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.