How Your Hormones Impact Physical Activity

Dr Colberg’s article: useful to know…

Dr. Sheri's Blog

Insulin injection

The human body only has insulin to lower blood glucose but has five hormones that raise it (with some overlap). This hormone redundancy tells you is that, at least from a survival standpoint, your body is desperate to make sure you do not run out of blood glucose; it is not as concerned about you having too much. Insulin is an important hormone for regulating your body’s storage of fuels (carbohydrate, fat, and protein) after you eat. It tells your insulin-sensitive cells (mainly your muscle and fat cells but also your liver) to take up glucose and fat to store them for later as muscle and liver glycogen (the storage form of glucose) as well as stored fat. During exercise, any insulin in your bloodstream can make your muscles take up extra blood glucose. In people who have a pancreas that functions normally, insulin levels typically decrease during exercise, and…

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Seven observations on using the FreeStyle Libre for a week

hand holding FreeStyle libre meter
You will prise this from my cold, dead hand…

Blood, I miss the sight of you… I’d gotten used to those tiny beads that popped from the tips of my fingers several times a day. This week, not so much.

And as misses go, it’s a rubbish one, right?

As the proud new owner of a FreeStyle Libre (may the universe rain her blessings down on NHS Greater Glasgow and Clyde), I know the much-vaunted advantages. Ability to test more often and easily. Probable positive effect on your HbA1c levels (the long-term measure of blood glucose in the body) and reduced likelihood of complications.

Here, then, are my observations on the lesser quoted points you notice when you wear one…

  1. I’m clumsy as heck. Yes, I keep bumping into door frames. Maybe I always have walked into them on a regular basis but when I hit my right arm (the one I’m wearing the sensor on) off a door frame, I notice. Three times in the first four hours of wearing it.
  2. The absence of black dots. Those of us who’ve spent our lives doing five or six blood tests a day (see above) can hold out fingers tips covered in tiny black dots. Occasionally, the skin peels away in protest. Three days in and mine VANISHED.
  3. Oh, the joy of the night-time test! You wake up, roll over, grab the sensor from our bedside table and wave it in the direction of your arm. Voila! The result. No messing around opening that wee case up, taking out the tube of sticks, popping it open, finding a stick and taking three attempts to insert it into meter, pricking your finger and missing the stick with the dot of blood, etc. And all done in the dark because you don’t want to disturb your other half.
  4. No more vampire impressions. I did blood tests on public transport, in offices, when out and about, in the gym, the cinema, the pub, restaurants and more. And I was discreet about it, but when your finger bleeds you suck it to get rid of the excess, right? Some folks think that is disgusting or that you should always wipe it on a tissue or surgical wipe. Who has the foresight to carry all that around as well as everything else?
  5. Having to remind yourself you can test whenever the heck you want. I’ll get used to the feeling quickly but I’m still adjusting. Shall I test again? No, no I only pricked my finger an hour ago and I’m only prescribed XX amount of sticks every months so no… Stop right there, lady. Shall I run the meter over my sensor again? Yes, yes, yes!*
  6. Staring at your graph. Oh the fascination of watching what your blood sugar levels get up to over eight hours. Telling yourself you will record this properly, oh yes you will, and work out patterns so you can make educated adjustments, rather than relying on guesswork.
  7. Missing the sight of blood. As you might have guessed, the intro to this piece was a big, fat lie. I’m one hundred percent happy that bloody fingers are a thing of the past (ish, you still have to do some).

* Ten’s the recommendation, in case you were wondering. Too many’s not good on the sanity levels.

My people all together – #type1diabetes

blood testing equipment type 1 diabetesEver sat in a room and thought, “I am with my people”? That was my experience this week as I attended an education session the NHS had put on; my attendance a condition for prescription of the Abbot FreeStyle Libre.

I doubt I’ve ever been in a room with so many other type 1 diabetics. Sure, type 1 is a hidden condition. Perhaps others travel on trains with me or flit about the offices of the University of Glasgow dropping their test strips wherever they go?* Still, my original statement holds. I reckoned on about 200 people there, with perhaps a third of them partners or parents.

All shapes and sizes

I arrived at the Queen Elizabeth University Hospital early and watched in fascination as folks trooped in to the lecture theatre. We come in all shapes and sizes—all ages, all colours and all creeds. Who were the ones with diabetes? I put it down to those of us who carried our precious bag—the FreeStyle Libre and the doctor’s letter handed out when we registered—tightly. I’d expected lots of young people, but that wasn’t the case. The average age, I reckon, was mid to late 30s. Every time I saw someone who looked a lot older come in, I cheered silently.

Take that, reduced life span, and shove it where the sun don’t shine.

Our session took the form of a PowerPoint presentation by one of the diabetologists at the hospital, followed by some Q and As. I didn’t bother asking anything. As an introvert, I’m not going to raise my hand in a room that full of folks—even if they are my people. But there were plenty who didn’t suffer from shyness who dived in.

Can you scan your sensor through clothes? Yup. (So handy!)

Can you swim with it? Yes, but only half an hour is recommended. (Seriously, do people swim for longer than that? It’s the world’s most boring form of exercise unless you’re in open water.)

How long does it take for the prescription to come through once you hand the letter to your doctor? About 48 hours.

Can you connect it to your phone? Yes—there’s an app for it.

What happens if it keeps falling off? Some people have slippier skin than others. Thankfully, the two times I tried the sensor it stayed in place for its allotted fourteen days.

Talking to my people

I longed to talk to my people, but didn’t. See above-mentioned introvert tendencies. Who would I have chosen? The Indian girl who talked about running, exercising and wearing a sensor? The man behind me who asked if the Libre 2—the one with alarms that sound if your blood sugar levels go up or down too rapidly—would be available for us in the future? The glamorous young couple where I couldn’t work out which one would hold out the fingers covered in black dots from too much finger-pricking?

No. The one I’d have picked out was the woman I guessed to be in her late 30s who came in with an older man and woman I took to be her mum and dad. I watched her sit down near me and wiped away a wee tear. That might have been me once upon a time, attending with my lovely, supportive ma and pa. My father died nine years ago and how I’d love to have shared this new, wonderful development in diabetes care with him.

Session over, my precious bag and I got onto the bus to go home. “A new chapter, Emma B,” I said to myself. “How terribly exciting.”

*About to become a non-problem. Yay!

Type 1s in the US dreading their 26th birthday

insuline supplies on the Diabetes Diet websiteSometimes a story pops up which serves as a timely reminder of how lucky we in the UK are (catastrophic, undemocratic political shenanigans which might lead to insulin shortages anyway notwithstanding)…

This week’s news feature that popped out to me was a BuzzFeed article about Millennial type 1s in the US, forced to come off their parents’ health insurance at the age of twenty-six. Insulin prices in the US tripled from 2002 to 2013 and a recent study found its average annual cost increased from $3,200 to $5,900 a year from 2012 to 2016. Unregulated capitalism—always a good thing, hmm?

Most Millennials, the article pointed out, have to contend with the long-felt after-effects of the 2008 financial crisis, debts left over from college or university and the gig economy where it is hard to get health insurance in the first place. Or there are jobs that don’t have insurance, the insurance doesn’t cover diabetes or the deductibles are so high, the insurance isn’t worth the paper it’s written on.

Rationing insulin

The reporter spoke with a number of twenty-six-year-olds forced into rationing insulin and using syringes and lancets repeatedly to try to keep costs down. One mentioned skipping meals so he didn’t need to take at least one dose a day, and another said her insurance didn’t cover the insulin she’d previously used. The one it sanctioned made her feel ill.

Why the age of twenty six? As the article states, outgrowing your parents’ health insurance has always been an issue for young adults with chronic health conditions. The Affordable Care Act of 2010 allowed them to stay on that insurance until they got to twenty-six—a universal deadline.

Even government-sponsored insurance is so “stupid expensive” one person quoted in the article said, it’s not worth it.

Different career path

And what about job choices? Again, those featured in the article spoke about sacrificing what they really wanted to do for a job or career path that offered sufficient financial reward or great insurance in order to get the life-saving medication they need.

Twenty-five-year old Allie Marotta told BuzzFeed she fears the approaching deadline.

“Being postgrad, figuring out your career,” she said, “all of that is crazy to begin with, and then adding the layer of worry about medical stuff and having it be a life-or-death situation, literally a life-or-death situation all the time.

“It shouldn’t be this hard. You see other countries doing it and it’s not this hard. There’s no reason for this to be the way that it is.”

Healthy Low-Carb Recipes for Chilling and Grilling — Nourishing World Blog

Some party and outdoor recipe ideas for low-carb courtesy of the Nourishing World Blog.

With the Summer Party season about to get underway, I wanted to share some great keto-Friendly Summer recipes. My Daughter and I recently did another round of the 21-Day Detox and found a few new healthy recipe favorites. This Buffalo Wing Sauce is keto friendly, Paleo and Whole30 friendly. My daughter ate this almost every […]

via Healthy Low-Carb Recipes for Chilling and Grilling — Nourishing World Blog

Approved for Flash Glucose Monitoring!

Cheerio oh meter – you are about to become a thing of the past. Ditto that test result too.

Joyous news, friends… I’ve received approval for funding for the FreeStyle Libre flash glucose monitoring system.

Oh, what changes this will bring! Firstly, there’s the ease thing. I often sit down for dinner, realise I’ve still to do a blood test and groan. Now, it will be a matter of seconds. Take out the reader, scan and voila. I’ll also be able to do TONNES of tests, and catch those pesky sugar levels when they misbehave firing to the top or plunging to the bottom.

As a wild optimist at heart, I tell myself my day to day energy levels will also shoot through the roof – diabetes being much easier when you’re not tired all the time because of glucose level misbehaviour.

Before I receive my very own precious reader and prescription for the thingies you stick on your arm, I’ll need to attend an education session. Once that’s done, a letter wings its way to my GP and she starts prescribing the arm thingies. (Note my fine grasp of the technicalities.)

So, there we go. Happy days! I’ll report back.

Exercise & Diabetes – short spurts or endurance stuff?

Emma Baird  at the start of Ben Lomond
At the start and cheery…

Exercise, as we folks with diabetes are often told, is essential for good management of diabetes. ‘Good’ doesn’t mean easy. The usual disclaimer applies; my experiences are unique to me, but this week’s blog post is inspired by last week’s climb of Ben Lomond.

Ben Lomond is a munro—i.e. a mountain this is higher than 3,000 feet or 914.4 metres. Munro-bagging is the activity where you climb them, stand on the top for a while taking pictures (if it’s not on social media, it never happened, right?) and then telling everyone you know for weeks afterwards.

As Ben Lomond is the munro nearest to where I live, it’s been on my bucket list for ages. My sister in law is a keen walker/hill climber so the two of us set off to tackle the mountain last Monday.

I am fitter than average. My FitBit tells me I’m in the top percentage of people my age and gender when it comes to the VO2 measurement. (If you can explain exactly what this is to me, I’d be grateful.) But climbing a munro? Boy, a different kettle of fish entirely. I didn’t prepare properly and I suffered.

So, here are the lessons I learned…

Prepare, prepare, prepare

Endurance exercise needs far more before-hand and after preparation than short spurts of exercise. I can do half an hour to an hour’s exercise without needing to take extra carbs or adjust my insulin. A mountain is something else entirely.

Stretch, stretch, stretch

Stretch out your calves, quads and glutes thoroughly afterwards. No, do. Mine ached for five days afterwards, particularly my calves which I put down to going up on the balls of my feet as I clambered over the rocks. When I got out of bed on Sunday morning and limped downstairs to the toilet, I went so slowly my FitBit didn’t register the steps.

Eat, you diddy

Eat beforehand. I know, duh. I had food with me but my sister-in-law and I did it first thing so I hadn’t bothered with breakfast.

Test, test, test

Blood sugar at the start – 9.8. One hour in, 13.4. I took half a unit of rapid acting insulin—3.2 half an hour later. In a panic, I shoved in too many jelly babies. At the top I ate a banana and took no insulin. By the time I got to the bottom, my blood sugar had hit the heady heights (appropriate analogy, huh?) of 19. I took too much insulin and by the time I got home, I’d crashed once more.

Oh for the Abbot Free Style Libre, which would have made testing blood sugar levels so much easier and adjustments more likely to be accurate. Some day my star will come and the good people of Greater Glasgow and Clyde NHS health board will see fit to prescribe it.

Enjoy the views

Except, this being Scotland, count on getting to the top and seeing nothing thanks to the thick layer of grey cloud that hovers there. Still, twenty metres down and the views were glorious.

Afterwards, we realised we’d climbed Ben Lomond on World Naked Hiking Day… sadly, everyone else who climbed it on that day hadn’t got the memo either.

All of which brings me neatly to—can you do endurance exercise when you have type 1 diabetes to deal with? People do. There’s the Novo Nordisk team of cyclists for a start. On the other hand, they’ve got a team of dedicated professionals behind them to help with diet and working out what they take insulin-wise. I’m willing to bet too, that they have access to all the latest gear—the continuous glucose monitoring, the pumps and sophisticated feedback they can interpret to work out how to cope with long bike rides.

Our ascent of Ben Lomond took just over two hours and ten minutes (844 calories on the FitBit), and the descent about an hour and forty minutes. It counts as the hardest fitness challenge I’ve ever undertaken, far more difficult than running a half-marathon.

[Talking of running, we were overtaken by two trail runners at one point. Lordy. In awe.]

I don’t know if I would do it again. I’d rather do short bursts of exercise interspersed throughout the day as I know what I’m doing and how it will affect me. I’m a mesomorph body type too. My body favours that kind of exercise as opposed to the endurance stuff. I can walk long distances and often do, but most of the time that’s on flat ground or its hills do not last more than 45 minutes. Hauling yourself up mountains is hard as heck.

With exercise it is easy to forget that there is a level above which there is no point in doing extra unless you are training for a big event or you’re a professional sports man or woman or athlete. I do Pilates for the flexibility benefits, I walk or run for cardio and otherwise I try to move a little throughout the day. That, I think, is enough for me.

What do you prefer—endurance exercise or doing short, intense bursts of it?

 

*Photos courtesy of Jacqui Birnie.