Libre Intentions

This will be quick - I've got to get a munchkin ready for a party in 30 minutes...

My first Freestyle Libre arrived in the post on Friday.  It's currently sat in its partially opened boxes on my sofa.  I'll probably take the plunge this evening - but right now, I'm filled with a sense of apprehension.

Not just because of the intimidating packaging (and thanks to those of you who've reassured me), but more because I'm not sure why I've got one.

There's no doubt it's popular among the online community - I've seen plenty of tweets and blogs about the virtues of it's quasi-CGM ability, and I've met a few people in real life who are incredibly complimentary about it too.

But I know my control is actually pretty good overall.  And I know I have the moderately addictive personality that could mean I can't just use two sensors and revert to conventional testing.  I've held off for so long because I want to make sure I'm going to use if for the right reasons for me.

Regardless of all the basal testing I've done, I know that at some point between 10 and 11am, my BG takes a dip.  Not always a huge one, but something strange happens around then and I'm hoping I can start to visualise what that is.

I also do a lot of exercise, and whilst I've worked hard to be able to manage my diabetes and run as much as I do, I've got a genuine curiosity about what happens to my BG whilst I exercise.  Again, the Libre should help me out there.

Lastly, I'll have some evenings where I eat late, and things don't behave in the way the usually do.  Last night was a prime example, where, despite meticulous carb counting and appropriate insulin delivery, I woke up around 16.5.  Not much cop is it?  Hopefully I can understand how that happens, so I can learn what to do about it in the future.

What I don't want to do is become someone who chases flat lines on a graph with temporary basal rates and huge doses of insulin.  I know from DAFNE that a more patient and informed approach is more likely to give better results and understanding in the longer term.

As you may know, I got to listen in on a few sessions at the Association of Children's Diabetes Clinicians conference on Friday, and two talks there really captured my attention.

Firstly, Dr Peter Adolfsson talk about how, in his native Sweden, patients (particularly paediatric patients) are introduced to continuous glucose monitoring before they start pump therapy.  Indeed it turns out, not all patients want or need pump therapy once they've understood how the glucose reacts to different situations.  This gave me hope I was making the right decision with a Libre.

The second talk was from Prof. Kath Barnard, who spoke brilliantly (and candidly) about the lack of psychosocial support for people using diabetes technology like CGM, and how many that self fund, do so and ignore a lot of the information they receive (e.g. cancelling/ignoring alarms from devices).  This made me feel more cautious with the Libre.

Am I getting myself into something I fully understand that will give me the information I want, without changing my existing attitude and approach to managing diabetes?  In short, I don't know.  But there's probably only one way to find out...

Divided and United

This blog was first published on the Diabetes UK Blog site in November 2013

Despite being a member of a "club" along with about 4 million other people in the UK, having diabetes is a very individual thing.  The intricacies of the treatment varies from person to person (think insulin to carb ratios) and some will have symptoms that others don't (e.g. hypo awareness).

How we each manage our own conditions, and everything else that comes with it, is a very personal thing to us.  The people we interact with and discuss our daily highs and lows (pun not intended) is also an individual thing.  Some choose to talk openly to the #doc (diabetic online community), others attend local meetings and some may only share with their nearest and dearest.

Despite the myriad individual things that set us all apart from other diabetics, I recently realised that there are a lot of things that do unite us.  I think it probably helps to remember when we're having a bad day that there's someone else who's been through the same things we have, and that should make us feel a little less alone in the universe.  What follows is a list of things that I think we've all done or experienced at some point in our diabetic journey (the list is a little Type 1 specific as I'm speaking from experience, but I've tried to include the Type 2 ones I've discussed with others)

• Being told "you can't eat that" or "should you be having that?!"  
• Testing your BG only to get a reading in the 20s that you can't possibly explain
• ...and conversely, getting a low BG reading when you have no hypo symptoms
• Writing down your insulin dose in a diary but forgetting to actually administer the dose (really hoping that's not just me!)
• Waking up in the middle of the night and losing an hour of precious sleep to deal with a hypo
• Hearing that you have the "naughty" type of diabetes (something I've heard said to Type 2s a few times!)
• Concocting an elaborate excuse ahead of annual review time to explain a wayward HbA1c
• Having a particularly bad day where you end up saying "sod it, I'm having chocolate"
• Stacking insulin doses so you end up with low blood sugar
• Having a BG reading that's either so high or so low that you do a double take on your meter
• Wasting a test strip because you don't get quite enough blood on the end
• Being slightly irritable and having someone tell you to test your BG because they think your sugars are too high/low
• Getting blood on your clothes after a bolus injection or a cannula change

It's obviously not a comprehensive list but hopefully it does illustrate that whilst we have our own individual plans for dealing with our diabetes, there are some moments we all share.

It can be hard to feel like you're always in control of every aspect of your diabetic life and it can be quite easy to feel like you're the only person in the world who is struggling with something.  Hopefully you might recognise a few of the things from the list above and realise that while we're all individual, we're also all united by the same things that diabetes forces upon us every day.

Can you think of any I've missed?

Tightrope Walking

I'm just back from my annual review and felt compelled to write a just-for-me blog for the first time in a long time.  What follows is pretty much a "stream of consciousness" affair (though I'll be scanning it to make sure it makes sense).  It might feel like a mish-mash of previous blogs I've written, so for any regular viewers out there, apologies in advance.  By the end, I'll hopefully have done a decent job at articulating my inner voice.

Thanks for reading.

In the last couple of years, I've started to look forward to my annual review rather than dread it in the same way a school boy who's forgotten his homework again.

Gone are the days where I'd spend hours thinking up excuses for why my weight, blood pressure, HbA1c and any other measure you care to mention were all going in the wrong direction.  Now I'm in a place where I feel educated enough to spend one of my bi-annual 15 minute slots, discussing my diabetes, any of my problems or concerns and feeling like part of a conversation instead of a lecture.  This is, of course, a good thing.

However, what I can't seem to shake is that feeling of despondency as I trudge through a maze of hospital corridors out into the rain and back to my car.

Once upon a time, I'd leave feeling guilt ridden and angry at myself.  It got to a point where a consultant pulled out a graph and said "If you don't change what you're doing, this [pointing at said graph] is when your kidneys will start failing".  I wondered what the point was.  Why was anyone wasting their time on me if I couldn't be bothered to look after myself?

Now it's a different story.  Today I left feeling frustrated because I was convinced I'd finally cracked it and that it'd be a bit of a chat, usual questions and checks and I'd be on my way.  Not so.  Today my consultant (who is without doubt, bloody wonderful), looked at the download from my BG meter and gave that intake of breath through clenched teeth that consultants do and said "look at all these low readings.  I'm worried you'll lose your hypo awareness".

Now before I continue to wallow in my hole of momentary self pity, I will say that, of course, she's right.  That is a concern, and losing my hypo awareness is one of my biggest diabetes fears.  Basically anything you can prefix with "losing" scares me.

Back to my hole... living with diabetes is tough.  Not some of the time - ALL of the time.  I've had it 12 years and it still kicks my ass.  I guess my consultant has a privileged view in some sense as she can look at 3 months worth of data and see the patterns quite easily.  I write my BG levels down but I've got a bit lazy at looking for patterns I suppose.

The thing is, high numbers worry me.  I know that a lot of high numbers will start to eat away at me and if I can't make them go away I'll feel like I can't look after myself and I'll give up.  I've done it before and it didn't work out well.  I'm always more likely to go slightly over on my insulin calculations to err on the side of caution because I know it's less likely to lead to a high reading later on.  I'd rather have a low reading than a high one (to which my consultant nodded along sympathetically).

I've previously likened having diabetes to walking on a tightrope.  Managing it needs a lot of skill and concentration and you need to consider what you're doing all the time.  If you lose focus you start to wobble and if you wobble too much you'll lose control completely.

It's easy to cry "no fair" but life isn't fair and I'm not 13 years old any more so I'm not taking that option.  I'll keep doing what I've always done - live and learn.  There's no silver bullet to make any of these problems go away and so I'll refine my own care and keep working at understanding how my body reacts to this enigmatic disease.  As I've said before, diabetes isn't who I am, it's just one small part of me.  Sometimes it needs more attention than others but if I'll carry on working to keep the disruption to a minimum.