The FreeStyle Libre—a two-week report

a sensor and reader on a post on the Diabetes DietYou find me, un-sensored and sad… Yes, I’ve completed two weeks on the FreeStyle Libre sensor and reader system, and now I’m back to finger pricks, at least temporarily.

At my last diabetes clinic appointment, my consultant* agreed that I’m a candidate for flash glucose monitoring (which is different from blood glucose testing, but more on that later) and sent me off with a 14-day sensor while I wait for bureaucracy to kick in.

So, what’s flash glucose monitoring like? For the uninitiated, the system comprises a sensor you wear on the back of your arm and a reader that can be used any time. Type 1 diabetes tends to encourage obsessive compulsive behaviour, and the FreeStyle Libre system facilitates that, though it’s no bad thing.

Where flash glucose monitoring differs from blood testing is that the sensor reads levels from interstitial fluid, so it lags about four and a half minutes behind blood glucose readings. If you drive, the DVLA requires you to do blood tests, rather than scans beforehand to avoid the risk of hypos while driving.

Parents love them because they can check children with type 1 diabetes while they sleep, able to work out if they are risk of a hypo, and they are also routinely prescribed for pregnant women who have diabetes as frequent testing makes it easier to maintain the tight control you need while growing a baby.

The accompanying app can be downloaded by others, who can gain access to your information if you give them permission. Again, something that is useful for parents although such scrutiny would have horrified the teenage diabetic me.

Here’s what I found:

Frequency of testing

After a day or so of overcoming the hesitation—I can’t do another test, I just did one an hour ago… Oh. Yes, I can—I averaged 11 scans a day, and about two blood tests usually at the same time to check accuracy and a few times because I was hypo.

Ease of testing

Easy-peasy-lemon-squeezy! You can use the reader through clothing, it only takes a few seconds. It’s much easier than pulling out a meter, sticks and finger-pricker—especially when you’re out and about.

Accuracy of readings

I had the odd bit of disparity—usually if my blood sugar was low, as the sensor lags behind blood glucose readings. However, most of the blood tests I did at the same time varied only by 0.1 o 0.2 mmol, and I did get hypo readings that registered at the same time.

Sensor adhesion

No issues there. That thing stuck to me for the two weeks. I didn’t do any swimming in that time, so I can’t attest to how well it works in that setting. Nor did I try it out in the sauna/steam room as threatened—though one suggestion a fellow user came up with was using cling film to bind it onto your arm. The reader lasted on the battery charge for the full two weeks too.

Most useful bits

There are lots of things that sell flash glucose monitoring to me—ease and frequency of testing two of them—but there are other super-useful components. One is the pattern tool. You can see where you have the most glucose variability and when you tend to have hypos. In the two-week period, I had (ahem) 17 low glucose events, most of them between 11am and 5pm and that corresponded with the time of day I have most glucose variability.

I’ve never been good at logging my blood tests. It just feels too much like hard work. I know you can download from your meter, but the checks I made on the flash glucose monitor gave me a clear idea of what happens. And, more importantly, some ideas of how to fix it.

The excess hypos may have been because of the half-marathon, which happened not long after I started my 14-day sensor and because I’ve been eating more carbs. As we say in the Diabetes Diet, more carbs mean more insulin. Bigger amounts of insulin mean bigger mistakes. A salutary reminder, then, that it’s back on the low-carb for me.

Thanks too, to Steven Morrison—my blog and book co-author’s son—who emailed me in detail about his own experiences using the FreeStyle Libre. He’s a convert too, and the cling-film tip came from him.

So when does my prescription come in? I’m now on a list for a short course at the hospital and once I’ve taken part in that, the organisers write to my doctor recommending she add sensors to my list of prescribed diabetes medications and gear. Fingers crossed, it doesn’t take too long.

 

* #LovetheNHS

The Good Ol’ Days of Diabetes

Ah, the good ol’ days of diabetes – glass syringes, peeing on sticks and rigid eating times.

cover of Artists Town by Emma BairdWe veterans remember them fondly and with the odd head shake in disbelief. Did it really used to be like that? by ‘eck, we have come far… Recently, I wrote a book, Artists Town, which features. a type 1 protagonist. My book is set in the early 1990s and life for we pancreatically-challenged has changed substantially since then.

My own diagnosis came in the 80s. Here’s what used to happen then. See if you remember any of this stuff, and newbies read it and gasp.

  1. Glass syringes. Yup! The environmentally-friendly option too, given the waste your average type 1 inadvertently produces these days.
  2. Urine, not blood testing. It was a lot less painful; a lot less accurate too.
  3. Dextrosol. Standard treatment for hypos were these chalky, horribly-flavoured, expensive sweets. After a while they turned rock hard too. When Lucozade tablets appeared on the market, I was in HEAVEN.
  4. Exchanges. Long ago, doctors and nurses taught us carbohydrate counting. One exchange was roughly 10g of carbohydrates and you were given an amount for every meal and snack. To make it simple, one tbsp. of cooked rice or potatoes equalled an exchange, as did a slice of bread or an apple.
  5. NO SUGAR. It astounds me that at some point post my diagnosis, advice for diabetics included ‘eat anything you want and cover it with insulin’. As a wee girl, doctors said no cakes, no biscuits, no sweet, ice-cream and watch out for sugar in ketchup. Nine-year-old me burst into tears.
  6. Tab – the only no-sugar fizzy drink on the market. It tasted of grapefruit. The no-sugar market exploded in the mid to late 80s.
  7. The all-knowing doctors. In the 80s, doctors were still viewed as all-knowing, authoritative figures and you didn’t question them when they told you why you were having so many highs/lows. They were the experts. Your day to day experience of living with diabetes counted for naught.
  8. Fruit salad. Young me got offered a lot of fruit salad for dessert – the world’s worst pudding when it comes to taste, and not that great for your blood sugar levels anyway. I haven’t eaten the stuff in decades.
  9. Terrible chocolate and carob bars. Boots had a line of chocolate they advertised as suitable for diabetics. It was a) not very nice and b) little better than the real stuff for blood sugar control. And as for carob bars… carob is one of those acquired tastes, and I never got it.
  10. Two (count ’em) injections a day. This is the one that will astound the newbies, what with today’s regimes of multi-daily injections or pump therapy. I took one long-acting and one-medium acting insulin, mixed together twice a day. This meant meal times had to be the same and stuck to every single day. While flexibility is nice, sometimes I think there are advantages to rigidity. “Sorry, I need to go. If I don’t eat now, I’ll collapse” – a great excuse to get out of anything.
  11. Thrift. My mum and I used to cut up my blood testing sticks to make them last longer, possible then because you measured your blood sugar level by comparing the colour the pad on the stick turned to a chart on the tube. We cut them lengthways, a fiddly but effective job.

Artists Town is now available for pre-order on Amazon.com and Amazon.co.uk Please note – this book contains adult content and strong language. 

Brexit and Insulin Shortages

a plstic box c ontaining insulin on The Diabetes DietInsulin shortages and low-carb dishes—no obvious connection, I grant you but bear with me.

The first relates to a news item on Channel 4 last night, which warned of insulin shortages post-Brexit in the UK as the country produces little to no manufactured insulin (apart from a factory which makes the stuff derived from pigs).

Sir Michael Rawlins, the chair of the Medicines and Healthcare products Regulatory Agency, told the Pharmaceutical Journal last Friday that, “We make no insulin in the UK. We import every drop of it. You can’t transport insulin around ordinarily because it must be temperature-controlled. And there are 3.5 million people [with diabetes, some of whom] rely on insulin, not least the Prime Minister.”

412,000 people on insulin

Strictly speaking, that’s no true as the Channel 4 story pointed out. Wockhardt UK produces the animal insulin, but its products are used by some 1,500 to 2,000 patients every year. And that’s less than 0.5 percent of the estimated 421,000 people in the UK who rely on insulin.

Channel 4 News spoke to the major manufacturers, Sanofi, Novo Nordisk and Lilly. All of them make insulin in Europe.

The Healthcare Distribution Association (HDA) UK which represents medical suppliers in the UK wrote to the UK Government post the referendum in 2016 to warn of serious upsets to the supply chain should Brexit negotiations go wrong.

Buffer stocks

HDA UK said the UK medicines supply chain had “inbuilt resilience” and “flexibility”, and that they were aware of proposals by the government and manufacturers to develop plans for a buffer stock of all medicines.

A spokesperson for the Government said they were confident of reaching a deal, there were contingency plans in place to ensure no disruption to supplies.

Channel 4 News’ fact check conclusion is that as the companies and the Government don’t anticipate shortages, we should be okay.

Back to low-carb recipes and my tenuous attempt to link the two. If you follow a low-carb diet and you use insulin, in general you don’t need to take as much insulin. If shortages come, you’ll have more time to use your insulin while the powers-that-be attempt to sort out this almighty mess.

Cue plug for this blog and The Diabetes Diet! Is that distasteful of me?! Probably.

 

 

 

Aubergine and Pepper Parmigiana

The Diabetes Diet picture of an aubergine and cheese dishIf you read your way through my weeping and wailing post about meat-eating and ethics last week (congratulations, by the way), then this recipe will seem a natural follow-up.

To recap, I’m reading The Ethical Carnivore: My Year Killing to Eat by Louise Gray and hoping for easy-to-follow guidelines that assuage my conscience about eating meat, falling short of killing it myself as I’m pretty sure I can’t do that.

In the meantime, there is always low-carb vegetarianism. I know vegans argue that vegetarianism is little better than meat-eating given what goes on in the dairy industry, but it’s a start. Besides, I can’t imagine a life without cheese.

Low-carb veggie

Here’s a low-carb veggie recipe for you—a bastardised version of aubergine parmigiana. Allow roughly 10g of carbs per portion.

Aubergine and Pepper Parmigiana

  • Servings: 3
  • Difficulty: easy
  • Print

  • A large aubergine
  • One red pepper
  • One yellow pepper
  • 400g tin chopped tomatoes
  • 2 cloves garlic, crushed
  • 2tbsp rapeseed oil
  • Grated rind of one lemon
  • Salt and freshly ground black pepper
  • 75g grated parmesan cheese
  • 50g grated cheddar cheese

Pre-heat the oven to 175 degrees C.

Chop the aubergine and pepper into equal-sized pieces and toss in one tbsp of the oil. Cook on a griddle until softened—about ten minutes.

Heat the other tablespoon of oil in a saucepan and add the chopped tomatoes, garlic and lemon rind. Allow to come to a boil and turn down to a simmer, stirring from time to time. Cook for about ten minutes to, allowing the sauce to become thick and concentrated.

Season the sauce with salt and pepper and sprinkle some on the cooked aubergine and peppers.

Layer up the vegetables, sauce and cheese in a gratin or rectangular casserole dish finishing with cheese. Cook for twenty minutes.

For other low-carb vegetable recipes, see:

 

 

Thrity-One-Year-Old Claims Cure for Type 1 Diabetes

A PICTURE OF BLOOD TESTING EQUIPMENT AND NEEDLES

A PICTURE OF BLOOD TESTING EQUIPMENT AND NEEDLESGoogle alerts frequently pairs ‘diabetes’ and ‘cure’ together, but most of the time the words don’t capture my attention. Even when ‘type 1 diabetes’ and ‘cure’ make the same sub-heading, I’m not jumping up and down.

Yeah, yeah, heard it, bought the tee shirt, and no impact on my life so far…

But The Sun newspaper carried a story this week about a 31-year-old who claims to have cured his type 1 diabetes with diet and exercise alone. Again, that approach can achieve results with type 2 diabetes but it’s the first time I’ve seen it accredited to a cure for type 1.

Exercise and diet

Daniel Darkes’ regime isn’t for the faint-hearted. He eats a diet high in zinc (nuts, oily fish and veg) and runs more than sixty miles a week.

But before you dig out your trainers and start stock-piling the Brazil nuts, Daniel’s type 1 diabetes has some qualifications. He has a rare, abnormal gene, which doctors believe might have restarted his pancreas.

The 31-year-old from Daventry in Northants developed diabetes eight years ago and stopped giving himself insulin last January (2017)*. He started cutting down on insulin after experiencing hypos in 2016. He travelled to the US in March 2017 to find out more. Doctors ran further tests to find out what we happening to his body.

Brain sending messages to pancreas

He was put on a fasting diet and exercised at the same time. The medical staff noted his brain had begun sending new signals to his pancreas, and he hasn’t injected himself with insulin ever since.

Daniel told The Sun that doctors believed his abnormal gene combined with exercise is the reason he’s been able to cure himself—it’s as if the gene acts as a back-up immune system and has recharged his pancreas.

He is still being monitored at Northamptonshire General Hospital.

Abnormal genes

I’m fascinated by this story—as I suspect most type 1s will be. I’m no medical expert so my opinions are qualified, but I suspect that Daniel’s abnormal gene plays a huge part in his ‘cure’ (and this won’t be regarded as such until he reaches the two-years-without-insulin mark). It’s also interesting that the description of his diet (scant as it is) sounds like a low-carb diet.

The article said that Daniel’s case “could provide a revolutionary new approach to treating type 1 diabetes”, while Diabetes UK said it couldn’t speculate on whether Daniel had ‘cured’ his diabetes or not, and that there was “no clear cure for type 1 or type 2 diabetes”.

 

*DISCLAIMER – please, for the love of all things injectable, do not skip your insulin injections if you have type 1 diabetes…

 

Coping with T1D in the Heat

Inforgrpahic about the heat by The Diabetes Diet

A screenshot of the weather in Scotland on The Diabetes DietHeavens above—this isn’t a post I’ve needed to write before but the last few weeks of incredible sunshine and heat in Scotland (Scotland! I’ll say it again, Scotland!) necessitates it.

If you’re a type 1, what special precautions do you need to take when the mercury rises? I prepared this handy infographic to help…

Please note—if you have neuropathy (nerve damage) this can affect your ability to sweat and therefore cool down. Go out early in the morning or later in the afternoon if you can, drink water to stay hydrated and exercise in air-conditioned gyms. Cut down on drinks with caffeine and alcohol, and take care of yourself as best you can.

Inforgrpahic about the heat by The Diabetes Diet

#TalkAboutDiabetes – Diabetes Awarness Week June 2018

What do you struggle with when you’re talking about diabetes? It’s Diabetes Week 2018 (June 11-18) and the theme of this year’s awareness-raising seven days is the stuff we find awkward, embarrassing, difficult or even funny to mention.

Here are mine:

  • I don’t like telling people in general. I’m not ashamed or embarrassed; I just don’t like drawing attention to myself.
  • Jelly baby etiquette. When you eat sweeties in front of someone, politeness dictates you offer them around. But they’re the medicine that corrects low blood sugars*, so stinginess is understandable.
  • Explaining a hypo when you’re in the middle of one. Most of my low blood sugar episodes are manageable. But I can be in the middle of a conversation and my mind goes blank. “Bear with me! My mind’s distracted. It’s screaming ‘SUGAR, SUGAR, SUGAR’ at me. My word power will return in a few minutes,” is what I should say.
  • Or don’t talk to me. When I’m high, conversation is too much effort. Please don’t take it personally.
  • I don’t talk much either when I’m high because I’m conscious of the nasty taste in my mouth and am reluctant to impose halitosis on anyone.
  • And don’t take the grumpiness low blood sugars produce personally either. First aiders once told me about diabetics who punched people when they were low, so grumpiness seems moderate in comparison.
  • Please know that managing diabetes is like having a part-time job that you do on top of everything else.
  • If you manage to work out I’m hypo long before I do, be aware I’ll deny it in an exasperated fashion. “Flip’s sakes, no I’m not. Look I’ll even do the blood test to show you and here it…oh. Alright then.”
  • Sometimes when I say I can’t do something because of the diabetes, I might be using it as a fab, ready-made excuse. It’s not me, it’s you. OH NO! I’ve just given away diabetes’ best-kept secret!

*I told a little girl my jelly babies were medicine once. She gave me one of those, ‘why do adults lie to me?’ looks.

Half Marathon – Diabetic Training Progress

Diabetes Diet Emma with her 10k medalMutters to self—so why did you enter a half-marathon you eejit? Because it was January, and the said run was in nine months’ time. Distance from something is the equivalent of wearing beer goggles. Everything looks do-able when it’s months away.

Anyway, the experts recommend you try a few other races to keep motivation levels up so I entered the Vale of Leven 10k, which took place this morning (Saturday 2 June).

Many runners think of 10k as nothing. Easy-peasy to train for and do. Not me. Mama Nature didn’t make me a natural runner. I plod. Sometimes a 4k feels like a Herculean struggle. I can walk long distances without finding it onerous or unpleasant. I should stick to that, right?

Mornings or Evenings?

Races mostly take place in the mornings too. I’m not a fan of morning runs. My blood sugars do weird zig-zaggy things at that time of day (see pic). I’d rather run at lunchtime or early evening when they’ve had time to settle down. Plus, there’s the whole ‘what to do I do about breakfast and insulin’ question.

Still, the day came round and I got up early. Are you familiar with west coast of Scotland summers? For the most part, they promise much and deliver little. This year, however, May has been unbelievably warm and sunny. Weather forecasters promised cooler weather and even rain, but it dawned bright and sunny once more.

Eeks. My ideal run takes place at about 8 degrees with drizzle and a strong wind behind me.

The run started at Moss O’Balloch next to Loch Lomond Shores and spectacular as far as scenery goes. Parts of the route were recycled so runners like me faced the depressing sight of the fast yins heading home as we puffed and panted our way past kilometres seven and eight.

Hanging out with the Back Pack

Ah well! Lisa Jackson who writes for Women’s Running and who has a fair few marathons and ultra-marathons under her belt talks about the joys of hanging out at the back of the pack. Crowds tend to cheer you on a lot more. The marshals, volunteers and people at the race were most encouraging.

Pain when it’s passed leaves an imprecise memory—thank god—so I remember struggling for the first two kilometres as they were uphill and then at the last bit where I speeded up to keep up with the one hour pacer. But the detail’s no longer there, just the relief and pride of finishing.

tee shirt and medal for a 10k runI’m a sucker for a goodie bag and this one included a tee shirt (too big, but they always are as they’re sized for men), a medal, a bottle of water and a Mars bar. Chivas sponsored the event, but sadly a wee nip wasn’t included.

First Finisher

It’s years since I’ve run in a race. You rely on the atmosphere to chivvy you on; the crowds shouting encouragement, so you keep running when you want to walk. Or crawl, in my case. This wasn’t a busy run—I’d guess 550 people—and the ability mixed. I channelled Lisa. Yes! It’s BRILLIANT to hang out at the back, or the second half of the group at least. According to the ticket I collected at the end, I finished 257th and the 22nd woman for my age group (senior vet, whit whit whit??).

For other diabetic geeks, my blood sugar when I got up this morning was 13.6 (oops). I took half a unit of fast-acting insulin to correct this and I took my basal insulin at 7.30am and knocked two units off the usual dose. To avoid working out food and insulin requirements, I didn’t bother with breakfast* and ate a Hike bar—Aldi’s own-brand protein bars, 25g carbs and 9g fibre—twenty minutes before starting. My blood sugar at that point was 10.6, so I took another half unit of fast-acting insulin. I didn’t test my levels immediately after finishing, but an hour later they were 9.6.

So, another three months and I run more than twice that amount. Ooh, ‘eck! I ran the 10k in 60 minutes and 53 seconds (I told you I was slow), which puts me on course for running the half in two hours-ish. Wish me luck!

 

*Don’t do this at home, kids. I have no nutritional or sports expertise related to type 1 diabetes or in general.

 

More Thrush Ladies?!

a picture of canesten cream on The Diabetes DietCould I live with more thrush? Ladies who live with diabetes, you’ll join me at wincing at this one. No thanks, eh? Who wants to spend their days wishing they were sitting in a bath of calamine lotion?

I ask because I filled in a survey last week which asked me if I’d take a tablet to help with my blood sugar control despite initial findings where the control group suffered thrush as a side effect. That wasn’t the only reported side effect—weight loss is another one—but the benefits reported are exciting.

The drug is sotagliflozin (marketed as Zynquista), made by Sanofi and Lexicon, and it’s a dual SGLT1 and SGLT2 inhibitor. At present, it’s about to be reviewed by the US Food and Drug Administration, as diabetes.co.uk reported.

The SGLT1 bit works to delay glucose absorption in the intestines which helps with blood sugar spikes after eating. The SGLT2 inhibitor makes the kidneys better at getting rid of excess sugar in the blood.

Zynquista had undergone clinical trials. People who took the drug achieved better HbA1c levels without increasing the risk of severe hypos. But one group of trial participants taking sotagliflozin developed diabetic ketoacidosis, compared to just 0.6 percent taking a placebo.

Participants on the trial lost 2.98kg compared to those not taking the drug.

Would I take it? Heck, yes, even if it means stockpiling the clotrimazole creams beforehand. All addition help in the blood sugar battle is always welcome.

 

 

Office Etiquette with Diabetes

person holding jelly babies at The Diabetes Diet
Mine, all mine!!

I waved goodbye gaily to office life in 2013, glad to embark on new adventures in freelance world.

There’s a lot to be said for freelancing, not least the ‘free’ bit. I love being in charge of my own scheduling. But the pay… ah, the moolah just isn’t to be found, folks. You’re undercut all the time by global competitors who can afford to write for tiny sums or people in your own country who do it for free as a hobby. Argh.

Anyway, I started a new part-time job in April, working in a communications role on a project at Glasgow University—a worthwhile project and the chance to add a regular income. The equal opportunities form asked if I had a disability. I ticked the ‘no’ box. It also asked if I had a chronic health condition. Er…no?

Okay, I get that I do, but until my thirties, I thought all I had was diabetes. When someone pointed out it is a chronic health condition, I was stunned. No, really. I know that sounds like a “duh” moment, but diabetes hadn’t caused me much hassle. Calling it a chronic life condition felt a bit like I was straying into hypochondriac territory.

Back to my new office job. I decided to be a grown-up and tell my colleagues about my condition, instead of sneakily eating jelly babies at my desk and hoping they didn’t notice. It’s not that I don’t want to tell folks; I just I hate drawing attention to it.

I introduced the subject at a team meeting in a round-about way. Did my new colleagues know of anywhere on the campus where I could offload spare medical gear , I asked. (And benefit others at the same time by recycling my stuff. See what I did there?)

They suggested places. I’d told them I was a diabetic by default.

Job done.

Next up—the hypo talk, where I explain what a hypo looks like and why I’m a stingy jelly baby hogger, instead of offering them around.