Can I trust my A1c?

After revising my analogue insulin regime, calculating my Insulin to Carbs Ratio (ICR) and Insulin Sensitivity Factor (ISF) with my endo...

Jeng Jeng Jeng Jengggg. I got my A1c blood test back to me yesterday: 7.3 %

Fuiyohh (Omg) it's like the highest number on that lab paper ever in my life.

(If you notice the right bar in my blog, the numbers were actually climbing up)

So, I messaged my mom. I decided not to call her because I know what she gonna say, anyhow she gave me a kinda long reply message (刻苦铭心，用心良苦 from-the-bottom-of-heart and well-intentioned kinda message). 

Considering those reading my blog now, please do not give me that "Aren't you a dietitian?" look. Please let me have the chance to express my internal feelings as a patient on intensive insulin therapy. 

Let me review these 3 months back...

• Lesser hypoglycemic episodes (used to be once every 4-5 days on average)
• Sugar high (about 8-15mmol/L) while I was adjusting my insulin to find out the right ICR and ISF.
• A1c 7.3% gives me an average of sugar level 9mmol/L. (hmmm fair enough)
• So, I can say: Those previous blood tests of lower A1c at 6.5% were probably falsely low because hypo episodes were very frequent. And therefore, those hypos numbers actually even out all the high numbers, leading to a lower A1c (%)? 
• Check this with the endo, she said yes it could be!
• All of a sudden, a realization that A1c can only be trusted after a good review. 

I have to work hard for a lower A1c next round. It's not easy, but I must do it! Already forward my A1c reading to my family, bf and friends, please keep an eye on me and encourage me! :p 

Saw that there is this new insulin pump-sensor combination system being approved by FDA: Animas Vibe Insulin Pump and Continuous Glucose Monitor System. The whole DOC is so excited about it. Unfortunately, I don't see it coming in Malaysia yet. 

Planning to get the Metronic pump in Mid December. Will join the 1 month pump trial first. *finger crossed

From www.medcomic.com

10 good things about diabetes

Obviously I hate diabetes. I can list down thousands of bad things about diabetes. I actually crack my head for these 10 good ones. 

But, life is about finding simple happiness even at your toughest moment, right? 

Yes, so today I am going to list out 10 good things about #T1DM, for me, at least. 

#1: Toleration to needles.

One example of toleration: I always do my injections in the car. Mostly moving cars. For countless time.

#2: Toleration to blood scene.

I have bigger response when I see a huge pimple on my face, than when I smear blood on my white bed sheet/cloth.

#3: Better diet. Better lifestyle.

I eat mindfully. I eat well for the sake of diabetes control. (I eat all the things that you eat, just that I eat with IQ and EQ and whatever QQQ, for most of the time)

#4: More health checks.

I draw blood every 3 months. I see the doctor 4 times/year. I check my eyes yearly. (Hmm not sure if visiting to hospital for health checks so frequently is a good thing lol)

#5: Mutual stranger friends.

I chat with T1D strangers. Can't believe I actually talked to strangers spontaneously. And yeah, now I enjoy making friends with strangers now! (Of course, strangers with T1D only la)

#6: I learn not to judge people.

Because some people irritated me so much when they judge me just by seeing some numbers. So, I promised that I will not give the same irritating feelings to other people.

#7: People concern about you more.

Actually, I am not sure if it's a good thing or what. I tend to back off a little bit when someone keeps an extra eye on me, because they think I am very vulnerable. lolll. (I will feel geli/awkward a bit when someone concerns about me overly, but deepest appreciation from me!)

#8: Wonderful sweet treats at home.

There is always chocolate in the fridge. Juice box in the fridge. Candies on the table. Coke in the car and Mentos in your pocket. (For hypo's sake)

#9: A reason to excuse yourself.

When people want to offer you more alcohol or extra food, and you actually don't feel like taking any more. Just tell them, sorry, you may offer other people. 

#10: Job employment.

Ah! Something new right? Last time I used to think that companies might not want to employ me because I am unfit/unwell. But now, totally different. Because I might be in a better position to do that job, than other well people.

Memes from http://imagestointrigue.blogspot.com/2012/03/exclusive-memes.html

HbA1c (%)

If you notice the changes in the HbA1c reading over the right sidebar of my blog, my HbA1c has been increasing steadily (not dramatically) over the past 10 months.

HbA1c is an indicator of diabetes control over a period of 3 months. Further explanation, click here.

HbA1c & Average BG level

5% = 5.5 mmol/L
6% = 7.5 mmol/L                     
7% = 9.4 mmol/L                     
8% = 11.4 mmol/L                   
9% = 13.3 mmol/L                   
10% = 15.3 mmol/L                     

11% = 17.2 mmol/L                     

12% = 19.2 mmol/L                   

source:http://www.accu-chekdiabeteslink.com/

Saw my endo in August and she sort of like teased me: Ha! I thought you're a dietitian? Why HbA1c increased?

But, I am still very much a lay-man patient, doctor! I do my part as patient in counting the food that I eat. But, sometimes diabetes stories are complicated. (very complicated)

So Dawn Phenomena it is. And we decided to change my insulin to Analogue Insulin (I always wanted to start using analogue insulin. It was just that the government clinic refuses to prescribe, because they don't think my HbA1c is dangerous enough *sighed). 

Started my MDI (multiple daily injections) with Novorapid and Lantus. I would say very good! As for now, I don't get morning high BG with unknown reason anymore. I go to bed with in-range BG and woke up with in-range BG. I am very glad :)

Just that...I have to pay more. lolll.

Following up with endo again end of this month. And will need her help to refer me to government specialist clinic. 

Later on, the next big thing is: Get An Insulin Pump! (which costs like a second-hand Perodua car in Malaysia)

I need sponsor a lil bit, also I need to work harder and smarter to cover necessary expenses for that pump! I simply can't wait! :)

This pump key chain is too cute!

PMS

Finally, I understand why I cried like shit yesterday night.

• Feeling all burnout by diabetes.
• Feeling being bullied so much by the neighbour. 
• Feeling nobody understands me.
• Feeling so goddamn 委屈. 

Because today is the first day of period. 

Hormones really mess up my life. lol.

credits to http://www.theredheadriter.com/

20 Facts About Me

OMG no entry for the whole August.

20 FACTS ABOUT ME

(Note: Last fact is a !!!)

1. I never have long hair for more than a year. (Yes, I love how I expose my neck with short hair)
2. I remember playing Lego in my childhood, not Barbie Doll.
3. My left ear is higher than my right ear. (That's why my spectacles are always senget/slanted)
4. I seldom cry. But when I do cry out suddenly with the most meaningless reason, most probably is due to hypo.
5. I cannot sing well and cannot remember lyrics well. (Perhaps, that's why I cannot sing well?)
6. I can swim pretty fast with breast stroke. (And I am very proud of it)
7. I swim only in the swimming pool. Only in chlorinated clear water.
8. I get goosebumps seeing those deep dark sea water or lake water which looks like Anaconda is in it. (That's why I only swim in the swimming pool)
9. I am afraid of fish.
10. I cannot clean a fish, even the smallest ikan bilis/anchovy (I guess I am afraid of living things that are dead with opened eyes)
11. But, I eat fish. 
12. And I can prepare and cook fish fillet. (Maybe because the fish head has already been removed lolll)
13. My highest recorded weight was 49kg. (I weighed around 45kg now)
14. My highest recorded BG was 49 too, in mmol/L. (Yes DKA, and I was diagnosed then)
15. I am the youngest girl in the family. Blessed with three wonderful elder brothers. 
16. I am a dietitian by profession. Also, I just passed my insurance agent exam! (I wanted to understand what insurance is all about. Also, to accept the fact that I can't buy health insurance anymore. lol *sighed)
17. I have a S-shaped Scoliosis. (The backbone is S-shaped, not my body shape is S lolll)
18. I am a patient. A Type 1 diabetic 24/7.
19. I am the first one in history in my family tree to have diabetes. (I hope I am the last one)
20. My last asthma attack was 10 years ago. (When is the day that I can finally say: my last insulin injection was......)

C-routine

The 24/7 C-routine of a PWD (People With Diabetes) 

Yesterday night 11.30pm, pre-bed BG was 7.5mmol/L. Injected Insulatard 12 units. 

Set alarm at 4am. Off to bed.

Woke up in my dark room at 4am (nearly dozed off by muting the alarm loll, like what I usually did).

On my cell phone's light. Check my BG, it was 4.2mmol/L. 

Insulatard has a peak action, I know, I know. I should have eaten some food which raises my BG slowly (like half a cup of milk or 1 piece of plain biscuit). 

Who on earth would want to eat something at 4am and she was not even hungry! Well, a T1D has to do this. But, I just dozed off, after seeing the number 4.2 screened on my meter.

Come, guess what was my BG when I woke up at 8am this morning? 

Jeng...Jeng...Jeng...14.5mmol/L! (Dawn phenomena due to a noctural hypoglycemia)

How do you feel like when you off to bed with a nice BG, also a nice BG at 4am, then kanasai woke up with a screwed up reading. *inhales deeply. It's just another day of T1D.

24/7 C-routine means

1. Carbs, carbs, carbs
2. Count, count, count
3. Check, check, check
4. Correct, correct, correct
5. Otherwise, I will Complicate my already very Complicated situation, and make it into real Complications.

Hopefully in the future there will be some great, safe and reasonable treatments to regenerate beta cells. Then only I can finally stop all these Cs. I appreciate all the great, excellent, wonderful insulin available currently, but inhaled insulin is something still very far from getting rid of the C-routine.  

Nevertheless, for all the PWD out there, (with my favourite homemade fries as background)

Weekly fruit prep

I have been pretty busy recently. Busy with the change-in-schedule-of-current-job-and-new-job. Let's see when I will get exhausted working in two places...I hope not.

Also, I missed my appointment to see my endo. And the appointment has to be postponed until early next month, my endo seems to be fully booked in July already. I need her to review back on my insulin doses and I want her advice on changing to analogue insulin. Die die also have to see her this month la. 

Working on tight schedule now as a dietitian, a tutor and also a volunteer. I don't even have time to draft out ideas for my blog. The recent blog idea that I came up with was one week ago, and now I kinda forgot what that idea was initially. Loll. 

Since, working life has been so far so busy (I hope I can settle down after this week!). The food that appears in my mind when I am in a rush is fast food. This is bad. Because I can't be eating fast food everyday! So, food preparations are helping me much to keep myself AWAY from eating junk food, fast food and processed food. 

I know...renting a room in a house which doesn't have a gas stove. How to cook? Cooking needs utensils and utilities. But, cutting fruits simply just requires a knife! Some fruits don't even need a knife!

Have been going to the market to buy one-person-quota fruits weekly.

Purposely bought a green banana because it ripen too fast in warm weather.

I am eating at least 2 serving of fruits everyday now. Making it as a habit. 

Oranges can be kept longer. The Pisang Berangan turned all yellow at night lolll, I bought these fruits and snapped this picture in the afternoon. Is my room too warm or what? Ending up eating 2 Banana and 1 Orange everyday for the past one week. Excellent bowel movement haha!

This week back to my hometown. More fruits available. Durians, rambutan and mangosteen season are finally in! I check my sugar like every 3 hours. Because when I want to enjoy and eat, I have to monitor and check more frequently. (I always tend to eat extra during fruits season). Fruits season can come to harm if I am reluctant to check loll.

Life as a diabetic means mindful eating

Mom cutting

Family eating from the watermelon bowl

My mom bought a big watermelon for the weather has been too hot. We were supposed to eat these cut-watermelons in the "watermelon bowl". But my mom made me eat from my own measuring cup. She was right, I wouldn't know how much I have eaten if I were to eat from this watermelon bowl. 

Well, sometimes, I eat very "emotionally". Sometimes, I almost forget about mindful eating, and I am glad that my mom pulls me back to reality every now and then loll. #lifeasadiabetic

Food and FGID

When talk about FGID (Functional Gastrointestinal Disorder), you must think I will soon talk about FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyol) right? 

Nah, not so soon that we jump into these poorly absorbed sugars.

Because FOOD is not just about poorly absorbed sugars :)

Food is composed of a combination of nutrients, rather than a single agent.

I think for many many years already, we all know that food plays a role in our digestive problem. But the role of food/nutrition in controlling gastrointestinal problem has not been clearly defined. I always hear the family and friends telling these: 

• I get diarrhea after drinking cow's milk, so I choose to drink homemade soy milk. Though no more diarrhea, but my stomach gets so distended like 3 months pregnant. 
• Oh I cannot eat too much watermelon, the going-to-toilet-to-pass-motion effect is very fast. (this is my mom haha)
• One small piece of mango is okay for me. But multiple small pieces, then I will be asking for troubles. (my boss's problem :p) 
• My stomach has got a lots of wind lately, keep on passing out gas below and this makes me feel so embarrassed. I tried stopping my Oat Bran powder, now the volume and frequency of gases pass out have been tremendously improved! I just can't figure out why is this so!
• I myself can drink milk, I have got no milk intolerance. But multiple times in the morning if I were to drink caffeine-containing drink, I will soon be finding toilet to pass loose stools. (this is my experience lol)

While I was a student, I have received very little training about food and digestive disorders. I do learn about how digestion of food occurs in the mouth, the passage of food in the esophagus, the digestion in stomach, small intestine and what are the works that colon do. Unfortunately, the dietary recommendations for FGIDs have been very basic or what my boss always says: Diet for digestive problems has been very rudimentary. Most of the time, we give recommendations based on experiences, or we stop taking so much of that type of my-problem-food based on common sense (like now, I stop taking caffeine-containing drink while empty stomach) rather than credible scientific evidence. 

If you're interested too, kindly search this review online!

Previously, I only do disease related dietary managements. When a person without any diseases comes and asks me about how this particular food causes digestive problems for him or what are the foods that can cause gastrointestinal upset for him, I cannot navigate and fine-tune his problem properly using diet/food therapy! Slowly, I started to gain interests in how food is related to digestive problems. 

Occasionally, for those with digestive disorders, it is not only FODMAP will irritate their guts. But a few of my patients, the type of fibres turned out to be the real culprit. There are so many types of fibres, other than the well-known insoluble and soluble fibre types. Previously I have been only thinking about: Oh! soluble fibre can help patients with cholesterol problem. But, I haven't really look into how soluble fibre can cause gastrointestinal upset for some people. Glad that now I understand way more than its role in lowering cholesterol.

I am still learning much about dietary measures for FGID patients. Wonderful news that scientific evidences of food for functional disorders have been increasingly published for these recent years. This means more and more guidelines for dietitians. And we shall no longer need to swim hard in the murky waters of "how food is related to gastrointestinal symptoms" :)

Awareness

Okay, for almost one whole month didn't look at my blog. Buck upppp, cbs!

Sometimes I am really beh song (angry + frustrated) for all the lack of awareness in public and also some health professions. I see my anger as a catching fire, every time I thought of it. I tell myself I will make sure I strive hard to do better to increase the awareness of disease and then stop all the nutrition myths. 

But then, once in a while, there will still be some people or even health professionals that make me so pik cik (frust) and gik sim (heart ache) for what they have said. (Of course they must have said something like #diabetesmyths or #nutritionmyths, and they never willing to do a discussion.)

So, they actually keep my fire burning and burninggg. (Hopefully the fire will not turn into ashes so fast lolll)

First, how to initiate awareness?

Must start from the parents, the teachers, the lecturers, the doctor mentors.

Because all these people above will be the one raising up the current children, the future leaders. 

For some of the times, I will be so stunned looking at some professionals telling me things that seriously made me speechless. Alright, and then when I smiled and tried to explain to them, they just thought: Well, I am the great professor, I don't think you're right. There is no need for discussion. 

Come on, dietetics and medicines are lifelong learning. I want a lively discussion. Not some judgmental statements from you, not one-sided conversation, I want a win-win situation. 

_________________________________________________________________________

I am so grateful that I was given a chance by my boss to have a short talk about "Food and GI Function" on the Functional GI Disorders (FGID) study day. Most of the participants are doctors or doctor lecturers, which I am glad because awareness starts from those who raise the future leaders finally!

Yes, I was nervous.
But, I can do it better next time. This will not be the last one :)

With my boss and Prof Peter.
Thanks for making a great effort in showing them that foods do play a great role!

Both of them are so inspiring. Special thanks especially to my boss, he teaches me a lots of experiences that I don't think I can find elsewhere. Despite some plans didn't work out as we wish for in the beginning, he has been a great mentor for me, and will continue to be, even our paths may not cross in the future :)

Why dietetics?

The decision that I make today, will determine where I will be tomorrow. 

The food that I eat now, will determine my sugar level later on.

The insulin that I inject now, will determine the amount of food that I can eat later on.

The present control of diabetes, will determine the complications that I may get in the future *touch wood

Before I pursued the Bachelor's Degree in Dietetics, I actually wanted to study pharmacy. I made up my mind to study pharmacy right after I graduated from Form 5 (high school). I applied all relevant scholarships with PHARMACY course as the first choice only.

And the only reason is...I wanted to get the cheapest but the best INSULIN in handy hahahaha

So, why am I a dietitian today?

People tell me not to eat rice or meehun or rice-made products because all these can cause diabetes #diabetesfoodmyth

People tell me that my mother must have been eating too much durian while she was pregnant with me #diabetesfoodmyth

People tell me that I should be on a low or no carbohydrates diet #diabetesfoodmyth

People tell me that I should not eat durian for the rest of my life (gosh, why so cruel to me) #diabetesfoodmyth

People tell me that I get hungry because there are too much sugars in my blood (I was hungry because...I was really hungry okay) #diabetesfoodmyth

People tell me don't eat this, eat that or eat that, don't eat this.

But they never tell me why. They never tell me how much I can actually take. They never explain to me. 

T1D already is very frustrating at times, all these claims sometimes aggravate the frustration. 

I need to inject insulin. But there are only 4 types of insulin for the moment. 

I need to enjoy food. For there are hundreds types of food!

Seriously, I have to stop all these #diabetesfoodmyth.

That is how T1D plays a role in determining this future of mine.
(Just one part, not being the whole part of determining :p)

Usually I do not tell

I usually will not tell others that I have diabetes, 

UNLESS you saw something peculiar and decided to ask me OR I have to tell you in case an emergency happens OR I tell you so as to give you inspiration, to motivate you.

My secondary school classmates all knew what I have undergone and most of them visited me in hospital during diagnosis time. Hence, I have no problem doing diabetes routine works in front of them. More, they never judge me because they went through the T1D adaptation phrase with me. 

But things were totally different when I graduated from high school and started leaving home to go Matriculation College (Pre-University) all alone.

My mom insisted me to inform my matriculation college roommates/close friends that I have diabetes and what they can assist when emergency happens. I still remembered the first time I mentioned to new friends that "multiple daily injections are my daily routine", my voice shivered. I was feeling like a freak, explaining to people that I am an odd girl with a chronic disease that needs needle poking everyday. And that we were all young that time, nobody actually understands what diabetes is. But, they were all helpful and willing to give in their ears to listen the needs that I may require. I am thankful :)

There are some closed friends in matriculation college that I have known for 3-4 years, but I never mentioned about my T1D to them and they did not realize any unusual acts too. Therefore, I never had the chance to be frank with them, though we were close buddies. 

My bf is the first guy friend whom knew about my T1D. I told him after he shared with me the secret of his. I guess that was when we started to share inner stories more frequently haha!

After college, another new phrase: University!

Still, my voice shivered when I told my housemates that I have diabetes during the first week of university. Now, recalling back, why did I shiver so much? Memalukan saja (embarrassing). 

I never tell any of my classmates because I could not find a chance to tell. Perhaps you will say: Well, you can tell them during freshman introduction night. But don't you think it will be extremely odd if I started my self-introduction like this: Hi, my name is Bing Shin. I am a dietetics student, also a Type 1 diabetic. I think they would stare at me the whole night long later on.

So I shut my doors to most of my university friends. Those times of facing diabetes were really hard, I strived so much all alone, believing nobody understands me. Then one day, a close classmate of mine found out something particularly strange about me: I must bring a blue case together to toilet before lunch time everyday. I was quite glad that she asked, then started explaining to her that it is actually my insulin pen case and why I need insulin etc. 

While in university, I decided not to tell any of my lecturers about my T1D because of this incident which made me sad for a little while. I was experiencing hypoglycemia in class with the lecturer talking in front of me. Hardly concentrating and finally lost control, extremely sleepy (not too sure if I was unaware of my hypoglycemia symptoms or I was just too afraid to eat candy in front of that lecturer). 

At the end, I actually went and so stupidly closed my eyes and nearly fall on the desk! The lecturer stared at me and was saying something to the whole class which I couldn't respond to that at all! My friend who was sitting beside quickly hold me up and stuffed in Mentos into my palm (not too sure if she realized I was hypo or she just wanted to pass me candy because she thought I was sleepy). 

Slowly, I gained back my consciousness and recalled back what happened just now. I couldn't remember what the lecturer said in front of the whole class just now, but I knew it must be some mocking at me. I had the first worst feeling in my university life.

After the class ended, I decided to approach the lecturer personally because I wanted to explain that it was hypoglycemia, anddd I really didn't mean to behave that way in her class! I wanted her to put herself in my shoes. But, all she said was: Oh really? Diabetes can do that? Then, she continued doing her work, while I just apologized and walked away. Second worst feeling ever on that day.

That was the time I captured that: 

Diabetes is common, but not everyone knows about every bit of it, even when you're a professional.

Why I blog?

The reasons I blog:

1. I find it hard to express my feelings verbally.
2. It is even harder to express the inner feelings to my closed ones.
3. But, it is easier to put all feelings in words and share it to anyone or everyone whom could be a total stranger to you.
4. I can view back my progression, my phrases in life.
5. And that makes me gather when I was at those times and how much I have changed over the time and where I can possibly be in the future.
6. I write it down for people to read, so they can try to understand me before judging.
7. Though I do not have the chance to travel around the world (yet), I hope I can connect to people who share similarity with me. 
8. To learn things at anytime, anywhere, with anyone.
9. To have fun. hehehehe

Alright, kidding lol

Through their eyes

Even if you don't have a medical professional background,

Even if you don't enter university to study,

Even if you don't read any nutrition related magazines or books,

Even if you don't have a chronic disease...

Please put yourself in the person's shoes. See things through the person's eyes. 

Not simply giving information which is not evidence based and not true, while you're not a medical profession person, you don't read nutrition books, you don't read medical books and you do not have a chronic disease. 

____________________________________________________________________________

A couple of weeks ago, a girl whom I am not close to her at all, came out of nowhere to fb-message me about my so-called insulin-injecting-pathetic-diabetes-life (by the way, my life is actually fantastic with insulin keeping me alive). 

She approached me and asked me: Mind sharing with me about your situation? I can help you. 

I am doing perfectly fine. But, I am curious about what kind of help she would like to offer me.

Then she started saying: If you want to give yourself a chance, there is a way to cure your diabetes. We have lots of critically ill patients, all successful stories. 

When I tried explaining to her about there is no cure for diabetes at the moment. More, my T1D is different a bit, and having to inject every day doesn't mean I am a bad type of diabetic (if she has been studying about this). Why can't people understand, why can't they just try to understand before judging me ARGH. 

Then she came judging again: I am not selling you anything. That's why I am asking you whether you want to give yourself a chance or not? Hepatitis B also no cure, but we have many successful cases.

Hello miss, if I were to judge you, I will straight ask what you're trying to sell in the first place. And who told you that there is no cure for Hepatitis B?! (Luckily that I have learned much from my boss) And you were saying medical books do not tell us everything?! (Those words from your mouth tell me everything is it?)

Few things I would like to clarify:

1. Having to inject insulin every day does not make me a bad diabetic. Just my beta cells are not making insulin hormone. I am injecting the insulin hormone, I am not injecting a medicine!
2. Testimonials are not evidence-based. 
3. There is a cure for Hepatitis B. Please do consult gastroenterologist for further discussion of which evidence-based treatment suits best for you, not by listening to testimonials only!
4. Hope is important for all of us. Hope keeps us alive. But, do not give false hope which may result in a more terrible consequences.

Seriously, thanks for offering your "help" to me. Through your eyes and words, I have learned that every time I correct a misconception, there will be another person who claimed that she is not selling anything, but spreading this misconception out again. God knows who is the next victim. 

Memes from diabetesdaily.com