A tragedy of errors with type 1 diabetes - when everything that can go wrong, DOES!

Did you ever have one of those days where everything just seemed to go wrong? Well here's the story of one of my days!

It started late at night when my pump gave me low battery alerts. I was too tired to get up and replace the batteries so I did the next best thing (or so I thought). I turned off my sensor as that was the biggest consumer of battery power. Hello, Fazlyn - NO ALERTS! But I thought, how bad can it be until morning? Seriously? VERY BAD!

I woke up later with a blood sugar of more than 20! Being pregnant, that is NEVER good for the baby and I was still insulin resistant. So out comes my insulin pen and lots of insulin.

It seems that since I had turned off my sensor I did not receive notification that my infusion site was problematic (yes, and I already had limited space because my tummy was no longer an option). So I was getting very little or NO insulin at all and had my sensor been on I would've know this and changed my infusion site. So all of this could have been avoided had I just woken my husband up to get the battery and even put it in or even help change my infusion site (yes, he had to help because I couldn't insert a new infusion site into my back).

Luckily though I didn't go severely hypo after because of the amount of insulin I gave. I tend to overcompensate when I see high blood sugars. It's like all my alarms in my head go off at the same time! But I decided to give myself a break and take the pressure off by saying that my daughter would still be ok (I said a prayer for this) since I don't go this high often. Also, I'm only human and even though I was being very silly and even irrational - these things do happen.

Needless to say I made sure they didn't happen again!

2nd Trimester with type 1 diabetes - welcome insulin resistance :(

Hi all,

It's been a while since I've last blogged but needless to say that I've had my hands and feet full :) My all day sickness (aka morning sickness) eventually subsided in my 2nd trimester and I felt a lot better BUT hello insulin resistance!




Source: http://www.reproduction-online.org/content/140/3/365/F3.expansion.html

I could look at food and it would increase my blood sugar! Even food that I could eat previously, e.g. proteins, without giving insulin now required insulin. Not small doses, actually LOTS of insulin. My gynae was concerned because I showed some ketones in my urine despite taking all precautions to keep my blood sugars normal. 

My HBa1c was still within a normal and safe range but my pump kept beeping for high levels and high predictors almost all times of the day! It was annoying and worrying so something had to be done! 

My solution - I would inject 20 units of Apidra (my insulin) at 11am every day. Failing to do this my blood sugars would run 'high' (e.g. above 8.0) most of the day. So even though I wore a pump, I was still injecting and using a lot more insulin just because I needed so much more to control my blood sugars. 

I couldn't wait until 3rd trimester for my blood sugars to get back into it's usual range and my body to respond in the way it did previously..... only time would tell though as I've learnt that not all people react in the same way and no 2 pregnant women seem to be exactly alike. 

The main thing though was ensuring that my baby was safe and not affected by high blood sugars. So I did what any mother would do - everything it took! 

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').