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THE MORNING SUGAR: A Window into your Type One Management

I lie in bed with one eye open, ears still ringing from my poorly selected, overplayed alarm tone. I sit half hunched over my glucose monitor attempting the first blood-drop-to-test-strip co-ordination of the day. Its 05h30, I have fasted for 6 to 8 hours, it’s time to dive into diabetes. My test strip sucks up the drop of blood and counts down to my first glucose reading of the day:

BEEP: 4.6mmol/l (84)

OR

BEEP: 9.6mmol/l (173)

OR

BEEP 16.6mmol/l (299)

The good, the average and the ugly.
These are the 3 general ranges of readings that might greet me at the first finger prick of the day. It’s only one of the many sugar readings that lie ahead, but it is a special one to pay attention to, as your morning glucose reading can provide important insight into your diabetes control.

A fasted reading has a myriad of information which you can choose to ignore, or preferably dissect and investigate for optimum diabetes control. I believe it is vital to ask myself why? Why is my blood glucose this level and what were my preceding actions?

I will take you through my 3 ranges and my general approach to morning sugar readings and how I personally troubleshoot these readings. We each tackle diabetes differently, but hopefully the following brings some insight into your morning sugars or encourages you think critically of those interesting rise and shine numbers!

The “Gem”
My personal values are 3.8-5.6mmol/l

Oh this is a sweet, gem of a reading. It’s the real “roll out of bed on the right side” number.
Perfectly in range, it is still important to acknowledge the formula that achieved this number. We could all do with a little positive reinforcement and mindfully recognize and enjoy our diabetes successes! I always ask myself, “What did I do well?”

This sugar reading generally informs me that I have correctly dosed my long acting insulin as it did not bring me into the clutch of hypoglycaemia when fasting during my sleep. It was also sufficient to meet the cascade of morning hormones such as cortisol and hyperglycaemia it brings along with it. This sugar happily greets me when I don’t snack after dinner and I eat around 3 hours before bed-time. This plan allows for an honest, stable blood sugar reading before bed where my injected insulin has already peaked in activity, and I can expect predictable glucose readings as I sleep.

The “Meh”
My personal values are 6-9mmol/l

It’s a sugar range that is higher than I would like for a fasting blood glucose level, but it’s not remotely the end of the world. To solve this morning glucose and to prevent it creeping higher, I have my insulin dosage for my breakfast plus a dash more insulin to correct. I wait 20-30 minutes for my insulin to start working and bring my glucose down before having my breakfast. I ask my “why?” and make a mental note of how I could improve and act accordingly. If went to bed with a great blood glucose level and I woke up high, it could be various things:

1. Insufficient long-acting insulin: The Dawn phenomenon

When I have my continuous glucose monitor (CGM), the Dexcom, attached, this will be displayed as a nice steady graph with readings in glucose range for the first 2/3rds of sleep, only to find in the few hours before waking my blood glucose slowly and steadily increases. This is due to the get-up-and-go hormones that pump through your body to prepare you for waking and tackling the day. These sneaky buggers include growth hormones, cortisol, glucagon and epinephrine and they increase your insulin resistance, causing blood sugar to rise.

2. Too much insulin: The Somogyi effect

This is an interesting stress response of your body, a rebound effect of low blood glucose while sleeping. If you have too much insulin, long acting or short acting, and you experience a low while sleeping your body mounts a survival response and encourages your body to release sugar back into your blood via adrenaline and cortisol. This low may not be rapid or severe enough to cause a seizure, but sufficient to mount a physiological survival response from your body.

3. Not enough short-acting insulin

This is usually prompted by snacking before bed and eating late. My stomach is still full and has not emptied. My blood sugar will be in range when I get to sleep, but as my tummy works to digest my food, sugar trickles into my blood which I thought I had sufficiently covered by my short-acting. This especially occurs if I eat meals that have a carbohydrate, protein and high fat content. It has even been dubbed “The Pizza Effect”, where fats and protein delay the absorption of carbohydrates from a meal. The most challenging part is that you don’t know when the carbohydrates are going to be dumped into your bloodstream as sugar. It could be more than 5 hours until you feel the true effect of your meal. This could also be a reason for a really high morning blood glucose reading, the one where you would rather turn over and head back to sleep, which brings me to my final morning range, which I like to call the “Lie in Bed for a Few Minutes in Denial”.

The “Lie in Bed for a Few Minutes in Denial”
My personal values are anything double digit

The “Man, I messed up” feels. I most likely did not give myself enough insulin for the previous night’s meal, or I ate complete rubbish, did a massive carbohydrate count guestimate (that’s right folks- guess and estimate can really be combined into one perfect word), it could be “the pizza effect”, or I forgot my long acting insulin.

The alternative explanation is that I woke up with low in the middle of the night and quite passionately, dove into my bedside glucose stash, bathed myself in sugar before falling back asleep in a pile a sweet wrappers. (Yes, I have awoken with gummy sweets melted into my back and bed sheet).

If my sugars are really bad in the morning, there is usually a pretty grand, blatantly obvious reason as to why they are absolutely deranged. I find myself glancing in the mirror, at my poor, hard-done-by face to ask myself why? My expression smirks, “Oh girl, you know why. You know.”

This is where the power of the mind can transform your day. You can switch to victim. You can choose guilt and actively bring yourself down. You can choose to let a number on a plastic monitor define your day or you can free yourself from mental binds, for you are capable, you are strong and you are going to tackle the day.

My go-to plan of action:

1. Massive bottle of water with loads of top ups
2. Small simple, low sugar breakfast (I find waiting for my sugars to come down before eating leaves me more frantic and stressed)
3. More water
4. Add Insulin
Tip: Don’t give yourself 70000 units because you are panicking and desperately want your sugar to go down as quickly as possible (TRACY SANDERS I am talking to you girl). A resultant severe hypoglycaemia does not make it easier to improve the day.
5. Forgive yourself, give thanks to your body for all the other goodness it brings to you and power forward.

Transform your WHY’s into WISE, pay attention to each nugget of information your body and glucometer communicates to you. By building up an understanding of your sugars, you build a stronger relationship with your body and mind. Work closely with your support network, endocrinologist and diabetes educator to make the correct adjustments to suite your body, always ask questions and challenge your knowledge and experience of type one.

Lyfestories: Rebekah’s Journey with Ulcerative Colitis (IBD)

I was diagnosed in 2009 with Ulcerative Colitis, I literally had no idea what this disease was, or how it would have such a huge impact on my life. After about a year and a half of trying every medication to try and control the flare up I was having, an extremely kind doctor suggested for me to have this life changing operation, to remove my bowel and replace it with an Ileostomy. He promised me I’d wake up symptom free and he was not wrong.

To this day, he is my hero, this amazing person who didn’t even know who I was, saved my life and gave me my life back and to this day I can’t thank him enough for that. I went from being in and out of hospital every other week, going to the toilet 20+ times, not being able to hold a job down to being this whole new independent person that could leave the house without worrying I was going to have an accident! I even got myself a job and I saved for a house.  I was also told I’d never be able to have kids and in 2015 I had the most precious little boy.

I created my Instagram account to raise awareness for others just like myself who have possibly been newly diagnosed, going through a flare up or have had a life changing operation and to show them that they are not alone in this battle. I’ve also been battling a condition called pyoderma gangreosum which is an incredibly rare skin condition to have next to the Stoma site and is usually associated with crohn’s patients. Again, I didn’t even know that this existed until I was diagnosed. My goal is to raise awareness–to let people into “thebaglifeofbeck” and for them to know the good and the bad times, and it’s OK to not be OK. It just helps us separate the good days from the bad, and since I’ve had my bag, the good days outweigh the bad. We’ve got this.

Real Talk with Dave: Tips and Tricks on Making Peace with your Diabetes

All Diabetics know how difficult it can be to find a common ground with their Diabetes daily, between the highs, the lows, the fears, and the pain, however, at some point, this can lead to a burn-out phase in our Diabetic lives, making it much harder to keep on moving forward. At the start of the new year, I have almost gained a new mindset for my Diabetes in which I am a bit more relaxed, knowing that it will all be okay in the end, that is why I want to share some of my own personal tips and tricks on how I manage my Diabetic stress & anxiety in the best way possible.

Over the past 9 years of living with T1D, I have come to realized that Diabetes is a really hard thing to go through in life, but finding ways to cope with your Diabetes as much as possible can be so rewarding in the long run! Don’t do Diabetes alone. Find a group of people to lift you up and motivate you to keep up the hard work you do! Diabetes is already a stressful thing to deal with, that is why these three helpful tips I use daily may help in finding a light at the end of the Diabetic tunnel:

1) Plan ahead – When out and about with T1D, many times you may not want to even think about Diabetes and don’t want it to get in the way of your outing, no matter where you are headed, however, always being prepared for the worst is the best way to avoid any unwanted stress, as T1D is a serious disease that needs to be treated and cared for 24/7. Just imagine how it would feel to be an hour or more away from your house, all to realize you forgot your Insulin at home… and your blood sugar is high (that wouldn’t be fun). In that case, I definitely recommend making a checklist (yes, an actual list) where you list all the necessary items that have top priority in managing your Diabetes on any outing, whether at school, work, and especially on a vacation. Each time you plan on going somewhere, be sure to check off the list prior to your outing and make sure you have all you need, and maybe even some extra supplies, all packed in a designated pouch or bag in which you can transport quickly on your way out. Better to be over prepared and over packed than the other way around.

2) Self-talk – One thing that I still struggle with is being in a constant fear of going low or excessively high when I am in a space (such as school) in which I cannot get out of very easily or am surrounded by many others who may not be aware of my T1D. In cases like these, I feel as though it is strictly up to me to take care of myself and make sure I am okay at all times, but, as we all know, Diabetes is an unpredictable disease. We all wish to never have lows or highs at certain times, but they can honestly happen whenever, wherever. In that case, let it be. If you go low, treat. If you go high, treat. Yes, you may have a bit of anxiety in having to deal with that all alone sometimes, but it is more important that you treat and take care of yourself, rather than the horrible outcomes of a severe high or low. The theory of self-talk comes into place by you having to mentally think to yourself that everything is going to be just fine. Think how you’ve been low and high before and made it out just fine each time, some were more difficult than others, but somehow, you managed to survive it… and like a pro!

3) Finding a support system – Most of the work I do in the Diabetic community is done via Instagram, @type1livabetic, where I try and encourage other T1D’s to look at life in a positive light and make life any way they want, regardless of their Diabetes. I didn’t always have that intention though. During my first few years as a Diabetic, I didn’t fully feel motivated or see the positive side to Diabetes as I do now. How did I overcome that? Well, I began to find other Diabetics via social media and just…talk! I began to connect with them and start talking with others on the true daily struggles we face and the feeling of connecting with someone who simply understands EVERYTHING you are feeling is indescribable. I found my support group online, but there are many other ways to do so. There are many in-person support groups at local hospitals, nowadays, a new trend is hosting a Diabetic meet-up, and simply attending a local Diabetic organization research walk or event can be life-changing and memorable.

In short, if you want to find peace with your Diabetes, give these three tips a try! Always have your medical supplies (and a backup plan) ready and with you in an accessible manner at all times, remember to think only good thoughts to yourself, especially in the hardest times, and find a group of people that you can be 100% yourself around, Diabetic and all, and hang on for the ride, because Diabetes is a huge roller coaster with many ups and downs. Find what brings you peace with your Diabetes and go with it!

Live well,

Dave

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25 Years of Type 1 Diabetes

On Friday 13th, 1992 at the age of 13 I was diagnosed with Type 1 Diabetes.

It was also a historic flood in my town and looking back on the pictures from it, I could clearly see how sick I was. I had all the classics symptoms: thirst, urination, significant weight loss, fatigue and looked gaunt like a ghost. My blood sugar was around 1000, which at that point I had no idea what a dangerous situation I was facing.

Little did I know how much my life would truly change that day due to my diagnosis. Many people would think it would be devastating and this would be a negative thing, but this diagnosis made me who I am today. Don’t get me wrong there have been some high’s and low’s, literally and figuratively, but I always had the thought process that there are two paths you go with this disease. You either let it control you or you control it! I chose to control it and let this be a diagnosis that I would do my absolute best to not let define me.

I just hit my 25 year anniversary living with diabetes and that is something I am extremely proud of. I even got my Eli Lilly 25 year medal! I decided to go into the nursing field after finding out at a young age all the mis-information that was out there, even among medical professionals surrounding diabetes. Then, of course, my next step was to become a Certified Diabetes Educator. After college I became the Nursing Coordinator at Joslin Diabetes camps and then transitioned to a Pediatric Diabetes Nurse educator there as well. I always loved working with children and their families since I felt I truly could relate to what they were all going through. I really think having them see someone that had been living with this disease for so long and was healthy without complications was a really motivating and positive thing for many of them.

After starting a family or my own (6 year old son and 8 year old daughter), I continued as a diabetes educator, but now work with adults and pregnancy patients along with being a lifestyle health and fitness coach.

I was fortunate enough to be a part of the Bionic Pancreas trial in 2015-2016, which gave me such hope for the future for myself and my patients and friends living with this disease. I was told when I was diagnosed that there would be a cure in 10 years and obviously that didn’t happen, so having a device that could make life a little easier and more manageable with diabetes would be outstanding! Living without the constant fear of hyperglycemia, having to count every single carbohydrate you eat, being able to exercise without fear of hypoglycemia would be a true dream come true. Dare I say it….make me feel a little more “normal”.

Using Diabetes To Inspire Others

Diabetes has been a constant in my life for the past 9 years. It’s been a rough and bumpy few years, and I can honestly say that this disease has really shaped me to be the person that I am today.

This disease is real. It has no breaks, vacations, or a pause button. Since the day I was diagnosed, I remember sitting in my hospital bed and my mom telling me how I will use this disease to help others, but at the time I didn’t think I could do that task. I struggled as a young teen dealing with Diabetes and wanting to feel “normal”. Growing up, I always felt like I had this thing that I could never get rid of. I wanted so badly to go out with friends and feel safe knowing that I won’t have a low blood sugar or have to lug my meter case around everywhere I went, and have to explain to them what I had in it. I remember feeling like I wanted to just give up. I ended up slacking a lot on my health. I didn’t check my blood sugar as frequently as I should have. I didn’t count carbs the way I used to. I seemed to have lost all means of being a Type 1 Diabetic. As a normal Diabetic does, I went to the Endocrinologist and received my life-changing news.

david1

I had just gotten my Hemoglobin A1C blood test and the Diabetes educator sat me down to tell me that my blood sugar average had been very high for a long time and if I didn’t gain control of my numbers, I could loose my vision, have arm and leg amputations, or have heart problems. Since that day, something clicked in me and I decided I needed to make a difference in my life and in the lives of those that I came in contact with on a day to day basis. I began making better choices in what I ate, exercised more frequently, and took initiative in dealing with this chronic disease. Shortly after, I went for a visit to the Endo and I began to improve more and more each time. That motivated me to use my positivity and excitement for improvement to create something that I could share with others going through the same thing or something similar as me. That’s when I got the idea to create @type1livabetic on Instagram.

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I chose to create something that I can use my love and passion for photography as well as my love for sharing positivity in Type 1 Diabetes. Since then, I feel as though I have really grown as a Type 1 Diabetic and became a part of this wonderful growing community. I am so blessed and privileged to do what I get to do every day. My goal is to inspire others with my disease so that they know that they can do whatever it is they put their mind to.

dvid-3

This is why I am here, to be a voice in the Diabetic community in hope of one day being freed from this life altering disease! One day at a time! 


If you would like to share your story with Lyfebulb and our readers, please e-mail contact@lyfebulb.com.

A Spot of Frustration

My son is now 18, but at the time of this original post on A Spot of Hope, he was only 17. Andy was diagnosed at age 4 with psoriasis and age 5 with juvenile psoriatic arthritis. Life has been a roller coaster ever since, especially when it comes to pharmacies and insurance. I’m sure so many of the chronically ill, but chronically fabulous, readers can relate to what happened back in April. It’s a never-ending battle.

Dealing with pharmacies, insurance and lack of respect has me feeling frustrated!

aspotoffrustration-photo

By the time my kid gets his biologic medication delivered, he will have been one month without taking it. No wonder he wants to sleep all day and has a bad case of brain fog! (Oh wait, maybe that’s just being a teenage boy…)

Anyway, one thing is for sure. He’s hurting. Don’t let his attitude fool you. He hides his pain well when it comes to his psoriatic arthritis.

So, why has it taken so long to get the medication? It’s been the perfect storm of mishaps that started nearly four weeks ago.

First, the boy didn’t tell me he was out of medication. We’re trying hard to transition him to the realities of college life and that his parents won’t be there to order his medication or administer it. So far, this life lesson could be going a lot better.

Next, I knew we couldn’t get the medication refilled without getting his labs drawn. I took him to do that, but the standing order script had expired. Luckily, the hospital took pity on us and gave him a courtesy draw.

The next day, I called his doctor’s office and spoke with a nurse. She said that she needed his lab results before the office would refill the medication. I explained that the labs were drawn yesterday and that his general practitioner who also receives a copy of the results had already called and said everything was normal. This did not satisfy the nurse, and I was told that I would need to call the hospital to get the results faxed to her. Unfortunately, I could not do that at the time because I was on my way out the door to an important meeting. She said it wasn’t her job to call and track them down, so we’d just have to wait until after the weekend.

Days went by and we were still waiting for some sort of update. That finally came with a call two weeks ago with Andy’s regular nurse. — Did I mention how much we love her? — She said the results finally updated in the system and she was refilling the prescription for him.

After waiting days for call from the mail-order pharmacy to schedule a delivery, I finally called them. The representative told me that they never received a new script, but there is still a refill left on his old script. Well, I tell her that’s not true because each time the script is written for three months only with no refills, and he gets a three-month supply delivered. Guess what happened at that exact moment? The new script just popped up on her screen. The doctor’s office must have just sent it over right then!

Really? How dumb do you think I am?

I wasn’t in the mood to play games or argue. I just sighed and said to fill it as soon as possible. But that wasn’t going to be possible. Why? Because we need a new prior authorization for the insurance!

The pharmacy representative assured me that they would be able to get the prior authorization and still have the medication delivered on Saturday. But, just in case, they would call if they ran into any trouble.

Needless to say, Saturday came and went. No medication. No phone calls.

No delivery on Sunday. After all, it’s Sunday.

No deliveries on Monday because the medication needs to be refrigerated.

No delivery on Tuesday.

I called early this morning to find out when this medication was scheduled to arrive. You won’t believe this coincidence! At the very moment I was on the phone with the pharmacy representative, the prior authorization came through!

Again, I wasn’t in the mood to play games. I just want the medication.

So, even though the medication hasn’t been delivered yet, I’m very hopeful — maybe naively hopeful — that it will arrive tomorrow. That will mean he’s been without his medication for nearly four weeks.

Every stage of this, there was a problem. I can be quick to blame Andy for not altering me sooner that he was out of medication. And, I can find fault with the nurse and the pharmacy. And, yes, I can even blame myself for not following up sooner. But, to do any of that would only prove fruitless.

The real problem lies in the big picture: The whole health system is a nightmare.

How can I transition my 17-year-old to take care of his own health in just a few short weeks when he turns 18 if I still haven’t learned to completely navigate it in the past 12 years?

I only hope that Andy plans ahead, asks many questions at every stage of the process, and has lots and lots of patience. That seems to be the only way to get through all of the red tape and nonsense.

And to think, he gets to do this all by himself in three months. Woo hoo!

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