Category: Diabetic Problem

Je suis fatigué of the monthly P

Sorry guys this one is for the girls. This is one aspect of life that doesn’t affect your diabetes, but for us girls we are faced with the not so pleasant monthly, painful and uncomfortable period. Diabetes, as you know can be absolutely crazy at times, when you are stressed, fatigued, ill, let’s just say a lot of things can affect your BG levels. So let’s now throw in the monthly period we girls go through.

PERIOD-2

 At different points in the menstrual cycle, BG levels can be affected. It can differ from person to person and for me, it has always been a challenging time. However, since I had my children, I’ve noticed that my need for insulin fluctuates a great deal at different times within a single month. Sometimes, I need more insulin and sometimes I need a lot less. My insulin requirement severely decrease. Why? I have no idea! Could it just be down to my body changing after experiencing pregnancy? Hormones? Who knows?

As a side note – This also reminds me of when I was going through my teenage years and all the changes I had to make in my insulin regime. Back then I was MDI taking two injections a day which then increased to five injections a day. Anyway, that’s a whole other post entirely.

As frustrating as it has been, I’ve had to deal with this extra struggle that comes with diabetes. At first, the patterns in my sugars were very hard to detect and I suffered from a lot with low BGs. It seems as if, my body just needed a lot less insulin at that particular time. Initially, I must admit I did suspend my pump at certain times just to try and avoid those lows. However, with a lot of hard work, I’ve managed to , when I needed to make changes to my background basal rates.  The only real way to do this is to watch what your sugars are doing. I had to write them down and try to find patterns over several months and then compare patterns from month to month. It was crazy!!

So what did I find out?

Week 1 of any month – This is usually the normal week and most stable week. BG’s are close to perfect.

May 2016 Week 1 Sunday 1/5/2016 Monday 2/5/2016 Tuesday 3/5/2016 Wednesday 4/5/2016 Thursday 5/5/1016 Friday 6/5/2016 Saturday 7/5/2016
BB 5.2 4.4 5 4.4 4.8 4.4 3.9
AB 6.4 7.9 6.2 6.6 8.5 8.7 9.9
BL 4.8 5.8 4.3 5.2 5.9 5.3 6.5
AL 6.6 8 7.6 7.9 8.8 7.6 8.4
BD 4.2 4.3 4.8 4.1 4.6 5 4.7
AD 8.3 9.3 8.8 7.9 8.5 7.4 8
BB 7.2 7.1 6.9 7 7.9 6.5 7.1
DN 6.7 6.5 5.8  6.8

Week 2 (before the P) This is when things start to get a little tricky and I notice a slight change in my sugar levels. My BG levels start to drop and at this point I have to decrease my basal rates. My pump (Animas Vibe) has a great setting which allows me to reduce or increase the basal rates by a percentage. So Initially, I reduce my basal rates by – 20%, which did nothing, so I then took it down by a further -40% which really helped to stabilise my BG levels.

May 2016 Week 2   Sunday 8/5/2016   Monday 9/5/2016 Tuesday 10/2016 Wednesday 11/5/2016 Thursday 12/5/1016   Friday 13/5/2016 Saturday 14/5/2016
BB 4.2 4 4.9 3.6 3.8 6 3.9
AB 5.8 6.3 5.7 7 7 7 8
BL 3.8 4.3 3.9 4 2.8 3.7 4
AL 5.6 7.4 6.8 6.7 9.9 7.6 7
BD 4.2 3.2 3 4.2 3.6 3.4 3.9
AD 6.5 10 7.7 7.5 7.2 6.8 6.9
8.3 9
BB 6 7.9 5.8 7.7 6.1 6 7.1
8 8
DN 4.4 3.5 5.5 5 3 4.1 5.2

Week 3 – (week of the P) – This week all chaos breaks loose on a BG level. Regardless of the changes, I’d made in week 2, I continue to experience severe lows which means I have to  decrease my basal rates even further. I do this by using the percentage setting again. First, I reduce it in increments of 10% until I’ve reduced it by -60%. This eventually seems to stop the frequency of low BG levels.

May 2016 Week 3 Sunday 8/5/2016 Monday 9/5/2016 Tuesday 10/2016 Wednesday 11/5/2016 Thursday 12/5/1016 Friday 13/5/2016 Saturday 14/5/2016
Changes in BR Changes in  BR Changes in BR Changes in  BR
BB 3.3 2.8 4.2 4.8 5 5.7 5.5
AB 4.8 5.9 6.4 7.5 7 7.5 7
BL 2.4 3.8 4.7 5 5.5 5.9 5
AL 6.6 7.4 7 6.9 7.4 7.7 7
BD 3.2 3.8 4.4 5.5 5.9 6 5.6
AD 5 6 7.2 8 7.3 8 7
BB 3.7 5.1 6 7.9 6.2 6.9 6.4
8
DN 2.2 4.3 3.1 4.2 4.6 6.5 4

To completely stabilise my BG’s I must then reduce my insulin sensitivity factor( ISF)  and insulin to carb ratio(I:C). My ISF is usually 1U will reduce my BG by 6mmol/1. During this week, I drop it to 1U of insulin reduces my BG by 1mmol/1. My, I: C ratio of week one is 1U: 6g (of carbohydrates), during week 3 this is doubled to 1U: 12g.

In general, during this week I feel hungrier and more exhausted than ever.

Week 4 – This week usually means that I have to increase everything, basal rates, ISF and I: C ratios. My BG levels spike beyond belief. I have to increase my basal rate setting by +60%, drop ISF back to 1U : 6mmol/l and I:C ratio back to 1U : 6g.

May 2016 Week 4 Sunday 8/5/2016 Monday 9/5/2016 Tuesday 10/2016 Wednesday 11/5/2016 Thursday 12/5/1016 Friday 13/5/2016 Saturday 14/5/2016
Changes in  BR Changes in BR
BB 12.8 8.2 8.5 7.9 6.1 5.5
AB 11.8 10 9.4 16 8 6.3 6.5
BL 8.8 8.4 7.5 3.3 6.6 6 5.3
AL 11.5 8.9 7.9 15.9 7.9 7.2 6.8
BD 7.9 12.6 9.1 4 6 5.8 5.6
AD 15 9.8 8.8 12 7.8 7.9 7.4
BB 9.1 14 10.3 11 7.7 6.9 6.5
DN 12.6 12 8.6 9 7 6.5 6

I suppose for those who have no clue about the work both I and my pump have to do to manage this condition, then you can really see how beneficial it is to me. I well and truly appreciate my pump and I am so lucky to have it.

I really think that the drastic fluctuations were due to possible pregnancy hormones which still existed in my system. I really don’t know, it’s just a guess. I decided to do a detox to try and flush out my system and I thought that maybe it would help to get me back into a more normal BG crazy diabetes management routine. After the detox, I noticed a change in the way my BG’s behaved. They weren’t as crazy as they had been and there was definitely a great improvement. I also took it a little further and started to:

  1. Work out more and maintaining a more regular routine
  2. Tried to get more sleep – which is hard as a mama of two but my body definitely needs and benefits from it.
  3. Eat more clean/watch my portions etc
  4. I do detoxes from time to time to flush out my system.

With all these changes I’ve been able to cut down my basal rates to just having two programme setting for the month. One for the week before and during my period and the two weeks after my period.

It’s a tough one girls but it has to be done. Close monitoring of those BG is really the only way to figure the unpredictability of those sugars on a normal week without a period. So it becomes even more crucial during the menstrual cycle.

This is yet another aspect of the crazy life of a diabetic!

 

Amina xx

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Listen to your body

Something I realised after my diagnosis was, I had to really start to listen to my body and try my best to understand what was happening to me.

body1The body is a complex system which does everything from help you move your arms, fight infections and even process the food we eat on a daily basis. It is able to constantly give you signs and signals which lets you know for instance that you’re coming down with something or if in fact the problem is more deep rooted. Without a second thought, your body breathes for you, pumps blood through your veins, just to keep you alive. It’s pretty miraculous!

In the case of diabetes the body also gives us signs. Signs which allow us to begin to recognise symptoms of lows, highs, falling or raising BGs. Even before my diagnosis, my body was giving me warning signs, showing me that something wasn’t right. Whilst experiencing the symptoms of thirst, constant urination, tiredness and the weight loss, these were all indications that something was happening.  This is why diabetes awareness is so important.  For me, with the knowledge my mother had of diabetes, I was able to survive and begin my diabetes journey.  Many people, who have no diabetes awareness and aren’t able to recognise any of the symptoms may not be as lucky as I was.

When we’re affected by things like stress, exercise or hormonal changes, we are able to begin to understand so many things.

In the case of low BG’s, I’ve had to make firm decisions in my mind that I am actually having a hypo and  then act on it in that moment. I’ve had to train my mind to distinguish and realise that a high BG is a high BG and a low BG is a low BG. It’s not easy but with time we begin to get a grasp on some of the warning sign we experience.

 Learning and listening to these signs are crucial to recognising future symptoms which will occur.

The human body is even more amazing in that we have been given five senses which guide us, as we traverse through the world around us. Our senses are able to send messages through the brain, with the help of the nervous system to deliver messages to us. These senses include: Taste, Touch, Smell, Sight, and hearing.

I strongly believe that we also have a sixth sense. (No I don’t mean seeing dead people lol).  This sixth sense i’m reffering to is our intellect. It is the sense which helps us understand so many thing including our physiology. For we diabetics, being able to differentiate between a low or high BG level sensation/s becomes quite critical, because let’s not forget these are medical emergency after all. In some cases we experiences low or high BG on a daily basis, whilst trying to obtain that number in the ideal range. It is an endless cycle of sustaining and monitoring. We check our BG, we bolus and we eat.

Strengthening your consciousness and being aware of your physiology is an advantage in that it will allow you to have a better comprehension, when changes arise due to BG levels.

You can begin to listen to your body by training your mind to make you more mindful of the signs you personally feel, before, during and after BG level changes. Identifying these symptoms will help make you even more responsive in the following hypo/hyper events to come.  I know that symptoms can vary and even change with time but what is important is being aware of what is happening to you in these moments.

Action, repetition and  finally recognition

When we experience any symptoms related to BG levels changing, our brain is able to create a memory of these symptoms we’ve experienced. This process is known as Recognition Memory.

Recognition memory is the ability to recognise previously encountered events, objects, or people.

brain

When we re-experience a certain BG related symptom, the brain is able to match a previous occurrence of the event happening beforehand. This then becomes an indication for us to know that we’ve experience this feeling before.  It’s becomes familiar and we know that we’ve gone through it in the past. We’re then able to recall this memory by accessing details related to that memory.

 Since we all know symptoms can vary from person to person, sometimes we miss a symptom because in fact maybe it’s a new memory which the body has never experienced before. Therefore, when this happens, it will be the first time the brain makes a memory of the event happening. If the event occurs again, it will then go through the recognition memory process to let you know that you are in fact familiar with this event taking place.

In the past I’ve experienced low BG’s were I don’t have any symptoms and remain in the low for a long time. However, this was mostly during my pregnancies, when there were so many changes occurring in my body. Nevertheless, even when I wasn’t aware of the symptoms and found myself in the middle of very severe lows, I still made a mental note of how I felt in those moments. This helped me to learn how to treat them and achieve a more normal BG level.

Hypoglycaemia unawareness can occur after living with this condition for many years. Constant lows can interfere with the release of stress hormones, which occurs when BG levels drop too low.  Stress hormones encourage the release of glucose. The liver secretes a hormone called Glycogen, which is decreased in people with type 1 diabetes after several years of living with the condition.  If glycogen isn’t being released then BG levels will remain low because the stress response isn’t producing any glucose to elevate the BG level. Therefore you remain in a low state for longer.

Tips to avoid hypoglycaemia unawareness

  • Test frequently to be more aware of dropping BG’s.
  • With the help of your diabetes team make adjustments to your Basal rates to try and avoid low BG’s occurring.
  • Develop an understanding of how to get those low BG’s back up and in range.

The next time you have a low or high BG try your best to be aware of what is happening to you in that instant.  Think about what you feel beforehand, during and after the hypo. Make a mental note and acknowledge the feeling you go through. Even if you have no initial symptoms and find yourself in the middle of a low, during the hypo you still experience certain feelings so try your best to be aware.

What methods do you use to recognise that your BG is low or high?

Insulin gone bad

insulin

How do you know if your insulin has gone off? Does it smell bad? Does it look bad?

The question of insulin being off is indeed a preemptive one. Of course, there are certain ways to examine the insulin, but still one can never be completely certain that, the insulin being used is in fact ok to use. There are a few precautions that can be taken to make sure that the insulin isn’t ineffective. These steps are:

(1) Always checking the expiry date on the vial. Is it expired or not?

2) Is it cloudy in appearance with clumps that don’t disappear even after rolling the vial in between your palms?

3) Did you store it in a very hot or very cold environment?

(4) Does the insulin look stringy?

(5) Has it changed colour?

A few other things to consider, which could affect the performance of the insulin are:

(6) Has the insulin vial been opened for more than 28 days, stored either at room temperature or in the fridge?(depending on which insulin type you have,  the number of days differ)

(7) Has the rubber on the vial been punctured several times, due to only small amounts of insulin been used?

If all checks are made correctly, then it will help you avoid using insulin that has gone off.

So, what do you do, when you think you’ve made all these checks and the insulin seems fine? Of course you use it just like I did a few weeks ago…..

I decided to change my pump site and used an unopened vial I had left over from my Summer vacation. As usual, I inspected the vial to make sure that it was still in date, that it was not cloudy in appearance with clumps and I knew that it was stored in the fridge.

During my vacation, I transported my insulin in a Frio bag. When I arrived at my destination it was significantly hotter so I then put my vials directly from the Frio bag into the fridge. Keep in mind the FRIO bag can be used for up to 52 hours and it will maintain the temperature that the insulin vials need to be at.  However, when I initially went to put the vials in the fridge, it seemed warmer than it should be, so I adjusted the dial and waited . The fridge cooled down so I put my vials inside. This one vial was never opened and remained in the Frio bag and then in the fridge throughout the entire vacation until I returned home.

I changed my site, bolused, had my breakfast and off I went to take my son to school. I came home, checked my blood sugar and it was  9.5mmols/l.

Hmm! Ok,  that’s great for a workout.

I worked out and what usually happens is that my sugar will drop. In this case, my sugar was 16mmol/l. I decided to give myself a bolus to bring my sugar level down. I waited and tested it 15 minutes later, only to find out that it had now jumped to 20mmol/l. I then thought that maybe it was the site, where I had put my insert and that maybe I should change it. So, that’s exactly what I did.  I got a new insert, syringe and used the same vial of insulin. (At the time I didn’t realise that the cause of my high sugars was in fact due to this insulin vial.) I changed my site and decided to bolus again to bring my sugar down. I waited a further 15 minutes and checked my sugar level, which now read a shocking 25mmol/l on my blood glucose meter.

What on earth was going on?

It wasn’t until then that I had the thought that, maybe this vial of insulin wasn’t good. I  decided to do my checks again.

(1) I looked at the expiry date 07/2017. It was in date so that wasn’t the problem.

(2) It was stored in the fridge and the fridge is in good working order and it was kept at the right temperature. Plus I’d transported it correctly throughout my vacation.

(3) It wasn’t stringy.

(4) It hadn’t changed colour.

(5) The vial had not been opened and therefore it still had the orange cap on it and of course it did not have any punctures in the rubber.

(6) I took a good look at the insulin, it seemed ok. I then decided to take a good look at the vial whilst holding it in front of a light and then I realised it was cloudy with a few small clumps in it. I then rolled the vial a few times in between my palms and the clumps remained . The insulin had gone off, which would explain my crazy high blood sugars. I throw the vial away immediately. I didn’t quite understand, when the vial had, had a chance to go off. I had taken all the necessary measures to ensure it would be ok, but I guess it must have been affected at some point.

To bring down my sugar I took a syringe and a new vial of insulin and injected 6mmol/s directly into my leg. I checked my sugar after 15 minutes and it had started to fall and it had come down to 23mmol/l. It then took nearly the entire day of bolusing and checking my blood sugars before they came back into a range that I’d concider good. I felt absolutely drained from all the elevated blood sugars I’d experienced that day. I had ketones in my urine, but thank god they slowly disappeared as my sugar came back down.

If you suspect that your insulin is indeed ineffective after doing all the checks, I would get rid of the vial immediately and open a new one. Remember, once a bottle of insulin is opened, not all insulin has the same open expiration date. For example Novorapid, once opened must be thrown away after 30 days for a 10mL cartridge and 28 days for a 3mL cartridge and penfill.

 Amina xx

 

 

 

 

 

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A moment of madness: When insulin got diluted/ injested! 

IMG_9219-0

Diabetic Problem #55:

Ever tasted insulin mixed with water?

Well this silly lady did just that, when I decided to change my insert just before dinner at the dinning table. Then obliviously I primed my pump right over my cup of water.

Did it click then?

Nope!!

Not until I drank 3/4 of the water and then said out loud, ” this water taste funny and smells sort of like insulin.” LoL

Only then did I realise what I had done. There’s a first time for everything and that will definitely be the last time.

I most definitely WOULD NOT advise you to ever attempt this brief moment of stupidity. It wasn’t my intention to try it out and by the way it taste dreadful! I doubt I’ll have any side effects but if I do I’ll be sure to inform you all.

 

Thanks for stopping by

 

Amina xx