A day in my life with diabetes - a good day!

Saturday 10th January
The alam went off at 8:28am, I feel well rested but still want another snooze. My husbands alarm went off at 8:30am and I was afraid that I would actually fall back to sleep so I rolled out of bed. I use the term rolled because that is actually what I do.

Into the shower. Out of the showe, dry off, get dressed.

I went downstairs, said good morning to my already fed and dressed daughter on the laptop. I filled the kettle to make tea. Tea is made and I pop two slices of Brennan's wholemeal slice pan into the toaster.

While waiting for the toast I did my first blood glucose test of the day. 7.3mmol/l, what a nice way to start the day. I give myself 3 units of insulin to cover the toast and 3 mugs of tea with skimmed milk.

After breakfast, it's time to drop the family of to Coder Dojo and for me to get the weeks grocery shopping done.

What seemed like a short time later I felt my insulin pump vibrate to remind me that it's been 2 hours since I took my breakfast bolus and that its time to check my blood sugars again. I felt fine and so I waited until I got to the car to do this. 4.4 mmol/l, a bit on the low side because there is still active insulin in my body so I ate half a Nature Valley granola bar to keep my levels up until lunch.

Then it was time to collect the family from Coder Dojo and go home. After all the groceries have
been put away and both children have been fed, it was time for my own lunch. I decided to have a two egg omelette with smoked salmon and cheese, one slice of Brennan's wholemeal slice pan again and two perfectly ripe kiwis. I worked out that this all amounts to 35grams of carbohydrate. While my omelette was cooking I tested my blood glucose and it was 5.2 mmols/l (I'm having such a good day). It feels so nice to have good numbers, warm fuzzies. I took 2.65 units of insulin to cover my lunch.

I enjoyed my lunch! Now I have cleaned up the kitchen a little after lunch, swept the floor of all the crumbs, transferred some laundry, put some other laundry away and emptied the dishwasher. I sat down to sort through some household budgeting. I shouldn't have done that-no, not for the obvious reason. I suddenly realised I'm so tired and it's not surprising because it was the end of the week where the children went back to school after the two week Christmas holidays but my body forgot how to fall asleep before 11:30pm.

I decided that all major household tasks were done for the day and I was going to have about three cups of coffee, read the newspaper and some internet articles. My insulin pump had perfect timing; it vibrated to remind me to test again before I made it to the comfy chair. My blood glucose test revealed 6.0 mmols/l. You should have seen my happy face!

Roll on the coffee and two small McVities chocolate biscuits. I know I should have them but they're left over from Christmas, someone needs to eat them and I'm too tired to resist. So I've estimated that they work out to be 15 grams and I bolus 1.15 units of insulin. I wonder to myself if the biscuits are more like 20 grams but I decide that the next blood glucose test will reveal it.

Dinner at 7pm and my blood glucose is 7.8 mmols/l, it's sooooo nice to the things right for a change. Enjoyed my dinner of ///////// and of course dessert after cleaning up.

The two hour post meal check revealed a 5.8 mmols - this is a normal reading for someone without diabetes but for me it's a bit too low for an after meal and with active insulin still in my body I give it a snack to work on. What can I have for a snack? Ohh I haven't had a packet of crisps in months, double ohhh Salt and vinegar. Sold! So 14 grams of carbs and a lot of fat later my blood glucose dream comes back to reality with a 11.2 mmols result.

I tempted the good vibes too often today.

What good is an insulin pump?

I met two people recently that I've known for a while, but I didn't know they have connections to type 1 diabetes. One person is a PwD and one is married to a PwD.

As always, the fact that I have an insulin pump comes up in conversation. And, as always, they ask "how I find the pump?" (that's an Irish person's equivalent of "Tell me exactly how you benefit from having it").

They don't really know what an insulin pump is or how it works. This doesn't surprise me because unless you are very interested in getting one you really don't do the research into it and in most of our diabetes clinics it's not really explained. (No need to promote what long waiting lists and lack of resources prevent you from providing).

Both people made the exact same comment of "but you still have to do the finger prick tests"! I wasn't expecting this comment so my response was insufficient. I had said something to the effect of "Well, yeah but I don't have to be messing around with two different types of insulin."

COMPLETELY, forgetting one of the best advantages of an insulin pump!

And I'm so kicking myself that I didn't think of this at the time but the point is you don't have to stab yourself with a needle 5-6 times per day, you only have to stab yourself once every three days. How could I forget that?


Next time I'll be ready! I hope.

http://blog.diabetv.com/differences-insulin-pump-injection/

One of the biggest questions that someone with type 1 diabetes may ask is, “what are the major differences between going on an insulin pump vs staying on injections???” well this is a very good question to ask. There are a lot of advantages and disadvantages between the two methods so let’s take a look at some of the more apparent ones to see which method is best for you.

• Insulin injections require a lot less training than pump therapy. Using a pump requires professional training and scrutinizing blood glucose management as opposed to insulin injections
• Insulin pumps mimic the function of the pancreas a lot better than insulin shots do making insulin distribution a lot more precise than insulin shots which helps reduce the peaks in blood glucose
• There is also a higher chance of developing DKA (diabetic ketoacidosis) while using a pump than when using injections (this can be caused when the tube is not correctly inserted under the skin and the user doesn’t notice)
• Insulin injections require multiple shots a week where insulin pumps only require one every three days or so (frequent injections can cause some resistance to insulin absorption).
• Insulin shots are more affordable than insulin pumps
• Insulin pumps require the use of only one type of insulin whereas insulin injections use at least two different types (a fast acting and a long acting insulin).

So whether you are looking for a more flexible method or if you just like to stick with your sliding scale at every meal, knowing the differences in the end will help you make the right decision regarding how you manage your diabetes.

I have moved to Blood Sugar Trampoline!

I've been playing around with a new name and a new look for my blog. And new focus. For more than a couple of months now.

Today I'm making the leap. I hope you'll come bounce with me and keep me company on the Blood Sugar Trampoline?

I will focus a bit more on my personal experiences living with type 1 diabetes and come out of the closet a bit more. I also think that you will find the diabetes information I've gathered over the years easier to find over at www.bloodsugartrampoline.com

Here it goes!

Spare a Rose, Save a Child with diabetes

Imagine living in a country where you could not afford to buy insulin for your child with type 1 diabetes? 

I'm so lucky that I was born and live in Ireland. I can go to a chemist at any time and walk out with a month's supply of insulin, test strips and whatever else I need to live. Without paying a cent!

If I was born elsewhere that would not be the case. I would not be able to afford my insulin and I would not be here today.

Yesterday, I donated money that I had set aside to Spare A Rose and give a child with diabetes a chance at life for a year.

Spare a Rose, Save a Child is the brainchild of the Diabetes Online Community in North America. The idea being to take the typical “dozen roses,” so popular on Valentine’s Day, and just buy 11, save just one rose and donate to spare the life of a child. 

The Spare a Rose, Save a Child campaign is directed at raising awareness and funds for the Life for a Child program, which is an International Diabetes Federation program aiming to take “contributions from donors go to established diabetes centres enabling them to provide the ongoing clinical care and diabetes education these children need to stay alive.” 

The idea was to take the typical “dozen roses,” so popular on Valentine’s Day, and save just one rose to spare the life of a child. “Spare a Rose, Save a Child” is simple: buy one less rose this Valentine’s Day and share the value of that flower with a child with diabetes in the developing world. Your loved one at home still gets flowers and you both show some love to someone across the world who needs it. From Kerri Sparling, Sixuntilme

#IWishPeopleKnewThatDiabetes....

Some of you may have come across the Hashtag #IWishPeopleKnewThatDiabetes..... on social media platforms such as Facebook and Twitter, over the last year. This hashtag is the brainchild of Diabetesaliciouness blogger, Kelly Kunik.

I met the superwoman herself last July at the MasterLab Diabetes Advocates conference. On that first morning, as I took a deep breath and joined a table of strangers. I know, I'm a very grown-up woman but I still have to force strongly encourage myself to do these things. I know I'll regret it if I don't.

Anyway, I did not recognise anyone but as soon as the ladies started conversing and using their first names, I started to connect the "who" to the "blog" and figured out that the girl sitting right beside me was Kelly.

Kelly has lived with type 1 since she was 8 years old (that's 38 years), and comes from a long line of direct relatives with type 1 diabetes, including her sister who in 1991 died from complications at the age of 33. Kelly gave an indepth interview in August to Diabetes Mine in which you can read lots more about her and why she does what she does.

The #IWishPeopleKnewThatDiabetes hashtag and the #IWishPeopleKnewThatDiabetes Day, (22nd April 2015), were inspired by 3rd grade teacher, Kyle Schwartz and her #Iwishmyteacherknewthat hashtag, which was heartbreaking.

Photo courtesy of DiabetesMine.com

Kelly says that "This day is about people living with diabetes taking to twitter and using the hashtag in unison for a 24 hours period to express the good, the bad and the diabetesalicious of it all."

The #hashtag and day took on a life of their own with over 16 countries participating and generating over 17 million twitter impressions to date.

The IWishPeopleKnewThatDiabetes hashtag has now become an initiative, a movement and a call to action where people can express themselves past the 140 character limit and in various multimedia formats. Kelly launched the "Iwishpeopleknewthatdiabetes.org" website last November. She (and I) encourages everybody to visit the website and submit your own "what you wished people knew about diabetes". You can also read some guest posts from rock stars in the Diabetes Community and some totally-not-a-rock-star-or-even-close people's guest posts (i.e. yours truly. I was so honoured that she asked!!!)

IWishPeopleKnewThatDiabetes.org is well worth a visit.

Operation Transformation - A National Movement

The tv show Operations Transformation is more than just a fluffy piece of entertainment. It's a national movement. And, for me, it's the most uplifting programme on telly today.

No, I swear I'm not crazy... or easily entertained!!!

I only began watching the programme a number of years ago, when the creators partnered with Diabetes Ireland to create more awareness about type 2 diabetes. It was only then that I realised this show is about so much more than getting five people to lose weight.

And I got hooked! Unlike any reality TV show that I have seen, it's not about putting people down or pitting them against each other.

Operations Transformation is advertised as a health and fitness programme. It airs on RTÉ One in Ireland. The show is a cross-media event broadcast via radio, web and television and it's been running (ha, ha, pun) for nine years.

The show motivates and inspires people and communities to come together to become healthier. They are partnered with Sports Ireland who help organise nationwide walks in over fifty locations all around Ireland.

It encourages everyone to take back control of their lives, no matter what your demons are.

How does it work?

Five leaders are selected and are supported and guided by a panel of experts in the fields of fitness, nutrition and psychology in order to reach their individual goals. The show broadcasts over a period of seven weeks but most leaders continue on their journey sucessfully.

The leaders are chosen on the basis that there is someone for everyone to relate to. The meal and exercise plans which have been created for each leader are published online so that viewers can follow the plans also.

The first two programmes of the series introduces all the leaders, who they are, what they do and why they want to do Operation Transformation. Let me warn you, it's a cry-fest. Well, no it isn't I'm just a big SAP!

You find out that these people are not just battling their weight; they have darker demons buried inside that are holding them back. Being overweight is just a symptom of what ails them.

This programme also gives you an insight into just how difficult it is to decide to lose weight and that you're crazy if you think there is a quick fix and that support is key. Why do it by yourself.

Why am I writing about this programme?

I think this programme is an Irish phenomenon and could be replicated elsewhere.

And this programme is educational; I was happy with my weight but the truth is that when I go clothes shopping I am definately not. 

As a person with type 1 diabetes I feel that the food I eat is healthy most of the time! I did pare it down a number of years back to drop some baby weight and it worked. And I get my 30 minute walk into my day 4 times a week so I couldn't be bothered trying to add more exercise. 

But when the show introduced me to leader, Noeleen who is 5" 3" in height and 75 kgs and officially obese - I woke up! I'm 5" 4" and 72 kgs!!! Yikes! Too close for comfort.

So while I really don't want to change the way I eat - I starting to think I need to move more to officially be healthy. Let's face it who doesn't!

All the leaders are inspirational this year and along with Noeleen, I'm especially interested in cheering for Chef John Conmy who has type 2 diabetes. During his fitness test during the programme he was discovered to have heart disease. He wasn't aware he had it and this programme may have saved his life. 

And then there's Clare Scanlan, who's has not been able to move past her grief after losing her 15 year old son to sudden adult death syndrome two years ago. 

The show has teams up with Sport Ireland, who organise nationwide walks in over fifty locations all around Ireland. The highest number to date who took part is over 19,000 people. Every year this numbers climbs and climbs.

People are doing it! Taking back control of their lives!

Diabetes Complications are Not a Sign of Failure

The complications of diabetes are real and people are living with them. People are also living in fear of them. Myself included. I am actively trying to overcome this fear because if I do end up with complications I don't want to feel like it is the end of my life. Or that I failed to manage my diabetes well enough. And I certainly don't want to be made to feel that it's my fault.

I don't believe just because I am doing everything in my power to manage my diabetes that I will be spared. I believe that if I have type 1 diabetes I still have the risk of developing complications. I strive to keep that percentage of risk low but it will never be zero.

I will not stop trying!

Image from http://www.coolnsmart.com/failure_quotes/

So, when a friend of mine, who has lived more than 50 years with type 1 diabetes and who lives with a number of the complications of diabetes, comes to our T1D meet ups and people imply she didn't take of herself, I get a little "upset"!

My friend has survived taking care of her diabetes when there was no such thing as a glucose meter! Imagine never know what your blood sugar was?!?

She has survived during a time when the phrase "carb counting" might as well have been a foreign language in Ireland. It didn't exist!

We also did not have Rapid Acting Insulins until the late 1990's. So, even if we did practice carb counting, it wouldn't have been much good to us. Sure, we could do a certain amount of carb counting on the insulins we took only twice a day but we couldn't fine tune it like we can today.

We also did not know that the tighter your diabetes control, the less likely you were to be at risk of getting diabetes complications. This research was only published in 1993 as the DCCT Trials.

93 years ago we died! Today, we have so many tools, technology and instant access to research that people with type 1 diabetes, who have been told for decades what they can't do are breaking all of those barriers.

So I ask you? Is surviving 50 years with type 1 diabetes and living with complications really not taking care of yourself?

My friends who live with diabetes complications may even say themselves, that they didn't do as much as they should have to take care of their diabetes. And I say you did the very best that you, and everybody else, knew how.

I am so lucky and proud to have friends like Deniabetic, who are helping me overcome my fears.

Post Christmas Blood Sugar Hangovers

The Christmas holiday lasts one whole week if not two in Ireland. Most businesses close their offices from Christmas Eve to the day after New Year's day to give their employees a well earned break.

The schools close for two weeks. This is where my diabetes can become troublesome. I'm a stay at home mother and when my children are in school I have a routine and I get out most days for a good head-clearing walk! It does my head good and it does my diabetes good.

During school holidays, getting out for that little but very important 30 minute walk is.... mmmm challenging. I could do it. If I really, really, really tried but there's always something else I could do too.

A two week holiday is more than long enough for my body, and my diabetes to figure out that my exercise has been all but forgotten and give me a bit of a telling off.

The grey-ness and the wetness of the Irish weather for the last month did not help either! Let's just say we would not have been surprised to see a giant ark after having SO much rain for SO long.

This holiday, my BG's started rise just before New Year's, at a time when I thought I'm almost there and I got away with it. My insulin to carb ratios need to be reduced radically and using trial and error the kids will be back in school before I have it figured out.

I'm also feeling a little of the January blues. The lack of exercise and my elevated blood glucose levels are leaving me deflated and unmotivated to do absolutely anything.... except declutter my house (figure that one out?).

So, I'm anxious to get back to school, I mean for my children to get back to school. :-)

I'm itching to get out for that first regular walk of 2016, to have a routine again and reclaim familiar BG patterns so I can make adjustments.

I also need to come up with a feasible plan for the extended Easter break we will have this year (it's 2 and a half weeks long starting on St. Patrick's Day).

I think I just found my new years resolution! And I think I'm finding my way back.

Midnight and Lows

I wrote about this hypo experience before I got my CGM (Continuous Glucose Monitor) and so these days crashing blood sugars are not coming at me like oncoming trains and I am able to get off the tracks in time.

A few nights ago, I experienced the feeling of watching a "train wreck" coming towards me and not being able to avoid it. The problem, I think, the fact that I had too many options available to me in trying to prevent my imminent hypo that I didn't know which one was best to choose.

Normally, when I check my blood glucose level two hours after my dinner and they are above my post-meal target, I know that some more insulin is required. On this occasion it was 3 hours after dinner and I was even more sure that I needed more insulin. See the 11.5 mmol (207 mg/dl)

HOWEVER! Approximately 60 minutes after I had given myself more insulin, the big red dot and the sharp dip in my mysugr app told me that my diabetes was not playing by the rules!  My blood sugar level had dropped sharply to  6.1 mmol (110 mg/dl). An otherwise respectable BG number but at this moment in time, especially with the remainder of my insulin dose to activate, I knew I was in trouble and that a hypo was coming for me.

I was already tucked up in bed with my teeth brushed. So, I reduced my background insulin by 50% for an hour and a half to counter the over correction of insulin. (Note to self; that wasn't the right choice - always go for the fastest acting glucose available).

At 12:13am, perspiration steamed off me. Thankfully, I had the wherewithal to check my blood sugars again revealing a 3.1 mmol (56 mg/dl). I took 3 dextrose tabs and lay back waiting for them to kick in. But, the heat coming off my body made me grab 2 more a couple of seconds later.

I tried to lay there waiting again but I became more agitated at having to wait.... and wait, and wait, for the heat and sweat and "jitters" to subside. The seconds felt like hours!

I decided to wait the 15 minutes out downstairs and suck on some boiled sweets to, maybe, trick my brain into thinking I was shoveling glucose into me hand over fist and avoid over-treating the hypo. I pulled out the laptop and tried to document this hypo ;-) Another effort to avoid over-treating-keep my hands busy.

12:37am, 5.8mmols (104mg/dl), still feeling shaky and mildly damp but can safely go back to sleep. After brushing teeth.... again.

And yes, I had the over-correction high blood sugar reading the next morning. Sometimes, you just can't win. But you try, and try to learn:-)

Happy New Year from Gráinne

I made it through another year with diabetes!!!

May the food be worthy of the bolus,

the alcohol worthy of the hangover,

may that one day not effect my HbA1c level too much and,

may we all be back on top of our diabetes in the new year :-s

Grainne.
See you in 2016.

I have nothing to fear but fear itself

Image from http://james-the-nose.deviantart.com/art/
A-deer-in-the-headlights-122552318

I attended a diabetes meeting once where one of the other attendees said they wanted to see photos of all the horrible things that can happen to a person with diabetes if they don't take care of themselves. That this would motivate this person into doing more to take care of their diabetes. I understood this person's point of view, they were much older than me and may have seen the "dangers" of diabetes as being more imminent than I did.

For me though "the fear tactic" doesn't work. I've heard all the horror stories. I've heard all of the threats in relation to what I should and what I should not be doing to take care of my type 1 diabetes. And I have been paralysed into doing nothing by them.

I think it's a well known piece of advice that fear is not a good motivator to get somebody to do something. Do you like it when someone threatens you? Even if it's for your own good? Does it make you want do what they say?

For me, it, absolutely, does NOT! But you might ask me what does get me moving and doing? My answer is "Information and inspiration" ;-D

I don't test my blood glucose more because someone told me I should. I do it because it was explained to me why I should consider it and how to use the additional information (EDUCATION, can't. say. it. enough.). And I could see almost straight away how this improved my management of my type 1 diabetes.

I do remember, all those years ago, when I was told that I had to eat a strict "diabetic" diet and I absolutely HAD to take my insulin at exactly the same time every single day. If I didn't I would end up with all sorts of ugly diabetes complications.

But guess what? Some people do all the right things and still get complications. And some people don't take care of themselves and don't get any complications.

Those were the days when we had very little in the way of diabetes research or education to revert to. But by God we had fear! And it got me nowhere!!

What did motivated me to do all the things that I do to take care of my diabetes? Education, education, education and some more education. Can't say it enough times!!! And of course, a good support network:-)

DKA Kills and the Type 1 Diabetes Awareness Project

We don't know how many children or adults die in Ireland because of undiagnosed Type 1 Diabetes but we can be sure that it does happen here, just like it happens all over the world. 

As the news is travelling through the diabetes community of yet another life cut short, I'm awakened, with a jolt, as to why the Type 1 Diabetes Awareness initiative from Diabetes Ireland is so important... And needs to happen soon!

Diabetes Ireland are planning on launching this Type 1 Diabetes Awareness project early in the new year. 

Image graciously stolen from Diabetes Mine

Up to 23 Irish children are diagnosed each month with Type 1 diabetes. The majority of these present to their GP feeling generally unwell but 1 in 8 will not be correctly diagnosed at that time. 

This delay in diagnosis usually means repeated visits to the GP and can result in diabetes ketoacidosis (DKA) which is potentially fatal.

The aim of this project is to encourage GPs to consider Type 1 diabetes first, as a potential diagnosis when a child presents feeling generally unwell and secondly to raise awareness among the general population of Type 1 diabetes signs and symptoms (The 4T's; Toilet, Thirsty, Tired & Thinner).

However, Diabetes Ireland still need to find one quarter of the funding for this project. They are determined to commit to the February 2016 launch date but if they don't find the rest of the money they will have to amend the initiative, which would make it less effective.

Does anyone have a wealthy relative??? 

Image from http://res.public
domainfiles.com/pdf_view/
52/13526046019596.png

Maybe if we start sharing this with our friends and talking about it, the people who hold the purse strings will take notice that this is important to us?

Just in case you're wondering; what is DKA?

" Diabetic ketoacidosis is a life-threatening problem that affects people with diabetes. It occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead.

When fat breaks down, waste products called ketones build up in the body." Find out more here. 

I'm back on CGM (Continous Glucose Monitoring) Yayyy!

Back in June, I did a trial with a CGM (Continuous Glucose Monitor) and I wrote a little about my experience here. Wearing the CGM was so valuable that I was very much determined to get it permanently.

I'm thrilled to say that happened on the 25th November. So I've been using it for two weeks. I had a little hiccup with my pump, which decided to die on the 30th, which made me appreciate the CGM more as it's so helpful the not only know what my blood sugars are but also know where they are going. It was such a relief to see that down arrow.

This time around I feel like I know what I'm doing this time around with this new gadget. The workshop I attended in July presented by author of "Think like a Pancreas", Gary Scheiner entitled "Making Sense of the CGM Data" also helped.

The technology was so new to me in June that I was preoccupied by "how does this thing work?". I was only just getting a handle on having all that extra information by the end of the two weeks. I had been able to upload the information to the software programme and identify trends where I could make some adjustments in my insulin regimen.

But then the trial ended and it was like being blind again.

The major benefit of having a CGM is having this;

This is the graph from my CGM data.

 as opposed to this;

and knowing what to do with all those extra data points.

After two weeks, I have been able to prevent a number of lows by my CGM alerting me to the fact that my BG was 4.4mmol/L and dropping. And I've been able to reduce the impact of how high my blood sugar climbs. It's my hope that this will increase how much time I spend within my target blood sugar range of 4 mmol/L to 10 mmol.L (72 mg/dL to 180 mg/dL) overall.

People who have lived with type 1 diabetes since before the 1970's often talk about how access to blood glucose monitors changed diabetes management in a revolutionary way.

I think that the CGM is a game changer for my generation of type 1 diabetes.

Insulin Pump Wizardry

I have been using an insulin pump for just over 5 years and I'm still finding new benefits in pump therapy. I should explain that I know I am very much a slooooowwww adapter of all things new - I go at my own pace.

Earlier this year, I started using the EzCarb and the EzBG features on my pump a bit more. Previously, I really only used them for correction insulin doses. I use an Animas Vibe pump and I'm told that on the Medtronic pump this feature is called the Wizard.

Since I've started using this feature I have noticed a reduction in the number of hypos that I have been having.

Before, I had a tendency not to factor in my Insulin on board, I didn't really have a way to calculate it. Insulin on board is the term used to describe how much insulin is left working in your body from the last bolus and how active it is.

Also, I would only factor in a correction amount of insulin if I was over 10 mmols/L (180 mg/dL).

I have to say that since using these features I feel like I have reduced the number of hypos that I have. However, I have nothing to back up my theory, it's just a hunch! But it feels nice.

I also like it because it separates out my insulin dose so that I know how much of my insulin is related to the carbohydrate, how much is a blood glucose correction and how much I have to reduce for my Insulin on Board.

Here's to continually making improvements and to tiny triumphs!

Disclaimer: I have not been paid by anybody in relation to this post. 

Walk Your Diabetic Feet To The Pathway of Good Foot Care

Our guest speaker at our November diabetes get-together in Co. Clare is a podiatrist from the local health centre (Thank you, Doireann). And I know that most people with diabetes know the basics of taking care of your feet, especially if you have been around diabetes for a couple of decades.

The reason I decided to post about our meeting is that the pathway to podiatry has changed a little in recent years and that is worth sharing this information (IMO).

But I have included an article which, coincidently, was published online this week, and contains some of the basics to lead up to the local information.

So, why do healthcare professionals stress the importance of good foot care?

“In almost all high-income countries, diabetes is a leading cause of cardiovascular disease, blindness, kidney failure, and lower limb amputation.” (from International Diabetes Federation). But a simple annual foot check can prevent or reduce your risk of developing serious problems with your feet.

“People with diabetes have special reason to take good care of their feet. High blood glucose levels may make feet susceptible to injury and infection. This is because the protective sensation in the toes or feet – your “pain alarm system” ­may slowly disappear with long term high blood glucose levels.” (from Diabetes Ireland)

The Foot "Issues".

The two feet problems that podiatrists (and people with diabetes) are on the lookout for are;

Nerve Damage

Nerve damage can cause you to lose feeling in your feet. You may not feel pain, heat, or cold in your legs and feet. You may not feel a pebble inside your sock that is causing a sore. You may not feel a blister caused by poorly fitting shoes.

Sores on your feet can become infected. If your blood glucose is high, the extra glucose feeds the infection in those sores and the infection gets worse. Nerve damage can also cause pain and lead to foot deformities, or changes in the muscles, bones, and shape of your feet.

Poor Blood Flow

Poor blood flow means not enough blood flows to your legs and feet through your blood vessels. Poor blood flow makes it hard for a sore or an infection to heal. This problem is called peripheral artery disease, also called PAD.

Sometimes, a bad infection never heals. The infection might cause gangrene. If you have gangrene, the skin and tissue around the sore die. The area becomes black and smelly.

Too much glucose in your blood from diabetes can cause nerve damage and poor blood flow, which can lead to serious foot problems.” (from the American National Institute of Diabetes and Digestive and Kidney Diseases)


Everybody with diabetes in Ireland should have a foot check by a podiatrist, children included, every year.

I know that some doctors and consultants might perform a brief foot check at your clinic appointment but our podiatrist (and lots of other reputable websites) state that if your foot check does not include a test using a tuning fork and a Monofilament tool.

Monofilament Tool

At your annual foot exam your healthcare professional will;

• Look at your feet for signs of problems, especially if you have nerve damage
• Test the sense of feeling in your feet using a Monofilament tool.
• Test how well blood is flowing to your legs and feet
• Show you how to care for your feet

How do access Diabetic Foot Care?

Referrals to your local podiatry service for people with diabetes are available from your GP, Public Health Nurse, Community Nurse, or Diabetes Clinic.

In Co. Clare, you can avail of a self referral form which is available at the Health Centre on Bindon Street in Ennis. It’s not available online. And we believe that this option is only available in Co. Clare.

Your very first foot screening with your podiatrist will assess you and place your feet in one of three categories; Low, Moderate or High risk.

If you are low risk, you may be referred back to your GP’s surgery for your annual foot exam. If this is the case then it will be your responsibility to schedule this. If you are referred to your GP, it’s really important that you keep a record of when your last foot check was and when to schedule your next one.

If you are Moderate or high risk of diabetes foot disease then you will probably continue to be seen in the Diabetic Foot Clinic, where they will send out your appointment to you in the post.

However, there are instances where the clinics fall behind in their appointments and it would be wise if you kept a record of when your last foot exam was and when your next one should be.

You can find more information from the HSE's Model of Care for the Diabetic Foot document, which was revised in October 2014.

Explaining Type 1 Diabetes to Non Diabetics

I spend a lot of my time "hanging" and communicating with other people with diabetes. I realise that I'm very lucky to have that when I have come across so many people who have never met anyone else with diabetes.

So, when I find myself in a situation where I have to explain type 1 diabetes to someone who is not a member of that community, I actually find it extremely difficult. Even when I know it's coming!

Two such encounters have prompted me to try harder in this and I sat down to considered the following;
- when I want to share my diabetes story where is the best place to start (without turning it into a rambling, never-ending tale)?
- And, how do I connect with people who have no connection to diabetes? How do I explain it so that they ask me good questions?

Here is what I came up with! And I did decide to try to keep it simple and specific to my diabetes, which means I know a lot of you will have lots more to add to it. But this is my starting point.

What is type 1 diabetes?

Type 1 diabetes happened to me when my body, for no apparent reason, decided to destroy the part of me that makes insulin.

What the heck is insulin?

Everybody needs insulin to be able to turn the food they eat, namely carbohydrates, into energy. If I don't have insulin, I will die of malnutrition, even though I eat.

Type 1 diabetes is kindof like an allergy to carbohydrate. I cannot eat carbs without taking insulin. And if I don't take insulin, what the carbs become once I have digested them, the sugar/glucose builds up in my blood and starts to do bad things to my organs.

What if, every time you ate any of these foods you had
stick a needle into yourself?

If I just didn't eat carbohydrate would that not make life easier?

A person without diabetes might respond to this with "What if you just didn't eat carbohydrate would that not make life easier?"

Not really, our liver, also, releases glucose and we can't turn that into fuel either. So, we actually have to take insulin to deal with that sugar/glucose that is being continuously released in the background.

So either way, we need to inject/infuse insulin or we die.

What if you just measure how many carbs you are eating against how much insulin you are taking?

One of the ways people manage their with type 1 diabetes is to measure how much insulin they take and measure how much carbohydrate they eat.

This is where I know I am going to lose you.

Type 1 diabetes is more complex than that. There are other factors that influence blood sugar/glucose (BS). Sure;

• Food brings BS up, but all foods raise BS differently. 
• Insulin brings it down.
• ANY physical activity has the potential to bring it up or down.

But there are things that influence BS that are not easy to measure.

• Hormones such as adrenaline, the stress hormone cortisol, menstrual hormones can raise or lower your BS. 
• Illness raises BS.

These are just a few, here's a list of 22 other factors that commonly influence BS.

Living with type 1 diabetes is tracking all of this and more. It's exhausting!


So all I need now is a guinea pig volunteer to try it out on? Oh and here's some more helpful tips to help explain type 1 diabetes to people.

The HbA1c and how does it fit into Diabetes Management.

Our HbA1c is just one piece of information in the picture of our diabetes management.

It is really important to our healthcare providers because that's how they measure how well THEY are doing in keeping people with diabetes healthy. It's a global measurement and so they can use it to compare their service to services in other countries.

For us, the individual with diabetes, it really doesn't have that much value. You might feel differently but for me, it's just another number, one of many that I use to manage my type 1 diabetes.

I have had a good HbA1c for a number of years now. But there was a period of time a couple of years ago when I had an excellent HbA1c of 48 mmol/mol (6.5% NGSP unit). However, both myself and my endo were confused because my blood glucose readings told a very different story. They were ALL OVER THE SHOP!!! Not one of my BG readings was within any of my targets!

They were so bad that while my meter was counting down from 5, I would close my eyes tight, cross my fingers and hope for a single digit, as in less than 10
mmols.

We figured out that I was having more than the occasional hypo during the night and not waking up (Flipping scary). These lows were offsetting the highs during the day, making my HbA1c appear excellent.

These days, I look up my average blood glucose reading over 30 and 90 days on my meter. Plus, I look at my "standard deviation". The Standard Deviation SD is a measure of how spread out my numbers are and it's measured in a percentage. 

"Say your average blood glucose reading is made up from a 13.9mmol (250mg/dl) and a 2.8mmol (50mg/dl) giving you an average of 8.3mmol (150mg/dl). The 8.3mmol (150mg/dl) average is not bad, but the 2.8mmol (50mg/dl) is too low and the 13.9mmol (250mg/dl) is too high. So if you only look at the average, you might think you are doing well, when in fact you are not doing so well.Source; Diabetes Daily

The SD from the example above is +/-7 which is quite a spread.

Ultimately, I want to smooth out the peaks and troughs of my blood sugars and that's why I would like my average blood glucose reading to be between 8 and 9 mmols and my standard deviation to be a small as possible.

I was always tempted to brag a little about having reasonable HbA1c results. But once I learned about SD it removed all temptation.

Diabetes Interruptus

Let me count the ways that diabetes interrupt my life.

Wednesday evening I attended a business women's network event. I know I eventually have to leave my career of stay at home mother because, well, they grow up, don't they! So I'm trying to get my head around the fact that I NEED to go back to work in the next year or two!!!

Anyway, half way through this event we had a much valued break where we could, you know, network. We had moved around the room and I had left my bag at another table. Once I assessed that the finger food was worthy of insulin and filled my plate, a very nice lady started a conversation as I was filling my cup with tea. I had to excuse myself to return to my bag because I needed to test my blood sugars and work out a SWAG (Scientific, Wild Assed Guess Bolus).

When I'd finished she was surrounded by 4 others ladies, clearly, she was a person that I would have liked the opportunity to talk to. But the opportunity was lost because of my diabetes.

Thursday evening, I over estimated my carb count at dinner and about one hour after dinner I began to descend into a low when my phone rang. I didn't recognise the number but I still had a hard time deciding that I should not answer it and deal with my hypo instead.

Turns out it was the Mum of one of my children's new friends wanting to arrange a play date. I didn't get to call her back for a couple of days.

I try to make sure that diabetes doesn't interrupt our family life or my life by planning ahead as much as possible.

But sometimes, it just doesn't work.

The Big Blue Test for World Diabetes Day

This year, for World Diabetes Day, I am piggy backing on someone else's idea and taking part in the Big Blue Test.

Why?

Because it's simple, it's easy, it doesn't cost me anything to participate, and it's giving to those who don't have access to insulin. Hell, it's just a good idea and I'm hoping that some of you will think so too and join me?

What is the Big Blue Test BBT?

The Big Blue Test is a diabetes awareness initiative that was started 7 years ago by an American non-profit organisation, called the Diabetes Hands Foundation (amazing organization worthy of another post). The BBT is about how one small change can have a huge impact on your health; if you have diabetes or not.

And every BBT logged raises money for those with diabetes who are less fortunate than us.

Results gathered over the lifetime of the program demonstrate that just 14 minutes of exercise has the potential to decrease participants’ blood glucose levels, in some instances as much as 20% (Type 1's should pack a Snickers;-D).

Not only is The Big Blue Test encouraging people who don't have diabetes to exercise and creating awareness about diabetes, but it's creating awareness in our own community about how effective even a little bit of exercise is as a diabetes management tool.

And, by participating in the Big Blue Test, we get to help people living with diabetes who are in need with grants for life-saving diabetes supplies, treatments and patient education, usually in developing countries.

How do I take the test?

Taking the Big Blue Test is easy:

1. If you have diabetes you test their blood sugar, if you don't have diabetes, don't check your blood sugar.
2. You exercise for at least 14-20 minutes.
3. You test again (if you have diabetes), and
4. You share their experience on BigBlueTest.org or through the app for iPhone or Android.

Log in, take the test. Do a little good today for yourself – and someone else.

From Diabetes Mine

What happens after MasterLab Advocacy Conference?

What happened after I attended the Diabetes Hands Foundation's MasterLab advocacy conference?

And thank you to Christelle Aprigliano from MyPerfectD, who inspired me to write this post in gratitude for being chosen as a scholarship winner to attend MasterLab last July.

The timing of which is significant because we just had our very first Thriveabetes conference in Ireland.

Before I go into what happened after MasterLab, let me first explain where I was before I attended.

I had an idea, that we, in Ireland, were entitled to experience the type of conference that people with diabetes in the UK and the US we're enjoying. A peer support conference. Turns out some other people had that same idea too. So, we came up with a plan, raised some money and were busy executing that plan to make Thriveabetes happen. And everything was going to plan.

However, until MasterLab I was wandering around aimlessly on the diabetes advocacy path. I really didn't know what I was doing or how to verbalise what I wanted to do.

On the very first morning of ML, we did the all-important ice breaker and introductions. I took a deep breath and tried to figure out why I was there in my head before it was my turn.

I introduced myself with "Hello, I'm Grainne, I'm from....", followed by my volunteer bit and then, added that really, the main reason I was there was to learn if I could organise Thriveabetes better. The response I got was that I should lead with the bit I ended with:-S Lesson #1 learned.

From that moment on, I was one of the organisers of Thriveabetes and I realised that every moment since 2007, when I helped set up our local diabetes support group, was leading up to this.

Every time I introduced myself I did it a little bit better and with more confidence. Without meaning to, I networked! But for me, it was an opportunity to meet the most interesting people and hear their diabetes stories; networking never seemed so easy! I had more Facebook friend requests in that week, than I had since I set up my Facebook profile.

At ML, I realised that I had found a path I wanted to travel, that I had been on that path; rambling unintentionally, for a long time. I found focus and I found my purpose.

Little did I know that in 2007 when I was at my lowest. I had been struggling to find decent diabetes healthcare for 18 months and I had just had a clinic visit where I sat in a Digital Chair Weighing Scales, used in nursing homes, retirement homes and rehabilitation centres.

I was desperate to find decent health care and I was desperate to find other people with type 1 diabetes to share with. That's when I set about starting our support group.

At the Thriveabetes Conference, we found that sense of community, of strength. We have found a way to connect with each other and a way to help each other.


Today, we are planning Thriveabetes 2016!