Try to become motivated again

 Hello again, 

Already the beginning of September and  after four months of traveling and almost three months of adjusting to a "new" life in the Netherlands, it is time to, kind of, start all over again with managing my diabetes.   In saying this, luckily,  my average BGL's are not bad.  The upload of the blood sugar meter shows 7.5.   

On the 18th of February, the movers packed the scales and since than I did not weigh myself.  I know/feel that I have gained some weight.  To be honest, I am a bit scared to see what the scales will say.  But as I will start maintaining this blog again,  I promise you all, that next time I will tell you, so a motivation for me, to put some batteries in the scales and step on it.  

                                               

I gained weight because I just enjoy all the good stuff in the Netherlands.  I am amazed by the enormous choice in the supermarkets.  The abundance of everything.  For example, when I left the Netherlands (16 years ago) there was just one kind of "stroopwafels".  Now there are all kind of luxurious filled and decorated "stroopies".  And that is just one example.  A stroopwafel is of course not diabetic friendly,  but a mini one, does not seem to be too bad,  (average carbs 5 gram).   This is true, if you only take one,  but the temptation to eat more is always huge.  So for the future, I have to stick to one again.   (A good tip, not to keep eating things is to take a sip of water, so the lovely taste is gone and you are not tempted to eat more) 

                                             

Another new thing for the near future, will be me, getting acquainted with the Dutch diabetic healthcare.  I have made an appointment with a diabetes specialist for the beginning of October, so in one of my next blogs I will tell you about this.  I hope he/she will be familiar with my pump and sensor combination.  And hopefully, he will support this, so I will be able to get the sensor funded by the health insurance.  To be continued. 

I have contacted the support team for the Tandem pump and I am able to get 24/7 support in the Netherlands.  The same counts  for the Dexcom G6 sensor.  Both items are available in the Netherlands,  but not as commonly used as in New Zealand.  

As my life is still very busy at the moment, it will be difficult to maintain a good diet and to exercise as much as I would want.  But I will start with the basics again, like a healthy breakfast instead of my favorite sandwich peanut butter with chocolate sprinkles.  I will aim to walk at least 10.000 steps per day.   Another simple goal is to drink enough water again.  And if I like something nice with my coffee, I will just take on cookie.  But most important is to be "happy". 

One thing I will definitely keep on doing is having a coffee at a nice outside café.  I found already  a nice new place where they make very good barista coffee.  It is also at a lovely spot in my new home town. 

                                  

Right, this is it for now.  I "talk" to you all in a couple of weeks time.  I hope I really got motivated again.  I will let you know. 

                             

                                                              In my happy space

                                     

Ups & Downs, Highs & Lows

My last post was in January.  The main reason was that I am traveling and I was not so motivated to sit down and tell my story.  I was not that motivated, as I thought, I did not manage my diabetes as I should.  Of course, this is all in my mind, so hopefully, when I write it all down, I can convince myself, that I am doing well.  

Mid February, my husband and I left for a trip on the South Island of New Zealand.  This was all we knew, no time frame, no fixed destinations, just the freedom to do whatever we liked.  I knew that managing my diabetes would be harder, so we would stay mainly in motels and self contained units (airbnb) with full kitchen facilities.  I hoped that living this amazing life, as that is what it is, would help me to relax more about my diabetes management.  Unfortunately, I have to say, after three months of traveling, it has not. 

While we stayed in a lovely cottage in North Canterbury,  I uploaded for the first time in six weeks, the information of my sensor.  I was pretty sure that the average BGL over the last three months would be a lot higher as usual.  Luckily I was wrong.  The result was 7.7 mmol/l.  In "normal" life, it was on average 7.6 mmol/l.  So I should have been really happy and yes, I was not disappointed, but still,  I hoped that this relaxing life style and  the amount of walking we have done, would have given a better result. 

The other thing I hoped was that during this trip, I would be less focused on the BGL numbers and that I would not look at my pump so often, as I do this quite a bit.  Unfortunately this has proven to be impossible.  Due to the more irregular way of living, the BGL's  swung way more.  Ups & Highs caused by different food or pump accessories.  Downs & Lows caused by different food and exercise.  I will explain this. 

Ups & Downs because of different food is easy to explain.  It is not always possible to know the exact amount if carbohydrates when, for example you go out of dinner.  Also, as you know,  I love "my coffee".  I also love the nice baked goodies on display in the cafe we visited.  The temptation just to have something nice was maybe a bit to high sometimes.  So if this caused the BGL's to go high, I could at least blame myself.  (But I should not blame myself)

I did enjoy this treat, without feeling guilty as it was my birthday treat

What is/was very frustrating is when I see a rise in the BGL's and I cannot explain this.  During this trip I have learned that during warm, sunny days, the insulin is not working as good as it should.  When the insulin in the pump has got too warm,  the basal (background) values are not correct anymore, so the BGL's are creeping up.  Another increase of BGL's is caused by saturation of the infuse site, if the chosen spot has already some scar tissue, so the insulin can not be absorbed any more. 

The Downs & Lows because of exercise I have "talked" about in other blogs.  It is so difficult to avoid going to low when I go for a walk.  I did a couple of longer walks in the past weeks.  One was the last day of the Abel Tasman track.  This was a total of 16 km and around 6 hours on the track.   It went really well until after lunch.  Approximately one hour after the lunch, I got a hypo.  Reason,  the insulin I gave myself for the food I ate was already "working" and together with my body burning the sugars because I was walking, the BGL's came down quicker than that my body could process the carbohydrates.  Even with the basal rate on only 20%.

These fluctuations make me insecure and I feel out of control.  This makes me look to often on my pump,  as I like to be in control and to be sure that my BGLs  are on average between 6 and 8.   If I think that the BGL's are too high or creeping up too quick,  I adjust my basal rates and/or I give an extra bolus.  This overwriting of the pump can also lead to lows,  as I don't trust the pump and of course too much insulin is actually the main course for going low.  

Anyway,  as I wrote in the beginning,  the average of the BGLs has not gone up enormously, so I do something right.  Will I ever be more relaxed about it all,  I don't know, I hope so.  For now,  I will keep enjoying traveling through New Zealand and just keep on trying to be a bit more relaxed about it.  

I really enjoyed the walks I did while I was traveling 

New Year resolutions, training and low carb banana loaf recipe

New Year resulotion

2021 is already two weeks old.  I think we are all relieved that we left 2020 behind and now we are looking forward to a better 2021.  What will it bring?  Will there indeed be a "new normal" or will we get back to "normal".  Whatever it will be,  I hope it will be a good 2021 for every one.  

                                                    Happy New Year

A normal thing to do at the beginning of a new year is to come up with New Year resolutions (in Dutch: goede voornemens).   I actually don't have any.  I just keep on doing what I am doing.  Question: "is this a new year resolution?".  Since I got my insulin pump, I lost around 10 kg and I am really happy about this, so if I keep doing what I do,  I will loose a little be more. 

The average BGL over the last 6 months were 7.6 mmol.  Although I would like to have this a bit lower, my specialist thinks that it is perfect, so again,  I keep doing what I do and things go well.   

On average, I do walk 10.000 steps a day.  I do this already for 10 years, so no change required for this.  I tend to eat healthy,  I never smoked and one glass of wine a month, that is not a problem either.  So I think for me there are no new year resolutions required. 

If you made some new year resolutions, good luck,  hope you achieve them.  

Training for the Half Dome walk. 

In October I wrote about my goal to walk up the Half Dome in Yosemite National Park.   The goal is actually more generic, to be able to do a full day hike again.  Last week my husband and I walked the "Skyline Walkway in Wellington". (https://wellington.govt.nz/-/media/maps/files/skyline.pdf) This is not a full day walk, but we walked for five hours.  

It went really well.  My main concern while I am walking is getting a hypo (very low BGL's).  So I work on figuring out what to eat and the amount of insulin to give when I am exercising.   We started the walk at 10.30 hrs.  My breakfast I treated as normal.  But one hour before the start of the walk, I lowered the basal rate to 20% and half an hour before the walk I ate 30 grams of carbs.  I did not give any bolus insulin for this.  During the first 2.5 hours of the walk,  my BGL's showed a constant level of around 10 mmo/l.   I was pretty pleased with this. 

We lunched after 2.5 hours.  I ate a sandwich and again I did not give any bolus insulin for this.  This was not so good,  because the BGL's climbed up towards the 13 mmo/l.  Not shocking,  but I had hoped that it would stay around the 10 mmo/l.   This was approximately 4 hours into the walk.  As we only had one more hour downhill to walk, I gave a correction bolus.  This was not a good idea, because just when we finished the walk,  I got an hypo.  So what did I learn.  If I eat something during the walk,  just give a bit of a insulin bolus to keep the BGL's level and never to correct the BGL's when I still have to walk for a bit.  Just do a correction if required after the walk.   Overall, I was pretty pleased with the result.   Up to  the next, maybe even longer walk.  

                                               Amazing views one the skyline walkway

Low carb Banana loaf (Yummie) 12 slices, 14 grams of carbohydrates approximately

I baked this really good low carb banana loaf.   The grams of carbs depend on the size of the bananas.  

Ingredients:

• 100 grams rolled oats (havermout)
• 3 ripe (small) bananas  ( 18 gram carbohydrates per 100 gram )
• 3 eggs
• 50 grams ground almonds
• 2 tbsp of something like butter, margarine or coconut oil, whatever you prefer
• 50 grams yoghurt
• 0.5 tsp vanilla extract

Mash the bananas, mix with the ground almonds, add the eggs, yoghurt and vanilla extract.  Mix it all together and add the rolled oats.  

Put in to a cake tin and in the over for approximately 30 to 40 minutes at 180 degrees.

Enjoy!!

Support and Christmas preparations

Very important for someone living with diabetes is the support of the people around them.  I think I did not realise how important this actually is.  I am a person who prefers to sort out things herself, because I don't want to bother other people with my problems and I think, I will figure it out eventually.  Now, I slowly start to understand that is OK to ask for help and to discuss what bothers me.  

When I was diagnosed with Diabetes 2, I searched on the internet about what to do to reverse the diabetes.  When it was not working, I got frustrated and blamed myself  but I never thought of discussing this with my doctor and/or asking for a referral to a specialist.  Of course sometimes I talked about things with my husband and with my friends,  but most of the time my reaction would be afterwards: "I will figure it out myself" 

Now that I know that I have diabetes 1 and that I have the insulin pump,  I start to see how important it is to ask for advice and to accept this advice.  It is still difficult for me, but writing it down in this blog  means that I really start to become aware of this.  

The most important support person is of course my husband.  How often already was he the one who had to deal with my mood swings.  One moment I am so happy when my BGL's are good, the next moment I am so terrible upset as the BGL's go up and I cannot understand why this is happening.  He tries to calm me down and he tries to put if all in perspective.  He went to the pump training with me and although my initial thoughts were that that would not be necessary, I now know that this was really important, as I should not exclude him from my "diabetic life".  Now he can advise and support me.  All I have to do is accept this.  

                                                            With my support of life

In the past I also waited way too long to contact my medical team.  Maybe I did not want to bother them because they would be too busy to see me.  Now I know that my diabetic nurse is just one email away and that he will make time to talk to me and that this will give me reassurance that I am on the right track.  

I know that accepting support and asking for help will always be difficult be me, but I see how important it is, not only when you have diabetes, but for everyone. 

So, the serious stuff out of the way, time for something fun. In three weeks time it is Christmas again.   Although you can eat "everything" when you are a diabetes patient, it might not be the best thing to do.  Knowing how much carbohydrates you eat and giving yourself the correct amount of insulin is a way to deal with.   I just want to deal with this a bit more responsible. 

Over the years I bought the magazine "diabetic living" regularly.  This magazine has articles about how to live with diabetes and it also contains nice recipes with the amount of carbohydrates.  I have four Christmas editions and I will "hunt" for our Christmas dinner in these magazines.  Later this month I will update you on the result.  

A Christmas cake needs to be made in advance, so that is already done.  Please see the recipe and the result below.  As the recipe might be really hard to read, but you like to bake this diabetic friendly Christmas cake, please let me know and I will forward it to you. 

 

Well, enough for this blog.  I hope you enjoy reading it and although I think it is hard to ask for advice, I love giving it and to be a support for someone else, so don't hesitate to contact me. 

Traveling with my new "best friend"

If you know me already a little longer, you know that traveling is my big passion.  I traveled extensively while being diagnosed with Diabetes, but traveling with the new insulin pump was a new experience.  I am just back from a  road trip of two weeks here in New Zealand.  I like to share some of the experiences with you. 

Let me start with the preparations.  On a daily base I already need to take quite some stuff with me.  I have this little pouch (photo one ) that contains: test strips, meter, blood test pen, insulin pen, glucose tables, needles, a full set to change the insulin container and infusion site for the pump, and my weekly dose of medication.  

This means that when I travel I have to calculate, how much of all these requirements I need to take with me  for the time I am away, plus some extra in case there is an unexpected delay.  Also there are a couple of extra things, like the BGL sensor, alcohol swipes and tape to adjust the infusion site.  Photo two shows everything I took with me for this trip of a fortnight.  Can you imagine what a pile it will be when I will go on a trip for three months again ☺ (hopefully sometime in the future again) 

 

    Photo 1                                                      Photo 2 

Two other new things I experienced, was making use of a spa pool and going for swim.  The pump is not water resisted. The BGL sensor and transmitter are.  A normal day to day experience is taking a shower.  For this I unhook the pump,  for a period of approximately 10 minutes.  As you will understand I wanted to enjoy the spa pool for a little longer than just 10 minutes. 

The advise is that you can be without the pump for two hours.  This means that you will not receive any basal insulin for this period.  I thought it would be good to go into the spa pool just after I had given myself a bolus for food, this would mean that there would be enough insulin in my body.  I did enjoy the spa pool, although in saying so, I think I was not as relaxed as I could have been.  I was a bit anxious about the working of the sensor and the transmitter. I was not so worried about the BGL's.  

The sensor and the transmitter kept working fine,  but my BGL's went up quite a bit.  I was without the pump for approximately 45 minutes and the result was that my BGL's went up to almost 15.  Not dramatic, but still I was not happy about this.  What did I learn? Whenever I like to do something like this again,  I have to give more "pre-bolus" so that the BGL's will not rise so much.  

Was it worth it? 

Eating and drinking are of course also quite different from the home situation.  We stayed in self contained accommodation most of the time, so I can prepare my food and I knew, most of the time, exactly what the number of carbohydrates were, so I could instruct the pump accordingly.  But part of the travel fun is going out for dinner, or as in this trip,  enjoy drinks and nibbles with friends and family.  For me it is extremely hard to "let go".  To "not care" and have BGL's that are a bit higher as normal.  I experienced some stress moments about this during the trip.  Back home, when I uploaded the information of the pump, it showed that  the average of the BGL's was not a lot higher than during a "normal"  fortnight, but still,  I will have to learn to deal with those "high's".

To end on a good "high".  I did some very nice walks during the trip.  I stood on the place where James Cook landed.  I climbed to the most eastern point of New Zealand and I hiked to some stunning waterfalls.  I definitely made some progress on controlling the BGL's while exercising.   

    

    Happy at Shine Falls                    Part of the 800 steps to the East Cape Lighthouse   

Traveling with my new "best friend" had its ups and downs,  but the overall control and management of my health was a lot better.  It will definitely not stop me from traveling and I hope that the world opens up again quickly.  Stay safe, where ever you are. 

First HB1AC result

As I wrote in the "meten is weten" blog of the 4th of September,  every three months I have a blood test done to measure the average HB1AC over this period.  As I started with the insulin pump mid July,  my first test over the full three months period was mid October.  

I was so looking forward to tell you all about the result,  as I was able to follow what my average mmol/L is, as I upload the information of the BGL sensor every week.   I was so happy with this information as it showed that since the 16th of July,  my average BGL's are 7.6 mmol/L.   This is such an improvement.  If you convert 7.6 mmol/L to HB1AC the outcome should be 46.   Of course I don't know exactly how accurate the BGL sensor is,  but I hoped and expected an HB1AC somewhere between the 45 and the 50.  

It takes normally 24 hours to get the result back and when the email of the GP came, I was so excited.  Unfortunately the result was very upsetting, as the email showed 56.  I was in tears,  I did not understand this at all.  How was this possible, after all my hard work, to get the BGLs to 7.6.  HB1AC 56 converts to 9 mmol/L.  I questioned everything, like would the blood test be done correctly,  but most of all, I questioned  the accuracy of the BGL sensor.  

Of course the result came in at a time I could not get hold of my diabetes medical team.  All I could do was email the nurse.  Luckily  the next day, he emailed me back straight away.  He could not answer all my questions, but as always he was good in re-assuring me, as he advised that he seldom had a patient who did so well and that 56 showed good management of diabetes control as the medical world  uses the target of HB1AC between 50 and 55 for this.  56 is close of course.  

However, he also advised about patients who are "high glycators".   Something I never heard off in my diabetes life.  It is good to have some explanation,  but this gives also more questions, like, will this have consequences for the future or could this be treated.  My nurse could not answer these questions, so I have emailed the specialist.  This story will be continued.  

Something completely different and something that made me happy this week was the 'find" of the perfect belt to wear the pump.  The pump comes with a clip, so you can attach it to your clothes.  This is not ideal, as there is a chance that it comes loose or it scratches your skin.  I was looking for something that would be small and convenient. 

You probably all know the feeling that "Facebook" can read your mind.  You get to see those irritating adds.  Well luckily for me, this one time they showed exactly the thing that I was looking for, a fitness belt with two small pockets with a zip.  Price via the side of the add was US $29.99 + shipping costs.  Well, of course being Dutch, I thought this was a bit over prized.  I started a search on internet and YES,  I found exactly the same belt, on a NZ website for just NZ $6.50 + delivery costs.  I ordered the belt straight away and I am so happy with it.  

                

An happy ending to this blog.  The next blog will be about living with the pump, while traveling. How will it be when I don't have my normal routines.  I will let you know.   

A new goal, "Half Dome in Yosemite National Park"

 As I wrote in my last post,  I have given myself a new goal.  I like to be able to walk up to the top of the Half Dome in Yosemite National Park in the US.  When this is going to happen,  I have no idea, but lets say in about two years time.  As you might have read (https://diabeatic.blogspot.com/2020/09/ ), when I was diagnosed with Diabetes 2,  I planned and trained to walk the Milford track.   To reach  the summit of Half Dome will be a real challenge,  but achieving it would be fantastic.     

                               

                                                        In 2003 I was half way 

The biggest challenge will be to get the BGL's right during this enormous exercise. At the moment,  the BGL's are all over the show, even when I go for a short walk.  To give you an example,  yesterday I did a flat walk off only two hours.  During this time,  the sensor showed me BGL's as low as 3.5 up to 13.  I started the walk with a BGL of 6.1, within 30 minutes,  I was too low and than after eating, but not compensating with insulin, the BGL went up, while I was walking and I had to give insulin to avoid going to high. 

Before I continue  I will explain first some basics of the working of the pump.  The pump continuously pumps a tiny bit of insulin into the body.  This is called basal rate and this is based on the calculation of how much insulin is required to get the BGL's on target (see below).  When I eat something,  I bring in on  the pump the grams of carbohydrates that I will eat. The pump calculates how much  insulin is required.  This is based on the carb ratio. All the "meten en weten" (https://diabeatic.blogspot.com/2020/09/) of the past have determined this. The insulin given is a bolus. 

Both the basal and bolus amount of insulin will help to keep/bring the height of the BGL to the target value.  The target is a number between 4 and 8 mmol/l, to live a healthy life and the calculations are based on for example to reach target value four hours after some food or in the morning before breakfast. 

I can totally understand, if all this information is confusing you.  Please contact me, if you like more information. 

Since I am using the insulin pump I have been doing quite a lot of walks already,  but unfortunately I have not found the correct way of controlling the BGL's.   The advise I have been given is the bring the basal rate as low as 20% or even stop given insulin at all.  This will need to be  done already one hour before I start the exercise.   Also,  I need to adjust the bolus amount of insulin as the body burns of the carbohydrates quicker, so less insulin is required.  It will be a lot of trial and error.  Hopefully the errors will not be too severe.  

I will keep you posted of my progress and about all the other walks I will be doing while training for this event.