The Luck of the Irish

As we celebrated St. Patrick's Day last week, I began to reflect of what it’s like to be a person with diabetes living in Ireland.

The luck o’ the Irish is often referred to in movies, etc, but in actual fact, when it come to diabetes, I think we should called it lucky to be born in Ireland.

We have socialised medicine here, we called it public healthcare. It gives us free test strips, blood glucose meters, insulin and lots of other diabetes medicine without any stipulations.

Private healthcare is an option here too but it usually only covers hospital treatments, although the insurers are starting to cover primary care visits a little.  With private health insurance you could get a private scheduled appointment with an endocrinologist but you don't, in most cases, get the backup of a diabetes nurse specialist or a dietitian.

When I hear stories from my friends in America, especially when I read Riva Greenberg’s piece in the Huffington Post about battling with health insurance companies for diabetes supplies I'm truly thankful that the reason Diabetes Ireland was formed in 1967 was to ensure that diabetes was included on the Health Service’s list of long term illnesses and therefore providing us with free medication and supplies.

We also have excellent health care professionals working in our clinics, just not enough of them.

Sure, there are lots of other things that we don’t have but we are advocating strongly for, such as national access to structured diabetes education, access to psychology, unlimited access to insulin pumps and continuous glucose monitoring.

And dealing with the health care professionals outside of the diabetes setting is frustrating. And yes, I did have to haggle with my diabetes team to make sure I got my insulin pump 6 years ago and my CGM last November. And yes, sometimes I don’t feel listened to at my clinic. But these are problems that are global.

But we don’t have to beg, wrestle or finance our basic diabetes needs.

A Day of Diabetes - A Good Day!

I wrote this post on Saturday 10th January because it was such a good day and worth recording. Don't worry though I will balance it with A Day of Diabetes - A Not-So-Good Day! And be assured that I do have many of those too:-D It's also written before I got hooked up to my continuous glucose monitoring system.

The alarm went off at 8:28am, I feel well rested but still want another snooze. My husband's alarm went off at 8:30am and I was afraid that I would actually fall back to sleep so I rolled out of bed. I use the term rolled because that is actually what I do. I roll over and off the edge of the bed - it's very effective!

I went downstairs, said good morning to my already fed and dressed daughter on her laptop. I filled the kettle to make tea and she had already made it! How lucky am I? ;-D I popped two slices of wholemeal slice pan into the toaster. While waiting for the toast I did my first blood glucose test of the day. 7.3mmol/l (131.4 mg/dl), what a nice way to start the day. I gave myself insulin to cover the toast and 3 mugs of tea with skimmed milk.

 After breakfast, it's time to drop the family off to Coderdojo and for me to get the weeks grocery shopping done.

What seemed like a short time later, my insulin pump vibrates to remind me that it's been 2 hours since I took my breakfast bolus and that it's time to check my blood sugars again. 4.4 mmol/l (79.2 mg/dl), a bit on the low side because there is still active insulin in my body so I ate half a granola bar to keep my levels up until lunch and went about collecting the family from Coderdojo and home.

After all the groceries have been put away and both children had been fed, it was time for my own lunch. I decided to have a two egg omelette with smoked salmon and cheese, one slice of wholemeal slice pan again and two perfectly ripe kiwis. While my omelette was cooking I tested my blood glucose and it was 5.2 mmols/l (93.6 mg/dl).

I'm having such a good day. It feels so nice to have good numbers and no crisis hypos getting in the way.

By mid afternoon, I decided that all major household tasks were done for the day and I was going to have about three cups of coffee, read the newspaper and some internet articles. My insulin pump had perfect timing; it vibrated to remind me to test again before I made it to the comfy chair. My blood glucose test revealed 6.0 mmols/l (108 mg/dl). You should have seen my happy face!

Roll on the coffee and two small McVities chocolate biscuits. I know I shouldn't have them. So I've estimated that they work out to be 15 grams and I bolus 1.15 units of insulin. I wonder to myself if the biscuits are more like 20 grams but I decide that the next blood glucose test will reveal it.

Dinner at 7pm and my blood glucose is 7.8 mmols/l (140.4 mg/dl). It's sooooo nice for the things to go right for a change.

The two hour post meal check revealed a 5.8 mmols (104.4 mg/dl) - this is a normal reading for someone without diabetes but for me it's a bit too low for an after meal and with active insulin still in my body I give it a snack to work on. What can I have for a snack? Ohh I haven't had a packet of crisps in months, double ohhh, Salt and vinegar. Sold! So 14g of carbs and a lot of fat later my blood glucose dream comes back to reality with an 11.2 mmols (201.6 mg/dl) result.

Well, it wasn't going to last forever, was it? But when the good days come they should be celebrated. 

What Good is an Insulin Pump?

Before I state one of the benefits that an insulin pump provides me with, I would like to point out that I believe that they are not for everybody. Off the top of my head, I can name three people who have public profiles who do not use insulin pumps and still do brilliantly with their diabetes management.

Good diabetes management is possible while using multiple daily injections. An insulin pump won't magically fix most of your problems with your diabetes - they are a lot of work. So if you are interested in moving to a pump, do your homework and find out exactly how you might benefit, google them, read book on them, talk to one of the representatives from the 2-3 companies who provide pumps in Ireland, talk to other people who have used them, and talk to people who tried them and it didn't work.

Now for my story....

I met two people recently that I've known for a while, but I didn't know they have connections to type 1 diabetes. One person is a PwD and one is married to a PwD.As always, the fact that I have an insulin pump comes up in conversation. And, as always, they ask "how I find the pump?" (that's an Irish person's equivalent of "Tell me exactly how you benefit from having it").

They don't really know what an insulin pump is or how it works. This doesn't surprise me because unless you are very interested in getting one you really don't do the research into it and in most of our diabetes clinics it's not really explained. (No need to promote what long waiting lists and lack of resources prevent you from providing).

Both people made the exact same comment of "but you still have to do the finger prick tests"! I wasn't expecting this comment so my response was insufficient. I had said something to the effect of "Well, yeah but I don't have to be messing around with two different types of insulin."

COMPLETELY, forgetting one of the best advantages of an insulin pump!

And I'm so kicking myself that I didn't think of this at the time but the point is you don't have to stab yourself with a needle 5-6 times per day, you only have to stab yourself once every three days. How could I forget that?

Next time I'll be ready! I hope.

If you are looking for a bit more information on the differences between an Insulin Pump and Multiple Daily Injections, here's some information from http://blog.diabetv.com/differences-insulin-pump-injection/

To know or not to know? A CGM Story

I'm so, so tired! Yesterday afternoon we visited some friends. It was a family-style event where everyone brought something to feast on. The food was sooo good.

The diabetic downside is that while the food is really good I had no idea what the carb count was and therefore, no idea what my blood sugar was going to do.

I've been using a CGM since last November and this has been really beneficial with reigning in those blood glucose numbers.

I could track my BG's while I was eating and even afterwards while talking to people using my CGM and I was quite impressed at how well my blood glucose levels were doing.

However, it was late at night, heading towards the wee hours when my BG's started to climb, and climb. Oh and climb.

If I didn't have a CGM I would have taken a little insulin and just gone to bed assuming that this action would have taken care of the elevated levels perfectly.

This is not what happened at all. I have my High Glucose Alert on my CGM set to alarm when my blood glucose levels are above 15.5 mmol/l. And this alarm will continue to go off every 30 minutes until my BG's come back below this level.

My first indication that my blood sugars were rising came at 10pm when my alarm went off. I calculated some correction insulin and hoped for the best.

The arrow on my CGM fibbed and said that my BG's were holding at 15 mmols (279 mg/dL) leading me to believe that they were done going up but this was definately not the case for 2 hours.

It's so difficult to sit and wait. I know that my insulin takes AT LEAST 20 minutes to start working.

11.20pm alarm indicating a higher BG. More insulin 11:40pm more 12:30am more 1:40am some more

Would I have been better off living in ignorance where I took an insufficient amount of insulin and just slept through the night spending 6 hours til morning way above a good BG?

Or was it worth it to spend those 4 hours (2 of them trying to sleep) to get it down to a more reasonable number and start a new day well?

I feel I did the right thing for me on this occasion. I felt that I learned something more about my diabetes because of it and I felt that I prevented a blood glucose reading of above 20 mmols/l

I'm tired today but the next time I know what to do to get to sleep. :-)

A simple task that turned offensive

The HSE approved funding for my Dexcom G4 continuous glucose system since November (love it!); I received my start up kit through funding from HSE’s community care budget. My Animas rep called me in January to tell me that my Dexcom G4 Platinum Sensors had been, finally, approved funding for them through Long Term Illness scheme. All I had to do was get my GP or consultant to update my long term illness book and bring it to my chemist.

In the meantime, she rang my chemist to explain that all that needed to be done was underway and gave them all the information they needed to order my sensors. Yay!

As I wasn’t due to meet my consultant until April (approximately) I decided to go my GP. I had everything I needed in hand. I knew exactly what I had to ask for. What could go wrong?

LORD ABOVE, GIVE ME STRENGTH TO DEAL WITH OTHER PEOPLE’S BAD DAYS.

After waiting one hour to be seen by my gp I left within 10 minutes, without what I needed. I met with the most “by-the-book” (yeah like anything about diabetes is by the book) and “professional”(not) GP, who by the way assured my on next visit that he WAS quite popular!

What happened?

Well, this chap, who is filling in for my regular gp, decided to focus on semantics. My LTI book had not been updated for 6 years, which is kind of a technicality but kind of not. He questioned me like an FBI agent about every item he had to list. He was very concerned about if I needed it every month or not??? It didn’t actually matter?!? But I didn’t know that yet.

I had to explain why things like a Hypo emergency kit, or Novorapid flex pens, needed to be included on my script for emergency situations.

All of a sudden, he threw his pen down and said I really don’t know what I’m doing here, can you go to your chemist and get a list of all your meds? Even though, it was right there in front of him! He added something to the effect of diabetics come in here asking for all this stuff that I don’t know about. (?!?!?!).

It was clear to me that he was done with me. And I was done with him. I was having a difficult time remaining calm and trying to figure out what to do.

I left in a state and decided to go direct to the source of all information required.

He gave me the impression that his problem was he didn’t know how to fill out my prescription as required by the long term illness scheme. So! I hopped into my car and drove over the Long Term Illness Section in Ennis.

I explained what had just transpired and asked for a guide for snotty GP’s on how to fill out prescriptions for the LTI scheme. The lady was really nice and explained everything. But I then had to remember it!

What I learned in the Long Term Illness Dept that I did not already know.

She told me the following;

• My GP should always have an updated list of all the medicines I use - regardless of who writes the prescription. My consultant should be writing to him with this information. (Does that actually happen? I know this wouldn’t be high on my priority list.)
• The LTI book does not need to be updated every six months. (The book itself says it does, the chemist says it does; I’m going with “it does”.) However, updated does not mean submitting it to LTI every six months. It means that the GP/Consultant writes out the prescription in the space (the yellow pages) provided every 6 months and you bring it to your chemist.
• If the item being prescribed is on the HSE’s List of approved medical supplies for diabetes known as “Core List F”, my GP only needs to write what the item is, he does not need to write a quantity. Once the item is on this list it is approved. So, again, no need to submit to LTI just take it straight to the chemist.
• However, if the item is not on Core List F but is on the “Special Product List”, then a quantity may be required.

If the item you are after is not on either of those lists this page might help you.

Ok! Onwards! I went home. All the while I practised deep breathing. As soon as I got home I called the GP office and rescheduled my appointment (another reason to be p****d off).

Next day, I arrive to his office to receive a “what can I do for you today?”(?!?!?!). At this point, I found it more than very difficult to stay close to calm and civil, while explaining why I was offended, frustrated with him, and annoyed.

All of which was news to him! He even had the naivety to tell me this was the first time someone has a problem with his bedside manner and that he was actually quite popular in the practice. I knew I couldn’t tell him he sounded like a twenty year old creating his first CV because I wasn't trying to offend him like he did to me.

I never heard the words “sorry” or “apologise” during our 15 minute consultation. No stepping down off the deity pedestal AT. ALL.

And so, I won’t be going back to him and I know it’s no skin off his nose. He can continue to be arrogant and emotionally immature….. until it bites him in the ass:-)

Because you know what goes around comes around - always.

A Shout Out to My Home Team

I am a huge champion for peer support to help us live with type 1 diabetes. My type 1 diabetes friend in Clare and around the country have kept me positive and fighting for almost 10 years now. But, as it's Valentine’s Day and the month of his birthday, this post is a tribute to my home team. My husband has been my very biggest supporter and cheerleader for over 15 years. 

From that very first day, when he asked me for books on type 1 diabetes so that he could learn something about it, to every day I have to use the code words “low”, “hypo”, “help” or “I’m fine” (biggest codeword ever for I’m not fine). Thankfully, that’s not too often.

He came to my most recent hospital appointment so that he could learn to insert my Continuous Glucose Monitoring sensor for me. 

He shares research articles he finds in The New York Times- he actually brought my attention to the Bionic Pancreas first all of those years ago.

He does 90% of the cooking (yes I know how lucky I am) and is always considerate of my carbohydrate, mmm, sensitivity.

All of my best ideas get bounced off him and therefore improved by his input.

He is constantly reminding me of what I can do.

He volunteers with Diabetes Ireland on their national council, even though he does not have diabetes. He even got to meet President Higgins on his first official act as president, but that’s another story.

He makes me feel like there are two of us working hard to keep me healthy.

He is my Type 3 and my Valentine.

By the way, hun, I have a feeling I’m going to suck again this year for your birthday - sorry! #SpareaRose and post on a blog:-D