For the past several weeks, I’ve been involved in a project with a friend and business owner involving several serious issues with another director, who, incidentally, hates my guts. Water off a duck’s back – the feeling is mutual. What that sneaky, underhanded, thieving director has done would fill volumes. While I’ve worked hard to make sure the evidence has been handed to the authorities, it’s taken many hours of my time and energy. I also knew that at the end of it, I’d have a project to sort it all out and to manage the two stores that were born of the original partnership.

On 23rd December, that other director, after we went to the lawyers with a 50 page document I’d prepared, was forcibly removed and he now no longer has anything to do with one of the businesses. The day manager was also given a DCM (don’t come Monday). So with 2 management staff down, I’ve taken both their jobs as well as what I would have been doing for the company anyway, as a consultant. I’m now fixing the sabotage as well. It’s been a complete nightmare and thankfully after 10 days we’re finally seeing some light.

So how am I faring with my pump and diabetes while doing 10 things at once and racking up around 58 hours work a week? You’d probably be as surprised as I was.

Despite carb-laden food being almost the only options for lunches and dinners from take-away stores and restaurants (who’s had time to do grocery shopping in the last 12 days?), and add to that all the stress, crazy hours, phones jangling, faxes pouring in and more, I’m surprised that not only does my pump allow me to handle all this with ease, the numbers prove that I’ve managed pretty well, all things considered!

I was supposed to be working in the other business – a much newer place with a lovely office. I was only meant to be doing 4-6 hours a day until things were sorted and then cut it back to 2-4 hours on 2-3 days a week (I still have other clients), but no one knew what a shambles the businesses would end up in, and no one anticipated the sabotage that happened in the 10  inutes before the police took the other director away. There are still some major problems with the other business, so it’s been closed since before Christmas. Because of that I’ve been working in the original business, in a small hole, slightly bigger than a broom cupboard. Getting to that hole in the wall, you have to go through a storeroom and through a bathroom. Gorgeous it ain’t! But I can see the humour.

I’m now doing a whole bunch of things that weren’t anticipated – rosters, fixing a POS System I’ve never laid eyes on before, ordering stock, handling staff problems, directing staff, putting new procedures in place, counting cash and a whole lot more, while still doing my regular IT Consulting and being an accounting software specialist. And then there have been times staff haven’t shown up, so I’ve raced in there, after 2 hours sleep, and got on the tills to get the customers through, with the phone in one hand trying to find someone to work the shift. It never stops – it’s a 24 hour place, and very popular.

New Years Eve was another nightmare with lines out the door. Thought I’d never walk properly again with the sore legs I had from standing. (I’m usually at a desk with a screen in my face.)

The remaining director, who has been a good friend for many years, fully acknowledges the ‘conditions’ under which I’m working. Believe me, he’s paying handsomely for my services, but there are a few issues he can’t pay for, even with all the tea in China. So, I wrote him a memo. I thought you might enjoy it too. We both needed a laugh after what was a horrendous week.

Here it is…

Dear Sir Mr Boss Man, Stockholm Syndrome Black-Belt, Slave Driver,

There are several issues I wish to raise in this brief lengthy and official letter.

Due to entirely foreseen circumstances, my legs, hip and back have failed. Under the law, people with this kind of disability must be catered for. After all, you do have a stinky dirty disabled toilet right outside my office and I?m forced to listen to the entirely un-mellifluous tinkle of nature, while trying very hard to concentrate in this chaotic environment.

Further, during those times, I?m unceremoniously imprisoned in my inhumanly small, stuffy and hot oven office at the will of the tinkler. (Check the Geneva Convention laws about the minimum size of cells). I am also now living in abject fear that one day I may be imprisoned there forever, without food, chocolate or cigarettes. That would be a tragedy of the worst kind, for which my estate will be bound to sue the pants off you (I changed my will today to force them to act on my behalf).

Because of the failure of certain parts of my body, I wish to respectfully request that a supply of Nurofen or similar be paid for by the company to comply with the law and to show me the smallest measure of respect for the terrible hardships I have to endure while employed by you. Perhaps you might also consider some No-Doz, but of course this is not essential, and probably not provided for under the law.

I understand that you have now perfected the method to age someone 10 years in 8 days, and I applaud you for it, but might I ask where your integrity is with this cruel and unusual treatment of loyal, hard-working employees? I understand that it?s provided free, so I really don?t want to look such a generous gift-horse in the mouth, so to speak, but surely you?ll agree it?s a tad excessive. I only expected to be aged 5 years not 10! This kind of misrepresentation is surely punishable by the Department of Fair Trading.

Further, I will be contacting the agency that has jurisdiction over abuse of old people and slave labour. This 17 hours a day you are forcing me to work, might well be considered excessive in the Western World and could be a crime with a lengthy jail sentence. Please be on notice that you could be charged under the law, and be forced to pay compensation as well as do jail time. And because I like working here… most of the time… I will only be claiming $10M compensation (not $20M as the law provides), and recommending that you not go to jail for these heinous crimes.

I have submitted a copy of this letter to my lawyer so that you cannot force me to retire on the grounds that I am making these complaints. Please be aware that on 1st January, the Fair Work System comes into effect. It provides massive overtime for all work over the standard 38 hours per week (note, not “per day”), which an old and decrepit person like me shouldn?t be forced to do anyway. Ha, and I thought a labour government was for the people, not for employers! This is the kind of nonsense they promote when they want to get votes from rich people. I know their game. And I now know yours too.

Did Mr Gone-Director ever force anyone to work 17 hours in one day? I doubt it! Even the wicked witch Miss Director’sWife didn?t have to work the 25 hours she got paid for. Wow, Mr Gone-Director sure treated his staff well and was especially generous with them, paying them for work not done. You?d do well to do the same! As you know, I?d never claim such a thing, so perhaps some kind of bonus is in order? It?s tax deductible, you know!

I?m truly sorry I have to bring these matters to your attention, but there will be far-reaching consequences if I don?t – both for myself and my long-suffering, working-man, non-English-speaking husband and my beloved CharlyDog, who simply will not fit in my office, as promised, no matter which way I rearrange the furniture. My husband fails to understand why you are stalking me from work to home all the time. Would you care to explain that to him after the police release you on bail?

You must surely admit that you did lie about the luxurious conditions at work, didn?t you? You got me to work there under false pretences, promising me a spacious office with air conditioning and a bed for poor Charly, who now has to stay at home all alone crying because you are so cruel.

Anyway… here are my demands. And I will not budge an inch on them.

By 4pm today, I demand an occasional company-supplied packet of Nurofen, otherwise I will have no choice but to take further action.

For insurance purposes I am bound to report these nefarious activities to the police and other authoritative bodies. To that end, I have already prepared a lengthy 50+ page report with dated photo and audio evidence of the alleged jailer-tinklers and the abject conditions I must endure, which I?ve given to my lawyer, and which will be taken to the police forthwith at 4:01pm if my demands are not met.

Oh and one more thing. I have also asked Mr Gone-Director to testify on my behalf, which he is very willing to do. I may even have to get <someone else> to intervene if this keeps up. After all, Mr Gone-Director had to endure these horrendous conditions for 6 long and arduous years! No wonder he?s a bit angry now! While I?m not as childishly vindictive as he appears to currently be, I am, unfortunately, forced to make these grave complaints because you are long past the agreed 2-4 hours a day you proposed when you hired me. Your name will be dirt when this gets around the community! You can buy my silence with good quality dark chocolate.

At 4:02pm, after my report is faxed around the globe (at my own cost, of course), I am considering beginning strike action.

Yours faithfully,

Miss Brunhilde Longsuffering Hardworker,
Emotional Blackmailer (EB) and Qualified Expert Letter Writer (QELW)

I made a comment as follows:

Lately I’ve been studying TAG (Total Available Glucose) of not only carbs, but protein and fat too. It’s a much better and more accurate way of bolusing for T1 than just counting carbs. I have a pump, so I do extended boluses for all but small meals and snacks. That seems to work better too.

The one thing that also drives me crazy is the inaccuracy of meters. Thank heavens we have them, but really, by now they could be much more accurate. The other one is that I wonder sometimes how some manufacturers get to their carb counts on food packs. I’m sure sometimes they’re just guessing.

TAG is a system that takes into account not only the carbs in foods but also the available glucose of protein (about 58%) and fats (about 10%) and working out boluses on that.

Not that boluses are inaccurate only because you’re not doing TAG. There’s so much more to take into account: fighting an infection, inflammation, pain, stress, weather, hormones and a whole lot more. It makes looking after diabetes, once thought of as a science, more of an art-form at times.

There’s a great discussion over at TuDiabetes. It started off about doing combo/extended boluses on a pump and evolved into a discussion about TAG. Read more about the posts in “Dual Wave Bolus”

Even if you don’t have an insulin pump, it’s well worth the read.

I do know how much and how easily my BGLs go up with stress – any kind of stress… the kind of stress that you wouldn’t ordinarily call stress. Day to day living is a stress of sorts. Having to be somewhere on time is stress. Trying to get a job done on time, even when you have plenty of time, is stress. Being in a crowded room with the din of everyone talking, is stress. Unless you’re in a meditative state 24/7, it’s all stress of sorts. While I may be more sensitive than some, daily living does have an effect on everyone. Managing diabetes is sometimes more an art form than a science.

Put stress together with the really hot weather we have here (in Australia) over late spring and summer, and it’s time for me to take a good look at my basal rates. Weather definitely has an effect on insulin needs too.

I know my current basal rates are not serving me the best way they could at the moment.

Who’d have thought in just 3 weeks, what was once a nearly-perfect basal program, is now quite off at some times of the day?

The problem is that being as busy as I’ve been, I’ve hardly had time to notice. Yes, I’ve noticed the numbers being off, but I’ve also had a much more varied diet (read: mostly more carbs than usual) and I’m very aware of my BGLs going up some 4-6 hours after a meal that is only a tad more than would be considered ‘light’, let alone a heavier meal – that one is a disaster! Mostly after dinner, the struggle with BGLs going up consistently, so long after dinner, is something I’m not yet sure how to handle.

Despite using extended boluses over several hours, I’m thinking I have to extend any bolus I do quite a bit longer. It doesn’t matter what time I eat, it still happens around the same time later. If I skip dinner (rare), it doesn’t happen, or if I have a very light meal, it also doesn’t happen. It’s called gastroparesis – delayed stomach emptying. Many people who’ve had diabetes for a long time have it. And it’s a bitch to handle, whether you’re on a pump or on MDI.

Sometime in the next few days I have to formulate a plan to test all the basals I have right now.

Remember that on injections (MDI), you do possibly 2 injections a day and it’s pot luck whether the relatively flat-line of Levemir or Lantus can come close to what the human body really needs. This is one of the reasons a pump is so great. You can adjust your basals any way you want and have as many as you need.

If you’ve never seen basal rates for a pump, this is what mine looks like at the moment. The time indicates what time that rate starts, and it continues until the next time listed. The number next to the time is the units-per-hour of insulin. I have 6 different basal rates at the moment. After I reassess it could go to 4 or 8 or whatever I need with the rates I need for that time of day. I used to go very low around 4-6am so the reduced basal rate at that hour is great! Also remember that you’re adjusting the rate for a peak around 1-2 hours later.

Basal Rates

12:00a 1.100

01:30a 0.925

02:30a 0.750

09:00a 1.075

03:00p 0.900

07:30p 1.125

I’m fast coming to the conclusion that unless you’re a total creature of habit – go to sleep the same time, wake up the same time, eat the same things at the same time, do exactly the same thing every day, on time – then the daily, and sometimes inexplicable fluctuations in blood glucose needs quite a bit more managing. Even creatures of habit have fluctuations, but certainly not as much as if the criteria changes drastically from day-to-day. I’m definitely not a creature of habit and I wouldn’t change that for anything. You live with some things, you change others to manage diabetes. Some things are not negotiable!

November 14th is World Diabetes Day. The theme for 2009 – 2013 is Education and Prevention. This is goes for both Type 1 and Type 2. While we still don’t know the trigger for Type 1, research on prevention is just as important as it is for Type 2.

November 14th is the birthday of Fredrick Banting, who along with Charles Best, is credited with the discovery of insulin in 1921. Imagine if you can, how people with Type 1 diabetes coped without insulin. They didn’t. It’s a painful death without insulin with 100% mortality. Now, some 88 years later, there are still people in the world who have no access to insulin. Thanks to global organisations like Insulin for Life, some insulin does get to people who would otherwise not be able to obtain it. It’s mostly economics. No, we are not all equal – certainly not in the realm of being able to afford what is now a simple, abundantly available medication.

Which country do you think has the highest rates of Type 2 diabetes? You’d be wrong if you thought the USA. From what I’ve read, it’s India!

Which countries do you think have the highest rates of Type 1 diabetes? You’d be wrong if you thought the USA. It’s Sardinia and Finland.

Which areas of the world have the lowest incidence of Type 1 diabetes? Zunyi, China, and Caracas, Venezuela.

Do you know the differences between Type 1 & Type 2 Diabetes? Can you name at least 3 other forms of diabetes?

Education!

I was not all that shocked to read what Kate from the T1DN, after attending the conference in Montreal in October 09, wrote in her report:

A central area in the conference was the Global Village where all the world’s diabetes association (the equivalent of Diabetes Australia in every country) had displays and staff there to chat with you about what they were doing. Through the Congress I tried to do the rounds of these stands and find out about anything that other countries were doing to support adults with Type 1 diabetes. I have to say I was shocked and amazed at how many times this conversation ended up with me explaining that Type 1 really is very different to Type 2 and the supports and services people with Type 1 need are also different. That Type 1 occurred in large numbers in adults was also not well understood – when I asked about Type 1 I was often informed about children and had to push and prompt. This appeared to be news to many of the associations I chatted with including several with high prevalence of Type 1 – Canada and Denmark, for example.

Even in this day and age, I also come across so many medical professionals who seem to know a lot of rubbish and unproven information about Type 2, and know even less about Type 1. They also know next to nothing about other forms of Type 1 Diabetes of adulthood. Why? Where is the education for professionals?

If the International Diabetes Federation (IDF) wants education to be the focus of its World Diabetes Day, they really need to start with doctors, nurses, Certified/Credentialed Diabetes Educators, pharmacists and the people who work for the various diabetes organisations world-wide! Educating these people is paramount and is the first line to the rest of the education the IDF wants.

But how is the right kind of education going to happen when so many professionals can’t get it right. Being mis-diagnosed for 30 years, as I was, isn’t confidence inspiring. Neither is being given totally wrong information on how to manage diabetes, from people who should have known better… and still probably don’t.

The IDF states (here) that

Prevention of Type 2: Lifestyle changes aimed at weight control and increased physical activity are important objectives in the prevention of type 2 diabetes. The benefits of reducing body weight and increasing physical activity are not confined to type 2 diabetes; they also play a role in reducing heart disease, high blood pressure, etc.

Wrong! Plenty of thin Type 2s. Emerging evidence that people don’t necessarily eat their way to diabetes. Plenty of obese and morbidly obese people don’t have and will never get diabetes. If in doubt, this article is a must read! As Jenny writes:

While people with diabetes often are seriously overweight, there is accumulating evidence that their overweight is a symptom, not the cause of the process that leads to Type 2 Diabetes.
Even so, it is likely that you’ve been told that you caused your diabetes by letting yourself get fat and that this toxic myth is damaging your health.

Blaming you for your condition causes guilt and hopelessness. Even worse, the belief that people with diabetes have brought their disease on themselves inclines doctors to assume that since you did nothing to prevent your disease, you won’t make the effort to control it–a belief that may lead to your getting extremely poor care.  READ MORE

If the professionals can’t get it right, what hope is there for the media which influences a vast number of people who, when we’re around them, can make our lives with diabetes so much more unpleasant than it already is?

The food police (“Should you be eating that?”) – yes, I’m Type 1, I have insulin and theoretically, I can eat whatever I want.

The totally misinformed (“Oh you have Diabetes, just lose some weight”) – no, there’s no cure for Type 1, plenty of thin Type 2s, plenty of Type 2s who need insulin and have already lost weight, plenty of Type 2s who do exercise, eat like birds and can’t shift the weight.

And please, folks, going low fat will do a whole lot less for diabetes than reducing carbs in your diet.

Learn about fructose without fibre and high fructose corn syrup and what they do to your body and your insulin response! See prior posts on this issue – here and here.

Yes education is always the key, but how can so many people (who should know better) get it so wrong for so long?

These cases are not only cute, but protect the pump, which has to last at least 4 years! As a Type 1 with an Animas 2020 insulin pump, I know how important that is! They come with a matching belt and can also be worn with the clip that comes with the pump. I’m hoping that kids will love these and be proud to wear their pumps and show off the cases.

The cases are available at www.estore.zansuri.com. They are designed mostly for kids, but teens and adults can wear them too! Please don’t hesitate to contact me if you have any questions.

— Insulin Pump Cases

Insulin Pump Cases - Flyer

— Insulin Pump Case – Dalmation Puppy

Insulin Pump Case - Dalmation Puppy

I had a gusher last week. That’s an infusion site that bleeds like crazy after you take it off. No problem – just another thing we have to deal with. I was left with a lovely, perfect-circle bruise that is slowly fading. After that one, the next infusion site became a warning about the warmer weather headed our way in Australia. It itched like crazy! Even using a barrier wipe.

When I pulled off the infusion set for that one, there was a lovely crimson oval, exactly the shape of my Inset II.

I was sure it wasn’t infected, just an allergic reaction, which took several days to fade, and hasn’t quite completely gone.

The site after that had a bleed, but the insulin line was clean and working, so I left it another 24 hours. I think I know how that happened on the second day.

Some kind of drama with 3 infusion sites in a row.

We had a dust storm on the east coast of Australia a couple of weeks ago. Since then, despite thoroughly steam cleaning anything I usually touch, I’m itchy.

I’m talking frustratingly, infuriatingly, exasperatingly, aggravatingly itchy.

My skin is a little flushed in places – more so on my face than elsewhere, but I don’t have a definite rash confined to a specific area. Just itchy spots here and there,  on my scalp, face and upper torso. Add to that the mosquitoes who can find me under bug repellent, and it’s a recipe for a prolonged scratch-fest. It’s driving me so nuts, that I think it’s probably raising my blood sugar at times. Stress always does.

Double doses of non-drowsy antihistamines (as advised by “Dr Steve”, as I’ve aptly named my pharmacist), haven’t helped.

Today, I added that horrid stuff, Phenergan. Yes, the stuff that puts you into a stupor faster than a bottle of vodka. Haven’t taken any yet but plan to before bed, so I don’t spend yet another night scratching.

I’m sure that all this contributed to the infusion site allergy.

So, it was site change day today. In nearly 5 months on a pump, I can still see the rather large bruise from the side I was injecting Levemir before. No amount of Arnica, massaged in thoroughly, is shifting it. That area is not yet ready for any infusion sites.

The old Novorapid (Novolog) injecting side, is ok as far as I know, but I haven’t been using either side of my belly for infusion sites (only above my belly button).  The only time I did, on the old Levemir side, I got a  pump occlusion, so in 4 months, I never tried again.

After this week of gushers, allergy spots, and my abdomen peppered with little red site-dots that I can still see weeks later, I thought I’d dangerously venture on down to the old bolus side for an infusion set site.

The pattern is that my blood glucose goes up with a site changes. It happens to many pumpers and it’s not a problem that I or anyone else I’ve read about have been able to solve easily.

I also had to go out today not long after my planned site change. Unless I got an occlusion alarm on the pump, how would I know whether the site worked or whether it was just going to be a usual site-change high?

I bit the bullet, and while I was at it, gave a small correction, which I’d needed. These days I also fill the 9mm cannula a tad more than is recommended.

My husband and I then went out, ran some errands, did some shopping, and went for a very short walk along the beachfront to listen to the sunset drumming. Always a treat.

I tested just before the walk. Yup, I was high – higher than when I changed the site. I gave another correction.

About half an hour later, we decided to go have some sushi. I tend to pick the good bits out of some and not eat much of the rice. That way, I end up with about half a cup of rice. Not too much to bolus for with the protein, and the extra sugar in the sushi rice, I think.

So I test again as we sit down. I’m higher still at 9.5 mmol/l (174 mg/dl).

So I’m going to throw some food at it as well. Not a good idea, I know, but we were in town, it was nearly dinner time, and I was starving after only a couple of eggs for breakfast. So was my husband. I also hadn’t got around to buying some meat or fish for dinner. We’d have done that on the way home so it didn’t have to sit too long in a warm car. The sushi was calling.

It was only 2-ish hours after the site change and it usually takes around 3-4 hours for my sites to get going. But I was also worried about the location of the site. Was it working or was this my usual site-change high? By then I was a little higher than usual, so I was suspicious.

We ate in the yummiest of the three sushi places in town. It was also 3 boluses later. I need to get home. Just couldn’t forego that sushi though.

And I’m going higher. By the middle of dinner, I’m 13.9 mmol/l (250 mg/dl), and not about to do a site change in the middle of a Japanese restaurant, with clients and acquaintances around me.

Nah, this is definitely a bad site. I never go that high in the first couple of hours. I need to get home. We finish dinner and  make a move.

There are buskers playing in town on Friday nights – really good ones, amplified most strangely by car batteries. I heard an incredible voice singing a Stevie Nicks song. We go look but can’t stay for all of the song.

A friend owns a store across the road. We always say hello. We can’t because it means a 15 minute chat, at least.

We can’t walk back up to the beach and watch the moon over the bay. We can’t stop off at the supermarket and buy some meat & fish for the weekend.

The stupid D takes priority.

As it was, I wasn’t panicking or rushing, but knew the primary target was home to get the site sorted.

We drove the 7k (4.3 miles) back to our house, bring in the shopping, say hi to and feed the cat and dog, and I get ready for another site change.

I test. What the? I’m 7.2 mmol/l (127 mg/dl). I test again to be sure. Pretty much the same. I often don’t trust my meter because it lies, and I never know which test is the lie, but that’s another story.

Dropped that fast? I guess so!

Seems as if the site was finally starting to work and the last bolus plus a bit of the others were finally starting to kick in.

Why on earth does the site take so long to get going? What happened to all those corrections? Well I know now. They didn’t just disappear into the ether as they usually do. It’s just after midnight, some 8 hours later, and I’m 3.8 mmol/l (68.4 mg/dl). Go figure!

Looks like I have another viable area of site-skin.

PS: Woke up itchy again but had the BEST scratchless sleep with 20 mg of phenergan!

Exercise makes the blood glucose of most people with diabetes go low.

I always go high during exercise or physical activity, then low 4-6 hours later, for several hours. I was an exercise-hypo virgin… until today.

Today I did 2 lots of increased activity – major cleaning in the morning and gardening in the afternoon. First time ever I had a hypo during activity – the afternoon one. I was so excited! What a sight! Raking leaves, eating carbs and no bolus!

I’d suspected the opposite would happen, but couldn’t be sure, I didn’t raise my bolus like I usually would for increased activity. I thought the second lot of exercise would still raise my blood glucose, but maybe not as much as usual. Totally wrong about that. When I checked, I was 3.3 mmol/L. And I’m pretty much hypo-unaware, so didn’t feel a thing except my eyes went strange – my only occasional hint these days that I’m going hypo.

So, I get a delayed “cure”, I guess – hours later! And with two lots of more-than-usual activity in a day, I can say (only on those days) that I go low during exercise. Gosh I almost feel normal!

Only other “cure” that I know of  is red wine with dinner. Very rare, but when I partake, the only problem is that I get tipsy on half a glass, so I can never drink enough for a really effective “cure” for the next few hours.  Pity!

What’s the answer? Exercise more and drink more red wine?

I’m trying hard to remember. What I remember and how it really was, I’m sure are two different things. Such is my recall about details I’ve barely thought about all these years. I don’t remember specific dates, just the year.

It was 31 years ago, in 1978, that I went to the doctor with some strange symptoms – unquenchable thirst, head-dropping tiredness, constantly and urgently full bladder. I was bundled off to see an endocrinologist. At that stage, my family doctor hadn’t run any tests or told me what he suspected. I suspected enough for both of us but was hoping it was some strange virus.

The endo was a lovely old professor at one of our local hospitals in Sydney. How kind and caring he was! I can’t recall exactly how it went or what tests were run, but I know he told me I had “mature age onset diabetes” and how unusual it was at 25. He couldn’t explain why. I was a little overweight,  having gained a few pounds in the preceding 2 years, but I was by no means obese.

The day wasn’t memorable, my age was.

Why did I get this ‘mature age’ thing at 25? No one knows.

It scared me silly. I’m not sure I was that compliant about anything in my life until that diagnosis.

I was taught to count calories, to weigh everything and was given a diet that seemed to limit carbs. No sugar or sweet drinks. No sweet anything. No potatoes, rice, pasta, limit the fruit and so on. Really, it was a great lower-carb diet, but it was never called that. And I stuck to it. Those tiny portions, just enough for a two-year-old. In 3 months I lost so much weight that I ended up skinny! I don’t think I’ve tasted a soda with sugar since and I never again was that skinny. It made the diabetes go away.

I stayed somewhat careful of my diet for a while – a few years. I even worked in a chocolate factory for 2 years and never touched a crumb! I have no idea how I did that – I’m a certified chocoholic!

Miraculously the diabetes was kept under control – no medication, no insulin, just diet. In those days, there were no blood glucose meters, so the odd test with a urine stick was all I had, plus a fasting blood test from time to time. I was told I didn’t have diabetes. Carry on as normal. Eventually, I got lax with diet and mostly ate whatever I wanted. Rice, potatoes and everything carb was back on the menu. Why the diabetes didn’t return during that time, I’ll never know. It might have, but my testing and doctor follow up was pretty much non-existent, and so were symptoms.

I knew diabetes could rear its ugly head again anytime. When I fell pregnant 10 years later, I wondered when it would hit. I was a very normal weight and at around 18 weeks, having gained very little weight, I was loaned a meter, put on insulin and told that after pregnancy it would disappear again. Most women get it in the third trimester. Why did I get gestational diabetes at 18 weeks? No one knows.

I came out of hospital 2 lbs below my pre-pregnancy weight, with an unexpectedly small baby. My BGL control had been pretty awful. I was very insulin sensitive and I remember having many hypos with only a half to two units of insulin and also having what today would be considered unacceptably high BGLs at times. Why didn’t I have a large baby? No one knows.

My syringes thrown in the bin, I was off the insulin and supposedly ok. Unfortunately, at that time I was diagnosed with lupus, an autoimmune disease. Getting my head around that pretty much put everything else in the background.

Over the next year or two, I had a couple of fasting blood glucose tests. Results always came back ok, or just a little higher that normal. Nothing to worry about, I was told, but as time went on, I didn’t agree. I felt something was wrong on top of everything else that was wrong. In hindsight, could fasting too long before a blood test – 14-16 hours – have given me ok BGL results? No one knows.

I was feeling like I had high BGLs after meals, by which time I was already watching carbs a bit. Eventually I bought a blood glucose meter and tested for a few weeks. On showing the doctor my graphs, he panicked… er… packed me off to an endo. I was angry. It had been way more than a year after my daughter was born and I’d probably been spiking all over the place!

So started the next battle with Type 2 and tablets. They did work, but they all caused horrible side-effects, so most of the time I didn’t take as much as I was supposed to. At that time, I also didn’t care. It was all too hard. The doctor kept giving me new tablets, and I kept having problems with them including hypos and GI problems that the doctor said was IBS. It wasn’t. Inexplicably, I’d gained some weight and couldn’t lose it no matter what I tried. Why? No one knows.

— Confused

BMI around 26 and gaining, my clothing 2 sizes bigger, my BGLs going higher and I was angry.

In 2006 I finally went on insulin, after 2 years of urging by a new endo. I had been needle phobic and I wouldn’t hear of it. I finally relented after HbA1Cs that were truly shameful. I was starting to care again. Diabetes burnout was over.

By then I was in my 50s with nearly 30 years of an on and off diabetes history. I was clearly Type 2, the medications were horrid, and I switched to insulin. Needle phobia gone. I had pens this time. Too easy. From that day, I wanted an insulin pump, but no way to get subsidised supplies in Australia as a Type 2, only as a Type 1.

In January 2009, after asking for a year and being told, “Impossible! You’re definitely a Type 2!”, I was finally sent for some antibody tests. I’d nagged a lot! I wanted to know for sure that I was not eligible for subsidised pump supplies. To everyone’s surprise, including mine, I had highly positive GAD antibodies on 2 tests, 3 months apart and c-peptide almost zero (0.1).

I had LADA – Latent Autoimmune Diabetes of Adulthood.

So that was my second diabetes diagnosis, and in many ways a somewhat more welcome one than the first one because this time, something positive would come of it eventually – an insulin pump. While I don’t remember the date of my original diagnosis, I certainly remember my insulin pump start date earlier this year. Finally something to celebrate!

On the other hand, that diagnosis brought up a bunch of nagging questions.

Is LADA what I’ve had all along? No one knows. Did I first have Type 2 then LADA? No one knows. When did I get LADA? No one knows. Did I get LADA the same time as Lupus? No one knows. Did I have a short or long LADA honeymoon? No one knows. If I’ve always had LADA, then why did it virtually go away for the first 10 years? No one knows.

Does anyone know anything?

Note to self: Stop looking for answers! No one knows!

Reflections on Fasting with Diabetes on Yom Kippur

Don’t get me wrong, I’m not a stick-in-the mud, but on some forums lately, I’ve seen some downright awful, inappropriate and uneducated advice. Perhaps it was advice given with the best of intentions, it nevertheless prompts me to write about the subject. Some of the info here is going to be obvious to most people, but maybe for some, not necessarily. I’m going to write about medical advice given and taken on the Internet. And finally, some advice about fasting on Yom Kippur.

Internet Advice: Beware!
We all know that we have ever-multiplying resources on the Internet – easy-to-find, immediate information for people who would otherwise not have access to it without the Internet. This includes the giving and taking of certain problem-solving medical advice – from small problems to life-saving ones. We learn, we explore, we take some advice, we dismiss some.

No doubt there’s a lot of rubbish out there to be waded through with an open but somewhat cautious and critical mind. That goes without saying. You come across it on the Internet during almost every possible information gathering mission.

I’ve watched and participated on the Internet since its beginning, in all different areas. This amazing, interesting and often engaging medium with websites, forums, blogs and so much more, in the area of health particularly, has often made me wonder how many have been helped! Too many for me to fathom. Despite all that, I’d like to talk about when that medical advice can be downright dangerous! While the dangers may seem obvious, sometimes being reminded to stop and think, especially for newcomers, can’t be all that bad, can it?

As it says in my blog disclaimer: Any personal information sent to me, will be kept strictly confidential. Please do not ask for medical advice. Only your medical team can see a full picture of your health. I don’t mean to offend, but I can’t, shouldn’t and won’t.

This, in my opinion, is part of responsible blogging and equally applies to participating in forums. The giving and taking of medical advice comes with a fine line that some people cross and don’t know they’re doing it.

I participate in blogs and forums as a patient. If someone has a problem I can identify with or know about, if I’m confident, I suggest reasons or solutions they may not have thought about. It’s entirely their choice what to do with the info. But I can’t always assume they’ll make the right decision, for them, and I hope I’ve communicated it properly too, but maybe I haven’t.

What We Don’t Know Can Hurt Them
I would almost never say, “you should”, and add some medical advice that I’m very enthusiastic about because it worked for me, or insist they take advice that a doctor should be giving. At least I’m aware that I shouldn’t, and I try not to. Unfortunately, I see this kind of advice all the time. While I assume everyone knows how to weed out the good from the bad, a small group of people still insist on giving advice in the most inappropriate way, often unknowingly.

If it sounds like I’m some kind of authority, I’m not, and don’t mean to lecture. I’m just giving a heads-up to those who haven’t thought about it in a while. It’s a subject that comes up often amongst my group of friends.

For example: diet advice. There’s lots of evidence out there that lowering carbs makes it easier to manage diabetes, especially if you’re having a problem. It works – both scientific and anecdotal evidence – so I don’t have much hesitation in suggesting it. No big deal, right? It’s just food. Yet, even diet changes sometimes need to be run past a doctor. Do I know that recommending what is usually a higher protein diet may be harmful for someone with kidney disease? Of course! Even recommending something so simple as eating different foods, comes with a lot of conditions and responsibilities. Many of us deal with much more serious and potentially hazardous advice.

If someone asks me what to change their insulin basals or boluses to, or what medication to take, I run for the hills. That kind of advice is definitely unqualified, inappropriate, and could be dangerous for the person adopting it. I can only hope that I responsibly relate what I’ve done and what has worked for me, and even then, it’s sometimes not appropriate to say anything at all.

Doctors giving advice on the Internet often have no real picture of the person’s full medical condition! Yes, of course, it depends on what kind of advice, but most doctors know what advice they can give and what they can’t, and will say so (unless maybe their egos get in the way). This is the line that patients sometimes unknowingly cross – the one that the doctors wouldn’t.

I’m neither saying that information given by patients isn’t knowledgeable (it very often is), nor that it’s right or wrong, but there are inherent dangers in giving certain medical advice to someone you don’t know. And there are also dangers in taking advice from others who don’t know you or your medical situation.

The onus is always on me, you, anyone to manage information responsibly – given or taken. That includes knowing when to adopt advice, and knowing when it needs to be checked with a medical team. That line will be different for everyone. It’s easy to cross that line in both giving and taking advice.

Unless I’m confident about the writer and about my ability to state the problem with all the background, and then correctly interpret information in the reply, I try to proceed with caution. Doesn’t always happen – enthusiasm often gets in the way.

Yom Kippur: Fasting With Diabetes
So that brings me to the issue of fasting on Yom Kippur, the Jewish day of atonement. It’s an arduous sunset to sunset fast with no food or water. In 2009, it starts this Sunday evening.

I thought about doing a blog post on fasting for Yom Kippur with diabetes, but hastily changed my mind. Then I thought about why not. Hence this post.

Any recommendations for altering medications during a fast, would be so individual that it would take a volume or two for a doctor or diabetes educator to give the kind of advice that would cover all people with all diabetes situations!

I thought about relating my own experience of Yom Kippur fasting and what I did with medications, but I doubt that would be helpful for anyone because everyone’s situation is different. How someone will react to something I’d do, could be different and maybe detrimental.

In no way would I want to give any medical advice on a fasting issue. I’m neither qualified, nor would I want to cause any harm. Too many scenarios as well. Here we go: Type 2s on diet only, Type 2’s on medication – both insulin promoting and insulin sensitivity enhancing – separately or both, Type 2s on insulin basals only, Type 2s on full insulin regime, Type 1s & 2s on injections, Type 1s & 2s on insulin pumps; Type 1s & 2s on a fixed insulin regime… and so on. I’m sure I’ve left out quite a few more scenarios. I think it’s minefield that few people should be stepping into as far as advice goes. I hope you agree.

Here’s some more interesting information about fasting on Yom Kippur that I am in no way promoting, endorsing or otherwise. Let that be the responsibility of the writer.

In the case of fasting on Yom Kippur, despite my warnings above, I would like to give you some “you should” advice!

If you want to fast, and your medical situation or treatment has changed since the last time you fasted, you should go to your Rabbi and your medical team. They should be the only ones deciding if you can fast or not, and if you can, how to do it.

Photo by Trodel (http://www.flickr.com/photos/trodel/ / CC BY-SA 2.0)