A Step in the right direction

Ever since I had my second child and had to spend seven days in a maternity hospital I have had a huge fear of ever being admitted to hospital again. That might sound a bit extreme but it’s the truth. I did not have any confidence that any of the staff in the hospital had the ability to care for me should I become incapacitated.

When I was invited to speak at a nurse’s diabetes training day I thought that I might charge in there seeing them as the enemy. Thankfully, my husband, who is very, very, very smart said that I should see it as a chance to let these very important people in the health service know how important it is to me that they are knowledgeable in diabetes and to commend the health service for providing the nursing profession with this opportunity.

Basically, this one day was part of an intensive diabetes training course for people working in the nursing and midwifery profession. And I was invited to give a patient’s perspective.

I talked about all the things I did on a daily basis to management my diabetes, such as the blood glucose testing, carb counting, record keeping, etc., and all the things I felt were important extras, like a good support system in the background and knowledge.

Afterwards, I had loads of really interesting questions. They seemed really interested in learning from me and in my 18 years of experience.

When I walked into the room my objective was to try and explain how diabetes was so complicated to manage and that it wasn’t just as simple as following instructions from a medical professional; I hope I achieved that.

And in return, I received hope that the next time I have a stay in hospital, (because let’s face it, there is no way that I will live out the rest of my days without ever being admitted into a hospital), that I have a bit more confidence in the staff to looke after me.

World Diabetes Day in Ireland

November 14th is World Diabetes Day. All around the world the diabetes community will mark the occasion in some way or another as we remember those who have passed from this life because of diabetes and  those who are struggling to stay ahead of their complications. We will also be thankful for every day that those who are living well with diabetes continue to do so.

It’s the one day I know I’m not alone in the world of diabetes.

This year the diabetes community in Ireland seems to be mobilising and making sure that the occasion doesn’t go unnoticed.

In doing so, I’m happy to spread the word that the following buildings will be going blue for World Diabetes Day; PricewaterhouseCoopers, Dublin, The Convention Centre, Dublin, The Round Room and Fire Restaurant Business & Events Centre@ The Mansion House, Dublin

On the Sunday the 13th of November, Diabetes Ireland will hold a “Diabetes Health and Awareness Expo” in the Rochestown Park Hotel in Cork. Diabetes Ireland is also looking for people to come forward and “Go Blue” for World Diabetes Day.

It’s my hope that this year World Diabetes Day make the 6 o’clock news in Ireland, so that everyone living in Ireland hears about it.

The cost of Diabetes in Ireland

People with diabetes are very fortunate when it comes to the cost of living with diabetes in Ireland.

Under the Long Term Illness Scheme, diabetes medications and supplies, such as test strips, needles, insulin, etc., are free to all people with diabetes. This scheme was set up in 1971, specifically to help people with diabetes manage the astronomical cost of medicine and subsequently covers another 14 illnesses.

The cost of a box of 50 test strips for my One Touch Ultra Glucose meter is $61 (€46). I use approximately 7 strips per day which means that it I were to buy a one month supply it would cost me €188 (ouch!!!). That’s just for the test strips for my glucose meter! I’m not going to give anyone a heart attack by telling you what my insulin, needles and the glucagon kit would cost! Believe me you don’t want to know!

I’m just thankful that this fortune doesn’t come directly out of my pocket because I could not afford it. I know that my taxes goes towards this cost but I don’t think I pay enough taxes to cover all the free things that most of us get but that’s not an offer to pay more!!!

We are not the only country who provides people with diabetes this benefit. I came across a discussion thread on  about how many glucose meter test strips GP’s in the UK allow their patients.

The National Health Service (NHS) in the UK, does provide test strips for free to people with diabetes but because of cost cutting measures some GP’s are placing restrictions on how many test strips a person with diabetes can get, regardless of using insulin or not. Some GP’s feel that 4 test strips per day is sufficient but if you are a person with type 1 diabetes (like me) on an insulin pump the pump manufacturers insist you test 6-8 times a day. Plus, if you are an active person or you drive a lot this is just not safe or practical.

I would hate for someone to tell me that I’m not allowed to test my blood sugar levels as many times as I feel necessary. After all, I’m not doing it for fun – it’s not fun at all, believe me!!

I use the information from my blood sugar readings to correct high & low blood glucose levels, to calculate my insulin to carbohydrate ratio for meals and food types. I thing that my having a decent HbA1c is because I can test as many times as I do.

I really am very fortunate to have this scheme and I will never forget it.

Slave to my insulin!

I needed to clean my house, so, I jumped right in to the hovering. Low (pun intended) and behold about 15 minutes into the project I’m sweating and I’ve got the shakes. I’m annoyed because I have to get the job done before the school collection run and now I have to take time out to treat a hypo.

I have never let my diabetes stop me from doing anything; I’ve travelled, worked, got married, had children. I did not climb any mountains but I didn’t want to. But when it comes to the blasted house cleaning, diabetes gets in the way every time!

In the end I would try to synchronise the vigorous house cleaning with blood glucose testing time, which would also coincide with two hours after a meal and thus lessen the risk of a hypo. But, that just resulted in needing to sit down and have a snack before I started.

Now I don’t know about others but if my mind is geared up for a bit of cleaning I would just as soon get into it than to sit around thinking about it (cos then I run the risk of putting it off altogether).

I felt I would never have the upper hand in blood glucose control.

However, that all changed when I got an insulin pump. An insulin pump is kind of like the intravenous drip you see hospital patients with. The pump is programmed to deliver insulin at different speeds throughout the day (known as a basal programme) and the speed can be as little as .025 of a unit per hour.  And if you need to have more insulin you can dial up the required dose and make the pump give you that insulin all at once, for example like with a shot to cover the carbohydrate in a meal.

 I feel I have more of the control. I know I will never be able to predict what stress and hormones do to my blood sugars but the problem of how the insulin is behaving in my body has been simplified.

So now when it’s time for a bit of cleaning I have the option to either suspend my pump (stop insulin delivery temporarily) or reduce my basal rate by a percentage. No need for snacks unless I’m in the mood for one.

Sometimes, I still feel like I’m a slave to my insulin especially when I get the estimates wrong but it’s not as often and not as frustrating because I use that information to make the next estimate more accurate J

​Preventing Diabetic Kidney Disease

Preventing Diabetic Kidney Disease

Disclaimer: This following information is not provided to you by a medical profession but by a non-medical third party and does not in any well replace any advice given to you by such professionals.

In October 2010, I attended a presentation given by Dr. Ray O’Connor on Diabetic Kidney Disease. I’m getting to the stage in my life where I don’t want to rely on luck alone to stave off the complications of diabetes and even though I trust my endo; I want to know more about the medical side of things myself. I am passing along the information that he provided.

Dr. O’Connor is a full time general practitioner (GP) who has a special interest in diabetes and he is also, among other things, the chairperson of a task force in the mid-west of Ireland to co-ordinate diabetes care in the region.

He introduced his topic by stating that most people who have kidney disease do not have any symptoms and feel well. In the image to the right, the part of the iceberg we see above water represents the number of people who know they have kidney disease and the part of the iceberg represents the people who do not know they have kidney disease.

What is Diabetic Kidney Disease?

Diabetic kidney disease affects 20-30% of people with diabetes (Type 1 & Type 2).

When the kidneys are working well, tiny filters in your kidneys, the glomeruli, keep blood proteins inside your body. You need these proteins to stay healthy. High blood glucose and high blood pressure damage the kidneys' filters. When the kidneys are damaged, proteins leak out of the kidneys into the urine. Damaged kidneys do not do a good job of filtering out wastes and extra fluid. Waste and fluid build-up in your blood instead of leaving the body in urine. With more damage, the kidneys leak more and more protein. More and more wastes build up in the blood. This damage gets worse until the kidneys fail.

What’s that Microalbuminuria all about?

The first sign of Kidney disease will appear when the blood vessels start to leak Microalbuminuria (little bits of protein) in the urine. A normal level of Microalbuminuria is less than 2.5. The test to detect if any microalbuminuria is present is called a Albumin:Creatinine Ratio (ACR) and is done through a urine sample and should be done once a year in all people who have diabetes.

How does your doctor screen for Diabetic Kidney Disease?

Your doctor should take a urine sample once a year to have it tested for the Albumin:Creatinine Ratio. A result of less than 2.5 is normal. A result of between 2.5 and 25 is stage 1 kidney disease and a result greater than 25 is stage 2.

How should we prevention Kidney Disease?

Keeping our blood vessels healthy will help keep your kidneys healthy. We do this by;

• Keeping our Blood Pressure under control, using ACE (angiotensin converting enzyme) inhibitors or ARBs (angiotensin receptor blocker), if necessary. Simply reducing our Blood Pressure with other medicines is effective also,

·         Good glucose control,

·         Restriction of dietary protein may be helpful,

·         Stop smoking will relieve the pressure on our blood vessels,

·         Cholesterol control,

·         Lifestyle modifications are helpful too. 

¾     Weight loss

¾     Exercise

¾     Reduction of protein

¾     Reduction of salt

¾     Reduction of alcohol

Conclusion

Dr. O’Connor summed up his presentation with these few points below that were easy to remember.

·         Get your urine tested for the Albumin : Creatinine Ratio (A:C Ration) at least once a year and Blood Pressure checked regularly

·         Keep your sugars controlled

·         Take your medication

·         Don’t smoke

·         Work on your lifestyle

I think it's safe to say that I have not done his presentation justice; you kinda had to be there to absorb the full impact and everyone who did attend walked out with more knowledge and more motivation to take control of their diabetes.

What should I eat now I have diabetes?

I was at a diabetes information evening last week and we listened to an extremely eloquent and knowledgeable dietitian give a presentation on the most commonly asked questions from people with diabetes.

I started to think about how much focus there is on food when you have diabetes and why this question is always asked, in multiple forms, so many times.

It’s one of the first questions a person asks themselves, irrelevant to what type of diabetes they have, when they get home from the hospital or doctor’s office after being told they have diabetes is “What should I be eating now?”

The answer to this question is different for everyone because each one of us lives very different lives. Some of us work outside the home, some of us don’t, some of us have children and some of us don’t.

So when you ask a dietitian “what should I eat?” The answer will be very general, long and contain a huge amount of information. (S)he loses our attention on sentence three because  it’s not the quick fix/easy answer we were hoping for.

My point is that I don’t think asking this question benefits anyone with diabetes. I think we should be asking “what am I eating every day and how do I modify it?’ Thus, taking control of the situation ourselves and not looking to others for answers. AND not believing that we are going to lose all of our treats.

To find out what we eat every day, we need to keep a food and blood sugar diary for, at least, two weeks. We should do this because when you sit down at the end of the day and list try to remember what we ate we inevitably forget a number of things.

And we shouldn’t just record what we eat but how much of it! This is hugely important because we could be eating all the right things but if you eat more food (healthy or unhealthy) than your body uses up in the form of energy, you will gain weight or be overweight.

Once we have our two week diary, then we can take it to a dietitian and go through it together. (S)he will help us figure out where we fall down on our healthy eating plan and decide what small changes we can make that will benefit us most and smooth out the troughs and peeks in our blood sugars.