The Other Half of Diabetes

This week I’m  taking part in the 7th annual Diabetes Blog Week, which runs from 16th to 20th May. Founded by Karen at Bitter Sweet Diabetes. Today's topic is The Other Half of Diabetes and I asked my other half, Mr. Blood Sugar Trampoline, who goes by the name of Phil, if he wanted to write something. I'm so thrilled he accepted. And speechless because.... well read for yourself.

The short version:

I've learned that we cannot control my wife's diabetes any more than we can control world hunger, but by taking a proactive role towards improving the healthcare environment and by supporting her empowerment, my anxiety over her health is not much different than my anxiety over my own health...and we're stronger as a couple because of her diabetes. 

The longer version:

Next week, Gráinne and I celebrate our fifteenth anniversary of married life together.  It has been a richly rewarding journey so far, and I look forward to continuing the journey for many many more years to come.  I met her a few years previous, playing together on a softball team.  I can't say as to when exactly I became aware she had type 1 diabetes; what I do remember is that as I began to learn her management regime, it seemed to my science-trained brain to be something fairly anachronistic...not that I really knew anything about medical best-practices for managing diabetes.

Back when I was 12 or so (in mid-80s USA), a boy in the grade behind me developed type 1 diabetes.  All the more we were told was that he was sick, he's better, but he can't eat any sugar.  "Here, try one of these diabetic candies!"  Yuck.  A decade later, I discovered a colleague had type 1 diabetes, she gave me a short primer that basically involved "testing blood sugar" and "injecting insulin."  But I was otherwise ignorant.

It turns out, Gráinne didn't really seem to know a whole lot more than me - she knew there was an HbA1C number, along with her periodic blood sugar measurements, that were supposed to be "good" but was quite difficult to hit.  And she knew that she needed to somehow adjust her insulin dose to her current blood sugar readings.  She certainly didn't know much (if anything) about carb counting.  As to what causes diabetes, how it affects the body, how behaviour and diet interact...these were all things that she wasn't learning from her doctor.

So I asked her "where can I learn more about this?" And I asked myself "how do we fix it?"

I suspect my reaction to diabetes is similar to PWD who are scientifically-minded and wanting to get on top of this thing...only I have the luxury of not having the terror that is "I am going to lose my vision and my limbs and die in childbirth."  (I failed to mention that as part of my diabetes education, I had seen Steel Magnolias, which frankly could be an entirely separate blog post.)

Certainly, there are echoes of my thinking in how a college roommate (and fellow physics major) took on his wife's type 1 diagnosis in her late 20's.  "This is surely just a simple function of carbohydrate, metabolism, insulin, and time that results in a blood glucose reading of X..."

As I am sure many of you were shocked to find out, it turns out it's not quite so simple.  Fats, the kinds of sugar (including alcohol), fibre, hormones (stress and otherwise), circadian rhythms, fatigue...and other variables like insulin that can go off, injection site, temperature.  OMG this thing is so damn FRUSTRATING.  And it's not even my body it's happening to.

About a year after getting married, we moved to Minneapolis for a few years of "getting to know my people."  We took advantage of the healthcare system there - my former colleague gave us a brilliant referral to a team of diabetes care professionals who really helped Gráinne learn some better tools and techniques for managing her diabetes.  For me, the most important outcome of this was that Gráinne started to become empowered in her own management.

When we moved back to Ireland, it was as if we stepped back in time.  There was no medical team looking after body and soul...just arrogant doctors who got upset when you didn't do everything you told them (eating the same food every day?  Seriously?).  It didn't seem that Irish doctors really understood the fact that diabetes is not a simple equation.  She has changed doctors way more frequently than is the norm in Ireland, seeking to find a fit as good as what she found in Minneapolis.

We can choose to see ineffective institutions as the enemy, playing the part of "victim."  The doctors are to blame, they're being paid the big bucks and are experts, they don't know what they're doing, they're hurting me more than helping me.  OR, we can choose to believe in the humanity of the individuals within these institutions and work to allow that to be expressed; the problem may be less with the individuals and more with the environment in which we all find ourselves.

So, in addition to shaping Gráinne's personal environment, we set out to improve the environment for everybody in Ireland.  We did this by getting involved with Diabetes Ireland (then called the Diabetes Federation of Ireland).  You learn a lot when you get out of a "selfish" mode of working - perspective builds empathy.  Community is empowering - there is great power in numbers. When these numbers are singing in concert while they're rowing in one direction, bureaucratic and institutional inertia can shift.

As a person I love deeply, I of course worry about Gráinne's physical health.  Her diabetes doesn't weigh on my mind anywhere near as much as it does on hers, but it's there.  Hypos scare me too (and selfishly, I'm glad Gráinne found that a CGM suits her...nighttime hypos she slept through are scary on a whole other level).

But being totally honest here, the thing I worry far more than her physical health is her mental health.  If Gráinne is stressed, that stress will invariably become my stress, and our family's stress.  If this stress were chronic, life would be pretty damn miserable for all of us.  Chronic health conditions can wear you out.  Ask anybody with Lyme disease, MS, Crohn's, HIV, chronic migraines, or frankly any other chronic condition.  But in some ways, type 1 diabetes is different.

 Type 1 asks its patients to undertake medical decisions multiple times per day, without consulting a medical professional, using nothing more than education and wits.  If you make the wrong decision you could end up in a coma or dead.  Or, if you make less-wrong decisions but do that a lot over time, you could end up blind or limbless.  And then there's the possibility of making the "right" decisions (i.e. one the medical professional would suggest), all of this bad stuff could happen to you anyhow.

What can I do to keep her head healthy?  I try to make sure she knows she's supported, and I try to "nudge" her in the direction she's looking but hesitating to head.  (As her confidence has built, there's been much less nudging.)  Sure there are down times, frustrating times.  She sometimes needs to vent, I can do nothing but sit there and listen, and give her a hug.

But that's not "diabetes life," that's "life life."  It just so happens we have this extra topic of stress and frustration that most other married couples don't have.  But we also have this extra source from which to build strength.

 When we said our marriage vows fifteen years ago, we already knew some of the "sickness" part.  We've been incredibly fortunate to be able to leverage that sickness into a source of strength and bonding.  If I could cure her diabetes, I would in an instant...but in some strange way I don't think I could imagine life without it.

Phil & I don't really talk about diabetes much, I suppose after 15+ years of being together there are somethings that you don't have to say but sometimes we might forget. Thank you Phil and here's to another fun-filled 15 years.

Phil, with some other woman :-) helping out at Thriveabetes 2015

Diabetes Blog Week

I’m sooooooooooooooooooo excited about taking part in my very first Diabetes Blog Week, the 7th annual Diabetes Blog Week, which runs from 16th to 20th May. I’ve admired Karen at Bitter Sweet Diabetes for a number of years so I’ll say it again. I’m soooooo excited!  We are all kicking off Diabetes Blog Week by talking about why we do what we do.

I write a blog because is a form of therapy for me - even since my early teens I used writing as a way to feel better about the world and about life. The making it public came about because I have too much to say and I like to listen. I’m part of a real-life diabetes support group and I need to zip it at those meetings. I do still talk and share at them but it’s my one opportunity to hear about other people's’ experiences and diabetes stories, and so I zip it as best I can.

So, Blood Sugar Trampoline is where I let it rip - nicely;-).

The most important diabetes awareness message I want to share is that the diabetes community needs to raise their voices if they want to improve our health service. At the moment, our health service is under resourced and inefficient. But the voice of the patient is a powerful one and a lot of us don’t realise that.

I’m passionate about fighting for the health service we, men, women and children with diabetes, deserve. It’s a big task and it’s a slow one. We have a lot of work to do in Ireland to improve our health service for people with diabetes and we only have only organisation trying to do it all. They are doing the best they can with their limited resources they have but they need us to help them. My husband told me back in 2007, that one of the ways you can make an organization better is to be part of it.

I hope that in some small way Blood Sugar Trampoline will inspire more people with diabetes to advocate for themselves and others. Many hands make light work!

Being "Diabetic"

I am very privileged to know lots of people in the diabetes community. I also know a lot of people who aren’t particularly bothered about being called “Diabetic”. I respect their choice on that. However, I am not one of those people. I may have been once when I felt so uncomfortable talking about my diabetes that I felt it was easier and quicker to say “I’m diabetic” rather than say “I have diabetes”.

These days though, the harsh sound of the ‘ic” at the end of the word makes me cringe. It’s like hearing nails scrape across a chalkboard. But I feel the soft “es” at the end of the word diabetes lessens the punch in the guts for me.

The very famous and very talented Kerri Sparling uses the tagline of “Diabetes doesn’t define me but it helps explain me” on her blog Sixuntilme.

I am a wife, mother, daughter, sister, former graphic designer, former payroll clerk, I’m Irish… etc. These are all things that define who I am.

I’m not going to give that kind of power to my diabetes.

I have blue eyes, fair sometimes blonde hair, fair skin, lots of freckles and I have type 1 diabetes. These are things that describe me and they are not all that important. What difference does it make if I have blue or purple eyes. Not much.

So for those who know me, I’m not a diabetic. I have diabetes. And for those who don't know me I ask that when you are talking to people with diabetes or about people with diabetes, please be aware that some don't like it. Thanks and appreciate it:-)

Here's what the American Diabetes Association has to say on the use of this term;

There's a reason the American Diabetes Association, Diabetes Forecast, and most scientific journals avoid using the term "diabetic" as a noun: People with the disease are diverse individuals, not a single entity. Some people identify themselves as "diabetics" and find that the term provides a useful narrative framework in which they manage the realities of living with the condition. But not everyone feels that way.

Many people with diabetes see the term as stigmatizing. They advocate that the language used to describe the condition and the person living with the condition be carefully distinguished. Another reason "diabetic" should be scrapped? Defining a group of individuals with a similar disease by their condition may prevent others, including family members and health care providers, from thinking about their experiences and needs as individuals.

Diabetes Summit & Future Health Summit Dublin

I am extremely honoured to have been selected as a patient speaker at the upcoming Diabetes Summit which is part of the Future Health Summit on Friday 27th May. The Future Health Summit runs over two days, May 26th and 27th, in Dublin’s Citywest Convention Centre. The Future Health Summit is actually a series of 15 separate summits covering areas such as mental health, medtech, oncology, wellbeing at work, clinical leadership, diabetes, ehealth, and homecare.

The Summit director David Neville expects 1,500 delegates to attend. There are seven patient forums, more than 100 speakers, over 120 exhibitors, and 15 separate summits being run. He also says “The conference is focused on how we care, what we eat and how we live”.

I will be participating in the Diabetes Summit, which is chaired by the Clinical lead of the National Clinical Programme for Diabetes and Consultant Endocrinologist, Dr. Ronan Canavan and co-chaired by Dr. Anna Clarke, Health Promotion and Research Manager with the Diabetes Ireland.

My fellow panel will include;

Dr Neil Black, Endocrinology & Diabetes Physician, and Lead Clinician, Electronic Care Record Implementation in Northern Ireland.

Prof Philip Home-Professor of Diabetes Medicine, Newcastle University. Former Chairman of the International Diabetes Federation (Europe). In 2009 he was Programme Chair for the IDF World Diabetes Congress in Montreal.

Professor Gerald Tomkin - Director of the Diabetes Institute of Ireland at Beacon & Endocrinologist, former president of the Irish Endocrine Society, the Irish Hyperlipidaemia assoc.s. Former Chairman, and now President of the Diabetes Federation of Ireland.

Dr Richard Lee Kin-Specialist Periodontist. He is founder of the Mint Clinic in Adelaide Rd., Dublin 2, dealing exclusively with the management and treatment of gum disease in adults and children .

And of course, me, Grainne Flynn-Patient Speaker.

With a panel discussion with all speakers chaired by Dr Eva Orsmond and Prof. Donal O'Shea.  No intro explanation needed for either of those. There is more information on the schedule.

Patient Workshops

There are also patient workshops taking place on Friday 27th May, one in particular of interest is the “Living with Diabetes- Personal Empowerment, Information, Choice and Ownership”. Speakers for this workshop include;

11.15 am  – “Living Well with Diabetes, A Personal Experience  – 10 Keys Tips”. Kate Gajewska who is a health psychologist, lives with type 1 diabetes and is a scholar in Population Health & Health Service Research – SPHeRE Programme

12.00     “Making Best Use of Your Professional Diabetes Review”  Prof. Seamus Sreenan, Consultant Endocrinologist at Connolly Hospital and Medical Director of Diabetes Ireland.

Professor Seamus Sreenan will advise individuals to better prepare for their hospital appointments and maximise the benefit of that appointment for the person with diabetes.  Professor  Sreenan is Clinical Director, 3U Partnership, Consultant Endocrinologist at Connolly Hospital and Medical Director of Diabetes Ireland.

Both presentations will be followed by a question and answer session.

When you book this event, your ticket gives you access to the open talks at the Summit  (tickets priced at €539). Admission to the workshop is €10 registration fee for members, or €40 to include 2016 membership of Diabetes Ireland. To register call  Diabetes Ireland on  1850 909 909.

Now I have to take care of a "Procrastination Monkey" by rounding up the "Panic Monster". This very entertaining video will explain more:-)

Ketone - Scary or Not Scary?

**** I am not a health care professional nor do I have anything that looks remotely like a medical degree. So take anything I say with a pinch of salt.

For this piece I have combined information I found on;  Diabetes Daily written By Ginger Vieira on January 4th, 2016, from Beyond Type 1 WRITTEN BY: Kyla Schmieg, BSN, RN and from The Type 1 Diabetes Network Australia Type 1 Diabetes Starter Kit

When I was diagnosed in 1993, I don’t remember hearing the word ketone back then. In fact, I don’t think I hear it until the early 2,000’s. Remember, diabetes education didn’t exist in Ireland before then - not to my recollection anyway.

In my 23 years with type 1 diabetes I have never tested for ketones. Firstly I don't often get sick. And secondly, when I’m sick I take all the recommended actions that deal with both being sick and flushing out ketones.

However, I hear a lot of talk about ketones and began to think that, maybe, I'm a bit too relaxed about them and need to know a bit more.

So, first, what is a ketone?

When our body can’t access glucose, it looks to burn fat for energy. Burning fat results in ketones.   

“Ketones build up can lead to Diabetic Ketoacidosis (DKA). Signs of DKA include nausea, vomiting, abdominal pain, fruity or acetone (think nail polish remover) breath, rapid breathing, flushed skin, and lack of energy.“ http://beyondtype1.org/ketones-the-6-must-knows/

Why are they so scary?

Ketones usually build up in a person with diabetes if they do not have enough insulin taken and can be fatal.

If ketones happen “too much too fast, it is not natural and it’s important to understand that ‘normally’ produced ketones are very different from ketones that develop due to insulin deficiency.

Moderate or large amounts of ketones in your body are very dangerous. They upset the chemical balance of the blood and lead to a condition called diabetic ketoacidosis or DKA. Some people also experience fast and heavy breathing and exaggerated beating of their heart. It is scary! If you experience DKA, you need to go to hospital to be rehydrated and monitored while the ketones in your body reduce to a safe level.

Many people with type 1 diabetes have never had an episode of ketoacidosis, but you may have already experienced DKA during diagnosis. Unfortunately, DKA is life threatening, so you need to understand what it is and what to look out for.” (from the Type 1 Diabetes Network’s Starter Kit page 37)

OK, I’ve got it so far.

This much is easy to follow but when I started hearing about the different type of ketones that were I got a bit lost. Especially when I heard that you can have ketone when you are not sick and have normal blood sugar levels. Until I did this research, I didn’t know if that was a “freak-out” or “not-to-freaky-out” situation.

Different types of ketones.

Illness-Induced Ketones

Illness-induced ketones can be very dangerous for a person with any type of diabetes. People with diabetes who are sick, especially with an infection, a stomach bug, or the flu should always test their ketones while they are sick.

A mild illness can cause low level ketones that are usually not life-threatening or severely serious. If ketones are at low levels, the general suggestion is to consume plenty of fluids and talk to your healthcare team about increasing your background insulin doses.

Even if your blood sugars appear in-range but you are producing ketones when sick, an increase in background insulin can help eliminate the ketones without dropping one’s blood sugar.

On the other hand, a person with diabetes, who is vomiting repeatedly will almost always need to get to the ER as quickly as possible. Vomiting, no matter the cause of the vomiting, will likely induce large ketones and can be life-threatening. Vomiting leads to severe dehydration which will escalate ketones further to a state of DKA.

Since severe ketosis will likely make a person extremely nauseas in addition to their illness-induced nausea, it can be nearly impossible to consume enough fluids at home to re-hydrate the body. An IV drip of saline at the hospital is essential to rehydrating the body, reducing or eliminating ketones, and stabilizing blood sugar levels.

Consult your healthcare team if you have concerns about your state of ketosis.

Starvation Ketones

Starvation ketones are simply the result of not eating enough food over the course of several hours. Both diabetics and non-diabetics can easily produce very low levels of ketones overnight, seeing a faint pink color on a urine ketone strip first thing in the morning. These are not dangerous unless, of course, this person continues to starve themselves.

Nutritional Ketones

Nutritional Ketosis is a state where the body is using ketones as a fuel source efficiently and safely. In individuals without diabetes or in those with controlled diabetes, having insulin on board to maintain healthy blood sugar levels keeps ketone production in the safe range.

This is achieved by reducing carbohydrate-intake to below 50 grams, because when glucose from food is limited, but blood sugars are still in a healthy range and enough insulin is present, the body will begin to burn body fat for fuel instead, producing low levels of ketones in the bloodstream.”

As long as blood sugars are maintained in the normal safe range with insulin, someone with diabetes can very safely be in Nutritional Ketosis.

When you’ve been in Nutritional Ketosis and not even known it:

• when you skip breakfast and don’t eat until lunch or later, your body is burning body fat for fuel and likely producing low-levels of ketones
• when babies are born, they are often in a state of nutritional ketosis for the first few days or week of life because they are consuming very little breast milk until the mother’s breast milk production ramps up
• when you eat a low-carb meal (eggs and bacon) for breakfast and don’t eat again until late lunch or afternoon…or…when you eat a low-carb breakfast followed by a low-carb lunch, your body is producing a low level of ketones until you eat a more significant serving of carbohydrates at dinner, etc.

Can you get ketones with a high blood sugar?

Ketones typically accompany high blood sugar. Ketones indicate your body needs more insulin. Most often if your body needs more insulin, it means your probably have a high blood sugar. Also, when an illness is present, your body releases hormones in response to the stress. These hormones lead to elevated blood glucose. That is why it’s recommended to test ketone levels during illness.

Can you get ketones with a normal or low blood sugar?

Ketones can also be present when your blood sugar is normal or low. These are sometimes referred to as “starvation ketones” or “nutritional ketosis.” During an illness or extreme diet change, if you have a significant decrease in carb intake, this can lead to the body using fat for energy because there are not enough carbs present to burn. Your blood sugar could remain normal or even be low in this case but your body could still be producing ketones.

From; http://beyondtype1.org/ketones-the-6-must-knows/

Conclusion

My conclusion is that, like diabetes, ketones need to be treated seriously. They are not always scary but you need to know why, when and how. And remember, if in doubt call your D-team. A quick phone call equals peace of mind.

Sources of information about ketones;

• https://www.diabetesdaily.com/blog/2014/11/dka-nutritional-ketosis-are-not-the-same/
• http://beyondtype1.org/ketones-the-6-must-knows/
• http://www.healthline.com/health/type-2-diabetes/facts-ketones#1

The Sneaky Low

I hate when the hypo just comes out of nowhere and hits you hard! It a very rare occasion that I have a hypo around lunch time. But yesterday, totally unexpected and without hardly any warning a 2.6 mmol/l (46.8 mg/dl) knocked me for 6.

I had been working upstairs doing light household chores. I decided to take a break and make some lunch because my CGM alarmed telling me that my blood sugars were 4.3 mmol/l (77.4 mg/dl) and I felt a bit on the shaky side but not much.

I threw a lunch together and sat down to check, dose & eat. WHAT!!! 2.6!!!!!! Then I realised not only was I actually shaking but I was sweating profusely. I decided to hold off on my lunch, which was low carb and protein - not a good start to treating a hypo, and I quickly chewed 3 glucose tablets.

I stepped away from my lunch to allow the glucose to kick in without obstruction from protein. I can’t believe I was that rational!!! Then again, I couldn’t figure out what I should do with my insulin dose - I should obviously reduce it a little. But should I include the glucose tablets in my carb count.

Fifteen minutes later I was still shaky but I think my brain was pulling itself together again. I checked my blood sugars again and I was 3.9 mmol/l (70.2 mg/dl), the food was sitting there waiting for me. I decided to put it out of its misery.

I took my reduced insulin dose at this point. It seemed like the right thing to do to avoid the low blood sugar rebound. I knew that the sweating had stopped because I got the chills but the shakes were still there and didn’t quite go away for about 30 minutes.

I did have to top the carbs up twice over the next two hours to keep my blood sugars in the safe zone which was another unusual circumstance for me.

The lesson learned today is to not to try to sneak household chores in before lunch! And always use diabetes lessons to avoid household chores :-D