Taking the long view…

One of the most frustrating things about diabetes is that even once you have managed to get out on top and get a run of good control, it can still throw you a curveball that manages to make you feel terrible, both physically and emotionally.

I’ve been trying, *hard*, to keep my BGs in line. Obviously there are days where I’ve semi-fallen off the wagon, but that’s mostly been as a result of circumstance rather than because I’ve gotten lazy. During the weeks I’ve been controlling my carb intake with a fanatic level of attention to detail, counting up tenths of grams in order to work out my bolus jabs to try as much as possible to keep myself on target.

Doing everything right, and still getting poor outcomes is such a dispiriting and demotivating experience.

This week, for example, on Monday night I slept really badly, woke up high and then fought all day to bring it down – and only managed to get back on an even keel on Wednesday lunchtime. There are few things worse then following all the advice and all the rules, and still feeling like you’re getting it wrong.

In these situations I think that the most important thing you can do is also the hardest. It’s all about reminding yourself that there’s more to life than an on-target BG. It’s absolutely right that you should try to have more on target than off, and that if they’re persistently off that you should figure out what needs to change and change it. But when you’re hitting your targets more often than not, cut yourself some slack.

Almost a month into my latest attempt to get good at this, my 30-day average is 8.5. In that time I’ve been on a stag weekend, and engaged in a variety of other activities that normally don’t play nice with good BG control. I’m really proud of that, and if I can keep this up, I’ll be on for a really decent HbA1c in August when I next go to clinic.

The longview is almost always more helpful. Sometimes the negatives stand out more than the positives – but even just stepping back to look at the last two weeks objectively – I’m pretty pleased that I’ve been able to do all the things I need to do, plus manually manage my glucose metabolism. And people say I can’t multi-task…

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What are you waiting for?

I’m mid-way through my sixth year of having diabetes (my diabeteversary is actually World Diabetes Day!), and when I think back to November 2007 – it felt like the world was ending.

I was given what felt like a life sentence.

To some extent that is true – but I’ve come to think about things in a different way.

Sure, things that used to be easy are harder (eating a sandwich, for example), and things that were already hard have gotten harder yet (the bout of flu I had in 2009 was terrible beyond belief). But I’ve decided to accept two things that are making things easier every day.

The first is that this is now mine for life. I am not going to be taken in by claims of cures, or artificial pancreases, or stem cell transplants. I don’t doubt that these things will all come to pass eventually, but whether we’ll all have fast access to them, I am not convinced (look at how hard it still is for some people to get pumps). Likelier than not, I am going to be dosing myself with insulin for the rest of my life.

This in turn leads on to the second thing and is, counterintuitively, quite liberating. I don’t need to wait to get better to do whatever I want. I’ve probably got about 50 years left, more if I’m very lucky, and so each and every one of those is going to count.

Already, over my first five years, I’ve done some things that have enriched me as a person and in turn made friends, family and HCPs wince at the idea of someone with a disease doing it.

I’m coming to the close of my first career (I just bought my last monthly rail ticket this morning!), which has seen me working long, erratic, stressful hours at the centre of government. I’ve had jobs that had me working nights and weekends, that saw me doing things that made my consultant blanch (I asked how best to work my levemir when visiting 5 countries with 5 timezones on 5 consecutive days – oh and how much further will it complicate things if I work 22hr days for all 5?) —but these are 4 years that have enriched me enormously and given me some incredible experiences that I will never forget.

So where next? Well, as a politics graduate with no science a-levels, the obvious next move is to go to medical school. This is a childhood dream – I have always wanted to be a doctor and so at 28, I’m taking a leap into the dark and going back to school to make it happen.

Who knows exactly where this will take me – the only thing I know for sure there’ll be more conversations with HCPs about how to keep my BGs in line in the face of horrible junior doctor rotas.

In between all of this I’ve been lucky enough to do things away from work that everyone gets the chance to – I just need South America now to have set foot on every continent.

I know that I’m lucky, and that I’ve had opportunities that others don’t an won’t get – but the message is still the same. Don’t wait to get better – make yourself better by not letting diabetes hold you back.

prick, scribble, jab, repeat…

So, over the last week I’ve decided to see how good I can get my BGs. It’s not been easy, but I’ve been pretty pleased with the results so far.

Here’s my strategy:

1. Testing, a lot.

Over the last 7 days I’ve tested my BG somewhere around 90 times. That’s testing about 12ish times a day.  For context, the tests I’ve done over the last week make up half of the tests I’ve done in the last month, so I’ve doubled the number of times I’m testing per day. I’m lucky to be able to do this – my GP accidentally increased my test strips to 400 a month. My fingers aren’t enjoying it very much, but there’s always sacrifice 😉

2. Meticulous recordkeeping.

I’ve become something of a diary fiend over the last week. I’ve been keeping two sets of records.
blood glucose diary

The first is an old fashioned diary, from a repurposed notepad. I’ve been using this to record all of my tests, carbs, bolus(±correction), my basals, and occasionally a not very helpful note about the reading/carbs/etc.

 

mysugr averages screen

The second way I’ve been collecting records is on my phone using the mysugr app. I mostly like this for the quick and dirty analysis it does. It plots out a (small) helpful line chart showing the trend, as well as averages, standard deviation, and an easy way to see how many hypers/hypos you’ve had over the last 7 days (26:6 hyper:hypo for me this week)

It’s not been that easy, but it’s certainly been easier than I was expecting. It’s surprising how quickly you build routine – although I found it was harder to keep up the rhythm of testing at the weekend when I was trying to relax and was feeling lazy, but I guess that’s just something that you get used to.

I think my TDD is about the same as it was before, I think I’m probably just deploying it in a more sensible way. Wherever possible I’m bolusing before I eat rather than after (which is a particularly bad habit when I eat something slowly – like lunch at work eaten at my desk in between emails). I’m correcting more often, but in smaller doses too – although I won’t promise that the days of 10u corrections are over just yet.

If I can keep this up, I’m looking at an HbA1c of around 7%, which will be a massive achievement for me, and will be my lowest ever. My previous best was 7.2% around a year after dx, and since then it was bounced around and been as high at 11%, but never lower than 7.9%.

One thing this week has taught me is that it’s incredibly important to step back from the day-to-day and look at the trends – to separate the signal from the noise. We all get annoyed by the peaks and troughs of our BGs, but it’s really important to look at each reading in the context of the last and the next to work out where you’re headed and to get out of the hyper-correction-hypo-overtreat-hyper cycle that it’s so easy to fall into. For one of the first times since I was diagnosed, I feel like I’m in control of my diabetes, rather than it being in control of me.

Let’s see how it’s all looking a week from now.