Post Prandial Glucose (PPG)

We say, we people with diabetes are always living inside the window of 4-8mmol/L. Diabetes does not stop at aiming at how good your fasting or pre-meal blood glucose readings are. It is about lowering the glucose variability. Yea it's about stopping the roller coaster in sugar sanity. Right, once a while, sugar still makes you ride on a roller coaster, I know. 

To handle this rollar coaster, to stay inside the window. Enormous things to consider, and most of it can't be measured. You can only assume, predict, wild-guess.

Did I miss out anything at all?

I have been doing a lots of Dual Wave lately. And it really helps in my lunch (which is usually higher in fat) and my dinner (I eat brown rice, lots of green and I love to squeeze lemon juices on my veges. Because the sourness and vege taste always match well and it makes the vege colour stays beautiful!).

Dual Wave (one of the Bolus Wizard Feature in pump) is the meal bolus being delivered into 2 parts: Immediate bolus and Extended bolus, in the amount and time frame decided by me.

That day I was so concentrating on my food, GI and dual wave, until I had forgotten that I had been running up and down the staircase. And CGM graph became like this without me noticing.

Only realised it when the alarm sounded

Then I tell myself, stop being a perfectionist at the asshole diabetes window.

Inhales.

Life continues.

Scoliosis

I was diagnosed with scoliosis when I was 15 years old. Or it could be a delayed diagnosis.

Ever since I started wearing arch support shoes, I generally felt very much better. No pain, no stiffness. All these good feelings and doctor's comment on follow up PRN (only when necessary aka pain occurs), I thought I can finally outgrow this spine issue. 

Unfortunately, it still makes me worry a bit when a chest X-ray was done in March during my dengue admission. 

I was like: I am taking x-ray to see if I have chest infection etc. But wtf, has my scoliosis gone worse?

Then, I started searching and digging out my X-ray done two years back. So, has it gone worse? 

How am I suppose to compare because one is captured at thoracic, one is at lumbar *sighed

Should I just go back to the doctor despite I do not encounter pain? 

Was really worry that I started searching for scoliosis surgery indications and videos, I was stunned at those pictures and videos. You may poke tiny needles on me ten thousands times but I am really afraid of surgery for now.

Shit, stop reading from internet and thinking those perhaps unnecessary things. Start consistent spine rehabilitation now. Thinking to start exercises like the Schroth method. Hope it will help. 

Tips on Carb Count

Already MAY 2015, how fast time passes!

March: 

Dengue admission (still drafting blog on it)

Taiwan trip (still drafting blog on it x2)

April:

Volunteer in a Cancer Survivors/On Treatment nutrition talk for Tzu Chi Organization

May (coming up):

Sharing on carb count and personal experience in Medtronic pumpers gathering

I would like to keep this mini 30 minutes talk (or sharing) short, sweet and still professionally done as a dietitian.

Stay tune :)

By the way, do you have any tips on carb count? 

Other than based on journals, it is also essential that it is based on experience, practically done!

Eye

Today is the yearly eye check up. Like always:

• See doctor. 
• Put dilating eye drops. Dilate my pupils in order to view the back of my eye balls more clearly.
• In less than 15 minutes, vision got a little bit blur already, suggesting the focusing muscle in eyes very relax now. 
• Waited for almost half an hour, so that the pupils enlarge big enough. I almost slept because I just sat there, doing nothing (had a hard time looking at my phone screen, too blurred vision!).
• Finally doctor called me in. 
• She had all the necessary checking done in 15 minutes.
• Everything in the eyes are good. Good job in 8 years of diabetes!
• Of course, TCA (to come again) in a year's time. 

I wonder how much time I have spent and will be spending in my life for hospital visits. Being one of the youngest in the clinic, while others are mostly elderly. People looked up to me when I entered the clinic, scanned through me. Some curious ones would ask: You're here to check what? I would just smile and say just normal regular check up :)

I observed people while waiting for my turn. People came with their children, came with their life partners or came alone like me, waiting for our calling numbers. All of them have their own worries: physically, emotionally or financially. I must have shown the same kind of expression on my face too. Ha! That's life!

Diabetes camp

Actually I should have posted this in December 2014 herherher!

I have never attended any diabetes camps before. I gave my first time to Paediatric Institute, Hospital Kuala Lumpur (HKL)'s diabetes camp, as a facilitator. Pretty awesome, though it was just a one day camp :)

It was their first time organising this camp too. Activities included:

• Ice breaking session
• Personal diabetes experience sharing by a future psychologist (Hui Wen) and a working dietitian (me)
• Knowing your macro-nutrients
• Carbohydrates counting
• Exercise using stretch bands

Photo took by a dietitian friend working in HKL :)

That's me, making friends with those kids. They are the cutest and bravest kids, telling you about their opinions on needles, how do they feel when they are experiencing hypoglycemia, etc. I asked about their feelings during treatments and symptoms experiencing, they said: Mula-mula takut, tapi saya dah boleh buat sekarang *with a smile on their face (I was afraid initially, but now I can do it by myself).

They were very shy. Very shy, but so strong! :)

Photo taken at the Titiwangsa Lake

Took some groupfies with these teens living with Type 1 Diabetes. You won't know how much they're facing everyday, just by looking at their smiles right? :)

Thanks to Dr Ting, all nurses and dietitians for making this to happen. I really enjoyed the sessions and I am sure the kids too had fun! And of course thanks to the dearly Mdm Yoke Lian who recruited me to join in as facilitator :)

Sharing a quote from a friend, Scott K.Johnson who has been living with Type 1 diabetes since 1980:

『Living with diabetes is hard work, but we make it look so easy.』

FAQ

Hi all, 

Today I am going to clear 2 of the Frequently Asked Questions about my insulin pump.

1) How heavy is your pump?

I am using the Medtronic MiniMed 522 pump, it weighs around 100g, according to the user guide. I weighed it using the food scale today, it is 111g. I would say it is almost like holding a soap bar in hand.

2) Do you need to charge your insulin pump?

Nope. This pump is operated using a AAA battery. One AAA battery can last for more than a month, if I am not using the CGM (Continuous Glucose Monitoring). Just changed a new battery, after the Low Battery alert.

Open the battery cap using a 5 cent coin, unscrew it.

I remember having a Tamagotchi Digimon way back when I was 10 years old. My pink pump looks exactly like that. It was just that Tamagotchi Digimon can communicate with another tamagotchi and battle haha. While, insulin pump communicates with my laptop to send insulin and BG logs, and be viewed in PDF format, so that I can show it to my endo during follow up :)

WHAT, WHY, HOW of pump

Have been sharing plenty about my insulin pump since December 2014 in my Instagram @sugarsanity. And I finally bought my very own pump in February 2015 *recalling the moment I hold it in my hand :))

Find out what is an insulin pump and how it works: here!

A few things that I had been considering very much before my family and I decided to buy it.

1) Cost

It is not an one-off cost. It is a long term cost. Other than my family and I have to bear the 2 years instalment for purchasing the pump, I have to bear the monthly consumables for my pump. 

Consumables are infusion sets and reservoirs. They are not reusable. I have to change these every 3 to 4 days, meaning I only have to inject every 3 to 4 days, rather than injecting 4 times a day.

Reservoir keeps the fast acting insulin (Novorapid).

Infusion set is like a tube that delivers the insulin from reservoir to my body with the help of insulin pump (the device). And there are many types of infusion sets, I am using the Sure-T.

2) Frequent finger pricking

Willingness to do more finger blood glucose checking, means more test strips. Last time because of the cost, I only test my blood glucose level twice a day, ie. fasting and pre-bed. Or I check it when I feel really unwell only. 

Now I have to check it more often, at least 4 times a day ie. pre-breakfast, pre-lunch, pre-dinner and pre-bed. Why? Because basal insulin is being delivered in small amounts every hour, as a fully insulin dependent person, a short period of time with no basal insuin can bring me to DKA (to the hospital).

Alright, usually I check it more often during my infusion-set-change-day, just in case the consumable is not working (which I always hope this will not happen).

3) More control

I am not a control freak haha. But I wish to have more flexibility. I wish to know how my sugar goes about in 24 hours, with the help of a Continuous Glucose Monitoring (CGM) and how many active insulin still available in my body in order to avoid insulin stacking, with the help of Bolus Wizard in a pump.

I was using the CGM while on a family trip to Taiwan. Love it! However, I do not use CGM everyday because of the cost.

4) I have hypo unawareness

I hardly remember the latest severe hypoglycemic event after using a pump. I certainly do not worry as much as those days when I drive, when I sleep, when I do presentation :)

One of the embarrassed moment due to hypo-unawareness, previous post.

To understand more about hypo-unawareness, here.

Diabetes emoticon

Hello my dusty blog and readers! *pointing fingers

I have already started using Medtronic Insulin Pump since Dec 2014. I have been sharing my feelings and pictures on Instagram @sugarsanity (that's why I did not update my blog for such a long time :p )

_______________________________________________________________________________

Back to the story. 

Describe diabetes with one emoticon. Hmmm I probably need to squeeze my face to show you that emoticon. 

Having diabetes is not something to celebrate. Is not something to be proud of. And it's mostly not something happy or positive. 

But, I guess for the coming 8 years of having diabetes. 

I do not mourn for diabetes anymore (but it is still not something to celebrate, I mean I don't celebrate it everyday literally).

I am not proud of getting this diagnosis (Sharing sessions on how I control how I live with diabetes...is consider as something to be proud of? Sharing is not about proud, it's about the inner pleasantness, inner satisfaction and the warmth).

Well, it's not something very negative now. I adapted well to its routine (maybe I should be happy about this).

Alright, the thing is, people ask questions that I am not too sure how to feel when I want to answer them. 

Whether I should feel happy, sad, angry or eye rolls while answering.

Example like what happened today,

She read my doctor's letter and asked: You have diabetes?! / You ada diabetes ke?! / 你有糖尿病啊？！(with disbelief eyes as if I have done something really bad)

And she asked after reading the doctor's letter. She asked after knowing the reality.

So...

What is the suitable emoticon or expression to show, when I want to affirm people: 

YEAH BUDDY! YOU'RE RIGHT! I HAVE TYPE 1 DIABETES *grinning with a peace sign

or OMG YOU'RE RIGHT, I HAVE DIABETES *covering mouth, blinking, looking upwards, preparing tears

or CORRECT LA! IT'S ME WHO HAVE T1D LA *eye rolls

I was really not in the mood today. I just answered her emotionless-ly: YES (full stop).
And she continued asking: Really? Omg Really?! Ya ke? 真的啊？

I was so tempted to answer: No lah, where got. / Ah, tak de la. / 假的。
In the end, I didn't answer her. I just nodded and walked away.

Gosh I was very rude right? On the way back, I was like: Maybe I should smile when I say that. But, smiling because I have diabetes at this age? (Will she be thinking I am crazy?)

Alright guys, I have Type 1 Diabetes (yes the young one, though I was diagnosed at 17. But FYI T1D can be diagnosed at any ages) and...I am really cool about it (you may ask me any questions about T1D, but probably can stop asking if I really have diabetes again and again after knowing the real)

Well, you can ask HOW? WHY? WHEN? WHERE? Not only just...really? really? really?!

So, describe diabetes with one emoticon. 

Maybe this  (yes, REALLY) haha