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.

Coeliac Awareness Week

Coeliac awareness week begins today and that's why I'll post more this week than just the normal one post on a Wednesday. I'll keep this post simple today. I wrote a post a couple of months ago on adapting to coeliac disease and I think it's the best way to start off. Let me redirect you to the post here: https://myautoimmuneblog.blogspot.com/2020/02/adapting-to-coeliac-disease.html?m=1