Incomparable - Oh, We Are Not The Same

 

Isn't it strange when we're told "We're in the same boat"? Not just in relation to Diabetes, but any given situation in life. It seems like such a lazy way to show empathy to me and it always has done. It's a phrase that is thrown around by people who I believe struggle to adequately relate to others and when a similarity happens it becomes their "go to".

Oooft! pretty harsh opening paragraph, sorry. I actually find the use of the phrase to be quite offensive and belittling of my own struggles in life. I relate to the issues Type 1 Diabetics face, of course. Many of which are indeed very similar or as near to being the same as they can be. Many are very, very different.

I think it's good to have an understanding of differences in regards to T1D, primarily because I think it's dangerous to assume we can all reach the same "goals". HbA1c, TIR, hypos per month, etc all have targets. The targets (which have been moved many times during my time with T1D) are considered the best way to live a healthy life with Diabetes. That might be right, who am I to argue? I do think the right approach to setting targets is to make them tailored to each person, taking into account personal circumstances, history, other health matters and frequently experienced problems for Diabetics such as burnout. I believe the engaged HCPs do practice that.

Should we scrap the 6.5% HbA1c and 70% TIR generalised targets and focus on individualised care? 

It's interesting to see an HCP cite an A1c as "A record" for them, on social media. Of course, such a Tweet got the attention it deserved. It did evoke memories of an appointment at Diabetes clinic, many years ago. On this rare visit, at some point in the mid 1990s, my then consultant referred to a different patient by their first name, as the person who he saw before me. Offering an "inspiration" to me, Dr X told me about the previous patient's HbA1c and how long he had been living with T1D & how I should easily achieve the same numbers if I worked harder.

Things have changed, I think. Haven't they? Perhaps not, if an HCP feels the urge to take to Twitter with such exciting news. Perhaps things are better but not entirely? Or maybe I'm being too kind? Certainly, my own experiences in clinic have been vastly improved on those of 25+ years ago.

You're probably reading this because you have Diabetes or you care for somebody with Diabetes. I could ply your eyeballs with inspiration for several paragraphs. You might even feel hopeful because of that. Instead, I'll try to keep it brief: You're never going to be a perfect diabetic. You'll have great days, days when you feel you absolutely own this condition, days when you check your blood glucose and your internal voice screams "Who's the daddy now!?". You'll also have days of despair and everything in-between. If you decide to engage others in Diabetes communities, such as GBDoc, you'll find differences in how others do things, how things work for some but not others, how we're not actually all in the same boat or sailing the same seas. We're not even facing the same storms. We're just trying to survive in our own ways, living our own lives and that's the only true identical thing which people living with Diabetes share.

Thank you so much for reading this blog. I do appreciate your visit and your support. As you might know, I LOVE COFFEE! So I've teamed up with a thing called Buy Me A Coffee. If you enjoy my content and appreciate the time it takes to create such things then you can buy me a coffee! If you leave your Twitter @ name when you buy me a coffee, I will personally thank you. If you'd rather be anonymous then that's totally cool. Thanks for the caffeine!

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What a Site! - Diabetes Tech Worn by Everyday Diabetics

Have you noticed the Diabetes Tech ads on your TV, lately? It seems to be a marketing avenue that a few companies are exploring. I'm happy about that. It normalises the use of the technology in day to day life and reduces stigma around Diabetes. One particular ad' caught the eye of my mother, who asked "Don't you use one of those disc things for your blood sugar?" She'd seen a Libre ad' featuring a woman, swimming. The conversation led to my explanation of how the tech works and how we both wished it was available in the 1980s when I was diagnosed. 

It also led me to think about the marketing around Diabetes technology. The images, videos and individuals used. Nick Jonas might spring to mind? Perhaps a few other names, too. Of course, the famous and the achievers deserve access to Diabetes tech as much as the rest of us but perhaps it's time to celebrate the "Everyday Diabetic" a little more in such marketing. I consider myself be a Everyday Diabetic - Just a man who talks about his condition, warts and all, on various platforms. I'm lucky to have an agreement with GlucoMen, who appreciate my content and supply me with their Day CGM. I'd love to see more individuals given similar opportunities.

So, reader! Allow me to present to you some of my tech wearing friends from around the world. Beautiful souls, kind hearts and living their best lives while wearing Diabetes technology to help them manage their condition.

It seems that we're a diverse lot. Not just in the management of our condition but where we put our technology. Arms are popular! The Libre wearer in the photo at the top of this blog moves hers around:

"I was in need of a new spot, as the back of my arm needed a bit of rest (the sensors aren't too kind to my skin, especially then - I expect they have changed something with the adhesive). Besides this it tends to come loose quite easily, so it's a lot less of a hassle on the front."

That's Julie, she says "I wear my sensor on the side or to the front of my arm, because I can see it I’m more conscious of it so I don’t knock it off, when I wore it on the back of my arm I was always knocking it off especially at work and when strength training."

Jimmy likes to keep his sensor warm, "I wear my taped up sensor on the inside of my arm (it doesn't like the cold)"

Some sensors have a habit of coming loose and falling off! So putting a strap on could be a great idea, especially if you have a 3rd party add-on such as Bubble.

Hot weather (even in the UK) causes issues, too. That's why Richard tapes his in place.

The 3rd party add-ons are still a popular thing when it comes to turning Libre 1 into a CGM.

While arms are still popular this pump user prefers core sites too, noting "Here’s where my pump is currently sited. I also use my arms, back and backside."

And if you have two pieces of tech for your blood glucose? "My trial of Dexcom is about to expire so here’s one of the Dexcom and a new Libre soaking in before I activate it in 24 hours time. Both on my stomach."

How about a pump on one side and a CGM on the other? Tummy button piercing is an optional extra which might not be NHS funded. This tummy belongs to a Diabetes tech user who is proud to show off her gadgets, "If it helps others, I'll be happy. I'm not shy in showing it either, bring on the summer bikini shots"

How about a close up on a pump cannula in action? Textbook stuff!

That one probably isn't in many textbooks! But, do you know what? Sometimes rules are made to be broken and if it works for you?... "The readings were less than 0.5mmols different and frequently equal to blood glucose"

Chest is best?

Robert might agree, with this upper-chest Libre. "Pump on my arm, libre on my chest, I'm usually the other way around. I try to avoid my waist for pump as I over did it a bit!"

Anybody for legs?

"I started using my upper legs for my pump sites about two years ago! Mostly because my CGM had to be on my stomach (it is now also been approved for your arms so that's where mine is now)! I have a lot of stretch marks, so a bit part of my stomach is unusable. I have also noticed that since switching to my legs, I have not had one bent cannula, this was something that happened often when i still used my stomach for my pump infusion set."

Guys use their legs, too. Including this pump user.

A late entry comes from this patch pump user. What goes on around the front, goes on around the back.

So, there's a splattering of lovely people and their tech sites. What, me? Alright then. It seems only fair that I show you some of my tech sites from over the years.

GlucoMen Day CGM on my tummy.

Libre leg.

Dexcom arm

Thank you very to everybody who contributed to this blog. I think we could make a calendar from these photos. Imagine seeing my thigh on June 1st!? K, maybe not.  Also, for confirmation, all contributions to this blog agreed to me publishing their image and quoting their words.

Thank you so much for reading this blog. I do appreciate your visit and your support. As you might know, I LOVE COFFEE! So I've teamed up with a thing called Buy Me A Coffee. If you enjoy my content and appreciate the time it takes to create such things then you can buy me a coffee! If you leave your Twitter @ name when you buy me a coffee, I will personally thank you. If you'd rather be anonymous then that's totally cool. Thanks for the caffeine!

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Covid-19 Vaccination - Dose 2 Side Effects

As the sticker in the photo says, I've had my Covid vaccination. You probably know that because you likely follow me on one of my social media channels and everybody must mention their vaccination and/or post a photo of their badge/sticker/arm - It's the law.

Before I start, if you haven't read my original blog post which followed my first vaccination then you can do that by clicking or tapping here

Side effects! That's why you're here. You want the gory details and possibly some reassurance before your own jab? Can do! We're talking AstraZeneca here, by the way.

I'm 72 hours post-jab and I'm beginning to feel more like my usual self. Certainly well enough to smash my fingers into a keyboard, unlike yesterday. To begin with, and for a while, nothing happened after the jab. I was expecting the violent reaction at around 12hrs, the same as Jab No.1 but that didn't happen. This time the side effects crept up on me.

The first changes of note began after 6 hours. I felt hot and clammy, similar to a hypo symptom. I'd already taken a pre-emptive dose of Paracetamol and that may have reduced the severity of any fever before it had the chance to begin. That feeling continued and escalated slowly for the rest of the evening until, when it was time for bed, my face and neck were feeling hot to touch and, strangely, my nose was hot! I was also beginning to sniff a lot. 

I did sleep reasonably well which was a surprise. I was delighted to not be woken at 2am by violent shivering and not feeling frozen to the core. There was more a sense of general uncomfortableness. A little like when you know a cold is just about to begin. I was also delighted to not feel like every bone in my body was hurting. The aches began after around 24 hours, especially in the back, shoulders and legs. The aches continued for a full day, despite a combination of Paracetamol and Ibuprofen. Normal side effects, according to the advice I've read and was given by the friendly jab-giving HCP. 

The worst period of side effects, for me was between 24 and 48 hours. Add all the above in with fatigue, a sore throat and running nose. Yuk! That said, it's just cold - mild flu-like symptoms but I think because I was confident in the knowledge that it'll be short lived, rather than a real cold or flu which might last for weeks, it wasn't overly distressing. In fact, it wasn't distressing at all to just rest. I'm great at sitting around and doing nothing. It's my favourite.

What about the Diabetes!?

I noticed that my usual carb:insulin ratio was no longer a thing. Previously, I was a 1u for every 10g guy. Easy! So, it was a surprise to need 18u for a 60g meal. Even that didn't succeed in bringing my blood glucose into range. Prior to the jab, my time in range was around 70% on average. I'd actually had several good weeks of over 80%. Here are the last 4 days:

Saturday: 48% (Jab day)

Sunday: 37%

Monday: 58% (after aggressively increasing my boluses)

Tuesday: 60% (Today)

Not wonderful and I'm still struggling to keep things in single figures. I'm sure that will settle down and I'm not very concerned. 

What I am is incredibly grateful.

Let's start with Covid-19. To date, I've dodged it and so have all my friends and family - The majority of whom are now partly vaccinated, fully vaccinated or at low risk. If the struggles of the side effects are anything to go by then I imagine the infection would be horrendous. The imagery and tales in the media and from others on social media confirm what an awful illness it is. 

People in other countries continue to die in huge numbers because of the virus. In England we had our first day of zero deaths for a long time, yesterday.

Although it's too soon to consider the world or even the UK to be safe, I feel like this pandemic has given me a different, better perspective on life. That happened to me in 2012, following almost two years of living with severe visual impairment. Two years of wondering if I'd seen my last of everything and everyone that I love. Then the world appeared again and wow! When that happens, you really appreciate the things that you were once complacent about. I'm in a similar place, today. The things and people I love are magnified. I no longer have time for the things I don't enjoy and I have no time for individuals who are... vexatious to the spirit! Desiderata still gives great advice.

Thank you so much for reading this blog. I do appreciate your visit and your support. As you might know, I LOVE COFFEE! So I've teamed up with a thing called Buy Me A Coffee. If you enjoy my content and appreciate the time it takes to create such things then you can buy me a coffee! If you leave your Twitter @ name when you buy me a coffee, I will personally thank you. If you'd rather be anonymous then that's totally cool. Thanks for the caffeine!

BUY DIABETIC DAD A COFFEE HERE

 

Don't Worry, Be Spiky

Sharing blood glucose graphs, A1c results, time in range and general day to day T1D information has been the subject of debate for a little while, now. Perhaps since CGMs and Flash Glucose Monitors began to be more widely used in the social media communities. I'm fine with that, as I've mentioned several times before. I think it's great to see the shared information and, to some extent, the info published by others has helped my Diabetes management.

I understand that some information can worry or even trigger others into feeling inadequate or guilty. It might even bring about feelings of envy or that you're not doing enough. I use technology to monitor my blood glucose but I also use insulin pens to inject my basals and boluses. Sometimes, I'm envious about others who talk about their pump and how it has reduced their burden and improved their management. Furthermore, I sometimes feel envious of others who mention Looping alongside the obligatory #WeAreNotWaiting hashtag. A little voice in my head chirps away for a few seconds; "I'd like to try that"  But getting access to a pump, learning to Loop, etc is not as simple as sending an email or demanding it from my consultant. Could I do more? am I damaging myself by not kicking up a stink and manipulating my HCPs to prescribe the latest in pump tech to me. 

Why others, not me? 

That's why I understand the negative feelings of some when they see shared information. I also understand that I cannot stop others from sharing their own information on their own social media accounts. So, for me, it's a question of skipping on by the tweets or posts which might cause me to feel negatively and moving to the next ones. I recommend that course of action if you struggle with the shared information of others.

And on we go to the main course of this blog. Firstly, let me just confirm that I have full permission to share the graphs you'll see below. Secondly, as you may have already guessed, I'm about to share some blood glucose graphs. If you're uncomfortable with that then thanks for reading until this point, please drop by again soon to read another blog post.

Before you see any graphs, allow me to explain why I'm sharing them and who they're from.

They're not mine. I'd love it if they were! They're from somebody who is learning about T1D and how blood glucose reacts, an HCP who does not have Diabetes. Their sensors were not destined for NHS patients or anybody living with Diabetes. I'm sharing these graphs because I think that I'm sometimes guilty of over-worrying about my own blood glucose. I suspect we all are at some point. In addition, I think some people "live on the edge" when it comes to blood glucose and have frequent hypos because of the fear of "going high". Whatever "high" might be! It's a personal thing from Diabetic to Diabetic.

Comfortable? Then let us begin.

Remember, this is a graph from a person who does not have Diabetes. It looks like lunch increased their BG from 6 to 9mmol/l before a steady decline over the next hour or two. Later on, look at that rocket ship! That was caused by a milkshake and it looks very similar to how my BG reacts to something sweet and carby, my Type 1 Diabetes BG. That number and that arrow might cause me to worry that I've miscalculated my bolus. I'm heading into double figures, rapidly and need to react. Usually, I will and the inevitable hypo appears on the horizon because I didn't need to do that.

The Non-D blood glucose eventually dropped and, assuming my bolus was correct, so would mine. Insulin, home-made or otherwise, does usually work. 

It seems clear to me that we're not designed to have a flat-line blood glucose. It doesn't need to be between 4 and 5 mmol/l, 24hrs a day. As a Type 1 Diabetic, it seems to me that being in that zone frequently is asking for many, many hypos. It's right on the cusp of the hypo zone. One small miscalculation, 5 minutes more physical exertion, forgetfulness, etc and you're treating a low. We're told to avoid high blood glucose because it increases the chances of complications but what about frequent lows? The brain needs glucose to function properly. If you're tip-toeing on the hypo line a lot then are you increasing your chances of complications of a different kind?

I'm curious as to the answer but I'd rather not discover that personally.

How about another one?

I'm getting graph envy... Anyway! A steady 6 mmol/l again with little spikes following breakfast and lunch. Totally normal stuff. No flat line at 5mmol/l because this person eats, works, exercises and lives a busy life, as most of us do.

I've got more.

Would that graph worry you? It's the same person. You might describe that as "Spiky" or "Yo-Yoing". Yet they're just sleeping, waking up, eating, working. All the while their lovely organic insulin is working away, keeping things as steady as possible. Just as we do with T1D. 

Last one

I'm not sure what is happening here only that this person's BG is trying to draw a cat. Or a bunny!? But there is proof that a person who does not have T1D can sometimes spike outside of the preferred range, briefly.

Let me be clear, I'm not advocating for complacency when it comes to managing blood glucose spikes. Keeping things in the Happy Zone is important but what I have learned from seeing these graphs is that it's normal to see your BG increase sometimes, particularly after a sugary meal or snack. I've learned that I don't always need to react immediately to a jump up in numbers if I have insulin on board. Finally, living on the edge of a hypo is not living and might possibly be damaging to my health.

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