A Xmas present from D

So Christmas day was nice, we went to church in the morning followed by having my wife's family over for lunch and going to my aunt's place for dinner.  Attempting to estimate my basal in the morning was a little tricky as it was 37 deg C  and our house currently does not have air con, so eventually I figured that I would stay at 8 units of Lantus, on the assumption that the additional eating would probably balance out the heat.  For the most part this worked with readings slightly over after breakfast (9.6) under before lunch (2.9) and a little up after dinner (11 & 8.4) on the whole I would consider that a highly successful Xmas day on the diabetes front.

On the weight loss front I was decidedly less successful.  I decided to torture my self and weigh in on boxing day, 3 Kg added in one day , Ouch.

Boxing day was also very pleasant it was 41 deg C and we went to my brothers house for the yearly gathering/swim.  I must of miss calculated something on the eating front over dinner as I had 4 high readings (8.4, 13.2,13..9,11) for me this was fairly unexpected. One or 2 in the high range, sure, but not off into the very high.

Yesterday was when things started to get a little weird for me, weight was trimmed back a bit (1 kg down and 2 to go), weather was still hot so stuck to a 7 unit basal, had my usual breakfast with a slightly higher bolus as my pre breakfast was 8.9 (I figured I must of over compensated for my pre bed of 5.3).   Post breakfast 10.1 WTF, no way that should be that high, so a little snack and twice the bolus required. Result 13.6 which I straight out bolused 2 units for, 1 hr later 14.6 and another 3 units straight up this eventually brought things under control by mid after noon.

Which brings us to today (another kg gone and 1 to go), same breakfast as yesterday again a larger than usual bolus 5 units instead of 3 and I still ended up at 12.1. 3 units straight up and all was good for the rest of the day.

It really knocks me when this happens, personally I think it was revenge for writing just the other day  that I had things under control. So diabetes as present reminded me that control is only a illusion and the best I can hope for is a understanding of what should happen not the certainty of what is going to happen.

I am concious that I have been feeling fairly lousy of the past couple of days and the abnormal readings could be my body fighting something.  I have been attributing the lousiness to heat, as it has be above 35 deg on both days and I only have fans to keep cool.  The other thing that I am thinking it could be is that the excess eating is making it's way through my digestive tract and is creating a build up of glucose, which is then being released once I get moving.  Either way I can only wait and see if this is a permanent change to the way things are performing or just temporary.

December DSMA Blog Carnival

This post is my December entry in the DSMA Blog Carnival.  If you’d like to participate too, you can get all of the information at December 2012 DSMA blog-carnival

2012 was Year 1.

On the 21st of October I passed my the first year since diagnosis, this was my year of learning diabetes.  Getting to know the unknown beastie, and learning how to tame it.  For now it is in it's cage, however like most beasties it is just waiting to burst free.

To be honest I think the biggest part of this achievement is that I survived sanity intact.  I am proud that I have managed to get a good level of control in my first year (although i am just waiting for burnout to hit). 

Reflecting on what I have learnt it is really hard, I can't tell you my carb to insulin ratio, I can't tell you exactly how many carbs are in any specific meal that I eat, and I can't even pin point exactly how much basal insulin I should be on.

What I can do is; look at what I am eating and inject according and get it right at least 3 quarters of the time; exercise and not get a hypo; go to sleep and be fairly certain I am not going to crash through the night and manage the effect alcohol is going to have and enjoy a drink.

On the whole it has been a huge mental shift, to get to consciously replace on of the bodies core unconscious processes, but one that I am coping with.  I feel blessed that in terms of chronic illness that i could get, diabetes is manageable and if it remains under control is something that should result in little long-term complications. 


Some numbers to reflect the journey
Hba1C = 5.8 
Tests = 3,260
Injections = ~2,200 

OK so the scales show the fact hat i have slipped a 1.3 kg jump in the past 2 days.  I have been more disciplined today and hope the scales will be kind.

I had  a rest day yesterday and today's times showed it I got a PB for 5 K only 2:34 left. The speed drop was gradual today which I am happy with. Additionally I managed to get some running in up the hill which greatly improved the time.

Looking forwards, Xmas is going to rough on the waistline and the BG levels, last year I managed by testing every hour on the hour,  I think this year I will do something similar as it did work, it is just the waistline impact that I have to worry about.

Slipping

Ok so the past couple of day's have not been so good.  I have fallen back into some of my old bad habits , my biggest trap is late nights, I sit up until late fiddling with a computer, long past when i need to be horizontal.  While this in its self is not a issue  what it leads to is.  When I am tired I am more likely to over eat and more likely to have caffeine ( something i am steering away from for my blood pressure), so i all not a good choice to stay up late.

In addition it is the social season so we have had visitors which means that I have drank more than i should, that has a 2 fold impact, it makes exercise hard the next day and also I eat more to keep the BG levels up all in all not conducive to weight loss.

However the scales are kind and today I was back on the exercise wagon I got a PB for 1 km of 3.34 so another 34 seconds to go.  I have included today's work out below as you can see it is my endurance that really needs work,  My initial pace is good but then it rapidly tails  off this is something that I hope to fix over time.

End of Janurary Targets

So rather than continuing on just doing what I am, I though I would set some targets for the end of Janurary, by then I aim to be able to run 1 km in 3 minutes, cover 3 km in 12 minutes and do 5 km in 25 minutes.  Hopefully all that exercise should mean my weight will drop to below 108 kg.

Pump Vs MDI

Over the past month or so I have been doing a lot of reading, of various bloggers and their love for their pumps.  I stand unconvinced at this stage that it is something for me.

As far pros and con's go this is how I see it.

Pumping is good because it is flexible in terms of delivery and make life easy in-terms of calculating the required rate of input.  It has the additional benefit that the insulin used is a short acting insulin meaning that if you have slightly over dosed you can back everything off before it gets serious. 

The draw back is that you have something attached to you 24/7, and you have handed off the control of the insulin delivery to a machine.  To me it is really the first point that gets me, I just don't like the idea of having something hanging off me.  I think it has to do with the fact that I am a clumsy person so anything on me is going to get bumped, LOTS, and when that thing is actually protruding from you skin, things are going to get messy.  The second point concerns me only a little, but in essence you are relying on a complex machine to work flawlessly 24/7.  I concede that the actual failure rate of the machines must by fairly low in order to get approval from the world therapeutic bodies, however it still does exist.  

And lastly scarring I am unsure what will produce worse scarring having a cannula or the constant needles of MDI.

A quick note on what my MDI regime is: 

Lantus: 9 am and 9 pm, dosage varies, tonight i have not eaten much so I won't have to much excess glucose floating around,I intend to have drink and have just exercised current BG is 5.7 so I have had 7 u, which should equate to a slight rise in BG over night. Tomorrow is 27 degree's, I am working so ~8/9 u depending on what my morning reading is.    

Apidra/Novo Rapid: 1 u per 10 gm of carbohydrate when ever I eat +/- any bg rise or fall I am intending, This means on average i will have 4-6 short acting injections through out the day.

At the moment this is what works for me,  It has meant me diet has not changed since pre diagnosis and i still have my BG under control. I wonder for how long though and I wonder if at that point a pump will make a difference.

After a rest day yesterday I expected better out of today.  The average speed over 5.8 km was 9.2 kph I would like it to be above 10 kph,  That will be tomorrows target.

End of Week 2

I am enjoying my exercise and since starting on this push I have run or walked all days bar 2, as can be seen below I am managing to average about 4-5 km per day.  I am personally very happy with progress so far, but I am apprehensive about the sustainability of the regime.  From past experience I am great at beginning a regime, and not so good at sticking to it. 

In terms of speed I seem to have hit a bit of a plateau and it is hard not to get a bit discouraged by this.  I rationally know that I am making good progress, Just 2 weeks ago I would not of even dreamed of being able to cover 6.5 km in under 45 minutes, however the niggling part of me says well why have you not improved your times since then. I think I will have to give it another week and see what has happened and look at changing things if there has not been any improvement.


And as for the point of all this exercise I am actually loosing weight? well yes, slow but surely the numbers are heading in the right direction 111 kg this morning which is a 1 down and 11 to go.

Yesterday day was my first meeting with a dietician.  I was very happy, she was happy, it was all good.  As I have been keeping a food diary for the past week we were able to have a meaningful conversation over what I need to do to reduce my cholesterol  (essentially increase soluble fibre a bit) and due to the increased exercise some more protein wouldn't hurt either.  Additionally she very nicely passed on a backup glucometer, YAY for freebies.

Last thing in the day I heard from the diabetes educator that came highly recommended from the doctors surgery that I attend, ad so far the jury is out.  For example please don't ever tell that  just because my HBa1c was 5.8 I must still be in a honeymoon period.  I put a lot of effort into ensuring that I am in range (10 - 13 tests, and Bolus injection most times that I eat, plus 2 long acting).  So only Monday will tell if I do get something useful out of this, although at present I rate chances as small.

Running continues well, today I changed the audio track to podrunner, I found that it suited me well and look forward to using it over the coming weeks.

I'm Melting

The past couple of days have been hot, not scorching hot or even damn hot, just plain old hot.  The temperature has been ~30 C and it has been enough to send around the bend.  Not from from run away sugars although that was happening on Sunday, but from the fact I just can't handle the heat any more.  I really don't know how to describe it, but I will give it a crack  For a start I feel physically off particularly in my head, the desire just to be really cool sit in front of a Air Con and emotionally I just don't cope well either I get cranky, the little things are to much and I really want to yell at somebody.   And to top that off the dread that my glucose levels are dropping, which was happing on Sunday, today i had a better handle on it a 20% reduction in Lantus meant that I was stable through out the day.  It really makes me think though if someone were to ask me what my dosage of Lantus was at the moment i would have to say somewhere between 16 - 21 because it it really does vary by that much.

On the weight-loss side yesterday and today have not what been highlights of self discipline  mainly due to Family engagements.  Yesterday I did not even bother to keep track of the Calories as I had way over shot my daily allowance by 11 am and it is just to hard to keep counting when the meal is finger food.  Today I did count and man stay away from puff pastry.  However at the end of the day I was under the net target which was good news.

For exercise I treated yesterday as a rest day and did not do any, today I gave the 6.5 k route another go, unfortunately I only made it to 2.5 km before my body said enough, I am not sure what it was (suspect heat) but I could not get my self moving again, all in all it means I did it in 52 min 10 minutes behind Saturday. Well tomorrow is a different day.

Skyfall

Last night was quite a achievement  I was able to go out and have a meal, and get the insulin right woo hoo.  Post the meal my brother and I went and saw Bond: Skyfall

Now I am not a Bond fan, but it thought the film was pretty ordinary, it almost felt low budget in a way, I can't quite put my finger on it, but it definitely lacked polish.

On the diet and exercise front, Apparently this morning marked a week the program, status weight is down by 0.4 of a kg which was the target rate so that is good.  For the the week I have managed to keep my net intake under 2000 cal or ~8400 kj I am not sure if this is sufficient to ensure weight loss as I suspect that I have a slower than usual metabolism (sounds like a great excuse to me).

I have successfully completed exercise on every day this week, and today was another successful venture.  A solid 3km jog followed by another 3.5 km of walk/jog, all up 6.5 km in 42 minutes, pretty happy with that.  I think I will stick to this route for a week or 2 and see if I can stretch my self further and drop the times a bit.

On the sucky side of today I was basically forced to take such a big run today, as my sugars were down all day.  As it was a Saturday I had thought that I had prepared for the activity increase by slightly undershooting  my morning basal (8 units vs the usual 10/11). But by lunch time I had had to have an additional 2 pieces of bread just to keep my sugars stable.  To put this in perspective on a usual week day I need about 5g of carbs per 2 hrs, the 2 pieces of bread is 8 times that/ 40g of carbs.  Lunch was sandwiches and so once again undershot on my bolus so I should of been fine, but no 2 hrs after lunch while visiting my farther in law in hospital, 2.9 BUGGER 8 jelly beans later and I was back on a even keel. However 2 hrs after that I was back down at 4.8 and having to eat AGAIN,  something i should not of had to do given the Jelly beans and the muesli bar that I took to even things out. well let us see what tomorrow brings.

First Annual Check up

Well the scales were kind and weight was consistent YAY for small mercy's.   Additionally yesterday was a really good day for BG control it was my first day in a month or so that I was 100% in range all day,  Yippee.

As the title of the post suggests today marked the first annual check up that I have had, as it is now 12 months since I was diagnosed. On the good side i had a HBa1c 5.8%,  this is a good result for me particularly as I had felt over the past couple of months that things were starting to spiral out of control, on a not so positive note my cholesterol is good for the general population and borderline for a diabetic, so off to the dietician for me.

This was the first time since diagnosis that I have had any idea of the services available and the checks required to maintain the lifestyle. So over the next couple of weeks i have a ophthalmologist, dietician,  my first real appointment with a diabetes educator and a check back to the GP over my blood pressure.  I think this is more doctors appointments than I have had in the past 5 years, but I suppose I will have to get used to it.

Now to the diet and exercise:  for what ever reason I just was not hungry today this has made managing the intact very easy and meant that I ate very little, however the BG readings were all over the place from a nice 6.1 first thing to a 10.1 after lunch and 2.9 crash just before dinner . on the exercise front I did manage to get  a run in and achieve a PB of a solid 2.5 km jog andl I completed the 4.5 k circuit in 29 minutes a whole 4 minutes less than Mondays time. Not bad improvement for the week.

Same route as yesterday, didn't quite manage to run the 2km straight pulled up about 100 m short.  No Hypo's today, so starting off was a lot better however a heavy pesto pasta beforehand really left me feeling weighted down,  Not looking forward to tomorrows  weigh in . However managed to better my time by a minute and a 1/2 overall.

Weight loss Day 3

First Day of blogging about this but I thought I should keep a journal.

As to why, well with the level of complexity around managing Type 1 diabetes and trying to loose weight it will be good to have a series of thought to reflect back on. 

Firstly to the diabetes side today I had my Hb1ac taken for my first 12 month check up, yep that it 12 months now, on the whole it has been remarkably easy to get used to.  It is however very wearing at times.  From the stats that I have I should be getting a result of somewhere around 6 %, given that my 3 month average of blood glucose readings are at around 6.8.  Almost did not make it today though as I woke up at 4.5 not a good reading to have if you have to drive on a empty stomach.  Luckily it was stable and stayed pretty much constant.

As for insulin after the debacle (In BG reading only,  had a really nice time) that was my holidays last week I have start I have started to split the Lantus injections at 12 hr intervals, after 5 days it really seems to have helped considerably my night time readings are now basically flat throughout the night and my day time reading are far more stable, although I do appear to be crashing around dinner time, something to watch out for.

Now to the weight loss this time last year i was the lightest i had been in 15 year at 99 kg unfortunately getting the diabetes under control has meant that my weight has gone back up to 112 kg and sat there for most of the year.  I have exercised off and on for the period but made no real inroads,  I think the main reason is that 112 kg is where my weight will sit given no management.  So I have started to manage it through calorie counting, and being more devoted to doing my exercise. The calorie counting is painful but myfitnesspal is making it easier,  on the exercise front I am really happy with how i am doing. 

I am using endomondo to measure the distances travelled and the Kj's consumed on the exercise side, it has the additional advantage that it syncs back to myfitnesspal  so that you don't have to dual record.

Today was a good day I managed to run consistently for 2 km I am not sure when I was last able to do that,  on the down side just as I was about to leave I had a 3.8 righty-o treat that with a can of soft drink, 10 minutes later 3.3 WTF wait another couple of minutes and we are back in the 4's and couple of minutes after that in the 6's, got to remember sugar uptake is not instantaneous and patience is required.

But 5kms in 33 minutes is fairly respectable over all look forward to seeing a improvement on the scales.