James Foston

Tester Walk: Part 5 of 5 by Holly Short

Hopefully this journey has given you an appreciation for your working pancreas. Trying to do the work of an organ whilst not being able to talk to the other organs is near impossible. If nothing else, writing this has at least allowed me to reflect on some guidelines for the actual day: no extreme drinking the night before, and regular snacks, not huge meals. Sounds so simple...

If you haven't sponsored yet, please do! Your sponsorship can directly impact research into better technology - in the past few years they've introduced an insulin 'pump' that can talk to the glucose monitor, creating a closed loop. As much as I've complained about the Libre in this post, it has been life-changing, and I'm so excited for the next big development – your donations can get us there!

Tester Walk: Part 4 of 5 by Holly Short

We make it home for 8ish, where you can see in the third picture we start to look like we stabilise, and the cake starts to hit. It's going up quite fast, so I guess at 2 - but alas, it should have been 1, or it’s too close to my other jab, and I end up low and having to eat more snacks despite the fact I am very full. Eating more food you don’t want is a horrible feeling. But I do, I stabilise again, go to sleep, and wake up to do it all again tomorrow.

This was an atypical day. On average, I'll go to work, have meals that I know what's gone into them and therefore can inject the correct amount for and at the right time, and generally have quite a low level of activity, so I can control myself quite well. But even then, external factors can creep up and derail you. It's a popular saying on forums that the quote of 'insanity is doing the same thing over and over and expecting different results' was clearly not said with diabetes in mind. But we keep at it because we have to! 

Tester Walk: Part 3 of 5 by Holly Short

We arrive at the pub and order about 5:15. We can see at this point, the KKC is starting to come 'online'. I order a starter and main, and we plan for dessert. The question is now 'when and what to jab'? I don't know when the food's coming out - if I inject too early and the food takes a while, I risk going low, and too late after the food has come risks going high. I also don't know exactly what I'm going to get - it's hard to calculate the carbs in a portion of rice you can't see, so is it better to wait for the food and calculate the 'correct' dose, or try go early to beat the spike? Also, any restaurant food's carb level is a complete guess anyway! Whilst calories have become more mainstream, carbs are not widely advertised - it is and always has to be purely an experienced guess.

Going back to the '4 - 10' target, we can see just how close the guess has to be - if I inject one or two more units than I should, I risk going low, and one or two less risks going high. We also now need to think of the external factors - I'm walking back and it’s still quite warm out, so need to reduce my dose for that. For dessert, I'm also having chocolate cake, which is hard to jab for because of the fattiness. In this circumstance it feels better to underdo it - so I go for 6 units to cover my starter and main, injecting between my starter and main, leave the dessert to be dealt with later, and hope the walk will combat this. You also shouldn’t do one jab and then another jab shortly after – doing two within four hours can somehow cause the insulin to ‘connect’ and double its efforts, again potentially causing a low. 

We start walking back at 6:30, at which point you can see I've started to spike dramatically, but then come down dramatically. Do you know what the Libre likes to do in this situation? Give you a 'sensor error' as the data is moving too fast it thinks it's wrong. So the up to date reading you've come to rely on are no longer present. This possibly shouldn't feel as bad as it does, and is the blessing and curse of the Libre - before it, I would check my blood sugar 3 - 5 times a day and have no way near this level of detail. But when you've got it, it's hard to not rely on it, and if you're potentially plummeting down into a low it would be good to know!

Tester Walk: Part 2 of 5 by Holly Short

We’ll start with the first Libre screenshot: 9am, we have a good start at around 5. I hope for this every day! It was especially significant this morning because I'd had *a pint* the night before. Alcohol is a nightmare. Sugary alcohol like cider, cocktails etc spikes your levels, but then alcohol overall lowers your levels, so it's a tricky balance to strike. It also has an impact on your levels for up to a day, so we need to bear this in mind as we progress.

I didn't eat breakfast, and my first meal of the day was lunch at around 1pm. Insulin doesn't come into your system immediately, so you need to inject it in advance of the meal. For me, I need to inject 30 minutes before my lunch to not get the spike you see pictured around 2pm. As you can see, I did not inject in good time on this day, partially because I was doing 12 things at once and only thought when I started cooking, and partially because I knew I'd be walking all afternoon so being slightly too high wasn't a bad place to start.

As one diabetes specialist put it, 'walking can kill me'. Exercise decreases your levels, even something as simple as walking. If we go out for a walk after tea, I have to factor in when to do my jabs to not go low. On this day, we started the walk around 3. The lunch time insulin starts to hit, and combined with the exercise, we get a dramatic drop. Also, it was a warm day, which can cause insulin to work harder than it should. Also, the aforementioned pint. Looking back, I clearly should have had something extra with my lunch. As it was, I clocked the graph's direction about 5.6, so had early snacks - but what to snack, and how much? I want to stave off the low and keep walking, but I also don't want to over-correct and go high. Good low snacks are dextrose tablets, which are pure glucose and get into your system fast. BUT! If I've had alcohol, there needs to be more complex food or it just won't shift. AND! It needs to be fast acting - it can't be too fatty.

So, I eat 3 dextrose, 3 jelly babies, and a Kit Kit Chunky, and keep going. A KKC is NOT a good example of a snack, this was more for the enjoyment and what was available from the service station we passed. I always carry dextrose, jelly babies, and my insulin – I am so rarely without a handbag! We keep walking, and I do unfortunately go low, so we stop for a bit until the food does start to catch up with me. What is slightly annoying about the Libre - you cannot see this low on the graph! It went down to at least 3.6, but because I wasn't down for very long due to the timing of the snacks, the software has tried to even out the spikes. This is deeply annoying. 

Tester Walk: Part 1 of 5 by Holly Short

As a 'tester walk', James and I (https://fundraise.diabetes.org.uk/fundraisers/hollyshort/wellness-walk-london) walked to a pub 4.5 miles away from our house and back. Walking back after a 3 course meal is not overly recommended, but the walk felt good and was about at the limit of my comfort zone, which feels like a good challenge! Instead of focusing on the distance, I'm going to do a diabetes/Libre deep dive of the day.

Firstly, some background setting. A Libre is a glucose monitor sensor that I stick on my arm and gives me continuous readings throughout the day. Blood sugar levels by the Libre are ‘in range’ at 4 – 10. Being too high is not good as it has long term health implications, and being too low essentially means you’re non-functional as a human being. When I was first diagnosed, the boundary was 4 – 7, and legally you have to be '5 to drive', so the ideal window to aim for really is a bit smaller than the graph seems. Then we have the maths part: for me, one unit of insulin usually* accounts for 3 mmol/L and should cover 10g of carbs eaten. If I had a score of 10 and did one unit of insulin, I should come down to 7. If I ate a bag of crisps that had 20g carbs, I should inject 2 units. 'Usually' does not account for any external factors, which we'll discuss throughout my day. Also, these figures can be quite different from person-to-person – it’s fully trial and error to figure out your general rule of thumb.