Sensor Issues

My prescription only allows me 2 sensors per month but each one lasts 2 weeks, which covers the whole of February but not every other month. That meant I started the 2 of September's supply in late August because I was getting a new sensor as soon as the previous ones finished. So I went almost 2 weeks without a sensor at the end of last month so as not to go into October's supply.

I started a new sensor a few days into the month so that I'd have them right to the end of the month. I started it Wednesday night before bed last week. On Thursday I checked a reading against a blood reading on my glucometer and both read the same. A further check the following day was close enough to not really make a difference so the accuracy was very good. No need to check with a finger sample for some time, I thought. 

Early this morning around 6am I got up to go to the toilet and whatever way I came back into the bedroom I banged the arm with the sensor off the door frame. I checked with my phone but the app said it failed to get a reading and check again in 10 minutes. But I turned over in the bed and slept until not long before my alarm went off. I checked again after I woke up and got the same message. I checked twice more after leaving sufficient time and got the same message both times. I knew then that earlier bang did damage so I removed it before going to work. I could see the needle bent on the sensor before disposing of it. I only got 4 days use from it. It's my own fault that it broke.

I decided to apply another one tonight just before bed and am writing this as I wait for the hour to pass before I can start taking readings. But all this means I'll have to go another 2 weeks without one at the end of the month, which is a bit annoying. 

The thing that adds to the annoyance is the fact that I had one before that half the sticker wore off but it clung on and I still got the 2 weeks out of it. Pity the one that got a bang wasn't as durable. 

Exercise and Insulin Sensitivity

Since it's the summer solstice, I decided to make the most of the early morning sunrise. I woke at 5.20 and set off for the Tralee-Fenit greenway about a half an hour later. My blood sugar was reading 11.6 and with only long-acting insulin in my system there was little chance of a hypo. I took a snack of a packet of gluten free crackers with me. I sat on one of the benches at the beach and scoffed the whole packet. Normally if I'm not sure how much insulin to take to cover a food item I allow one unit of insulin for 8g of carbohydrates. But I took 2 units less to allow for the cycle back and the fact that I was going straight to work instead of home. 

I wasn't too busy at work but kept going using a lawnmower. About half an hour before break I felt low. I took a couple of glucose tablets before even testing because I needed to find a place to sit down. My sensor said "lo" which meant there was too little glucose in the interstitial fluid to get a reading from. I told my colleagues I was low and needed to sit down. A couple of minutes later a finger sample for my glucometer read 2.8 so, thankfully, I wasn't as low as I thought. I took a bottle of glucojuice while sitting down. As soon as I was within range again my sensor showed my sugar was rising rapidly and measuring 6.6. So I took 5 units of insulin instead of the normal 4 because I was about to eat on my break and thought I'd go too high if I took 4. 

After break I was using the lawnmower again. I felt low less than an hour after eating. Both sensor and glucometer read approximately 2.8. I only had 2 glucose tablets left, which I took, and no food to keep me up. I got back up to 4.4 and asked my supervisor to let me go away early as I had nothing to help me recover if I went low again. He understood and I left early.

So it seems exercise first thing in the morning before eating could mean I require less insulin throughout the day. The cycle to Fenit took about 45 minutes and the return took less because I wasn't going all the way home. I won't be doing that every day. It was just a once off for the solstice. But perhaps I should get up earlier in the morning and do some form of exercise before work to elevate the heart rate and get the blood circulation going. Maybe it'll be easier to stay in range with less insulin if I do. 

It's always surprising to me, the difference between insulin required for normal day to day routine and how much less is needed when I'm more active. It caught me out today. It turned out to be way less than what I thought. 

Sunny Averages

I just wanted to do a quick post. This is the first time in a long time, certainly this year anyway, that my averages have been all green. It must be connected to the sunny weather because it's only been less than a week since I've increased my long acting insulin to 14 units to stop myself from trending higher in the morning than when testing before taking long acting.

A Different Experience

 I went to A&E (the ER for you American readers) earlier this month. But before I get to why, I must briefly tell you about when I was diagnosed with diabetes. Four years ago this month, a few days after Christmas, I presented myself to an out of hours doctors service with symptoms resembling what my brother had when he was diagnosed nineteen and a half years previously. I was sent to A&E when my blood sugar and ketones were very high. I remember the staff in the hospital never made me feel any stress or trauma even as I was awake through the night while I was looked after all night. I took it all in my stride because of how the staff took care of me. The only uncomfortable experience was I had to try and call a nurse or wait for one to pass by when I needed the toilet. I had to pee in a plastic jug because I was hooked up to a saline drip and insulin and couldn't haul them to the toilet with me as they were on a set system to administer it.

Fast forward to one of my Diabetes nurse appointments and she told me if my ketones get above 1.6 to call a doctor. If they get above 2 go the hospital. Now back to earlier this month. A colleague and I were sent home early from work because we were both unwell and looking very pale on a Wednesday morning. I tested my Ketones that morning with the intention of calling in sick if they were high. They read 0.1 so I went in only to be sent home later that morning anyway. I phoned in sick with flu the following morning. I couldn't get a doctor appointment on the Thursday or Friday and the out of hours service were not answering calls. My blood sugar was in the 12s (that's around 180mg/dl for those that don't measure mmol/l) even though I wasn't eating. On Friday night they went up above 14 and ketones to 2.0. I made a call for an ambulance on Saturday morning. I was told they'd be hours because they were very busy and the roads were treacherous due to ice and sub zero Celsius temperatures. I cancelled the ambulance and made my way into the town centre to look for a taxi. None there so I walked as far as the train station because there are usually taxis there. None there either so I ended up walking to the hospital despite nearly slipping on icy footpaths. I was seen by the triage nurse after about half an hour and everything beyond that was completely different to when I was diagnosed. My ketones had gone above 2.0 at that stage, making it to above 4 during my time in the hospital. I had blood taken and a tube stuck in my arm. A few hours later I was hooked up to a drip in the hall outside the triage and a change of shift happened and the nurse on the next shift removed the drip. I wasn't put on any trolley or moved to any treatment area. I didn't have my long acting insulin with me so I asked the nurse for some when I was due to take it. She said she'd get me some but she never did. At one stage during the night I said I wanted to go home to take my long acting insulin but another nurse told me there were only two people ahead of me in the queue for a doctor so I decided to wait. This was approximately 2am Sunday morning. I was sent back out to the main waiting area beside reception. This was when my ketones tested above 4. I got a gluten free sandwich to eat from one of the kitchen staff so that I could take insulin as I couldn't remember how long it had been since I took any at that stage. As I was eating I was called back in by another nurse to get further blood tests done. Then sent back out to the waiting area. 4am, about fourteen hours after arriving at A&E, I was finally called by a doctor. She took me to a treatment room only to tell me wait outside in the hall. She got me to give her a urine sample and asked me a few questions about me, my flu and my diabetes.

After that she took me back through A&E to the hall outside triage. Walking through A&E was like a war zone with all the bodies on trollies in the halls waiting for treatment, full treatment areas and not enough staff to cope with demand. I was put on another drip outside triage. I had to contain my annoyance and irritation at this stage because I could see the pressure the staff were under. The doctor came back to me a couple of times and the last time she came back with a diagnosis of dehydration due to flu. I don't know what the blood tests showed up but she also gave me a prescription for antihistamines and told me I could go home. So, basically, my ketones were high because of dehydration and the fact that I couldn't eat for a couple of days due to flu. It wasn't DKA (diabetic ketoacidosis) that I suspected it might be. I ended up walking home again at 7am Sunday morning after approximately seventeen hours in A&E.

Compared to when I was diagnosed with diabetes four years ago, it was a terrible and depressing experience. It was so bad in there that there was another man sitting in the hall outside triage waiting to be hooked up to IV antibiotics telling the nurse that he still wanted to go home despite the fact that he was coughing up blood. I think they wanted to send him to a bed in a ward because of his medical history and I hope he got treated properly after I left.

I don't want to get too political but the Irish government, department of health and health service executive should be ashamed of themselves for the way they've let the public health system deteriorate. We have a two tier system where those who can afford to go private get the best of treatment as soon as possible while those who can't are herded like cattle into something resembling a war zone. The nurses and doctors in the public hospitals do a great job considering how they are understaffed, under resourced and hospitals are mismanaged. I always credited the facilities and staff at my local hospital and was in disbelief when I heard stories at how bad things have gotten. I certainly believe it now but not enough credit goes to the staff in there for what they have to cope with.

Finally Saw An Endo

 I finally saw the endocrinologist after two cancelled appointments and a postponement. My first time seeing an endocrinologist even though I was diagnosed with diabetes at the end of 2018. I was in the hospital an hour. I got weighed in the waiting area at the outpatients by a nurse - 82kg with shoes on and stuff in my pockets. When I eventually got called by the endo the whole thing felt rushed and going through the motions. I had questions I wanted to ask and have a proper discussion about my diabetes but I never got a chance because the whole thing was so rushed I never thought of it. It's nothing like the care I get from my diabetes nurse and she has multiple patients as well. He looked at my notes, asked me a few typical questions, took my blood pressure, examined my tummy where I do most injections and checked my feet. He said my HbA1c was in the sixties when I asked him about my blood tests but didn't tell me much else apart from saying my thyroid reading was ok when he saw I had overactive thyroid in my teens on my record. Overall I found it to be a disappointing experience. He cancelled on me twice and postponed the appointment that ended up taking only about ten minutes. For perspective, I was in with a rheumatologist during covid restrictions and I had a more thorough examination and a good conversation about possible issues even though he found no conditions that he would specialise in from his examination of me. So I don't get why a 10 minute going through the motions that was going to be rushed anyway had to be cancelled! Just a note that in Ireland we do mmol/mol and not % for HbA1c, for anyone in % land.

On a different note, I checked myself a while after a junk food supper (always gluten free) and my meter said 7.6mmol/l. My sensor said 7.1 and steady, not rising or falling. The reason I checked again after eating was because I expected to need an insulin top up because of what I ate. But there was no point in topping up and risking a low with those readings. When I'm testing before taking my long acting insulin it might still be high as the supper time insulin wears off. But I probably won't top up because the long acting should bring it down a bit overnight. I find that if I top up too close to my long acting, only the fast acting will be effective so my reading might not come down as much sometimes. That's my own personal experience anyway.

Faulty Sensor

I put on a new sensor on last night and waited an hour after the initial detection scan as per usual. I scanned when the app said the sensor should be ready. It failed to get a reading with a message to try again in 10 minutes. This was nothing new. It was already late so I turned over and went to sleep. I got up this morning and the first thing I did was try to get a reading from my sensor. But a message came up on the app to replace the sensor because it wasn't working. That was a first! Half the sticker from the previous sensor had come loose in the past week or so but it was still taking good readings.

I removed the sensor. I rang the number on the box and after the usual pressing of numbers on the keypad I eventually got through to a customer service agent. He got me to go into the app menu and told me how to navigate to the error messages. I read the message with a little number code. He took my details and said they'll send out a new sensor with a return pack for the old one. That'll take about 5 days which means it's back to finger pricking at least 4 times a day until next week. Not ideal.