Diabetes Wise

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!

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.

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 Small Rant

Diet coke with added vitamins and antioxidants? WtF?

This makes me really mad. It's the kind of marketing crap that perpetuates the myth put about by the junk food industry that it's perfectly alright not to eat a properly balanced diet because you can get all the vitamins you need from a bottle of coloured, flavoured and carbonated water instead. As if it really amounts to the same thing!

Seeing this advert again, for probably the ninety-ninth time, on a full building height bill board on my way home tonight has caused this rant t re-surface after a couple of weeks of suppression.

Don't get me wrong, I'm fond of Diet Coke for all kinds of reasons. But I also recognise that it is a completely nutritionally worthless item and, as a dentist, that when drunk frequently the acid content will lead to erosion of tooth enamel and loss of tooth surface.

But if you're really too lazy to get a proper balance in your diet, you could just try swallowing a couple of multivitamins with a regular can of Diet Coke. It amounts to the same thing!

Cause and Effect

Oh yes, we did.

Oh yes, I did

Oh dear. Around two hours later I was 14.7. That's 266 for my American friends.

Just for the record though, every single bite of that cheesecake was worth every single mmol above my target.

But if anyone knows the secret bolus formula for eating at Cheesecake Factory without a ridiculous spike, please let me have it!

A Typical Banana

Can anyone out there wiser than I enlighten me as to what exactly constitutes a 'Typical Banana'?

I couldn't quite believe my eyes when I saw this! I've never bought bananas prepackaged in a plastic bag before. In fact, on the whole, I tend to try and avoid buying fruit and vegetables in Tesco Supermarkets, where most things are prepackaged. I'm not a food snob. It's just a ridiculous waste of plastic packaging, and another thing I have to collect up for recycling. But I was in Tesco, I needed bananas and bagged bananas were all they had.

It struck me as particulalrly ridiculous given that the bananas in the bag varied very considerably in both size and... er.. bendiness!

Tuesday Top Three

1) Today, I was a prisoner in my own lounge.

Mr Gas Man was sprawled across the central hallway of my flat for two hours, replacing the burnt out immersion heater in my hot water tank. And I chose that two hour window in which to be low.

No access to the kitchen (obvious source of carbs) - that is right where he is lying.
No access to my bedroom (glucose tabs kept by the bed) - that is right where he has piled all his tools.
No access to the bathroom (glucose tabs in the cabinet) - a large tube is draining the hot water tank into the bath tub.

And all the stubborness and irrationality of a low blood glucose preventing me from just asking the guy to move for a moment.

So today's number one is most definitely the Quick Fix Keychain

Clipped to my meter case and containing 16g worth of glucose tabs. I got my carbs without having to give in and ask. A win-win situation!

2) Also today, I dropped my pump. Twice.

So today's number two has to be Tubeguard

After my bad experience with EZ-Wrap, I love this even more. Not only does it keep my long tubing tidily away from those pesky door knobs while it isn't needed, but it also takes the place of a 'safety loop'. You know, that thing they told you at your pump training about taping down a loop of the tubing so that the infusion set doesn't get pulled out if you drop your pump. That thing that kind of negates the point of quick-to-detach infusion sets. That thing that no pumper I've ever come across actually does. But with the Tubeguard firmly clipped to a pocket or waistband, that is what takes the strain if you drop your pump.

Which I do. Far too frequently.

3) Today's number three...

... is apple flavoured hypo treatments.

After years of orange and lemon or 'original' (for which read'yuck') flavoured Lucozade, they've just brought out an apple flavour, which is delicious. It also compliments the great 'Sour Apple' Dex-4 glucose tabs, brought over from the US.

They're what I use to fill up the keychain!

A 'Free' Plate of Pasta

I've always thought those signs over ATMs that say 'Free Cash Withdrawals' are a scream. You'd think people would be queueing around the block to get their free money. Sadly this is not what those signs mean. They simply mean you won't be charged a fee, on top of whatever you take from your account, for using the machine. Shame.

Likewise, by free pasta I don't mean that I didn't have to pay for my plate of pasta. Sadly I did not have a cute, funny guy take me out for dinner and pay. Shame.

Anyone who was ever taught the exchange system of carb counting, or ever had a rigid carb diet, with fixed carbs and insulin doses at each meal is probably familiar with the term 'free' as applied to food. Food containing no carbs, that therefore does not need to be counted. In today's terminology: doesn't require a bolus.

Not something you would usually associate with pasta.

But yesterday pasta, a great big steaming plate full, with mushrooms and pesto, was - or rather could have been - completely and totally free.

Wha??

I've seen a string of lows in the last few days that have required round the clock temp basals of -20%  and drastically reduced bolus ratios. Maybe spring is finally here.

Last night, I bolused a conservative amount, about 60% of what I would normally bolus, for my plate of pasta. Within an hour I was low. By the time three hours came round, I'd eaten enough extra carbs and lowered my basal by enough that I could have had that pasta for free.

Instead I paid for it in extra food, extra calories, extra blood glucose tests, extra time devoted to diabetes management...

Ain't it fun?

Yeay!

Guess what I had to drink today?

Yeay!

If you don't understand why this makes me happy, you need to read this post. I'd like to think I had something to do with them bringing it back, but somehow I doubt it. Just hoping it is here to stay!

Digestive Biscuits

If I were to pick a food to sum up my childhood, it would have to be the digestive biscuit. Sure, I enjoyed plenty of 'kiddie' foods as a child, like fish fingers and alphabetti spaghetti, but it is always the standard digestive biscuit that stands out.

Since it appears the majority of people who stop by here are in North America, it seems sensible to start with a clarification. A biscuit, in the UK, is what in North America would be termed a cookie. The king of the everyday biscuit is the digestive, and the king of the digestive is McVities.

First developed in 1839, the high baking soda content was said to aid digestion, hence the name. I'm informed the American equivalent is roughly the Graham Cracker, only they're more crumbly and less sweet. (As an aside, I've always pronounced Graham as "Gray-ham". My brother has been trying to teach me otherwise!)

Digestives now come in multiple varieties: with chocolate pieces in, covered in chocolate, covered in caramel and chocolate.... 52 chocolate covered digestives are eaten in the UK every second!

It isn't the chocolate covered ones that define my childhood though. Rather, the humble plain old original digestive. Truth be told, without the extra touches, the digestive is a pretty hard, dry biscuit. It's best eaten dunked in tea! There is an art to this - too short a time dunked and it will still be hard in the middle; too long and you will find half your biscuit has dropped to a soggy mush at the bottom of your mug; and if you take too long getting the sucessfully dunked biscuit to your mouth, you get soggy mush all down your front!

But dunked digestives weren't the thing either. The digestives of my childhood were plain, dry and exactly 10g of carbs each.

Sometimes they were soggy, because I'd left the lid off the box and they'd begun to go stale. Sometimes they were smashed to bits from being carried in the bottom of a bag or pocket wrapped in tin foil. But every day at school they were two in mid-morning, two in mid-afternoon. And some days they were 'extras', following Lucozade for a low.

They meant that I got a glass of water in the classroom, when the other kids had to use the fountain outside, because they were so dry to eat alone.

They caused John to get told off, because he stole one out of the box.

They caused Debbie to say "It's not fair", because she wanted a snack too.

They caused me to get told off, for leaving crumbs in my notebooks.

They were boring and, after a few years of almost daily munching, virtually tasteless, but they were dependable in giving me the carbs I needed. We experimented with other varieties at times, but nothing, in these pre-MDI days, was quite as good as digestives.

Now, as an adult, I can't bear plain digestives, but as with Diet Coke I guess I kind of owe them something! If I search hard enough, I probably still have somewhere the box with "Caroline's Digestives" on the lid.

Just for the Taste?

No, it was more than that.

I was diagnosed with diabetes the same year that Diet Coke was launched in the UK. This was, in many ways, a good thing. Leaving aside that, even without the sugar, Diet Coke is a major threat to your teeth, (thanks to the phosphoric acid,) and leaving aside any debate about the safety or otherwise of artificial sweeteners, (because I just don’t want to go there,) it was a viable alternative for me when all my friends were drinking the regular stuff at birthday parties, or wherever. It made me feel ‘not different’, because I was drinking basically what they were and because I didn’t have to suffer feeling ill for doing it. I didn’t need an extra shot, or have to be embarrassed because I had to run to the toilet twenty times in the course of an evening - due, you understand, to the sugar in the Coke, rather than its volume.

I still drink Diet Coke. I feel a funny kind of gratitude to it, for giving me those ‘normal’ times that water just couldn’t have done. I wouldn’t drink the normal stuff even now because the blood glucose spike it would give me is way too high and rapid to be avoided, even with a timely bolus. I guess I do, in my own way, fit their marketing philosophy, no matter how pretentious it sounds, that Diet Coke “empowers people to… feel their best.”

Aside from that, it is basically a bunch of empty calories, and I’m not doing extra hours at the gym for a bottle of drink, no matter how shapely and beautiful the bottle! So no, if I want a vodka and Coke, it’s a vodka and Diet Coke, thank-you-very-much, and a friend who won’t ask for that at the bar for me won’t be a friend for very long!

Since the day they took the sugar out of Coke and Diet Coke was born, there have been a lot of twists on the theme. With lemon. With lime. With Vanilla. (But of course you always want what you can’t have. My personal favourite is Diet Cherry Coke, sadly unavailable in the UK, along with raspberry and Splenda versions.) They also took the caffeine out, to make a caffeine free version, and even experimented with taking the calorie out, calling it Coca-Cola Zero, which kind of makes you ask what was left. Just the (uh-huh) taste of it – of course!

The latest Coca-Cola invention is not a twist on Diet Coke. In fact it puts the calories, and caffeine, right back. Coca-Cola Blak, a coffee infused cola launched in France this month, has ‘twice the caffeine of regular coke’ (but apparently that’s a third less than your average cup of coffee) and is up to, um, 47 calories!

Is it just me, though, or does coffee coke sound really bleurrrgh? I certainly won’t be drinking that for the taste of it!