Confused between Hyper & Hypo

I was in Bangkok for the past four days. Enjoying the very well-equipped 7-11 that they have for almost every 100 meters. Enjoying walking for 10,000 steps every day during that 4 days, as I was travelling on feet, by MRT and BTS only.

On the third night in Bangkok, I and my boyfriend went to the Suan Lum Night Market for dinner and night market shopping. That night we both were having really sore legs because had been walking for the whole day to Siam Paragon and to Pratunam Market. I was worn out, but considered that it was the last night over there, so didn't want to waste the chance and time to experience the atmosphere of the night market in Bangkok!

Diabetes is 24/7. Even when I am on vacation, I still have to work for diabetes. 

Diabetes = Nasty boss

I injected insulin at a corner and begun my food hunting journey at the night market. Didn't eat much, mainly on fruit juices, fruit cuts, Thai-style garlic bread (very oily) and some BBQ chicken. At 10pm, we were about to take MRT back to our hotel. I was feeling so exhausted and leg sore all over. In my mind, I was thinking it must be due to the whole day walking or too much of good food during this travel. I was feeling with much confidence and assurance that "My sugar must be high now, at least >15mmol/L". The kind of bone-tired, worn out, ready to drop feeling were so similar to hyperglycemia. 

I couldn't find any water to wash my hand at that time. Anyhow, Yes or No, better give the sugar a check with uncleaned hands before I leave the night market. So, I poked my little finger to check the sugar, assuming that my little finger will have the least likelihood to have a false reading.

The glucometer read 3.4 mmol/L. 

I was shocked. Suddenly all the tired feelings made sense, although I was having lots of good food and fruits, but I was active! Hmmm wait, or is it because of my uncleaned little finger? From my experience, only plain water can dilute your blood from pricked finger and hence giving you a false reading/a low reading. But my little finger is dry (I wiped it hard on my cloth before I tested),  If my uncleaned little finger had some stains from food or juices, the reading will probably be high, definitely not low. 

Alright, at the end I turned around, walked back to the night market and got myself a half cup of juice and the very oily toasted bread with sugar on it. 

When I got back to the hotel, checked my sugar again, it was 5.0 mmol/L, even after eating toasted bread with sugar. Confirmed that I was confused between Hyper and Hypo just now and thank god that I ate some more food before I left the night market, or else I might be pondering in my "Hypo Wonderland" while on the way back in MRT, believing that I must be real exhausted that day.

Oh ya, I have lost all my photos in my phone because I ignorantly let someone had the chance to steal it. I don't want to repeat the whole sad story again.

Pineapple bowl!

Let me open the cover of bowl

Tasty Thai Pineapple Fried Rice!

Although the pineapple bowl looked big, but actually half of the pineapple is still pineapple, they only put in about 1 medium bowl of fried rice, accompanied with chicken floss, shrimps and sliced Chinese sausages. My fibre of the meal came from pineapple only :p The fried rice stayed warm until the last bite because of this amazing bowl! :)

Make food with 2 C

I usually will not comment much on buying Real Food at organic shop, especially for those nuts, seeds and grains family because we hardly or totally don't find them at wet market or supermarket. Nuts, seeds and grains not only give us the vitamin and minerals, also the healthy fats and fibre! Particularly for vegetarians who barely receive healthy fats from fruits and vegetables.

Last weekend, I over heard some promotional sentences from an auntie who is selling Chia Seeds. She marketed her chia seed as excellent in lowering cholesterol, lowering body fat, making your tummy small, good in controlling sugar level and it's from Mexico, chia seeds' origin country. Also, you must only eat her chia seeds in this way: Soak it in your drinking water until it expands, becomes gelatinous, then drink it together with drinking water whole day. 

Chia Seed totally sounds like a super food from her mouth. My idea of super food is not one food, but a variety of food. And of course Chia Seed is one of the super food that is rich in Omega-3 fatty acids and fibre! And you know what? The famous "Chia Pet" that you always see in RM5 store, the hair that grew out from the ceramic head is actually grass that grew out from Chia Seed :p

Interesting huh. haha I just found out today!

Chia Seed which is rich in Omega-3 fatty acids no doubt can help you to control your cholesterol (I used the word "control" because I don't want anyone to mistaken it as can lower cholestrol, no matter how much cholesterol diet intake). However, reducing your tummy's fat? Sorry to say, Chia Seeds do not act specifically on your tummy's fat. Controlling sugar level? Perhaps yes due to the fibre content. But be watchful of the intake of Chia Seed because too much of fibre may cause gastrointestinal discomfort. Also, Chia Seed is a high protein seed, which may not be suitable for some patients. Please talk to your physician or dietitian first, before you start consuming. 

Oh ya! My title today is make food with 2 Cs - Colourful and Creative! Why la you want to eat this nutritious Chia Seeds only by letting it expand in drinking water? 

Please sprinkle it on your oats! Add it into your cookies dough! Enjoy it with your fruit smoothies! Incorporate it in your puddings! For more, visit WellnessMama. 

Real food can never ever be dull!

By the way, in real life, Chia Seed looks like this in pudding.

Picture from ifoodreal.com

After expanding, somehow looks like our biji sago, right? :)

Hypoglycemia related headache

The reason for this headache is a sudden rush of sugar into the body system after I eat. I don't always get this kind of terrible headache when I eat something in order to restore my sugar level from hypoglycemia. 

I am kinda phobia towards the headache which attacked me a couple of times already. The headache was so horrible that I can't sleep nor do anything. Panadol did a little help. But the headache really made me feel like banging my head to the wall (which I actually already did in the last attack).

During the headache period, the sugar level was completely in range. Just the headache was really killing me. Sometimes I just don't understand how my body behaves. 

I have to keep emergency pain killer with me. Just in case this sudden attack of headache. I know it's weird that I failed to figure out why this happened, after all it is my body. Why is it that I am not aware of my body! Sometimes a more severe hypoglycemia will not give rise to this at all, but sometimes out of the blue moon, it will occur. 

Tonight. Now. I think it is coming back. Not sure if I was encountering hypoglycemia just now before dinner. Current sugar level is normal, two hours after food. 

The pain is arising bit by bit, very similar to those of previous times. To prevent the severe attack later, I'd better pop in two Panadol first.

I search online for this hypoglycemic headache related articles, some say it is because of the sudden rush of sugar into the body system, the sugar hit the brain cells so much that it causes them to expand and hence triggering the headache. It is definitely not a migraine because it strikes the whole head, not one part only. 

Hmmm...or this headache is not related to T1DM at all? Or it is just the stress that I am having? But I can cope with stress, I don't get headaches because of stress. Also, this pain always comes after food.

Not sure if I am right for relating all nuisances to T1DM every so often.

Get fat even by drinking water only?

I must set a target of one post about Dietitian and one post about T1DM every other day.

Weight management is a big market for the dietitian to hit on, because the prevalence of overweight is hiking over these years. And there is a lot of motivation, encouragement and talking for weight management, later on only is counting, calculating and balancing.

Just like the previous post here. Some in the public might have some misunderstanding concepts about the dietitian's job. They thought that I will restrict their favourite food from the rest of their life. Or when they saw me having a weighing balance or a fat analyser beside me, they will say something like:" Oh, I know my number is going to be big on that scale, so no need to step on it." As in, they're already accepting themselves being like that, and decided not to do anything about it. 

Come on, Health is Wealth and restriction for you is the last thing I will do. 

Back to the title. I have been hearing stories like this from my mother, friends and clients.

"I have been eating the same type of food and the same amount of rice since I was 30 years old. I don't understand why is it that I am getting big size at this age!" - a 50-year-old woman 

"I have been eating fruits and vegetable for my lunch, and I skip my dinner. I only eat more during the weekend. At the end of the month, I didn't even lose a single kg." - a 25-year-old woman

"I exercise every day. And I eat very little. Sometimes, I don't eat after I exercise because I don't want to store back those fats. Just don't understand why is it so hard to lose even though I exercise every day, might as well don't exercise already." - a 30-year-old man

Why is it that when you thought you're doing the right thing, as in eating less and exercise more, but still zero results in weight loss? The answer is you probably have spoilt your metabolism. And of course, our metabolic rate decreases as we age. Equation reveals so too.

Basal metabolic rate (BMR) is the energy that you used when you are resting, for breathing, digesting and etc. Harris Benedict equation can be used to calculate your BMR by using your age, sex, weight and height to determine. Assuming you are a female of 165 cm and 55 kg at age 20, and assuming your weight and height have been static. Lets see the graph below.

I guess this graph explains the question why you still gain weight much despite eating and drinking the same type and same amount of food for the past 20 years. And you will be gaining more weight, if your metabolism has spoiled due to improper eating habits and lifestyles.

When the inner body's metabolism is spoilt, no matter how little you eat, how much you exercise, at the end of the day, seriously you will get fat even by drinking water only. That is how hard weight loss always seen in the eyes of the beholder.

So now the solution is how to fix your metabolism, which is already gone hay-wired?

Educating you to eat right and well with real food is the first thing I will do when I consult a client who wants to control weight (See, I won't even count calories first :p). Even when your metabolism has dropped as you age, I promise you will age healthily with satisfaction on your weight. 

Fear not, for nutrition is easy after you understand how the equation goes :)

The Seventh Year Itch

#DiabetesArt

Time passes so fast. Today marks the beginning of the Seventh year living and striving with T1D.

I remember how I would follow what my mom told me to eat and drink during the first year of diagnosis. A lots of misleading education from the public to my mom, and hence the effects were on me. 

I drank before Misai Kucing (Cat Whiskers) for the whole day, for which they believed that it helps in reducing blood sugar level. Also, fruit juice with bitter gourd as the main ingredient, they said bitter gourd can help in lowering sugar level. And the most ridiculous one was 符水, in which the Daoist burned the "mysterious" writing on a thin sheet of yellow paper in a bowl, added water to the ashes, then asked the innocent girl who was staring at her mom to drink it finish! (my mom desperately wanted me to get cured without logical thinking already). Oh ya! There was another one, a so-called God-sent prophet was telling my mom to give the poor daughter to eat as much watermelon as she can. Watermelon can cure her, because the Kuan Yin said so to the prophet. Excuse me, I am a Buddhist, not a Daoist. And eating too much WATERMELON is very refreshing I know, also very HYPERGLYCEMIC!

Okay, I understand that when a person/family came to the end of the road, when they lost their rationality, they would try out all sorts of method from the ground to the sky (from Herbs to the Heaven). Accepting a serious medical diagnosis includes a few phrases. That time, it was a total Denial Phrase for my family and I. Thank god, it didn't last very long, if not I would be admitted to hospital again, this time for food poisoning. 

Definition from internet

The Seventh Year Itch = A supposed tendency to infidelity after seven years of marriage

For me is this

The Seventh Year Itch = A supposed tendency to lose control after seven years of dealing with diabetes

I was checking my sugar level yesterday, I am checking my sugar level today and I will be checking my sugar level tomorrow! Thinking to myself: Good! Checking blood sugar every day, so perfectly in control! No itch! 

But, wait a minute. Who says you only need to check your sugar level, CBS? When was the last time I looked precisely onto my feet, onto the skin between those toes? When was the last time I carefully examined my abdomen and thigh's injection sites? 

Not only sugar level, too many things will "itch" for T1D!

Wish me luck!

I do not want to consult a dietitian?

Excuse me. You do not want to consult a dietitian? May I know the reasons for this? 

I was thinking about this a few days ago. In fact, I think about this matter almost every day now. Perhaps the public does not know what a dietitian is, or perhaps they thought they knew what a dietitian is, but they got all the wrong thoughts in their heads.

In the hospital, I only see patient with a doctor's referral. Of course I can be such a volunteer to go and see patients who do not have referrals. Once in a blue moon, a really rare blue moon, a patient will ask for a referral to see a dietitian. I'd very glad to consult such patient because his/her readiness to change is COMMITTED, i.e. He/she is willing to take whatever it needs to achieve the goal that the dietitian targeted! Such patient not only motivate his/her own self, but also motivate me tremendously!

It has been several times already, when I introduce myself as a dietitian that provides nutrition consultation, they will start commenting about how much restrictions a dietitian will ask them to do, and they still want to enjoy their food for another half century, so a dietitian is like a headmaster restricting their daily favourite food intake. They said all these even before I start explaining on what I am supposed to do.

Dear Tuan-tuan dan Puan-puan (Ladies and Gentlemen),
I will not restrict you from eating your favourite food. For goodness sake, I hate restrictions more than you do.

1) I am not your mother. Like what is written at Eatright.org, the last thing I will do is to give you a one-size-fits-all diet advice. I totally believe that each individual is extraordinary in their own ways. Asking you to stop eating this or stop drinking that will only make me look more like your mother. Okay, I may talk like your mother, but I definitely will set a goal that is realistic and of course predominant for you only.

2) I am not a salesperson. After talking and explaining to you about nutrition, my ultimate goal is not to persuade you to buy a million dollar product, but my goal is to educate you about what is the best nutrition for you and how you can make better health based on your personal usual dietary intake and lifestyles. Okay, I will only recommend the real food, whole food for you, which you can easily buy from the market outside.

3) I am not an accountant. I am not so calculative as: One day, exactly 8 glasses of water.  If not, you failed.  One day, sugar level must be within 4 to 8 mmol/L. If not, you failed. Okay, of course I do count calories and nutrients, but my paramount idea is to want you to enjoy real food, play around with nutrition, while being at optimal health status. Nutrition is easy to understand, just need some proper guidance and encouragement on how to master it and maintain it.

Haiyo, just eat la.
But MINDFUL eating :)

I hate it

If you hate a person, just don't talk to him/her.

If you hate a food, just don't eat it. 

If you hate a place, just don't step onto that ground.
If you hate a subject, just don't study it and simply fail it.

I really hate diabetes. Can I leave it alone? 

I hate that it gives me so many restrictions. 

I hate that it is so time-and-money-consuming.

I hate that it makes everyone thinks that I am so sugar-addict.

I hate that people always say they can't believe I have diabetes.

I hate that hypoglycemia makes me look dumb, stupid and ridiculous.

I hate that hyperglycemia makes me all so fatigue and thirsty.

I hate that I have to be mindful eating all the time.

I hate that freedom is no longer with me. 

I hate it so much.

No matter how much I hated it, I still have to do all that it requires me to do. 

Sometimes I am just so tired of it. 

Okay, I love myself I love myself I love myself I love myself I love myself! Which is greater than I hate it. 

Just do it, cbs. 

Lazy/Reluctant/Non-compliance

The weather is so hot. Sweaty days must go for a good cold bath.

Today again, no water supply.

 I wanted to go out for a jog after work this evening.

Today again, very hazy. Not a good idea for outdoor activities.

I had my bitter gourd fried rice as lunch. So not satisfied with the meal, that I bought Lime Ice cream to eat.

Today. Not again. I ate the whole ice cream by MYSELF.

This crazy weather with hazy smoky foggy air and no water supply will continue until the day after tomorrow. According to the newspaper, water will only come after 55 hours. OMG. 

Yes, I am Lazy and Reluctant. It is very hard to be a compliant patient for these 55 hours. 

By the way, even though I can be complaint now, I am seriously stressed up and hungry andddd sugar is high for no reason!

Okay, calm down. Take a sip of water (save some drinking water for tomorrow) and hypnotize myself. Amitabha.

Beating the Bloat

Title adapted from one lecture by Prof. Peter Gibson, Monash University, Melbourne.

During my internship year in UKM Medical Centre and Hospital Kuala Lumpur, or even during those days studying in University, NONE of the lecturers or dietitians mentioned about FODMAPs. 

F - Fermentable

O - Oligosaccharides

D - Disaccharides

M - Monosaccharides

A - And

P - Polyols

Just got the latest publication of Gastroenterology Journals (January 2014) from my boss to read. January's HIT TOPIC is finally FODMAP! A rather new topic to the Malaysia's dietitians, but the reason to prescribe this diet is not new at all, the most familiar, usual, recurrent syndrome presenting to gastroenterologist everyday.

Irritable Bowel Syndrome (IBS) is categorized into four categories, namely: IBS-D (diarrhea-predominant), IBS-C (constipation-predominant), IBS-M (both diarrhea and constipation alternating) and IBS-U (neither diarrhea nor constipation). However, the very frequent complaint that I heard from patients are bloating, belching, burping and flatulence. I believe very much in some food can potentially worsen the "wind problem", other than bacteria in your colon. And FODMAP can definitely beat the bloat up to 80% in most patients!

And of course, before you start finding an experienced dietitian to consult you on this diet. You must make sure the gastroenterologist has ruled out all other diseases first. We do not want to risk your life, missing any of the organic diseases. Medical diagnosis should be made and confirmed by the specialist doctor. After diagnosis of IBS is confirmed by the gastroenterologist, now it is the time for DIET THERAPY by dietitian (never ever try practicing this diet by yourself!).

I don't know if you are like me. If I can choose, I would like to be on a whole-life diet therapy for my T1DM, without depending on insulin. I would choose to have a whole-life diet therapy, rather than a whole-life medication-poking treatment. Okay, insulin is a hormone, not medicine. (So, am I like hormone imbalance now? loll)

When we talk about nutrition or any new diet therapy, we must first look at the evidence before we start to recommend. Although the scientific evidence on positive effect of reducing high FODMAPs food in IBS has so far been relatively limited, but good news is the research is growing and accumulating over the last few years! More and more studies are showing us that gastrointestinal symptoms can be lessened through diet therapy, though there is no cure in IBS, but symptoms can be controlled, just like T1DM :)

I love how nutrition and diet can help us not only to enjoy healthy food, but also to control diseases and symptoms. I know how terrifying and disheartening it is to know that some diseases are incurable. Despite all the bad news that come together with your disease, at least you know you are still in control of it. Never lose hope. 

Diet therapy is not a cure, but it is your sword in the battle :)  

Water

Water is one very important necessary nutrient. Without water, confirm! No matter what sorts of World Best's Fish Oil la, Antioxidant la, Amino acid la, all will not be absorbed well without sufficient fluid.

I am feeling so Dehydrated, Constipated, Irritated. Dehydrated because of no drinking water. But never-mind, there is always an option to buy Mineral water from market. Constipated is when I already bought mineral water and started drinking to keep myself hydrated, I need to go toilet more often but there is no water supply to flush! Argh. That is when the feeling of Irritated comes in. 

I am biting on raisin bread and wholemeal bread with ham tonight. Easy food without the need of water to prepare, just bought from the nearest bakery. Very sad because I am so craving for fruits every night and now I couldn't clean and cut fruits with water. Maybe I can try washing fruits using Mineral water, or perhaps I should wait tomorrow and see how. Aiks.

You may ask: Why didn't you store up pails of water? Yes I did. But bowels activity have been quite good for tenants in the rented house, toilet will stink if no enough water for flushing. Life is so inconvenient without water. How do people in desert actually make a living with such minimal water? 

Air is so hot, dry and hazy, my mouth is feeling dry frequently, make me mistaken it for hyperglycemia. Goodness. 

You may give me no air cond, no internet, but please don't give me no water. I hardly make a living here, seriously.

Nothing about Nutrition

I realised that sometimes it is not essential to talk about nutrition during the first visit with the patient or client. Because nowadays, majority people practise an unhealthy hectic lifestyle that lead to their nutrition deficiency or diseases. The first measure should be to find out why are they unable to eat meal on time, eat high trans fat easy fast prepared food, eat their meals speedy and etc. And then suggest ways to overcome these obstacles. Especially for weight management clients. 

I have to admit that I am still a junior dietitian and there are a lots more for me to discover. Even till the day I become a senior dietitian, there are still much about nutrition and dietetics to explore because nutrition dietetics progress everyday to a better era. It is a long-life learning.

A senior pharmacist was chatting with me on the other day. He told me that my role is not only to educate about nutrition but also to consider little things about eating habits. For example: To eat fruits before or after meal? Is drinking water before a meal makes a better diet or worse? What kind of nutritious food when taken in large amount will result in indigestion?

I will try to answer these questions at here. But, to be frank, again there is no 100% in nutrition. Hence, every diet must be individualised. There is no one recommendation that works for everyone. 

1) To eat fruits before or after a meal?

   Many claim that we should eat fruits alone or on an empty stomach, due to better absorption of nutrients as all the enzymes work for the ingested fruit only. Some also mentioned that if fruit is taken with a meal, it will slow down the digestion process, leading to fermentation of sugar in fruits (fermentation by the bacteria). Hmm yes, fructose sugar might cause gastrointestinal problem for people who have sensitive bowels, but it also depends on how much fruit and what type of fruit. And generally, fructose sugar is easier to digest with the intake of other food or with intake of glucose. About better absorption of nutrients, our body is basically designed to absorb a mixture of nutrients/food, unless if the person has malabsorption problem. 

I guess, whether to eat fruits with a meal, before or after a meal is depending on your needs. For example, Vitamin C in fruits helps in absorption of Iron, therefore if you want to have better absorption of iron, please do not eat your oranges on empty stomach. Whereas, if you want to avoid over-eating during a main meal course, perhaps you can try eating 1 serving of whole fruit before your meal. Fibre in fruit can help to fill up your stomach with lesser calories.

2) Is drinking water before a meal makes a better diet or worse?

   I remember my coach dietitians were giving tips to weight management client on how to increase their satiety before they consume a main meal. Drinking 1 glass of water before meal can avoid the patient from over-eating during the main course. But somehow we have forgotten to mention when to drink water before a meal. 

Okay, one essential thing that I must mention is drinking water during a meal/with a meal is not essentially good. Because while our stomach is secreting gastric acid to digest the food in the stomach, if we were to drink too much water, we can potentially dilute the gastric acid and hence making the digestion not so efficient. Alright, my idea is too much of water is not good, but little water may be helpful, and also when you drink it. Drinking 1 glass of water 30 minutes before your meal, can prepare your stomach for digestion, other than giving satiety signal. And of course, sipping soups during your meal is definitely alright. But, keep in mind is sipping, not too much. 

I remember the gastroenterologist always consults his patients with this: If an emergency of acid reflux happens and you do not have any medications at home, you can try drinking lots of water so as to dilute the acid in the stomach. But of course, if too severe, please visit the Emergency Department.  

3) What kind of nutritious food when taken in large amount will result in indigestion?

   Beans, honey, garlic and onion are basically nutritious food. From my experience, after I advised the patient to stop eating these food and start them back in smaller quantity, their gastrointestional problem improved by almost 80% most of the time. 

Picture from www.wholesomeone.com

Please do consult your dietitian or pharmacist for any related topics.

Sorry, I give up.

I am sorry, sometimes I give up explaining to you about T1DM.

Today, I was consulting a 60 year-old Indian uncle about Food Intolerance and Diabetes. His diabetes is Type 2.

A few misconceptions that he is having:

1. Guava can help in lowering sugar level. But he forgot about eating guava with all other different types of fruits can increase his sugar tremendously, despite Guava is known to have a low Glycemic Index (GI).

2. Bitter gourd cannot help in reducing blood sugar level (which I agree with him, but I disagree with his explanation). His explanation is bitter gourd has a natural insulin property. So, when we eat bitter gourd, it will actually stimulate our pancreas to secrete less insulin. Less insulin = Higher sugar level.

3. I told him that I am also a diabetic patient, but is Type 1, in which my pancreas no longer produces insulin due to autoimmune. Then he started showing me an astonished face and saying that my parent must have diabetes but they didn't know yet. I told him, neither my parent nor my grandparent has diabetes. He insisted that my great grandparent must have diabetes, and during their time, medical diagnosis wasn't so advanced yet, so doctors missed out the diagnosis. 

Okay, I give up. If I continue to correct him, I wouldn't be able to finish my consultation and he would start pointing all my Nenek Moyang (ancestors) have diabetes. 

I do not want to sound too harsh in my consultation that would make him feel that I am offensive. Therefore, I corrected his "Guava" and "Bitter gourd" misconception slowly and I praised him that not many people know about Glycemic Index. One extra compliment for him is when I gave an example about 2 bowls of Brown Rice and 1 bowl of White Rice, he actually understands well about Glycemic Load. 

Okay la uncle, I forgive you because you certainly should know more about T2DM, instead of T1DM :)

Picture from BBC Science

Cost of Diabetes

Cost of diabetes, especially for T1DM, as follows:

1. Test strips

I can't afford to test my sugar for 8 times in a day ever since I was diagnosed. My mom who works as a home-based tailor strives hard to pay for my test strips. She knows testing sugar is essential for me. I always wanted to save money by using less test strips (I know it's bad, but I feel bad for using so much of my mom's blood sweat money).

2. Lancets

Honestly, I don't change my lancet often. Probably once in a blue moon (Okay, I know the recommendation is a new lancet for every pricks. But, I am the only one who is using the lancet only mah). I always change it when I feel it is no longer sharp.

3. Pen needles

     If I buy them individually, they will cost around 50 or 60 cents per needle. So, my mom always buys them in bulk like 10 boxes (Each box has 100 needles, so 10 boxes can last me for about 500 days if I were to use 2 needles/day).

4. Alcohol swabs

I am no longer using alcohol swabs nowadays. Okay, you may ask me no sanitation before you inject or before you prick your finger? Hmm. It is seriously not convenient for an MDI patient to swab alcohol every meal (Well T1DM is all about the inconvenience, or I am just lazy). But no worries, I always make sure my hands and injection sites are clean before I poke.

5. Insulin

I am getting all my short acting and long acting insulin supplies from Government Clinic, in which they charge only RM1 for each visit. Real cheap, but I have to wait for the whole morning to see a doctor and to wait wait wait and wait due to the long queue. And they are never ever going to get rapid acting insulin for me because according to the pharmacy, rapid acting insulin is much more expensive and very few patients are using them, so they will not order (Though I cannot accept this explanation, but due to economic constraints, I cannot afford to go to a private hospital, I have to accept the reality).

6. Blood test (HbA1c)

I check my HbA1c every 3 months which you can find my results on the right side of my blog. Now that I am working in a hospital, the lab person is charging me the staff price only! Very cheap!

7. Hypoglycemic agents

These agents are actually candies. Regretfully, I cannot find any pharmacy or supermarket selling Glucose Tablets or Glucose Gel in Malaysia. So, I am depending on the various types of sugar like Mentos, Skittles, Hard candies or Juice boxes. I used to take chocolate, but they melt too quickly and easily get over consumption LOL.

_______________________________________________________________________

I do not own any insurance before I was diagnosed. Anyhow, I heard some insurance company will not cover our diabetes supplies for long periods also *sighed

I have thought of changing from insulin pen to insulin pump. Have been seeing other T1D bloggers using pumps since decades ago. And they are receiving so much benefit from pumps and CGM! I am so tempted to buy one by installment payment. But, those infusion sets will cost a bomb for me every month, and it's currently hard to get rapid acting insulin from government hospitals. 

Anyway, to buy or not to buy a pump, I still have to wait when my pen needles are finishing. I still have like 600 or 700 needles more in stock. Hmm, let me finish those needles first.

Don't worry, insulin pump doesn't look a thing like that :p
(Picture from diabeteshealth.com)