Thursday, 22 November 2012

HbA1c - A Good Measure?

(*pre-warning – I’m still old school and am working in percentages – to convert try here)

Every once in a while comes the judge of my success at being a person with Type 1.  As with most measures for us it comes down to a number. Whether it’s BG test results, number of hypos, waffy moments, total carbohydrates in a day, carb to insulin ratio, basal levels, etc, etc, it's all based around numbers. Here I feel advantaged as I quite like numerical stuff. My job involves a lot of Excel and that makes me happy. Hashtag = sad.  As a slight diversion I have real sympathy for any person managing diabetes who struggles with numbers. It must be an absolute nightmare to add to the challenge that we face. You have my deepest respect for the extra daily challenges involved.

Anyway, back to the HbA1c thing.  As the whole piece is about the test I thought it might be worth having a recap on what it is and what the number means.  

In simple terms it’s a measure of glycated or glycosylated haemoglobin  This is a form of haemoglobin that is measured to identify the average plasma glucose concentration over prolonged periods of time. Normal levels of glucose produce a normal amount of glycated haemoglobin  As the average amount of plasma glucose increases, the fraction of glycated haemoglobin increases in a predictable way. This serves as a marker for average blood glucose levels over the previous months prior to the measurement. There is a belief that it’s weighted towards the previous two to four weeks too. 

HbA1c is used by clinicians as a judge of control and can be a factor when considering treatment options including suitability for pumps etc.

Perfect then. Surely an average ‘score’ allows my team to see how well I’m doing at maintaining a good average BG level. Or maybe it doesn’t. As a numbers kind of guy I realise that an average, especially a mean is a very poor measure of numbers over time. For example the graph below shows 15 blood glucose tests (not me, I promise Doctor!) all outside a typical target range of 4-8 mmol/l (72 -144 mg/dl) yet the average is bang on the target at 6! Would you think the nine hypos here are a good thing?



And we’re not helped that our lows can’t normally go lower than around 2.5 whereas the highs can relatively easily get to high teens. How easy is that to skew an average? We haven’t got a chance really.

So where does my history lie? We’ll stick to recent times as that’s all I can remember relatively easily and records before then were written using multiple pens and both hands in the waiting room. So around March 2011 I was at 10.1%. A little hard work by me brought this down to 8.6%. A few months later and it was 8.2%. Fantastic downward graph that I knew I could keep improving before the bottom of the curve kicked in. Then Adam arrived and the first result last December came in at 7.6%. Absolutely chuffed about this and really proud that I’d hit the sevens. Especially proud as I know it’s not unusual for the first pump one to be a slight rise. I was convinced that further pumpwork would bring this to my target of 6.something without too much stress.  

The next test was around March this year and this again was downwards but not quite hitting my target. Still going in the right direction but I’ll admit to being a little disappointed with my 7.3%. 

And so the next blood tests were booked for last week and I turned up and volunteered my very generous veins to the nurse who duly removed a decent amount of blood and I left slightly squiffy (I never like my bloods being taken!) but still optimistic of a decent score.  Recent BGs had been good and floating around the waffy level quite frequently which should help the average.

Overall I’d say my control is a world away from where it was two years ago and the time taken with the help of my nearest and dearest is really making positive effects on my overall control of my condition. But – did you see that coming – I’m still not happy. On my personal scale of success at managing my condition I see anything starting with a 7 or 8 as failure. Which is harsh. I’ll speak with people online who are really struggling and trying their hardest to get under 10 and I don't think bad of them in the slightest. We each have our own personal challenge. I’ll encourage them and say that everything needs to be taken in perspective and they mustn’t feel like they have failed. At all. So for me to complain about wanting to achieve a 6.x is insensitive at best.  And on the flip I know of others who would view a 6.1 as absolute failure. An example would be Nigel Jenner from Diabetes UK as I recall here. It does come down to everyone’s target being important and at the same time each result isn’t a judgement; it’s just a very crude measure of something that gives the only real measure of long-term control without the use of CGM - I wish!

So it’s time to for me to reveal my score and also time for another graph! As I’ve said I was aiming for 6 point anything, with a previous measure of 7.3%. So after going to the Doctors’ Reception and asking nicely if my results were back I got the official verdict. Are you ready? Do you want to know what I was told? OK, here goes; “The Doctor has said Everything is 'fine'. Bye. Next.” No, no, no, no. No! My response surprised her a little bit but when I asked for a printout she seemed happy to supply it to me if only to get rid of the nutter in front of her – yes, that was me. So the two page printout of every detail of my bloods was returned and as always it takes a minute to find the number I wanted. There it was; the judge of worth and success of managing a condition that after 33 years I should have a grasp on. 7.2%. Yep, a massive 0.1% reduction. 0.1%! That surely is within permitted error margins. So effectively no change. Just to prove it here’s the graph to show the flattening of the curve.




After coming home, sulking and trying to find a bright side I turned to the oasis of optimism that is Google. Now apparently the target level for people with Type 1 is between 5.9% and 7.2% - depending on site visited. I was in! So why didn’t that cheer me up? I knew that to go online and sulk about ‘only’ getting a 7.2 would be a little crass. So I made comment about being a little down without shouting the number. It wasn’t appropriate; especially as the same day I was telling someone who’d just got a 8.7 that that was fantastic news for them because any progress is good progress, that they’d had less hypos and the HbA1c is hugely flawed as it’s an average. This showed to me I needed to go back to my first graph.  The numbers prove nothing really apart from that it really is a bad measure. But it’s also one that me, and others too, place a huge significance and fear on.

My control in the last year has been so much better and Adam has given me the freedom and flexibility I’ve never felt before. It’s this that I should be thinking of and realise that I cannot and should not be defined by a number.

Thanks for reading,

Dave

PS. I’m still desperate for my next one to start with a 6 though ;-)

Thursday, 25 October 2012

Adam's School Report


Student: Adam Pump

Year ending: October 2012

Dear Parent of Adam,

It’s come to pass that Adam Pump has nearly completed a full year of education so it is time for Adam to receive his annual school report.  Please read through and add any comments at the end.

Mathematics:
Adam is very strong at mathematics using his advanced algorithmic skills to calculate bolus amounts and adjustments based on the magic formulas of carbohydrate and correction ratios. Despite this Adam sometimes struggles with his binary view of whether his owner (AKA Dave) has perfect or non-perfect BG levels. To improve in this area Adam could sometimes use his judgement to decide whether the same correction ratios should be used at all times. For example if Dave posts a BG of 2.8mmol/L* (50mg/dL) and then records 15g of carbs; suggesting a small dose of insulin using the Bolus Wizard isn’t always the cleverest idea.  *Dave, please note your performance here also needs improvement as Adam prefers to operate within 'non-waffy' BG levels.

English:
Adam needs a little improvement in this area. He’s trying to articulate what he’s thinking but using a very restricted menu style approach that hides away much useful information. Adam also needs to consider maybe using different forms of communication for different situations.  Due to the constant beeping involved in any Dave interaction, Dave chose to replace Adam’s audio output with vibrations. This is great but it would be useful if Adam could use different methods at different times of day and for different alerts. For example if Adam has completed delivering a square wave a small vibration is appropriate. However if there is an occlusion / blockage at 3am Dave would appreciate a loud alarm with Inspector Gadget stylee arm to shake him until he wakes up. Or even just some repetitive beeps.

Geography:
Adam has had an excellent school year with only a couple of moments that required detention.  Most sets have lasted three days with little comfort issues suggesting they could go longer if just left where they were. Adam did however have one instance of pure rebellion. Without any warning he threw his tubing at a nearby moving pram handle and leapt from his wearer’s pocket after detaching from the skin completely. After this Adam has been much better behaved and hasn’t suggested a repeat performance. I think we all achieved understanding of what was acceptable on that day.

History:
Adam is strong with modern history memorising recent dosage and blood tests. He could try harder in applying his history knowledge to the current situations and how that might assist his wearer. For example Adam knows that Dave went low for three Saturday mornings running at around the same time of day. Using so far unseen initiative Adam could suggest to Dave, maybe by email, text or vibrate that he needs to tweak his basals the following week.

PE:
Adam likes to get active and this should be praised. Dave also likes a run now and again and thanks to a fantastic Spibelt they work together well to get out and about. The use of Temporary Basal Rates (TBRs) when exercising is a huge plus over the old regime of injecting and setting the basal insulin amount once or twice a day. This was proven fantastically last May with the assistance of Adam’s cousin Colin the CGM to enable Dave to do a full day of exercise with very little drama along the way. Well done Adam.

Headteacher’s comments:
Due to a late connection Adam only joined is in November 2011. Dave had survived the previous 30-odd years with MDS (multiple daily stabs) and often looked at the technically advanced facilities of pumps such as Adam with high suspicion of ‘always being connected’. Despite this delay in being accepted Adam has worked hard to give the control needed to enable his wearer to live as normal a life as possible. Dave does understand the drawbacks of Adam needing to be working all the time without fail but Dave understands that the benefits proven faar outweigh any connections nuisances.

Overall Mark:
B +

Parent’s comments:
Life isn’t perfect and a few hiccups along the way including the continued struggle with pasta and pizza mean that Adam isn’t going to make everything perfect. But, and this is a big but, the ability to bolus and eat on the move along with the priceless TBRs means I am very happy with Adam’s permanent attachment to my body. I am hoping the next year shows continued improved BG control and Adam maintains his high levels of reliability.

Tuesday, 28 August 2012

Mortal Meter Kombat

Mendor Discreet v Bayer Counter XT

Occasionally new meters come along that really interest me and I'd love to give a go to see if they’ll replace the trusted one I use every day.  Over the last eighteen months there have been two successful new arrivals for me that have slotted in nicely alongside my trusted Accu-Chek Nano.  First came the Accu-Chek Expert that gave me my first introduction to bolus wizardry and really helped to start to bring my levels down onto a level that some would consider to be ‘a little high’.  Next up was the Contour Link that arrived with Adam using magic powers and witchcraft to combine with Adam to save having to actually write down the results anywhere. OK, it’s Bluetooth not witchcraft but it’s still magic!  Along with them there have been a few disappointments for me including the initial Verio and the iBGStar that I REALLY wanted to become my favourite meter but doubts over the test results meant it returned to the shelf in the bathroom with the rest of my diabetes stash.

So up next in the high expectation stakes are the meters I have this week pitched against each other to find a winner in the latest round.  In the blue corner we have the Bayer Contour XT which is an update to the previous Contour but promises much tighter error boundaries.  And in the red corner is the Mendor Discreet which promises discrete (do you see what they did with the naming there? Clever, eh?) testing in public wrapped up in a very slick package resembling a smartphone.




What’s in the box?

Contour - comes with the usual stuff that is frequently looked at briefly before being thrown away – meter, stabber with ten multi-coloured lancets, multiple user guides, 10 samples strips and a soft pouch case (12cm x 15cm)

Discreet - here’s the flashy new boy with his fancy-pants packaging (I like it) – meter inside foil vacuum packaged wrapping), a single user manual, 25 lancets, control solution and USB cable.




Getting started

Contour – I’ve had a few Bayer meters and the set-up is the usual methodology. The date and time were preset which was nice but the time was an hour out which sort of killed the effort.  Darn you British Summer Time.  However a quick visit to one of the manuals quickly got that corrected and also highlighted the extra functions available in the Advanced Mode. This includes meal / exercise markers, personal hi/lo settings and summaries, 480 test memory and selectable post-meal reminders. This meter requires no coding as is becoming more common in these modern times.



Discreet – The meter arrives with one lancet inserted with the cap still on and the case open. The time and date were preset (correctly) and once the cap of the lancet was removed the plastic case could be closed it give a package that was of a similar height and width of an iPhone (other smartphones are available – although maybe not in the US!) but about twice as deep.


  
Comparing the two the size of the pouch/case for the Discreet in your pocket/handbag/manbag is about half the size of the Contour.

In use

Contour – The contour behaves like a very well produced modern meter should. It retains the solid feel of the previous Contour.  The huge difference here is the promise of much tighter margins for error.  There’s a bigger piece here about this subject but anything that helps to remove the uncertainty of a test is a good thing.  Like the Discreet the result is returned after five seconds – is that the meter standard now? It seems to be and to be fair I don’t think there is a great need to go quicker than that. For anyone complaining tsk, tsk, tsk; please revisit the 1980s where tests involved waiting a minute before wiping away the half an armful of blood needed and then waiting another minute before matching to a colour chart by eyesight.  Anyway, the added recording options are also good for those who like to do such things.  Here is where I hold up my hands and admit that tagging tests as mealtimes, exercise etc is something that I know I’ll not get round to even though it’s a useful-to-know it does require the effort to do.  Sorry Bayer and your developers.  The Contour came with 10 strips which is good to test general functionality but in relation to accuracy I’ll just have to believe the marketing as I found no proof either way that it was more accurate than the Discreet or my current Nano. Below is a photo of the same blood on multiple strips with very similar results. This occurred on every occasion so reliability showed no advantage in the short-term although that’s not to say there isn’t a longer-term benefit. 



(And yes I did take food following this waffy moment before taking the second photo!)



I do like to download my data so it was a little disappointing to see that once again Bayer require the purchase of a cable to get the data downloaded.  As I’ve bought one before this isn’t an extra cost for me but for others who are tagging and detailing their records it seems a little cheeky to force them to buy a data cable when the amount spent on strips either directly or through prescription / insurance will be significant.

Discreet – Here is where the Discreet earns it’s stripes, or stars or whatever your locality’s mark of respect is.  To reveal a strip you pull the lower case down until the strip pops out revealing the bit that needs the blood adding to it.  Pull the case down further and it will pop back after priming the stabby-thing ready to extract the blood.  Press one button on the front to get the blood, apply the blood, get the result after the standard five seconds. Close both sections of the case and return to whatever you were doing before the need to check arose. Simple, effective and relatively simple to do.  The strip cassette comes with 25 strips built in and when you open the case it flashes up how many strips are left. This part is really good unless like me you like to fiddle and decide to remove the cassette to see what it looks like. This automatically resets the counter to 25 – but I guess this is something you’d only do once before realising the error of your ways. And here is where video speaks better than words so it's time for a vid (be warned there is no commentary) ...


So far so perfect, however this is where your opinion on sharps replacement comes into play. I believe the concept of the Discreet is that it’s something you can just throw it in your bag and test ‘Discreetly’ which is fine if you use it once only while out and about. To replace the lancet requires a partial disassemble of the meter to replace the lancet and dispose of the one already in.  To me that sort of kills the point of an all in one device. 

Obviously we all follow our nurses’ advice to change the lancet after every test so we’re used to that anyway. Well, sadly I don’t and my Multiclix can manage for many weeks while I rotate the six lancets until it ‘really’ hurts. I know this isn’t good, but it works for me.  The lancet on the Discreet is very fine so whilst giving painfree blood extraction I found it went blunt after 3 stabs.  The result was that I carried the meter in my pocket along with a Multiclix for the blood bit.  For me this worked OK and was a good compromise but obviously doesn’t give me the full ‘single package’ solution promised by the Discreet.  It also mimics the practicality of the Accu-Chek Mobile although it comes in a much, much sexier package.  Can a BG meter be sexy?  Hmm, Dave needs to get out a bit more!  Data download is possible using the supplied USB cable although unfortunately not on a Mac at the moment.  This seems a little contrary to the market Mendor appear to be aiming for i.e. young, tech savvy, mobile etc - which I don’t claim to be any of by the way.  Riku @ Mendor tells me it’s on the way so I may just be being a bit impatient.

Will I continue using?

Contour – Not at the moment. And this is with regret. As regular readers will know I have a Medtronic Pump that has a Bluetooth link to my Contour Link.  I spoke with a representative of Bayer at a recent exhibition about when the Link would get the next XT strips and was told it’s ‘imminent’ but is dependant on getting approval from Medtronic.  When that arrives I think it will jump towards  the top of favourite meter list probably replacing the faithful Nano that for some unknown reason maintains it’s position as first choice meter. Although obviously there will be the funding decision with the new strips commanding a premium price for their improved accuracy.  I’m aware some GPs local to me are restricting strip provision to certain cheaper manufacturers so this could be a concern.

Discreet – This is a difficult one. If I can get approval from my GP to get them on prescription then I think I will.  It’s such a ‘cool’ (again, unlike me) design that even though it fails on the blood extraction part I’d be willing to carry a Multiclix just because I wouldn’t need that pain in the bottom canister of test strips rattling around in my bag / pocket.

So in my Mortal Meter Kombat Death Match there is one clear winner. In the red corner it’s the Mendor Discreet. Whoop, whoop, whoop. It offers something that’s that little bit different in a package that ‘nearly’ works well.  Yes, the blood extracting bit is flawed but the automated strip production in a very snazzy case offers something exciting and new - apart from the Accu-Chek – but it looks a lot better! 

PS. Reading through before posting this I was thinking about what both meters lack. It’s something that not many have but for anyone testing at night is priceless. I know the Freestyle Lite has one but I’m not sure if others do too. It’s not that hard a concept but for some reason it isn’t catching on. A light. A what? A light. Yep, so that when testing in the middle of the night applying the blood to the strip is a simple operation without waking up anyone else around. And for maybe using the Discreet whilst in a dark location this could be the ultimate funky young things 'D' toy.

PPS I know the Accu-Chek Mobile has been doing the one-package thing for a while but I haven't got one of those so can't compare :-P

Thanks for reading and as always comments appreciated.

Dave

Tuesday, 24 July 2012

What’s Better? High or Low?

So following on from my piece on what classifies as a hypo (you can read it here) – and the addition of the word “waffy” to the worldwide vocabulary - I thought I’d develop the idea that the patient with diabetes and the medical professionals have different opinions on what is good and what is bad. Again I’ll be basing my thoughts on my slightly messed up thinking following 30-odd years of varying control levels and judgement. I could use medical research and qualified expert opinion but why should I start doing that now?


Before we start I’ve a simple question for the fellow Ds reading this. For the non-Ds don’t give up; hopefully the rest of this piece will give you a delve into the brain of one person with diabetes – as always your diabetes may vary, so this isn’t guidance or the opinion of everyone but it’s mine and the one thing writing down my random thoughts has proven is that others think the same as me. Maybe. Sometimes. 


Anyway I promised you a simple question so here it is:
What is better to be slightly low / waffy / hypo (4mmol/L or 73 mg/dl) or to be slightly high (10mmol/L or 180mg/dl)? 


OK, you don’t have to tell anyone your answer but I’ll guide you through mine. I’ll preface this by saying that I have relatively good hypo awareness and no noticeable complications.


For me it’s going to be the low every time - apart from when driving, operating heavy machinery, unicycling across the grand canyon etc. For years the one judgement of ‘success’ of my 24/7 ‘management’ – lol there’s another lose term, was the score returned by a simple blood test that takes a mean average of my BGs for a long period. HbA1c measures your average BG for the previous eight to twelve weeks. That’s perfect you might think. Surely it’s the easiest way to look at what my ‘normal’ BG is. So for years when looking at the results Consultants (Endos) would look over their glasses at me and say “Hmm, that’s a little high, you need to bring that down”. Simple English you might think but the use of the word high when discussing HbA1c has had a huge influence on my opinion on whether it’s better to be serially-waffy or ‘high’. If I have to bring down my average then I need to get as low as I can reasonably be for a long as I can and also try to reduce the number of ketone-inducing hypers to lift the average to a more normal level.


This sat well with me as a logical practice for years before the huge head-mess from my diabetes specialist nurse who suggested that the best way to bring down my high A1c was to reduce the number of hypos and aim to lift my target BG levels. What?  How?  Yes, again, I know the logic is there but it’s erm, wrong. You can’t tell me for years my BGs are too high and then ask me to fix it by reducing the number of lows and lifting my target levels. Malfunction, brain does not compute!!


So after picking me up off the floor and explaining the logic we agreed that my high levels were due to over-treating of hypos and therefore if I had less hypos I would drink less Coke and there’d be less of a rebound. Perfect. Then I had to glide through meetings with my local GP’s Diabetes Nurse who was still in 1986 in her thinking (that was similar to mine) that if my A1c was high then I wasn’t having enough insulin. Thankfully she was happy that maybe my DSN was the one I should check anything with first.


So me and the DSN have treated the cause of the high average but she’s still contrary to me on what a dangerous level to run at is. I’d prefer to bounce along at between 4.5 and 6 (81 and 108) in my perfect D dreams, but this is ‘not good’ in her world of being trained that any hypo is evil. I’ve got relatively good hypo awareness so any waffy moments can be helped with a couple of Fruit Pastilles (3g of carbs in each) to lift me gently out of head-fuzzines.


And so we sit at seemingly opposite sides of the same desire to improve my overall control and bring my average BG to a figure that can sit comfortably on their trained measure of what will prevent ‘complications’ in the near/far future. If my BGs are high I know that blindness and imminent death will be around the corner. The proof of this conflict is when I borrow a CGM for a week. I have one coming up and once again look forward to the background trending analysis it can provide. Going off on a tangent slightly the CGM benefits this time won’t be useful in measuring a normal day as we’re off to the London 2012 Olympics for a few days on the day after I have it stuck in. Obviously when we applied for tickets we went for the high profile sports to see the world’s most talented and most famous athletes. Hence why we now will be watching the group stages of women’s basketball and women’s hockey. Hey ho, we’ll be there and I’m still pretty damn excited.


Where was I?  Ah, yes. CGM analysis. When we sit down and analyse my BGs her eyes will zoom in to anything marked red as a hypo and mine will go straight for anything in double figures. In her defence she’ll also look at those in the middle and compliment me on any that are in range; whereas I’ll ignore those and just look at the failures. She’ll come out with statements such as “Oo, you were a little low all day that day” while I’ll be looking at the same figures of between 4.2 and 5.8 (76 and 104) and think “Wow, you got it spot on that day Dave”. For me low is good because I'm now at a stage where I'm relatively comfortable how much treatment I'll need to bring it up. Treating a slight high is more of a black art with correction doses frequently ending in lows. 



So who needs retraining; me or my DSN? I know I can't be alone in my thinking but going back to the previous blog how do I persuade my healthcare professionals that all hypos aren't evil?

I absolutely love the psychology that comes with being a person with diabetes and how much of a factor in a someone's treatment it can be. As our day to day management is in our hands, it is a foolish Health Care Professional who thinks that by telling us what is 'correct' it will be enough to get us to buy into the principle. I know there are some HCPs out there who do know all this but for them to understand why takes time and reprogramming of their mind too.


To conclude what is best waffy or high? I know the real answer is that neither are good and perfect control is what we must strive for but for as long as we are told that complications (there’s that word again) arrive because of bad control which is judged by  highness on the A1c scale, I think I’ll stay tending towards the low side. DSN; I’m sorry.


PS. I hope everyone in the UK has now completed their feedback to the government on food labelling. If not, why not?  Go here. Now. Thanks :)

Tuesday, 17 July 2012

The Big Event

Hello again.

Just a short one today to say look here, yes here.  You’ll then find my review of Diabetes UK’s first Big Event.  It had a few trade stands and a selection of 19 lectures and discussions delivered by healthcare professionals and other people with diabetes – and sometimes that was the same person ☺

I hope you enjoy it although I apologise if it’s a bit long – I do tend to ramble a bit as you might have realised by now.

Before you go though I’ve got a request for my UK readers – Hi there.  The government has a consultation in place at the moment relating to food labelling. If like me you like your carbohydrate values shown on your food then you need to tell them before they swap them for some simplistic traffic light symbols.  I’m not sure how the pump’s bolus wizard would handle me telling it that the item I was holding had ‘amber’ carbohydrates.  And maybe you’d like it to be compulsory to show total carbs per packet or item rather than just per 100g leaving you to guess how heavy something is.  If you would, tell them.  Tell them now.  The consultation ends on 6th August 2012 so I’m afraid this isn’t something you can put off to do later.  It won’t take long. Just do it. NOW! HERE!

Hope you have a good week.

Dave

Tuesday, 10 July 2012

What Is A Hypo?


Most regular readers of the blog (there are at least six of you I think) will be experts on the whole diabetes 'thing' through either living it or living very closely to someone with it.  So asking the title question of this blog might seem a little strange.  But it's been puzzling me for a while so I thought I'd take this moment to have a ponder and think it through.

In true high school essay stylee I'll start by looking at the dictionary definition and then break this down as to why it might not be the case.  So using the modern equivalent of the OED we shall see what Wikipedia has to say on the matter:

"Hypoglycemia, hypoglycæmia or low blood sugar (not to be confused with hyperglycemia) is an abnormally diminished content of glucose in the blood. The term literally means "low sugar blood" (Gr. υπογλυκαιμία, from hypo, glykys, haima). It can produce a variety of symptoms and effects but the principal problems arise from an inadequate supply of glucose to the brain, resulting in impairment of function (neuroglycopenia). Effects can range from mild dysphoria to more serious issues such as seizures, unconsciousness, and (rarely) permanent brain damage or death."
Blimey, that's a bit scary! But having such a clear definition should make it easy to answer the standard clinician's question asked in many appointments: "How many hypos do you have?" or "When was your last hypo?" But that's the problem, for me, and I'm guessing other people with diabetes, it's not that simple.  In a 24 hour period I may bounce a few times into a state that might be medically classed as 'hypo' but a quick treatment with either a couple of sweets or my scheduled meal means that it doesn't really cause a pulse on my 'that was a hypo' radar. More that it was a low that needed dealing with in a mild and not overly urgent way. 

For me answering the question I'd search my not vey brilliant memory for moments where I had to either take time out of what was occurring at the time or be in such a state that it's noticeable to others. And I think that's my trigger to acknowledge. If my waffy moment (for definition of 'waffy' see here) needs the assistance of other people or triggers a 'what's he doing?' by other people then I'll classify it as a hypo.  Indeed the DVLA in the UK are primarily interested in those events they classify as 'severe hypos' that require the assistance of another person to judge whether you are a fit and proper person to drive a car. 

It may be just me but I also think it depends on the circumstances as to your judgement on the question.  As I have relatively good hypo awareness I feel able to self-classify my 'attacks' - I really hate that word by the way as it conjures up images of me waving a knife around whilst trying to find some coke to drink.  However a parent or carer can only use the numbers from the machine and behaviour judgements and so much more simply classify. i.e. 4.8 mmol/l (86 mg/dl) - "Oooo, that's a hypo. Eat!" 5.2 mmol/l (94 mg/dl) "Well done, excellent score". And here we are also ignoring the vagaries of blood glucose meters to provide an accurate yet reliable and consistent result. Read an excellent piece here for further analysis of the unreliability of BG meters results.

For me I think it comes down to a hypo being more about a feeling and brain squiggle rather than a number on a machine.  I think I've mentioned before the flaws in the judgement provided by a single HbA1c reading and similar rules apply to BG readings.  I was discussing Adam (my pump) with a friend at the weekend who is a teacher and I was giving an example of the bolus wizard to show how it calculates insulin dosage based on carbs and BG.  So I did an obligatory test and it came out at 9.9 mmol/L.  To which the teacher exclaimed that that seemed very high and wasn't I concerned?  I then explained that it was a couple of hours after a bran loaded breakfast, I'd lowered my basal because of having an active morning, I was being pretty active on the touchline and IOB suggested it was pretty good.  So as always it's everything in context.  A 4.2 just before dinner for me is slightly lower than I'd like but not overly bad.  But a 4.8 an hour after I've eaten with plenty of insulin stacking up is a much bigger worry.

So in summary, and to answer my opening question; I don't really know.  I know you've read this far hoping for the magic answer but I must apologise and explain I truly believe its a personal judgement.  As always 'your diabetes my vary' so if a doctor asks you how many hypos you've had ask them to clarify what they mean before giving them an answer close enough to the truth so that you can both work on reducing them even further.  For me it will still remain classified by the treatment type:
*1 Fruit Pastille (FP) = 3g carbohydrate
Four FPs or less = waffy. 
Five to seven FPs = mild hypo. 
Eight FPs or more or a can of Coke (not Diet) + abusing random people = hypo worthy of note + apologies aplenty required.

I hope that was helpful although I'll admit it was lacking in ultimate clarity and guidance.  Sorry. 

__________________________________________________________________
Finally today I'd like to dedicate this blog to an old friend of mine that sadly passed away just before the weekend. Back in my youth I took a year out before heading to university to help look after a wonderful man called Mayo who had Duchenne Muscular Dystrophy and was studying at Leeds University.  As a country lad who'd just turned 18 he gave me a whole new slant on life and always had a positive outlook even if he'd been dealt a very bad hand of cards from the start.  His disease meant he was restricted in movement but not in any why in his mind.  He was at true gent who always looked for the best in everyone and I feel honoured to have had a chance to share a part of his life with him.  My thoughts and prayers at this time go to his wonderful family who were also some of the most friendly and warm people I have ever met.

It's at times like this when as a diabetic of the modern era i must take the time to realise that it's not all bad and the medicine and technology of the modern age make my condition something I can manage in a relatively unobtrusive way.

Dave xxx

Friday, 15 June 2012

Diabetic Dad

It's Fathers Day on Sunday in the UK and also I believe in the US and Canada. A day to celebrate how great dads can be and hopefully get a little pampering from the kids.

As usual I have approached the day with focus on making sure the gift I for my father is suitable whilst not being too costly. Thanks Dad, you taught me well ;-)  It always takes me a while to realise that I now sit on the other side of the gift fence even though I've now had one or two little ones for over six years now.

As I say that bit of me was drifting along until I saw a tweet from the Diabetes Hands Foundation asking for any comments on dads and in particular dads of diabetic children or diabetic dads. So here's my bit...

Story 1 - My superstar Dad:

I've grown up with diabetes since I was three so my dad has been there for pretty much my whole journey until I left home.  Looking after a diabetic kid is one of those things that can only be appreciated, and then only by a very small bit, once the diabetic has a kid of their own.  We were out walking with Laura, my mum and dad and maybe a few nephews up Whitbarrow Scar.  Back in the day I maybe wasn't as vigilant as I could have been and half way up the hill I went a bit 'waffy'. Waffy was always my parents gentle way of say I was having a hypo without making too much fuss.  Laura wanted to wait with me but my dad gently told her it was OK and to carry on. I then sat there for a few minutes turning back the clock to when he had done that decades before.  It was only a small moment that was over in minutes but is something that has stuck with me since because he never forgot what to do and was always there to help when needed in a calm and reassuring way. Thanks Dad.

Story 2 - My artistic son:

I'll admit this isn't quite as 'deep'.  When my son was younger it used to be bath time every night before we dried and changed him on the landing (not sure if 'landing' is a british term but I use it to mean the piece of our house at the top of the stairs outside the bedrooms and bathroom; a 1st floor foyer if you like).  One of these nights it was before dinner and my BG decided to plummet.  It was either me or Laura who went to get some biscuits and I laid flat out on the landing waiting for the BG to come back up.  Son decided to get a pen and use me as a drawing pad and quite happily drew on my face laughing as I didn't have any energy to prevent him.  It has now entered family folklore on how he looked after me in my hour of need.  This isn't a story of heroic rescue by the son just something that still makes us all smile 5 years on.

So that's my bit. Being a son or a dad is the best thing in the world and I'm lucky to have fantastic parents, children and a wife to share this world with.

I hope everyone has a fantastically wonderful weekend and I promise to update the blog very soon with more pieces I've got lined up.

Take care.

Dave

Tuesday, 15 May 2012

A Short Walk in the Lake District

It's been a while so usual apologies for life taking over the time needed to blog but that's normal so hey-ho.

The weekend just gone gave me one of my biggest challenges since going on the pump.  Last year a friend of ours told of her tale of doing a 40 mile walk in the nearby Lake District - one of Great Britain's National Parks and although I'm biased I reckon it's the best.  The walk starts in Keswick at the north of The Lakes (as the Lake District tends to be abbreviated to) and finishes at the south in Barrow-in-Furness which is so far south it used to be in a different county!  As the discussion was over a few beers my mind was in full 'well why not?' mode and the thought process decided that I should give it a go the next year.

Well winter came and at the time May seemed a loooooooong way away so what's the harm in signing up, joining my sister's team and giving it a go.  And newly attached Adam the pump would be a help.  Surely.  That's what he's made for.  Training schedules were occasionally glanced at and after a few half-decent distances I decided to up the challenge a little by running some of the route on the day.  My thinking here again was selfish.  If I'm going to be doing 40 miles on my feet my body would appreciate it if I'm not stuck out there too long and at the very least it's a way to 'ensure' I get in before dark. Well that's the plan.  Obviously in the build up to such events much discussion is made with team members, family and beer buddies about predicted finishing times and targets.  This length was entirely new to me so I was predicting myself somewhere between 9 and 10 hours with a dream target of 8.

Positive Mental Attitude was also remembering that I was starting at an altitude of 160m and finishing at 60m.  A net decent of 160m - how hard can that be?  It's downhill!  I chose to ignore the altitude profile below.  Ignorance is the best form of defence!


Whilst Adam was going to help I also knew borrowing a CGM from the local clinic would give me an extra advantage against my body's campaign to trip me up constantly.  I made my appointment and got hooked up on Friday morning. This gave me the rest of the day to make sure it was working before the early start.

As the start was nice and early at 6:00, I was up at 3:50 getting my kit on before shoving some breakfast down as quickly as possible to give me some basal carbs to get me through the morning.  I chose to bolus at near to full value as I've been fighting highs after breakfast recently so didn't want DKA to add to the stress of the day.  I'd already programmed a basal reduction to 60% of normal from 4:30 to give me an appropriate reduction in insulin whilst my body came to terms with the sudden influx of exercise.

On the journey up to start kindly taken care of by my brother-in-law I occasionally glanced at the CGM graph to see the upward trend expected and the walk starting value of 12.8mmol/L was a little higher than perfect but within range of where I'd hoped to be.

The start was just like the rest of the race in that it was organised perfectly. After blipping my timing chip I was off with a mixture of running and walking and a smile on my face.  As I knew I wanted to go at my pace the iPod was loaded with an appropriate soundtrack for the day - to start with we had Radio Lancashire's commentary of the home and away legs against Birmingham City and for the middle section I had the full 4 hours of the commentary from the Play-Off final two years ago against Cardiff. What more motivation can a man need?!!!

I was conscious to not start too fast and just enjoy the dawn breaking views such as the one over Thirlmere below.


My plan of attack for the day was a few jelly beans and muesli bars regularly.  I knew the checkpoints would also have fruit occasionally so this would be useful for a change flavour.  I expected this would be enough carbs to counteract the exercise when pair with the basal reduction.  As I like to be self-sufficient I knew I had enough food and socks to get me through the day in my rucksack so anything extra I picked up would be a bonus.

As I climbed up Dunmail Raise the summit greeted me with the smell of bacon butties!  Considering it was around 7am the roadside was packed with cars and minibuses serving up cooked breakfasts to their team-members.  At the time I couldn't imagine anything I wanted less, so my respect goes to any of my fellow walkers who took this on board.  The first official checkpoint was Grasmere and this gave me a chance for a slowdown and another quick BG check that backed up the data I was getting from the CGM.  A fill of the water bottle from the (still excellent) support and I was off again before hitting the steepest section of the route - that's metaphorically not physically hitting although I felt the need, if not the energy to punch the road ahead.

The views on the course were outstanding and here's another I took on the rise out of Elterwater:



As you'll imagine the 30 or so miles involved ups and downs of varying nature. I was taking carbs on board in the form of a steady slow chew of jelly beans and a Tracker bar (other grain bars are available) every 45 minutes or so.  The occasional half a banana was chucked in for good measure and the BGs were winning a gold medal even if my plodding efforts weren't.

At 24.6 miles I was met by my wife and family who gave me a huge psychological boost ahead of the 4 mile gentle uphill section ahead.  And just to mess with my head I arrived at that point about ten minutes quicker than I 'ran' the London Marathon three years ago.  There are two possible reasons for this: 1. The improvement in my diabetes control and joining Team Pump in the last year has boosted my physiological ability, or 2. My strategy three years ago should have been to think, sod the running malarky and splits; just jog a bit, walk a bit and you'll be fine.  This is one to ponder for my next marathon attempt - nothing booked so I can ponder forever on that one.

Another slight head-mess at around the same point came at the next checkpoint.  No-one really knew me on the event apart from family attending.  I beeped in to which the marshall said "Well done Dave, keep going!" It took me few seconds to realise he was looking at a laptop with my chip time on it so of course he knew my name, probably also knew my birthday and next of kin too, but as fatigue is setting in a little it was slightly unnerving.

After about 30 miles the check points were becoming more frequent and my head was constantly trying to work out a finish time to aim for over the last few miles. I knew I was close to achieving 8 hours but was desperate to get under that barrier so that my time could start with a 7.


For those of you hoping for a massive physical failure or hypo in the last mile for dramatic impact I’m afraid you’ll be disappointed. It was steady away and I came up the finishing straight quite comfortably and even managed a sprint to cheer the crowds watching at the side – although despite baiting from some teenage lads I refused to dive past the man in front on the finishing line.  Again here organisation was fantastic with my chip being taken of my lanyard and swapped for the medal seen below.  I was also given a small but perfectly formed certificate with my finishing time and splits on it.  I did swear a little when I was given it and saw the time of 7 hrs and 53 mins.  7:53!  Well done me!  Although I know this was a bit self-congratulatory I thought I’d done well.  In the spirit of the event I was also given two refreshment vouchers to be used anywhere in the finishing area.  Now obviously being the ‘athlete’ that I was I took the option that most of my fellow walkers were doing and used one of my tokens for a meat and potato pie with peas and gravy and the second for a pint of beer. I was tempted to go for the liquid only option as I knew I needed rehydration but I wasn’t entirely sure which way my BGs were going to go so some carbs were the safer option.

And now for the bit that may lose the interest of any non-diabetics out there. My range during the run was between 4.5 mmol/L and 7.9 mmol/L (81 mg/dl to 142 mg/dl) and my basal reduction seemed to do the job perfectly. I started a little high but nothing a good bit of exercise couldn’t fix.  As you’ll see from the graph below I rose a little after I’d finished at 2pm as my body wasn’t needing the carbs but still had the insulin shortage from the previous temporary basal. I switched back to my normal profile pretty much soon after I finished but didn’t take anything extra to account for the shortage over the next couple of hours. I might have also guessed my pie carbs a little wrong but I was happier to keep it a little high until the following day.




For me Team Pump won this easily as doing the same event with Levemir would have been a lot trickier – and I also wouldn’t have had the reassuring glances at the CGM to see that I was doing OK.

All in all it was a great day with one of the world’s greatest athletic stadiums as my backdrop.  Will I do it again? Maybe.  But the problem there for me is that I’d really hate it if I was slower than this time so that would mean some ‘proper’ training next time!


As always, thanks for reading.

Monday, 26 March 2012

A Bad Ten Minutes

A gloriously sunny weekend coincided perfectly with a weekend away with the lovely Laura, my sister, her husband and two friends.  The destination for our escape without the kids was Reading and although I wasn't expecting much we were pleasantly surprised at the location and excellent variety of shops and food and drink spots.

Saturday was planned as a bit of light shopping in the morning before the 'boys' went off to watch our wonderful Blackpool FC demolish Reading FC in the afternoon. For the purposes of this piece that is the last time the football will be mentioned apart from the admittance that that part didn't go exactly to plan. 

The morning was going wonderfully. I'd risen early and encouraged by the sun went for a walk around town and even grabbed a shirt in the Next sale as they'd opened at 7 for the locals to attire themselves in cheap winter clothing on the hottest day of the year so far. Following a wonderful buffet breakfast with multiple boluses we walked back into town and the intervening three hours had increased the number of people milling around and generally trying to be obstructive.  After Laura found some sandles and a birthday present in a shop she went outside for some fresh air whilst I volunteered to fight my way into the queue to pay.

Then it all started to kick off a little in my head and panic central moved in.  I did the usual patting of my pockets to find my wallet and discovered it was worryingly not present. I started to go back towards the shoe area to check I hadn't put it down whilst picking up other bags. Rushing back through the crowded shop a rather stressed mum who was fighting through the other way and pushed past with her pram. The pram handle looped around my pump tubing and yanked out the set leaving me disconnected and my already high stress levels went flying off the top of the scale. If anyone's read or seen Charlie and the Chocolate Factory imagine the chapter towards the end where the lift (yes it is a lift not an elevator) explodes through the roof - that was my head at that point.  I stopped dead for a second or two holding the pump and the tubing actually thinking - pump, tube, you, body, should be, connected, help, what now?  First steps were still towards the shoe area as the wallet was of more urgency at that moment. It wasn't present so I rushed outside, remembering first to hide the items to buy behind some socks as running out of a shop holding stuff with a panicked look on my face was not going to help the situation. Once outside I checked the other bags and found the wallet - phew! At this point I talked with Laura about what we needed to do and firstly decided to go back in the shop to buy the stuff.

So this is where you seasoned pump wearers now casually say that the next step is to discreetly find somewhere to do a quick set change before continuing the morning in a relaxed manner. Well you'd be right. Apart from the fact I didn't have the spare set to hand to do this. I know! I've read the manuals, read the books, listened to the lectures and thought about the problems.... but .... I just haven't got into the practice of carrying a spare set around with me at all times.  Why would I? I've had the pump nearly five months and I've not had a set fail yet so why would I need to change apart from every scheduled third day?  Well I now have the answer in a 'real world' example.

This is however, where the story turns a little in my favour for two very key factors.
     Firstly we were staying within five minutes of my current location and my spare sets were back at the hotel. Unlike a day where I would quite happily leave the house oblivious to the risk I was in easy reach of the solution to my insulinless problem.
     Secondly, and this is the big one, I was in possession of a CGM for the week. I get to borrow for a week at a time every couple of months. Using this I knew that due to the walking around and guessing at boluses for breakfast I'd been at the lower end of my acceptable range all morning so could last for an amount of time without having to rush back too quickly. Until we got back I was continually checking the disconnected Veo to look at my rough levels and trends and thankfully didn't get a sudden rise.

On return to the hotel I changed the set and bolussed for the missing insulin to reduce a rebound later when the missing insulin would have been at it's peak.

So now comes the issue of how I'm going to prevent the exposure I had at the moment after the set come out.  Ensuring the tubing is more tucked away is obviously important but it can't hide the fact I need to be carrying a spare set whenever I'm more than about thirty minutes from home.  I currently store my spares in a fantastic extra-small Exped waterproof bag but this needs me to hold it all the time or put it down and forget it in a bar somewhere. A bag would be much easier to remember but I'll admit I'm not a fan of manbags (even when they are made by Stripy Kat) and bigger rucksacks as this just feels like something that takes away from the pump-convenience although it's obviously something I need to get over. Quickly.

This experience has shown I'm being foolish in my behaviour but I'm still not overly sure how I'm going to manage it going forward. In the short-term me and my Exped aren't going anywhere unless we're together.

Any tips for stress-free but easily handled protection will be greatly welcomed.

Cheers,
Dave

Thursday, 1 March 2012

I've also written here....

Happy New Month to everyone.

This is a brief post as it's a pointer to here.  For those who don't know Shoot Up or Put Up is a more relaxed and not so serious look / blog / forum at the whole D subject but still offering experience based advice to anyone with diabetes who pays a visit.  If you do land there please say hello although anonymous lurkers are also fully welcomed.

Last Thursday I had a different day when I left home with no testing strips.  The article explains my views on the day and how different people reacted to it.

It will be time for another me and Adam update soon but in the meantime I hope you enjoy this short piece posted

Happy reading and thanks for taking the time to visit.


Wednesday, 1 February 2012

I Want It Back! AND Meeting Real Diabetics!

Hi

Time for a quick update and some further feedback on the CGM.


CGM - Muuuuuuuuuummmmmmmm, but I reeeeeeeeaaaaaalllllllyyyyyy want one! :(

Well the CGM  had to go back. I loved it and would be tempted to self-fund but the ongoing cost to me is unfortunately prohibitive.  I'm a numbers kind of person and will happily spend all day building macros and nested formulas in Excel until the cows come home.  The chance to view a constant graph of my BG and the predictive alerts was mesmorising.  I don't have bad nighttime hypos so never got to use the Low Glucose Suspend but understand it's value to users in countries where it is licenced.

I managed to get 7 days out of the sensor but day 7 readings went a bit quirky so I'm not sure if that was me or the sensor.

The only decent sized negative was that I had another bit of kit stuck to me.  It's taken decades for me to think that having a pump permanently connected is a bad thing so maybe this extra contraption adorning my previously 'clean' body was a step too far too soon.  A combined pump and CGM can't be too far off so I'm hoping once the Veo 'fails' (more on this below) in four years there'll be a suitable all in one device.  The stumbling block will still be the cost of consumables but I'm a glass half full person so this won't be a problem ;-)

I got to meet REAL diabetics in person!

Last night was the first time in I've been to an organised meeting for diabetics in about 25 years. And it was the first time I could go feeling that my voice was important and on a level with my peers. As I've now joined the P Club I was invited by my DSN to a meeting of local pump users and we were joined by my Consultant who provided some interesting feedback on the politics and approach of pump supply and management in my local area.  It was fascinating to hear stories of other pumpers and pump use ranged from five years to one week.  What surprised me most was the average age of the users being much higher than I thought it would be.  However, that might have been down to willingness to attend rather than the actual spread of local pumpers - old people love social meetings like this and the suggestion for the next one to be in the pub might help to bring a few more younger ones in. <--- I know, that me sound really old!!!

As might be expected everyone loved their pump but it surprised me at how much some people were adamant it had changed their lives.  Particularly the older users who had previously stuck with a very static and fixed meal and exercise plan loved the ability to "just go for a walk and eat an apple whenever I like".  There were a couple of #teammdi members there who were pondering the move across and I think it helped to smooth any fears although I did say, and will continue to say, that moving to a pump should only be something you do if you really want to.  It doesn't guarantee perfect control but facilitates
the ability to do so.

It was great to sit down with other diabetics for a couple of hours even if there were the customary "Hi, I'm Dave, I'm a diabetic" introductions at the start.  Hopefully it won't be too long until the next meeting and hopefully a few more attendees who are closer to 21 than retirement.

Oh, one last thing.....


Pinch, punch, first of the month. Have a great February!

Friday, 13 January 2012

CGM Is MINE - well for a week anyway

Just a quick one today.  Please meet Adam's and my new best friend Mickey the Minilink Transmitter.


Added onto my Veo this gives a complete CGM-Pump combo that allows what I think is some of the best control options currently "available" to type 1 diabetics.  You'll notice I've put available it little speech marks as they're not available to everyone due to funding, insurance etc.

I am fortunate that my local clinic has a couple of transmitters that it can loan out with a single sensor applied by the DSN.  It was inserted using the 180 degree Serter and was relatively painless.  It's stuck on with the supplied sticky stuff which I'm hoping will be enough for the six days I have it.

After an agonising two hours whilst it calibrated I ate some food, bolused, for the first time ever I'm getting a linear graph of what's roughly happening to my BG levels whilst the carbs and insulin take effect.

The next six days will see me doing lots of basal testing and also exercise and using patterns to try and find out what works for me and what doesn't.  Tomorrow starts with a huge test while I spend the day replacing my garden fence recently bent to destruction in the wind.

I know people have varying success experiences with a Medtronic CGM but as this is my first time and so far the Veo is proving reliable I'm hoping we get on perfectly fine. An update will follow next week providing my graphs are as flat as I hope them to be - yes, I am now laughing and shaking my head.

Tuesday, 3 January 2012

Nine Weeks In

Firstly many, many apologies for the delay in updating the blog.  Life appears to have decided that free time no longer has a place in my existence so finding the chance to update has passed by too quickly sadly.

So, how have the last two months gone.  In summary it's been pretty good.  As predicted by the Team Pumpers from before I joined the dark side there are ups and downs but so far I believe I've made the right decision.

I thought it would be interesting to revisit my pros and cons list from beforehand to see if I was thinking logically or just trying to tell myself that pumping can't be as good as everyone said.

Firstly the perceived pros:
  • Better control - well so far that's a yes and a no.  It's too early for A1cs but I think my average is improving in the right way.  I've had a couple of evenings where set problems meant delivery either stopped or was hindered causing BGs of 19mmol/l (350mg/dl). I'm still not convinced similar control couldn't have been achieved by even tighter MDIing but the ability to bolus for 5g of carbs is just extraordinarily wonderful.
  • Public dosage - a big win here.  The ability to test then click and go means buying some food before jumping on the train doesn't involve a squeeze down a packed train carriage into a moving toilet to try and administer a roughly correct dose.  And it's also provoked conversation with my friends and family.  Whereas before I was very quiet about my injecting now they love the tech involved and are interested in what I'm doing.
  • Closer to natural - yep. No arguments that the method matches more closely what the pancreas would do apart from the random failures now and again.
  • Less injections - wow! What a big win. Grabbing some food and clicking a button wins every time.  Initially I had a few painful sets but moving to a shorter needle has fixed that generally.  Although a bit randomly the left side of my stomach tends to be where I feel any pain instead of the steady-away right.  I still do a little smile when delivering any bolus because of the ease and the precision.
  • CGM - Still waiting to test this one. I'm hoping to get a first go with the clinic CGM in two weeks so we'll see how that goes.  I'm very keen to give this a go as whilst my control is improving I'd love a more smooth-lined track of my BGs through the day (and night).
  • Tech - Oh yes baby! This is where the pump wins every time. Gadgets are coooooooool (and does me saying "cool" mean that I am not?).  My old Aviva Accu-chek Expert was the star performer in the MDIworld but the magic of bolus delivery and bolus-on-board calculations is a big winner. However, I do sometimes pine for the compact beauty of the Novopen that is sadly no longer my constant companion.
  • Long-term complications - It's only been two months!

Now the perceived cons:

  • Always there - This was what I thought would be a big negative and there's no denying it is. But, and this is a huge but, it's worth it.  Yes it's always attached but the number of times a day I think about it is very few and leaving the house no-longer needs me to remember my pen! Night-time is not a huge one but it's not yet at the stage where it can be forgotten when I er, sleep, with my wife. Detachment happens but the sticky-outy bit is still present.
  • Kit failures - Yep, these happen too.  I don't think I'm yet confident enough with the pattern of my BGs not to be scared by quickly rising 'scores'.  Early on I had a few problems with the longer sets and did a few extra changes when there was a background niggling pain.  I'm still not sure if I was over-reacting but it felt good to do something to fix an apparent problem.  I'm yet to have a total pump failure or a daytime problem so unexpected set changes haven't happened at an inopportune moment to cause me any problems.
  • Compulsory testing - I was already up to about 6 tests a day anyway so not much real change and I'll admit that if I want a day-off testing I'll bolus based on a perfect score and I haven't had any major failures yet.
  • Outside opinion - This has been fantastic.  For the first time people have properly spoken to me about it and more often than not they show a genuine interest as they know someone, somewhere who's injecting or pumping too.  I haven't noticed any increase in people perceiving me as 'ill'.

Unpredicted highs and lows

  • Square wave and dual wave boluses - I'm having fun playing with these to give better control over killer foods.  Pasta and pizza is just about mastered although, for me, Chinese food is proving to be a black art. I'll get there but it will take time.
  • Profiles - How fan-dabby-dozy are these little beauties.  My life is fairly static but planned profiles for days when I'm commuting by bike and train are superb.  It's on days like this when I could get down on one knee and propose to the Paradigm - if I wasn't already married and could actually marry tech!

So in summary: I love it but it's taking time to get sorted.  We'll get there and so far I have no regrets.

I appear to have rambled a bit again.  Thank you for getting this far and all feedback is welcomed.

This is the first of two posts today. Be sure to read the second one here Thank You DOC :-) 

Thank You DOC

This will be a brief one as the message is simple:

Thank you, thank you, thank you, thank you, thank you.

For once this isn't to anyone in particular. But to you and anyone else who has ever read something I've blogged or tweeted.  And an even bigger thank you to those who've just written about their experiences and troubles with the big D.

For years I was in an effective diabetes wilderness looking after myself but never talking to other diabetics and the DOC was just something I didn't even look for. And it's not that I couldn't find you; I just didn't look.  I didn't understand how much I could get from talking to others in the same position as me.  And I know this is because for years every D I seemed to speak to had perfect control and everything mastered. I didn't have this and didn't want to be told how stupid I was.

However, venturing onto Twitter and certain forums where A1cs weren't boasted about as badges of honour soon made me realise I wasn't on my own and people were facing the same or similar questions to me every day.  And because it's a worldwide community, whatever time of day it is there's someone somewhere to hold one or both hands if needed.

So in summary thank you and keep up the good work everyone. Someone out there, even if they don't speak up, appreciates what you're doing. Every day.

This is the second of two posts today. Be sure to read the first one here Nine Weeks In :-)