Food = Maths Problem

Small talk can lead to big revelations sometimes. I just got a reminder of how un-normal I am because I live with type 1 diabetes last week. And it was good!

As I was out with my walking Bud after St. Patrick's day, last week, she mentioned that she was feeling very bloated after having a McDonald's 3 days ago. I replied that McDonald's has a tendency to do that to me too but only for a day! Then she said that maybe it was all the stuffing her face she did over the bank holiday weekend.

She kind of made it sound like this was something that a lot of people do and I think she was kind of looking for someone else to say they did it too and feel less guilty about it.

Well, I don't have to tell you all that she did not find any compassion here and we moved on to the next mundane subject.

However, the thought that a lot of people blindly put food into their mouths, not considering what the consequences are, and actually consider that to be normal, stayed with me. It was half a lifetime ago that I probably did that too.

I had forgotten that that the way I eat and how I feel about food is not normal.

For me, and I suspect a lot of people with type 1 diabetes, food is a maths problem and who wants to do those! When I have to carefully consider every single morsel that goes into my mouth by analysing it for carbohydrate, fat and protein content, try to determine the quantity I'm about to eat, what time of the day it is, what my insulin to carb ratio for that time of day is, then how much insulin I should take, when I have to do all that why bother in the first place?

The only reason I would bother is because I'm hungry or because it looks so good it's going to be worth it.

I only eat to survive, same way I inject insulin to survive.

But if normal is sitting around eating everything in sight just because it's there then I am quite happy to not be normal and feel good about it.

Finally, an upside to having type 1 diabetes..... maybe?

Type 1 Diabetes & Alcohol

I really enjoy a beer! Especially, on Friday and Saturday evening. I'm a stay at home mother so on Friday evening when all the young people in my house are tucked up in bed, I reach for a bottle of beer and that's what signals to me that it's the weekend. I have 2 beers on each of those nights.

This morning, I was thinking about how much I used to drink in my twenties. And about how if I knew then what I know today about the risks of "boozing" would it have made me more responsible with alcohol? I also wondered how the hell I'm still alive!!!

THE major risk (apart from being stupid while drunk) is that while your liver is working hard to eliminate the alcohol from your body it can't protect you if your blood sugar drops. Usually, when a person with type 1 diabetes has low blood sugar, the liver prompts the release of stored glucose and you should come out of it. We try to treat hypos ourselves before that happens because when the liver prompts the release of glucose it releases too much. (Disclaimer: I am not a medical professional and this explanation of what happens when T1D & your liver meets alcohol may be over simplified and my understanding of it may not be wholly accurate.)

But when your liver is busy dealing with alcohol it doesn't realise there is another risk. Livers can't multi-task.

Back in my twenties I was still a bit new to my diabetes. I sometimes tested when I got home from a night on the town. I sometimes gave in to the callings of the chipper or Supermac's. I never would have alternated with minerals (soft drinks) and as for asking for a water!? That was a very uncool word.

How did I survive? It had to be luck, it had to be!

These days if there was a rare occasion to drink more than two beers I would always test before collapsing onto my pillow. I very often have a pint glass of water next to my drink. I go to bed with higher than normal sugars, just to be sure to be sure. And even though the glucagon kit isn't effective with alcohol in your system I still carry it in my handbag (you want people to be able to say they tried everything).

But, most of I really don't drink anywhere near the quantity that I used to in my twenties. I like not to be hungover when answering the 300 thousand questions from my son. I like not to be hungover and glued to my couch on a nice day when I could be outside with my family. Why did it take so long for me to cope on? And I am so glad I did!

Low Blood Sugars Cause Bad Decision in Co. Clare

I do all I know how to, to keep my blood sugars between the lines on the "good control"graph. But sometimes all the forces in the universe collude against me!

One such occasion occurred last week, I had parked myself on my couch with my night-time herbal cuppa and settling in to watch The Mentalist. The children were in bed and not a peep out of them.

Universal influence No. 1; Hypo. I could feel my temperature rising and I could feel some droplets of sweat on my skin underneath my clothes. I reached over for my glucose meter to test my blood sugars and yes I was a 3.5 mmol/l. I knew that since I injected my dinner insulin one hour and forty five minutes earlier that my blood sugars were likely to be heading further downwards.

I reached into my meter pouch for some glucose sweets because I needed something to work fast. I had forgotten to restock or maybe I chose not to restock as they are always handy in the pantry?
Universal influence No. 2; out of super fast acting glucose.

Turns out the pantry was not convenient enough.

I was reluctant to leave my couch but I knew that I had no choice. So I made it as far as the kitchen (I will point out that our pantry/utility room is off the kitchen and our kitchen is not large) where I got distracted from my mission. I started opening cupboards in search of something nice??? I spotted my mothers delicious fruit cake and decided this was what I was having - it looked soooo good.

Universal influence No. 3; Kitchen put in the way to pantry.

Mmmmm.....

It did taste good. I returned to my spot on the couch. But the sweat was still accumulating under my forehead hairline and I realised that the cake was just going to take too long and I was getting more antsy. So I did what I should have done in the first place before I got distracted and got some glucose sweets.

Once my brain started to pull it together, I realised that now I was going to have the massive spike in my blood sugars. So I tested at one hour after hypo and two hour after hypo (13.0 mmol/m) and took some counteracting insulin going to bed to head it off.

What did I wake up at? Flippin' 17 mmol/l!!!!! It's a vicious circle.
Universal influence No. 4; Take insulin but still have high blood sugars.

Low blood sugar equals fuzzy brain equals BAAD decisions regarding food equals high blood sugars.

The long suffering life of a type 1 diabetic...

It always grates on my nerves when I hearing myself described as a person who has suffered with diabetes. You know, that fingernails-on-a-blackboard noise type of annoying. I felt that the word "suffer" implied that I was weak or ill. But I don't look like either of those things, so how can I be a sufferer? Especially when I'm having a good day?

But then, I tried to come up with another way to describe my life with type 1 diabetes I have decided that while I don't like the word, it does seem like it's the best one to describe it.

I considered "survivor", but that word implies that somehow I have left diabetes behind me and it is no more. No such luck! Diabetes is never going to leave my life (unless of course there is a cure).

What about "Conquered"? But that would suggest that I battled and won. And again suggests that my diabetes is no more.

I think I would still prefer for people to use another word to describe living with diabetes but until I, or you, come up with a better word, I will have to suffer the word "suffer".

Finding Help with Carb Counting

One of the many ways people manage their type 1 diabetes is Carbohydrate Counting or Carb Counting. Carb counting has been a successful way to help manage type 1 diabetes while giving us a more flexible lifestyle since the 1990's. But it has only really taken off in Ireland since the noughts.

Carb counting is based on the idea that if the carbs in our food make our blood glucose levels rise consistently, then it makes sense to try and measure them and come up with insulin to carb ratios. It can be a lot of work in the first two or three weeks but after that it most of the work involved does not have to be repeated. 

So, if you are a person with type 1 diabetes and are interested in learning more about carb counting, where do you start?

In Ireland, there are two structured education courses for adults, DAFNE(Dose Adjustment For Normal Eating) and BERGER. 

The DAFNE course originated in Germany in the 1980's as the Düsseldorf Approach. It was designed by the diabetes team at the Diabetes Centre in Düsseldorf, led by Michael Berger. People learned to match their insulin dose to their food on a meal-by-meal basis. The aim is that they can keep healthy blood glucose control without a higher risk of severe hypoglycaemia. 

In 1998, a team from the UK adapted the Düsseldorf Approach creating the Dose Adjustment For Normal Eating (DAFNE). 

There are 6 diabetes centres in Ireland running DAFNE, click here for the list, and the diabetes centre in University Hospital Cork runs a variation of DAFNE, which is named after the original creator, BERGER.

The parents of children with diabetes have the CHOICE programme and that is run in the 5 paediatric diabetes centres that offer insulin pump therapy to their patients.

The six up and running paediatric diabetes centres offering the CHOICE programme are;

• Adelaide & Meath Hospitals, incorporating the National Children‟s Hospital (AMNCH), (Dublin)
• Children‟s University Hospital, Temple Street, (Dublin)
• Cork University Hospital, (Cork)
• University Hospital Limerick /University Hospital Galway, (Limerick / Galway)
• Our Lady‟s Hospital for Sick Children, Crumlin, (Dublin) 

• And soon to be up and running Sligo General

If you don't attend any of these centres, you might have access to a dietitian who would work one on one to teach you carb counting.

If this option isn't available at your diabetes clinic you should be able to find a dietitian who runs a private practise who will instruct you in carb counting, such as the services provided by Diabetes Insight in Cork. 

However, when you call to make the appointment be clear about the fact that you want to learn how to carb count and how to work out insulin to carb ratios.

If you are interested in learning more about carb counting, the wonderful people at InPut Diabetes in the UK have some excellent resources.

Belated Valentines Day Post

I have lived with type 1 diabetes for almost 22 years. My husband and I have been together for 15 years; married 13 of those. And since he came into my life I'm happy to say that I have not lived with type 1 diabetes alone.

He is with me every step! He wants to know as much about diabetes management as I do and often he does. Sometimes, he looks at my record book to help me figure out patterns in my blood glucose levels. It may be my diabetes but my whole family lives with it, especially him. Whatever happens to me affects him in a big way!

About a year ago, I put him through something unthinkable and I hope I feel the guilt always because it reminds me that we are in this together.

It was unintentional, and unfortunate for him, but it taught me a valuable lesson. 

We attended a family occasion. I did all the usual tasks to make sure that I enjoyed the day without stressing about blood sugars. I tested every couple of hours and adjusted for highs and lows. 

Unfortunately, that one last drink, the multiple boluses I gave myself for a 4 course meal and not knowing as much about how alcohol effects glucagon as I do now, led to me collapsing in the shower the next morning out cold.

My husband knew to test my blood sugars and that it was probably a hypo. He also knew that I probably did not have my glucagon kit with me. While he was testing my sugars he was panicking about what he was going to do if it was an unconscious hypo. He didn't want to call the paramedics but he knew he would have to.

Lucky for both of us, I started to come around. I was "loopy" but I was responsive. It probably was the recovery side of an undetected hypo.

One of the first things I said to him was "I'm sorry", not because it was my fault that I passed out, well not really, but that I was sorry he had experienced that panic and terror of trying to figure out what to do.

I spend so much time thinking about myself and how to take care of myself better, so that I can be around for my family for decades and I wasn't prepared for someone else having to figure it out. 

I realised that just because I have never needed my glucagon kit doesn't mean that I should not carry it. Just because there are hospitals everywhere doesn't mean I should rely on someone to bring me. 

I was consumed by the guilt I felt for what he went through because of me.

I now make sure I have an in-date glucagon kit in my purse at all times. I'm pursuing a Continuous Glucose Monitoring System to help with nocturnal hypos. AND I will never, never drink that amount of alcohol again!!! And so far, so good. 

Thank you, marvellous, wonderful hubby for taking on me and my diabetes and for your support and help with it.