Driving in Ireland with Type 1 Diabetes

Recently, I read a story relating to a person with type 1 diabetes (T1D), who was involved in a minor traffic accident. While sitting in the car afterwards, they decided to check their blood glucose when they were approached by the gardai in an aggressive manner.

This person was very offended and initially I was too on behalf of all people with diabetes (pwd). But then, on processing the situation a bit more and imagining myself in it, I looked at it from a different perspective.

I imagined that I was the Garda, who did not have any knowledge about diabetes. Let's face it, most people who don't have diabetes don't know about it. Not an excuse, I know but it's a fact. And remember that the Gardai is one of the few remaining organisations that a person who uses insulin is disqualified from.

So is mise garda (forgive my terrible irish grammar), on the "beat". I come across a driver who has a small gadget in their lap, I might have even see blood. As a garda, I see all sorts of normal activity every single day but this is something I have never seen before. What is a normal activity for a person with T1D is not a normal activity for a person without T1D and with only approx. 20,000 people with T1D in Ireland (aged from 0 to 100+) how often would a garda come across this kind of activity?

My garda training kicks in and that is to consider if this person is a treat to public safety. I'm also a young garda which means I don't have a lot of people experience to draw from so I would probably be extra cautious. (this situation is totally fabricated by me and I'm making a lot of gigantic assumptions here).

I think that in a strange situation like this I would act first and ask questions when I had ascertained that the situation was safe to do so. What actually happened in the real situation here was that a senior garda came along and gave the young garda a bit of a scolding for his behaviour.

I know it was probably frustrating for the pwd to have had this experienced but also a missed opportunity. If we are to change the perception of diabetes in the general public and create more awareness we should try to use every opportunity we can to educate as many people as possible, one person at a time.

I've included a link to some practical guidelines for people with diabetes to consider before you get behind the wheel and remember the guidelines are not about making life difficult for people with diabetes but keeping us and others on the road safe. See the links below:

http://www.diabetes.ie/living-with-diabetes/living-with-type-1/what-else-you-need-to-know/driving/medical-considerations/

http://www.diabetes.ie/living-with-diabetes/living-with-type-1/what-else-you-need-to-know/driving/

Let's be safe out there! And stay calm!

Throwing in the towel is just not an option with diabetes.

I've had type 1 diabetes for 20 years and I can confidently say that most of that time I have been in a positive frame of mind about my diabetes and the future. And I think this went a long way towards me managing my diabetes well.

However, for about 18 months now I've been struggling with my diabetes control and the struggle dragged me to a place I don't remember ever being before. That place where I had had enough of diabetes. I wanted a cure RIGHT NOW! I really, really wished I didn't have diabetes.

I became completely frustrated with my diabetes and so exhausted from all of the decisions around daily management. I would go through that long mental check-list when trying to figure out how much insulin to give, how much and what type of carb I was about to eat, was I going to be more or less active in the coming 2-4 hours and even though I had considered everything I thought there was to consider, there
was always something I would forget to account for. It felt like the if's, but's and maybe's were just too many.

I became fixated on my blood sugar readings, to the point that I would close my eyes as my meter counted down to reveal my blood sugar reading and hope that the number that came up would at least be in the single digits, which of course it hardly ever was. 

Now that I'm in a place where the light can shine in, I'm beginning to think that it was really the other health related issues that had accumulated over the 18 months that brought me to the bleak place. We had two tragic losses in our family that had a huge effect on me and some of the every day aches and pains that come and go, started to stay around permanently. Maybe my diabetes was a convenient victimizer, something more visible than emotional stress. 

Thank goodness for my wonderfully, supportive husband and my gorgeous children, who without their knowing it kept me going.

I suppose that even though I felt physically beaten, mentally, I didn't want to give up. I started reaching out for help. I read my copy of Dr. William Polansky's "Diabetes Burnout" to give me ideas on where to ask for help. I finally went to my GP to ask for help with the other health related issues I was experiencing such as neck and shoulder pain that was getting worse. And I started going to counselling for the emotional stress that probably started this whole spiral of deflation. 

It seems that once I did those things my diabetes just bounced back into decent control. I'm still amazed at how quickly it complied and I suppose I will never truly know why it became so out of control. I still have a ways to go to get back to full health but my diabetes management isn't standing in the way anymore.

The Great "Sugar" Confusion

I thought I knew a lot about food and in particular carbohydrates and sugar. However, I attended a diabetes support group recently that sent my head spinning in confusion.

You see, I always thought that the word "carbohydrate" referred to the group of foods that have the most influence on blood sugars and that "sugary" foods would be part of that group. So when a gentleman remarked that white bread was full of sugar my head slowly exploded.

 Inside my head I was asking so many questions;
- do you mean sugar as in table sugar and that it's an ingredient of bread?
- or do you mean in comparison to wheat/brown bread?
- are you talking about carbohydrate and not sugar?
- are people confusing those two words?
- when dietitians talk about sugar; are they talking about sugary foods, table sugar or a subgroup of carbohydrates?

I started second guessing my knowledge and I couldn't respond to the comment which was then followed with other remarks about other foods, such as bananas that are also full of "sugar". Help! But of course none of us had the knowledge to sort all of this confusion out.

So off I went to Google university to try and figure out my confusion and find out once and for all what the word "sugar" actually means. I'm still not very wise but my opinion is that the word is being used in all sorts of contexts and that most of the other general public are confused too.

There's sugar as in table sugar, complex sugar or carb which is a type of carb (obviously) and the other one which is simple sugar/carb, sugars as in my blood sugars.

We have invited a dietitian to our next support group meeting and I think it's going to make for a very interesting evening and hopefully be enlightening.

Diabetics can't have sugar!

How many of us have been on the receiving end of this response? How often have you been offered a nice little treat only to have it whipped away from you because they just realised you're diabetic and OMG "can't have sugary foods"? I must have seemed deranged when I lunged forward across the table and grabbed the little chocolate bar from that lady :-)

I usually don't get too upset with people when they try to "protect" or "safe" me from myself but when my husband told me about his experience with this remark I was a little more peeved. Here's what happened....

He attended a cooking course recently which was attended by approx. 30 people where the course facilitator remarked more than once during the day about diabetics not being allowed sugar. My annoyance came about for two reasons.

The first is that it's just not true. Believe me - google it. Diabetics are allowed to have sugar, just not too much of it. But that is the guideline for EVERYONE, diabetes or not! Too much sugar is just as unhealthy for people without diabetes as it is for people with diabetes.

The second reason hurt me more because person is considered an expert in their professional field of food and has the ears of a lot of people, and is therefore feeding this myth. At my husband's course 29 people went out into the world reaffirmed that diabetics can't have sugar and ready to impart their new knowledge to any diabetic within radius.

I felt that no matter how much effort we put into diabetes awareness and educating the general public about the facts of diabetes it just take one person who has the attention of many to strike out all that good work. It's frustrating.

My hubby is outstanding though! He decided to write to the two organisations involved; Diabetes Ireland and the cooking school to suggest that they work together to raise some diabetes awareness and to put the course facilitator straight in the nice, polite way that he does things.

Hopefully this person will see that discouraging people with diabetes from enjoying her delicious cakes, puddings and scones doesn't make sense and start delivering facts instead of myths. I'm always the optimist.

Why exercise is "tricky" for T1Diabetes, episode 4

A quick recap;
In Episode 1 I talked about one of the reasons that exercise was "tricky"for people with type 1 diabetes is that it can cause low blood sugars (bs) and therefore you may end up eating to replace the calories you used and therefore rendering exercise as a form of weight management as a bit of a lost cause.

In episode 2 I rediscovered that some hypos prevent rational thinking and even though you have taken all the precautions you can you still might end up in a "pickle". I had a low towards the end of my walk and despite having my meter and glucose in my pocket I still thought I had to get home to treat my low.

In Episode 3; I talked about different things I was trying to eliminate such a high blood sugar (bs) reading before my walk and such a low reading after. 

Today, episode 4, and 3 & a half weeks into my new walking regime I think I have found the safe zone.

All this week my bs readings have been in the target range before breakfast, below 10mmols one hour later and just before my walk and in the target range after my walk. I returned to my oatmeal from breakfast because I found that my branflakes would make my before walk bs very high. And my basal strategy is to suspend my insulin pump from delivery insulin for the duration of my walk. 

I'm going to still monitor my bs before my walk but I am hoping to eliminate that one bs check in another week; once I'm sure my sugars have stabilized I won't need that check.

So I'm happy to report that I have (hopefully) overcome the challenge of exercising with T1 Diabetes and eliminated the "trickiness". 

P.S. Bonus, I've been able to give up the digestives (having none in the cupboard helped) :-)

Why exercise is "tricky" for T1Diabetes, episode 3

Just a quick recap;
Episode 1 answer was that exercise is "tricky"for people with type 1 diabetes because it can cause low blood sugars (bs) and therefore you may end up eating to replace the calories you used and therefore rendering exercise as a form of weight management as a bit of a lost cause.

The answer from episode 2 is that some hypos prevent rational thinking and even though you have taken all the precautions you can you still might end up in a "pickle". I had a low towards the end of my walk and despite having my meter and glucose in my pocket I still thought I had to get home to treat my low.

Now on to episode 3.

On day 3 of my walking/get in shape experiment, I decided to reduce my basal insulin programme for one hour before my walk, which coincides with actual breakfast time. 

The result being that my bs were a little high at walk time at 11.4mmols. My walk was uneventful and when I got home my bs was 3.6mmols which is hypo but lets face it, it's not 2.9! So I treated and added the digestive biscuit just because these hypos are getting old:-( Anyway, the packet of digestives are gone now so I think my hips are somewhat safe or maybe they're really never safe:-)

The next day, what did I do? Well I switched my healthy breakfast to a healthier one. I seem to have this desire to make my life as difficult as possible. So lets skip ahead to the first day where everything works out perfectly.

Day 5 of my new regime. My new tactic is going to be suspend my pump and so cutting off delivery of insulin completely for the duration of the walk. My before walk bs was 6.0. Could not be better! The number of my dreams! After my walk my bs was 4.0 - I see the light at the end of the tunnel. 

Day 6; I decided to reduce my breakfast insulin by just 0.25 of a unit just to see if that would keep my in the safe bs number zone. Eureka! I did forget to test before my walk which might mean that I'm getting ahead of myself but my after walk bs was 5.8. 

Tomorrow is another day and hopefully all this extra bs testing is not for nothing and that I can scale it back soon.

Why exercise is tricky for T1Diabetes episode 2

Answer no. 1 from my last post was that exercise is "tricky"for people with type 1 diabetes because it can cause low blood sugars and therefore you may end up eating to replace the calories you used and therefore rendering exercise as a form of weight management as a bit of a lost cause.

Answer no 2 is that some hypos prevent rational thinking. Here's what happened on day two of getting back in shape. Let's try the walk again shall we.

What did I do different this time? Well, I reduced my basal insulin by 30% for 2 hours at 8:30am which was a half an hour after I ate breakfast and a half an hour before my walk. And I remembered to test my blood sugars (bs) before I left the house for my walk. It was a decent 7.8.

Happy out and a pleasant walk in a grey overcast day. That is until about 5-10 minutes from the house when I started to feel a bit jelly-legged and my head was a bit fuzzy. My bs's were low and I could feel it. So I tried to breathe deeply and stay focused on getting home to test my bs for confirmation and to bring them back up again. I remembered that I could suspend my pump and stop all delivery of insulin until my bs's started to come back up.

I did make it home. The glucose meter revealed that I was indeed having a hypo, (2.9 for those of you who want to be alarmed). I grabbed the nasty glucose sweets which I keep in the testing kit. And while waiting for them to work I also grabbed a cup of coffee (why not!). Another problem with hypos is the waiting for your bs's to come back up while you still feel the symptoms and your brain insists that YOU NEED MORE SUGAR!!!! Yes, I gave in, but only to a digestive biscuit:-)

Once the symptoms had abated, I started to go about my day again. Always a housewife before a diabetic, I realised that the washing machine had finished and that by the time I would have the clothes out drying I could test my bs's again just to confirm that they were coming back into a good range, 7.8, perfect and resumed my basal rate on my pump.

Then, like a bolt out of the blue, I realised that I carry my testing kit, glucose and phone with me on my walk every day for the exact situation that I had just come through and why the hell didn't I use it? Oh yes, because the brain is the first part of the body to feel the effects of low blood glucose and so rational thinking can't be difficult or in fact lacking. What are we like!

Stay tuned for episode 3-I think I've cracked it but I don't want to speak too soon!

Why exercise is tricky for T1Diabetes episode 1

So it's the first morning of back to school for me, a stay at home mother with type 1 diabetes. The lazy days of summer are over and it's time to get back in shape and tone up those flabby muscles that returned almost overnight when the summer holidays began.

I was actually looking forward to it.

I thought I did all the right things. My blood sugars before brekkie were spot on at 5.2, for a change. I had my healthy breakfast as usual, that didn't change over the summer. I took my bolus. My blood sugars (bs) had been running high after my breakfast during the summer so I didn't reduce my bolus dose. And because of the high bs's I didn't reduce my basal insulin either.

So I got into the usual routine, got children ready for school, dropped them off, chatted a little to some of the other mothers I hadn't seen for 8 weeks, got home.

I moved my testing kit, glucose supply and phone into my pockets so I could carry them and off I went. It was a pleasant morning; it was dry and not too grey. I felt good.

This is all going well except when I tested my bs after my walk which coincides with my 2 hour after meal check I was 3.9. I felt quite shaky so I figured my bs were still dropping. I decided to have a cup of coffee accompanied by a mini Crunchie and mini Fudge instead of the nasty glucose sweets that I usually treat hypos with. Cos, really, the fact that I had to replace the calories I'd just used was enough to drive me to a very large chocolate eclair but I used a little restraint.

Once recovered from the disappointment I brainstormed to find things I could do to lessen the low bs after the walks. I told myself "it's day 1" and "I shouldn't be too hard on myself". It's going to take a couple of mornings to get this right.

Never give up, never surrender:-s

Low carb lunch-my %%%%

My husband recently surprised me with a lunch date. Yes, I know how lucky I am and surprise lunch dates are only the tip of the iceberg but that's another blog.

Anyway, while I was pondering over the menu I was thinking to myself that I would like to have a healthy, moderately low carb lunch in keeping with my meal plans. I went over the menu a couple of times and finally settled on a "low-carb chicken caesar wrap". I thought that this option would not only be tasty but would have less carbohydrate than a sandwich.

My wrap arrived and did indeed look tasty. It did look bigger than the wraps I have at home which contain 20g of carbohydrate each so I was generous with my insulin bolus. I normally have between 35 and 45 grams of carb as my lunch (a large portion of which is a piece of fruit) and take 3-4 units of insulin. I guessed that the wrap was approximately 30g of carbohydrate because in my opinion if it was more than that then it's not really low-carb, is it? I took 3 units thinking it wasn't too much but wouldn't be too little either.

Boy was I wrong! At my 2 hour post meal blood glucose check I was 14mmol! I had a lovely lunch with my hubby full of conversation that didn't revolve around our children or chores only to have the good taken out of it. Total frustration!

Diabetes Rules

I may have mislead you all by the title of my post today. Opps! ;-) It's not meant to be "Diabetes Rules!" as in "Diabetes Rocks" but it's "Diabetes Rules" as in the rules to diabetes.

OK, so there aren't any "official" rules to diabetes, there are some very broad and general guidelines and there is a very good reason for this. It's because everybody is different and everybody's diabetes is different so too are the guidelines for each person.

So here are the rules I have come up with for myself, which are specific to when I'm having a bad day with Type 1 diabetes:

Always take your insulin.
No matter how you feel now, you will feel a thousand times worse if you don't take your insulin. Remember how ill you felt just before you were diagnosed. Yeah, that feeling will come back if you don't take your insulin.

Test your blood sugars regularly.
Now that you are taking your insulin like you should, it's time to look at how much you are taking. The best way to determine if you're taking sufficient amounts is to do some reconnaissance blood sugar testing. 

To check if you are taking the correct insulin dose for your meals and snacks, test your blood sugars before you eat and then again two hours after. If you want to check on how much basal insulin your body needs get some advise from your diabetes team. If they don't have enough advice for you, you can do some research on websites such as Diabetes Health or this website.

Use some form of carbohydrate counting.
There is quite a bit about diabetes management that you just cannot control or even measure, such as hormones, stress, illness. However, there are three elements of diabetes management that you can control and measure. They are insulin, food, and physical activity. If you know the quantities of insulin, food and physical activity then you can come up with some sort of system to work out how many grams of carbohydrate will be covered in a unit of insulin. My carb counting involves reading nutritional labels and weighting out the carbs.


And there you have it! Those three rules are my biggy's. Even if I'm feeling a little burnt out I make sure I don't waiver on these three rules for myself. I feel like if I just keep to my three "biggies" that I can keep from drowning in the diabetes doldrums and keep complications at bay.

After that, if I'm feeling a bit more positive, I troll through the many reliable diabetes websites and support forums for new information or a new way of saying something old that makes more sense. I also have my real life support group of people with type 1 diabetes who never fail to give me a kick-start. :-)

Updating to a new glucose meter:-)

Ahhh the glucose meter. What a wonderful invention! They've only been around since the 1970's but they have had such a huge impact on life with diabetes.

I remember my first one - I think it was a BD brand and it was about the size of an iPhone but twice as thick. I think I had that one for about 5 or 6 years. This is quiet a long time by today's standards.

Anyway, I have kept that trend up for almost 20 years - I very seldom change my meter. I know what I like and stick with what I know. Plus, it's really inconvenient to change.  In Ireland, people with diabetes receive all of their diabetes medications and supplies free from the Health Service Executive (HSE). The inconvenience comes from the paper work involved in changing your prescription for the test meter's strips and the lancet device's lancets (aka finger pricker).

However, I recently came across an ad for a glucose meter that had an interesting feature to me and decided I would change meter types after a gap of 6 years. I had the opportunity to have an upclose look at one at the Annual Diabetes Exhibition in Dublin last November and decided that it was worth the effort of changing.

I remember asking the sales rep how many strips came with the meter because I was probably not going to see my endocrinologist until March to get the prescription and I didn't to start using it until I had the supply established. She, helpfully, mentioned that my GP would be able to provide me with the script too. And yes, my GP is a little more convenient than my consultant but she seemed to assume that I would have a reason to visit him more often than my consultant. Truth is I haven't seen my GP since September when I had to bring one of the children in!

So, here we are at the end on January and my husband was heading into the GP, I gave him the note with the product information on it and he came home with a script for the strips.

Then within a couple of days, I sent the script with my Long Term Illness book to the Long Term Illness department of my local HSE offices. They update the book and a medical officer approves it and send it back to me. I got it back in the post within a week and a few more days later I had my new test strips and lancets.

It only took 3 months!

By the way, my new meter is the OneTouch VerioPro and I'll let you know how it does.