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. 

Why, why & Why

We all know that time flies and life without the insulin pump seems a long time ago already.  It is only just three months that I am "hooked" up.   I remember that I was very anxious when I had the training and I wondered how it would change my life.   It has definitely changed my life.  Luckily in general for the better.   I spoke with my specialist and with the diabetic nurse and both consider me some kind of "miracle" as they have not seen any one who reacted so well to the use of the pump.  As you can imagine I am really happy about this.  But it is not all roses.  

The reason it goes so well in general is the fact that I do the carb counting really well.  It goes not so well when I go for a walk or after I have done a walk.  This is a learning process and I will write about this in my next blog: " my new goal,  a day walk".  

Another learning moment was a couple of weeks ago, when all of a sudden, within one hour,  the BGL went up above the 18 and I had not clue why.  Unfortunately it was not because I had a nice piece of cake.  It was even more alarming as the BGL's according to the BGL meter were 27. I got quite stressed and I was wondering: why, why & why.  

During the training, the diabetic nurse urged me to check for ketones when the BGL's are above 15.  Ketones is a new thing in this blog.   Ketones are bad for patients with diabetes 1 (and I was told, you dont have this when you have diabetes 2).  In short,  ketones poison the body.  You can measure this with the BGL meter and special test strips.  I was told that when the result is above 1.5, you need to look for medical attention.  Well,  the meter advised  me 1.7, so I had to take some action. 

                              

                                                                     Action required

I followed all the the roles in the training book.  First thing I gave myself insulin the old fashioned way, with the insulin pump as there was obviously something wrong with obtaining insulin via the pump.  Second thing  I did was drinking 0.5 liter water, to take care that the ketones would leave my body as soon as possible.  The third thing  I did was changing the infusion site as I had the feeling that this could be the problem. The fourth and final thing I did was calling  the medical assistance help line and after some questions of a nurse, I was advised to see a doctor.  Of course this all happened in the evening, so my husband and I went to the after hour service in the hospital.  In this current "Covid" world,  a place you like to avoid, even in New Zealand.  

Luckily there were no other patients and I was seen by a very friendly doctor within 10 minutes.  This very friendly doctor advised me straight away that I probably knew more about the insulin pump than he did.  But he also told me that I did the right thing by coming to the hospital and have a check up.  The good thing was that I did not feel unwell.   I was just shaken and very insecure about this all and I needed re-assuring.  The doctor did some checks and with a BGL/Ketone meter of the hospital, the values were re-checked as well.  This showed that the ketones were back to 0.4. This is within the normal range and BGL's were 19, so still high,  but not as crazy as 27 and not rising.  

So,  yes, I was re-assured that there was nothing serious, but I still had a lot of questions.  For instance, was my meter correct because the ketones had come down so quickly  and was I overreacting?  Well,  on both these questions I got the answers from my diabetic nurse.  Yes, ketones can come down so quickly, because as soon as your body gets insulin again, ketones are "chased" away.  And he also advised, no, I was not overreacting, it was the first time that my body did not receive any insulin and I did exactly what I was suppose to do.  It was a very good learning moment and now that this happened, I know that next time, I don't need to see a doctor,  but just do the things I did and it will all settle down again. 

 Spot the insulin on the infusion set

So why did the BGL's go up so quick and why did I not obtain any insulin.  It all happened after I changed the infusion site of the pump.  I need to do this every 3 days.  I was entering the little needle somewhere in the abdomen.  This is also the location where I injected myself with the insulin pen.  These  injections have caused that on certain spots there is scar tissue underneath the skin.  You can not see or feel this scar tissue, so it is kind of "hit and miss".   This time, it was a hit and because of this the insulin could not enter my body and was "send" back along the needle, out of my body. (This is called tunneling in the medical world)  See the photo of the infusion set with the needle and the wet spot of the insulin.   Unfortunately you don't see this when the infusion set is in. You really need to take the infusion set off, to spot this.                 

 For me, the solution to avoid this from happening again is to place the infusion set on the area around my hips and/or in my lower back.  So far, so good.  I now know what to do, when the BGL's suddenly rise above the 15 and I have no clue why.