Canine CGMS - dogs trained to detect hypoglycaemia

No really. I'm not making this up.

I saw fascinating snippet on BBC Breakfast today featuring a mum and her young type 1 daughter. They are one of the first families in the UK to benefit from a specially trained 'assistance dog' which can detect hypo- and hyperglycaemia by changes in the scent of the diabetic.

Yup that's right! Amazingly the dog can sense when the girl's blood glucose levels are either too high or too low and alert her. In one instance at a family disco where the girl had been dancing away with her brother, on returning to the table the dog began licking and nuzzling her before rummaging under the table and fetching her blood glucose meter. Her bg level had dropped to 2.5mmol/l. The dog sleeps in the girl's bedroom and will go to fetch her parents if her blood glucose levels drop too low overnight.

There are currently 10 dogs in the UK, trained by small charity 'Cancer and Bio-detection Dogs'. The dogs have been placed with type 1 diabetics with poor hypo-awareness. The work still seems to be in its early stages, but it is hoped that the trained dogs will be allowed to register with Assistance Dogs UK and granted the same status as guide dogs for the blind.

Dorcasdog - I will be expecting great things from you next time you come to stay...

Dishing Up

I've been trying to concentrate much more on Mike's needs, when it comes to meal times, over the last few months. We are lucky enough as a family, to be able to all sit down together for both breakfast and tea. When the children were younger, sitting together did not mean eating the same food, Mike and I enjoy spicy food, and our kids (like most kids) like to separate out ingredients and have both gone through a variety of picky phases, which drives me mad. Friends round to tea, adds another interesting dimension to what I can or can't present at meal times, forward planning is impossible when you may get a vegetarian home on a spaghetti bolognaise day. Even so, I've always enjoyed cooking for the family because it feels like such a worthwhile thing to do well, much more essential than cleaning (which I only do when we're about to have visitors); and it's a good job I enjoy it because when the kids were small I would end up cooking all afternoon to be able to cater for everyone's needs.

The hardest thing is dividing carbohydrate in a measured way. We all eat a similar quantity of food now, but when the kids ate less, dividing the pasta to ensure that Mike had approximately 60grams of carbs for his meal was tricky. In the baby/toddler phase, I just cooked two completely separate meals, one for us and one for the kids. When they were a little older, I cooked simple food, enough for three portions, and divided one of those portions between the kids, then I'd cook an extra veg dish which I could spice up to make the meal more interesting for me and Mike. The next stage got harder, and the measuring less accurate, and with appetites varying, we would often find ourselves finishing the things off which are hard to resist, (like fish fingers) but it can play havoc with your levels. It is a relief now to know that the kids have good appetites and I can just divide everything equally between the four of us.

It does mean that we all have a calorie controlled diet, as a neccessity. I'm sure the kids aren't really aware of that yet. It can make for a rather odd looking meal. The portion of pasta we allow ourselves looks pitiful, but I add a lot of veg to everything to boost the quantity of stuff on the plate. New potatoes present a whole other problem, delicious though they are, to ensure Mike has enough carbs he has to pretty much fill his plate with them, though Mike will allow for that and use less insulin, he doesn't have to have exactly 60grams of carbohydrate at every meal of course, but it's the way we've always done it and it seems to work. You get used to all the measurements, 3oograms of rice is enough for the four of us, 400grams of pasta etc. it makes life easy. I've managed to get back to buying only wholewheat pasta, and there have been no complaints, and I have gone back to trying to vary the type of carbs much more, which was something I read in a Balance magazine years ago. It makes sense to me, if only because too much of anything can be bad for you.

I am aware that I have spent quite alot of the past thirteen years preparing and cooking food, and that not everyone has the time available to do that, (or would want to). To me it has been a luxury I'm grateful to have been afforded, though it is extremely nice when someone else offers to cook for a change. Maybe one of these days I'll be all cooked out and hopefully I'll be able to hand the baton to someone else and then and only then will I offer to do the washing up.

Jane

Basal driving me bonkers

This is ridiculous.

Perhaps I've brought it on myself with a few smug posts about feeling that I'm doing a little better lately, and how I finally seem to have wrestled Lantus into submission, but diabetic readers will be unsurprised to know that it's gone a little pear-shaped over the last few days.

Most annoyingly of all, my recent successes with Lantus have evaporated and I've been waking to early morning test results around 3.5mmol/l again. Starting the day a little low invariably has a knock-on effect for my control for the whole rest of the day for me, and I've been struggling to rediscover my recent run of good form. Diabetes is like walking a tightrope with complications on one side and hypo-induced coma on the other. Tricky enough if your balance is good to start with, but if you start out wobbly you're in for a difficult time.

So I'm basal testing again to see if I can discover the new magic numbers.

The technique I've come across goes like this:

1. Choose a day when you are not doing anything particularly strenuous and your fbg is in range
2. Take basal and any other medication as usual but miss breakfast and don't inject any bolus insulin.
3. Don't eat anything and drink only water until lunchtime and test every hour or two
4. If your basal dose is correct you should remain within 1 or 2 mmol/l of where you started
5. Repeat the test for another 2 days (they don't have to be consecutive)
6. Then move on to missing lunch, then evening meal
7. If you are really hardcore you can also test every hour or two overnight (I confess I've never quite managed this part of the process, and have always been able to convince myself that my dose must be about right, surely?)
8. If you notice a consistent rise or fall in bgs during the tests consider making (or talking to your doctor about) a modest change in your basal dose, perhaps 1 or 2 units up or down
9. Then start the testing process again
   

Not a perfect day to start the test today as fbg was 3.5, but I'm going for it anyway. I also had coffee rather than water which will also muddy the waters a bit (lactose in the milk will push bgs up a bit).

I'll let you know how it goes.

Update: Day 1 test went well despite the wobbly start. Completely solid bgs from mid-morning onwards. Now, do I sloppily move on to lunchtime? Or do it properly and complete the morning test a few more times? Hmmmmmmmmm...

Update: Lantus problems and going round in circles

Living on the edge

My control has been, in recent weeks, really pretty good I think. Certainly it feels significantly better than it has been for several years, and it was never really bad even then. A change of insulin, adjustments my approach to my basal (Lantus) delivery and a slightly more focussed attention on carb:insulin ratios are all paying off. All those peaks and troughs are being evened out.

I'd tightened up quite a bit before the switch from NovoRapid to Humalog, but even so I think the change (and the time/date dose memory of the Memoir pen) have been hugely helpful to me. In a quick, thoroughly unscientific compare-and-contrast of a fortnight's figures on each insulin here's what I've found:

I am now having
30% fewer low-level hypos (my warning signs are significantly improved as a result)
28% fewer results outside my target range of 3.9-9.0mmol/l
80% fewer fbg (pre-breakfast) results outside target range

So it feels very much like the effort is paying off, and while I do catch myself smiling an occasional smug smile these days I also recognise that these closer-to-normal figures bring with them their own set of peculiar problems.

If you are happily spiking away into the teens after every meal you have a degree of slack while your insulin chugs away before you might dip into hypoland. With my new tighter range I'm spending far more time at or near 5.5mmol/l - which, while good, is also just on the edge of going hypo. A few weeks ago I'd miscalculated breakfast and was 10.0mmol/l before lunch. Slightly annoyed, I decided not to eat straight away, but to stroll to the supermarket to pick up 4 pints of milk. The walk is level and takes about 6 or 7 minutes each way at a fairly easy pace. When I returned with the milk I tested again to find I was 4.0mmol/l. This was just what I'd hoped for, but at the time I was struck by the size of the drop, over the short space of time, with the very little effort expended. To drop from 5.5mmol/l to 3.5mmol/l is all too easy.

Living life at or around 5.5 basically means, for me, that I need to take a little short-acting carbohydrate whenever I walk anywhere or do anything, in order that I don't dip low. There are some days when you overdo it slightly, which is a bit annoying. And days when you don't allow quite enough - I slightly underdid the compensation yesterday for a late evening walk. Went to bed at 6.2, but fbg was 3.5 this morning so I was obviously trending downwards last night.

Much as I'm still fairly pump-averse it makes me envy pumpers with a CGM (continuous glucose monitor). Now that would be a life changing bit of kit.

There's Mike, and then there's the diabetes.

Blimey, it really is one long maths lesson isn't it!

Since we started this back in February, there have been a lot of changes in the way that Mike manages his diabetes, which you will know all about if you have been following this blog. We always knew there were a lot of variables, we've always known that it is practically impossible to get it right all of the time; but add in changing the way you use your background insulin and you have yourself a mathematical equation capable of turning your brain inside out every morning.

It is a long process, which has already improved our family life, though it is not yet completed. Maybe it never will be, because as soon as you think you've got it right, something happens to make everything change. I think the thing that has made life better, is our attitude towards Mike's diabetes. We acknowledge it and we talk about it and learn about it. We don't ignore it, and assume that's just the way it is and that things could not improve. Mike is more willing to look for help and try new things, and we are all interested in seeing what works and how it works and what we can do to help.

It is a little bit like having a new family member, because without the regular morning hypos which did affect Mike quite badly, we rarely see Mike and the diabetes together, we see Mike, and he looks after the diabetes and tells us all about it and how it's getting on. Like having a friend that can be a bit annoying sometimes.

Jane

Every day ups & downs on Twitter

For those that like the world of tweets and twittering (and who doesn't?) we have set up a twitterfeed of the blog as @everydayupsdwns.

We will also posting any little updates and/or interesting bits of Diabetes-related stuff that we come across online. How could you resist?

You can follow us here: http://twitter.com/everydayupsdwns

And there was evening, and there was morning...

Just a quick update on the ongoing Lantus experiment... If you've popped by before you may have read that I recently changed the timing of my Lantus injection to combat fairly frequent, low-level morning hypos.

After the initial euphoria of my new-found pre-breakfast bg stability had worn off, I began to notice an unfortunate side effect of the new system. True, I was no longer waking up hypo 3 times a week, but I began to find that after breakfast my blood glucose levels would 'spike' - rising steeply and peaking way higher than I'd like.

When I'd suggested shifting my Lantus dose to the mornings to the DSN at the hospital, she had said that in her experience it merely 'moved the problem'. While this wasn't exactly true in my case (as I wasn't having consistent late afternoon hypos) it did appear that I'd simply swapped one problem for another.

My overall control has always been pretty good. A few swings here and there, but on the whole, fairly respectable HbA1c's (the test that reveals how 'normal' your blood glucose levels have been over the previous 12 weeks or so - below 7% is the guideline). One of the things I'm noticing about my renewed focus on tighter control is that you quickly move your own goalposts. I know for sure that one of the ways I've kept my HbA1c's in check is by having rather too many low-level hypos to counteract the high readings over the same period. Good control is not about constantly swinging from high to hypo, but as with all average-based assessments the HbA1c can hide the true picture.

In short, I was not happy to constantly spike after breakfast especially since I was now missing all those pesky morning hypos that would have kept up the illusion of good control in my HbA1c.

So for the last week or so I've been splitting my Lantus dose, half at about 10pm and the rest at around 7am the following morning. My reasoning was this... Lantus takes a good 3-5 hours to get going (this is why it is often recommended that you take the dose last thing at night). It also lasts around 18-26 hours, depending on the person - I think it's around 20-22 hours for me. What I think was happening with my breakfast time dose was that yesterday's had run out, and today's wasn't kicking in until mid-morning at the earliest. This meant that my breakfast bolus was having to cover basal requirements as well as whatever I was eating. By injecting half and half I now have two activity curves running out of phase so that the onset of one is covered by the activity of the other.

I have to confess that the timings of the doses are based more on convenience and the likelihood that I'll remember them than any complicated graph-based calculation of perfect timings, but for the last week or so both fbg (pre-breakfast blood glucose level) and post breakfast readings have been pretty much bang on target.

Well apart from the day I forgot to inject that is... but that's another story.

Update: Basal driving me bonkers