Back To The Future

Great Scott! Or similar words have been exclaimed by me since the summer of 2023. The reason for such excitement? Hybrid Closed Loop. You've probably read some of my gushing on the subject and I continue to talk positively about it today because... well, sleep never gets old.

Prior to HCL, like many using the tech, I was using a pump and various types of CGMs separately and that was perfectly acceptable. My numbers were as good as they'd ever been; Great Time In Range & HbA1c. I felt no urgency to switch to closed loop.

As is often the case, talking to peers results in changes and it was an unrelated conversation that resulted in one kind person sending me a spare Dexcom G6 transmitter... then another from another person... and Anubis transmitters from two others. People within the diabetes community are really very kind. All that tech meant I could try HCL for a good while - over 6 months. So, I did.

There are lots of posts about how well things went for me in that period. Towards the end of my HCL time, I had my diabetes review with my consultant. He agreed that HCL was working well for me and that funding would be discussed at an upcoming meeting. Fantastic!

Of course, the tech expired as tech has that annoying habit of doing. I thought nothing much of it. I assumed it would be a seamless transition back to simple pumping and CGM use. It was. Reinstalling the old app was a pain in the neck because I can never remember usernames and passwords but, after some swearing and sweating, I managed to get set up again with Dexcom One. Quite soon, I realised just how much work I was putting in to this type of management compared to the recently ended Hybrid Closed Loop days.

The numbers were not looking great. *sigh* I thought I'll get through the life of the current sensor, then I'll buy a G6 transmitter and hop back aboard the Looping train. I noted the difference in managing Type 1 Diabetes through HCL vs standard pumping, on X. Peer support came to the rescue (again). Another spare G6 transmitter landed on my doormat just two days later. The #PayItForward movement is a remarkable one. My donor would not accept any reimbursement for postage. Blessed, I promised to donate something to my favourite diabetes charity - Action4Diabetes as my own Pay It Forward. Of course, if I'm ever in a similar position to my donor friend, I will do the same thing for others. 

So, I'm back in the future! and over the last few days, the numbers are already proving how incredible the technology is once again. When just pumping and using a CGM separately, my average blood glucose was 8.5 mmol/L. I know that's not terrible, really. Yet, I could "feel" it. I was sluggish and just... blunted. Finding the right words is difficult. Needless to say, I was not myself.

And after a few days in the loop?...

Already, a significant difference over the previous 2 days. I think the numbers speak for themselves. You've probably read enough gushing from me, by now.

What happens next? I'm going to relay my experience and thoughts to my diabetes team. To move to HCL, then move off it, then move on to it again seems a little unusual and they may benefit from hearing about what has happened while looking at the data.

Also, and I've said it many times, I can never repay those who have been kind to me over my diabetes in the last 7 years - since opening up and talking about it online. I do try through various means. Some of those don't sit well with everybody and that's alright. Even the kindest will meet opposition and anger and jealousy. Do good things with good people. You'll usually finish up sleeping soundly, especially if you're using Closed Loop! 

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Hybrid Closed Loop - My Thoughts

The future has arrived! Yes, I know many of you reading this will have been managing your diabetes with Hybrid Closed Loop for a while now and that it's not exactly new news for you. 

At Dad Towers, I've been hesitant to take the "next step" from insulin pumps and CGMs to the "all in one" of HCL since I began using an insulin pump in 2021. I didn't feel the urgency to change what was already working well for me, I didn't feel inspired to learn about closed loop, HCL, AID, APS and host of acronyms which were, to be frank, a bit of a turn off. I write those words as somebody who is very pro-tech when it comes to diabetes management and as somebody who understands most of what HCL means. Still, in the last couple of years, I felt in no hurry to try it.

As is often the case, conversations with peers, particularly well-meaning peers within #GBDoc, resulted in the change. As is also often the case, I've done this without the "blessing" of my consultant or an agreement with any of my HCPs. We'll talk about access later on.  The kind-hearted folk within #GBDoc have taken care of me on so many levels in the last 6 years, so I suppose it's not really a surprise to have transmitters, sensors and even different CGMs sent to me to try out. It's not a surprise, yet my heart bursts with gratitude when others offer the time, energy and often money to support me. I'll do what I can to pay that forward, of course.

Right, let's get into it; HCL, is it any good? 

Firstly, take a look at the image above. That's a screenshot from Dexcom Clarity. A nice splattering of green days and impressive time in range. For the system I'm using (Control IQ via Dexcom and T:Slim) those numbers didn't take long to achieve. The first day or two on HCL was fascinating to watch. My pump was constantly adjusting my basal rate, administering little boluses, reducing basal, suspending insulin, etc. Basically, it was micro managing everything and doing so for 24 hours a day. I love a little micro managing action myself, but even I can't do that for 24 hours a day. Impressive stuff and the results were almost immediate, lines have been flatter, spikes less spiky, hypos less severe, and I imagine my next HbA1c will reflect this improvement in management...

...management? Yes, you're still the boss, you can still administer a dose, you still need to carb count and pre-bolus for your meals & snacks. You're not a complete passenger with HCL but, if you're anything like me, you'll need to learn to let the machine do it's thing and trust in the tech. 

I've put HCL to the test a few times, including early on when I purposefully carb counted 50% lower than the meal actually contained. I expected a spike and it did happen, yet HCL sprung into action and upped my basal rates quite dramatically. It caught my purposeful error and brought me back into range within an hour or so. Wow!

Recently, I spent a few days away on a short break. That included a day at the beach. Walking and warm weather is a recipe for a hypo for me, but I thought I'd put HCL to the test again. I left my hypo treats in the car and armed only with a debit card to purchase food and drinks from a little cafe, I set about wandering around the sands... some running around too, with a Cocker Spaniel enjoying the new environment to sniff and explore. I kept an eye on Control IQ, which displays my blood glucose alongside exactly what's going on insulin wise. From a starting BG of 7.6 mmol/L, things dipped to 5.8 mmol/L and at that stage my insulin was suspended by Control IQ. Trying to not worry, I headed to the cafe to buy a sugary drink and as I cracked open the can of brown fizz, my BG was back to 6.4 mmol/L. No input from me, closed loop did all the work.

Of course, I'm not suggesting ANY level of exercise won't require some input from you when you're using HCL but, for me at least, walking around a beach for a few hours wasn't the huge problem it once might've been. And I definitely don't recommend leaving your hypo treats behind - That's just silly. 

However, that's a tremendous thing about closed loop; it reduces the worry, the decision making. You can just crack on with whatever you need or want to do and if any problems arise they're likely to be minor ones that need minimal input from you. 

It's not a cure. It's definitely not an "artificial pancreas". What it is, is an advanced way to manage T1D. Now, the only issue for me, as it was with pumping, will be to convince my consultant that HCL is right for me. That means obtaining Dexcom G6 funding.... or does it?

Whaaaaaaat?

Well, the thing is, Dexcom One sensors will work perfectly well with G6 transmitters. The sensor codes have been "hacked" and a list of Dexcom One code: 2222 = Dexcom G6 code: 4444 (as an example) is freely kicking around on your Interwebs. So, essentially, I only need the transmitters while I'm prescribed Dex One sensors. Conversations are to be had! 

Finally, you've probably noticed that Partha & co. have been working hard on making HCL accessible in NHSE. There'll be criteria, and from the outset it looks less stringent than the insulin pump criteria of old (7.5% A1c vs 8.5%) so, that's a good thing. I imagine access will be more relaxed as the next few years roll by until we reach a point where all with T1D can access closed loop in England and Wales. Perhaps that's called the Libre Point? Remember in 2017/18 when access to Flash was the big issue? Here we are, 5 years later and still not cured, but access to that tech is no longer a problem.

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Dexcom One CGM - In Review

It's been a number of years since I last used a Dexcom CGM. In 2018 and 2019, I used the Dexcom G5 followed by the G6 and my experience was "patchy" for various reasons. So, it was with hesitancy that I accepted the Dexcom One "Starter Pack" during my latest diabetes review appointment. It was offered to me following the sharing of my experiences of Freestyle Libre 2.

Firstly, how wonderful to have a choice of blood glucose tech. I know most areas in England and Wales are offering a choice of Libre 2 or Dex One yet many are still finding it difficult to access one or the other - mostly Dex One - at the time of writing this blog post.

The Starter Pack contains everything you need for 10 days CGM use - 1 transmitter and 1 sensor. You'll need to install the Dexcom app on your phone and create an account if you don't have one already. Then, you're ready to go!

You'll need to "pair" your phone with your Dexcom One transmitter. Pairing is a simple process, just follow the steps on your phone screen. Once you are paired up, you can insert the sensor using the single use applicator. By the way, be sure your phone is compatible with the CGM. Dexcom will have a list of compatible handsets on their website. 

The sensor applicator looks and feels a little like a computer mouse. There is one orange button to insert the sensor under your skin and a small protective orange strip to cover it. You'll need to snap that off before you press the orange button. You'll also need to remove the two slips of paper that cover the sensor adhesive area. Once the paper is removed, hold the applicator against your skin and press the button. Sensor inserted! Just ease away the applicator and dispose of it as best as you can. It's a pretty chunky lump, making recycling difficult. Some have suggested breaking it up with a hammer to make recycling easier. I think Dexcom could do a lot more to be planet friendly, here.

Before you go waving a hammer around, pop the transmitter into your sensor. Next, follow the app instructions to begin the warm up process. If you've never used a Dexcom CGM before, then get ready for a wait. The Dexcom One takes 2 hours to warm up so, maybe don't do this right before bed.

The warm up process was problem-free and BG values began to appear. The first few readings were pretty close to my actual blood glucose. "Great!" I thought, until my BG dropped so low that numbers became letters on the Dexcom app. However, I wasn't hypo. Things didn't get any better for a good 6 hours, throughout that time I remained outside of the hypo zone. I decided to let the CGM "bed in" and, erm, go to bed.

I don't know if it was just really tired from sitting in a box on my living room floor for a few days, but the rest seemed to do the CGM good! Fasting BG in the morning was very close to the Dex One number, which was also very close to the Libre 2 number (I'm wearing both devices at the same time). 

Heading towards 7 days with Dex One, I've become comfortable with it and I have begun to trust it. Compared to Libre 2, it has been closer to my actual BG for more of the time.... just! The difference between the two is very minimal for me. L2 is reading a little lower (it usually does) than Dex One, but not by worrying amounts. 0.5 mmol perhaps as an average.

Accuracy aside, the Dexcom One app is a very stripped out affair compared to LibreLink. It will offer some eA1c info via Clarity and some Time In Range data, but there is no place to leave notes and no way to screenshot the app. Read this in your best Nick Jonas voice - No screenshots? Really?! Some of you are going to suggest using third party apps and you're right. You can screenshot and note leave using different apps. However, I'm not a fan of unofficial apps when it comes to my data, support, security, yada yada. Also, the tech newbies don't want to be overwhelmed by having to install multiple apps to do things they could do with one app on LibreLink. I'm not a newbie, I'm just big hearted and I care about the people who are.

The app is my only gripe, really. Yet, it works and how often am I going to leave passive-aggressive notes about the sensor accuracy? Do I really need to screenshot my BG to encourage keto diet zealots to question how long I'll be keeping my toes with those numbers? Maybe not. I've drifted off track. My gripes aren't a big deal. They're little annoyances. The important thing is the CGM works well. At least, after the first 6 hours.... 8 hours if you include the warm up. Yeah, that first day is pretty annoying. I can accommodate that, though.

What else? 

- It's ergonomic. No sharp edges to catch on clothes, bed sheets, other humans, etc.

- It's simple to set up. Minimal steps and great on-screen instructions.

- Satisfactory accuracy vs Libre 2.

- 10 day wear isn't wonderful. That's 3 sensors per month vs the near 2 for Libre.

- 90 day transmitter usage is... okay... remember GlucoMen Day have rechargeable transmitters that last for 5 years.

- Waste could be better. That big lump of applicator, 3 times per month. Eeek.

That's about it. Soon, I'll need to make a choice for NHS purposes. Dexcom One or Libre 2. Which one do you use? Have you been given a choice?  

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Diabetic Christmas

Ho ho ho! Merry Christmas. It's that time of the year again! Fun, food and excess are on the agenda for many, including the diabetic community. Whaaaaaaaat? But, you can't have excess, food or fun if you have diabetes, can you?!

If you were to pay attention to many media outlets, websites and the social media accounts - often claiming to be a diabetes expert, doctor, lifestyle coach or miracle worker who can cure you of diabetes and herpes (!?), then! you might be forgiven for believing that Christmas and diabetes do not mix. I can't and won't talk about your diabetes in relation to Christmas, that's a ridiculous thing to attempt because I know very little about you and your diabetes or how Christmas impacts upon you. The common use of "We" when diabetes advocates talk about the condition has never sat well with me. "We" suggests to me that a person is expressing the views or conveying the words of a community largely or entirely. In reality "We" refers to the person behind the keyboard or microphone and perhaps a relatively small number of people who have diabetes. It's totally alright to use the word "I" when expressing yourself, I promise. So, with that little rant off my chest *I* have a few things to say about T1D and Christmas.

T1D because that's the diabetes I live with. I'm a Type 1 Diabetic. 

Christmas has historically been a tricky time of the year for me especially those first few years as a recently diagnosed diabetic. Looking back, the avoidance of chocolates and sweets and pursuing precise carb counting seemed very reasonable at the time. Strict "control" was hammered into me and my parents. Of course, I stole sweets and chocolates and had strangely elevated blood glucose for several years at Christmas time. That advice and care seems a lifetime ago and indeed it is, I've recently passed 38 years with T1D. Today, there is no advice offered to me unless you count the unsolicited, largely nonsense, advice offered via the sources mentioned above. Christmas was a tricky time but no longer. Why?

Education has played a large part in understanding my own T1D. That has emerged through the lived experiences of my friends and peers and, to some degree at least, the official information published by recognised authorities on the subject. Alongside the education, the tools of 2022 are a million miles better than the tools of 1984. Come to think of it, the tools of 1984 weren't much of a thing at all. Finger pricking took an age and involved popping down to B&Q for a colour chart. Berocca style tablets had to be dropped into a tube of your own urine and injecting insulin involved borrowing a javelin from Tessa Sanderson and mixing two different types of Banting Juice together yourself. Definitely not the good old days and before 1984 it wasn't exactly a rose garden either. The tools of today are simply incredible in comparison. A tiny pump and a CGM are attached to me and they're helping me to effectively manage my blood glucose and live a much less burdensome life than in the years gone by.

Less burden, well managed blood glucose... it sounds like Christmas might not be such a stressy diabetic experience now. It's not for me. If I know the carb count, I bolus for it. If I don't know the carb count then I'll guess and correct any mistakes later on. The CGM alerts me when I'm high or low OR even when I'm within 15 minutes of a high or low event. I can relax and enjoy what any other person might do during Christmas. That never seemed like a possibility to me when I was young and I'd simply given up on the idea of an easier diabetes during my 20s and 30s.

Apparently, life begins at 40! My diabetic life has certainly gone through a renaissance since I hit 40, since I grabbed the little shit by the neck and took charge, since I embraced and accepted it, since I discovered a huge community of peers - dozens of whom are now really great friends, since I pushed for the technology which I need to lift the burden and improve the numbers which I get a little obsessed about from time to time. 

A Diabetic Christmas feels like... Christmas! to me, at least. I hope it feels like that to you and that you have a relaxing and fun time with the people you love. If you're struggling for any reason then please don't feel that you're doing anything wrong. You're not a bad diabetic! Help and support is available through so many avenues that it would be almost impossible for me to list them all. Instead, don't give up. Seek the help that you need and push for the support, information, medications and technologies that you need for you and your diabetes. Merry Christmas.

  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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Too Much Or Not Enough

I'm a very vocal advocate of individuality in diabetes. I've certainly used the "YDMV" (Your Diabetes May Vary) acronym many times during discussion and when expressing a view. Type 1 Diabetes is often viewed as simply injecting or pumping insulin to manage consumed carbohydrates and I'm fine with that. I think if you don't have T1D, live with a diabetic or work in the world of diabetes then why would you know much more? It's not wrong, of course, but it doesn't really cover more than the very basics.

Inside of our world (assuming you live with T1D, live with a diabetic, work in diabetes, etc) you probably realise that it's so much more than carbs and Banting Juice. All the decisions that we make are well documented and there are likely lots more that differ from person to person. You might have your own unique decisions to make in regards to your diabetes because you're an individual, living your own life and managing your own diabetes. Diabetes mirrors life in various ways and certainly, for me, the differences between person to person is one of those ways.

I think I've stated the obvious and I'll get to my point and what the title of this blog means!

I've recently mentored a few of my peers in regards to their T1D, you may have read about some of that on the Twitter. The vast differences between those people and the hundreds of other peers who I've engaged with is apparent but one thing which crops up frequently is some of the advice given by HCPs - advice which I'm struggling to understand and it looks a little something like this:

"You're scanning your Libre too much"

 "You're not finger pricking enough"

"You don't need to check your CGM that often"

Those three pieces of advice might be right, of course. My own experience is based upon the "too much scanning" advice. It was likely well meaning! I had complained about injection burnout which may have been confused with general burnout. A high number of sensor scans may have raised a red flag and well meaning advice followed. It was the wrong advice because, for me, I wasn't scanning too much. Why? I live my life in my way as an individual. Scanning a sensor, when your phone is often in your hand due to work and other commitments, was not tasking me or burning me out. Perhaps if I was working 10 hours a day as a taxi driver or heart surgeon then the same number of scans would be difficult or even impossible and noteworthy as a cause of burnout. 

"You're scanning too much" doesn't take into account me as a person with my own life. It compares me to others and even the HCP's life experience and what they believe to be the right amount. I stated why I scan as often as I do and why it's not a problem and we moved on. I don't fear speaking up during a consultation but I do know that others have issues in that setting and they feel anxious about doing anything unless they're nodding in agreement with an HCP.

"You seem to be scanning your Libre a lot. Is that causing you any problems?" might be a better way to address that red flag. But who am I to talk about communication!? *wink*

The same could be said for the other two pieces of advice, above. To notice something a little unusual is right and great care and it should be questioned but never judged or followed with a sweeping statement. "Too much" might be just right, "not enough" might be just right. Great care considers individuality and works with that. Ask questions, talk to your patient, get more information.

The above three pieces of advice might seem innocuous and to some that might be right, to others it might pile pressure on to an already over-spilling plate of decisions and burden and stress. That's why I'm very vocal about HCPs treating us as individuals in every respect and why it makes great sense to treat each other in the same way.  

 As you might have seen, a conflict has broken out in Ukraine as Russia has invaded that country. The scenes on TV and on social media are horrifying. What can we do? Well, I don't think there is a wrong way to help if you donate to charities who are active in helping the people of Ukraine. I support many charities but one which has always had my heart is MSF. Medecins Sans Frontieres translates as Doctors Without Borders. When it comes to the health of others in disaster areas, war zones and the like then I think we all have a duty to do what we can to help and help those who directly help! such as MSF. With that in mind, all donations to me via Buy Me a Coffee and all the pennies generated through the ads dotted around my pages will be donated to MSF. I will make up the difference for the fees taken by PayPal and Buy Me a Coffee. That will run until further notice, no time frames and possibly until Ukraine is a free country again. Thank you for reading my blog. 

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Time

Have you ever entered your diabetes diagnosis date into that online form, which gives you your estimated number of finger pricks, injections, etc? You get a nice little info-graphic to share with your peers to highlight just how many times you've pierced your own skin in the name of staying healthy. I seem to remember there are hours of sleep lost and estimated hypos, too. It's interesting, I guess, to see how quickly big numbers can build up and when you've racked up a good number of years with diabetes, those numbers become enormous.

Perhaps those numbers will be less of an issue, as more and more people seem to be moving towards technology to manage their T1D (and T2D in some cases). Changing a pump set around 104 times a year seems less impactful, and a CGM 26 times? Definitely less of a smack in the chops compared to 3500 finger pricks. The burden of diabetes is spoken about a lot and I still think that showing your burden in a simple info-graphic can help others to understand you and your condition better.

The burden of diabetes is a multi-faceted affair for me but the weight which hangs heaviest on my shoulders is time. That hasn't always been the case, though. Diabetes played a very minimal part in my life during my teens and early 20s. That is until it didn't and I woke up in a hospital bed or the back of an ambulance - it played a pretty big part, then. I've told the stories from those days on many other occasions, I won't bore you with them in this blog. Time, though! It's a precious thing. We're all born with a finite amount of it after all. It makes sense to make the absolute most of our time while we're still stinking up the place but diabetes just loves to steal those hours, days, maybe years from us. How can we minimise that lost time and maximise our life enjoyment?

I had to pause after that last sentence. I fear becoming some kind of life coach w*nker.

Let's look at the easy option; Ignore it. I don't mean completely ignore everything in regards to your T1D because you'll be struggling and gravely ill within a few days. However, doing the minimum by taking your injections, treating the inevitable hypos and hoping the hypers will go away by themselves. A terrible idea, I know, and exactly how I lived with the condition for far too long. I got off lightly, I could've easily died, you don't want to try this option. You may get away with it for a while until you don't.

A harder option; Carry on with your current management but adjust other aspects of life. You MIGHT find that works for you if other areas of your life are burdensome. So, work? relationships? toxic friends? bad habits? Cleaning up your life might be a good idea in general but it doesn't address the time burden of your diabetes and, it might be argued, freeing up more time from other aspects of life could allow diabetes to take up even more of your precious life - it's very needy like that! Pursue happy living as much as possible of course but this option feels like you'll be ignoring the diabetes time burden and will it eventually bite you on the bum? With a heavy period of burnout to follow?

A sensible option; Address it and find solutions. Start at the top! What's taking up the absolute most time in your life in regards to diabetes? Waiting rooms, probably! I jest. For me it was the finger pricking. I could see the benefits of frequent checks and I still check, today but far less often. The solution was technology. At that stage it was Flash and because I spend a lot of my waking life with a phone in my hand it was never an issue to scan a sensor - it still isn't! compared to foil wrappers, strips, lancets, prickers, meters and losing each of them at various points. Next, injections - I was injecting up to 8 times per day, pre-pump. It's time consuming stuff and, if you know me and my various limitations, eventually very burdensome. The gift of Pumpy McPumpface arrived and that burden was lifted alongside a stack of other QoL improvements.  I'm sure you'll have your own diabetes time burdens - feel free to tell me about them in the comments below or on social media.

The change from finger pricking and MDI to CGM and pump has had a profound impact on my life for the better. It also highlighted two things to me:

- Technology is a force for good and for living a better life with diabetes.

- Having more time means less burden (of course) which means less stress, which leads to great improvements in mood, sleep and general health. 

Tech won't solve all our time burdens. Hypos and hypers will happen, complications might happen, life events will always happen and they're famous for impacting negatively on diabetes! Sometimes there is little or nothing we can do but our best to get by. Others, however, can help to reduce our time burdens.

HCPs, primarily the decision makers, As your Clinical Lead has said many times! Don't block access. In the UK every T1D has the right to Flash or a CGM under the NHS. I'm astounded at stories of people being refused access to that technology even today. If your patient wants it then provide it. And pumps? You may have read about my fight for NHS pump funding (seriously time consuming!) Step away from the criteria, talk to the patient and find out why they need a pump. I promise that they didn't decide on a whim and that it takes a lot of courage to start that conversation. Even if their A1c is great, don't dismiss the idea because that's not great care. Great care considers personal circumstances alongside health conditions and A1c & TIR. Are you going to improve their long term outcome in life and not just their A1c? 

We all know that Looping will be the main treatment for T1D in the coming years and delaying access to the tech which facilitates Looping helps nobody but might hurt the patient. 

Friends and Family, You'll never fully understand T1D because, unless you have it, that's impossible. So, a great way to reduce our time burden is to not question our decision making, don't ask why we're hypo, try to avoid making us feel guilty if we woke you or asked you to help us. Talk to us when you have questions, of course but avoid 20 quick-fire Qs when we're trying to stop a severe low. Try to understand that a treated hypo doesn't mean we'll be our usual selves straight away. Our mood might change with our blood glucose level, it's probably not about you. Our medical appointments, although frequent and tedious, can be very stressful for us, try to avoid highlighting them as an issue and an inconvenience to you. Doing those things can help us to feel supported and less likely to explain, or even apologise for, each diabetes related incident. 

Peers, This one is super easy - Don't judge. That includes diets, exercise, lifestyles... everything! Don't offer negative remarks to another because they do things in their own way. It's never helpful! At the very least you'll look like a judgemental, mean spirited, bully. Live your own life, share your experiences, if somebody asks for advice or opinions well then is your chance to vent your splaining spleen. Shooting down an innocent peer can result in them questioning their management, make unnecessary changes and hiding away when they have a question and need support - all adding to their time burden of living with diabetes. Be the voice of encouragement and empathy.

As you might have seen, a conflict has broken out in Ukraine as Russia has invaded that country. The scenes on TV and on social media are horrifying. What can we do? Well, I don't think there is a wrong way to help if you donate to charities who are active in helping the people of Ukraine. I support many charities but one which has always had my heart is MSF. Medecins Sans Frontieres translates as Doctors Without Borders. When it comes to the health of others in disaster areas, war zones and the like then I think we all have a duty to do what we can to help and help those who directly help! such as MSF. With that in mind, all donations to me via Buy Me a Coffee and all the pennies generated through the ads dotted around my pages will be donated to MSF. I will make up the difference for the fees taken by PayPal and Buy Me a Coffee. That will run until further notice, no time frames and possibly until Ukraine is a free country again. Thank you for reading my blog. 

BUY DIABETIC DAD (MSF) A COFFEE HERE

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It's Good To Talk

 

I have a new-found admiration and I'll get to that in a moment. Firstly, some context;  I've hosted podcasts, created several vlogs, spoken on the radio, quite a few people appear to follow me on social media, too. In a different life, I played poker on TV and once upon-a-time I played in the World Series of Poker, the biggest card game in the world. You might say I've been around in various guises when it comes to being in the public eye in the last 15 years. I must be brimming with confidence, right? You might read my tweets and my online persona comes across to you as a confident, sometimes outspoken, funny, charming and rather good looking, humble, young man. Some of those things are true! The real truth is that I'm a quiet person. I suffer from social anxiety. I use the word "suffer" deliberately because, unlike Diabetes - which I have, there have been times when it has been on a different level of troublesome.

There are reasons for my social anxiety which go way back. That is for another blog, perhaps! It'll likely be too long to be interesting. I'm not going to offer advice or suggestions on how to "get over it" either. That's for you to work out, if you're relating, sorry. What I can offer is my own experience.

Life has a way of moulding us, directing us, forcing us into situations. Sometimes it takes trauma, grief in it's many forms, exquisite joy or an event to really open our eyes to important things and exciting opportunities. Perhaps the Covid-19 pandemic, the lockdowns and well documented horror have given you a new perspective. Perhaps you're doing new things already and appreciating the people and things around you more than before. Maybe you promised yourself to be that way but it hasn't worked out. That's alright. Lots of us promise to live a new, healthy life on Jan 1st each year. I'm not sure how many of us live up to those quietly spoken words which we weren't truly believing in anyway.

You might have read about my Diabetes complications, before. Sight loss and the dark (no pun intended) places that it lead me to, followed by recovery and a new-found "Wow!" for the world. Then, I told myself that I would do new things. I did. I built a business and probably over-enjoyed myself in many other ways (again, stories for another time). My 40th birthday had a similar but "purer" affect on my views. I decided to open up about my Type 1 Diabetes, expecting nothing more than some minimal engagement on my very early and terrible vlogs. 4 years later, it was one of the best decisions of my life. It's good to talk!

The new-found admiration? It's for those taking a leap of faith by speaking in public for the first time. I've spoken at business meetings and haven't really felt uneasy. Those meetings are often boring and a matter of fact, information sharing, exercise. Speaking publicly about something personal such as your health is pretty terrifying! but... fun! Terrifunning? Like a rollercoaster! but a rollercoaster which you control. That's because you're the one who truly knows everything about that subject. I did that a few days ago at a grand old hotel in Stratford-upon-Avon. A private engagement with some lovely people who were extraordinarily kind to applaud me and ask many really great questions. Although that subject was about the CGM which I use, rather than me, I still felt comfortable after a few seconds. After I left that rollercoaster, I wanted to get back on. The fear had gone and the excitement of the occasion came through. Also, I felt I'd lived up to my own promise of doing a new thing which I once would never have even considered. It's good to talk!

I realise that I'm lucky to be given opportunities within Diabetes. I am after all a "Joe Bloggs" (blogs?) Diabetic. I won't be running any marathons or climbing any mountains, you won't catch me trout-pouting in a bikini on Instagram, I'm unlikely to star in any Super Bowl ads or have my hilarious jokes recognised by TV bosses. I don't create drama for content, either. I'm no false advocate who has unsavoury motives. I'm just a person who talks about Diabetes with his peers. Perhaps you are too? I imagine we get along famously already. It's good to talk! 

Social anxiety feels real. That demon is frightening but I'm beginning to realise that he's not real. He is an imaginary monster under the bed, who goes away when you're brave and you look under there. That bravery takes a lot, it can take a long time or it can be triggered by an event. If the opportunity presents itself then I strongly encourage you to go for it and look under the bed and never look back. Do the scary things.

If you'd like me to do something scary then get in touch - daddiabetic@gmail.com Bungee jumpers and sky divers need not apply!

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

 

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!

BUY DIABETIC DAD A COFFEE HERE

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Diabetes Decisions

The Thinker

Life is an endless list of decisions. It can be as mundane as what socks we're going to wear today or something as serious as a relationship or job choice. Whoever you are, decisions are an inevitable part of life.

Diabetes isn't a decision, largely. I know Type 2 Diabetes can be avoided or delayed in SOME people but for individuals like me, with Type 1 Diabetes, it's not a choice. What comes after a diagnosis of T1D is a new life of decision making. Your old life decisions will still exist, of course but now you've got to find some extra thought capacity for the decisions that diabetes brings.

"180!" is the joyous cry at a game of darts, when a player scores the maximum. It's also estimated to be the number of extra decisions a person with T1D makes in a single day. Let's do some easy maths:

- You're a light sleeper and you manage 6 hours of sleep per night

- For 18 hours you're awake.

- You're making, on average, 10 diabetes related decision per hour.

- A decision every 6 minutes.

- 1,260 decisions per week.

- 65,520 decisions per year.

I'm in year 36 of T1D. Go ahead and pop those numbers into your calculator. Little wonder that I've started to lose a tiny amount of head hair.

Even as I wrote those numbers, I had to double check that it's right. It seems that it is. Of course, your diabetes may vary. I know that if you're sleeping for longer and using closed loop for your insulin delivery and BG management then your decision making is likely to be much less of burden on you. You're still making decision but probably a lesser amount. If you're struggling with diabetes burnout then your decision making may be vastly reduced or even nil.

It's not just the numbers, though. It's the magnitude of the decisions made. Each day, I average 8 injections of a substance that could easily result in my death. A mis-calculation is very common. That means a corrective injection or eating/drinking something carby to stop my blood glucose from falling too low. The latter being of my immediate concern but the former can also result in life altering complications and/or a shortening of my life. Those decisions to a non-diabetic or a person recently diagnosed must seem enormous and incredibly stressful.

They are.

Of course, the majority of T1D management is simply a persistent monotony. I once described it as 99% boredom, 1% sheer terror. That's because the decisions I make are mostly around what I need to inject to cover the activities and carbohydrates in my day to day life, needle changes (and lancets!), sensor changes, ordering prescriptions, attending appointments, giving up bodily fluids into little containers and handing them strangers... you get the idea. It's not exciting, thankfully! I'm pretty pleased with the boring. The last thing I want is an exciting chronic illness which might kill me.

Boring doesn't mean easy. I do the boring to avoid the terrifying or, at least, minimise the terror. I'm still here so I guess things are going alright, right now. 

There is hope! and it's about time that I put more positivity into my blog. Technology reduces the decisions and the burden of T1D. I say that with the strongest conviction. I don't "loop" and I don't "pump" but simply using a CGM has helped to lighten my load dramatically in the last few years. It seems that pumping and looping (?) is a natural progression for me and I have no doubt that those progressions will lighten my load further. Of course, I hope for a cure but I'm realistic. I'm 44 years old and that probably won't happen in my lifetime but I do think that technology will continue to advance and make the T1D decisions for me. Perhaps 180 will only be associated with the darts, one day in the future.

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

 

Freestyle Libre 2 - In Review

 

It feels like it's been a long time coming for UK based people living with Type 1 Diabetes. The Freestyle Libre 2, the sequel to the box office smash original, is now here and is available to eligible diabetics on the NHS.

I don't really do reviews. If you've seen my vlog then you'll probably be aware that I focus my attention on talking to other people living with diabetes, sprinkled with the odd rant about whatever issue is burning in my belly at the time. So, I'm going to keep this "plain English" and try to focus on areas which I think are important to me. If you're especially interested in an area that I don't touch upon then do leave a comment below or get in touch via the usual channels.

What's in the box?

Does it look familiar? If you've used the original Libre then it probably will! It's exactly the same thing. All your old favourites are here; Insertor, applicator, 2 handy alcohol wipes and an instruction manual which you've never read. There isn't anything noticeably new. Even the outer packaging looks the same apart from a number 2.

Not that the packaging really matters, aside from the waste (I'll get on to that soon). You're not really here for that. You're here because it's new and you've heard it works "like a proper CGM". It's true, it does. 

Users of Libre 1 can turn their sensors into a CGM via a nifty piece of kit called a Bubble or a Miao Miao. Essentially, both are Bluetooth devices that can sit on the top of your Libre sensor, taking in all that lovely data. That can then be sent directly to your phone and an app such as Diabox. No need for scans! Cool! Well, yes apart from the need to purchase a third party piece of hardware and turn a reasonably flat piece of tech, in the Libre sensor, into quite a bulky lump on your arm (or wherever you choose to wear yours). 

"Hold my pint!" exclaimed the boffins at Abbott and they set to work to remove the need for a third party device, uglying up their little discs of loveliness. The result is Libre 2 and it works just like Libre 1 did with Bubble or Miao Miao.

Accuracy!? Tell me about the accuracy!

No blinding with science, here. If you want to hear about MARD and the likes then those figures are freely available on other good web sites, and some bad ones. For me, so far, I think it's as good if not better than Libre 1. I've tested it against my most trusted blood glucose monitor at different times of the day, when high and when low and it's pretty close, sometimes exact. Day 1 was a little "out" on the numbers but I was expecting that after reading about similar stories on social media. It did settle down after around 6 hours.

Diabox? Huh?

You're going to need it to take the data automatically, like a CGM. The app can be difficult to find but do ask for help on Twitter via #GBDoc if you're struggling or visit this tweet by my friend Louise. When it's working it'll look a little something like the image above. Your numbers might be different (better). The app allows you to customise alerts and turn off the ones that you don't want, or find the most irritating.

There may be other ways of turning Libre 2 into a CGM. You may want to explain those to me! Feel free by using the comments box below. I've heard of some sort of patches for the LibreLink app but I couldn't locate the info and I'm impatient to use new tech.

What about LibreLink?

You're going to need to keep that. If you're NHS funded then you're very likely to be sending your data back to your clinic via this app. So! Remember to scan! Or your clinicians will think you've given up or have departed this world. The sensors keep 8 hours of data so, how often you scan is up to you. I try to have a flash every hour or so. It also serves as reassurance that your Diabox numbers are tallying up with the scanned sensor numbers.

The leftovers?

I'm not mad, I'm just disappointed. Having used a different CGM recently, by a company who are taking packaging and hardware waste very seriously, it's a real blow to be faced with an "updated" version of this product and the waste is still the same as the original.

There it all is, including a previously worn sensor - for the sharps bin.

I know Libre 3 is on the way and I have high hopes for improvements in every dept, especially in left over waste. Don't let the planet down, Abbott! 

Should I get one?

If you're NHS funding eligible, yes! I know some of you are happily finger pricking, some don't like the idea of wearable tech on their bodies, 24/7, some might feel overwhelmed by the process of getting one and the new avalanche of data. I get all that. Here's what I've discovered:

- Less finger pricking means less burden. Don't buy into the idea that you'll never finger prick again. You will need to when you're having a hypo or need to check that your sensor is working accurately.

- You don't notice it. Some sensors sting for a while but pretty soon you'll wonder if it's still on.

- You're in control. Look at your data as often as you feel comfortable. If you're used to finger pricking 8 times per day then you are allowed to check your sensor 8 timer per day.

That's all I have to say. I hope you've found that quick review useful. Again, if you would like to know specifics then please get in touch.