Diabetes & The Vaccine Booster Hypo

Tis the season... for colds, flus and Covid. I imagine that many of you have experienced some kind of seasonal illness by now. Certainly, my own household has been through the usual coughs & colds and I imagine there will be more to come in the months that follow. We all know that colds are just going to happen. Flu, too will hit many and Covid shows no signs of going anywhere anytime soon.

Omicron, the latest Covid variant, seems particularly worrisome. I wasn't aware that things had developed beyond Delta. Time flies with Greek alphabet virus mutations, I guess. I don't know if the latest variant is more worrisome because the media have built it up to be so, if governments & scientists are using it to increase the uptake of boosters, if it's social media driven, if it's truly something to be very concerned about or if nobody knows, not yet at least.

I'm sure we'll know more in the coming weeks. Until then, booster jabs appear to be in high demand. Pre-Omi, it was very easy to book a booster jab appointment. I made one for the following day and only three others were in the queue in my local pharmacy. Yesterday, with news of Omicron plastered across all media, a booking was much harder to come by. An online booking system placed one of my household members at 450th in the queue. Last week, there was no online queue. Fear is a driver of many things... perhaps not T1D management. 

So, I've had the jab and 6 days have passed. I feel reassured by the data which indicates a strong protection against Covid illness for the vaccinated. Although, I'm disappointed by my lack of 5G despite upgrading my phone. I had the Pfizer flavour and it felt the same as my first two jabs; not very painful, no bleeding, just a little tight feeling in the outside of the shoulder. Previously, things had escalated at around 12 hours after the jabs. The shaking, sweating, feeling freezing cold, headaches and generally pretty grotty all arrived on the 12 hour mark. I expected the same and so I settled down for a night of paracetamol, drinks and the adding and removing of clothes. Nothing really happened to that extent. What did happen, was the strongest hypo that I've had for a good 4 or 5 years. 

You're a frequent reader of my waffling, so you already know that I don't get much in the way of hypo symptoms. My BG needs to begin with the number 2 before I'm even moderately aware that something isn't quite right. So, it was with great surprise to feel strange at a little over 4mmol/l - according to my CGM. Alright, I'll eat a few sweets to stop that little drop. 10 minutes later...

BUZZ BUZZ!

The screen was red and the number was 3.8. Now, I'm very grateful for the Diabetes technology that I use. It's saved me from very worrying moments and many lost hours of sleep. In this instance, I think it may have saved me from blue lights and a ride in an ambulance. Before the BUZZ BUZZ, I was feeling very sleepy and I was very close to actually falling asleep - in the back of my mind, I attributed that to the booster jab and I wasn't concerned. I'd just eaten some sweets and felt fine after all! Had I fallen asleep then I fear the outcome could've been very bad.

Let's try a finger prick

3.6 mmol/l

Few things, outside of caffeine, will stir me faster than a hypo. The shovelling of Squashies into my mouth began. I will eat three at once when low. I know that's pretty much 10g of carbs and it's easy to keep track of. I noticed, hand delving in to the packet, that I was shaking. What on earth is this!? A shaky hypo, like it's 1996? a very retro symptom.

BUZZ BUZZ DO DO, BE DO BE DO, DO DOOOO

What a cheerful sound; the sound of my CGM alerting me to a severe low. BG - 3.0 mmol/l.

At this stage, I'm swearing and eating. Sweareating? Eatcursing? Munchfuc*ery? Whatever, the Squashies were going in at pace, washed down with a tube of Glucogel.

I was soaked. Every inch of my body was sweating. I felt a combination of shock and delight. I have hypo symptoms! I can't wait to tell everybody! - Oh, yes, let's concentrate on staying alive first. My lips were numb and, as I stood to get more hypo treats from the kitchen, I noticed that my legs weren't really working. Wow! It's like every hypo symptom that I'd missed in the last 4 or 5 years had decided to visit, all at once.

Finger prick - 2.8 mmol/l

Alright, now I need help. I was alone, at home, with my son who was busy doing some gaming thing. I couldn't really walk and felt the safest option would be to call him. He brought a large glass of juice to me while I ate half a chocolate log, shaking and not able to communicate very well.

Another 15 minutes passed during which I found I was reminding myself that my pump was suspended, no insulin was going in, I had approx' 3000g of carbs on my side, it was going to be alright. 

It was, of course and eventually all that glucose lit the blue touch paper. I felt terrible and had the prospect of the booster jab side effects to come. They arrived, in the middle of the night, alongside a gut-rot which had me begging for the merciful release of death. 

6 days on, I've read some tweets by fellow T1Ds who have experienced a lot of lows since their booster jab. Maybe it's a thing? or it could just be a coincidence. To suddenly have such strong hypo symptoms, following much improved BGs (thanks to pumping) seems utterly strange. I hope they stay for a while and it wasn't just a fleeting visit. Horrible as they are, they are a great natural warning that something is wrong.

Do get your vaccine booster if you've yet to have yours. And maybe keep your hypo treats close by, just in case.

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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The Diabetes Technology Revolution

Welcome, Comrades. It's another blog about Diabetes tech because you haven't been inundated with news of it through your socials. Of course you have and it's been fantastic news! If you've missed it, in short, T1Ds in England and Wales are set to be given NHS funding for CGMs and some T2Ds (on insulin) are set to be offered NHS funding for a Flash Glucose Monitor.

The gates aren't being kicked down just yet. The above seems likely to go through in the March of 2022 because the behemoth that is the NHS and NICE aren't exactly agile in directional changes. Cool, fine, okay. 

The news doesn't really impact upon me. I'm one of those lucky social media types who are offered CGMs in return for reviewing and talking about functionality. I'm delighted for my peers, especially those who don't get along with Libre because of accuracy issues, adhesives, etc. I do hope that the CGMs on offer are varied, however. Having used several in the last 4 - 5 years and having spoken to probably thousands of other users, it seems apparent that different systems work better for some than others. I don't know why that might be but I've certainly noticed some monitors aren't within my personal parameters of acceptable accuracy and comfort. Recently, how environmentally friendly these devices are have become more of an issue - I've been talking about that since the summer of 2020 so, that's nice to see and it will be fascinating to watch how the different companies react.

Type 2 Comrades on insulin, how happy are you? I really hope that this news is the start of a more level playing field for you guys and you're offered equal respect and reduced stigma because of this and future developments. 

Are we really now heading into a full on Diabetes tech revolution? I saw Libre as the first step on that ladder when I first began using it, despite it's questionable accuracy, a few years ago. And now we're here - on the verge of total CGM access, no need to be under 18 or pregnant or both. Looping trials are seemingly progressing well. Type 2s are now at the party. Perhaps there'll be a cure in 5 years!? Hahaha. Sorry.  I think we are and we're right in the middle of it. The drivers of change must be thanked for that because even if this is as far as it goes for the next 10 years it will be a huge advancement in care and undoubtedly improvement in the long term outcomes for Diabetics.

Vive la révolution!

Where next? You've read this far without me mentioning NICE pump therapy criteria. But! budgets, tax payers! but there are people who need it more than others! but this, that and the other. I'm done with buts. If I wanted buts I'd be a colorectal doctor. Where there is a problem, there is a solution. If the problem is money then the solution is to obtain more or reduce spending to balance the books. But where from!? - Read the above about "buts". I'm happy to work on that solution for a very reasonable salary. If the problem is the current NICE criteria, and it REALLY is, then revise it. Just today, I've been told of others who have purposefully let their blood glucose run high to obtain pump funding because of the NICE criteria. Let that sink in. I know that I've briefly spoken about this before but now others are openly approaching me to tell me of such occurrences. That's self harm. In the short term, you risk DKA and possibly death. In the long term, you increase your risk of Diabetes related complications. Self harm and risking awful health problems to obtain something which should reduce those horrible things happening in the first place. 

So, today I'm calling for the scrapping and revision of the NICE criteria for NHS pump funding. It is not fit for purpose. Not only is it unfair and far too stringent, it is resulting in real harm in the real world and that is shameful.

 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

90 Days on an Insulin Pump

The 90s were definitely "my era". At the beginning of that decade, I was a schoolboy. Ten years later, I was engaged to be married. Everything in between was magnificent; the friendships (some of which still exist today), the nights out, the loves, the football, the TV, the Internet became a big thing and the music... Wow! the music. Of course, many reminisce about their teens and early adulthood and remember things through rose-tinted spectacles. Why not? Holding on to good memories can't be a bad thing. So, the 90s were important to me but you didn't come here to read my autobiography. 

90 days on an insulin pump has become incredibly important to me, too. I'm not sure I would swap the entire 1990s for this experience but it's up there with life changing events. 90 days is often the window used to monitor T1D management. Your HbA1c, TIR, hypo events and all the usual MOT bits and pieces get the once over by your HCPs for that period. I have some data because of using a CGM, some of that looks like this:

- Time in range: 82%

- Estimated HbA1c: 6.8%

- Hypo events: 7

 How does that compare to Multiple Daily Injections? I have some data!

- Time in range: 63%

- Estimated HbA1c: 7.5%

- Hypo events: 9

I am delighted by the improvement in the numbers, of course but they are a second, a distant second, to something more important. Something which, once we've accepted that Type 1 Diabetes is here to stay, becomes something we might strive for; a good quality of life.

QoL will differ from person to person because we all lead different lives. For me, it means reasonable levels of sleep, to not feel overwhelmed at the prospect of another injection, to wake up without Dawn Phenomenon ruining my morning, to be able to bolus for meals in comfort in public, to have more confidence in so many ways... to feel, dare I say, a step closer to being a person who does not have Diabetes. A baby step, perhaps given that I look like Robocop. Your move, NICE.

Ah, yes, NICE. Guidelines, criteria, a tax funded system. I know, I get it. Tax payer funded healthcare must have a criteria for various things which could impact upon the purse. So, unless you meet the current insulin pump criteria, you're going to find NHS funding hard to come by. Your health and wellbeing is secondary to the bottom line, sorry. That's the harsh reality of where we are with insulin pump access in England. All the noise and enthusiasm about Looping trials is super but you can forget Looping unless you're on an insulin pump and for that you need to meet the NICE criteria. A1c under 8.5% and on MDI? suddenly all the exciting Looping headlines don't look so... exciting.

"Keep asking"

"Keep making noise"

Oh, I will. Earlier this month, I reached out to my practice nurse and GP in regards to my switch to pumping and the barriers I am facing in getting full NHS support for it's long term use. We did have a nice exchange and I feel very supported by primary care but, of course, there is little they can do to change the decision of secondary care. Secondary care are understanding to a degree but their hands are tied by NICE criteria and a limited budget. Frustrating, eh!? This isn't a Path To Pumping blog, it's a little overview of the last 90 days, so I'm going to stop this particular subject in this paragraph. Needless to say, we are not done.

A few things have cropped up in other discussions, lately. Some questions which I can actually answer!

How does long acting insulin work in the pump?

It doesn't. The pump continually "drips" fast acting insulin. That becomes your basal. You don't notice it happening as you might not if you've ever had a drip in hospital. Your pump is programmed to give you the insulin you need, hour by hour. For a bolus, you ask it for more!

How are you rotating sites with your pump and CGM?

Legs! Although I have plenty of abdomen to work with. The CGM is a "set and forget" thing for 2 weeks, the pump cannula can then be moved around that. The pump works perfectly well on a thigh, by the way.

Are you going to Loop?

Once I have obtained NHS pump funding and Looping is embraced across the board, maybe! I know some are Looping and have more lows than me but similar numbers in other ways. I will, undoubtedly, try it. It seems inevitable and I expect numbers to be the same or better but the more important QoL will be ramped up another notch.

One of my patients mentioned your switch to Fiasp and Pumping in their appointment!

Good! Apparently, I'm an "Influencer" but I don't try to be. 

It seems that my switch to pumping has gained a lot of interest from my peers and various HCPs. As always, what works for one does not necessarily work for all. However, if you think that pump therapy might work for you then please do start the discussion. Noise will change things for the better for us all. The squeakiest hinge gets the most oil.

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

Due Diligence

How is your Diabetes Awareness Month going? Still aware, I know. Hilarious jokes aside, there has been a lot of really good information and experiences shared on social media. Yesterday, World Diabetes Day, saw the awareness posts increase further and I think that's a great thing. If we want others to understand the condition which we try to manage 24/7 then it makes good sense to talk about it openly. 

It makes good sense for the people living with D, the Diabetics, to talk openly. Even if the facts aren't always correct, you'll still read first-hand lived experience. I've been an advocate of talking for several years now because, for me at least, it is a source of therapy, information exchanging and a super way to just vent about my T1D.

As individuals, we don't really need to perform much due diligence ahead of publishing our thoughts. It might be a good idea to hold fire if you're angry or upset or going through a rough time with your mental health but I think on a general day we can simply hit the Tweet, Post, Submit, Send buttons without much of a care.

In the world of health care, for profit or otherwise, I think far more care is needed and I think that there is enough information and help around for any business to avoid the brown hitting the fan. That is especially true if your business is Diabetes focused. Then you really need to be getting the right people to give you the right advice because nobody loves a pile on like social media folk while trying to balance their blood glucose levels. Some of us are happy to highlight the damaging, too. What sort of advocate would I be if I didn't vilify the hurtful and stigmatising of my peers? A pretty bad one, I reckon.

I don't actively hunt for the trash content, I have a life. I will amplify it when I see it. I might have a little sarcastic rant or simply pose an open question. Of course, how a business reacts to that is their "business" and how I give my support to them in the future, if I amplify their campaigns, if I accept any work from them, then depends on that next reaction. I think that's the correct way to behave in most aspects of life. See a mistake, highlight the mistake, wait for correction (or not) then move on in whatever direction is most morally comfortable for you.

The World Health Organisation posted some pretty awful things in relation to Diabetes on World Diabetes Day. Normally, I would include a link or a screenshot here but I think many of you have already read that rubbish or it won't take you very long to find it if you haven't and you're very interested. It's disturbing to think that an organisation of that size cannot hire somebody to perform some fact checking over their Diabetes posts and infographics. A little due diligence for the care of their 10.1 million Twitter followers, especially those who live with Diabetes, shouldn't break the bank. I imagine the right Diabetes advocates would offer their time for free for such a thing. 

That is not the WHO's only "gaff". They were busy stigmatising during their Compact summit in April. 7 months later and more trash from the same organisation. I could talk about some of their Covid-19 posts, next. The list is starting to look pretty long and very, very trashy. 

So, right now, that's me done with the WHO and everything related to them. I'm sure they'll cope without me. It was all a bit downhill after Baba O'Riley anyway.

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