Not Noodle

I was "donated" a bag of nice Pot Noodles for when Sandra was away on holiday. Thank you.

I have always liked pot noodles (sorry), but they are one of a few foods that cause problems for blood sugar, even though not too bad in carbohydrates. Another is some maize snacks like Monster Munch. They send my blood sugar super high for a short period. I have to avoid them.

Thankfully I have mastered pot noodles now, waiting for my blood sugar to be low, drinking some whisky (yes, that has a massive impact on slowing the whole process!), and taking some tablets to help with the blood sugar on top of the daily insulin, and I can eat a pot noodle safely.

But today I was fooled, I found a "not noodle". One with no noodles!

I did what anyone would have done, and combined the spicy sauce packet and the not noodles with the next pot noodle to make a pot₂ noodle. And wow, it was spicy and intense - amazing. They should do pot₂ noodles as a thing. It was amazing.

Freestyle Libre vs Dexcom

I have used freestyle libre CGMs for a long time.

Yes, obviously, I’m diabetic, but I have always felt like a sort of amateur diabetic! I take one injection of slow acting insulin a day, not like real diabetics that have match a dose to what they eat every meal. I did not know imposter syndrome was a thing with diseases :-) However, having seen the CGM readings for a couple of non diabetics now I can see that my blood glucose is very different to “normal” and feel a tad more “legit”…

But not having to match insulin to every meal (I take tablets with meals to help) I’m not the normal target for a CGM. However, if you can afford them, I would recommend them for anyone who is diabetic even if like me it is more “mild”. Indeed, perhaps even more so where I cannot easily compensate for eating the wrong thing, the CGM has helped me get my diet right (on most days). My reaction to carbohydrates is far from obvious as some simple things can send my sugar spiking but others are no problem. The CGM helps me learn the problem foods and drinks, and what is not a problem. Even so, that is not always consistent, and can have surprises...

For example:-

• The small hump on the left last night was an evening meal with loads of rice and vegetables.
• The big spike in the middle was breakfast, which was a single sandwich (i.e. one slice of bread cut in two) and bacon, with a tablet even. No idea why so high!
• The small hump on the right was a large roast beef dinner, vegetables, and even a nice cherry cheese cake with syrup - which I expected to be a "problem"...

Not an ideal day for sensible diet, but the effect is not anything like obvious from the meals!

However, one issue with the freestyle is they occasionally screw up and don't work. Yes, in theory, I could send them back, but it got so annoying I decided to try a Dexcom instead.

Freestyle libre

• Each sensor lasts 14 days - means changing on same say of week.
• Takes one hour to warm up at start.
• Has to be scanned regularly, and only holds last 8 hours. Any older data lost if not scanned.
• Works out around £25 a week.
• The newest model has alerts for low/high but still needs scanning for readings.
• Occasionally screws up and you waste a £50 sensor. Yes, could send it back.

Dexcom

• Sensors lasts only 10 days.
• Works out around £37 a week (on yearly plan).
• Takes two hours to warm up at start.
• Updates phone via Bluetooth so no scanning. Seems to catch up if not near phone for a bit, but no idea how much memory.
• Has alerts for low/high, or soon to be low/high.

The actual sensors are different, the Dexcom has sensor and transmitter. It is bigger, has a bigger sticky patch, and thicker. The transmitter is silly - 3 month life limit and buy a new one (I included in above price), but seriously, in one off, it is £200! Why not 50p for a new button cell? And it is not like it is more complex that the whole freestyle sensor which is £50. Definitely some level of price gouging there, in my opinion.

Having said that, their web site makes no sense - you can buy packages, or individual sensors as it says "You can always choose to pay as you go, purchasing Dexcom products whenever you need them". However, the individual sensors say "Limit: 1 per user". So do they mean you can only buy "one at a time", or "one, ever". I assume "one at a time", but if that is the case the Starter pack (3 sensors and transmitter for £159) which says "Limit: 1 per user" would be the best deal of all, if it means "one at a time", so I have no idea!

The other thing that is interesting is the difference in the actual readings... Here is the last 24 hours on Dexcom and Freestyle.

The breakfast peak shows as 15.3mmol/l on the Dexcom, and under 13 on the Freestyle. The dips over night (that caused an alarm) shows as 3.1mmol/l on the Dexcom, and nearer 4 on the freestyle.

Scaling and overlaying you can see they are close, but not quite the same.

Problems!

The sensor lasts 10 days, well should do. I managed 5 days before it was too painful, and I removed it. The start pack has three, so I'll try one on my arm, but if that does the same I'm going to ask for a refund. Never had this with the FreeStyle Libre.

FYI, a week later this is still not healed properly - it is getting there but pretty serious reaction. I tried on my arm, and whilst the reaction was a lot less severe, I had to remove it as it was too irritating after a few days.

Dexcom are being slow to do anything. I've filed an MHRA report anyway.

Diabetes, and CGMs (Freestyle), non-diabetic using one!

I have been diabetic for a few years. My mum was too, since she had me, and we suspect this is what did my grandfather in (undiagnosed) to be honest. It is often hereditary.

I have often felt almost like some sort of fraud. I have insulin, as just taking tablets was not working, but the process is to review my HbA1c, maybe once a year, which is a test that sort of gives an average blood glucose over some months, which is not that good a "picture". But (having lost some weight) I am on a low daily dose of insulin now. That has advantages (one jab) and disadvantages (cannot adapt to changing circumstances easily). I have tablets too. It is "mild" compared to many people.

However, when I started losing weight, I also decided to buy, with my own money, at a cost of some £100+ a month, a continuous glucose monitor (CGM). It sticks on my arm and logs interstitial glucose levels and keeps a history. It has its quirks, like only 8 hours of data (and some times I try and sleep more than that!) so has to be scanned at least that often for a full picture. It is also maybe half an hour behind blood sugar levels, so I can feel hypo when it shows higher as it has not caught up.

However, I have found it hugely useful with managing my diabetes and diet. It is really good for making me aware of the wrong things to eat (basically sugar) and what I can eat in moderation and get away with in, and how much I can eat of something without getting away with it. This is mostly feedback of history rather than "am I really hypo now" which a blood test can do.

Sadly they are not cheap, but I feel they should be used more. They are normally only prescribed for people with severe diabetes, but I can see they should be really useful, even for people just trying to control it with diet. It is a shame they are not cheaper and prescribed more.

Recently I was able to see what a "normal person" is like on one of these. That said, it was rather odd. A friend of mine (who will, no doubt, read this blog) was diagnosed with gestational diabetes. So I gave her a CGM (and another as she knocked the first one off on a car door, FFS). She did not want to do the requested 8+ finger pricks a day, so my treat.

The thing is, having used the CGM, no way is she remotely diabetic. This is one day (with her permission)... Yes, charge that battery FFS!

Subsequent days I have seen are lower than that. She does not spike over 7 even when eating stuff she knows she should not.

For me this was really interesting as I did not know what a "normal", non-diabetic person looked like on a CGM, and now I do. It puts my graph to shame, and I am well controlled (apparently).

Like I say, I almost felt like a fraud, until I saw that, and I know I am nothing like that good. My diabetes is mild, under good control, but very real. I don't feel like a fraud any more, and even wonder if I need fast acting insulin doses when I eat as I can peak at 10 mmol/l, and occasionally more.

Interesting stuff.

P.S. As requested, here is one of mine, on a really good day... Most days I am peaking higher.

Fun game!

I am getting used to the glucose monitor now, and starting to get the hang of keeping things in check a bit more.

What is driving me somewhat mad is how things can be unexpectedly inconsistent. Some nights I can be bang on normal (in the green band) all night; others droppings really low, so much so I wake up feeling ill and even have to have something to eat; but another night gradually going from too high at midnight to too low at 6am as a nice gradual drop. This is all on exactly the same insulin dosage.

Some foods have massively more impact on blood sugar than others, and the clues are on the packaging, obviously. The main peak today was eating 3 jaffa cakes, that was all, just 3.

I have pretty much decided that even if we drive to the restaurant in Bracknell, I need to make the effort to walk back afterwards even if a couple of miles, as that really does knock down my blood sugar nicely.

Though today I have had a couple of lows that I would also like to avoid.

P.S. Yes, I know crisps and jaffa cakes are a bad idea, you don't need to tell me :-)

P.P.S. Yes, it did go up a bit after that, but clearly walking made a dent!

My first Borg implant

Actually, just a Freestyle Libre glucose sensor!

As you will know I am diabetic, but I am reasonably lucky at this point that whilst I don't make enough insulin, I only have to have one long term injection a day. This is, in some ways, a mixed blessing, but I would rather not have an injection with every meal.

When I have a good routine I don't have to check my glucose levels, but I am losing weight (lost 19kg so far) and this is causing a bit of fun and games. I have been lowering my carbohydrate intake and my insulin but I do need to keep things in balance. On top of all of that, exercising is helping and means I am lowering my insulin even more to avoid hypos (low blood sugar) all the time. I was managing to have high glucose and low glucose, both of which are a problem. I was getting fed up pricking my finger to be honest.

So I got a Freestyle Libre glucose monitor. It monitors interstitial glucose levels so apparently has a lag of 10-15 minutes compared to blood sugar glucose, but it is monitoring all the time, and allows me to see how my glucose levels change during the day. It is easy to just scan from my phone by holding it to my arm. It has a memory of 8 hours (I am surprised not longer) so you need to scan at most every 8 hours to not have a gap in the readings, but that is not really an issue.

I am not really the typical user for these. They are also not cheap (over £60 for a sensor that lasts 14 days). Normally these would be used by people that need insulin with every meal. In my case I am trying to make sure my insulin levels are right for a daily dose, but also trying to work out when, and how much, exercise works well to keep my glucose levels in check. Also working out if, and when, and how much Gliclazide I need to take. Having this near instant feedback from the sensor, and the graphs, is ideal. Hopefully I will not need to keep using them as I get in to a more sensible routine.

Basically, at this point, I need to go for a walk after each meal. Doing that, and taking a tablet with my main meal, should keep my glucose sensible all day. But it is a learning exercise for me, and I have only been using this for a few days. I managed to have a level of 12 mmol/l for 9 hours after having a pizza and not going for a walk, but at least I know without having to prick my finger.

I thought it would be uncomfortable to be honest, but not had any trouble sleeping on it. I did catch my arm on a door frame at one point, but otherwise it seems pretty easy to cope with. It is waterproof. I am not sure how easy it will be to get off at the end of the 14 days, I'll see.

Losing weight is good, but definitely causing changes, not just with diabetes. I have actually had to stop taking blood pressure tablets! You do have to be careful changing things like this (and I would suggest asking your doctor/nurse). I reduced dosage slowly and monitored blood pressure carefully - but basically I was getting dizzy when I stood up. Blood pressure of 100 over 60 is a tad low. I now have sensible blood pressure with no medication, which is a side effect I did not expect!

I also did not realise that there seems to be a big market for stickers people put on the sensor! Crazy.

Insulin

I am diabetic, and it is inherited from my mum. So I am on insulin, for a few years now. It was to be expected.

I am lucky, as currently I only need one shot a day of a time release insulin (over 24+ hours) and some pills when I have a meal...

But my dosage is mostly pretty consistent, and I try to stick to routine.

I know I have had issues with insulin in transit before. I went to Greece for a week and quickly realised my insulin must have got cooked in taxi from airport to hotel as it was not working - high blood sugar, asleep all the time, and zits and boils (one on my nose ended up with antibiotics once I was back home). Really not nice.

So I wonder how well the insulin is managed before I get it from pharmacist. Recently after some change of medication I upped my daily dose from 40 units to 70+ units a day. Medications for blood pressure have caused such changes before, but this seemed a tad extreme.

I have taken to using a cooler pack specially for the insulin now even for short trips, and will do so this week for trip to a ship for a cruise.

But this week (yesterday) I started a new batch, and today, well, WTF? This morning I went for breakfast as usual at Costa, but by the time I got there I could hardly stand, was shaking, and really wondered if I would pass out! I had breakfast, coffee, and also 500ml of Lucozade as well, and when I got home was only a 7 on the blood sugar (which is high side of perfectly normal), but all day I have been hitting hypos and eating and drinking more and more sugary drinks! This is silly! That said, I got a shit load of work done!

WTF? I am wondering if I had a bad batch before, or something. I need to work on maybe lowering my dose over the next few days.

A holiday is bad enough for this, and time zone changes, but this on top of it is not funny. More test strips and reserve chocolate for this trip I think!

If you wanna be the best, if you wanna beat the rest, medication's what you need

OK sorry, that slogan was from some old TV show and was "dedication" not "medication", but so easy to change in your head.

Amlodipine is the latest they have me on for blood pressure. I changed from Indapamide to this, and it is, err, interesting.

First off, the Indapamide made me very "on-edge" but I could get work done, but was out of breath all the time.

Now on Amlodipine it is different. The first thing was going off the Indapamide meant I was hypo (low blood sugar) and had to quite drastically lower my insulin. Hypo is pretty easy to spot and to fix, if you have snacks.

Then put on Amlodipine I was hyperglycaemic, which is harder to spot. You feel more tired, which is easy to dismiss. But you also find infections, spots, acne, boils, and all sorts within days. Not at all nice. High blood sugar can be a real pain, and take a while to recover. Though, low blood sugar can be dangerous in very short timescales too. It is harder to die from high blood sugar, generally, but not nice.

What is key is any change of any medication, even if unrelated to diabetes, do the blood sugar tests like mad, even if only for a few days! Other unrelated medication like these drugs for blood pressure can have a massive impact!

Amlodipine has massively pushed up blood sugar and I am on almost twice the daily insulin now. That alone is strange.

Routine is everything - change anything from routine and it all goes to shit. I had this at the weekend, with being late for my usual breakfast. OK breakfast is a costa coffee and sausage roll, but normally at 8:30. My body does not understand weekends. On Sunday, my blood sugar went from high 7 to low 4 in 20 minutes and by 9:30 I was shaking. Going on holiday, along with a few time zone changes, is going to be, err "fun". I'll cope. There is 24 hour pizza on the ship!

As long as I stick to routine now, I think I have it sussed, finally. Much higher insulin, but breakfast, some light lunch, a proper dinner (with Gliclazide) and a few drinks... The daily routine works and keeps me on balance. It amazes me sleep for 8 hours+ works to be honest as during the day that would not, so clearly my body learns a routine and adapts.

It was so much easier when my body regulated this crap entirely by itself! One day we'll have stem cell or artificial replacement pancreas implants, but for now, I inherited this crap from my mum. Not her fault, obviously, and she has had a way harder time than I have. But that's life.

Insulin pens and temperature

How hard is it to mess up your insulin?

The instructions with my insulin pens are pretty clear - store in fridge 2°C to 8°C. The in use pen should not be stored in the fridge but kept below 30°C (for a maximum 4 weeks).

Advice for flying is that you take the insulin in hand luggages as it could freeze in the hold. I have been on holiday before. I know the drill, or so I thought.

So what happened in Rhodes?

I am finally back from a week in Rhodes, a nice holiday with my wife this time. The villa was nice, and had lots of effective air-conditioning. The short excursions in to the outside where it was hot were OK. I actually got a bit if exercise even. The villa even had IPv6!

As normal I took two new pens in my hand luggage, put one in the fridge on arrival and one on the side (in an air-conditioned room, so well below 30°C) to have my daily dose.

I am lucky that at present I only need one dose of a slow acting insulin as my body does manage to make some still, with the help of some tablets. Indeed, a change of routine (i.e. my evening meal being late) will usually leave me hypo, and somewhat cranky!

However, in spite of the change of routine, and 2 hour time shift, I was not getting at all hypo. Indeed, I was not eating much at all. At the start of the week I felt mostly OK, but as the days went on I felt increasingly tired and even thirsty. What really gave it away was that I started getting spots, which is a sure sign I have high blood sugar.

Blood tests showed my blood sugar was indeed unusually high, even hours after eating. I was now taking the maximum dose of gliclazide to try and help matters. What was going on? I do not normally have to bother testing - I have a routine that works, but this week was not working.

I tried the other pen, but no better. It is a slow acting insulin, so I could not tell immediately if it was helping or not, could I?

By the time I concluded that it was also not working, we are on the last day, having slept a lot and thrown any hope of reading a book out of the window.

Finally home, gone 3am in the morning, having had one small sausage roll at the airport some 8 before, with a gliclazide, and nothing for about 4 hours before that, my blood sugar was still high. So I got a new pen from the fridge and had today's dose a few hours early before going to bed.

Well, I know now, that if there is a problem, then taking working insulin does indeed have quite a quick impact. This is useful for future reference I think. By 6:30 this morning, blood sugar low and shaking slightly (hypo), so time for some breakfast.

Now to get back into my usual routine again.

What did I do wrong?

The issue is that I don't think I did anything wrong. The plane was not hot, the taxi may have been a bit hot but that was like 25 minutes from airport. The rooms were not hot. I have a feeling the fridge may have been on the cold side, maybe too cold (i.e. below 2°C) so will have to take a thermometer next time maybe, but that does not explain the first insulin pen being broken. Maybe it was that short taxi ride in the hot Rhodes heat? Could that really be it?

Overall it seems something it a bit sensitive and the effect is not instantly obvious (well, not so much in my case, as I say I still make some insulin myself). It can have quite a nasty impact on an otherwise fairly enjoyable holiday.

What next?

There are cool bags you can get, but being a techie I am more interested in a tiny portable medication fridge - no moving parts or liquids so ideal for travelling. Yes, someone sells them! I think I will have to invest. I really do not want this happening again.

So, keep cool, and keep your insulin cool, especially when travelling.

P.S. An "eating bugger all as you have no insulin" diet did not help as I am exactly the same weight as when I left. I think it must be the "sleeping all day" side effect that thwarted it.