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. 

Latest Diabetes Nurse Appointment

 I had my latest nurse appointment. The patient in before me, who looked to be a similar age to myself, sounded like he was only getting blood strips for ketones for the first time because it appeared from overhearing their conversation that he wasn't aware of the strips or when to test for them, what readings are normal and what to do if they're not normal. 

Anyway, my blood pressure was normal. I probably could have taken an extra unit with breakfast this morning because my blood sugar read 10.1mmol/l at my appointment. We discussed why I feel NovoRapid is better than Fiasp for me. My weight is down half a kilo from my dietitian appointment earlier this year. I'm 82.2kg now. She did the quick finger pick Hba1c test that came back as 68 which is unchanged from my previous blood test hba1c. But she noted that the predicted hba1c from my freestyle libre readings for the last 2 weeks is lower which means it's coming down. I think she said the target is between 53 and 58, I forget. 

She said my blood pressure is normal so I'm happy with that. She did my feet test with a poker and tuning fork and everything was normal. She said there used to be plenty of diabetics who had nerve issues in the feet after years of diabetes but that if I look after myself I might never have any issues there.

She ordered blood tests but said to wait until 2 weeks before my endocrinologist appointment in october to do them so the results will be fresh for that appointment. 

I asked her questions at the end and she answered them for me. First of all she said it's OK to occasionally have two large meals in the day instead of three but not to do it regularly and that a dietitian wouldn't recommend it at all. Another question I asked was about if I needed to snack every time I top up between meals. Basically if I have a top up about an hour before a meal I should take a small dose so there's no need to snack and to allow for the fact that the NovoRapid already taken is working in the body at meal time so allow for the insulin already in me when calculating a meal dose. I also asked if a site was damp due to sweat would it affect my insulin dose. She said it shouldn't. 

I like those appointments because it feels like the only time I'm getting actual physical medical care for this horrendous curse of a disease. They're great for my mental health too because there were times when that would be the only friendly interaction with people I'd have for days if not weeks.

Oh yeah! She gave me a chart print out from her computer of my libre readings too so I can process the data myself. That's it in the photo. I didn't even ask for it, she just gave it to me, which is great.

New Glucometer, Alternative Test Sites

 My glucometer stopped reading test strips and the screen on my spare wouldn't work so I had to call my diabetes nurse. She left a new meter for me at reception in the hospital and I collected it today. Anyway, looking at the instructions while setting up the new meter, I noticed what you see in the picture. I only ever use fingertips but I didn't know (with the latest freestyle optium neo glucometer anyway) that you can also take blood sugar readings from the forearm, upper arm and base of the thumb! Ketone readings should only be taken from the fingertips though. I'll keep the upper arms for my freestyle libre sensor though. 

I was ok without it because I have a "contour next" digital meter in case my freestyle libre doesn't work. But that doesn't take ketone readings and I just noticed that the strips for that (which I don't have a prescription for) expire at the end of this month. I have an appointment with my nurse in August and I'll ask her if she has any spare strips for the contour next meter in case of emergency then.

Coeliac Awareness Week

In recent years coeliac awareness week hasn't felt like that big of a deal for me. In a way it's probably a good thing. I have it fairly well managed and I generally know what I can and can't eat. There are events happening for it like the gluten free kitchen company and coeliac society of Ireland hosting a support group event locally and Becky Excell doing an online live cooking event for the coeliac society of Ireland. But I think more people are more aware of what coeliac disease is these days and the food products available have much more variety than they did even when I was diagnosed just over 8½ years ago and that has contributed to it not seeming as big of a deal as it was to me when I first heard of coeliac awareness week.

Perhaps somewhat ironically, one way to tell when my diet is healthier or less healthy is by the frequency of me buying stuff from the gluten free/free from aisles in grocery shops. As in the less frequently I get stuff from those specific aisles the healthier my diet is at that particular period of time. 

If I'm eating healthy I'm generally cooking proper meals for myself consisting of vegetables, fruit and unprocessed meat, none of which are in the gluten free/free from aisles. If I'm not eating my healthiest diet I'm buying gluten free packaged products, biscuits and sweets, all of which are generally placed specifically in gluten free/free from aisles in supermarkets. I have been getting a lot of quick & easy products that are gluten free instead of going to the bother of cooking wholesome nutritious meals lately. My blood sugar has generally been manageable though because I'm more active with work.

But I digress. If you're coeliac and your diet is healthy you might find that you're visiting the gluten free section in a shop less and less and sometimes avoiding it altogether. If you feel better because of it, that's great. 

My diet needs an overhaul but it's tricky to get myself into the right place mentally to do that. 

NovoRapid v Fiasp

Starting with a disclaimer. This is my own personal experience and may not necessarily reflect how different insulin products will work in your body. 

In December my diabetic nurse changed my insulin. Long acting was changed from Lantus to Tresiba and fast acting was changed from NovoRapid to Fiasp. I started Tresiba straight away even though I had a full box of 5 lantus pens left. I gave the lantus to my nurse to give to another patient. I was halfway through a NovoRapid box so decided to wait until they were finished before starting Fiasp. I could see a change, for the better, in control of my blood sugar after only a few days of being on Tresiba. 

About a month later I started Fiasp. I took one less unit than I would have for my first meal with it. I was a bit high after so topped up with a couple of units as I would have done with NovoRapid. I was high before taking Tresiba that night. 

There was another time I needed to go somewhere one afternoon after eating my lunch. I checked and was over 11 so felt sure I could get there and back without worrying about a hypo. I got half way to where I needed and felt low. Both freestyle libre and meter confirmed I was hypo. So I sat on a wall (the weather was fine) and took a few glucose tablets. Once my blood sugar was back up it was too late to get where I needed so I popped into a nearby shop to get a snack in case of another low and went home. My blood sugar was in the high teens when checking before my next meal.

Here's what Fiasp felt like to me. The more I took the longer it felt like it lasted in my system but it never lasted as long as NovoRapid. It acted too quickly to be effective on slow release carbs at times. Whereas if I took 2 units of NovoRapid it'd last as long as 12 units even though the effects would be proportionately different. I needed less units generally to cover a meal with Fiasp but the effect of NovoRapid is more consistent. Once I was out of range under Fiasp it was a lot more tricky to regain control. But in range it felt pretty good. 

I asked my diabetic nurse to send me a new prescription for NovoRapid when I was coming to the end of my supply of Fiasp because I didn't like Fiasp overall. 

I'm back on NovoRapid now and I think NovoRapid and Tresiba are the best fast and long-acting insulin combination for me.

I Only Took 2 Units Today

A few weeks ago I was at work and couldn't take insulin at break time because I never brought a needle for my insulin pen. I ate anyway because my break at work is when I eat breakfast. My blood sugar went above 15mmol/l when I checked myself before leaving work and was above 16 when I got home. I took insulin and ate when I got home. I made sure to replace needles in my meter pack as soon as they run out after that, rather than occasionally forgetting the night before.

Today I checked myself as normal before break. I was 4.4 so decided to wait until after eating before taking insulin as I was going to be more active after break and wanted to bring my sugar up. I checked myself a while after break before getting into the most hard working task of the day and it was only gone up to 5.1 so ended up not taking any insulin at work. A big contrast from a couple of weeks previously. 

I had to be somewhere in the afternoon after work and it was about a 40min walk from where I live. My blood sugar was above 11 when I got home from work so I took 2 units in the leg and ate a banana on the way. On the way back my blood sugar read 4.4 again so I used it as an excuse to eat a Dr. Coy's chocolate bar. I also called into another shop for a small Schar chocolate bar. 

It's 17:20 as I'm writing this and I've only taken 2 units of insulin all day. It's amazing how different the need for insulin can be on a given day. It's also amazing the how different factors like activity levels and even the difference between warmer and cooler weather can affect one's need for insulin. 

Dietitian Appointment

79.3kg (175lbs American readers) I lost 2.2kg (5lbs) since the last time I saw the dietitian. It surprised me because I wasn't very active over the winter and I eat more than 2000 calories a day. She suggested it could be because of struggling with high blood sugar in the months between February and May. Not a healthy way to lose weight. But my blood sugar is better than our phone appointment in April so I can maintain it in a healthy way now. Nothing to report on the coeliac side of things. Like I said to her, I live alone and no one else brings food into the flat so things are pretty much under control there. 2nd vaccine tomorrow and diabetic nurse appointment on the 18th. 

I got the AstraZeneca in April and I was very sick for a week after it. But I'll go for my 2nd one tomorrow to be fully vaccinated. Hopefully I won't be as sick this time.

I was supposed to be seeing the diabetic nurse today too but it got cancelled for some reason. They were going to put me in for the end of July but I told them I was struggling with high blood sugar, had no diabetes clinic since I last saw the nurse in July 2020 and have never seen an endocrinologist even when I was in hospital after being diagnosed at the end of 2018. That and losing the convenience of being able to go straight to the dietitian after seeing her. So now I have an appointment for next week instead. Seeing the diabetic nurse is a happy place for me so having that cancelled after being waiting for so long wasn't good for my mental health. I was in a rage the whole day after the secretary rang me to say it was cancelled. I couldn't understand why I got in such a rage and my mind went to a dark place but it's strange how they can get triggered.

I never did anything on the blog for coeliac awareness week. I might mention that if I think of it the next time I think of posting. What prompted me today was I was on LinkedIn yesterday posting something and updating my profile when I was reminded that there's a link to this blog in it.

Maths For Diabetes

I was trying to work out how much carbohydrates for every unit of insulin I needed to take and how many mmol/l above target for every extra unit I needed to take. Here is the information I had: I consumed approximately 286g of carbohydrates over the course of a day, I took 23 units of fast acting insulin on that day and all that left me at the 7mmol/l you see in the photo. The 8 units there don't count because that is my long acting insulin dose I take every night at 10pm. I made a slight mistake in calculating the carbs per unit. I said 286÷23=1x instead of =x+1 (target reading + 1. The target is 6mmol/l). 286÷23=12.4 to one decimal place. It should have been 12.4=x+1 => 12.4-1=x=11.4. But having it at 12.4 allows for days that I'm more active when I would be a bit more sensitive to insulin so I'll leave it at 12.4g carbs per unit. 

The next thing was working out how many mmol 1 unit of insulin covers. I wasn't sure how to do this but here's what I did. It'll give me a close enough rough guide. 23 units of insulin over the course of the day left me at 7mmol/l. 23=7x, 23÷7=x=3.3 to one decimal place. So take one unit for every 3.3mmol I'm above target. This may or may not allow for the amount of carbohydrates consumed but, like I said, it's good as a rough guideline. There are variables outside this that will affect what my reading is like snacking between meals which I don't test or dose for, how long after my last dose I snack (which can leave excess glucose in my blood when the dose wares off) and being more active than anticipated between meals (which can lower my glucose). So my calculations can't be 100% accurate. This rough guideline should help give me more control than winging it for the previous two years. "Should" being the operative word!

I have the time at the moment to research and work out the nutrients in dishes that aren't already in the food section of my health app and input them manually. Once I input info manually the app stores it for me for future use. Once any food has the nutrients in the app I can see how much carbohydrates in a meal as the app adds it up for me. I can calculate how many units needed then. If I didn't have the time I'd still be winging it and would say keep doing what works for you to anyone else who hasn't got the time to be working out carbs in a meal and calculating the amount of insulin to take with them. Another thing is I don't round up where the digits after the decimal point are closer to the number above (eg. 6.9 I'd take 6 units). When I first started counting carbs I was using 11g/unit, rounded from 11.1 and a meal had 40g of carbs. I took 4 units because it was closer to 44 than 33. I ended up going hypo just before my next meal. That is why I now go with the whole number and ignore what's after the decimal point when calculating units to cover a meal.

A Quick Update

 I've decided to update all the recipes on the blog to include nutritional values if I can since I've a health app that allows me to log macro and micro nutrients of the food I eat. I started today by updating the salmon fillet with nectarine infusion recipe in the blog post titled "The Feels And A Recipe". Over the next few months every home made dish that I haven't logged into the app before, or can't search the app for, will need nutritional values researched and worked out regardless of whether it's on the blog or not. Except for recipes in Jenna Zoe's Plant-based Paleo cook book which has nutrients. Well, it has macro nutrients but not micro nutrients with each recipe, but that's enough to let me know the minimum information I need for the app and the carbohydrates in a dish for the purposes of how much insulin is needed to cover a meal. So that's the plan for the blog if I'm not posting something, which means I'll have to be active on the blog again even if it appears that there's nothing new on it.

Managing Diabetes

I changed my phone recently to a Samsung because the Samsung health app allows me to log meals and it gives me an outline of the main nutrients taken from meals based on the data input. I can also log blood sugar and, importantly, insulin doses. I did a rough calculation a couple of days after I started using the app. It worked out at taking one unit of insulin for every approximately 11.1g of carbohydrates I consume. I rounded off to 11g. So now I take one unit of fast acting insulin for every 11g of carbs plus one unit for every 2.5mmol I'm over 6mmol/l before a meal. The carbs for my evening meal the following day was about 40g - less than 44, more than 33 but closer to 44. So I rounded to the nearest 11 which was 44 and took 4 units for it. At the time of testing before taking my long acting insulin before bed my blood sugar had dropped to 4.1mmol/l. I allow for a drop of 3mmol overnight when taking long acting insulin. So this meant I had to eat before bed. Had I taken three units of insulin instead of four I would have been above 6.5mmol/l. I would have still taken a half a teaspoon of raw honey to prevent a low and stabilise my blood glucose but the point being I will always round down to the nearest 11g in future. Lesson learned. So, for example, if there are 54g of carbs I'll still take four units instead of five. I won't take five units until 55g or above to be sure.

This evening I had a Dr. Coys chocolate bar while out & about. But it didn't seem to affect my blood glucose. It read 5.9 before my evening meal. Here's where I'm getting to the point of the picture. The carbs for my evening meal worked out at about 90g this evening, warranting an eight unit dose. But I decided to give myself seven units because I didn't want to be below 6.9 taking lantus. With the 2.5mmol for every unit guideline I figured I should be approximately 8.5mmol/l taking long acting insulin. As you can see, those seven units left me at 8.6mmol/l at long acting dose time. 

It really does seem that the help of this app will give me greater control over my diabetes over time.

When Diabetes Behaves

I took insulin before breakfast around 10.15 yesterday morning. Went on a bus journey after that. Close to 14.30 I felt like I might be going low while sitting talking to someone. I tested myself and my blood sugar read 6.1mmol/l. So I continued with what I was doing without having to worry about my blood sugar. I didn't eat at all while I was away until I was on the 17.30 bus home. It was 17.36 when I tested myself and took insulin to eat though. 3 hours after testing myself and over 7 hours since took insulin and ate anything and my blood sugar still read 6.1! It's amazing. It wasn't even lower. I wasn't very active but still, I hadn't eaten for more than 7 hours when I normally go 4 hours between meals. I jokingly texted the person I was talking to earlier that they must be good for my diabetes because my blood sugar was the exact same as when I tested earlier. Sometimes diabetes just behaves itself it seems. Knowing how it behaved itself could be useful for future journies and activities while I'm away.

 I ate a bar of chocolate on the way home from the bus though, which pushed my sugar to 12.2 (exactly double the previous 2 readings) when I tested before taking my long acting insulin last night.

Trying To Access Glucometer Insulin Settings

 Today I want to talk about my meter not working the way it used to and my efforts to get Abbott to allow me to change that. My meter is a Freestyle Optium Neo. It used to be able to allow me to log my insulin doses. I don't know why but at the end of March this year that function just disappeared from it. I have the Freestyle Auto-Assist software on my laptop and, as can be seen in the first photo, meter settings can be changed from here like date and time. I can also generate reports to see how my insulin doses (if the function still worked) and blood glucose are trending. The one I want is insulin settings.

This is where the long acting and meal doses can be set. I just need access to this in order to be able to log my doses in my meter again. I don't need a new meter. But there's a catch:

As you can see from the third image, I cannot access insulin settings without a code. I went on the Abbott freestyle website and got a customer service number. I called the number and got through to a woman who sounded Eastern European and English obviously was not her first language. She took the serial number of my meter, recommended I download the Libre view software and said she'd call me back the following day. My meter does not work with the libre software even though the Libre View website suggests it should be compatible. I discovered this by not being able to access my meter on the laptop from the usb connection from either Libre View or Auto-Assist when the libre software was downloaded. So I got rid of the libre from the laptop. Just as well because my diabetic nurse accesses my meter from Auto-Assist at our appointments. Meanwhile I went back to the freestyle website and got a contact email for customer service and explained the situation. The woman I called rang me back the next day and I explained the situation and how the libre didn't work for me. She told me I would have to contact my diabetic nurse to get her to contact an area representative for my region and get a code. She was unable to give me a code herself. The following day I got a reply to my email. It said: "Regarding your query, please be kindly informed that this access code can only be obtained from the healthcare professionals, therefore may we kindly advise you to contact your healthcare professional in order to set up or change the insulin dose values". 

I can understand a newly diagnosed patient not being allowed access. But I have been managing diabetes for more than one and a half years and all I want is to be able to log doses in my meter again. When I was at my appointment with the diabetic nurse a month ago she said she didn't have a code for optium neo meters and didn't make an effort to get one, that I'm aware of, and that is why I went to the effort of contacting Abbott myself. 

 

HbA1c

It's been a while since I posted. I planned to post today when I got my HbA1c result Monday. Indeed I'm partly doing it to avoid doing something else not health related. I come up against mental barriers sometimes when trying to accomplish certain tasks and I procrastinate and distract myself to get rid of the anxiety. Doing this blog today is another distraction. I can even struggle to stay focused and driven at the best of times and that happens with the task of keeping up with this blog too, hence why it it took so long between posts this time. Anyway, I'll do a mental health post another day.

I went to the diabetic nurse Thursday of last week. It was hard to believe it had been October when I saw her last because of the corona virus. I didn't even get to talk to her over the phone for my last appointment in April because she was up in the wards instead of in the outpatients. I talked to her colleague that day. All went well with my appointment on Thursday and I got blood taken for my HbA1c afterwards.

I'm striving for continuous improvement and my results have shown that with one caveat, one of them isn't included in the tweet above because it wasn't in the list of results taken with a normal blood test. It was taken with a finger prick and a detector that isn't as accurate as the normal blood test. I have a sticker in a 2019 diary with that one. The label on the sticker reads DCA Vantage. That test gave up a HbA1c reading of 51 mmol/mol. The other two results after it have been in the sixties. To be honest, I wasn't expecting my latest one to be lower than October. I told the nurse I was expecting it to go up a bit but she reckoned at the end of the appointment that it would be down and she was right. My averages over the winter were very high as the honeymoon period was long gone. But I made adjustments to how I dose with insulin in the spring and even recently changed my meals around a bit and it worked out well.

I wonder will I ever be in the fifties again? That's a long term diabetes goal to strive for.

The Feels And A Recipe

Someone shared this tweet recently and I felt it. I think it really sums up living with an autoimmune disease. So I decided to screenshot it and share it here. I don't know anything about the person who tweeted it or what their state of health is. I just wanted to share the tweet.

The other thing I had in mind for today before I saw the tweet was to share a recipe. My presentation in the picture might not be great so I was debating with myself whether to include it or not. In the end I decided I might as well since I took the photo. Nectarines were on special offer in my local grocery shop recently and when I saw that I knew I had the perfect dish to use them with for dinner. The photo shows a single serving. I also heaped vegetables on the plate to have a full dinner.

Salmon Fillet With Nectarine Infusion

Serves 4

Ingredients:

2 tbsp minced fresh coriander leaves (cilantro)

2 tbsp minced red onion

2 tbsp freshly squeezed lime juice

4 wild salmon fillets*

2 tbsp extra virgin olive oil

1 large nectarine cut into very thin wedges

Method:

Preheat oven to 220C (425F).

Combine coriander (cilantro), onion and lime juice in a small bowl. Brush skin side of the salmon with one tablespoon of the oil.

Place salmon, skin side down, on a wire rack. Press nectarine wedges evenly on to the salmon flesh and cover with the lime mixture.

Drizzle with the remaining tablespoon of olive oil and bake for 15 minutes.

*Note: My local fishmonger didn't have wild salmon when I made this recently so I used farmed salmon, which would have a higher mercury content.

Credit: The Paleo Diet Cookbook by Loren Cordain, Ph.D.

Approximate Nutritional Values per Serving:

Energy: 688kcal

Fat: 42.6g (Saturates: 7.3g, Trans: 0g)

Cholesterol: 143mg

Sodium: 142.4mg

Potassium: 1,335.9mg

Carbohydrates: 24.6g (Sugar: 14.9g)

Dietary Fibre: 3.7g

Protein: 52.7g

Vitamin A: 29.4%

Vitamin C: 56%

Calcium: 7.3%

Iron: 8%

Coeliac Disease And Oats

Today for coeliac awareness week I'm going to talk about oats. Oats are a bit of a grey area when it comes to coeliac disease. Technically, they are not a gluten grain but the environment in which they are kept for food production means they get cross contaminated with wheat, barley and rye. The protein in oats is similar to gluten which means it can be cross reactive and not every coeliac can tolerate them. I've read in some places that most coeliacs cannot tolerate oats but official coeliac societies say different. Maybe the ones that say most aren't allowing for the difference between regular oat foods and ones that contain pure oats, which are labelled gluten free. Here's a quote from the Coeliac UK website: "Oats contain avenin, which is a similar protein to gluten. Research has shown that most people with coeliac disease can tolerate oats with no problems. The issue is that sometimes oats are produced in the same place as wheat, barley and rye, and then become contaminated with these other grains". Australia, on the other hand, has stricter rules regarding what is gluten free. I've been told food has to be less than five parts per million to be declared gluten free and that any food with oats, even pure oats, is not allowed to carry a gluten free label.
When I was first diagnosed the dietitian told me to avoid oats for up to a year to allow my gut to heal, as oats can only be tolerated on a fully healed gut. When I was doing a bit of research for this post, I saw that the Coeliac Society of Ireland also say you have to allow time for the coeliac antibody production to go down to normal otherwise you will still react to oats. This can take up to 2 years. It also says that some people will still not tolerate oats. Sensitive people will experience symptoms while some will react but not be sensitive to symptoms and the lining of the gut lining can still get damaged without them knowing. The advice there is to receive regular follow ups with their medical team to monitor tolerance. It says do not use oats if you have raised tTG antibodies and do not use oats if you have gastroenteritis.
There was also a thread on the site relating to someone who asked about being sensitive to oats. In it, the moderator said that the symptoms described were similar to the reaction of someone introducing a large amount of fibre into their diet when they are not used to it. That is something to also consider when trying oats.
I don't tolerate oats. Anything labelled gluten free with oats, I avoid eating. My gut is sensitive and delicate so oats are tough on it. Maybe I could try gradually reintroducing them again as it's been years since I had any but it's easier to avoid them. What prompted me to do a post on oats today was what you see in the photo. I was in Aldi the other day looking at what gluten free special buys they had on offer for coeliac awareness week. Every product you see has oat flour in the ingredients so I can't have any. In a way I'm glad because if I could tolerate oats I'd buy them and eat a whole packet in one sitting. That would mean a number of things - an oats overload possibly triggering a reaction, a sugar overload definitely triggering a reaction and I'm diabetic so my blood sugar would spike and I might not take enough insulin for it if I had it just after a meal or maybe none at all snacking between meals. Inflamed gut and hyperglycemia, not a good combination.
So the message is if you are newly diagnosed with coeliac disease avoid oats for at least a year then gradually reintroduce them in small amounts to see if they're tolerated. Whether you do or don't, you do what works for you when it comes to oats.