Alcohol and Diabetes

  • Alcohol moves quickly into your body without being broken down in your stomach the way food is
  • Within 5 minutes there is enough alcohol in your blood to measure
  • The liver wants to clear the alcohol quickly as it can’t release any glucose stores until it has taken care of the alcohol

ONE STANDARD DRINK – IT’S NOT MUCH!

  • 100mls wine
  • 30mls spirits
  • 1 can low alcohol beer 330mls
  • 300mls (half a pint) beer

HOW MUCH ALCOHOL CAN YOU HAVE?

  • 2 standard drinks for women
  • 3 standard drinks for men
  • Don’t drink on an empty stomach – have carbohydrate snacks like bread, crackers and cheese, popcorn
  • Drink other things in between alcoholic drinks like water, diet fizzy, juice (will provide some carb if there’s not much food around)
  • Never count the carbohydrates from alcohol as part of your food intake
  • Don’t swap alcohol for food
  • You may need to have more carbohydrates at bedtime and less insulin overnight and the following day
  • Exercise lowers blood glucose levels and drinking may lower them further so it’s good to remember this if you are dancing as well as drinking

BE PREPARED FOR HYPOS

  • It can be hard to tell the difference between hypo symptoms and getting drunk
  • Have your meter, some glucose and carb snacks with you
  • Make sure your friend/s know you have diabetes and what to do if you go low and when they need to call for help
  • Wear your medic alert bracelet / pendant

RISKS OF LOW BLOOD GLUCOSE

  • Because the liver is processing the alcohol it can’t release glucose stores if your blood glucose level starts to drop
  • Glucagen injections are not any use if you have alcohol on board and go into a hypo
  • So you need to eat when you are drinking alcohol
  • Hypos can occur overnight or even as late as during the next day

CHECKING BLOOD GLUCOSE / INSULIN DOSES

  • Before you go to bed eat some supper (no rapid acting insulin with it) e.g. multigrain toast, banana, milk drink OR pop into your nearest BK or similar!
  • Reduce your long acting insulin by 20% / temporary basal of -20% on your pump, more if you have been dancing
  • Next morning check again and have some carbs for breakfast, may need less insulin to avoid hypo
  • Drink plenty of water or diet drinks
  • Watch for delayed hypos

HANGOVER / SICK

  • Decrease insulin
  • Follow sick day rules
  • Keep drinking plenty of water or diet drinks; drinks containing sugar if not eating or your blood sugar is low

TAKE HOME MESSAGES

  • Always eat some carbs when drinking
  • Don’t drink and drive
  • Always have some hypo treatment / snack with you
  • Make sure your friends know what to do if you go low

More on My Diabetes

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Insulin

On this page

Site Rotation
Injection sites
Different insulins
Websites
Advantages and disadvantages
Checklist
Sleeping

SITE ROTATION

It is really important that you rotate the site where you give your insulin. If you get a favourite spot it will get lumpy and prevent the insulin from being absorbed properly. You may notice that you are running higher than expected and wonder if the insulin is working properly; or you may have unexpected lows when the insulin is suddenly released from the lumpy tissue in a rush. The proper name for this is lipohypertrophy but it’s easier to call it lumpy and try and prevent it from happening!

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INJECTION SITES

You can choose from the following areas:

  • Measure 2 fingers width above your tummy button and 2 fingers widths below it and then you can go along that line from each side of your tummy to the other. You can also go between the lines but not too close to the tummy button as the skin is too thin there
  • Do your first injection of the day on one side, the next injection on the other side and so on
  • Divide your tummy into 7 vertical sections and do your day’s injections within that vertical stripe
  • Or you can use your thighs – tops of your legs and sides (outer areas probably more comfortable!) but don’t inject your rapid acting insulin here is you are about to do some exercise – it will make the insulin absorb more quickly and could cause you to go low
  • Upper arms are another area but they are not recommended
  • Your butt is another place but it can slow down the absorption of the insulin as its a fat storage area

Whatever works for you is good as long as you don’t pick a favourite spot and keep hitting it with the needle. It will get lumpy! (see above)

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DIFFERENT INSULINS

 PUMP THERAPY – ANOTHER OPTION FOR SOME PEOPLE

An insulin pump is a small computerized device , about the size of a pager or small deck of cards. It has the potential to mimic normal release of insulin from the pancreas, but cannot decide itself how much insulin to deliver – you must tell the pump how much insulin you need.  The pump contains rapid-acting insulin only, which infuses into you via a very thin flexible tube that attaches to a soft plastic tube or metal needle that sits under your skin. This insulin is delivered in two ways: as a basal rate, or as a food or correction bolus.

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The basal rate replaces your long-acting insulin. The rate is programmed to deliver a small continuous trickle of insulin that keeps your blood glucose stable between meals and overnight. The basal rate can can be varied throughout the day to meet your specific basal requirements. You can also temporarily reduce or increase your basal rates if need be. For example, you may want to reduce your basal rate if you are exercising (exercise makes your body more sensitive to insulin), or you may want to increase your basal rates when you are sick (being sick normally makes your body resistant to the action of insulin, so you need higher doses).

A bolus is a larger dose of insulin that is given to match the carbohydrates you eat or to correct a high blood glucose level. To determine an accurate bolus dose you need to be proficient in carbohydrate counting, which is the key to success on a pump.

A bolus dose can be delivered immediately (if you are eating a normal meal) or over a longer period of time if you are having a very low GI  or high fat meal or “grazing” over a longer period of time.

InsulinPumpProfile.png

Learning how to use a pump for your insulin is quite involved. You will need to be able to commit to a long period of working closely with your diabetes nurse specialist, your diabetes medical specialist, and your diabetes dietitian in order to develop the skills and knowledge to manage on this way of taking insulin. But once you have the skills, using a pump can give you the most flexibility in terms of lifestyle choices out of any of the current systems or methods for delivering insulin.

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WEBSITES FOR MORE INFO ON INSULIN PUMPS:

To follow are the websites for the two PHARMAC funded insulin pumps and also a few suggested websites that may give you more information about pumps from people who use them. If you find any other good ones please let us know! It’s best to check the reliability of the website. There are lots of sites offering amazing cures and if only they were true – you wouldn’t be reading this! So do be careful.

For the  Animas Vibe pump check out  http://www.nzms.co.nz

For the Paradigm 512 or 712 pump check out 

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Effective, safe use of the pump requires:

  • Commitment to checking blood glucose at least 6 times a day, every day.
  • Using carbohydrate counting.
  • Adjusting insulin doses based on blood glucose levels, carbohydrate intake, and physical activity.

The main advantages of pump therapy are:

  • Increased flexibility in lifestyle.
  • Predictable insulin delivery.
  • Precise insulin delivery.
  • Ability to accurately deliver 1/10th of a unit of insulin.
  • Tighter blood glucose control, while reducing the risk of low blood glucose.
  • Reducing episodes of severe hypoglycaemia.
  • Reducing wide fluctuations in blood glucose.
  • Helping manage the “dawn phenomenon.”

The main disadvantages of pump therapy are:

  • Risk of skin infections at the infusion site.
  • Risk of diabetic ketoacidosis (DKA) from pump malfunction or absorption problems.
  • Cost: if you do not qualify for Pharmac subsidies.
  • Checking blood glucose at least 6 times per day.
  • Letting others know that you have diabetes.

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SELF CHECKLIST WHEN THINKING ABOUT PUMPING

  ASK YOURSELF THESE QUESTIONS:

  • Do you test and record your blood glucose levels at least 6 times a day?                        Yes**   /  No
  • Do you use your blood glucose results to adjust your insulin?                                         Yes**  /  No
  • Are you matching your meal-time insulin dose to the carbohydrates in your meals?      Yes**  /  No
  • Do you adjust your insulin doses according to your activity levels?                                  Yes**  /  No
  • Are you ready to be attached to a device that lets people know you have diabetes?     Yes*  /  No
  • Do you have realistic expectations? (it is not the “magic bullet” to solve your diabetes problems)                                                                                                                             Yes** / No
  • Are you comfortable with the technology and mechanics of operating a pump?          Yes*   /  No
  • Are you a problem-solver?                                                                                            Yes*  /  No
  • Are you prepared to practise good sterile techniques?                                                Yes*  /  No
  • Do you have family and/or peer support?                                                                      Yes  /  No
  • Do you call your healthcare provider if problems occur?                                              Yes**  /  No

 Your responses to these questions are all ideally “Yes” before starting on a pump. Those marked with a single asterisk are helpful and those marked with a double asterisk are required for successful pumping.

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SLEEPING WITH AN INSULIN PUMP

http://www.loop-blog.com/

12 Ways To Sleep With An Insulin Pump

Posted: 14 Jul 2015 12:00 AM PDT

When I first got my insulin pump and got into bed, I asked myself, “If I have to wear this to sleep, where am I supposed to put it?” I quickly found there are many answers to that simple question. Like me, many people are initially unsure of how they will sleep with an insulin pump, but this challenge is not as difficult to overcome as it may first appear. We asked the DOC to tell us what they do and here are the top 12 ways to sleep with an insulin pump.

1. The PJ Clip

“Clipped to my pajama waist band. I specifically seek out thicker bands so the clip doesn’t make holes through the material over time.” – Kristin Mudd

2. The Undies

“I just clip my pump onto my undergarment and tuck the tubing inside the undergarment.  This allows me to buy whatever type of sleep wear that I enjoy.  My pump is safe and secure and out of the way.  After all we all want a goodnight’s sleep.” –  Kitty Castellini, MiniMed Ambassador

3. The Body Pillow

“I sleep with a body pillow on my side and I put my pump under the pillow. I switch sides a couple times through the night, but have somehow learned to move my pillow and pump with me in my sleep.” – Whitney Mielke

4. The Blanky Buddy

“In a pouch made from the same material as my sons favorite blankey! Made by his grandma for him!” – Christina Byerly

5. The Classic Pocket-T

“I have a t-shirt with a left breast pocket that I turn inside out and put my pump in that pocket during the night.” – Lee Bring

6. The Bra Clip

“Clipped to the strap on the middle of my bra. Pretty much wear it that way all day.” – Michelle Wilson

7. The Skilled Sewer

“I had pockets sewn into my night gowns. I put it in the pocket secure the pocket with a safety pen. Works really well!” – Pamela Swearingen Primrose

8. The Workout Shorts

“Workout shorts with a key pocket. Pump fits perfectly there. In the winter, workout leggings with a key pocket. Those with a t-shirt have become my favorite PJ’s with the pump.” – Meri Winchester

9. The Back Sleeper

“When I was playing with the Tampa Rays baseball team in 1998 I had a stress fracture in my back and I was told to always sleep on my back and so it grew to become natural to me to always sleep on my back so I put my insulin pump on the side of my pants when I sleep and it never gets in the way.” – Jason Johnson, MiniMed Ambassador 

10. The V-Neck Nighty

“I always buy nightgowns with button down or V-neck collars so I can clip my pump to the front of my nightgown. I use the pump clip not the holster so it weighs less. It’s also close enough to hear any alarms or adjust a temp basal rate if needed in the middle of the night.” – Peggy Sue Small

11. The Velcro Strap

“I slide it into a pocket attached to a Velcro strap I purchased from Medtronic. It straps around my chest and the pump is safely tucked away, but due to the clear window, I can see my numbers if I need to see them.” – Andy Inskeep

12. The Monkey

“I made a little pouch on a soft-cloth belt with a flap over the pouch in the shape of a monkey for my son, so he would answer this question by saying, “Monkey holds it.” If not Monkey, then Froggy, or Zeebie [zebra], or Stripey [striped, but no animal]. He’s asked for a lion next…” – Elizabeth Platt Hamblin

Not every one of these will work for you. And not everyone has someone to make them a monkey (though wouldn’t it be great if we did). But hopefully something here will help you get some much-needed zzz’s.

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More on Medical:

  correction  testing  clinic  healthcare  issues

Correction

On this page

Using a correction factor

USING A CORRECTION FACTOR (ISF)

This is a method to estimate:

How much will 1unit of my rapid acting insulin (Novorapid / Humalog / Apidra) lower my blood glucose level (BGL)?

When will you use it?

To increase your usual insulin dose to correct high blood glucose levels at:

  • meal times
  • unexpected highs between meals
  • at bedtime but a HALF correction is recommended at this time of the day until you are confident it is working for you

HOW YOU WILL DO THIS?

Correction.png

Download pdf

Remember – your rapid acting insulin has approximately a 3 hour duration

SO if you have given a bolus at – for example 12 midday – by 1pm you have used up 30% and there is 70% remaining.

By 2pm you have used up 60% and there is 40% remaining.

By 3pm you have used up 90% and there is 10% remaining – NOW is a good time to correct a blood glucose level that is higher than you want it to be.

If you had corrected at 2pm with 40% still remaining (active insulin on board) then you must take that into account by working out how many units are still active from the 12 midday bolus and subtracting it from the correction you want to give now. Maybe it is safer for you to wait an hour (3 hours = 90% used up) and test to see if you are still above target. If you are correct and reduce that risk of hypo that comes from stacking boluses!

More on Medical:

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Testing

On this page

Testing tips
Testing Safely

TIPS FOR FINGER-PRICKING AND SHARPS DISPOSAL

  1. Wash hands in warm water and dry well. Warm water helps improve blood flow to the fingertips.
  2. Choose a different finger to prick each time:– The little finger, ring finger and middle fingers are usually best.Avoid using any fingertip that has a lot of fingerprick marks on it.
  3. Massage firmly from the base of your palm to the pad of your fingertip several times until fingertip is red and full of blood.
  4. Press fingerpricker to side of fingerpad, (not side of finger!). Push button and hold a few seconds before removing fingerpricker.Massage again from base of palm to pad of fingertip until a good drop of blood forms.  If not enough blood wipe away first drop then massage again.
  5. Apply drop of blood to target area of test strip and ensure it completely fills. If target area not completely filledyou may get a falsely low reading.If you are using a Caresens meter you must apply the blood at 90 degrees – the strip acts as a straw and sucks the blood up into the meter.
  6. Apply pressure to pricked fingertip with a tissue for at least 1 minute – this helps prevent bruising.
  7. Change lancet (needle) in fingerpricker after 10 – 15 tests. The sharper the lancet the more comfortable the fingerpricking.

           You can buy more lancets at chemists – they don’t come on prescription

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TIPS FOR SAFE HANDLING AND DISPOSAL OF SHARPS

“Sharps” is the name for anything sharp that could cause injury and transfer disease or infection to another person.  Sharps include lancets from your fingerpricker, syringes and pen needles from insulin pen. It is your responsibility to dispose of your sharps safely.

  • Dispose of your sharps when they are dull, bent or have come into contact with anything other than clean skin
  • Buy a certified sharps disposal container from Diabetes Wellington or your chemist to keep used sharps in
  • If you cannot find/afford a certified sharps container, use an opaque, heavy duty plastic child-proof container (eg. a used bleach or dishwasher detergent bottle, or a glass jar with a lid)
  • Return full sharps containers to Diabetes Wellington (free to members or a gold coin donation) or bring to the Diabetes Clinic for disposal
  • Or check with your pharmacy to see if they dispose of sharps
  • Never share your fingerpricker, insulin pen or syringes
  • Keep all sharps out of reach of children

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More on Medical:

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Help and Support

WHO TO RING:

When you are newly diagnosed and need insulin doses:
Ring either your nurse or diabetes doctor.

When you need a prescription:
Contact your GP

When you are sick:
Your diabetes nurse
Your doctor (GP or specialist)
And follow the advice on the sick day management page

When you have lots of highs or lows:
Contact your diabetes nurse or specialist


APPOINTMENTS

In Capital & Coast District Health Board you will be seen in outpatients diabetes clinic approximately every 6-12 months, although when you are newly diagnosed it may be a bit more frequent to start with.

At clinic you will see the doctor, and sometimes a diabetes nurse. Usually clinic starts off with a general chat about how things are going in general, how things are going with your diabetes and any problems are discussed. You should bring your meter and logbook with you so that the meter can be downloaded and the results discussed with you. Any changes to the insulin will be made at this point.

The doctor may examine your injection sites, thyroid gland, abdomen and feet. Any referrals to allied services will also be discussed – dietitian, podiatrist, psychologist.

Finally a prescription will be written for you to take away. The doctor is very happy to discuss any issues. If you need any further prescriptions in between specialist clinic appointments, you need to go to your GP.


LABORATORY TESTS

When you come to clinic the health care assistant will do a finger prick (you can use your own device) for an HbA1c blood test which indicates your blood glucose average for the last 3 months. Once a year, you will be asked to go to the community laboratory and have some bloods done (to check for related disorders) and a urine test. Every two years you will be referred to the optometrist and have a free photograph taken of your eye to check for any diabetes related eye problems.


EATING DISORDERS

Type 1 diabetes and an eating disorder is particularly challenging to live with – as the person and for those around you. Here is a fantastic NZ / Australian website with moving testimonies of people who have lived with this combo and are now flourishing, good resources and links for information, help and support. It’s www.deda.org.nz. Check it out!


 

Tips and tricks

At last I have someone sending me some tips and tricks! Thanks Naomi!! Would love to hear from you, please send them in.

Let’s face it; diabetes can be an awkward condition to live with at the best of times, and a downright dangerous one at the worst, but just like anything in life it’s possible to make it easy-as with just a few simple tricks at your finger tips. It’s all in the know-how and the practice and once you’ve got down some of the basics, you’ll find some of these will come as second nature.

Of course, no one’s expecting you to learn everything immediately, but take some time and consider which of these tips you might want to make a go at, and which ones work for you. You may even discover you’ve already found out some of these on your own!
That being said, if you’ve come up with something we haven’t, then feel free to drop us an email or share it with us on the forums. After all, diabetes doesn’t have to be a lonely condition and sharing what we know and looking out for each other can make living with diabetes seem a whole lot simpler.

Basic Management and Control

You’ve heard it plenty of times from doctors and nurses, and probably from your parents too, but getting in control of your diabetes is a pretty big deal. If anything, it can save you a lot of trouble in your later years, but more than that it will help you live life to the fullest and, often, all that’s needed is a little bit of preparation. The rest will fall into place. Here’s a list for you to look over:

  1. Don’t ignore it. Take control – This is first on the list because it’s the most important. There are always going to be times when we feel like denying we have diabetes or ignoring the complications it causes, but the truth is you need to take control of your diabetes before it ends up controlling you. After all, it’s pretty hard to deny you have diabetes if you end up in the hospital due to poor management.
  2. Aim for routine – Most people (diabetes or no) can really benefit from keeping a daily routine, but for people with diabetes it just makes everything so much more manageable. You’ll find waking and sleeping, eating and snacking, studying and exercising at the same hours every day will add consistency to your blood levels, improve your mood and save you from any nasty surprises. But don’t be afraid to try new things!
  3. Keep your insulin and blood meter in an easily accessible place – In other words, store it in the place you are likely to use it. For most of us that usually means the kitchen or dining area, but if you’re flat-sharing or living on campus this might require a little more strategy and negotiation. If you’re pretty bad at remembering to take insulin or check your blood, then keeping everything in plain view is a great idea. And for people always on the run, try sourcing a spare meter and insulin pen to have in your bag at all times.
  4. Make blood checking part of your routine – Yes, it’s aggravating making the extra effort to take blood levels, but then you probably thought the same thing about brushing your teeth as a child. You brush them without thinking too much about it now don’t you? The same can become true for blood checks. At the very least, try to whip out your blood meter before every meal and you’ll soon make a very useful list of blood levels you and your doctor can work with. Not to mention; knowing what’s going on with your body from meal to meal is exceptionally useful!
  5. Keep a record – This follows in from number 2 above, because once you’ve gotten into the habit of checking your blood routinely, it’s a simple-as to make a note of it. Just keep that pen and paper in the same area as your blood meter or, better yet, try downloading a phone app that you can record in with a couple of clicks!
  6. Check the record yourself – That’s precisely what it’s there for. While it may seem like something only your doctor or nurse are interested in seeing, they don’t have to be the only ones adjusting your insulin. Circle numbers that seem strange to you and keep an eye on patterns. Many meters also allow you to upload your results to a computer so you can see those trends and make your own decisions. At the very least, this puts the power back into your hands and allows you to make confident, informed decisions
  7. Consider alternatives – There’s no rule stating that you must stick with the method of control you started with. When I was first diagnosed with diabetes I was part of the first generation to use insulin pens. Before that we were using syringes and our absurdly bulky like blood meters took a minute and a half to calculate. Now we have all sorts of insulin from mixed to long acting to fast acting, as well as pumps for people with super busy lifestyles. Add to that the newest range of pocket-sized, ultra fast meters and you’ll everything you need to find the type of control that works for you. Awesome.
  8. Be prepared – Much of management and control is simply about making sure you have everything in the right place at the right time. No matter who you are, if you’ve got diabetes then you’re going to have hypos and highs from time to time and they have that funny, little habit of striking at the most inappropriate of moments. Usually when out and about, and nowhere near a kitchen, am I right? However, keeping the basics nearby and on-hand will give you the confidence that if something does go wrong it’s just as simple as retrieving what you need to make it right again. Here’s a checklist of things to remember to keep in your bag at all times:
  • Insulin
  • An extra pen, needle and cartridge
  • A meter
  • A fast-acting source of sugar (dextrose, non-diet soft drinks, etc)
  • A slow-acting source of carbohydrate (biscuits, banana, sandwich, etc)
  • A mobile phone
  • Money (for food or travel)

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More on My Diabetes

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Relationships

The following is an excerpt from a book Carrie Hetherington is writing. Carrie is in her mid 20s and has type 1 diabetes. She is amazing, full of energy, always got new ideas, started the petition on Caresens meters, now an ambassador for International Diabetes Federation (IDF), has written a book for kids newly diagnosed with type 1 and is now doing this book which isn’t out yet but you get a preview with her permission… and then when it is finally published we will let you know and you can buy it and help Carrie make millions (haha)!!

“You may be a man, a woman, a teenager, or a grandparent. You might have one husband, three wives, be divorced 6 times, or be relishing and enjoying your singledom. Whatever your current situation might entail, you have probably thought about dating at some point in your life. Even if it was giving your hand in marriage to your primary school sweetheart on the netball court with daisy chains and buttercups as your bouquet; truly believing you had married your soulmate.

Some may think dating is fun, some find it exciting or awkward, and some lock themselves inside, terrified by people and the world, refusing to step outside the front gate. My dear reader, if you are unfortunate enough to fall into the latter, you may need some extra support from a more qualified source!

It doesn’t matter if you live in England, New Zealand, or a yurt in the middle of Mongolia, we know that diabetes does not discriminate. When you confront dating and you have a naughty misbehaving pancreas, topped off with a reliance upon gadgets and tubing most ‘normal’ people have never laid eyes upon, things can begin to get tricky. Dating seems to take on a whole new dimension and questions we never previously considered somehow become the focus of our whole universe.

‘How do I tell my boyfriend / girlfriend?’

‘What if my syringes or pump make them run away?’

‘What if they take pity on me or treat me like an invalid?’

If you’re a teenager and you add in those self conscious pangs of low esteem…ok, scrap that, it doesn’t matter how old you are, that can happen to the best of us! Things can really begin to feel daunting for some people.

Most diabetics face this chronic, unpredictable little gremlin of a disease 24 hours a day, and will continue to do so for the foreseeable future until that blissful cure is discovered. Until then we must smile, find a silver lining in every moment and band together in laughter. Thriving, surviving and clinging to our sanity, or what little may remain of it.

This book was written to make you giggle hysterically, grin from ear to ear…maybe even shed a tear and hold your sides. To make you feel beautiful/handsome and confident, and approach those niggling questions with gusto, knowing that most diabetics will all face them at some point along their varied journeys, and you are never alone.

If you have found the love of your life, well you can have a jolly good laugh at the ridiculous predicaments the rest of us have confessed to end up in and count your blessings that you have survived this period of your journey. Congratulations.

Happy reading dear friends!


 

Living with Diabetes

On this page:

A Day in the life
#IWishPeopleKnewThatDiabetes website
Living with Diabetes
Bad Diabetes Day?
Leaving Home
Diabetes Burn Out
Problem Areas in Diabetes (Paid questionnaire)
Tattoos and Diabetes
Steroids and blood glucose levels


A Day in the life

“I originally made this video for my journalism class at my college. Follow me through a (quick) day-in-the-life with Type 1 Diabetes! If you’d like to contact me, tweet or message me on Twitter ! I love hearing from other diabetics!”

Devon Arbenz


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Join others to let off steam, get support…whatever you need!

Try out this new website which encourages tweets and posts about what you wished people knew about diabetes. This is what the creator of the page says:

Welcome to #IWishPeopleKnewThatDiabetes Initiative website, a place where people (Yes, THIS MEANS YOU,) can share their thoughts and feelings about what they wish people knew about life with diabetes and go beyond the 140 character limit of the twitter hashtag, and in whatever media format they feel comfortable.

My name is Kelly Kunik and I’ve lived with type 1 diabetes for 38 years and I’ve been blogging about all things ‘diabetesalicious’ for the past 8 years, here and will continue to do so~

Back in April, 2015, I wrote this blog post, which turned into #IWishPeopleKnewThatDiabetes Day on Twitter.

The past few months I’ve reached out to a few Diabetes Online Community friends to submit posts on and this site was born!

It’s my hope that this website becomes a place where people living with diabetes can share their feelings in various mixed media formats to inspire and educate others in the process.

And a place where people sans diabetes can come away with a better understanding of what it’s like to live with diabetes.

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Living with Diabetes

Do you have those terrible, awful, no good days with diabetes? I think most of us do. And sometimes you have more than your fair share. I have been lately. This week I have had approximately 5 out of 7 days like that. So I was thinking that we need to have some things we can turn to when these days hit.

Here are my 5 things you can do when you have a bad day with diabetes.

Scream and shout – if you wake up with a blood glucose level that makes no sense at all, have a day that is more like living on a bouncy castle than solid ground, or can not work out what the hell is happening, then feel free to let it out, scream and shout, whinge, complain, even have a cry. Letting these emotions out is useful and helps you get to number 2.

Nut out what to do about the situation – if you are facing one of those days with diabetes what can you do to get it sorted? Can you tweak things, go for a walk, have a rest day to recover, or make some changes to your overall management?
Talk to someone – this is so important. Tell someone close to you, post it on facebook, call a friend. You need to share these shitty days so they don’t hold as much control over your life.

Call your diabetes team – if you are having more than your fair share of bad days with diabetes maybe you need to call your diabetes team and get some input about what changes may be able to help.

Let it go – sometimes, once you have had a scream and a cry, worked out what to do about the current situation, talked to a friend, written a blog post, called your team – the only thing you can do is let it go. Tomorrow is a new day and the next and the next. You are more than your diabetes and you can learn to lessen its grip on your life and focus on something else. Put some music on loud, take a walk, paint a picture, go op shopping, tidy the house, take a short holiday, make love, cook, visit a friend. Do something other than diabetes and watch its tricky little face fade into the background.
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Bad Diabetes Day?

ONE STEP AT A TIME
This is a wise blog post from Melinda Seed, a type 1 in Australia, who blogs a lot on various topics.

Is it any wonder we can feel overwhelmed?

Eat healthy, lose weight, test basals, test boluses, count carbs, know GI factors, check bsl 10 times a day, cut down saturated fat, control your cholesterol, exercise, don’t sit…….

I know when I start to think about “improving control” there are so many things to think about you can either get analysis paralysis or then, who hasn’t suffered the frustration of enthusiastically launching into a get fit/healthy program only to hypo massively at the end of day one and your diet plans fade away amongst the detritus of emptied jellybean, biscuit and chocolate packets.

It’s all too overwhelming, either to think about or to cope with all at once. There’s a cliche “it’s a marathon not a sprint” and that’s true for diabetes. Sporting metaphors don’t really do it for me, so I prefer to think of it like taking each year of school at a time. You’d fail if you were expected to do calculus in Kindergarten, right? It’s a bit like that, one step or lesson at a time is all you can do.

Choose one action that will move you forward from where you are now, even if it’s tiny, just get started. Say it’s reducing your a1c then choose 1 thing, for example, making sure that without fail you test last thing before you go to bed and first thing when you wake up-or whatever other action you think might help. Getting your overnight sugars right (well as right as they can ever be, you know what I mean) can have a really big impact on your a1c and it’s while you’re sleeping, so win-win.

Similarly if you’re at the doctors and get some sort of lecture about improving your control, ask what is the one thing you can do to have the most impact on improving your a1c. You don’t have to agree with the doc about the particular action if you don’t want to but it is an effective way of focusing on something practical rather than the overwhelming notion of “improving your control”.

What’s the one thing you can do today?
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Leaving Home

Check out this article from Diabetes New Zealand magazine.
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Diabetes Burnout

Burnout is not the same thing as depression. It’s when diabetes just feels overwhelming, things are not going well, you’re fed up / frustrated / irritable / etc etc etc

William H. Polonsky has written a great book called Diabetes Burnout and it’s worth reading this. He also has lots of short clips on You Tube (just search by his name) and his website is also worth a look.

So if you are feeling burned have a go at the PAID Questionnaire in the section of the website (PAID = problem areas in diabetes, sadly doesn’t involve payment!). This comes from the Joslin Centre in Boston, USA which is a great centre for diabetes management, research and treatment. Do the questionnaire, print it off and take it to your next diabetes appointment, either with your nurse or doctor. You may be surprised at your responses and it may help breakthrough some of the negative stuff you are dealing with.

Polonsky also recommends:

Give yourself a break instead of beating yourself up when things go wrong
Be honest with yourself and use positive self talk
Find support that is encouraging for you Identify barriers to your management of your diabetes
Make a plan and stick to it each day

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PAID QUESTIONNAIRE – Problem areas in diabetes

PAID Questionnaire
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Tattoos and Diabetes

Tattoos are created by using needles to inject ink under the skin. Having diabetes doesn’t mean you can’t have a tattoo, but before deciding to have one done you must be well and ensure that your diabetes is well controlled. You must let the tattooist know that you have type 1 diabetes.

Getting a tattoo can be quite a long process depending on what design you have chosen. You can expect your blood glucose levels to rise while it’s happening, but you also need to be prepared for hypos depending on how long the procedure is, and how you react to stress.

The main complication is impaired healing as high blood glucose levels can increase the risk of infection and slow the healing process down.

Other things to consider before getting a tattoo include:

  • Where will you put it. Some websites suggest certain areas should be avoided such as your butt, shins, ankles, feet and where you usually inject your insulin
  • What design you choose. If you are using it as a medic alert then it needs to be clearly visible for paramedics
  • Checking out the tattoo parlour first. Are they registered? How do they sterilize equipment? (They should have an autoclave to sterilize equipment). Do they use a new sterile needle with every tattoo? Will they wear gloves?

If you feel unwell or see any sign of infection after your tattoo has been completed, you should seek immediate help from your GP, ED or diabetes healthcare team.

AFTER-CARE

Taking care of your skin immediately after getting a tattoo can both prevent infection and help keep it looking great.
Acknowledgements: Diabetes UK; Harvard Health Blog

After a tattoo session is over, take off the bandage within three to five hours. Wash your hands with antibacterial soap and warm water, then wash the tattooed skin. Pat dry with a paper towel or clean cloth towel.

  • Allow the skin to air dry for 5 to 10 minutes. Then apply a very thin layer of Vaseline, Aquaphor, or other ointment.
  • Repeat the washing, drying, and moisturizing process three to four times a day for four days.
  • When the tattooed skin starts to shed a thin flaky layer of skin, do not scratch or pick at it. At this point you can switch to a moisturizer—don’t let your tattoo get dried out for the first few weeks.
  • Call your doctor if redness or swelling persists after a few days, you have a fever, or you notice a rash in or around the tattoo.

POSSIBLE PROBLEMS

  • Allergic reactions – you may suffer a reaction to the substances used in the inks and equipment.
  • Skin infection – the tattooed area of skin may become infected if the studio and/or tattoo equipment is not clean or proper aftercare is not applied.
  • Scarring – tattoo application can cause the formation of an oversized scar known as a keloid, which can be irritable and slightly painful.
  • Blood-borne diseases – if the tattoo needle or ink has not been sterilised, it could put you at risk of blood-borne illnesses such as Hepatitis B or C.
  • Wound healing – high levels of blood glucose could delay healing of the tattooed skin and increase the risk of infection.
  • Change of heart – having a tattoo removed is much harder and more expensive than having one done, so make sure you are 100% sure about your tattoo plan before going ahead with it.

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Steroids and blood glucose levels

What are steroids?

Steroids are medications used to reduce inflammation and suppress the immune system. Steroid treatment is commonly prescribed for short periods of time to treat conditions such as rashes, musculoskeletal pain, injury, and respiratory ailments. However, steroids can also be prescribed for longer periods of time to treat certain inflammatory disorders, autoimmune disorders, and organ transplants. While steroids can help reduce inflammation and reduce pain, they can also significantly increase blood glucose levels in people with diabetes, as well as individuals with impaired glucose tolerance or pre-diabetes. Why is this? Steroids increase the liver’s release of glucose, and cause insulin resistance, which leads to insulin (either injected or made by one’s own pancreas) working less efficiently.

What if I’m prescribed steroids and have diabetes?

First, let your prescribing doctor know you have diabetes, because they may be able to prescribe an alternative medication that will not affect your glucose levels. If alternative medication is not an option, inform your diabetes healthcare team immediately so they can determine what adjustments need to be made to keep your blood glucose levels within your target range. Your pharmacist and your healthcare team should be your chief resources for questions about any medication that you are taking.

What should I keep in mind while taking steroids?

1. Steroids don’t elevate glucose levels consistently throughout the day, so you may need to check your blood glucose more frequently. Your healthcare team will determine how often. You may find this glucose monitoring guide helpful.

2. You may need to increase your insulin doses to accommodate the increase of insulin needs. Talk to your healthcare team about using the temporary basal rate or adjusting your basal pattern if you are on an insulin pump, and adjusting using your mealtime insulin dose. If you are doing multiple daily injections you may need to increase both your background long acting insulin and your meal time bolus which you can do by lowering your carb ratio and your ISF / correction factor, or if you are not using those tools, generally increasing your meal bolus a few extra units.

3. Test your blood for ketones, as directed. Notify your healthcare team immediately if your ketone levels are over 0.6 mmols, your glucose levels remain high after their advised insulin adjustments, or you’re experiencing nausea, vomiting, or shortness of breath.

4. Carry fast-acting carbs, such as glucose tablets/gels, fruit juice, or Mentos, to treat hypoglycemia in case your glucose levels drop.

What if I change or stop my steroid dose?

Eventually, your healthcare team will taper down your steroid prescription. It’s important to not stop your steroids prematurely, as this may cause significant illness. When your steroid doses are tapered, your insulin doses will likely need to be lowered as well. Continue to check your glucose levels as advised, and discuss your insulin regimen with your healthcare team.

Being under the weather is no fun, but if you have diabetes and are prescribed a steroid, frequently testing your blood glucose and proactively communicating with your healthcare team will help you stay healthy!
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School, Work, and Uni

On this page

School
Massey University
Victoria University


At School

At school it’s a good idea to make sure the school is aware that you have type 1 diabetes. Either you, your parents or your diabetes nurse should do some education with the teachers, especially the PE teacher so they know how to help you if you have a low at school or are unwell. Your diabetes nurse can provide a management plan for the school that is individualised to you.

You should have a hypo box at school with some form of glucose in it (Vita tabs, Dextrotabs, Mentos, juice boxes), some follow up carb (biscuits, small muesli bars) and a Glucagen kit (orange box). This can be kept at the office, usually the best place for high schools as you are changing classrooms all the time. You should also have a civil defence kit at school in case of emergency. You need to arrange to keep insulin in a fridge, some test strips and some extra carb foods (tinned beans, tinned rice pudding, muesli bars etc). It’s your responsibility to check the expiry dates on your insulin and test strips.

Once you are doing NCEA credits you need an exam letter for special conditions which your diabetes nurse can supply. You are registered with NZQA. If you have a hypo during the exam, for example, you can use the evidence on your meter (dated and timed correctly!) for any claim afterwards.

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Massey University, Wellington

ABOUT US

In Wellington, the Health and Counselling Services are combined and operate as a single service providing professional medical and counselling services to students.

SERVICES

The Student Health and Counselling Centre offers high-quality holistic health care. Holistic health care has a direct relationship with educational excellence and is dedicated to promoting the development of students to their highest potential. The health centre’s policies and practices are designed to provide a safe, professional and private environment and to support students’ goals through independent thought, freedom from ignorance, understanding of self, and by ethical conduct. The clinic is accessible, welcoming and cost effective to all Massey students.

The centre is staffed by doctors and nurses, counsellors, a physiotherapist and a nutritionist. It offers a general practice service, including ACC, sexual health and family planning consultations.

The Student Counselling Service at Massey Wellington offers a confidential, professional service dealing with issues such as relationships, self-esteem, grief, anger management, sexuality and abuse. All counsellors are members of a professional body and follow the appropriate Code of Ethics.

Counselling offers an opportunity for you to talk to someone who will listen without judging you. We offer a private, free and confidential service and look forward to meeting you during your time at Massey Wellington.

ENROLMENT

All current students are entitled to access the health and counselling service. SHCC is part of a PHO (Capital Primary Health Organisation). Students choose to either ‘enrol’ with SHCC or be seen as a ‘casual’ patient (enrolment means that you choose SHCC to be your main provider of primary health whilst you are at University). Enrolment forms are available at the centre or can be downloaded here.

COMMUNITY SERVICES CARD

Most students are entitled to a community services card. An application form is available at the Centre. You must have already sent in your completed application form to be eligible for a free doctor’s appointment.

EXISTING MEDICAL CONDITION

If you have any ongoing medical conditions – eg asthma, epilepsy or diabetes – please inform the nurse at the SHCC as soon as possible. This is in order to provide you with the most appropriate treatment in the event of an emergency.

LOCATION

Student Health Centre (SHCC) Third Floor, Student Services Building, Wellington

CONTACT US

Tel: (04) 801-2542 or ext 62211 Fax: (04) 801-2547

OPENING HOURS

Normal Opening hours: Mon – Fri 8.30am to 4.30pm
During Semester Break: Mon – Fri 9am to 4pm

EMERGENCIES

AFTER HOURS AND WEEKENDS

The After Hours Medical Centre 17 Adelaide Road, Newtown Tel: (04) 384 4944
Healthline : 0800 611 116

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Victoria University, Wellington

TE RATONGA HAUORA TAUIRA

Excellent student focused care and support is available for students who have Type I diabetes at Victoria University of Wellington.

If you are a current student at Victoria you can register as a patient at the Student Health Service and almost all of your diabetes health care including laboratory tests can be completed on campus.

Our Diabetes team includes GPs Dr Cathy Stephenson Dr Sandra Bennett, and Practice Nurse Amanda Trueman. Kirsty Newton, Diabetes Nurse Specialist from the Diabetes Clinic at Wellington Hospital, visits the Service every three to four weeks during Trimester I and Trimester II. Dr Jeremy Krebs, Clinical Leader of Diabetes and Endocrinology Service at Capital & Coast District Health Board, sees students at our clinic on the Kelburn campus at 7 Friday morning clinics which are held throughout the academic year.

We have regular coffee meetings and education sessions including carbohydrate counting, healthy nutrition, alcohol and type I, and there is a Facebook group too.

Students have direct email and text access to Amanda which makes it easier to arrange repeat prescriptions, or when you need a new meter or insulin pen, or you are feeling unwell.

The work of the Diabetes Team at the Student Health Service was featured in the Nursing Review magazine. Check it out.

We also work closely with other services at Victoria to ensure students are able to access dental care, medic alert membership, are able to sit university examinations where they are can check their blood glucose level and eat and drink.

The Student Health Service provides full primary health care for all your other health care needs too, and for students who register as patients there is no charge for routine nurse and doctor appointments.

The Student Health Service is strongly committed to providing students who have Type I diabetes with the best nursing and medical health care possible. We want students to enjoy their time at Victoria, to achieve academically while also safely and effectively managing their health.

More information about Student Health Service is available.

If you are considering studying at Victoria University of Wellington and you would like to visit or talk with Catherine at the Student Health Service please give her a call on 04 463 5308.

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