ran straight over my ski tips catapulting me in to the air and tearing my calf muscles. The snowboarder riding the chairlift above heard very clearly what I thought of snowboarders at that point! Thanks to wonderful friends, lots of ice and massage, I was back on the slopes the following morning though.

    The second accident occurred on Friday while we were over at the resort of Montgenevre, in France, at the far end of the Milky Way ski area. We'd had a pretty good morning, although we accidentally took a complete beginner down a very steep red run with zero visibility due to a sudden snow storm! This was thanks partly to poor signposting and a crappy piste map - what kind of piste map shows higher areas of the resort nearer the bottom of the map than lower ones?! I skiied that run twice, but then came unstuck on another, probably less difficult, red run just before lunch where I hit unexpected ice and twisted my knee. It took until yesterday for the full glory of the bruising to emerge, so I still managed to ski out the week on Saturday.

    P1010402_2 On Thursday night we enjoyed dinner at the top of the mountain. We played football in ski boots (as difficult as it sounds) and went bum-boarding, which basically involves sitting on a plastic dish and sliding, down the bottom of the empty pistes, before eating a lovely meal. I elected to indulge in the included wine and so, rather than skiing down to the village in the dark, we rode down on a Skidoo. What I didn't realise was that the Skidoo driver was going to take us straight down the same ski run as the skiers. No quiet track through the woods, but straight down steep Red-11 in the pitch dark with  the snow cannons blowing. All I could do was close my eyes and hang on tight! I have to say this was probably the scariest experience of the whole week, far scarier than standing at the top of any black run and realising the only way is down!

    Diabetes-wise it was an interesting week. My blood sugars were fairly well behaved, but there is also lots of CGM data that mimics the mountains and valleys we were surrounded by.

    I discovered that the CGM alarms are pretty useless when you are skiing. They would invariably go off when I wasn't easily able to stop and deal with them, progresssively escalating to irritating sirens that distracted me from the skiing. After the first day I turned the high and low alerts right off during the day and simply checked my numbers and trends at the beginning and end of every run. I also discovered that keeping my basal rates the same, but not bolusing for food worked well. I ate a fairly standard breakfast, generally stopped for hot chocolate mid-morning and ate a fairly standard lunch. It's the first time I've tried this approach, so I think the jury will be out until I've experimented a bit more with it.

    Another thing I learned this week was that keeping tubes of glucose gel in the cargo-style pockets on the side of my ski trousers wasn't a good idea. At some point I must have fallen one of these, leaving me with a very sticky, messy pocket!

    The only other significant diabetes happening was when I'd obviously failed to tuck my tubing back in properly after checking my pump on a chairlift. Somehow the tubing got snagged on the chair as I skied off the lift. It twanged back pretty quickly, but not before dislodging my infusion set. I've now added "the top of a mountain" to the list of odd places I've inserted a new infusion set!

    P1010392 Overall it was a fantastic week, even if our hotel rep was something of a prat, the hotel food was less than gourmet and we had to up ridiculously early for both our outward an return flights. It was wonderful skiing and wonderful company, and good to spend a whole week with Rob. To the right is instructor Luciano who patiently tried to beat my bad habit of turning my upper body out of me, and helped me work on perfecting  proper pole plants, so I'm also definitely a better skier now than I was a week ago. Honestly you've got to envy this guy though - he teaches sailing all summer and skiing all winter...

    Can't wait for my next snow fix!

    Hic... Hic... Hiccup

    All my life, or at least for as long as I can remember, I've experienced regular bouts of hiccups. Unfortunately there is nothing quiet, subtle or ladylike about my hiccups. They don't make a gentle little gurgling hiccup noise either. These are violent, rumbling beasts, lurching up from my diaphragm - more of a HUUUURK.... HUUUURK.

    They drive my mum to distraction when they happen in her company. I once had an attack on a tube train and after a few minutes, half the carriage were trying to restrain their mirth. An ex-boyfriend had to excuse himself from the table at a restaurant as he was unable to control himself laughing at me, and thought it bad enough that I was already making a spectacle of the pair of us!

    My record hiccuping attack?

    It lasted a full hour!

    And once I've had one set of the hiccups, you can bet I'll experience another, or sometimes several, within the next 24 hours.

    I've long suspected that there are triggers for my hiccups. Alcohol, especially beer, is an obvious one. But what about blood sugars? I've been harbouring a sneaking suspicion that high blood sugars may set me off. Over the last few months, I've been trying to conduct a (very unscientific) piece of research by testing my blood glucose every time my diaphragm twitches.

    So far there has been a strong positive connection between high numbers and the first set of hiccups in any given day. After today, I'm fairly convinced. 

    About two hours after lunch, engrossed in paperwork, I felt the familiar sensation start up behind my ribs. My first thought was that I was glad not to be with a patient at that time, but that was hotly followed by a thought to test my blood sugar and then:

    LUNCH BOLUS!

    I took my sensor out just before I ate, as my skin was getting a little sore and irritated looking. Since I was at work, I didn't replace it. I obviously didn't bolus for my pasta salad either. It went clean out of my head. Without the CGM to alert me, I'd soared up to the dizzy heights of 17mmol/l (306mg/dL).

    Eeek! As I hicced and huuurked, I dialed in a correction, but I knew that while the insulin would fix the high it wouldn't have much effect on the hiccups. They went away 10 minutes later, but sure enough they've been back twice already this evening!

    Is this symptom of hyperglycaemia peculiar to me? What strange things happen to you?

    The Accidental Overdose

    Because I prefer to be discrete, I tend to leave my pump's alarm set to vibrate, and that means I'm used to random buzzing from my pocket, my waistband or wherever my pump happens to be lying beside me. High alerts, Low alerts, Cal reminders, low reservoir alerts... between the pump itself and the CGM the list is endless.

    The 522 is pretty cool in that it will give you a different number of vibrations for different alerts. Three means 'take no action' and happens for stuff like temp basals. Four is something which requires prompt action - highs and lows for example. Six means 'pay attention to me now or you'll be sorry' - No delivery alarms and stuff like that.

    The problem is, I often only feel one or two vibrations so I have to dig out the pump to check no matter what.

    This morning, sitting on a bus overcrowded with soaking wet passengers, I felt that single vibration. I pulled off my gloves and dug through layers of coat and sweater to reach my pump in my pocket. As I glanced at it, I was sure I saw the bolus delivery screen, but a second later it was gone.

    The strange thing was, there was no alert to have triggered an alarm. And the only other time the pump vibrates is when it finishes delivering a bolus. Scanning rapidly to the bolus history screen, there it was. I'd just given myself a 4.6 unit bolus.

    Only, I hadn't.

    Or at least I hadn't meant to. I'd eaten breakfast about 40 minutes earlier and bolused then. But that had only been 3 units via the bolus wizard. It was right there on the history, below the 4.6 unit manual bolus.

    The pump had been in my pocket the whole time and easy bolus is disabled.

    So what on earth happened?

    The only conclusion I can come to to is that somehow, in the course of getting on the bus, I'd leaned on my pump in such a way as to press the buttons in sequence: ACT, ACT, down arrow, ACT, ACT, up arrow...for a while, ACT. But crazier yet is that with every press of the ACT button, the pump vibrates.

    Still, it's either that or else I was briefly abducted by aliens. Unless anyone has any other suggestions?

    Oh, and the overdose was sorted with a temp basal and a big bowl of cereal when I got to work.

    CGM Reflections

    Tomorrow, it will be exactly 18 months since I first got hooked up to Medtronic's original Guardian RT and I got to learn for the first time what truly amazing things my blood sugar could be doing while I wasn't looking.

    Back then, the device looked straight out of the 1980s. The monitor was cumbersome and heavy and had a tendency to make a death leap from my waistband more than once a day. The numbers were real-time, but the graphs weren't. To figure out the trend, the true value of this device, you had to scroll back through the last dozen or so numbers and draw a mental picture of where you were going.

    But compared to fingersticks alone, compared to what I'd had for the previous 23 years, this thing was a revolution. The drawbacks of irritation from the adhesive and the size of both the transmitter and the monitor were easily outweighed by the information it gave me. And the timing for me could not have been better, coming just days after the diagnosis of Addison's threw a huge spanner into the workings of my diabetes.

    From the get-go, I didn't want to not have regular access to this technology ever again. I couldn't see that I'd ever really want to be without out. That still holds true, but I cannot believe it was only 18 months ago. Things have come so far since then.

    After starting up with the Guardian I cycled between that and a loaner 722 until I got my own 522 pump which I've been using for the last 14 months. The real-time graphs were as much of a revolutionary step-up from the numbers alone as the numbers alone had been from fingerstick data. We've all heard the analogy about it being like driving with the windshield uncovered for the first time. It's true.

    CGM really has made an enormous difference to me. Right back at the beginning it was the biggest single thing in helping me retrieve my confidence, bruised and battered as it was from  countless episodes of severe hypoglycaemia  as my cortisol deficiency went undiagnosed.  It was the major reason I went back to work so soon and makes a regular difference to my working life now.

    As a dentist, I cannot afford to be hypoglycaemic on the job. For my patients' safety. For my safety and the safety of the people who work with me. Even if a high-speed drill in hypoglycaemic hands weren't dangerous, how would I be able to do a good job, a job up to my high standards, if my brain were fogged by a low? I couldn't, plain and simple.

    Previously, my only defence against lows was regular fingersticks, prevention and relying on my symptoms to alert me to quick drops between tests. With my hypoglycaemia awareness shot by recurrent lows and so many years of diabetes, I lost that weapon. The only other way I could see to cope was letting myself run higher, much higher, during the working day. That would have meat trading the immediate risks for the long term risk of my practicing life being cut short by complications such as retinopathy and neuropathy, as well as making me feel awful.

    I do run looser targets at work, for safety's sake and because my mind is very focused on the job and not always so much on diabetes. But with my CGM in pocket to alert me when things are amiss, I feel safer. Without the worry of diabetes I stay focused and my patients get the best of me. And the targets are still tight enough that I haven't had an A1c over 6.6 in the last 18 months.

    And outside of work, it makes innumerable differences too. I've written before about the difference between a blood sugar of 5.5 that is stable versus one that is going down or up. More than 50% of my bolus calculations are now influenced by the information about where I'm coming from and likely to be going to. Travelling across time zones, working out at the gym and living alone are all helped by the numbers from my CGM.

    Of course I can, and did, do all these things without that information. Many people lived with diabetes long before even fingersticks were available. Anyone who strives for good control wouldn't dream of doing that now, and I'm beginning to feel the same about CGM. After all, a healthy body knows where it's at at all times, why shouldn't I?

    There are drawbacks, of course. A recurrent problem is irritation from the transmitter rubbing on my skin, although I've recently begun placing a piece of gauze under the transmitter, which seems to help. I've written before about accuracy, and while it's true that I have few problems and I find the trend is almost always right, screwy sensors do happen.

    I can get burned out by it too. Rob recently described my pump/CGM combo as a little bit like being permanently attached to a Tamogotchi pet, and it was a good analogy. When the fifth or sixth alert of the day starts up, I sometimes want to kill it! Sometimes when my numbers stay consistently above the high target range I get frustrated much more easily than I would by a series of fingersticks showing the same trend.

    The bottom line though is that I still love it. The breaks I take these days are mainly for financial reasons. Eighteen months on, I'm still no nearer securing funding but the longer I go on using CGM, the happier I am about choosing to forgo something else and instead spend the money on sensors. I can't really give it a much higher endorsement than that.


     

    Numbers for the New Year

    Happy New Year!

    Continuing on the numbers theme...

    I'll be celebrating my 28th birthday three weeks yesterday.
    I'll shortly reach the six year anniversary of my pump start.
    This year will mark seven years of living with the stigma of epilepsy and 2 years of living with Addison's.
    I will also reach my twenty-fifth year of diabetes.

    Twenty-five years.

    Blimey. I don't know where the time went, but I know I've come a long way.

    Yesterday was also the third anniversary of this blog.

    I'd have liked to have posted yesterday, but I didn't expect to spend so much of my day travelling half-way around the country on a series of different trains. I was hoping that in next year's statistics, the number of complaints made to Virgin trains would be zero. Sadly that statistic is already at one.

    Strictly speaking the chaos was not Virgin Trains' fault. It was caused by Network Rail over running on engineering works. But it turned my simple, direct three hour service to turn in to a three-changes-and-a-ten-minute-route-march-through-Birmingham-city-centre service. It took six hours and I was thoroughly unimpressed with Virgin's response to the situation - they cancelled the replacement bus services, gave us no information and left this type 1 diabetic with no access to food. (Don't worry, I had snacks, but I was rather hungry without any dinner!)

    And guess what? They still aren't done with the engineering work! Britain, railways and joke make comfortable companions in a sentence. Lord knows what will happen if the forecast snow arrives tomorrow...

    There is one other disappointing statistic already this year: In the six years I've been pumping, I've never before had a site infection. 2008 has brought my first.

    When I use my thighs for sites, I've always used Quicksets or Insets. But this weekend I had only Silhouettes with me. I've successfully used Sils in my abdomen, hips, buttocks and arms. This was the first time I'd used one in my thigh. It had grown increasingly painful and red looking over the last couple of days, winking at me everytime I went to the bathroom.

    I knew it wasn't working right. The 150% basal I was running was a big clue. But my journey was bad enough, I didn't have a chance to start changing out a set on an overcrowded train. And when I got home, well, I should have changed it then. But I was exhausted. I wanted to sleep. Stubborn little me took a somewhat generous bolus via syringe, knowing it would account for missing basal, for the snack I ate before bed and went to sleep.

    The syringe bolus worked. At 2am I was at 7.3 (131).

    Unfortunately by 6am I was at 19 (342) and nauseated with ketones.

    Pulling the old set revealed an angry red mountain with a little nodding yellow head. I only had to touch the skin nearby lightly for the mountain to erupt like a volcano.

    Ewww.

    So I've spent the first working day of the new year with a pounding, throbbing volcano along for the ride on my thigh.

    But I have my secret sidekick antibiotics, so here's hoping he won't be sticking around for much of this brand new shiny year!

    Habit Forming

    NaBloPoMo was habit forming.

    Twice this weekend, on both Saturday and Sunday, I found myself thinking "I haven't posted yet!" And "What am I going to post about?" Even, whilst out with friends at 11 o'clock on Saturday night, "Eeek, how am I going to be able to post before midnight?"

    Perhaps I'm addicted to this now. Or perhaps I'm just deeply tragic?

    I'm the kind of person who forms habits slowly, but once they are there, they're hard to break.

    Take the codes for new bottles of test strips. This weekend I discovered I'd gone through a whole bottle on the wrong code.

    "I must put in the new code... I must put in the new code" I chanted to myself as I opened a new box of strips.

    "Code 16... code 16... code 16."

    Shoved the strip into the meter.

    Click. Thunk.

    Drop of blood on the strip.

    Test complete.

    Doh!

    Didn't change the damn code! As soon as that strip is in the meter, I'm on autopilot to get the blood on the strip and the test done. It is such an ingrained habit, that no matter how much I try to remind myself to do it, I always forget to change the code.

    Reassuringly, when I tested again after changing the code, the result was just 0.2mmol different (around 3mg/dL). But still,  perhaps it is time I got one of those 'no code' meters.

    Just a thought.

    A1c: Really?

    Amongst other things today, I had an appointment with my diabetes consultant. I know full well that I've moaned before about feeling unsupported and not wanting to do it all myself, but honestly I sometimes wonder about the point of these visits.

    We spend a lot of time going over the same old ground, about the emotional burdens of diabetes, about hypoglycaemia frequency and so on. But looking back, I can't see the last time anything ever really got done as a result of these appointments. I can't think of a time where I've made changes directly based on what we've discussed.

    It's not that that is necessarily a bad thing. I'm not sure that there is really an awful lot that I want to come out of the visits. I don't want my consultant to fiddle around with my basal rates or carb ratios because, quite frankly, what does he know? I'm the one living with this. I'm the one that does it day by day. And even if he made changes that worked for a while, everything will change again long before we next meet. If I were to rely on my diabetes team to make all these changes, I'd be up the creek without a paddle more often than not.

    Today felt perhaps particularly pointless because I'm not due for retinal photography, tests on my feet or any of the myriad of blood tests used in the early detection of risks and complications. I had all those things done just a few short months ago.

    I did get my A1c, of course.

    It was 6.6.

    'Really?' was my first thought.

    I was honestly, totally shocked. I've seen a whole bunch of wayward numbers lately, and, at long last, fewer hypos. I guess I was expecting those two things to combine and push the result up a little higher than it was. It was good to learn, I guess, that things might have been going better than I thought.

    But other than that, what else is there to have got out of today? Am I missing something about professional diabetes care that should be totally obvious?

    Sensible vs Stupid

    Sensible Caro: Stayed comfortably asleep in bed this morning.

    Stupid Caro: Got up and went out in the cold.

    Sensible Caro: Drank cups of tea and watched daytime TV without worrying about anything else.

    Stupid Caro: Went to work, because there was no one else to cover and she was worried about that.

    Sensible Caro: Chilled out and relaxed.

    Stupid Caro: Snapped at everyone and burst into tears because she felt terrible and couldn't cope.

    Sensible Caro: Managed to keep her blood sugars somewhat in range.

    Stupid Caro: Saw every number from the sky to the floor.

    Sensible Caro: Feels much better tonight.

    Stupid Caro: Feels somewhat better, but now realises she did herself no favours.

    Guess which one is the real me?

    I really have no idea what I was thinking when I got out of bed this morning. Perhaps it was simply that I wasn't thinking. Trying to work? Who was I trying to kid, more like!

    It would be easy for me to blame it all on the responsibility of my job and not wanting to let people down, but sometimes I'm just my own worst enemy. After everyone so generously sent me their best yesterday, I go and pull my worst on myself!

    I am feeling a bit better though, and my eyes in particular are much less swollen and sore. Now, if I could just shake off this damn cough... cough... cough.... cough

    Real People Sick

    I think it was Allison who coined the phrase "Real People Sick", meaning illness that people without diabetes get. *EDIT* The term actually comes from Kerri. See here for more. 

    I'm "Real People Sick".

    This is coming to you from my bed (thank you wireless network) where I've been tucked up for the last hour and a half or so. I've got a throbbing headache, fever, runny nose, aching neck and a nasty, hacking cough that makes me feel as though I'm coughing up knives. To cap it all, my eyes won't stop streaming and so swollen that I look as though I've been crying for a week.

    P1010295

    So I've beaten a hasty retreat to bed (at 7.45pm!). I've taken paracetamol for the fever, and something a little stronger for my headache. I've got a two litre bottle of water, straight from the fridge, a bumper box of tissues and back-to-back re-runs of Friends on TV.

    But that is where "Real People Sick" ends. Because even when I'm "real" sick, I'm still chronic illness sick too.

    My blood sugars are behaving like... well the point is they're not behaving. Amongst all those 'ordinary' supplies, I've got my meter for frequent testing and juice for bounce-back lows.

    And then there is the reaction to another number. The temperature number. When I checked my temperature earlier and saw 39.2 (that's over 102 in Fahrenheit) blinking back at me, my first thought was that all the shaking I'm doing might not be shivering after all. For someone with Addison's disease, it's definitely time to crack out the extra steroids.

    And later on they'll do their own number on my blood sugars.

    I feel truly awful.

    I want to crawl in to a hole for a very long time. But unfortunately I need to keep checking my blood sugar every couple of hours.

    So much for "Real People Sick"!

    Dans Le Noir?

    Literally: In the black.

    I'm talking the kind of blackness that makes you feel like you're swimming in ink. The kind of impenetrable darkness where you cannot see your own hand in front of your face.

    That is how we ate our dinner last night, at the Dans Le Noir? restaurant here in London.

    The idea of eating in a completely pitch dark room, guided and served by blind staff, is a novel one, at least to me. And it proved to be an experience on so many levels.

    The evening began with our group forming a chain, locking on to each others' shoulders as we were led by our waiter, Graham, into the darkness. One by one Graham led us to our seats and, in a complete reversal of preconceived roles, we became totally dependent upon him.

    We were asked as we entered the dark room to keep our voices quiet and warned, quite accurately, that our sense of hearing would become more acute. Deprived of vision, we quickly came to rely on our other senses. Unable to simply glance down the table to see who was seated where, we had to use our voices to map out a plan of the table. I quickly developed a need to touch anything and everything on the table, to fill in for the missing sensory feedback from my eyes.

    We all learned a lot sitting there in the dark. We learned how to do familiar things, that we  normally take for granted, without visual feedback, such as pouring wine into a glass without spilling it. Placing food in our mouths without being able to see what it was. In this respect, it struck me that we had one important advantage over a truly blind person. We were all blinded. Many of us resorted to picking our food apart wit our fingers and putting it in our mouths, perhaps being quite messy along the way in what might normally be deemed a socially unacceptable manner. But then, no one could see us, so it was easy for us not to let it matter.

    We learned about communication and the role that sight plays. In the darkness you cannot read visual clues or body language, but this actually makes it easier to be a little more spontaneous in what you say and makes behaviour more free without the pressure of conforming to accepted standards.

    We learned, too, about taste. You do not order specific dishes at Dans Le Noir? Instead, you select a 'surprise' menu, with a choice of meat, fish or both or a vegetarian option. It is only afterwards that you see the actual content of your dishes. Not knowing what food is in front of you forces you to concentrate on taste and texture and removes preconceived ideas about whether you will like a particular dish based on how it appears or what it is called. Without sight, we weren't very accurate at identifying our food. I was completely stumped by an item on my plate that felt like a bird's nest and tasted fired - it turned out to be crispy noodles. Of those who selected the menu containing Guinea Fowl, none identified it correctly. Rob ate cold Parma ham that he would normally have not given a second glance to.

    Of course the evening presented particular challenges to me. All objects that can produce light, such as mobile phones, are banned from the dark room. Whether to take or leave my little Freestyle meter was a difficult decision. I actually ended up leaving it in the outside locker, knowing I could get to it at any time if I needed to. My pump, on the other hand, I kept on. But I  then found myself faced with a very difficult problem. I did actually hit the backlight button at one point, ready to perform the preconditioned reflex of bolusing before my food. I left the light on for about 3 seconds, instantly mortified at having introduced even a tiny bit of light in to this experience, and suddenly realsising that without being able to see my food, there was no way at all for me to assess the carbohydrate content.

    Looking back, I probably could have arranged with staff to view my meal beforehand, but I'm glad I didn't. It would have ruined somewhat the experience that I've already outlined. I'd had a good reading going in to the meal and so elected to bolus immediately after leaving the dark room with what is a fairly average amount for a restaurant meal for me. Something worked, because by the time we got home, my blood sugar was 4.0 (72).

    I learned though, how vital a tool sight is in the management of diabetes. We use it each time we test our blood glucose, each time we bolus and, most difficult of all to find a replacement method for, we use it to count carbohydrates.

    I truly discovered the irony of diabetic vision-loss.

    And perhaps this principle was the biggest part of the night. That we all learned things about ourselves. Each of us had fears to face in that room. Some were claustrophobic, simply afraid of the darkness. Some had a fear of eating food they could not see.

    For me, it was like facing my fear of blindness head-on.

    And it was scary.

    For several minutes all I could think was that this was what it would be like to have that ultimate fear realised. And for several minutes it seemed overwhelming. I wanted to shout for Graham and have him take me back outside to the light. But then it hit me that if this were for real, I wouldn't have that option. There would be no returning to the light. Rather than freak me out more, that thought made me more determined to stay, to work through it. That was the point at which my hands went in to overdrive, seeking out the missing feedback. Learning. Discovering.

    By the end of the evening I realised that yes, being totally blind, living in a world devoid of colour and faces would be awful. But we still had good food and wine. We still had voices and laughter. We found new ways of doing familiar old tasks. I felt safe with the support of others - Graham our guide, and Rob sitting to my left, holding my hand and reassuring me it would be ok.

    I learned that if it ever happens, I could find a way to cope. And my little daily worry knot loosened just a little.

    Friday 'Fings

    A couple of things to share on this sunny Friday. Except they're 'fings, rather than things. This is for more than alliteration's sake. I went to high school in a town where a large proportion of the population were unable to pronounce the 'th' sound, using instead a 'ff' sound. Today I sound a little like those people.

    Which brings me to:

    Fing One

    Early yesterday morning I was somewhat abruptly reminded of the perils of hypoglycaemia, especially when you live on your own. The hunger might drive you to the insensible option of eating your own lips. Or more likely your jelly legs might forget how to do the simple one-in-front-of-the-other walking thing (I mean, come on legs, how hard is that?) and put you splat on the floor. Taking a bite of your lips on the way down.

    Which is roughly what happened to me.

    It appears I smacked my chin on the hard edge of the bed frame and sent one of my top front  teeth through my bottom lip.

    Being a dentist is a blessing and a curse if you manage this kind of injury. A blessing in that I was able to simply go to work and get looked after and stitched up by my wonderful colleagues. Who truly were wonderful, even down to pointing out that I was probably shaking like a leaf because  this was a pretty nasty shock and I'd completely forgotten to kick up my steroids.  I really need other people around when my brain flakes out! I've also been able to cheat and use dental anaesthetics for relief at times when the pain has got really bad during the last 30 hours or so.

    Being a dentist with this kind of injury is curse because it sparks obvious jokes about being on the receiving end and getting my comeuppance. Oh yes, the patients really do find it funny. (Not that I ended up doing much work yesterday.)

    I won't post pictures, because even I  think I look hideous, but suffice it to say that I have some lovely bruising and look a little like I've over-done some lip filler treatments! Please keep my front tooth in your thoughts. It has endured this kind of bashing before and I fear this may be the time it gives up and dies. Come on little tooth!

    Fing Two

    As if I wasn't unintelligible enough speaking through my fish lips, I appear to have lost my voice this morning. Damn cold  that is doing the rounds. A few hot lemon and honey drinks (through a straw of course) have picked it up a bit, but I definitely sound as though I have a frog resident in my throat.

    A frog talking through a fish's mouth. Now there is a thought!

    Fing Three

    Irritable Bowel Syndrome Award

    On a more positive note, I was very honoured this week to receive notification that I've been awarded a 'Health Leader Award' by the Irritable Bowel Syndrome Treatment website. These awards recognise sites that are "squarely on the side of the patient." Since that is exactly where I aim to be, I'm very proud to been given this award.

    There is a list of other winners over on the site, which are worth checking out.

    Fing Four

    This article from the BBC came to my attention yesterday.

    To say that it makes me mad is an understatement. I've not looked in to it further, and it could be that my own Primary Care Trust is one of those still in deficit, but it makes me angry to hear of so much money essentially going to waste when I'm still being denied any coverage for the CGM technology that has changed my life and allowed me to keep working (for the NHS, oh the irony!).

    And it isn't just about me either. Up and down the country patients are having test strips rationed and told that, although they are good candidates, they'll have to go on waiting lists before they can commence pump therapy (actually illegal regardless of resources, but that is a story for a different day). All the while there is money burning a hole in the Treasury's pocket. All this anger without even touching on even bigger issues outside of diabetes care.

    I couldn't agree more with John Appleby, who, in the article, states:

    "A surplus of that size [is] not necessarily a healthy sign, as the money could have been spent on services. If the NHS does end up with a significant underspend at the end of the financial year, that will be a real loss to patients".

    Too true.

    Have a great Friday.

     

    Running on Empty

    At 8am this morning I had a choice:

    a) get up now and refill my reservoir/change my infusion set, or

    b) roll over and grab five more minutes sleep.

    I chose b.

    (Five minutes in fact turned to over thirty and a mad panic to get ready and make it to work for 10am ensued.)

    At 8am this morning I had 3.2 units remaining in my insulin pump. Not anywhere near enough to get me through the day, but I made my lazy choice based on the 10-15 'hidden' units at the end of the reservoir. Minimed pumps never show they are there, but I know they are.

    And 13-18 units was plenty of insulin to last until this evening.

    Or it would have been, had several of us not decided to head out after work for a Chinese meal.

    Mmmm... Chinese.

    Mmmm... big bolus.

    Sitting in the restaurant in Greenwich I contemplated my empty reservoir and the plate of noodles and chicken that I'd just ordered.

    I knew what had to be done.

    I am very lucky to have work colleagues who don't bat an eyelid when I pull out insulin,  a reservoir and infusion set and proceed to change out the entire thing right there at the table, without even dropping a beat from the conversation.

    I know that there are many people who would not do it that way. I know that there are many people who would actually criticise me for doing something so medical in public.

    This is the way I see it: I was running on empty. If your car runs out of fuel, you fill it up. Or, a better analogy, if you get hungry, you eat to fill yourself up. To me, insulin in my pump is no different. It was a necessity right then, so that I could go on with my evening in the way that most people take for granted. None of my immediate dining companions objected, and nobody else in the restaurant had any cause to even look at what I was doing. And yes, it was clean and I had already washed my hands.

    A girl's gotta do what a girl's gotta do and filling up her insulin pump and changing her infusion set is an important part of this girl's life!

    Diabetes 365

    I've been looking at the Diabetes 365 photos from other bloggers, such as Beth, who started the project, Bernard, who started the flickr group, Amylia, Jillian, Sara, Penny and all the others in the flickr pool.

    And I've been inspired.

    Initially I was going to wait to join the project until the madness of NaNoWriMo (currently at 21, 196 word) and NaBloPoMo.

    But then I took this picture.

    And I wanted it to be my first.

    There is also a kind of neatness to starting and ending 365 on World Diabetes Day.

    Speaking of neatness - I've been shamefully bad at using Flickr during the course of the last year. It started when I came back from two weeks in the Caribbean in January with far too many photos to edit and upload. Much like logging diabetes data, the longer you stay away from Flickring, the harder it is to go back! Especially if you're a little anal, like me, about having everything in the right order! I've actually made a start tonight on those Caribbean photos, but anyone looking at my    photostream will find it in something of a disorganised state!

    I promise it's a work in progress

    So to add to NaNoWriMo and NaBloPoMo we have Diabetes 365 and a major Flickr photostream update!

    It'll be worthwhile in the long run.

    And I truly believe the Diabetes 365 project could also be very worthwhile, in raising awareness of what it is like to live with diabetes every day of the year.    

    Day Off

    Dearest diabetes,

    Thank you very much. You were most kind today.

    When I sat down to lunch, with around 40 members of my extended family, my blood sugar was a healthy 5.5 (99). You must have known, diabetes, that I was so busy with conversation that I forgot to feed you your insulin, forgot to pay any attention to you. I'm sorry for that. You know that I am usually devoted to you, my constant companion and I didn't do it intentionally. I really truly cannot tell you how much I appreciated you disappearing for a while. When, horror struck, I realised my neglect, my blood sugar was at a nice 6.8 (122).

    Don't worry about my silly liver, telling you about how you missed an opportunity to send my blood glucose sky high together. You actually did great work today, no matter what he says.

    In fact, I've been wondering if you would mind terribly, awfully much taking next Saturday off too? And the one after that? Go on, honestly. Sure, I may miss you and your constant interruptions a little, but if you want to throw in the odd weekday as well, I really won't mind.  I think I may be ready to get by without you.

    In fact, I'm hereby increasing your vacation allowance to 365 days a year. No, really. I think you've earned it. Do go on and take them all.

    Please?

    Ever yours,

    Caro

    Adding Insult to Injury

    I came to this blog entry on Tu Diabetes from the Diabetes Daily Headlines.

    The question posed is a good one. It inspired a meander back through all the physiology, pathology and general medicine that is stored up in my brain from six years of university study, which in turn inspired this post.

    And I realised once again that our bodies don't half like to add insult to injury after developing us diabetes.

    This is how it works:

    The liver doesn't sense blood glucose levels. Instead, it relies on knowing the level of insulin in the blood. The blood insulin levels in a non-diabetic only become low during periods of fasting. When no food is arriving in the stomach, very little insulin is being released. The liver responds by saying:

    "Oooh look, there's no food around. Cells all over the body will be starving! I had better release some stored glucose and make some new glucose and dump it all in to the blood." Cue excited hand flapping and dancing.

    Okay, that isn't exactly what happens, but you get the idea. All is well and good in the non-diabetic. The cells get their food. Everyone is happy.

    And conversely, when the insulin level is high, the liver gets busy hoovering up all the glucose and storing it away for the next time it needs to release it.

    Those of us with diabetes, however, frequently find ourselves in a paradoxical situation.

    Diabetes works out fine when a high insulin level following a bolus corresponds with plenty of glucose in the blood to store away. The diabetic holy grail is matching every bolus perfectly with the amount of glucose available.

    It rarely happens. The pancreas of a non-diabetic doesn't look at the food sitting in the stomach and go "Ooooh, I think that is about 30 carbs, here have a squirt of insulin <this big>", which is a representation of the way we bolus. Insulin release is much more sophisticated and, because it goes directly in to the portal circulation, the insulin acts very rapidly before being used up. This not only means that the correct amount is always delivered, but also means that insulin doesn't hang around for 2-3 hours to have a effect in the middle of a gym workout.

    Our squirty bolus however, wandering slowly as it does through the jungle of the sub-cutaneous landscape, can. We may actually have too much insulin, which drives our blood glucose level low. The liver continues to respond to the insulin level and thus not only doesn't produce any glucose for us, but actually continues to take more glucose out of the blood stream, dropping the blood sugar level even lower.

    Alternatively, we may have too little insulin. We may even forget to bolus entirely. In that situation the glucose from digested food builds up in the blood and then the body really adds insult to injury. The liver responds to the low insulin level and says the body must be starving. It releases stored glucose and also manufactures more glucose (gluconeogenesis) pushing the blood glucose level even higher. Like that is what we need.

    The bottom line: in diabetes the liver always does the opposite of what we need. And nobody is happy.

    Of course, with high blood sugar, the pancreas of a person with type 1 diabetes will never do what it needs to and spit out insulin. Which is why untreated type 1 is fatal.

    The good news?

    So long as you haven't had your pancreas removed, most people with diabetes can still produce glucagon. The stimulus for glucagon release is the low blood glucose level itself, so glucagon can come to the rescue even in people with diabetes.

    The catch?

    Well actually, there are two. Firstly the absolute level of available glucagon is not important - the ratio of insulin to glucagon is. So if you have a lot of insulin in your system, glucagon release may still be ineffectual. Secondly I've heard of studies that have shown that the glucagon response tends to wane and become less predictable after several years of type 1.

    And all of that, my friends, is just another reason why diabetes really does suck.

    Unlucky 13

    I'm not a particularly superstitious person.

    Actually, I'm not superstitious at all. To me, a black cat is just a black cat and magpies are just magpies. I'll happily cut my nails, and my hair, when I want and I'll walk over any number of drains in the street. I don't walk under ladders, but that is common sense, not superstition!

    Thirteen?

    Just a number.

    Thirteenth of the month?

    Just a day...

    Or so I thought. But whether it was the date or something else entirely, the blood sugar monsters have been out to get me today.

    It started off badly. At around a quarter to two this morning, I woke up to find my pump and I had parted company. It had made a bid for freedom out of the far side of the bed leaving its tail of tubing trailing in its wake, infusion set still attached, ripped clean from my body.

    There was a very big part of me that wanted to leave it there. I wanted to stick two fingers up at it and say "You can't get one over on me. If you fancy a night sleeping on the floor, you've got it!"

    The idea of rolling over and ignoring the problem entirely was given more consideration that it surely should have been.

    But diabetes invades my every waking hour. I don't want it invading my sleep. I wanted to ignore it so badly.

    Of course I didn't. I didn't even really pursue a mental calculation of how many hours until I would be getting up and whether I could get by on a interim shot of Humalog. Instead, I forced myself out from under my warm duvet into the cold of the bedroom to collect a new infusion set. Given that I only had around 20 units left in the reservoir, I grabbed one of those as well and proceeded to replace the entire shebang.

    By late this afternoon, I was back wishing I'd left the pump where it was. The infusion set having been placed through a blur of sleep, the adhesive had caught up a little and it has irritated and scratched at my skin all day. And as for my blood sugars, they've soared and crashed from 2 to 20 and back again.

    I'm frustrated.

    I want to blame my pump because it is a tangible object. I love my pump, but unlike my other love, this relationship is tinged with hatred and resentment. I wish I didn't rely so totally on it. I wish I had a fully functioning body that didn't need it.

    That's the bottom line. It's diabetes that I'm frustrated with. It's diabetes that I want to toss out of my bed.

    But I can't.

    So I'll resign myself to the fact that today was an unlucky day; Tomorrow is a new one.

    Ruined Lie-in

    I was woken by R.

    "You're going off, babe."

    I could hear the screeching siren of a long ignored alarm on my Medtronic pump, muffled somewhat by the fact that it was buried underneath my stomach. Extricating it roughly and unwrapping the tubing from around my body, I glanced at the screen.

    LOW 2.6 (45)

    "I'm low" I mumbled. I reached across to get my testing kit, but it seemed to take a monumental effort. I let the black nylon case fall on to my chest, unopened.

    "Babe."

    No response.

    "Babe, you were going to do a test." He digs me in the ribs. "Come on babe."

    Several minutes later, the low confirmed, juice grabbed from the window sill and my blood glucose beginning the slow upward climb, R is drifting gently back to sleep.

    "Seven thirty seven" I say, to no one in particular.

    "Seven thirty seven?" mumbles R. "What's seven thirty seven?"

    "Too early to be awake on a Sunday morning when we've got nothing in particular to do with the day" I respond. "Damn low blood sugar, ruining my lie in."

    Thank You For Giving Me Courage: D-Blog Day

    Dblogday_2

    It takes courage to take on diabetes.

    I'm not talking about bravery. You don't have to be brave to stick needles into your skin when the choice is do or die. But you do have to find overwhelming strength from inside to choose to face the challenges it throws at you, to choose to take them on. To run full pelt after control, even when you don't quite attain it.

    It is far, far easier to back down. Let it control you. Let it win.

    Since the introduction of insulin, diabetes is no longer an automatic death sentence. But insulin is not a cure. Eighty-six years after the discovery of the wonder drug, millions of people worldwide still rely on it as life support. We live in a changed reality, a 'new-normal', attempting as best we can to control and reign in the beast that is diabetes.

    I was three years old when I embraced my 'new-normal'. It's no longer 'new'. I don't remember how it feels to be any different. Despite more recent technology - a pump and continuous glucose monitor - I, and the countless other users of insulin, live with the constant threat of hypoglycaemia hitting when we least expect. When we're alone, unprepared or defenceless. It is a risk we run every day.

    At the other end of the swing, we live too with the constant threat of hyperglycaemia, the very hallmark of diabetes. Kinked cannulas, spoiled insulin or simple 'user error' can lead swiftly to ketoacidosis. Coma. Death?

    But diabetes doesn't have to kill you to take away your life. The consequences of poor control loom over us on a daily basis. Our eyes are threatened. Our kidneys are threatened. Even the feet that we walk on are threatened. My eyesight is essential to my career. I already know what it feels like to be unable to walk, to get around. That is not a life I want.

    Diabetes takes a piece of my life every day. It takes a chunk of time in monitoring blood sugars, thinking about food and exercise, changing and maintaining pump supplies, ensuring I don't run out of my life supporting insulin.

    Diabetes too, threatens my life in a more subtle way. A year ago , I was deep in the pit of a depression centered around diabetes and the overwhelming impact it has on my life, the sheer size of the task of facing it head on. I felt isolated and alone, the people close to me unable to truly understand what taking on diabetes means. I was afraid.

    But I found courage again.

    And I found it here. In the community of people who blog about their diabetes.

    You are the people who understand. You monitor your blood sugars, think about food and exercise and maintain your supplies alongside me. We come from all walks of life and several corners of the world. But we all share this one thing. I wish nobody had to face this, but for as long as they do, I'm glad to face it alongside this group of people.

    Thank you all for inspiring me on a daily basis and helping me to reach inside for the courage to carry on.

    Just thank you.

    (For more about D-Blog day, please stop by Gina's post. And if you have a blog and are affected by diabetes, please join us on D-Blog day and post the logo above.)

    Christmas, Anytime of Year

    Okay, okay, I'll admit it. It doesn't matter how many rants I have, via twitter  or otherwise, there is one place (or more accurately something like 48 bazillion places worldwide) where I would be quite happy for it to be Christmas every day. Every. Single. Day.

    The place?

    Inside a branch of Starbucks.Holiday_trio

    I know it's bad. I know its oh-so-NOT diabetes friendly, but so long as they have Gingerbread Lattes, Peppermint Mochas and Cranberry and Orange Muffins, they can hold Christmas every single day of the year.

    Stepping off a bus outside Borough Station earlier on my way home from a hospital appointment, I couldn't help but notice the snow flakes etched on to the windows of a fairly recently opened branch on the other side of the street. The promise of Christmas inside acted like an invisible hand, guiding me to the crossing, over the road and in through the front door in a blast of cold air.

    They had the red cups, the turkey feast panninis and a list of festive food and drink. I was like a kid at, well, Christmas! For a minute, it didn't matter that we're only just out of the first week of Novemeber. It was Christmas and all I cared about was what I could have. New for this year includes Creme Brulee Lattes and Skinny Cranberry and Orange Muffins - does that mean I can eat twice as many?

    I know I shouldn't have, but with a healthy 5.3 (95) blood sugar and a morning spent at the hospital behind me, I convinced myself a treat was in order. Who am I kidding? I didn't really need any convincing.

    One grande Gingerbread Latte (minus the whipped cream) and 3 units of insulin later, I'm cruising  in the 6's (110-125) range.

    Yeah, secretly I can't wait for Christmas. Or at least, I can't wait for Starbucks' Christmas!

    A Different Perspective

    Almost two weeks ago, when I wrote this, I was thoroughly fed up of the invasion of test strips, pump caps and other diabetes paraphernalia into my life. I joked with a friend that if I ever commit  a crime, I'll make it easy for forensics to find DNA evidence to connect me to the scene: there will be a little trail of discarded test strips, each with a smudge of my blood on.

    It does wear me down. Far more than having a pump attached to me. Even more than performing the tests that spawn the strips. I'm not sure why, but perhaps it is because I seem powerless to stop their spread - more powerless even than I am to control my blood sugars!

    But today, walking along a busy London street, I glanced at the floor and noticed a discarded test strip. A few paces on and there was another. Then a third.

    I knew they weren't mine. They weren't the brand that I use.

    Seeing those discarded strips so close to where I spend I my working day, they were just another reminder that no matter how isolated living with diabetes may seem, there are many others close by tackling the same issues.

    I'm lucky to have found all the people who blog about diabetes, and found others through various organisations and internet sites, but maybe my own used test strips may send a message of comfort for someone who is struggling with the burden alone.

    A very different perspective indeed.

    Working for a Cure

    I was rushing around Greenwich in my lunch break weaving through the throngs of people, a mixture of lunchtime shoppers and leisurely tourists, desperate to get to the bank. Mixed in to the crowds are multiple charity collectors and those wielding surveys on clipboards. Greenwich is a prime spot for them, but I just don't have the time in my limited lunch break.

    I'm approaching the pedestrian crossing opposite the bank when I make the mistake of letting one of them catch my eye. He's a brave soul, wearing a short sleeved T-shirt with no jacket on this cold autumn afternoon. As I take him in, my excuses ready on my lips, my eyes wander down and read the lettering on the shirt.

    Diabetes UK.

    In a instant the excuses in my mouth dry out and reform. From one honest explanation about my lack of time to another. This is a charity I already support.

    'Good afternoon! Can I...' was his opening.

    I shook my head. 'I'm sorry' I said 'But I'm already a life member anyway.'

    'Oh. Right' I'd clearly taken the wind right out of his sales. 'Why's that then?' he said, clearly puzzled by this different excuse to move on, not stop, not participate.

    It didn't occur to me, in the hurry that I was, to think this question rude or intrusive.

    'Because I'm a life member of the diabetes club' I responded. 'I've had type 1 for over 20 years.'

    His surprise was written all over his face, but then, as I made my apologies and headed for the bank he called after me 'Maybe it won't be forever. I'll keep working hard to get you a cure.'

    I couldn't help but smile. Maybe he meant it literally. Maybe he has another job as a researcher in a laboratory somewhere. Even if he didn't, he really is playing a part in helping to find the cure.

    We need as many people like him as we can get on board.

    How much glucose can a glucose sensor sense?

    It was Kerri that got me  thinking about woodchucks chucking wood. It was that which gave me the silly title for this post.

    And it was a new comment on an old post that inspired the topic. Adil asked:

    How long can the sensor actually last?

    What surprised me most about this question is the fact that I've not answered it explicitly before. Or rather, that I've not answered it here. I've explained countless times to other folks, on mailing lists, in comments on other blogs and in person, how I prolong sensor life and what my sensor life cycle is, but a quick check of my archives confirms that while I've mentioned it briefly, I've never really explained it here.

    So, first the "official answer'. The sensors are designed and approved to last three days. Now that is out of the way we can get in to the real world.

    There are several reasons why three day use doesn't cut the mustard for me, not least of which is cost. I'm still not getting any financial assistance for the cost of sensors. I'm told there has been a recent price reduction although I can't confirm as I haven't ordered any sensors recently. I'm working through several "expired" ones I obtained from an acquaintance. [Shh, they are working fine. *knock knock* (on wood).] Previously the UK price was working out close to 50, yes fifty, pounds each. For those of you in the US that is a whopping US$100 per sensor. Every three days? Yeah, I don't think so either.

    Admittedly if you have funding or insurance coverage, there isn't the financial incentive to prolong sensor life. But there is another very good reason.

    Like a fine wine, sensor accuracy appears to improve with age.

    This is purely anecdotal, but it is an observation shared by other CGM users, bloggers included.  I find the first three days of sensor data the least accurate of all and so pulling the sensor out every three days would be somewhat counter-productive.

    So the unofficial answer to the question is a little along the lines of how long is a piece of string. Personally I use my sensors for two week stretches. I restart* the sensor at days 3 and 6 and it gets up and running again within 15 minutes. On day 7, I disconnect the Minilink and charge it up, leaving the sensor in place. This typically takes 10-20 minutes. On reconnecting there is two hour initialization period and I'm then good to go for another 7 days, restarting on days 3 and 6 again.

    But as with everything diabetes, your mileage may vary. Some users have gone much longer. Others stick to shorter time frames. I know one woman who cannot get any usable data past nine days. I stick to two weeks because by that point I'm usually getting the very beginnings of skin irritation. Who knows whether the length of time that I go is damaging my tissues below the surface Sadly the decision on sensor life for me is in a large part economic.


    * To restart the sensor at day 3 or 6: go to Sensor --> Sensor Start --> New Sensor and then press ACT. Don't wait for it to ask you for a Meter BG. Just go straight to Sensor --> Enter Meter BG. It will tell you the sensor isn't ready, but press ACT and put the number in anyway. The sensor will pick it up and use it and it stops it alarming to ask for the number a couple of minutes later anyway.

    For more about my CGM experiences, see the archives Knowing My Numbers - CGM

    Reduced to Words

    "Diabetes, poorly controlled. On insulin"

    "Epilepsy. Suffers grand-mal fits."

    These were phrases that jumped out of patients' records at work today. Records not made by me, I hasten to add.

    These few words, accurate as they may have been, really told me nothing about the people they referred to.  Beyond the fact that there is no mention of what "poor control" means or why the person with diabetes  has it; beyond the fact that "grand-mal fits" is a somewhat out-dated description; these words seemed like such an tiny, unimportant entry of things that no doubt shape the people they describe enormously.

    They do nothing to justify the impact of diabetes on that person's every waking decision, from what to eat to how much to exercise. They do nothing to show the time and effort that person may already be putting in to improve their control, or the fear of complications that may grip them.

    A short description goes no way to defining how the risk of a seizure can impact on a person's life, the scars on their face a much starker reminder of the force of a condition such as epilepsy.

    Reducing a life changing medical condition to a few words is a near impossible task and at the beginning of a month I'm dedicating to the writing of words, it struck me what a poor job words sometimes do.

    Is there anywhere they don't end up?

    I was cleaning out the filter in the dishwasher earlier. Along with a stray food scrap I found a used test strip and one of those plastic Quick-Set donut caps.

    And rinsing the shampoo out of my hair in the shower the other morning, I glanced down to see a test strip circling the drain.

    Is there anywhere this crap doesn't end up?

    I can't help but wish for the day when I can ban it from my house. The day when I don't have to rely on this stuff anymore.

    Blog Action: Reduce, Reuse, Recycle

    Bloggers Unite - Blog Action Day

    We may not think of it often, but having type 1 diabetes and using an insulin pump has an enormous potential for impact on the environment. The miles our supplies are shipped, the extra car journeys to collect supplies and prescriptions or attend hospital visits and not least of all the extra waste. And while having type 1 diabetes in the UK may exempt me from having to pay from those prescriptions and supplies, it doesn't exempt me, or any of us, from a commitment to support the environment of the world we live in.

    I'm particularly conscious of the amount of extra waste diabetes and pump supplies generate on a weekly basis.

    Granted, reduction in the number of supplies we use isn't really a feasible option - death generates a fair amount of carbon! But what about the manufacturers? Sara  posted here about collecting a million of the tiny plastic donuts that fit over Medtronic Quicksets. I can't remember the last time I used one of these. Probably around a month after I started pumping when I realised that you don't need the cap to seal the set, just to make the edges smoother. No one has ever complained about my rough edges, so now I toss the caps in the bin at every set change. How many more go to the same fate? Is it really necessary for the manufacturers to include one of these plastic caps with every set rather than, say, two in every box of ten? If enough of us tackle them on it, along with sending them 1 million back, is it just possible we could make a difference?

    As far as recycling goes, whilst I diligently separate out my glass, plastics and paper for recycling, I rarely give more thought to diabetes waste than 'sharps' or 'not sharps'.

    Necessarily we all ditch a lot of plastic every year that is attached to the sharps we must dispose of in a safe way. But as for the rest - I'm certainly guilty of just balling everything up together and tossing it in the bin. The plastic cartons that hold infusion sets - they can be recycled. The paper lid covering the plastic carton, and the paper tabs holding the tubing in a loop - those can too. The outer cartons holding sets, reservoirs and insulin bottles or any other medication - definitely fit for the recycling pile.

    And although I'm not sure whether insulin vials would be accepted for glass recycling, Julia has made the very creative suggestion of saving them up to make a novel set of Christmas lights. Along similar reuse lines, test strip pots make wonderful holders for all kinds of fiddly items and I'm told used infusion set tubing, with the ends snipped off, has a multitude of uses in the garden!

    Much as one person turning out their lights or not leaving the television on standby won't make much difference, one person reducing, reusing or recycling their diabetes supplies won't make much difference either. But what if we all did it?

    I challenge you all to think about it today.

     

    Updates - Exams and Pumps

    1. My new pump has arrived.

    Yay!

    And, it arrived on time as promised. Double yay!

    In fact, even Medtronic were impressed at their own efficiency. On Friday morning, when I already had the new pump attached and pumping the telephone rang.

    "Hi, I'm just calling from Medtronic. I understand that you have a pump that needs replacing" came the chirpy greeting.

    "Well I did. It's been replaced though, thanks" I replied.

    "Oh no, the American technical assistance line isn't able to replace them direct, so it hasn't actually been replaced yet" she said, with the patient manner of someone who has had to explain this point before.

    "Erm... I can assure you that it has. The new pump arrived this morning and I'm wearing it now!" I responded.

    "Oh, I'm terribly sorry..."

    "No problem, it was already dealt with yesterday."

    "Well, that's great..." I don't think she knew what else to say, caught off guard that the job had already been done. I'd definitely rather they tried to replace it twice than not at all!

    I'm also pleased to find that Medtronic no longer demand that I pay the cost of shipping and insurance to get the old pump back to them. This was an aspect of their customer service that really bugged me a few years back. I once had two pumps to ship back to them at once where the total cost would have come to around twenty pounds. In that case I dropped the pumps off at my hospital and let the rep pick them up from there, but glad I can simply send this one off at the Post Office.

    2. The exam went pretty well.

    Went well, insofar as there were a decent number of very straightforward questions that I definitely knew the answers to.

    Went well, insofar as nobody batted an eyelid about my pump, clipped visibly on my waistband, or  my test kit laid on the desk and called in to service twice during the three hour paper. After all my panicking it turned out that I actually knew the exam coordinator from when I was an undergrad!

    The exam did not go so well with regard to my actual blood sugars, which hovered between 10 and 13 (180 - 235) throughout, failing to respond to corrections.

    It must have been stress, because the minute I left the exam hall, it started falling nicely.

    Another Pump Bites the Dust

    There is a definite theme emerging amongst diabetes bloggers in recent days. And it seems like my pump is the latest one to join the club.

    Last Sunday afternoon, as I lay curled up the sofa with R and my MacBook, my pump started up an insistent pattern of 6 vibrations. Uh-Oh.

    "MOTOR ERROR"

    Huh? Well, I've never seen that before.

    Without really thinking, I cleared the alarm and, since it was due for a change anyway, loaded a new reservoir. Problem solved.

    Until yesterday evening.

    "Buzz... buzz... buzz..... look at me" demanded my pump.

    "MOTOR ERROR"

    This time I figured I'd look it up on line.

    This is what I found out:

    Motor Error
    Insulin delivery has stopped. This alarm occurs if your pump detects a motor error.

    No shit, Sherlock!

    None the wiser, but with a cruising blood sugar of 10.7 (185) I went ahead and rewound and reloaded the reservoir and plugged in a bolus. I figured I'd give Medtronic's 9am-to-5pm-weekdays-only helpline a call in the morning to check it out.

    But then, around 15 minutes later and approaching the midnight hour, the pump piped up again.

    "Buzz... buzz... buzzz..... look at me"

    "NO DELIVERY"

    Hmm. Coincidence?

    Unsure, I dug out the cost-of-a-local-call-connect-you-to-Medtronic-in-California-24/7 telephone number and dialled.

    I explained the problem, finishing up with "so I just wanted to check what those alarms actually mean, since I couldn't find anything in the user guide."

    To be honest, I could have done with Mr Medtronic-California being a little more chipper. It was approaching midnight for me so I guess I was allowed to sound tired and jaded. But midnight for me meant 4pm in California. Being even more honest, though, I guess I knew it was coming before he said it, probably before I even picked up the phone to dial.

    "For safety, we have to recommend that you discontinue using the pump and revert to the back-up plan you have in place with your medical professional."

    Damn.

    Mr Medtronic-California couldn't arrange a replacement directly,  but to give them credit, I did receive a call from Mrs Medtronic-UK this morning. She had all the details in front of her and was ready to arrange a replacement to be shipped to arrive tomorrow.

    I admitted to her, sheepishly, that I was still using the pump in question.

    "Were you not advised you to discontinue using it?" she asked, surprised.

    "Yeah." I admitted. "It's just that reverting to back-up isn't as simple as it sounds."

    "My blood sugars are doing great." I added, as an afterthought.

    "MOTOR ERROR" responded my pump, smugly.

    Examination Questions

    Next Monday I'm sitting an exam that will count towards my first post-graduate qualification.

    And I'm nervous.

    The English school's examination system, coupled with my high desire to achieve and my choice of degree programmes means that I'm no stranger to exams. In fact, they were a summer ritual for eleven straight summers in a row. The moment the weather started warming up and the scent of fresh mown grass and barbecues started drifting in through the windows, I'd know it was time to get my head down into my books. I'd emerge pale, pasty and blinking like a mole several weeks later to enjoy the rest of my summer.

    This, though, will be my first exam in three years and that is definitely a contributor to my nerves. The ritual of revision and preparation seems strange, alien almost.

    But there is more to it than that.

    There is diabetes.

    Being diagnosed at such a young age, diabetes has undertaken every exam with me. I'm glad to say, it has rarely been a problem (the odd French and German spoken language exams aside). But then, I've always been in a secure environment. At school my diabetes, and the adjustments that may be necessary to accommodate low and high blood sugars, were common knowledge.

    Even at university, where some of my exams were sat in vast, impersonal halls with a thousand other students, my diabetes, my pump, my need for testing supplies and snacks were all listed in my record. Even if an over zealous invigilator should question what the little silver device - my Freestyle meter - on my desk was, as normally happened, I knew it would get straightened out without problem. I never felt that my sitting an exam would be jeopardised by diabetes.

    Diabetes being an unregistered candidate for this exam didn't occur to me until I received the candidate information letter.

    There it is, towards the bottom:

    "mobile phones or any other electrical device are not permitted in the examination hall... Use of any electronic device is not permitted during the examination and regular checks of the hall will be made."

    My pump, CGM and testing kit are suddenly prime candidates for getting me kicked out. Even after putting in a call to the examination office, I still feel uneasy.

    As if the stress of just trying to  pass the exam won't have a deleterious enough effect on my control!

    So the question is, will trying to hide my pump, given that I may want to pull it out to deal with CGM alerts, end up drawing greater unwanted attention than having it "out-there". And would I be foolish to try and rely on CGM alone for the 3 hour paper? Your thoughts are welcome and appreciated.

    Covered Without Conditions

    I travel fairly frequently. I love holidays and visiting new places, but the one thing I'm always super-fastidious about is travel insurance. This isn't directly down to diabetes, but more down to the memory of a short stay in a Florida hospital aged nine and what it would have cost my parents without insurance coverage.

    However, I've always found travel insurance something of a sticky issue. In fact, I have at least two "free" policies, as part of a bank account and membership of an organisation, that I don't use. Why? Because given that they exclude all pre-exisiting conditions, they are next to useless to me. I know how these insurers work, and believe me, they'd try to blame a broken leg on diabetes somehow.

    A few years ago, I found a good deal for an annual policy. They were willing to accept my pre-existing conditions, provided I went through an extended medical questionnaire with a nurse representative and accepted certain conditions that they placed on me - such as limitation on coverage for loss of or damage to routine supplies. They hiked my premium up too, in line with my risk status, but it still worked out a pretty good deal. I've always been thankful just to be covered.

    I've renewed the same policy each year since, too afraid to let it go in case I can't find more cover elsewhere. In fact, I didn't even claim for the 36 hour delay I endured on my return from Barbados in January, for fear of rocking the boat.

    So imagine my surprise when I renewed the policy today.

    The usual questions:
    You want Worldwide or European? Do you want wintersports with that?

    Then it was time to concentrate. Here comes the medical bit.

    "Have you had, or are you waiting for any tests or specialist appointments, other than for routine follow up, in the last year?"

    I'm thinking carefully. No. This was all done and dusted over a year ago. And diabetes and other endocrine issues are definitely just routine follow up at this point in time.

    "Have you or a close family member or business partner been given a terminal diagnosis in the last year?"

    Thankfully that is definitely a no.

    "Have you received a diagnosis of, or are you awaiting results of testing for, HIV?"

    Offering up more thanks, that'll be another no.

    And so it goes on in a similar vein.

    Every question was a no.

    "That's fine" says Mr Insurance Representative. "You cover will..."

    "Hold on, hold on" I countered. "I need to check this. I answered no to all your questions, but you need to know that I have several pre-existing conditions. I usually have to speak to your medical representatives too. You see, I'm a type 1 diabetic, and I've... umm... had problems with insurance before. I just want to make sure that I'm definitely going to be properly covered."

    "Oh. Erm... Ok. If you can hold the line, I'm just going to check this out with my supervisor."

    I'm plunged into a telephonic abyss, punctuated by occasional bursts of tinny electronic music. A few minutes pass as I doodle over