Monday, October 04, 2010

how to explain diabetes

recently i've found myself attempting to answer all sorts of questions about diabetes - from friends and family alike. most of the time my diabetes goes unnoticed, but occasionally people will ask things like: what can you eat? how bad is your diabetes? how does it affect you? what is diabetes again?

i am SO happy when people ask me questions, because it means that they want to understand and learn more about diabetes. but sometimes, it can be tricky to explain it in a way people understand, especially as the cause is not known yet.

so, most people don't really have any idea what diabetes is, and if they do, they probably know more about type 2 than type 1 (or they never realised there were two types!). and they'll probably throw the word 'hypo' or 'sugar' in there as a way of attempting to sound like they know something. most people just look confused and very serious - they simply don't know to what level it affects your life or how ill it can sometimes make you feel.

when explaining diabetes i start with this simple explanation of the two types, so at least that's cleared up in their heads:
there are two types, one for young people - which is what i have, and one for older/larger people. type 1, for younger people, is where the body produces no insulin and it has to be put in with an injection or pump. type 2 has to be controlled with exercise, diet and tablets - these people usually have some insulin but it doesn't always work effectively.

from there, if they are listening, i continue with the explanation of what insulin does/is:
your body needs energy to work. energy comes from sugar and carbohydrate, you need insulin to turn food into energy. without insulin, all the sugar keeps going round in your blood, and you get very tired because you have no energy.

from then, i would probably explain an insulin pump, show them it and explain why i have it instead of injections. i might also explain why i eat a little differently to other people.

here are a few common q&a's:

so, what can't you eat?
actually, i can eat anything but i prefer to eat low/no sugar things and wholemeal products, because they are better for my sugar levels.

what's glycaemic index?
it's a measure of the speed of the carbohydrate. a high gi food would enter your blood stream very quickly and cause your sugar level to spike - this puts massive pressure on your pancreas to produce enough insulin quickly. low gi foods are released over a longer period of time, and are better for the body.

what is it like to feel low?
it's like being tipsy. i get dizzy and very energetic, then hot and sweaty and then i have to blink a lot to try to stay alert. i get very chatty and shaky. and i want to eat everything in sight.

why do you get really ill, and what does it feel like?
when my sugar level is high, i get really tired. i have a headache, and feel really thirsty. i become less responsive and less alert. this is usually caused by not enough insulin. and if it keeps going on, i can start to feel really really bad, because my body will try to use fat to create energy and this produces a toxin called ketones. i get very ill when these are in my body, and sometimes am sick or very faint.

explain ketones again?
these are a by-product of the body trying to turn my fat reserves into energy. they are a toxic waste product that harms the body.

most people never realise how serious a disease it is, because most people with type 1 manage it really well and without other people noticing there's anything different about them. so, occasionally i like to slip into conversation that i've been in hospital with it, and i could go into a coma or have a fit. that scares them into thinking it's kind of important! shock tactics sometimes work...

i realise this is only a few questions, so if you have any questions you want answered, or want to know how to answer a question someone else has asked you, please don't hesitate to ask me!

Monday, May 17, 2010

stress and diabetes

i've recently had some high sugar levels, and i've been trying to work out quite why. as they don't totally seem to make sense. of course the longer your sugar level stays elevated the less sense everything seems to make, which is why it's very important to get your level down asap.

this morning i woke up with a bad level. and today was a really big day at work. rubbish. i cannot make decisions with a bad level, and get confused really easily, so going in to work was a no no. plus it's illegal to drive with a level over 15 - so i couldn't get there even if i had wanted too.

but my mum mentioned this morning just how frequently i got a bad level on a monday morning. what was it about sunday that made my levels sky rocket overnight? normall i attribute it to the amount of food i consume whilst lazing aorund the house, but yesterday was a really busy day, and i didn't really take time to do much lazing. instead i wondered whether my infusion set needed changing, but no it was only just a day and a half what was it?

it made me think about stress, and how that might affect my levels. in theory, stress makes sugar levels go higher - partly because you are less able to take care of yourself when stressed, and partly because it physically can elevate your levels. so, i wonder whether on a sunday afternoon/evening i've been stressing out too much about the week ahead. and perhaps lately i have...i don't know.

i'm definitely going to look into getting a new pump soon. and i can't wait for some hotter weather to really get my metabolism going and the absorption rates going a little faster. our english winter seems to be dragging on and on, and i'm a little concerned that we might only get a few weeks of warm weather before it turns cold and wet again.

i suppose i wondered if any of you (my lovely readers♥) have ever noticed stress affecting your levels? and what your experiences are? i always love to hear what you've got to say...

the only other thing i've got to say is that if quitting jobs and emigrating to australia was an option i would have done it by now...healthier food, more sunshine, connected community = better sugar levels and health all round? i think so.

plus also i've found when i'm stressed i tend to comfort eat, and now my brother's moved back home there's actually unhealthy food in the house - and i don't cope brilliantly well with temptation!

Sunday, May 09, 2010

a new diabetes doctor

on friday i went to meet my new diabetes specialist. for those of you who have been following this blog for a while you might know that i've been incredibly blessed in the past with a brilliant specialist team, even though they were an hour away. and before that i had a doctor who had no idea how insulin pumps functioned, or could be beneficial to me.

so, in an effort to stay a little greener and closer to home, my old specialist referred me back to my local hospital where there is now a small specialist team. so a good five or six years after leaving, i returned.

i was quite nervous. i had not had brilliant times at this hospital, and the paediatric doctor's even made me cry at one point (not good, i don't respond well to tough love or misinformed criticism). so after a little wait, the doctor introduced himself and called me into his office.

and thankfully he was brilliant! he asked me all the appropriate questions, and answered all of mine in plenty of detail so i understood. his advice was knowledgable and came from a really solid understanding of what living with an insulin pump is actually like; which is really helpful!

having a good specialist working alongside you is the best thing ever. people are different, so it's important to get someone whose advice you respect and are willing to follow. it's obviously different in the uk, the us and other countries, but i believe that everyone has the right to good patient care, and it's important to make sure you are getting the best treatment possible.

have you ever had a bad experience from a doctor? or have you also been blessed with a really encouraging and supportive team of doctors?

i hope you are all well ♥

Wednesday, March 10, 2010

low in the night

going low in the night is something i've been struggling with since i changed my basal rates after the awful january blues i had.

i'm so glad i actually wake up though! the only 'episode' i ever had was during the night, so I'm happy to wake doesn't annoy me at all. i tend to find myself becoming more and more conscious, and then more aware of how hot i am feeling, and then aware of the dizziness i feel as i try to sit up to find some water.

it clicks that i'm low, and although i've always got a snack next to my bed, sometimes i'll get out of bed and have late night toast with some honey instead (snacks can be expensive, so i don't like to eat them unless it's 100% my last option)

sometimes i'll have some lemonade instead, depending on how low i feel, and how tired i am. sometimes i've been known to roll over, fumble for a snack in my handbag, open the packet, and munch very slowly and thoroughly whilst my head is still on the pillow and my eyes are shut. and then once i finish just fall straight back into sleep. i only realise i went low when i have a dodgy taste in my mouth in the morning, and there's an empty packet lying on the floor.

i really hate the fact that i've had disturbed sleep, but i can't quite seem to find the balance, sometimes i'll wake up with an ok level after that, or i'll wake up earlier in the morning with another low.

the reason for these lows is usually exercise, as i don't usually get much of it, and i never remember to adjust my basal rates! perhaps if i exercised more frequently then i would have better control? of course i would. i must put that on my to-do list :)

have you had scary night time experiences, or do you check your levels during the night? - i used to do that, but when i'm really tired i don't hear my alarm to wake up!

Thursday, February 11, 2010

chocolate cake that's perfect for diabetics

i never thought i would say this with such happiness and joy, but i ate a quarter of a chocolate cake last night, and had no headaches and awoke with a good sugar level...who would have thought?

well i bet you're wondering how that's physically possible, given i get a headache whenever i eat refined flour or sugar, and there can't possibly be an edible cake that's made without either of those ingredients? well there is!

last night i made black bean chocolate cake...and it is seriously good. it's cheap and easy to make as well. i've posted about it on Not Just Apples, my healthy eating blog. but here's a sneak preview!

according to the recipe it has only about 6g of carboydrates per 1/10th of the cake. wowee - that would mean that the whole cake would have about as much carbohydrate as one slice of regular chocolate cake!

Friday, January 22, 2010

educating yourself

definitely one of the best things you can do to keep yourself healthy is to keep keep reading and rereading helpful books and health information.

i am a complete addict to reading about low GI foods and healthy diet related things, but unbelievably it's taken me a long long time to pick up the insulin pumping books my mum bought back when i first got my pump.

all those bits of paper are all the notes we took in the first few training sessions, which were pretty interesting to read in themselves. but i really wanted to retrain myself about basal rates, and there were lots of helpful things i can't believe didn't really sink in since i first learnt everything.

 - it takes 5 hours for all the insulin to be absorbed. i think this is just a changing of age thing...that it takes longer to absorb as you get older, but no-one has told me this really, so i haven't adjusted. instead, up until 2 days ago when i read the book, i would correct my level 2 hours after bolusing if it wasn't back to normal. now, i know that i should wait a bit longer and it should be back to normal before my next meal, and if it's the perfect level i'll know to have a little snack to keep me going to my next meal. when i was younger and my metabolism was faster i guess it would have gone in that quickly, but it certainly doesn't now.

 - there's all these phenomenons in the night and the afternoon. there are common basal types for diabetic, of which i fall into two categories: the night time high and the afternoon low. i have adjusted my basal rates accordingly now, but i hadn't fully appreciated that this was common and at what times of day i should edit my basal to account for this.

anyway, my levels are fast approaching normality thanks to this knowledge, and a drastic change in the way i handle things.

i've edited my basal rates throughout the day, so they are higher at night and lower in the middle of the day. plus i've stopped food grazing, and unnecessary snacking: if my levels are good then i ought to need a snack twice a day to keep them on the right track.

i've been checking my levels way more over the past week. havoc for my poor fingers, but great for my levels. and thanks to my 'diamedic' iPhone application I can really see where my sugar levels are going and keep tabs on them much better.

perhaps i'll look into getting a more recent insulin pumping book to keep myself 'in' on the latest news! any suggestions?

Thursday, January 21, 2010

Staying Positive & Resisting Food Envy

I know several of you struggle with keeping positive, and I can assure you that I do too sometimes. And really the best way that I know to keep thinking positively is to get some perspective.

When I was younger and sulky my mum always would remind me of how fortunate I am in comparison to other children...I can still walk, I can still see, I have a good brain, I have a lovely family, etc. This is by far the best way to keep a diabetic level headed.

It's only an illness if that's what you make it, you can't let it rule you. I'm never a diabetic, I just happen to have diabetes.

Another way I learnt to encourage myself is to make special versions of things. For example, healthy pancakes or dark chocolate mousse, which would make me feel super healthy and happy. Once you realise that the things you can't eat are bad for you anyway, I think it makes things a lot clearer.

I know that for a young child who wants to eat cake and cookies and stuff it can be hard, but I reckon if I were the parent of a diabetic I would try super hard to make sure that they never felt left out and always had their own more delicious looking food so they weren't tempted. Make them feel proud of their food too; not all kids will find a raspberry whole wheat muffin so tempting, until you put some dark chocolate chips in it and wrap it in a really posh muffin wrapper. That kind of thing will make it look posh and expensive without actually being so...and it'll make the child much more proud of their food. It's like the kids whose sandwiches are cut into triangles instead of rectangles; it just shows more love and thought has gone into the food - i was always jealous of the triangle sandwiches!

Also, it's important to keep just healthy food in the house, and make all the family eat the same low GI food as the diabetic. Giving them separate meals will just make them feel worse, I can assure you. It should be only when they can make the choice of eating something different that it's ok for them to have a separate plate...otherwise I would suggest all eating the same til then (and that'll probably be when they're 18 and leave home).

You need to encourage the healthiness of the food, and not negate it. And disguise meals too, make them look like regular meals, and don't mention that it's whole wheat or low GI until they're old enough to understand why that's important - and they're the ones to mention it.

Also, if it's an important event where there's special food, like a birthday or Christmas, then don't tell them they can't have something. Let them have a small sliver of birthday cake and make some low sugar mince pies. Let them feel a part of it, it's even more important on these occasions that they join in.

If it's you that's the diabetic, then you just need to be prepared for the consequences of your actions. I can quite happily not eat real pizza or real ice cream because I know how ill I feel afterwards. I am sensible when I'm at a buffet to choose lots of vegetable dishes and avoid the pastry things. And I know that choosing sensibly will have a huge effect on how long I remain healthy. It's important not to abuse your body, and eating healthily has a massive impact on your long term health as well as the short term.

If your child or you are feeling really depressed about diabetes, then it may just mean a change of doctor. My old doctor made me cry and feel like nothing I did would change the future of my health. But a soon as a I switched to a specialist doctor who understand A LOT more about how I was feeling and coping, I wanted to feel better and knew that all the effort I was making was actually making a difference to my health. I want to go to see the doctor knowing that I've done everything I can to keep myself well; so that they are proud of me.

If you are looking for some motivation then think of a couple of things, how you want to outlive your parents so that you can look after them when they are old instead of the other way around, and how you want to be a great parent when you are older and have enough energy for your kids. If it's your child that needs motivation, then short term motivation is probably better and you could also set up goals and targets with them. For instance if they can drop their average sugar level over a week or decrease their HbA1c level next time they go to the doctor, then you'll take them horse riding/swimming/cycling in the forest/berry picking. Let things not be motivated by food, but some healthy family activity!

I hope that helps some of you struggling parents out there and keeps you diabetics happy. My last thing to say is that, it's not realistic to be positive all the time, sometimes what you need is a really good cry before you can move on. Don't forget to get the perspective in your life and work hard towards a longer, healthier and happier life! Remember too that if you are looking after yourself you will naturally feel happier and more positive!

If you want some healthy recipes you can either check out my healthy eating blog Not Just Apples or go to the Enjoy Healthy Eating website, where there's plenty of nutritious recipes.

Monday, January 18, 2010

Levels, levels, levels...

I know you probably don't necessarily want to hear too much wailing from an insulin dependent diabetic who can't keep control of their levels, but perhaps some of you might find it comforting to know that even the most  experienced pump users run into sticky situations, and then how they try to work their way out of it!

i've mentioned when i've had bad levels before, but that might just be one or two over twenty and i'll have a pretty good idea of the cause. but the levels i've had since after christmas have been ridiculous and inexplicable.

generally once levels get high they are very difficult to keep back down again, so it's always best to prevent that through exercise, healthy eating and regular set changes. but we all know that some of these can slip out of falter quite easily, can't they? actually, i think my problems started once i got back from my round the world trip (see some of my previous posts for more info) as i went from a very active routine on not much basal insulin to one with very little exercise on the same amount of insulin - and i didn't figure it was too different that it needed a change, what a silly person i am!

fyi, whenever you change your routine, do a fasting blood glucose to redetermine where your basal rates should be at, as they will almost definitely need to change along with your everyday activities! if you don't know what a fasting glucose is, it's basically where you fast for one meal, and check your levels every hour within that period. it's a very effective way of checking your basals are right. there's just one tiny problem with have to start with a good level - something i've not been able to do properly yet!

so what i have done to keep myself in order with these levels is:
  • to change my infusion set - i find that different batches of sets can sometimes be the problem, so open a new box if it doesn't seem to work well on the second change.
  • to eat super wisely - i always do this anyway, but writing down what you eat, how much and when can help to determing whether this is making a massive difference on your levels - any secret fats?
  •  to up the exercise - which becomes increasingly difficult when you start to run out of energy, but a walk is always good, just make sure someone is with you
  • to keep drinking loads of water and do ketone tests, if you show signs of ketones you might have to go to hospital for permanent supervision as this is really dangerous
  • to get a good amount of sleep - your body will need rest and recuperation to restore it's body back to health, which will take some time for sure, give it the chance to have good sleep by going to bed earlier than normal
  • to phone the hospital after 3 successive days of trying and constantly bad levels you don't understand - i spoke with a nurse who insisted it must be my basal rates or an underlying illness (i now have a cold and a much higher basal rate!)
well, i still haven't got the levels down properly but they are much better. i'd like to be able to put my set somewhere else to help with better absorption but i don't have a lot of fat in my arms or thighs, like at all, so i don't know how that would work? i'll sort my basals out first and then let you know...

have a great day all of you!

Friday, January 08, 2010

Diabetes in the Snow

Amanda asked me this question:
We had not been to cold country, had never experienced snow/winter. Do we need to take special care or precaution for pumpy during winter ?

Now, I feel I am vaguely able to answer this question, seeing that I am currently looking out at 3inches of snow (and have been stuck at home for the last few days because of it!). Snow isn't something we usually get in England, and when we do everything shuts down or doesn't function properly. But it is nice to look at isn't it?

As for managing diabetes and an insulin pump there's only a few things you need to keep in mind in the winter:

  • eating more: a sad but true result of being cold or stuck at home is that one tends to eat more, and i've definitely noticed this whenever it snows. so, it's good to make sure that you've got a good stock of healthy snacks stored in the house and no bad stuff (chips/pizza/cheese - not good, but my mum tends to keep them in the freezer). plan your meals ahead, and don't oversnack or eat too much comfort food, as you'll probably upset your infusion site - i've done this a couple of times, and you end up bruising your set by pushing too much insulin through.

  • lack of exercise: for some this isn't such a problem, as for example, I love to go for walks in the snow, and it does help me from getting 'cabin fever' from being trapped at the top of our hill. But for others, I can definitely see how it's possible to want to hibernate all winter and exercise as little as possible. But, may I recommend heading out in the bad weather every morning just for a brief moment, in order to get your systems started for the day, and breathe some deep breaths of fresh air.

  • the cold: of course, living in a colder climate will in turn effect the absorption of insulin into your body: aka it will be slower and less absorbant than it will in a hot climate. so make sure to do a fasting basal check and change, and keep a close eye on your sugar levels. to help the absorption you can have a hot bath or a session in a steam room or sauna, and make sure that the place you spend most time inside is nice and warm. this is REALLY important, because this will effect how long your sites will work for; you might have to change them more frequently in colder weather.

  • illness: this is obviously something that winter brings, and some people appear to be more prone to catching colds and viruses more than others. but illness can definitely effect your sugar levels, and if you are at all worried about your levels whilst you are ill you should ask someone to come and look after you. if you start vomiting or passing out, then you should definitely head to the hospital. -i personally don't get ill that frequently as I keep exercising and eat super healthy food.

  • blood circulation: definitely important to remember to keep your feet and hands really warm during the winter, as diabetics are far more likely to have problems with these body parts later in life, so you need to take good care of them whilst they still work. (if you are working at a computer all day, keep checking your hand temperature as it can drop fairly low without you realising) if you're heading out for a walk bundle up with a pair of gloves/mittens and wrist warmers too, scarf, hat and as many pairs of socks to keep you toasty.

  • be careful: there's lots of weather related accidents this time of year, so be careful and don't do anything unwise like jumping on ice, or driving in a blizzard. make sure that your health gets priority.
that's really all i can think of at the moment, i hope this is helpful! any more questions, please ask...

Friday, January 01, 2010

Partying with a Pump

Ok, well this is blatantly something that comes with maturity. i’m sure of it. or, a very strong will and sensible head. both of which i guess i’m slowly acheiving!

this last couple of weeks has really seen an interesting set of sugar levels, and i’ve been trying to fathom why they should be so. and here’s what i have concluded:

- partying and pumps generally don’t mix, but they can work if you plan them out properly and you check you sugar level frequently. and it’s even more important to check your levels and look after yourself before and after the occasion, or around the party season in general!

basically, i had amazing, near perfect levels from Christmas Eve to Boxing Day, but the week before and the week after were incredibly rubbish. partly due to it being a time of rest = no exercise = bad control. and also due to the different types of food and change of routine – both bad and not so easy to control.

anyway, i was totally psyching myself up and preparing for amazing levels on the three most festive days, and totally missed the before and after parts. next time i must learn to be aware the whole holiday season.

but, when it comes to specific parties there’s a few things to keep in mind to keep your control good:

- if there’s dancing, make sure you change your basal rates as the level tends to plummet in the middle of the night otherwise.
- make sure you ascertain the timings, like when it starts and when it finishes, and prepare yourself for an early exit so you don’t throw your routine off balance
- if there’s food don’t be afraid to ask what type, ask for a special meal or ask when you’ll be eating. this is very important!
- figure out how long it’ll last and what kind of activities there will be, so you can be prepared for all eventualities
- in case of a party you must attend that’s secretive or you can’t quite get all the details, take spares of everything with you, and loads of snacks and emergency supplies to keep in your car.

basically just don’t be afraid to ask anything, don’t be shy, and make sure that you LOOK AFTER YOURSELF to the best of your ability. some times you might feel annoying or a bit pestering asking all these questions, but it will help you enjoy the party more, i promise!!

as always, if you have any questions, leave them in the comments sections and i’ll get right on with answering them!