Wednesday, 16 November 2011

Still Twirly But So Far So Good

Just a quick one today with an update on me and Adam.

Meeting with my new piece of tech was fairly pain-free and a little bit exciting.  I went through the set-up with my, as always, excellent DSN and the first set insertion was pretty easy.  The set is located about half-way between my side and my belly button.  The wonderfully supportive Laura has requested a movement outwards next whilst she still adjusts to my new appendage so we'll see how that goes tomorrow.

I started with a single basal rate set at 0.5u.  On to this a 50% reduction was applied to run until my legacy Levemir ran out of effectiveness.  But after a few lows before 9pm and the end of the temp basal I decided to reduce the 'un-temp' rate that kicked-in at 9pm to 0.4u. I arrived at bedtime with a BG of 3.2mmol/l (58mg/dl) I quickly gobbled 15g of carbs and set my alarm for 2am and 4am knowing I'd be up at 6.15am to go to work anyway.  I was pleasantly surprised with scores of 8.9 (160), 8.8 (158) through the night and waking to 8.2 (147).

Last night passed similarly uneventfully with a single middle of night test of 6.6 (118) and waking up to exactly the same.  A drop in the next hour or so to 3.5 (63) quickly proved that it's wrong to be smug.

Initial thoughts are still very positive although I'm still getting used to feeling very guilty for not injecting when I eat; even though I know I'm still delivering the insulin by pressing a few buttons.  Testing has also become less stressful as I know that it's not going to be followed by either a meal bolus injection or a correction injection and the hassle that involves.  And after working with my Accu-Chek Expert with so long it's been fun to go back to the compactness of the Aviva Nano when testing.

I did have a minor test-strip drama yesterday as I'd already swapped my GP prescription to the promised Contour that I'd be getting with the pump.  Unfortunately I'm still awaiting the Contour delivery so a quick call to my very willing Mother-in-law who is a doctor's receptionist (everyone should get one - fantastically useful for appointments, rushed prescriptions etc) meant I could pick some more of the old faithful Aviva strips up before I ran out last night.

Next steps are going to involve setting up some basal profiles and adjusting my ratios on time of day, day of the week etc.  I think it's because my mind tends to work mathematically that this challenge excites me rather than the dread of the unknown.

My first set change is scheduled for tomorrow and will be done with the watching eye of the DSN before I fly solo.

Finally, and it's a little embarrassing to admit, but I feel I'm among friends, I, have, a, manbag. Yes. I am officially metrosexual. Well, not quite, it's not a proper one. Just an extra small Exped Ultralight Drysac.  I love them as they are simple, strong, waterproof and this is just the right size to hold my kit without being too cumbersome. I'm still at the stage of believing the DSN and carrying spares of almost everything and this fits the bill perfectly. And obviously it's tangerine, NOT orange as they describe it. Definitely not. Nup.

So yes, it's still too early to say it's perfect but so far it's pretty good.

Have a great day.

Friday, 11 November 2011

P-Day Approaches

So I'm nearly there.  A relatively short journey towards pumpliness remains after a near lifetime of daily stabbing. At  the age of three I (or more accurately my tormented mother) started injecting once a day, through time this doubled to twice and then a strict four to the current 'multiple' number depending on food and required correction boluses.

After a chasing phone call to my DSN a couple of weeks ago the pump arrived at the clinic last Friday and I'm booked in for Monday the 14th to go live with attachment, insulin and everything that goes with it.

So what are my thoughts as I approach so a significant shift in my treatment?  I'll be honest; the predominant word is 'fear'.  I'm scared that after a virtual lifetime of daily injections and a long-acting background dose that just kept me ticking along until I ate and bolused, I'll now be reliant on a little bit of tech to keep my background BGs at a respectable level.  I love tech, and all the stuff that goes with it.  A cupboard of redundant meters and phones prove this beyond reasonable doubt.  But, and this is where my semi-irrational fear sits with me - tech can go wrong.  If my phone stops working, I curse Apple, spend a few hours reloading and then love it all over again.  If my pump fails I'll find out a few hours later when DKA kicks in for the first time in a couple of decades.  Now, for all you regular pumpers, I know this kit is reliable and safety checks are there to ensure it works properly.  But at go-live minus three days my fears are taking over a little.  I think I explained it best to my fellow new-pumper Mike when I said I want my pump NOW but not yet, all at the same time.  The benefits are going to be huge, as mentioned in most previous posts, but as I've not got it yet I'm tempering my enthusiasm slightly.

Anyway, negatives aside I am excited. For the observant amongst you Monday is also significant for other reasons. It's officially been recognised as World Diabetes Day. I love the irony of me starting a totally new regime on a day when diabetes around the world will highlighted as the important disease/illness/killer/condition/nuisance that it is for so many people.  What better way to celebrate for me than to start my first 24 hour period where I don't need to inject since I was an incredibly thirsty and tired three year old boy with a bad hair style and questionable fashion sense.  Wow!  Although I can't say the years in between have improved my styling much.

So how have I prepared?

  1. Well firstly I wore a pump for a week with it attached to my skin but without the cannula inserted. That seemed to go well and the permanence of it is less of a worry than it was back in August when I first weighed up the goods and the bads. 
  2. Next step was, on the recommendation of many, to buy and read John Walsh's Pumping Insulin book.  So far its given a good background but I'm sure that in the coming days and weeks I'll learn more and more as I keep going back hoping it can answer my "what do I do now?" questions.  
  3. My prescription for Novorapid in vials went into my excellent Doctor's surgery this week and I picked up my mini-bottles today. Once again memories came flooding back of times when drawing up insulin was needed before I got onto the 'pen' regime to make vials sooooo last century. 
  4. I've calculated with difficulty my TDD (Total Daily Dose).  I've had real trouble here as one day never matches the next and my food intake can't be classified as consistent. To try and find a good starting point I've averaged the last two months and just gone with that value. Thanks to my Aviva Expert I'm fairly comfortable that my current correction values and ratios are fairly accurate but I'm sure they'll get changed in the next few weeks too just to confuse me even more.
  5. Talked lots with my fantastically supportive wife about what's coming up and, as always, been given the answers I need to believe I'm doing the right thing. And as she said "Try it, if it doesn't work, at least you've given it a go."
So what happens next?  Monday afternoon at 2pm I meet with my team at the clinic and go, go, go.  I believe I'm fairly well researched and knowledgable but I'm sure my D will come and bite my ass at some point just to prove that the 'so many vucking fariables' can't all be accounted for.

My final mention today goes to the people that have given me support and confidence in my decision over the last few months. Firstly a big thanks in general to the DOC and in particular the Twitter 'family'. My continued surprise in the warm regards and good advice is a wonderful thing to experience.  Having 
previously hated standing in the school playground when teams were picked at football (that's Association Football or 'soccer' with a correctly shaped, spherical, ball) I hate to name people individually so I'll say thank you to all and especially the UK (and Spain) section who seem to 'get' me the most.
However, I will make an exception for two:
Mike previously mentioned has been on a very similar, reluctant, journey to me making the switch from Team MDI to Team Pump. For every question I've had Mike has seemed to have similar and whilst we couldn't always answer them, knowing that someone else was having the same thoughts made everything seem a little more 'normal'. 
And Emma you can consider your work is complete. The Duck has provided some very honest feedback from the dark side that answered most of my concerns but was also honest enough to discuss the drawbacks even when I was a reluctant MDIer who was convinced that tight MDI control was as good as, if not better than, pumping

So this is one chapter of my diabetic life over with a new exciting one only a couple of days away.  Not sure what's going to happen but I'm going to have fun finding out.

Sorry I've rambled a bit again on this one but I felt I needed to defrag my mind fully before the next step.

Hope everyone has a great WDD and stay safe and healthy.


Tuesday, 18 October 2011

Another Step Closer

Welcome to the latest update in my inevitable journey to pumpliness.

At the start of my blog it was a case of 'sort yourself out Dave' and I'm sure the more experienced pumpers might have seen the signs early-doors but it took me a while to convince myself that this was the right step to take. And yes, I still have concerns about delivery failures but hey, I'll get over that.

So today was my first training session with the pump and my excellent DSN.  Thanks to some pre-reading of John Walsh's Pumping Insulin and the Medtronic training guide I was fairly comfortable with what I was being told but it was useful to get my hands on one and have a good play with it.

We went through a few menus and scenarios and agreed that it was pretty much like a phone and once set-up correctly seems to be as complex as you'd like it to be.  There was quite a bit of "not many of my people do that" when I asked about advanced settings, "but if you can work it out that's great and then you can teach me" so that may be something I have to play with myself.

I'm due back for another session on Friday although I'm not sure what else is to cover until my pump arrives.  Apparently it has been ordered last Friday but might take two weeks [Mike @ Everydayupsanddowns - I think you'll be the first of us to abandon #teammdi]

I have though been given a pump and some sets to have a play with on a leather bag for four days.  Me being me, I've pushed that test a little and have attached the tube to my stomach (without the stabby bit) and then attached the tube to the Veo that has no liquid in it.  This is the true test as I wanted to banish the biggest 'it's always there' concerns forever more.  As a bonus, tonight is a football match to watch and tomorrow I'm working in the office so will have it for the commute etc.  It's these scenarios where I believe it will work best so we'll see.

I also enquired about borrowing their CGM for the first week to give a better understanding of my levels early doors.  I was initially met with "Erm, we don't normally do that" but a little bit of persuasion later and it looks like it's a goer.  I can feel my long-term goal of a CGM permanently may take some time but small steps have got me this far. That is a battle for after I'm up and running.

On the negative I was advised that I'll need a manbag or suitable carry-all for the spare kit I'll need to have with me at all times.  I'm still not sure on this but I guess that knowledge will come with time.

So after about two hours it's still sticking on and not annoying me too much.  Now it's just the wait until go-live day. I'll admit to getting impatient - I like to research things for, erm, a long time, but once the decision is made I want it NOW!

Thanks for reading.


Friday, 30 September 2011

Team Pump Wins

For those of you following my journey towards a decision I don't think you'll be too surprised by my request today.  For those of you hoping I'd stay in the light on #teammdi, I apologise as I have been drawn to the dark-side.

As mentioned last time, I saw my Endo and he was supportive of whatever decision I wanted to take. Thanks to the thoughts and input of the DOC my lingering doubts have been lessened.  I wouldn't say removed; more that I'm coming to ask if it's really that important.

So what are the driving factors for change for me:
  • Convenience. The ability to be able to bolus in tiny amounts and easily must be my number one driver.  Taking today as an example; I'd been floating around 7.8mmol/l (142mg/dl) all morning.  At this point I always find a single unit too much of a correction and a half-unit by itself injcted has no effect at all.  Tomorrow I'll be going to a sporting event where fish 'n' chips are the traditional pre-match cuisine. Normally I'd skip as, for me, injecting on the street has never been something I'm comfortable with - blood testing, yes, injecting, no.  I know that's my hang-up but this is my decision after-all. A pump would give me the chance to bolus-and-go which would appear to be much simpler.
  • Number of injections.  Recent improvements in my control have brought along an increase in injections.  Previously I'll admit to being very lax and injecting at main mealtimes and the basal at night but since I actually started testing effectively I'm finding most food comes with a stab in the stomach.  And a few weeks ago my basal stabs doubled from once day to twice. Now after 32 years you'd think I was used to injecting but I'm afraid I'm still not that keen. A shock, I know, but there it is.  The idea of one 'shot' every three days has a much greater appeal even if I know that that one hit might sting a little more than before.
  • Funding and approval is available.  The way I'm seeing it is that I've thought about it long enough and the only way to see if it works for me is to give it a go.  As it stands currently I'm getting support from my Endo and DSN so why turn it down now? I might have another 12 months of umming and ahhing to decide that maybe I should give it a go, only to find out that cut-backs mean it's no longer available to me.
  • Tech is gooooooooood. I'm a tech boy and like my gadgets.  New meters excite me so having new tech to play with is always good.  My current Accu-Chek Aviva Expert is a fantastic meter and whilst losing the bolus calculations, having a pump to do that for me is good.  And it also means I can shrink BG meter again back to the Aviva Nano which is also good. Yes, I know I will need much more kit now but being able to slim down one piece compensates a little.
  • Choice of pump and CGM.  Well, technically no, not a choice. My clinic only supply the Minimed Paradigm Veo.  This is good for me as out of all current generation pumps available this is the one that floats my boat.  Permanent CGM is not being offered initially as the clinic like to loan out a wireless Minilink transmitter for 6 day sessions rather than fund it individually. However the loans can be pretty frequent as not many people do it.  Going forward I may start a campaign for the CGM so having a pump that is compatible from the start makes that easier. And.... tech changes, in the four or so years I'm gonna be connected to the Veo, CGM functionality may develop so having the capability now gives a little bit of future-proofing. Ever hopeful anyway. I'll end this little bit with apologies to those unable to get one if they do want one.  Funding (either NHS, private or health insurance) is always a primary driver and I know I'm fortunate to be able to have the choice.
  • I can go back.  This is a big one.  If it works great, if it doesn't I won't have lost much in the meantime.  Carpe diem and all that bollox!
The negatives still exist (always there, tubing, tech failure etc) but I'm finding that with D it's not always the positives that have to be compared but the negatives.  It's a crap 'condition' so we've got to make the best of it we can and for me, at the moment, the pump is the best option available.

What happens next?
  1. Whilst I was there today an email was sent confirming my desire and for the NHS Trust to proceed with the purchase.
  2. I need to read. Pumping Insulin - thanks for the many, many recommendations, is on it's way to me thanks to the wonders of Internet shopping - so I need to get into that and do some serious cramming.  The way I see it is that if I can hit the ground running, me and P (yet to give it a name, although Adam appeals to me for some reason) will get on much better from the start.
  3. On the 18th and 21st October I have some 1-2-1 training sessions with the DSN to go through the workings of the pump and ask any practical questions. I expect then we'll go through the detail on infusion sets etc.  As a side-note I'll be sticking with Novorapid (Novolog) as my insulin of choice as it works and we've not fallen out yet.  30 years of Novo can't be wrong.
  4. In early November P (or Adam) gets presented to me and I leave 6 times daily injections behind for a lifetime of wires and tiny adjustments - well, for ten years anyway when the 'cure' arrives. It has to be ten years as it's been that far away since I was diagnosed.
So that's where I am and how I got here.

As always, thoughts, comments, arguments and mild abuse welcomed.

Next update expected either after training or once pump arrives.

Wednesday, 14 September 2011

One Step Closer...

.... to having to make a decision.

As I've said before I'm moving along the conveyer belt towards a pump but am still not sure whether to run towards the light or just bail and stick with what I have.

Last week's review at the hospital was another productive hour of my recent drive to 'sort things out'.  It was the first time I'd met him and after an initial nervousness on both parts we got down to some fairly heavy discussions.

Short-term we agreed to try a split of my basal (Levemir) with 2/3 of the units around 10pm and 1/3 at around 10am.  For me this is a fairly significant change as my night-time dose tended to be at bedtime rather than a set time.  Obviously on a 24 hour dose this has less of an effect than if staggering it to twice a day.  Today is the first day of the new regime so alarms have been set for 10am (not needed as remembered and dosed) and 10pm.  So far, so good but we'll see in a week's time how it's working.  I can see the logic for the extra dose and agree in principle but the obvious issue here is the extra daily stab.  Now after about 35,000 injections an extra one a day shouldn't make too much difference - yes, it was rough calculations but BLOOMIN' HECK - how many????  But it does, it's another little inconvenience to add to everything else we have to manage.

I was aware the Dr was largely pump-favouring and we had a fairly lengthy discussion on whether better A1cs was because of the pump or as a consequence of the control and monitoring needed.  The end agreement was that yes, with my continued monitoring and CHO counting, lower average glucose results could be achieved there was no guarantee of how big those savings would be.  However, on the flipside, the ability to adjust in much, much smaller doses was a benefit neither of us argued about.

I asked about funding and was assured that with my current obsessive testing, longevity of being a D and desire to improve this wouldn't be a problem.  He also said he'd need to speak to my DSN to confirm that she believed it was right for me but I've already primed her with my desire to progress the process.  And here I apologise for it being relatively easy to everyone who is fighting for one for themselves or their offspring.

I'm back with the DSN in a couple of weeks and I will be asking if I can borrow one for a few days just to have it stuck on but not giving any doses.  That way I'll be able to see if one of the key negatives - always being there - is that important anyway.

Whilst the conveyor keeps moving towards a pump there's still a huge part of me resisting.  My previous blog gave a pretty long list of the pluses and minuses but now it's down to a few key minuses:
Always there - currently I'm Dave who happens to have diabetes that he treats with a small pen (now two pens) in his pocket. The future could be Dave the Diabetic with something always there to remind him and everyone else.
Nightime - I go to sleep currently after injecting and now that my basal is doing it's job. I've not woken up and needed to test for a pretty long time. Pump means I have to have confidence that the thing stuck on me is working correctly 24/7 and the only way to know this is to test. 
Daytime - as above. I bolus when eating and know that it's delivered because after an airshot the plunger on my pen goes down. Pump needs me to have certainty that when I hit that electronic button it delivers a requested.

The pluses are well known and are a huge draw but I need to get my head around it first.  My wife, as always, is very supportive and agrees that a trial might be the best option next.

As plenty have said I wouldn't lose anything by giving it a go for at least a few months to see whether it was right for me or not.  

I apologise lots if any of the above is repetitive of what I've said before but that's where I (still) am.

Next update will be after my next DSN appointment.

Finally as a little PS is a picture of a competition prize I won this week.  I tend to enter online competitions if it's easy, of something I like and from a company I trust not to flog my details to the viagramongers of the interweb.  I'm still waiting for at least one big telly or weekend in Vegas.  However, I did get an email saying I'd won a behind the scenes tour of the Thorntons chocolate factory!  Unfortunately work commitments meant I was unable to accept but asked if I could have a runners-up prize instead of an 'I Love Chocolate' hamper.  For those taking out their carb counters that's 910g of carbohydrate or 91 lines / exchanges.  Pass the Novorapid I may be here some time :)

Thank you to Thorntons and they will be gratefully consumed by me, my family and colleagues.

Please read, comment and RT.  All feedback gratefully received


Wednesday, 24 August 2011

The Big One - To Pump Or Not To Pump

So I now get to the biggest question of my recent delve into the online community.  

Firstly a bit of background for my non-local readers - hello by the way, I still love the fact I'm discussing something very personal to me with people from around the world when for the last 30 years I've not really discussed it with anyone outside my very close family. And, I even know some of your 'real' names. - Anyway as I was saying; funding for pumps in the UK is very much down to luck. Firstly you need to live in an area (Local Health Authority) that provides pumps and then you need a Consultant, or Endo, that agrees with your justification for having one. As ongoing costs are free to the user (if NHS approved) this cost is significant. Just like the rest of the world, money is in short supply at the moment, so everything is short-term rather than appreciating saved costs from ongoing care etc. I am extremely fortunate to live in a LHA that provides pumps and indications so far are that the Endo will support my request, if I make one.  So the decision for me is a lot simpler than for a lot of the DOC and I must be thankful for that.
I really sympathise for those less fortunate where the battle for funding/supply is constant, but, this is my story so thankfully, that’s not part of my challenge.

However, the decision to make is still a big one. For me, pumps seem to have been around for a long time developing from the size and convenience of bricks to something a lot more discreet.  I'm going to try and break it down into good and bad points.  However, I'm certain the end decision will be made by the heart rather than the head.

I'll start with the good bits (the pros):

  • Better control - For everyone selling the pump concept, and yes I'll include a significant chunk of the DOC here, I'm told frequently that A1cs improve dramatically and without fail. I can believe testimony but is this because of the pump or because of the amount of control needed to ensure the pumps 'works'?If I do as much testing and carb counting as is required on the pump but without the pump can I achieve similarly fantastic results????
  • Public dosage - The biggest problem I have with MDI is the publicness of shooting up.  Pumping would give the chance to subtly administer my dose without the need to hunch shoulders or visit the bathroom. 
  • Closer to natural - there's no escaping that a continual supply of bolus is a lot closer to the non-Ds norm than basal once a day with boosts whenever I eat.  This has to be better for the body, or that might just be my flawed logic.
  • Less injections - I'll admit the contraption for inserting the needle looks a little scary but it has to be better than injecting at least four times a day. Every day.  My skin wants a rest but I guess I've got the wrong 'thing' for that to be able to happen. 
  • CGM - Although I can't get funding for a permanent CGM, the local clinic loans them out frequently to pump users and this is a big draw. If CGM was available to my current regime the decision would be even more obvious to me. 
  • Tech - I'll admit to being a gadget freak so having another toy to play with does excite me a little. Sorry.  
  • Long-term complications – Again I’m fortunate. After 32 years of not perfect control I still have all my limbs and eyesight.  By changing to a pump and it’s ‘better control’ do my chances of maintaining my toe count improve?

So what in my head is stopping me from signing up straight away (the cons):

  • Always there - This is the biggie. For me multiple injections means I cam sometimes leave the house and just take myself. I can go out relatively clutter free. On a good day I just need my pen. If I'm being vigilant I'll also grab some sweets and if really, really conscientious I'll also take a testing kit.  That's it. Lightweight and disability free for a few hours. Going on holiday I have two pens plus a spare, a testing kit, some needles and spare insulin.  Now compare this with the swag needed by a pumper.  I’ve seen varying amounts quoted but the minimum is at least double of what I take currently.  For me double-kit means double the amount to forget also.
  • Amount of kit that fails - to test my pen I do an air shot of half a unit until I see liquid. Inject. Done.  No air bubbles and I know that if I dial 8 units and feel the plunger go down I can be pretty confident I've delivered 8 units.  Tech goes wrong, and sometimes it won’t do what I tell it. If it’s a pump that fails the consequences take a while to be discovered and then resolved.  And a total pump failure means a whole regime change for 24 hours while waiting for a replacement. 
  • Compulsory testing – i.e. if I want a day ‘off’ on MDI I can check my fasting BG in a morning and do normal carb counting and dosage adjustment through the day to get me to the end without feeling crap.  With pumping if I don’t do the testing how do I know everything is working OK and that I haven’t got a major problem?
  • Outside opinion – I know this is shallow and I know this will vary from person to person but for me it’s quite important.  I’m ‘Dave’. Not ‘Dave the diabetic’ or ‘Dave the bloke with the medical contraption permanently attached’. Just ‘Dave’.  I like that. I like being judged by my bad hair or poor dress sense rather than a pitying look.  I also like being just me for my family.  My wife is very, very dear to me and I don’t want to be the ‘freak with the wire’ that she’s been dumped on.  And do I want to give her a constant reminder that I’m faulty goods?  When I undress at night I’m left with my body with no attachments or signs - apart from pepperpot fingers and occasional bruises.  There’s nothing ‘unnatural’ attached or showing to get in the way of a good night’s sleep. This is a really complex part of the debate and is hard to summarise but for me D is part of me, not what defines me.  By jumping to the permanent attachment am I flipping that?
So that’s it, the main meal part of my debate.  I had hoped that getting all this down would make my decision easier but I’m not sure it does.  The DOC has plenty of examples of pumping working perfectly and finding a MDIer in the mix is often not easy.  However, does that mean it’s right for me?  I’ve had a few discussions recently with some good online friends who are very positive that pumping is the way forward, and I really value their input, but the big cons listed above are holding me back at the moment.

I’m not sure how many of you will have got to the end – I apologise for the length, my head needs to dump now and again – but as you have made it, I’d really, really appreciate your input/feedback and if you can answer any of my very vague questions then all the better!  My next Endo appointment is in two weeks so my head will probably have exploded by then.

Thanks for reading.


Sunday, 21 August 2011

The Start of the Change

So it's only taken 32 years but now it's time for me to take the control.

My always dreaded HbA1c managed to creep over 10 in April this year so the nurse at my doctor decided it was time I got to the consultant (endo) at the hospital.  Being a little bit of a swat this scared me a little so I cracked on for the next few weeks trying to get everything more under control.  

For the first time, I stepped into the Diabetes Online Community (DOC) and after browsing a few forums where tests results were displayed as badges of honour, I eventually came across a few that had real people with similar issues and concerns to me.  My first plug here for Shoot Up or Put Up who gently nurtured me and gave me some confidence to go to my appointment with the facts and questions I needed to try and sort myself out.  To say I was fired up and ready with all my guns would be a good analogy.

After getting over the initial teeth-sucking, the registrar and I agreed on a plan and I was fortunate to reunite with my Diabetes Specialist Nurse (DSN), Zoe, who I'd last seen in the last millennium.  Sitting with her we sorted out a plan of attack. In conjunction with the dietitian we agreed that my high A1c was probably due to too many hypos rather than flying high all the time.  This was a hugely new concept for me.  The plan of attack was to lower my once-daily, nighttime basal and then match the bolus' to the carbohydrates in my food.  This immediately sent me back thirty years with memories of weighing mashed potatoes and counting 'lines' or 'exchanges'.  Some things stick and my first question was "Is a digestive biscuit still 1 line?" - and the answer is apparantly yes!  After so many years of maintaining a casual relationship between food and dosage this seemed very strict but matched my mathematical brain which suggested the logic made perfect sense.  I did ask about restarting a fitness campaign at the same time but was asked gently to hold off on that until my carb ratios were sorted.

Following this I've returned a few times and together we're getting there.  My improvements have been helped greatly by recent technical improvements in my kit cupboard.  First up came the Carbs & Cals iPhone app that's excellently useful in helping to judge the carbs in my food - I got the printed version first but the app has all the same content in a much quicker to read format. Next is the Novopen Demi that allows me to inject half units which is much easier when doing the maths for the carb ratios. Finally, and the newest arrival, is my Aviva Accu-chek Expert. It is fantastic and is part of the reason for the increased dilemma as to whether to switch to the pump or stay on MDIs.  Mike has done a much better and longer review than I could possibly have done so I'll kindly link to him here. Thanks Mike.

A1c taken whilst at the hosptial for the first visit was 7.9 which shows what I could achieve without any professional input but obviously still a long way from the 6s I crave.

So that's where I am. On the road to better control but still not sure which path to take next.  The next decision is the big one.  Do I stick to MDIs or leap into the world of pumps?

Next up in the blog will be where I try and break down the advantages and disadvantages of Pump over MDI.  Obviously switching to the pump would be a huge change for both me and my family so I need everyone, and especially my better half, to help me make the right choice.

As a post-script I'd like to send my love to those across in the US of A who aren't as fortunate as the majority over here in the Great of Britain. Whenever I need new insulin or test strips I just go online to my doctors website (just done as writing this reminded me I need more test strips), fill out a repeat prescription form and collect from the pharmacy two days later, for free - and that's the big bit.  The NHS often gets a lot of stick but for me 'it does what it says on the tin' and I am truly grateful to be living in an age where it is available to keep me alive and in a country where I'm not at the whims of an insurance company whose business model is to try and restrict how much I can get.

Friday, 19 August 2011

Where to begin...

Welcome to the blog and whether you've come here deliberately or landed by accident when looking for fruit with medical conditions I welcome you with all my heart.

I was born in 1975 as a son of farmers from Cumbria and the brother of two elder sisters and one elder brother.  The early years are so long ago now that my memories are very vague and mostly involve picnics in the car in the rain. 

Then in 1979 my life-changing moment arrived and I didn't even really appreciate it.  Obviously my memory is tiny of that time but I do remember lying on the sofa before the local Doc, a very polite gentleman called Dr. Procter (and I still believe he has the perfect doctor's name), told my parents to get to hospital pretty sharpish as he'd just diagnosed me with Diabetes Mellitus.  Back then I'm not certain it was called Type 1 but the consequences were very similar to today. 

After my parents practised on an orange a few times they were told to inject me once a day and strictly control the amount of food I ate and balance this with any exercise.  At the time I was still 3 so didn't really appreciate how devastating this must have been for them and it's only now with small kids of my own that I can understand the torment they must have gone through.

Over the years developing technology moved my treatment from single injections and peeing into a test-tube to multiple daily injections (MDI) and testing my blood glucose levels with a fancy meter in ever shrinking sizes.

The middle years also involved trips to the dreaded consultant that normally involved multiple coloured pens and the test diary being filled retrospectively to prove my control was being managed closely.  The big block on this charade came with the introduction of the HbA1c test which measures your average blood glucose levels over time so showing a list of fake perfect numbers wasn't really helpful anymore.

The mid 90s had the highlight of meeting my wonderful wife and this gave me some more focus to really get everything under control but still over the years it's not really been as good as it could/should have been.

In my 'other' life I'm quite a technical kind of guy so I'm still amazed at how little time and effort I took to seeking out the Diabetes Online Community and the support they could offer.  I think I was convinced that D wasn't going to define me so I shouldn't spend much time looking into it apart from occasional tests and hoping my dosage adjustment was roughly correct.

The addition of a fantastic son and wonderful daughter brought some real focus and the start of a push to really get control of something that had been ‘there’ but not ‘carefully managed’ for over 30 years.

In 2006 I ran the London Marathon with the continued support of my wife after getting an automatic entry for applying so many times unsuccessfully.  Although fundraising really isn't my thing I decided to raise some money for JDRF for entirely selfish reasons - as their goal is to find a cure for T1.  In the training and before the race I met a few other Ds and this was probably the first time in over ten years I'd talked to anyone outside my family about it.  Yet still I held back and presumed everyone else had it sussed and I was the uncontrolled freak.

Which is brings us more or less up to date.  I hope to follow this intro up with some more posts on how I've got to where I've got to now and my thoughts going forward.  Stick with it because I'm not sure what's happening next – hence my current blog subtitle of ‘To pump or not to pump!’