Sunday, 31 December 2017

2017 Reflections - a busy year

*DISCLAIMER - Please note in this article I am purely referring to Type One Diabetes and my personal views in relation to the Animas Vibe as well as my own personal experiences of NovoRapid and Fiasp. Remember Your Doses May Vary and all information found in this blog post is my opinion and is what works for me ONLY. It is not intended as medical advice. Please consult the relevant health care professionals before you make a change to your treatment plan in any way*

Well it's been a while hasn't it....

This year has certainly been one of ups and downs...and I'm not even talking my diabetes. There has undoubtedly been a lot going on with job changes, buying a house, family illness, house renovations to name but a few. Oh, and then of course there's the diabetes to throw into the mix.

Well after the HUGE transformation that the insulin pump made to my life back in July 2016, I would love to say that it's been smooth sailing ever since. In reality though - that just isn't diabetes now is it?

Despite my control being vastly improved from the 49 hypos a month.... (that’s right...49 a month!!) that I was having prior to starting Insulin Pump Therapy (IPT), I had still been having a few night hypos and some before meals. As a result, I trialled the Dexcom G4 sensor in the hope that the CGM link-up to my Animas Vibe pump would help with the night time hypos. Unfortunately, despite a number of attempts to use the Dexcom, for some reason I cannot get on it with. After seeing some amazing results from other people using it, I was sadly disappointed to have many false alarms and very inaccurate readings on every sensor, despite trying different sites. 

As a consequence, I intermittently used the Abbott Freestyle Libre to gain an insight into the patterns of my diabetes during those 2-week periods.
Although, as many will point out, it doesn't have the full features of CGM's such as the alarm functions or insulin suspension option, the accuracy that I get from using the Libre made it a much more reliable method of gaining continual, uninterrupted data.

I didn’t just look at the CGM/ Flash Glucose Monitoring options in isolation though. I also looked at the effects of how my recently developed (past 2 years) insulin-sensitivity affected my control. One major issue I kept facing was the difficulty of pre-bolusing at the correct time before a meal. This was particularly problematic when eating out at a restaurant or when eating at other people's houses. I would find that I would often hypo before the meal arrived, meaning a lot of explanation as to why I was eating just before we were about to eat. Step up FIASP!!!

Fiasp (a form of faster acting insulin) despite eliminating the vast majority of pre-meal hypos in a short space of time, it did take a couple of weeks to adjust to. One of the major adjustments I had to make was lowering the amount of insulin I needed for meals. It seemed, that with the differing profile of Fiasp and also not needing to pre-bolus before eating food meant that I didn't need quite as much insulin as I previously did. Conversely, I had to increase my basal rate slightly to keep my levels within the desired range. These adjustments were aided by the use of the Libre in the first few weeks of transitioning to Fiasp. Again, I am aware that a number of people have had difficulty adjusting/ using to Fiasp, however I have personally found it really beneficial.

And this was only half way through 2017...

Although some of hypos previously mentioned were still happening and my diabetes levels were erratic at times, progress was being made bit by bit. Pre-meal hypos had now been addressed!

Despite all the above, there was still another big step forward towards better diabetes management to come thanks to some hard work of a group within the NHS.

On 1st November 2017, the Abbott Freestyle Libre sensors became available on the NHS to those who meet the criteria. Despite some inevitable teething issues, as is often the case with new drugs and change, almost 2 months in there are a number of people around the UK who are benefiting from this prescription introduction. I am very grateful to be one of these people who has been massively helped by 6 weeks’ worth of data, patterns and invaluable information that I’ve seen already. What a way to end the year!

Therefore, although progress can be slow at times and it can often feel like things don't progress much from the research stage in some areas of diabetes, I would say that 2017 has been a year of fruition. This year has given us more choice in terms of the diabetes technology available on the NHS, a new insulin coming to market, trials of new CGM'S such as the Roche Eversense taking place as well as lots of pipeline developments (the DVLA changes for example) that I'm sure we will see in 2018.
Despite there also being some potentially negative changes with Animas pumps no longer being offered to new patients, I personally view 2017 as a year of advancement, with the progress still continuing into the year ahead. Additionally, and definitely on a personal level, 2017 has also provided me with the amazing opportunities to be part of formal/national diabetes events/ meetings, social meet-ups across the country and getting to know more local people with diabetes. All of these events, combined with new technology and differing approaches has certainly enriched my knowledge when looking at my diabetes management choices and decisions.

So, let me wrap up this post by saying that despite being optimistic, I am also not blinkered to the challenges that the NHS, people with diabetes and Health Care Professionals will face in the coming years as new technologies and approaches are introduced. I am yet to master the art of perfect diabetes blood glucose/ sugar levels as you can see from my Ayres Rock impression that happened before Christmas due to illness and festive eating (ooops!). However, I was able to see this thanks to the progressions of 2017 and to monitor my corrections and adjustments in addition to regular finger-prick tests.

Yet despite the challenges that diabetes throws our way...I am excited to see where we will be in a year’s time when we reflect on all that's happened in the world of diabetes in 2018! Bring it on...

Thank you to everyone who has read my posts and I have met in 2017. I wish you all a wonderful and safe New Years Eve and I look forward to sharing my 2018 adventures with you very soon.

Until next time, keep injecting 💉 or pumping 📟 insulin!

Ros x

Sunday, 24 September 2017

A diabetes reconciliation: 1 year of insulin pump therapy

*DISCLAIMER - Please note in this article I am purely referring to Type One Diabetes and my personal views in relation to the Animas Vibe as well as my own personal experiences of NovoRapid and Fiasp. Remember Your Doses May Vary and all information found in this blog post is my opinion and is what works for me ONLY. It is not intended as medical advice. Please consult the relevant health care professionals before you make a change to your treatment plan in any way*

So I can hardly believe it, but it is well over a year since I first loaded a cartridge of insulin into the pump and pressed 'GO'.

And what a year it has been...

I would love to say that it was plain sailing from the start, but then that wouldn't be diabetes now would it?!? 
However, despite a couple of quite literal, highs and lows...the last 14 months of insulin pump therapy (IPT) have honestly transformed my life for the better. In fact, I'd go as far as to say that I've got my life back!

Prior to the pump start in July 2016, I had battled with my blood glucose levels for the previous 2 years, with the final 6 months seeing me having nighttime hypos so extreme that I didn't wake up on a couple of occasions until my parents let themselves into my house and physically shook me. I don't think I will ever fully appreciate how much they worried about me during this time, other than remembering the look of fear in their eyes one day when they woke me from a hypo... 

To say that I became scared of sleeping would be an understatement. Nonetheless, I would reach a point in the day where my eyes were so heavy that I couldn't fight the tiredness anymore and I would drift off to sleep, but this would be with a sense of worry and concern about whether I would hypo in the night or not wake up for my alarm the next morning. It was literally a guessing game...some weeks I would not hypo during the night and other week's I would hypo 3 or 4 times. To say that I was physically, emotionally and psychologically exhausted would not quite cover it. I was running on empty...

The day I finally got the 'yes' to pump therapy was life-changing for me. I knew that there were no guarantees or quick-fixes attached to insulin pump therapy, however it meant that I had an opportunity to approach things differently and to be able to inject the minuscule amounts of insulin that I actually needed after suddenly becoming hypersensitive to insulin. This substitute to multiple daily injections (MDI) for me became a life-line that I had dared not hope for.

After a few weeks of waiting and some training sessions, finally it was the day to start on using my insulin pump. To say that there were high expectations would not quite cover it. For me, my whole future as a functioning, working and independent adult hinged on the pump therapy being effective or at least improving my diabetes control somewhat. This probably wasn't the best way to start insulin therapy, but then again, diabetes doesn't always make things easy for you, and quite frankly, I didn't have many other options open to me and at 33 years old I wasn't ready to give up.

I felt like it was my first day in school again...that I didn't know what I was doing or what the rules were. But like an eager student keen to get top grades, I wanted to get the very best out of pump therapy and had researched and spoken to many people about it before I started. This is something I would highly recommend, as pamphlets and websites don't give you the reality of life with an insulin pump. I needed to know the benefits and the pitfalls before I experienced them, I needed to be prepared! For me, speaking to people who used an insulin pump on a daily basis both before I started pump therapy and in my early days, transformed my approach and gave me a huge confidence boost about the things that could be achieved. This is where the online diabetes community really come into its own. No question was ever to basic or viewed as silly. People who I had never spoken to before all took the time to answer my questions, point me towards sources of advice and to offer their support which I had never experienced before. From these people, I found the information given to me about adjusting basal doses, the use of temporary basal rates and where to wear your pump (a really question when wearing a dress!) were all hugely helpful and comforting in the early days. On the occasions when questions pop-up now, the online community are always there to help out.

As I got more confident in the functions of the pump I found that my control continued to improve. Nonetheless, as I eluded to earlier, that didn't mean that everything was perfect the moment I switched from multiple daily injections to pump therapy, but I would say that my life literally changed within days. No more night hypos, no more yo-yoing blood sugars from one extreme to the other and no more headaches, nausea and exhaustion. More importantly, as time passed from the start date of pump therapy, the fear and concern began to fade from the eyes of my parents and close family and friends. 

The most recently change for me has been the switch from NovoRapid to Fiasp in the last few months. This eliminated the need to pre-bolus before a meal. This may not sound like a huge deal when you're at home and you know your food will be ready to eat in 10-15 minutes, but this became a huge issue for me when eating out at restaurants or other people's houses. Mistiming an insulin dose could wither result in overly-elevated blood sugars where insulin was given too late or hypos occurring prior to the meal if the insulin was given too early or the food is delayed. Despite Fiasp not working for every person with diabetes, I am grateful that for me it has given me the freedom to inject just as I start to eat, and to avoid the pre-meal insulin dilemma. One more little step towards being able to take actions towards managing my blood sugars safely. After a few initial dose tweaks and a bit of trial and error when it came to exercising, I finally figured out the quantities I needed on a typical 'Ros' day!

Finally, I started to feel like I had some control in my day-to-day blood glucose levels, even if diabetes does like to throw curve-balls in there every now and again. In fact, the last two days have been a diabetes 'mystery' that I am still playing detective over as you can see from the Libre graphs below. Yet despite these little or big conundrums that type 1 diabetes likes to throw our way, thankfully these days they are few and far between.

Thankfully, looking at the journey overall since beginning insulin pump therapy, my blood sugar levels have really stabilised (despite the odd obscure number every now and again), with my last HbA1c result coming in at 6.0% or 42 mmol/mol.

Therefore, after lots of reading and research, speaking to many people including healthcare professionals and fellow people with diabetes, making many dose adjustment decisions and trying new approaches and a new insulin, I would say that this year on insulin pump therapy has been momentous in my diabetes adventures. For the few road bumps that I've had to overcome or work around, I have been able to enjoy my life a lot more and to feel far more confident in taking the reins when it comes to my diabetes management.

Thank you once again for taking the time to read my blog post.
Until next time, keep injecting 💉 or pumping 📟 insulin!
Ros x

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