Insulin Pump Wizardry

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

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

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

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

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

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

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

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

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

Explaining Type 1 Diabetes to Non Diabetics

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

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

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

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

What is type 1 diabetes?

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

What the heck is insulin?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The HbA1c and how does it fit into Diabetes Management.

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

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

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

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

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

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

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

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

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

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

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

Diabetes Interruptus

Let me count the ways that diabetes interrupt my life.

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

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

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

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

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

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

But sometimes, it just doesn't work.

The Big Blue Test for World Diabetes Day

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

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

What is the Big Blue Test BBT?

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

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

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

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

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

How do I take the test?

Taking the Big Blue Test is easy:

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

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

From Diabetes Mine