DiAthlete Running Notes

“Having type 1 diabetes certainly makes running exciting!”

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I had a training run this afternoon and went at it with a good pace, shorter distance. Good to be back running, although no upcoming races and, as yet, no confirmed major challenges this year (more to come on that) but it’s important to keep positive and ready.

As an athlete you need to work hard to keep on top for both performance and general fitness, whilst looking after your body. As a person with type 1 diabetes, that brings a whole new level to the game! You have to keep on top of everything!

GOOD POINTS in training today: Diabetes! I’m the boss of that:

Started with a blood glucose level of 12.0 mmol/l (216 mg/dl).
Finished with a blood glucose level of 10.5 mmol/l (189 mg/dl)

- Likely to now gradually decrease, blood checks in the next 30 minutes to hour.

Completing the run! (only 3 miles nothing like 900 miles!) but in living with diabetes my opinion is that it doesn’t matter how fast or how far, it is all about finishing what you set out to do and that’s how you stick it to diabetes.

I consumed around 10gs of orange juice and had lowered basal insulin rate by a unit this morning (on split long acting dosage). If I was running further and at a more consistent pace, I would have lowered it much, much more! Shorter distance, 5k, can mean you run faster and can even increase blood glucose if competing (this was training).

Aside from diabetes, I ran with a new technique. Had a bad previous injury 6 years ago and it meant I naturally altered my running pattern to protect weakened ankles. This caused worse effects on joint areas. Thanks to an assessment session with Lisa Jackman, who will be doing a 10 week yoga-fitness development training program on me for running, she highlighted the problem. Legs felt good running today.

BAD POINTS: although there’s not too much on the calendar in the coming weeks just yet, I need to build my fitness levels back. Stamina is there no question, it comes from will power largely, plus I’m a freak. But recovery time has increased after runs, so need to lay off the late night cheese and beers and get the healthy stuff back inside more often! Cholesterol is important with long term diabetes for all types.

Type 1 Diabetes and Sport!

Recently on the DiAthlete Facebook Page I shared information ‘from the horse’s mouth’ on my experiences and knowledge regarding type 1 diabetes and the effects in sports and exercise. Through Aerobic and Anaerobic exercises, there are different occurrences that can take place – and therefore, different methods of control to take on!

Life with diabetes should never be allowed to hold you back from doing what you enjoy in life, performing to the best of your abilities and living life to the fullest. From experience I have built up the education for control in sport that I have today, so I hope this might help you – and to think, I once got awarded a ‘Double E’ grading for GCSE Science… but life with type 1 diabetes taught me what I know!

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Aerobic Exercise

As you might have figured through here by now, I am a long/ultra distance runner. I endure challenges to battle my diabetes with an aim to succeed in order to help inspire you – as it is my sincere belief that this medical condition cannot prevent us from any accomplishment in life, no matter how crazy!

Ultra running, along with the likes of long to middle distance runs, cycling, swimming and even walking, all register under AEROBIC exercises. Motorsports will largely offer a similar effect, as although you are not physically burning glucose, the heat and intensity of it will decrease blood glucose at a similar rate. Other sports such as Tennis, Boxing and Weightlifting, can also offer a similar effect – with a combination of both aerobic and anaerobic.

THE EFFECTS OF AEROBIC EXERCISE:

Aerobic exercise is energy being released with oxygen for cells from glucose – meaning that with the body burning energy at a consistent rate, with say what I do in ultra running, glucose are consistently being burned up too. With diabetes this of course means that our Blood Glucose Levels will therefore decrease.

For me I have been there over the years, on the ground, face down, shaking through the serious effects of almost worst case hypos. I’ve been a runner for 8 years. And through it I have learned. I never had the advice or support from professionals when I first started up, I was just a kid keen to get out there and take the fight to my diabetes. I succeeded in that, yet, had many lessons to learn along the way – which I did. And that has only developed my knowledge. If you haven’t ever had your back up against the ropes, then how will you know how to fight your way off of them? That’s diabetes in my opinion.

I have tested my body out like a test dummy to learn more about my condition. I found in aerobic exercise, swimming to be the more rapid glucose level decreasing exercise, where your entire body is constantly in use – this may alter with different forms of swimming but the front crawl particularly requires a full body effort. Secondly, long distance running burns up energy at a more gradual rate but with a constant decrease. You work your whole body once again, the legs working the most but with the arms pumping and the mind focused. And thirdly, in my research, cycling decreases levels very consistently as well, with the legs working at a higher rate than running but not the full body motions.

Aerobic exercise brings about higher risks to low blood glucose levels DURING exercise. This can also repeat post exercise in the hours to follow, going on the amount of energy burned up. The answer: prevent the hypos!

HOW TO KEEP CONTROL DURING AEROBIC EXERCISE???

Don’t get disheartened if a hypo does take place during exercise and absolutely do not let it prevent you from participating!

Learn from it. Why did this hypo happen? That was what I was asking myself back in 2009 when I attempted to run around the Isle of Wight and found myself on the floor to end the first day of a hilly 70 mile weekend. It cost me big, I fell behind on time on my challenge – a year later though, I came back and completed it.

I figured the need to include more carbohydrates, as I was taking on quick acting glucose through fruit every hour but it often wasn’t enough for the level of endurance I was taking on. I then identified other areas from hourly consumption of carbohydrates (I aimed for 30gs per someone weighing 70kgs), to the most important finding: the level of insulin in my body.

Firstly my intentions was to decrease the quick acting insulin before runs, my Novo Rapid injections before a morning meal and not taking any quick acting for snacks during the exercise. I found this may be better for short distance runs of half an hour to an hour. However, being out there all day running ultras – it was the background rate of Basal insulin which was key. Taking a split dosage of Levemir the first step forward:

Having it split whilst being on MDI meant more flexibility for sports. In aerobic runs, I found my Basal to have a great effect and required much less insulin. I reduced my daily basal insulin by 50% for my ultra running events, where I was on 14 units and 14 units a morning / evening split, I decided to alter to just 2 and 12 units for a ultra day. This will alter with every exercise for every person, but the key is figuring out how much the lower or increase by through testing your blood glucose levels regularly!

I feel for those on an insulin pump, the accurate working out of hourly carbohydrates is more important, as well as lowering the quick insulin rates.

For me, whilst enduring the challenge of running 30 miles a day for 30 days in 2013 across the UK, I then found what worked best for me on MDI was adding a third injection of basal insulin on a split dosage and timing it to perfection: if I injected my evening dose at 10pm, then when running at 9am the next morning some of that evening dose would still be active. Come the afternoons, with only 2 units in my system, despite the exercise the blood glucose levels would increase – as there was no basal insulin in the background. So I added another unit for the afternoons and then had my evening dosage a little earlier.

My main message is, your diabetes is yours; it is your responsibility and you’re the boss of it. It is great to get advice and we have a positive community to help each other. But if you want to try something a little difference, go for it. If you believe that a tweak here and there might work better, try it out, test your blood glucose levels and see the results. You live, you learn, you improve. This week I’ll also post about anaerobic exercise – which surrounded my childhood years!

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Anaerobic Exercise and Type 1 Diabetes

Following on from the last post on aerobic exercise, here shares some experience and advice in facing other forms of endurance. Anaerobic exercise largely consists of exercises surrounding speed and power, with high intensity in shorter durations. Sports such as Football or the majority of activities in Athletics are good examples of anaerobic exercise, which has a reverse effect on diabetes blood glucose levels.

A little thing known as ‘the adrenaline effect’ will cause blood glucose levels to actually rise during exercise, through the sudden bursts or alteration in movement. This causes the liver to react and release more glucose into the bloodstream, therefore increasing the levels. When you consider the 100m sprint, you might have warmed up, psyched up and then be static until suddenly then bursting into full speed. This would possibly be enough to trigger the liver glucose release. In a sport such as Football it is furthermore likely to cause affects, where the game is on going for 90 minutes – you might be walking, jogging and then suddenly bursting into a sprint to chase the ball down. In my football playing years, to my surprise I would quite often come off the pitch with a hyper zoned blood glucose level – instead of what many might think to be the opposite.

Many contact sports have the best of both aerobic and anaerobic. A good example is Rugby: a physical battle on one hand which would aerobically lower blood glucose during play, yet, sudden bursts of energy and quick sprints will fall into play. It can also depend exactly what position you play in – for example in Rugby you have positions for ‘forward packs’ who tend to be the warhorse type of 6ft5 powerhouse figures in a team, that you wouldn’t necessarily want to bump into down a dark alleyway – they are the players engaging more into the opposition with scrums, rucks and mulls. Quite the physical side of the game. Backs play an important defensive role too but are the runners in the team, the players who will receive the ball and burst forward with it. So it is more likely that if an entire Rugby squad had type 1 diabetes, the forward pack would be looking to prevent hypos during the game more than the backs, who might be looking to prevent the hypers!

In football: a striker might be walking about more than any other position, other than a goalkeeper, during a match (should always be on their toes though!). But a long ball might be played forward and suddenly that striker is going to be more required to burst into action and get on the end of the ball with a sprint. Whereas, a central midfielder might be covering a lot more ground, box to box. The differences in game styles could create a difference in blood glucose levels and how the adrenaline effect takes place.

Even in running this can take place, more so in competitive running such as 5km races; when your pace is increasing and there’s that sprint push to finish – same thing! What I found, in perhaps taking a few risks, is the alterations of pace could be a last resort saver. On one occasion I was out a running long distance challenge, which is aerobic, and my blood sugars had gone low. The problem I faced was that 5 miles was still to go. The advisable solution would be to stop – but to me, that’s a feeling of giving up. I was out of supplies and had no money on me, so I decided to change my pace from a consistent rate of running to a mixed pace: jog, sprint, half sprint, walk… just repeated until I made it back home. The result:

1. I made it back home safely – and that’s the important part. It isn’t about taking risks, it’s about finishing what we start and showing that diabetes isn’t stopping us.

2. My finishing blood glucose was 6.5 mmol/l (somewhere around 130 ml/dl – good basically!), it had risen up 3 mmol/ls from when I was hypo during the run with 5 miles remaining!

CRASHING TO A HYPO A FEW HOURS LATER??!!

Energy has still been burned nonetheless! So if the blood glucose levels do find their way up to a ridiculous reading in being hyper during, or just after, exercise, it is very common for the hypo crash to follow it up a few hours later.

This can be a serious problem, suddenly catching you out off guard almost – where you might think about being on the higher side and assume the hypo from exercise isn’t coming. One thing that is important in diabetes is that you always have to be on the ball (no pun intended) and so regular blood tests on exercise days are key. If you’ve put in a hard shift for the team, or pushed the limits down the gym, that crash is likely to occur later in the day, or even during the night.

Repeat hypos can also take place. Although are more common when they happen during exercise. Sports where I mentioned there are a combination of both anaerobic and aerobic exercises, are more likely to be the one’s to cause repeat hypos, which may take place more instantly after the exercise and then come on later again in the evening, and even over the next 48 hours it is definitely advisable to keep close checks on blood glucose levels.

INSULIN AND ANAEROBIC EXERCISE

On Multiple Daily Injections (MDI) as I am, one thing that can frustrate during a competitive sports match is not being able to fully concentrate – which can happen if blood glucose levels are running higher! When playing football, one method I adopted was actually taking, on a split dosage of daily background Levemir insulin for my basal intake, MORE of the basal insulin. I figured simply that when I was coming off the pitch with a blood glucose level in the teen or 20s in mmol/ls, I clearly needed more insulin in the background to counteract that release of glucose from the liver.

Did it work? Yeah. In the game, it did. I used to be a good player and type 1 diabetes didn’t prevent that. I would take an extra unit of background insulin and the results were I’d come off the pitch at a respectable level – meaning I performed with a strong level of concentration. However, there are one or two issues in that:

The HYPO CRASH! If you have more insulin working in the background and have endured a tough session or have been putting the work in on the pitch, on the dance stage, you name it, then that crash is going to come more sooner and more rapidly. So for me, upping the background insulin to maintain better control in anaerobic sports, it meant that the risk of hypo would be more forceful much sooner after the game. A way of counteracting it was the post game sandwiches – eating early, within half an hour, after finishing the games and taking less quick acting insulin with the food.

There isn’t really any MUST DO THIS, MUST NOT DO THAT when it comes to it; glucose naturally being produced internally is difficult to control – whichever way you look at it. For aerobic exercises such as long runs, cycling, swimming, heck even going to a club and dancing all night, you can perhaps prepare better given the fact levels will decrease during, with consistent rates of exercise. When it comes to different exercises and quick bursts in anaerobic forms, this brings up challenges and again, it is your diabetes and your decision to make a few tweaks on – although there is more to think about; by testing blood glucose before, during (where possible) and after exercise as much as possible you can keep on top of things! Learn what levels of insulin are working for both basal and bolus and consider what times are best for meals – particularly after exercise.

Ultimately, diabetes can never stop you in anything if you are determined enough not to let it!

Miami event

Lifelong Medical Exemption Certificate (???)

Opening my Wednesday post up on a bright winter’s day in South East London (between hail storms), I was somewhat taken by surprise to read about a £100.00 penalty charge and additional £40.25 prescription charge coming my way…

Medical Exemption Certificate? What would have been helpful, in a view of common sense really, is if the NHS Healthcare Professionals made an effort to explain exactly what this is and also how long it is ‘valid’ for…

Below is my letter to the NHS Business Services Authority, in response to this penalty charge:

Dear the NHS Business Services Authority,

On the 3rd February 2015 I received a letter through the post regarding NHS prescription charges, complete with a Penalty Charge Notice. This seemingly quite random check reflected that I had committed an apparent felony, when collecting my monthly medical prescription for the month of November 2014. I had made an ‘incorrect’ claim that I did not have to pay for my type 1 diabetes essentials, as I didn’t have a valid medical exemption certificate – case reference: 11140788892. As a young adult who has lived with type 1 diabetes for the previous 15 years and 1 month, which medical records will confirm, there is little one can do when diagnosed with such a condition; therefore, I do not agree with the villainised concept you appear to have tarred me with in regards to this penalty. Hereby I wish to present my appeal against these charges.

Firstly, I would like to introduce myself. My name is Gavin, yet some, particularly young fans who live with type 1 diabetes, do also refer to me as ‘The DiAthlete’. What The DiAthlete does on a regular enough basis is kick diabetes’ backside! What my work entails is reaching diabetes communities and passing on some motivation, some encouragement and a sense of stickability; possibly three things missing in the media conception of diabetes. I endure challenges, and by challenges we are not speaking about 50 sit-ups on a local park bench, we are talking feats as extreme to my name as completing the 30/30 Challenge in 2013 – where I ran from John O’Groats to Land’s End (the length of mainland UK) in 30 days, covering 900 miles and defying diabetes. I also proudly represent the UK in a global program where we are one of 70 nations in the International Diabetes Federation’s Young Leaders in Diabetes. And to add to that, I once had the honour of being a London 2012 Olympic Torch Bearer for my accomplishments from age 17 onwards in supporting the type 1 communities. So, please tell me, does that sound like somebody who would be out to ‘cheat’ the NHS system?

The first clear point in my argument against your charges, which has been presented as a £100.00 penalty charge plus £40.25 prescription charge, is the fact that absolutely no effort from the NHS has been made to inform myself, or indeed many others with type 1 diabetes, of awareness about the medical exemption certificate. Personally my local and assigned GP, Dr Thavapalan, is based at Little Heath Road Doctor’s Surgery, Bexleyheath. I have scheduled an appointment with him, which has the earliest date for Monday 9th February (an indication perhaps of how difficult it is to book an appointment, regardless of whether you know or do not know about medical exemption certificates) to discuss this matter. I believe that part of the responsibility does sit with Dr Thavapalan, as he has never spoken to me of the need for a certificate to prove I have type 1 diabetes in relation to receiving my medical essentials; but is that his job? He has signed the approval for every prescription in knowing of my medical condition through records. My parents, Mr Vincent and Mrs Angela Griffiths, were completely unaware of any kind of certificate, and they dealt with my diabetes needs from childhood at the age of 8 until later teenage years. If the Doctor’s never knew to inform them of such a certificate, how were they to know?

To extend this, then upon my progression from childhood care to adolescent care in my diabetes management, where the responsibilities fall upon myself for my prescriptions and healthcare, if my parents were not in the know regarding the certificate, then how was I to know?!

Aside from the Doctor’s surgery, key other areas in healthcare should be where to look? This being my diabetes clinic at Queen Mary’s Hospital in Sidcup or my Pharmacy, Lloyd’s on Pickford Lane, Bexleyheath, where I collect my essentials in prescriptions. Never, never, have I received any information on this. Following a phone call with a lady called Jill earlier today, who works for you at the NHS Business Services Authority, as lovely as Jill was she explained to me that it is my responsibility to research and validate an exemption certificate. That it may be, yet, if no healthcare professional bothered to make the effort to explain the need for this to me, then how am I to know and feel the need to research this? If my prescriptions of insulin and blood testing strips, that are important to my long and short term survival, have always been provided – why would I research exemption certificates when I was put under the impression that I live with type 1 diabetes, a serious medical condition, and that qualifies for the right to be provided with the required resources for me to ultimately live? Perhaps this penalty charge has been given to the wrong person – maybe you should look at the Pharmacy responsible for not checking with patients that they have the required qualifications to be given prescriptions? (Although I am sure, as it would seem they were too, that type 1 diabetes does qualify…)

It could even be proven, if you took this matter as far as the courts, that actually the person who ticked the box of the ‘medical exemption certificate’ for the prescription forms was not in fact me. It was the pharmacist. You see, I have a particularly odd way of holding a pen, which could indicate that I didn’t tick that box. It is possible that my signature is on the papers, but as an unaware individual who had been offered no advice or information regarding this matter by either the Pharmacy or Clinic, a British Citizen with a requirement to receive insulin as my human right to live, how was I to know?

In my lifetime so far I have injected close to 30,000 needles with accurate and worked out units of insulin and have taken close to 60,000 finger-pricks for blood glucose level checks. If I had not have taken these actions, I would not be alive. That is what type 1 diabetes is. I am no ‘fraudster’ or whatever you are making me out to be by sending this penalty, and I absolutely should not be made out to feel that way – or any other person with type 1 diabetes; I am simply an innocent human being who battles a 24/7 medical condition and who really doesn’t have the funds to pay out £140.25 because of having that 24/7 disease. I refuse to make such a payment and request that you revise this penalty and the system, annul the penalty and prescription charge and make it more clear across the nation that we need Medical Exemption Certificates. My suggestion is that validity of such a certificate should also not stand for 5 years, we live with type 1 diabetes mellitus for life and therefore our exemption should stand for that timeframe as well.

Please listen to the common sense that I present here.

 

Yours sincerely,

‘Mr DiAthlete’
Gavin Griffiths

Taking this argument further, I have come to realise that there are many in my situation, within England particularly, unaware of the medical exemption certificate – especially young adults who would have had type 1 diabetes during childhood, progressed to adult care taking the responsibility for prescriptions and long term health independently, and have never been told by an NHS professional about the need for this! It is not as though the majority of young adults like myself can really afford this kind of penalty (for the crime of having type 1 diabetes and not receiving advice). It has also been brought to my attention about the 5 year validation of this mentioned certificate, which is also ridiculous: type 1 diabetes is lifelong, therefore any exemption validation should be lifelong – made clearly aware from the point of diagnosis to both patients and families.

PLEASE SIGN THIS PETITION FOR A LIFELONG MEDICAL EXEMPTION CERTIFICATE TO ALL WITH TYPE 1 DIABETES IN THE UK IF YOU AGREE!!!

DiA-Gadgets

Last week I was invited by Medtronic UK to come up to their head quarters, in the delights of Watford, and attend a meeting regarding their latest development in diabetes technology and the world of insulin pumps, the MiniMed 640G.

Pump

Personally I’ve always been a more straight forward type; for example in my days on the football pitch I was never the pink boots, twinkle-toes and make-up type of player… I was always the sleeves up and battle hard type, coming off the pitch drenched in mud and blood. And that’s the mentality I’ve always had in diabetes too really, to get stuck in and get on with it.

In the time I have lived with diabetes I have seen some major changes and developments in care come about, which continue to progress – this latest meeting with Medtronic being an example of that. There are insulin pumps as an alternative of the multiple daily injections I have always been on, continuing blood glucose monitoring systems, developments of an ‘artificial pancreas’ and all kinds of improved devices in terms of blood sugar meters and even insulin pens (check out Timesulin who have a simple but effective cap for insulin pens, so you don’t forget when you last injected insulin).

With all the diabetes ‘gadgets’ now in the world, I recall Alex Silverstein saying: “it is an interesting time to have diabetes!”

Indeed it is, especially when you consider once there was a time when people would take a slash (urinate) on an ant-hill and see whether their natural liquid was sweet enough, with high glucose, to attract the ants out to it.

In the modern world, personally, I’m not all that technically minded it is fair to say. I have some key skills in creating events and organising crazy challenges, as well as the heart to succeed in those challenges in my fight against diabetes; yet, I’m very old school for a young adult. An example, I prefer to listen to The Rolling Stones way ahead of One Direction. The fact One Direction now twice got a mention on my blog offends my pride. There’s simply no comparison between those two. None at all. In light of my old-schoolness, I have always remained on multiple daily injections, where in being an active diabetes advocate in the Western world, I have had opportunities to make a change in the past and go onto the insulin pump.

Last year with the United States tour for Marjorie’s Fund I had my first DiA-gadget taste. Firstly, I am absolutely delighted to hear that the funds we raised on that adventure will be used by Marjorie’s Fund to help support diabetes supplies in Gambia this year; with Dr Baker working with my IDF Young Leader pal Lamin on that!

In the U.S Tour I was on Dexcom’s G4 Platinum continuing blood glucose monitor (CGM). It was a good experience for me. The first time I wore the sensor I had an incident with some blood drops coming out, but after support from the #DOC passing on advice, it was easily solved. And I never had a situation like that with it since. What I really liked about the Dexcom was how it detected whether my blood glucose levels were rising or falling – I think that is key for anyone with type 1 diabetes.

It’s importance increased really for me given that I do not have very strong hypo-awareness symptoms. Once upon a time I used to have strong symptoms, which probably acted in a similar way to the CGM in terms of awareness: I’d get shakes and shivers when dropping low in blood glucose, and alternatively a quench of thirst and a regular need to urinate when rising high in blood glucose. In not having those symptoms come on too strongly anymore, having a device that beeps, vibrates and makes you aware of that is a great advantage. I successfully completed the 7 marathons challenge of running around Long Island and Manhattan, New York, and only had 2 hypos in the process, which isn’t bad considering 180+ miles of endurance…

I did kick myself for those two hypos though as they both came on the very last run! I injected my normal rate of Levemir basal insulin without thinking, where I usually lower my daily intake by 55% on a split dosage on run days (see, mathematical skills enhanced through diabetes..).

In travelling to Watford, home of the Hornets who Crystal Palace of course beat 1-0 in the 2013 Championship Playoff final, to attend Medtronic’s advocacy group meeting, I wasn’t sure what to expect. I knew all other attendees were on the pump and so I wasn’t quite in the know as they were. My technological terms are along the lines of “sticking the needle in” and so I had to quickly adapt! I guess what has put me off from going onto an insulin pump over the years has been two things really:

1. The idea of being attached to something

2. How will it affect me in sport?

From the latter of those two I know most in sport and exercise talk fondly of the pump – it is something that helps their control better for that. A few years ago I remember seeing Dr Gallon and he was strongly in favour that someone doing the level of endurance I was should be on an insulin pump. However, I have built many experiences up and have loved gaining the knowledge of control on injections – it is what I know and what I do. So why change? Has always been my question.

In the meet it was great to see numerous familiar faces and also meet people that I knew of through their online advocacy but had never met in person before. And Kyle Rose was there, of course, he is every-bloody-where I go! The Alps, San Diego, Melbourne, Watford…

In hearing all about this Medtronic MiniMed 640G, initially my thoughts were… who names these devices? Dexcom G4 Platinum, Medtronic MiniMed 640G… my assumption is J.K Rowling. The evidence is in the Nimbus 2000…

But actually from what I was hearing, and granted what I was hearing needs to be released (end of Feb in the UK I believe) and proven, I was really impressed. Their aim was clearly laid out to provide people with better health in diabetes, improving both the short term risks and long term control in health. What appealed to me the most regarding this device was the ‘SmartGuard’. Now I’d never heard of a SmartGuard before, it sounded to me like Stephen Hawking in a Red Coat outside of Buckingham Palace. The concept of the SmartGuard in this insulin pump of Medtronic really did intrigue me and seems a potentially great step forward in diabetes. And where I am concerned, a great step forward in sports and exercise for diabetes management too!!

It uses modern technology such as the cgm’s ability to predict the increase or decrease of blood glucose levels. It notifies you when dropping high or low, and this alarm can be altered, say if slightly hyper after dinner (as often expected) and turned to vibrate so you don’t have the annoying beeps continuing. Then this SmartGuard operates to keep your levels safer from hypoglycemia – stating that it will prevent 80% of hypos. When the blood glucose levels (in mmol/ls) are 3 mmol/ls above the level you put in for your HYPO mark (say 3.9 in most cases) and decreasing , it will automatically stop the insulin into the body to prevent the hypo. You don’t have to do a thing.

My question was: “What about in exercise where your levels might be dropping at a much faster rate than normal?”

And the answers I received suggested that this device will automatically adapt through the SmartGuard, calculating how rapidly the levels are decreasing and acting to prevent the hypo. I also asked about whether you need to tweak your insulin for the exercise and the response was that no you do not. The system works to prevent hypos in any way, shape or form and the further remark was that you wouldn’t even need to load up on carbohydrates beforehand to prevent hypos with exercise. Medtronic seemed very confident in this.

I made a suggestion at the other end. If this is effective and prevents 80% of hypos, brilliant! In terms of hypers, currently they are able to alert you through vibration that the levels are increasing and reaching your high threshold level. This allows for you to then act and stop the hyper yourself. The suggestion I made was whether they could also prevent hypers from happening, automatically releasing insulin at a certain level. This isn’t in the device, yet, according to Medtronic, that is the next step. They might owe me a few drinks on that one!

From what I understood in being at the meeting is that the DiA-Gadgets are so advanced now that anything is possible for the future. This MiniMed 360G really does appear a great way of bettering control of diabetes both short term and long term and I was really impressed by Medtronic’s ambition here.

Would I go on to the pump? Who knows… que sera sera!

(with Dave, Mike, Lindsay, Lesley, Kris and Kyle – the Taxi Team of diabetes advocates heading back after the Medtronic meet. Step aside Ellen DeGeneres!)

Pump Team

Running with Diabetes

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Running is the ultimate competitive hobby, even for those not intending to compete. From taking on races in actual competitions, 100ms like Usain Bolt, relays, 5kms, 10kms, marathons… to going for casual runs in general, there is always a purpose: to succeed. To run to keep fit, there’s a purpose; to run to lose weight, there’s a purpose; to run for the thrill of it, there’s a purpose! For those living with diabetes, every time they run they are competing against their diabetes…

Type 1 diabetes can have short term challenges in sports and exercise, for the blood glucose levels can lower and present a risk of hypoglycaemia. Type 1 diabetes management in exercise takes key decision making and understanding; an accurate consumption of carbohydrates per hour and precise intake of basal and bolus rates of insulin, to correspond with the level of exercise, is where the answers sit.

Constant rates of exercise will lower blood glucose levels gradually, however, with type 1 diabetes the body cannot dictate how much insulin is supplied. A basal rate of insulin is what a person with diabetes injects to replace a daily level of insulin to work in the background, which means in exercise if there is too much insulin stored in the background it will work with the rate of exercise and lower blood glucose levels rapidly. Injecting a reduced rate of basal insulin therefore proves key for control in an exercise such as long distance running.

On the contrary, particular exercises can trigger the opposite effect, otherwise known as the ‘adrenaline effect’. Blood glucose levels can actually be made to rise during exercises, by triggering the liver to release natural storage of glucose into the bloodstream. This can take place through sudden bursts of pace, such as altering the pace from a slow jog into a sprint. Contact sports such as football are quite common to cause hyperglycaemia in blood glucose levels; however, the level of exercise takes a delayed effect and hours later can crash the blood glucose levels lower.

Low blood glucose levels isn’t normally a problem that connects with type 2 diabetes but exercise  brings many advantages for it long term, which it can do for type 1 diabetes likewise. The benefits which a healthy lifestyle and regular exercise provide go without saying in general; exercise boosts a healthy blood flow and blood sugar levels, reducing risks of further complications developing such as cardiovascular disease.

Running is a hobby for enjoyment and for fitness, from casually taking in the scenic views to competing for fulfilment; running with diabetes adds a whole new level of interest to the hobby, it is all about control.

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Pharmacy Fridge

Does anybody have an old/spare FRIDGE hanging about that they wish to rid of?

Following my second trip to collect my diabetes prescription, the charming (in a sarcastic tense) boss lady of Lloyd’s Pharmacy in Pickford Lane, Bexleyheath, stated (not for the first time) that her fridge is not big enough to keep my things…

Now, I would have been apologetic but for the fact I have already mentioned this was my second trip there, and I had previously been to collect all my essentials on the 19th December, when due. On a wasted trip to get my prescription previously, they did not have the full amount there on time, “no worries,” I said as I was fortunate to have spares remaining in going away the following morning, “I’ll have to collect after Christmas though, as I am going away.”

Personally I do not mind the fact that the decent employees of Lloyd’s Pharmacy in Pickford Lane, Bexleyheath, regularly load up a bag with the wrong insulins or with test strips missing, as it rather amuses me to correct them. I do not mind that they quite often have to ask me to come back a day later, for the right prescription to come in. I DO mind, however, being spoken to in a rude, undermining manner with little respect.

I am very fortunate that in the UK, where I am from, access to insulin is quite comfortably available and therefore, even if I sometimes have to wait an extra day, I am going to get exactly what I need to keep on top of my health. Other countries around the world, over 90 years after the founding of insulin, are not remotely so fortunate and this needs addressing. But, living with diabetes is not my fault and not something I can help too much, although with a positive attitude I can turn it into a positive input to my life too; for this lady to talk to patients in that tone is unacceptable.

I have an answer! If I can get hold of a Fridge, I will generously wheel it up to Lloyd’s Pharmacy, Bexleyheath, and present the charming boss lady there with it. Maybe this will be one less problem for her charms to handle… just a thought.

small fridge

How I envision that ‘small fridge’ she always talks about…

15th DiAversary

Diathlete Barcelona

2015: a new year, a new start… well, kind of. I am still going to be living every day with diabetes, of course, there’s no retirement from that just yet. In fact I’d much prefer to rewrite that opening phrase to say: a new year, a new opportunity. 

As a Millennium diagnosee, January 2015 means to me that I am now 15 years with experience in living life with type 1 diabetes.

…And nobody bought me a bloody card for it!

One of the most vital things that has always gotten me through life with diabetes more easily is a sense of humour. Diabetes is, no question, an extremely serious condition which requires constant management, similar to having a young child in your responsibility every day. You have to look after that kid, however annoying that little brat might be at times… but humour was the first way I managed to really begin to accept this condition into my life, all those years ago.

It is indeed not funny to prick a finger, draw blood to keep on top of blood sugar levels around ten times per day, every day. Nor is it funny to inject insulin into the body multiple times per day via a needle to ultimately stay alive, having measured out carbohydrates and worked out mathematical equations beforehand to predict how much insulin is needed for each meal. The effects of a hypo or hyper blood glucose level, which brings both short term and long term risks in health, also aren’t comedy zones. Yet, in being someone who lives with this every day, I believe the best advice was once sung by dear old Charlie Chaplin:

‘You’ll find that life is still worthwhile, if you just smile.’

In school my best friend Matt and I both played for the school football team in defence. Matt is of both Chinese and Caucasian genetics and our nicknames at the time, as a tag team, were ‘Needles and Noodles’. This could be deemed ‘racist’ as well as ‘diabeticist’ in the modern day, yet, we made these names up ourselves. And it felt good for the first time in my life to reflect a different view of diabetes, not focusing on the negatives that come with daily cans and can’ts, dos and don’ts; I was in the driving seat, which made it a whole load more positive.

Hypos? I’ll treat them if they happen and, once treated and in a fresh state of mind, recap why the hypoglycemic level happened in the first place. Did I inject too much insulin? Was there less carbohydrates than I anticipated? Was it related to exercise and if so, what form of exercise? Many more could be added to it, such as how long after exercise did my blood sugar levels drop?

And the same for Hypers… How? When? And, Why?

In time, 15 years personally that I have now come to celebrate, you build a little thing which is a big deal called experience. And in that experience, it doesn’t always go to plan. You have your ups and your downs in life the same as every living person, and this of course is echoed by blood sugar levels, which in a body that doesn’t produce insulin is always going to have the ups and downs! Within that key word, experience, the advantage you gain is to remain positive, relaxed and to use your knowledge of your own body in order to resolve any problems. Keeping positive is key and it becomes a lot easier in time to do.

There will always be challenges in diabetes, as there will always be in life. Diabetes adds to the challenge, you could say. As somebody who rather enjoys a good challenge, I can see the positives there too. In a recent DiAthlete Facebook Page post I shared my view that ‘if you find your inner determination, then you have found the key to unlock anything deemed ‘impossible’ in life.’ And I truly believe that. Success comes from within and in having diabetes within me, as many readers will do too, it only serves to make me all the more determined.

Over the Christmas holiday period I have been away and have also managed to keep my fitness levels respectable, with some high altitude hikes and runs in the Alps. I say respectable as in currently writing this, after the New Years celebrations, I am in no doubt suffering with the Irish Flu…

2015 is here now, my Happy New Year wishes to you all, Feliz Año Nuevo. New challenges arise whilst the old the challenges continue. I say, challenges… accepted.

In the words of Sir Winston Churchill:

‘A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.’

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Global Belief

My thoughts this evening are with those families now grieving in loss and the people of Sydney who innocently went to a coffee shop, to start their days off, only to be disturbed by ONE fool of man-kind with a gun.

What point does it prove to the world, if this attack was in an extremist name of ‘Islam’? Muhammad was a Prophet sent by Allah to guide humanity the right way; therefore, attacks such as this only dishonour his given purpose. My thoughts are also with the innocent person of Muslim faith, who now in Sydney, or elsewhere, might walk down the road and be misjudged as a result of one foolish person with a gun’s actions.

And on the contrary, with the West’s responses, particularly in air-strikes which do not always hit and kill the intended targets but also mistakenly end the lives of innocent people around areas of the Middle East, what exactly does that achieve for the world? It is in the writing of Christianity that Jesus of Nazareth said: “you have heard that it was said to the people long ago, ‘You shall not murder, and anyone who murders will be subject to judgement.” Therefore, it can only be said that by engaging in wars which result in mass deaths, the only aspect people of the world succeed in is defying their own faiths.

I do not wish to bang on about all the religions and contradictions in the world, personally I am not a religious man – so what do I possibly know?

Well, what I do know is the power of belief. If I did not believe in myself, I would not have been able to have once endured running 900 miles in the space of a month, whilst obtaining the small task of successfully managing a disease. Belief is something that every human-being needs in their life, in many different forms. Whether it comes from a faith, or whether it comes from within, if you wish to achieve you need to believe. For that reason, any form of belief is a human right to be respected.

My point is that whether you are white, black, brown, yellow or even turquoise in skin colour, underneath the skin our blood is red and we each share that, to the air that we breathe, in common. Corruption in the world, a misguidance which leads to hate, is what turns people of mankind into utter fools, ready to draw the colour of blood (which they themselves have) from another’s life. Whoever you are, do not become a fool.

It was slightly over a year ago when I saw people of all nationalities, languages, skin colours, cultures, religions, beliefs come together to share an experience of a lifetime when in Melbourne. This was all for the diabetes cause, but it was a fine example to the world of how we can all get along together. We all share our lives in the same world, after all, so why not share respect?

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DiAvation

The idea has always been to go out there and bloody-well have a right good go at it, old boy.

Thanet 2008 fin

Back when I first started running it was just something to try and support my local diabetes clinic with, they needed a bit of help at the time. What I instantly found was how quick people were to put you down, whether it was from old fashion knocks on doors to try and gather up some sponsorship and getting abruptly rejected, to concerns in general regarding my health. The GO ON SON, YOU CAN SMASH THIS attitude was often lacking.

Fortunately, that is rather more within my own character and it has been a key ingredient towards succeeding. With every big endurance challenge I have taken on, there has always been that element of doubt or negative vibe from elsewhere, from writing off my chances to labelling me foolish. To the negative minority, I say the words thank you. It is always an added bonus to have more points to prove.

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I have diabetes and in having it, I can achieve anything I set my mind to do in life; the same as anybody.

lands end photo

There always comes a point during the challenges when you have to dig deep down within yourself, to find that will to continue, to keep fighting, keep pushing on. The pain barriers grow the further you go and that’s when character takes over; how much can you take? What more is left inside of you after your body has physically endured every limitation imaginable? This has nothing to do with diabetes in the sense of it causing any problems, by keeping on top of it more often than not diabetes doesn’t result in interfering with the strides; what this comes down to is how much mental strength and determination you have in the mind. Ultimately, that is where diabetes has a big role to play… because of living my life with it, every day, 24/7, I am much more determined to succeed than your average person is.

Run

And when the finish line comes into vision, everything comes out. The fists clench up, the teeth lock together, the legs widen out and the pace powers forward into a finish of shire passion.

It means everything.

knackered

Running was never something I looked to as an interesting hobby, initially. It seemed boring compared to football; which as a teenager years ago was my life. However, once starting it, it gave me that buzz like no other. From the passion that just comes out the more you go on, to defying the medical condition, the disease, which consumes time and thoughts every day in life, it all comes out. Running for me has become this method of expressing myself and striking back in my own way.

jdrf running

If anything, the blood sugars and challenge of keeping control makes it even more interesting. From working out the amount of insulin I need in my body for the level of endurance, to the calculations of carbohydrates per hour, per mile, it becomes highly fascinating. And all in all, when succeeding by crossing that finish line at the end, it makes the taste of victory even sweeter in knowing you worked out how to keep on top of diabetes whilst doing it.

55km finish point

When I run I always have one competitor, my diabetes. And I am a competitive individual. It is not all about the exercise, the taste of victory at the end means that we can take on any extreme in life, down any path of life and diabetes can be beaten by not holding us back.

Be the DiAvation.

london 2012 relay 2

The Eiffel Effect: adrenaline and diabetes

On recent travels the DiAthlete ventured to the French Capital of Paris. And there, whilst tasting the suspicious delights of snails during mealtime and calculating the amount of carbohydrates to go with that, I also went to face my one phobia in life… heights.

Paris tower

How facing your fears can make blood glucose levels rise

It was many years back where the fear first began for me. I had never been keen on being around heights to tell the truth, but flying had never been an issue, just going near edges. Then, as a very young school boy on a trip to the Isle of Wight, I went up for a 30ft abseil. I went too early, fortunately my harness was attached but the rep at the bottom with the ropes hadn’t given the order to go. All I recall was slipping instantly and then dangling from the 30 ft edge in my harness, too petrified to pull myself together as I gazed downwards. I was up there, hanging on, for some time.

Despite the phobia, I’ve always been the adventurous type. If I don’t succeed, I’ll keep trying. I recall going straight back up the stairs to give the abseil another go after that experience and I must have been no-older than 7 years of age. At 8 I was diagnosed with type 1 diabetes.

I had the experience of Paris once before, where I was probably around 9 years old. This entailed the Eiffel Tower and my phobia very much getting the better of me.

So, to be back in Paris, I decided to take it on once again. To begin with the queue for the North side was ridiculous and much more expensive. So it made sense to take the smaller queue on the South side and pay less… then, once making the top tiers, walking around and seeing the North side any way.

E twer

We did just that. Before climbing the thousands of stairs it was also common sense with diabetes to take a blood glucose test. It registered at 3.9 mmol/ls. Hypo!

Lorea wanted me to treat the hypo there and then, but I knew what was coming. This would be a very unorthodox way of treating a hypoglycaemia and highly inadvisable, but I’ve always been the type to enjoy experimenting my body as a form of self-research. My view was that when climbing the extreme heights of the Eiffel Tower, I was very much facing my fears. In doing just that, blood glucose levels would increase. The reason I believed this was because of the ‘Adrenaline Effect’ where in sport, for example, a change of pace from a jog to a few sprints can cause the liver to release natural glucose into the blood system. This causes spikes in blood glucose levels for people with diabetes. My view was that the fear-factor would trigger the same effect, regardless of the exercise in climbing the stairs.

Up and up we went… and the further we got, the more my phobia kicked into place. That twinge feeling, the hairs standing up on the neck, almost feeling sickly from inside the stomach. I was wearing my Dexcom CGM which proved to be a useful tool in this ‘experiment’ as it reflected with the arrows how my blood glucose levels started to rise.

Eiffel Tower stairs

One of the parts I hated the most was reaching the first tier. As beautiful as the views might have been, there was this one part toward the centre where you can look down and see the people like ants queuing up below you. Maybe this added a mmol/l or so on to my levels…

Eiffel 2

And then, going up again, my phobia increased all the more. By the first tier my blood glucose levels had risen from 3.9 to 5.6. As I continued upwards, I really got the shakes and it was nothing to do with hypoglycaemia, as reflected by my CGM. The main part that got to me was the holes in the floor and the cage-like views, it was a long way down. When it comes to aeroplanes I am absolutely fine. And also, recently in Slovenia, I was climbing and walking along a castle wall, the fear element was there but not the way it was when up the Eiffel Tower. The level of height is what caused my phobia. Regardless of that… I kept on walking forward, perhaps cursing once or twice (speaking the native French there) and made it to the top of the stairs.

5.6

When up there my blood glucose registered 7.0 mmol/ls.

Eiffel

7.0

And then it was the climb downwards. I done this part quite well, moving fast. But I think that part freaks me out the most, as you’re always looking down. Once at the bottom my CGM indicated that I was 7.9mmol/ls and increasing…

Eiffel 1

I guess the points made here are that firstly, fear can trigger off the adrenaline effect! And secondly, living with diabetes cannot prevent you from doing anything. By this I mean to say that despite my levels increasing during, I was still able to get to the top and that was despite my fears also. Don’t let diabetes ever stop you from getting to the top!

Post Adrenaline Effect Blood Glucose Levels?

What happens to the blood sugars hours later? Similar to a game of football really… I crashed toward a hypo!

In a football match I used to find my blood glucose levels would spike quite high, something frustrating as this can affect mentality and performance. It was caused by this effect, through the constant changes of pace during a game. Yet, hours after the match, when my blood levels may have registered a high level, I would then CRASH to a hypo.

My way of counteracting this effect in football was by upping my basal insulin to prevent the extreme highs during a game and then would instantly dig into the sandwiches after the match.

When climbing the Eiffel Tower, it wasn’t a game of football and I didn’t go hyper. It rose to around the 9.0mmol/l mark before calming, but I still had done a lot of exercise – climbing nearly 4000 steps to go up and down. I did crash. Also being in Paris, we were making the most of it and seeing all the places to see, so there was plenty of walking. Eventually we found this cushty little restaurant close to the Arc de Triumphe called Le Hide. Excellent food, one must say.. and that was where the snails were tasted.

The key advice here would be to keep on top of things. Know your levels and keep tabs on them as much as possible, especially when you’ve been active in the day.