Diabetes Wise

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!

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.

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!

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!

Bruges!

I'm incredibly slow with this update, but Rob and I spent last weekend in the beautiful Belgian city of Bruges.

We'd planned the weekend to visit the Christmas markets and experience the newly opened St Pancras International and High Speed 1 rail link on the Eurostar. However, we'd timed it principally to coincide with my parents visiting Bruges as part of a short winter cruise break.

Saturday morning felt particularly early, given that my work Christmas party had ended up scheduled for the evening before. But the check in and security procedures for Eurostar are a dream for someone who has regular experience of Heathrow Airport! The new high speed line, opened along with the new St Pancras International Station on Novemebr the 14th, allows for 185mph operation over the entire route with the exception of the Channel Tunnel itself, where speeds are capped for safety reasons. It took just a little over two and half hours from check in, and a little under two hours from the train departing, to reach Brussels.

Which is faster than my regular London-Liverpool commute! Enough said.

Sadly the onward journey from Brussels was not so smooth. Some kind of staff action was causing horrendous delays and there was very little information on when and if trains to Bruges would be departing. What little information there was was provided in Flemish and French, which it fell to me to translate, since Rob does not speak French at all. I always find it surprising how much French I am able to understand, and even at a push actually speak, given how long it is since I studied it. More surprising still is how much Flemish I am accurately able to read given that I've never studied the language, but this perhaps because in written form it has strong similarities to the three languages I have studied - English, French and German.

The transfer to Bruges ended up taking as long as the London-Brussels leg, but we made it in time for a quick lunch before visiting the Snow and Ice Sculpture Festival at the Stationsplein.

 

Me, with an ice penguin

It was a cold weekend in Bruges, but after wondering around the sculptures we were keen to get back outside, where it was warmer!

We headed to our central hotel and then took a wander around the Christmas markets. It was not only cold, but also quite wet, which provided ample excuses for frequent stops to get warm and shelter. We began with waffles, drenched in Belgian chocolate sauce (absolutely divine) followed later by warming gluwein and plenty of local beers.

The only diabetes moment of the weekend came shortly before dinner when the cold, the walking and probably an overestimated bolus for the waffles caught up with me and sent my blood sugar crashing to 1.9 (35), which left me feeling a little hungover and reduced my appetite for dinner. We still had a wonderful evening though.

Sunday was a brighter day, if still very cold. We had a leisurely buffet style breakfast at our hotel and had time for some Christmas shopping before meeting my parents in the central market square. Although time was limited, we fitted in some sightseeing, a further perusal of the markets, more Gluwein and a delicious lunch of Mussels washed down by more Belgian beer!

Sadly we didn't have a lot more time before we had to hop on a train back to Brussels and the Eurostar home and my parents had to get back to their ship. I would have loved to have stayed longer, but had to work on Monday morning. The beauty of Eurostar is that it brings several European cities close enough for a very short trip like this, or even a day trip, without necessitating taking time off work. I've no doubt we'll go back soon.

Rob didn't have to work on Monday or Tuesday and I was treated to the novel experience of being greeted with a ready prepared dinner and a glass of wine as I arrived home on Monday evening. It made me wish just that little bit harder that we weren't two hundred miles apart on a daily basis.

Overall though, it made for a wonderful weekend!

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 the back of the renewal reminder notice. Mr Insurance Representative comes back on line.

"Thanks for holding. No one has never asked me about that before."

I'm raising my eyebrows, but he can't see tat down the phone line.

"As long as you could truthfully answer all the questions with a no, then you're all set to go."

I'm almost too dumbfounded to actually give him my credit card details.

Covered, without any conditions at all. I still can't get my head around it now.

The Mystery of the Missing Meter

I'm currently still on vacation in San Francisco, taking advantage of the free WiFi in the air-conditioned comfort of the Metreon. It may just be the result of dragging my luggage around SF on Muni and Bart between a friend's house and my brother's office, but the Bay Area natural air-con doesn't seem to be going at full strength today! This is just one of several stories I have to share from my trip.And thanks for all the advice about Cheesecake Factory. I haven't risked a re-run yet, but there is always tonight...

Last week we had a pretty full day planned up at Fisherman's Wharf. We'd taken advantage of the San Francisco City Pass which included both a Bay Cruise with Blue and Gold Fleet and a ticket to the Aquarium of the Bay. I had booked us tickets on an evening tour to Alcatraz and also hoped to fit in some time at the awesome Musee Mechanique and a meal to showcase the madness of Bubba Gump to R. An exciting day, but the kind of tightly planned schedule that just doesn't leave room for things going wrong. Certainly doesn't benefit from the invitation of diabetes t spoil the fun.

We started out with a delicious pancake breakfast and, for me, a pretty hefty bolus to cover all that syrup:

 

Next up we took the F-Line streetcar round to Pier 39 and started out our day with the Bay Cruise, sailing right out beneath the Golden Gate Bridge and around Alcatraz Island

I could have sworn to you that at some point on that cruise I checked my blood sugar and it seemed to have come down nicely from breakfast. I'd have bet against a dunking in the freezing water of the bay that I did it.

Back on dry land, we took a look around some of the shops and other tourist tat on Pier 39 before heading into the Aquarium where we enjoyed tunnels through the tanks, starfish and jellyfish and sea anemones:

During our time in the Aquarium, I rummaged through my backpack several times, searching for tissues, my phone and money, but I thought I was careful not to let anything drop out the pen bag.

It was shortly afterward, as we were waiting for our table at Bubba Gump for a very late lunch (to fit in with a schedule of late dinner post-Alcatraz visit) that my CGM alerted me that it needed a calibration within two hours. As I checked the screen I noticed a double down arrow indicating a fast fall. No problem, we'd be eating fairly soon but I'd just do a fingerstick to check...

I looked everywhere. I emptied every pocket in my backpack, piling everything up on the bench beside me and growing ever more frantic as the search yielded no test kit.

Damn.

I needed the test kit then. I needed to check I wasn't already low. I needed to calibrate my CGM well before we would get back to the hotel. We wanted to eat, and as R pointed out, Bubba Gump's isn't the kind of food you can tackle without means to know accurately what your blood sugar is.

I wanted to wing it, rely on the CGM and keep going. We were on the wrong side of town to go back and pick up my spare kit. I didn't want to ruin the day, but deep down I knew that the day would be ruined anyway if I couldn't stop worrying what level I was at or if I purposefully tried to run high to avoid a low - I'd feel awful.

It was only then that I turned to R and started to cry.

"I just can't believe I've lost it." I said, as it hit me that this is the little Freestyle Flash that  got in pre-launch trial in the UK some three or four years ago and that I've used ever since. My blue Multiclix, a present from a friend and very much preferable to the white version sold in the UK, was in that kit. And all my data. All the numbers from the trip so far that told me how well I'd been working out the time zone change and the pancake breakfasts.

"I'm being pathetic" I sobbed, "but I was really kind of attached to that meter, and I know I tested on the boat earlier. I could have lost it anywhere." I imagined my little kit falling off the side of the boat and swimming to the bottom of the bay or being swept out into the Pacific.

"You're not being pathetic" R said , giving me hug. "I totally understand. Let's go and see if we can find it."

We went back the Aqarium, who were very helpful, even checking the restrooms that were closed for cleaning, but no sign. Next we tried Blue and Gold, who were much less helpful and as we got redirected from person to person, I gave up.

"Come on"I said. "Let's just jump in a cab. This isn't helping and I need a meter now."

A speedy cab ride later we were back at the hotel.

And there, nestling in the bottom of the small black bag I'd taken out to breakfast, was my precious kit. It seems I'd imagined testing on board the boat earlier, which perhaps proves that it is possible to take a least a little vacation from concentrating on diabetes.

And all's well that ends well.

We got back to Fisherman's Wharf, via Cable Car, too late to fit in Bubba Gump ahead of Alcatraz. But Alcatraz was awesome, and afterwards we enjoyed a sunset view from the window with our Bubba Gump Shrimp.

 

I've been keeping a much closer eye on that little black kit for the remainder of our vacation. I won't be leaving it behind again.

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!

I Hate Packing

I hate it, hate it, hate it.

Well, not so much the actual packing. The slotting of things into spaces in the case, squeezing it all together so the lid closes with ease without too much of a struggle.

It's more the preparation that gets me. Deciding just how many pairs of shoes I need to go with all those carefully selected T-shirts and whether I have just the right balance of trousers, shorts and skirts. I hate wading through electric cables ensuring I have the correct chargers for the hordes of "essential" devices that seem to be necessary in this day and age. I hate that no matter how many trips I take, it never seems to get any easier or faster to do.

I hate it more, though, that when I've cut it through all that stuff, when most people would be done with the task, when R has reached the bottom of his to-pack list, I'm still going with an enormous list of medication and diabetes related paraphernalia, the importance of which puts everything else into the shade.

I can't believe how long that list gets: test kit and spare, strips, lancets, glucagon kits, glucose tabs, insulin, syringes, infusion sets, reservoirs and pump batteries... I could go on.

I glanced around on the Heathrow Express train earlier and couldn't help but notice how much more luggage I seem to have than other passengers.

But at the same time I cant help but think all the extra effort will be worth it for two relaxing weeks of holidays, especially in light of the anniversary I will celebrate whilst away.

The packing is done now, I'm typing this in an airport hotel bedroom, ahead of my flight tomorrow morning. And I'm looking forward to two healthy weeks in San Francisco more than I can possibly tell you all.

Postcard from Paradise....

Sorry about my extended absence. Currently cruising in the Caribbean on board Arcadia.

I'll be back, if I don't decide to stay in paradise forever.....

San Francisco: Diabetes-Wise

After a near-as-damn-it strip search at San Francisco Airport Security; After a two hour delay caused by a "leaky pressure seal" and the wait for a new aircraft to arrive; After 10 hours wedged into a seat next to a continual snorer; After two of the best weeks of my life: I'm home!

I'm so excited that even though my jet-lagged body thinks it is the early hours of the morning, even though I have a suitcase full of dirty clothes to wash and even though I've not yet had chance to download and sort through many of the huge number of photos that I took, I want to launch right in with a full account. But I know that if I did it right now, I couldn't do it justice. If you are interested in a non-diabetes oriented account, and more pictures, they will come soon, but  now just a taster:

Diabetes-wise, I had a pretty good trip. I came a little unstuck but getting over my jet-lag a lot faster than I ever have before and failing to turn my pump clock back fast enough to keep pace, which led to a few swings in the first few days. But compared to doing a trip like this on MDI... no contest! My biggest problem came over the Easter weekend, when we took a drive down the coast on Highway 101. I filled my pump up that morning from a bottle of Humalog I'd been carrying in my backpack. It seems that the insulin in that bottle may have been no good. As we cruised down the coast, my blood sugars cruised between 11 and 16 (200 and 290) all day, which changing the set and injecting with a syringe failed to solve. I had only taken the same bottle of Humalog along with me, and certainly didn't feel terrible enough to warrant turning back. So I ran a  +70% temp basal all afternoon and filled the pump with new insulin that night, which solved the problem. These angry looking shots of the Pacific capture my mood towards diabetes that day, but I still had a great time.

We ate some great food, including this masterpiece at Horizons in Sausalito. I got the carbs way wrong. If anyone cares to guess my calculated value based on the insulin units finally required, answers on a postcard comment please...  We also ate at a fantastic place in the Mission called Andalu, which serves a modern take on Tapas; Small Plates. Small Plates dining is great for a social meal with friends and family, great for variety but terrible for carb counting, since most of the food isn't all on the table at one time, never mind on your plate. Let's just say I needed a couple of corrections after that one, but the delicious Strawberry Margheritas probably didn' help much!

I got my fix of junk too - Hershey's, Oreos and the much coveted Lucky Charms (yes, I know they turn the milk green, but they seem to have got around that by making a chocolate version, that turns the milk brown instead!) Fortunately, while this stuff isn't good for anyone, it is easy to bolus for pretty accurately, thanks to the standardised nutrition facts, which just aren't as good in the UK.

My favourite souvenir from the trip?

Yes. It is a box of Insets.

Before you fully establish that thought that I am totally crazy, let me give you the explanation. Insets are not available in the UK, due to some sort of problem with Medtronic. The Animas distributers in the UK are therefore only able to supply Comfort and Comfort Short sets. If you want a 90 degree infusion set, you need to order it from Medtronic, Roche or Smiths. The problem for me is that if I order from elsewhere, I have to pay full cost out of pocket. So I stick with Comforts, which I actually quite like, especially the Shorts. When I used to use Quick Sets I had far more set problems than I have ever had with Silhouettes or Comforts, but the 90 degree sets scar my skin, and so quite possibly the subcutaneous tissue, a lot less, and they seem to stick better when I go swimming. So when a friend offered to trade me a box of Insets (I took a box of Comforts back in return) I jumped at the chance. I really like them, but since I only have the one box, they will have to be a 'special occasion' set!

And my favourite welcome home package?

Which contained:

My brand new replacement pump. What more could I ask?

Flowers In My Hair

My suitcase is packed, I have my passport and tickets. All that remains is for me to put some flowers in my hair.

I'm off to San Francisco!

'Tips'

Someone out there knows that I've got diabetes. Well obviously. I know that you know that I've got diabetes and that my family and friends know that I've got diabetes. What I mean is that someone who is responsible for the direction-of-junk-into-my-cute-old-style-snail-mail-letter-box knows that I've got diabetes.

How else can you explain a twenty six year old getting catalogues full of 'Special Shoes', 'Walk-in Baths' and even, gulp, 'Aids for Erectile Dysfunction'. Yes, really. Despite the fact that I am, (or at least was the last time I checked) a woman and no man even lives at my address, (unless he is hiding in the back of a cupboard somewhere and I don't know it) I get these with frightening frequency. I hope I'm not being insensitive to the needs of those affected here, but the marketing people have gone way wrong somewhere if they're writing to me!

Today, amongst the bills, demands for money, bills and more demands for more money, was a gem with 'Travel Tips For People With Diabetes' emblazoned across the top, along with pictures of syringes, bottles of insulin and a blood glucose meter. I suppose, to the people who put this together, these things define diabetes. Personally I'd prefer to see pretty pictures of palm fringed beaches. I have enough of insulin and blood glucose meters on a daily basis. But I digress.

The leaflet was packed full of oh-so-useful completely useless information.

Take this one, for example:

Keep yourself hydrated by drinking plenty of bottled water

The implies that either
a) you purposefully allow yourself to become dehydrated when you are not travelling. This is supposed to be a 'Travel Tip' remember? Or
b) that you would allow yourself to become dehydrated when travelling if you didn't have diabetes along for the ride.

I hate being patronised.

Let's see what else is in there.

Once you arrive, make sure you put on your Diabetes ID bracelet or necklace

Is it just me, or is this a little daft? Wouldn't it be better to wear the ID whilst you are travelling as well? This advice is also drastically at odds with the best one of the lot, the one that, if I'm honest, really inspired this post:

Don't travel alone if you have diabetes

Right.

Good job this all arrived now. I'm heading off to San Francisco in a couple of weeks. As long as, that is, I can find a friend to go with me at this short notice. I shouldn't be allowed out on my own. I've got diabetes you know.

Bah!