The funny side of type 1 diabetes

Yes, I know that having type 1 diabetes is a condition that requires attention and that has consequences if not well controlled. However, some moments you just have to sit back and laugh out loud (LOL)!

So these are some of my LOL moments:

• When I was still at university and it was time to test & give an injection, I would do so without thinking. However, later I was told and saw the look of HORROR on some of the faces of my friends around me who didn't know I had diabetes. Their looks were classic, especially when I lifted a bit of my top up to inject! LOL
• When I went to Malaysia and my pump set off the detector, they asked if I had a phone and then I lifted up my dress to show them my pump instead. Yes, I was wearing a tights underneath but they got so embarrassed that they sent me behind a curtain to a woman LOL
• At work when my pump beeps for low or high glucose readings I just lift up my dress to check, however the guys around me start to think I'm working at Teasers LOL
• In all of the above cases I wear either a pair of tights or a petticoat but my friend jokes that one day I will forget to put this on and they will have a show LOL  I think it's just wishful thinking on his part :)
• I received a silver award in the Learning and Growth category at work at the very lavish function. Even though I put my sensor alerts off it still starting sounding like an ambulance when I had to go up on stage mainly due to my blood sugar dropping below 3. Luckily this noise was blocked out by the sound of the clapping and I didn't have to lift my dress up as I wore a skirt and top LOL
• My colleague teased me that for graduation night (when I received my M.Com) I would go up on stage and then would have to lift my dress up to take care of my pump. Actually that would have happened as I gave insulin without realising that every time I would put something to my mouth to eat someone would call me. So I checked my pump before going up on stage, switched off my basal so that I would not beep and spared myself the embarrassing moment of telling hundreds of people why I was lifting my dress up and didn't get this moment captured on capture or video LOL

So while having this condition is not really funny, you have to appreciate the funny moments for what they are. It stops you from going completely INSANE! LOL

Eid (or other religious or general celebration) and the impact on type 1 diabetes

Eid is the celebration held after the month of Ramadaan, when the moon has been sighted. Like other religious, traditional or general celebration (e.g. graduations, birthdays etc.) celebrations generally affect blood sugar control NEGATIVELY.

With so many delights on offer, from breyani to trifle to all sorts of different treats and sweets, it's difficult for anyone to resist. However, not resisting or changing your insulin to accommodate this increase in carbohydrates makes most blood sugars rise like a rocket! (unless you're exercising of course...but come on, this is unlikely on a day like Eid or Christmas). 

So instead of trying to stop the person with diabetes from having ANY treats, moderation is probably the better option. This includes amending the day's insulin requirements. Also if you are making a 'diabetic-friendly' option, it is probably best that EVERYONE eats it, so that we don't feel excluded or 'alien'.

There are other scenarios as well though....for me, I would give my insulin in advance (the 4 times a day injecting option) to accommodate the things I thought I was going to eat. However, I then decided not to have those options and go HYPO! Needless to say this didn't impress my mom much as we had to stop enroute to family members to stop and buy a chocolate. So regardless of having soooooo many carb-rich options available, I just didn't eat as much or whatever I thought I would have. There is a slight problem with planning TOO much lol

Now, on my pump I don't have these issues. If there is something I really want to have, in moderation of course, I just give the neccessary increase in bolus. It makes life so much easier as I don't have to prepare in advance or have to deal with high blood sugars levels later :)

In addition planning 'blood sugar control friendly' parties may be a challenge, but there are many recipe books (I have a good one) that provide options that everyone will enjoy. At the end of the day it is about the enjoyment of all of these occasions, let's not let hypers or hypos get in the way :)

Ramadaan and type 1 diabetes

Ramadaan is a very important month for Muslims across the world and is the third pillar of Islam. According to wikipedia, the five pillars of Islam are as follows: "The Qur'an presents them as a framework for worship and a sign of commitment to the faith. They are (1) the shahada (creed), (2) daily prayers (salat), (3) fasting during Ramadan (sawm), (4) almsgiving (zakāt), and (5) the pilgrimage to Mecca (hajj) at least once in a lifetime.^"

During ramadaan muslims abstain from food, drink and sexual behaviour from sunrise to sunset.

For people with diabetes this may be a difficult time, or at least I found it to be. This is due to the fact that when everyone else is fasting, you can not and you need to eat. I often thought that I should just get a big label of my forehead that said 'diabetic on insulin - need to eat, can't fast!'. Especially when I was at school and everyone else was fasting, I would eat in the classroom or have to find some place where no-one else would see. Not really because I was hiding but because it was more considerate for the others. Many times I would not eat, just because I would feel so bad and as a result, I would go hypo.

I've realised, many hypos later, that this is not the way to do it. Now when I need to eat, especially when I'm pregnant, I just eat. I do sometimes get the shocked looks of people who see me wearing a scarf and eating but then I think that it's not really important to my life of the well being of my baby. I walked with my mom and was feeling the onset of a hypo, so I bought a cinnamon twist and ate it while I walked. Even my mom commented that people were looking at me funny and I told her the same thing, 'it is ramadaan and I understand that they expect me to be fasting but I can't. So let them focus on themselves while I focus on myself and the well being of my baby.' I should not be behaving like a criminal because I'm not. Neither should I be feeling guilty, because I have nothing to hide.

Granted I should not be openly eating in front of people that are fasting, out of consideration, but if I need to - I will. Also, God has made allowances for people with conditions like me. I pay fidya.

As is known the Muslim Judicial Council (MJC) normally calculates the amount according to the prices of rice which is the staple food of Cape Muslims. That refers to an average type of rice, not necessarily the best type available. This is bare minimum, for those who can afford we say that they can and may increase the amount according to their means  OR they may decide to hand out their fidya by calculating 2.5kg of higher quality rice and either hand it personally to the recipients of the equivalent thereof in money.

This year the minimum amount for Fidya is R13.00 for each day that I am unable to fast (so either 29 or 30 days, depending on when the moon is sighted). I usually use this amount together with my alms, to purchase food and deliver it to an orphanage. It helps others that are less fortunate than me.

So to all of you that are unable to fast, or have children that are unable to fast, it is not anything to be ashamed of or feel guilty about. True, it took me many years to learn, but I have and I feel a lot better :) God does not give us burdens that we are unable to bear, so why should we let the looks of others let us feel less worthy?

Now I say, if you need to eat - then eat! If they judge you, let them. It is not their place to judge you anyway. Enjoy ramadaan and all it's blessing, you deserve it and most importantly be thankful of all you have.

Morning aka all day sickness, hypos and dehydration

Hi all,

It's been a while since my last blog and that is mainly due to the fact that my head was stuck in a bowl or the toilet A LOT! Yes, many women get morning sickness during pregnancy but what it means for women with type 1 diabetes is HYPOS, possibly LOTS of them!

Here's an example: I woke up at 3am with my pump beeping that I was going low (3.5 reading). My husband got out of bed to get me juice (really sweet and supportive). I did not feel so great thereafter. I got up and went to the bathroom at 4am only to have my hubby come and clean up with a mop (rather gruesome pic but it's only human). Now this means that I'm feeling really ill and my blood sugar is dropping even faster! WHAT NOW??? I went to the kitchen and tried dates (conveniently there as it's Ramadaan). The dates seemed to work but my blood sugar was still very low.

Shame, my poor hubby had to stay up as it was time for him to eat before starting to fast. I guess no-one said it would be easy but boy does it get tough at times! At times I didn't keep anything down for the entire day. I called my gynae and then I was admitted to hospital as she was concerned about my hypos and dehydration.

So Monday morning and I'm off to the hospital, my mom driving. Luckily I packed quickly as I was sure I was going to be staying there overnight.

My gynae told me to go to main reception and that they would sort everything out for me. I have to admit that I was impressed by the efficiency of the hospital, Vincent Palotti. They knew who I was, who my dr was and called for the codes so that I could get pre-authorisation. By the time someone came to fetch me, my name was already on the boards and they were getting my bed ready. Time to change into pjs and 30mins later someone from Patchcare was there for my blood work.

The hospital was going to organise me lunch but I wasn't really hungry, so they said that they would bring me a sandwich and tea later. The drip was painful but I have to say that it worked! The nurses came and did regular checks and because they knew I was on a pump just came to ask me my readings and treat any hypos. I actually educated them on pump therapy as not many of them had seen patients on a pump.

My dr came around a few hours after being admitted to check on me. My first blood work report was done within 40mins. I have to say that even though I don't really enjoy being in hospital, it was great that my dr was proactive and had me admitted. All my blood results were fine, except I discovered that I have another antigen.

According to wikipedia:

Many pregnant women carry a fetus with a blood type different from their own, and the mother can form antibodies against fetal RBCs. Sometimes these maternal antibodies are IgG, a small immunoglobulin, which can cross the placenta and cause hemolysis of fetal RBCs, which in turn can lead to hemolytic disease of the newborn, an illness of low fetal blood counts that ranges from mild to severe.^[3]

My dr is not too concerned as I can be vaccinated and my baby can be vaccinated, after birth, as well. I knew that I would have 1 antigen, but 2 was rather shocking. At least I know that it was found early and that there are things can be done about it.

I'm back at work since Wednesday last week and the morning sickness is subsiding. I will reach the end of my first trimester tomorrow God-willing and hopefully things will improved steadily :) Dr says that there is no guarantee that it the morning sickness will totally disappear already but if I have the same situation again, they will take the same actions.

It's off to eat now as my pump is beeping again. Luckily though I am happy with the hospital, my doctors and the staff. It makes me feel more confident that I've got the right team taking care of me and my baby :)

The first trimester with type 1 diabetes

So now the work continues (no, it doesn't start as watching blood sugars should already be a daily activity).



The difference is though that it comes with tiredness and morning sickness! This name is a LIE as it can and probably DOES occur throughout the day. My mom had morning sickness for 24 hrs each day. Luckily mine is not that bad. However, despite the morning sickness I had a fever AND gastro. Now this just MESSES with my blood sugar control! I never knew that I'd have these challenges, but I am (I'm sure God/Allah is just trying to teach me the patience I'm going to need lol). This led to hypos and dehydration and affected the way my sensor works (I actually just took a sensor break for 2 days as I just couldn't stand hearing 1 more beep!). I finally came to my logical senses and put in a new sensor (much to the happiness of my hubby and baby probably).

Last week I went to the endo for my Hba1c, then the gynae for my 1st scan (baby is 10mm and has a strong heart beat) and then went to the GP for my other symptoms. Now, if you've ever been pregnant you will know that there are very few companies that will explicitly state that their medical products are safe for use by pregnant women. That leaves me with the limited choices of Panado (ok, this did help with the fever) and apparently Immodium isn't too harmful either.

For morning sickness there are tablets available but if you want to try the natural route - try preggie pops. Lots of women, according to my GP, swear to the effectiveness of this (but just watch your blood sugars as it does raise them). I found them not to work, when I did try it out. Apparently making or drinking ginger tea is also effective (my hubby went out and got it for me and even found me the sugar free version but I've yet to try it).

I've learnt that every women is different and that pregnancy affects us all differently. I'm a type A personality and I find that not having control over so many things can be just FRIGHTENING! I guess it's another lesson I have to learn and I'm trying to get my head around it 1 day at a time.

But ultimately the most amazing experience was hearing and seeing that little heart beat. Nothing else beats it. I actually wasn't too excited when I saw it (I guess because of my friend's baby's heart that stopped beating) but I'm starting to realise that I just need to let this negativity go (hormones related I'm sure). My hubby and I have chats about my anxieties more regularly these days and it's amazing having a supportive and understanding partner (even the 1 who says 'No, you can't have chips because it's going to raise your blood sugars').

A positive pregnancy test for a type 1 diabetic :)

I thought that I'd be blogging more regularly but I'm just sooooo TIRED! Apparently it's one of the signs in the first few weeks of pregnancy but boy do I wish that I could rather stay in bed all day! Alas, I need to get out of my pjs and come to work (medical aid doesn't pay for itself).

My husband was teasing me for the whole week telling me that my period is late, but I didn't want to get my hopes up only to be disappointed. My friend teased me as well so when I did the test and saw 2 lines I was really HAPPY :) Although now that happiness is mixed with some anxiety (but this is probably linked to the HORMONES that is wreaking havoc on my blood sugars).

I know that I'm a competent and intelligent women that takes care of her diabetes BUT I just wonder what would happen if I go low with a baby around? It seems that my hormones just makes my anxieties seem much worse than they are. I chat to my husband about it often and his advice is for me to recognise the thought, decide what to do with it and then move on. He also told me that this sounds like new age nonsense but I've proven that I can look after myself (yes, I have had some rather serious episodes but my pump and sensors make my life so much easier). So no matter what I feel, I have a loving and supportive family and I am and will be able to deal with whatever life throws at me. In my emotional turmoil it sometimes sounds too unbelievable but I know that he is true. He is also true about this - there are only 2 things: 1 which I can control and the others that I can't. For the ones I can't control I should have faith and for all the others I should do everything I can (with help of course).

My pump is just beeping with an 8.8 reading, time to give 1 more unit and just let this one go. Yes, it has been in the 8 region for the passed 2 hours but I'm doing what I can about it, now it's just time to not stress as stressing raises my blood sugar. Also time to consider just having fish and salad for supper. Ah such is becoming life. I'm not stressing about it though because my 1st month Hba1c test was 6.1 so I shouldn't be too worried. It's only (based on what my husband has read) if my Hba1c gets to 10 that there is risk to the foetus.

Shoo, now to think positively, make the necessary changes (daily or hourly as required), breathe deeply and believe (like my hubby does) that everything will be ok and if it isn't - we'll manage that as well.

Pregnancy and type 1 diabetes - Preparing for pregnancy

So I guess by typing this I'm putting word out there that I'm pregnant :) Approximately 6 weeks by the time I type this.

This is despite the 'old custom' of waiting to tell people for 3 months after finding out. I suppose it's safer as most miscarriages happen during the 1st trimester but if I can help someone else I'd rather be spilling the beans early lol

I've starting reading maternity books way in advance and chatted to my endo and gynae when my husband and I decided that now was the time to start a family (good bye happy money lol). Also also had the opportunity at this early stage to discuss concerns and the effect of my diabetes on the foetus.

Here's what I've learnt:

• Even though I will be classified as a 'high risk' pregnancy I'm at no greater risk IF I ensure that my blood sugars are within an acceptable range
• Hba1c results before trying to conceive should be in the 6 range and should be taken at least every 3 months
• Even though I have diabetes I do not have to test my baby's blood glucose often (I was concerned about this). They will do the test at the hospital.
• I do not necessarily have to have a C-section unless I have complications, but I can discuss this with my gynae
• My baby is less at risk than my brother's (who also has type 1 diabetes) baby of having type 1 diabetes (as he would be the carrier in this instance)

Breathing a SIGH OF RELIEF and hearing that many of the other women I know that also have type 1 diabetes have all had healthy pregnancies and babies. So this keeps me hopeful, despite having an experience of a type 1 diabetic who's pregnancy did not go well at all. Let's not dwell on this negative for long.

So these are the actions I've taken:

• I ensured that I upgrade my pump to get a sensor (so that I could obtain my glucose reading every 5 minutes and spot trends)
• I went for my Hba1c tests (ok maybe not every 3 months) but I was closely tracking my trends monthly
• My Hba1c result was 6.0 by the time I fell pregnant

Now just to deal with PREGNANCY - mmmmmm I was always well controlled and I take special care to ensure that my blood sugars don't go crazy! Ok fine, I don't also go exercising as regularly as I should and I could do with less carbs, but I'm  not perfect but I do TRY! I've found that it's harder to control my blood sugars now but I'll cover my game plan in my next post (it's the HORMONES I tell you lol).

Travelling with type 1 diabetes

Since I've been travelling, I've always found it lots of fun but I realise that with diabetes I need to take extra precautions and pack more :) Just some additional things that I feel need to be considered:

• script from my doctor for medication - I got pulled over in Phuket as my insulin was showing as liquid in my carry-on bag. Surprisingly they were the only people who checked. Even in Malaysia where they make an announcement about 'drugs' - they didn't check my bags. I guess wearing the scarf helped in this case :)
• at least 1 extra set of everything - I usually split it in 1/2 so 1/2 goes in my husband's bag and 1/2 goes in mine (just in case 1 bag goes missing). I make sure I put both bags together because just now they arrest him lol
• I remember to put insulin in with biocool bag (those blue gel like things you get at the pharmacy)
• my pump always sets off the metal detector which leads to me showing my pump (very funny when I have to lift my dress up) and being searched - I guess wearing a scarf adds to it lol
• extra batteries for my pump - it only seems to like Energiser and who knows where I'll find those in places like Morocco?
• Wearing your sensor on during flights were highlighted in the manual and it said that you should turn it off - I kept mine on & I'm happy to say that none of the flights crashed :)
• On long, long flights my blood sugar was dropping before they served food - so I usually take snacks along with me or I have to order the halaal, diabetic meal especially so that they  bring it first.
• Keeping hydrated especially for my sensor is important but I haven't found that they give enough water or rather I have to keep asking. Sometimes they should just give me a big bottle and save themselves the trips to my seat every time lol
• I keep pen sets with me as well - just in case my pump decides to give me issues. This happened on my flight to Malaysia when my blood sugar was raising for no reason. I changed my catheter site before the flight but despite that it kept raising some more. So I had inject, without pen sets it would have been more tricky.
• So I pack with good control in mind - this includes things to keep my blood sugars up (all the chocolate I like eating) and things to keep my blood sugars from going up (treats like nuts)
• I usually pack things like Provita biscuits - I know it sounds silly but it's not easy to find these in all places!
• My pump makes it easier to travel especially when I fly in different time zones. In some cases I don't even adjust to local time and it really didn't make a difference. Everyone is different though - so don't trust that this will work for you!
• When swimming make sure that you put your pump somewhere safe! Lots of pumps go missing at the beach. For that reason I have my pump insured for almost as much as my car!

Above all, I usually travel with someone. My sensor makes it so much easier since I get low and high predictor messages and my pump has a suspend function to prevent comas. In some cases though, this all fails and you just need someone, who knows you, to assist.

Other than that - it's all just lots of FUN (I just have to remember my pump in wet conditions lol).

Menstruation and type 1 diabetes

I blogged previously about the challenges that women with type 1 diabetes face, now here is another - MENSTRUATION. Menstruation occurs at puberty and describes the physical and emotional changes that a girl or boy go through making them adults and capable of reproducing (having children).

Source: http://www.wakeuppune.org/site/index.php/sex-education/puberty

In some women who have type 1 diabetes, the hormonal changes that come with menstruation can cause changes in blood glucose levels. Monitoring levels and adjusting insulin accordingly is key to managing this monthly shift (Krisha McCoy, MS). 

In a study of Menstrual Cycle Differences Between Women With Type 1 Diabetes and Women Without Diabetes (http://care.diabetesjournals.org/content/26/4/1016.full) the following differences were reported:

Table 2—

Self-reported menstrual cycle characteristics of women with and without type 1 diabetes by age range

	Type 1 diabetes	Without diabetes			P
				Sisters		Control subjects
<20 years of age (n)	143	186	158
Bleeding ≥6 days	56.5	41.6	47.7	0.04
Cycles >31 days	24.8	14.3	17.8	0.07
Heavy bleeding	25.2	18.1	22.4	0.31
Any irregularity	78.7	64.3	66.7	0.02
20–29 years of age (n)	143	186	158
Bleeding ≥6 days	52.8	38.7	40.5	0.04
Cycles >31 days	22.1	8.0	12.3	0.002
Heavy bleeding	27.0	14.7	21.0	0.03
Any irregularity	76.8	55.4	55.5	<0.001
30–39 years of age (n)	141	180	152
Bleeding ≥6 days	44.8	41.1	36.2	0.36
Cycles >31 days	11.9	8.4	8.3	0.53
Heavy bleeding	25.0	18.6	25.2	0.29
Any irregularity	67.5	57.9	53.8	0.08
40–49 years of age (n)	100	114	91
Bleeding ≥6 days	40.8	36.0	29.0	0.34
Cycles >31 days	8.6	11.1	10.4	0.87
Heavy bleeding	21.6	27.5	29.2	0.55
Any irregularity	67.6	67.4	62.1	0.74

• Data are %.
  
  
  
  
  
  According to the results of the study 'women with type 1 diabetes had more menstrual problems (long cycles, long menstruation, and heavy menstruation) before age 30 years than sisters and control subjects. These differences were all statistically significant, except for heavy menstruation at age <20 years. No differences were observed after age 30 years. Women with type 1 diabetes experienced later menarche, earlier natural menopause, fewer pregnancies, and more stillbirths than women without diabetes. Multiple regression analyses revealed that type 1 diabetes caused an approximate twofold increased risk of any menstrual problem before age 30 years. These were primarily related to long cycles and long menstruation in women aged <20 and 20–29 years, as well as with heavy menstruation from 20 to 29 years. Oral contraceptives were protective for any menstrual problem and heavy menstruation from 30 to 39 years of age. With history of pregnancy from 20 to 40 years of age, any menstrual problem and long menstruation were more likely' (Elsa S. Strotmeyer, PHD, Ann R. Steenkiste, MS, Thomas P. Foley, Jr, MD, Sarah L. Berga, MD and Janice S. Dorman, PHD).
  
  
  According to Jay Cohen, MD (medical director of the Endocrine Clinic in Memphis and clinical assistant professor in the department of family medicine at the University of Tennessee),  "Two or three days before menstruation, as estrogen and progesterone levels are changing, a number of women — but not all — will notice that their insulin needs increase substantially because their blood glucose levels are rising,” In addition he adds that, "In women whose diabetes is out of control, high blood sugars can put a woman at increased risk of vaginal and yeast infections, and can also affect regular menses," says Cohen. "Once again, it is important to have good blood sugar control on a regular basis.” 
  
  So ultimately it all still boils down to the same thing: TEST, TEST and TEST and then use the test results to make the necessary changes to your insulin requirements. Also speak to your endo or gynae if you have any concerns.

To insulin pump or not to insulin pump? That is the question...

If you or someone you love has diabetes and you have considered changing to an insulin pump, there are some questions you need to ask yourself to assess whether this is the right tool for you or them. The pump is not a magic silver bullet for obtaining great control, it is merely an enabler. It has great benefits but it also takes work on effort on the side of the pump wearer.


Also, given the cost of the pump and consumables making the right decision is important as spending a lot of money on anything that is not going to be used or meet your expectation would be a crying :'( shame.

 


My husband bought me a book called, 'Pumping insulin' by John Walsh and Ruth Roberts. They include questions to ask to decide whether changing to the pump is right decision for you. Areas covered include the following:

1. Motivation - e.g. how well have you accepted your diabetes?
2. Expectations - e.g. what do you expect your pump to do for you?
3. Need - e.g. are frequent highs or lows a problem for you?
4. Preparation - e.g. what other approaches have you tried?
5. Questions for parents to consider -e .g. is your child willing to wear a pump?

They've also included an assessment questionnaire that I've included below.

Gauge your control
1	How motivated are you to control your blood sugars?
	not very	0	1	2	3	4	5	very
2	Number of blood sugar tests your do each day:
		0	1	2	3	4	5	(or more)
3	Number of injections per day:
		0	1	2	3	4	5	(or more)
4	Do you record your test results
		yes	(5 points)	no	(0 points)
5	Do you use your test results to adjust your insulin?
		yes	(5 points)	no	(0 points)
6	Do you match your short-acting insulin to the carbs in each snack or meal
	by carb counting or other means?
		yes	(5 points)	no	(0 points)
7	Do you use extra insulin to correct high blood sugars?
		yes	(5 points)	no	(0 points)
8	Do you adjust your long-acting insulin doses?
		yes	(5 points)	no	(0 points)
9	Do you get an hba1c test to evaluate your control at least every 6 months?
		yes	(5 points)	no	(0 points)
10	Do you call your doctor when problems occur?
		yes	(5 points)	no	(0 points)
								TOTAL =
Self assessment
	Points	0 - 9	10 - 19	20 - 29	30 - 39	40 - 49
	Meaning	A bit casual	Honesty pays	You've got the idea	Minor changes will help	When do you start?
							

I found the book really informative and enlightening, even after I was already wearing a pump. Check for it online. It was worth getting.
http://www.amazon.com/Pumping-Insulin-Everything-Success-Smart/dp/1884804861

The guide I obtained with the Medtronic pump was also really useful. So be sure to read it.

Have a fabulous day :)
Fazlyn

Reference: Walsh, J and Roberts, R (2006) Pumping insulin, San Diego : Torry Pine Press