Diabetes, gastroparesis and weight loss

Hi everyone! As some of you may have noticed I have been AWOL for quite some time on social media and although I am trying to keep up with my diabetes activities I'm finding it a bit of a struggle. The main reason for this is the sudden and (currently) unexplained lack of energy I have been experiencing which has left me with little to no "get up and go" to do the extra work that I used to do on my blog. I say it's unexplained, but there are a few reasons which stand out to me such as being unwell with gastroparesis which had caused me to vomit almost daily for around 3 months now, sometimes up to 4 - 5 times a day. Sexy, right?

Meal time management and hypoglycemia

A little while ago the team at Novo Nordisk approached me to write a blog and record a video about how I manage my diabetes to avoid hypoglycemia. As food is one of my favourite things in the world I decided to focus on carbohydrate counting and the way that it has helped me to overcome my highs and lows around food. 

Please click on this link to read my blog and watch my video. 

Please also give Novo a follow on twitter for more updates. 

Laura x 

Guest Blog - So what is a diabetic diet?

A big thanks to Dan for writing this guest post! You can check out Dan's social media platforms at the end of this blog.

How many times have you been asked the question:

"But you're a diabetic, can you eat that?"

If you're anything like me, it's been a fair few times.

I understand the well meaning of this from those who aren't familiar with diabetes. They've heard certain stories from the media and word of mouth about how diabetes is essentially a sugar related disease and they've assumed that you can't eat sugar or anything fun.

Review of the new Carbs and Cals books

A few weeks ago the lovely people at Carbs and Cals contacted me to see if I wanted to provide feedback on their new books; Carb and Calorie Counter, Smoothies and Salads. Of course I said yes straight away, these would be the perfect tools to aid my new diet/exercise and overhaul of my diabetes/gastroparesis management, all rolled into three delicious looking books! (cont)

Gastroparesis: From The Top

It has been over 7 months since I was diagnosed with Gastroparesis, so I thought it’s probably about time that I started attempting to get my confused, fuzzy brain around it. For me this means getting all of my thoughts out onto paper (ahh fresh internet paper) in order to make some sense of something that is utterly confusing and something that I’d much rather ignore. Unfortunately Gastroparesis doesn’t like to be ignored though! (Cont)

Stur water enhancer

A few weeks ago the peeps from Stur contacted me asking if I'd like to try their water enhancer. As I was about to say "thank you, that's very kind but I don't drink water", I thought back to the one and only new years resolution that I make every year and every year I break - To drink more water! (cont) 

The unpredictable side of Gastroparesis and Diabetes Management

“I heard you”, Mr T said.

“What did you hear?” I asked.

“I heard you being sick again. Why were you sick?”

This morning I’d woken up feeling nauseous. I got out of bed, leaving Mr T asleep, and pottered around the house, tidying and chatting away to the degus. I took an anti-sickness tablet and made myself some ginger tea – someone had suggested drinking it when nausea sets in. Not long after the kettle had boiled I was in the bathroom bringing up last night’s dinner. I had eaten 12 hours ago yet there it was, clearly it had been sitting in my stomach overnight, not heading anywhere. I instantly felt better after emptying my stomach, brushed my teeth and went back to my ginger tea. It was a relief to have the undigested food out of me and the nausea settled quickly, but it wasn't healthy, I knew that, I worried about the damage that was being done after years of vomiting on and off. 

I checked the screen on my insulin pump and looked back over the CGM (continuous glucose monitoring) trace for the past 12 hours. I could see that my pump had suspended my insulin around 45 minutes after I had bolused for my evening meal – the pump does this when the CGM picks up that I’m heading for a hypo. This must have been because the insulin started working before the food had digested. Throughout the night I could see that my glucose levels were unusually flat, with no post meal rise at all. This wasn’t surprising now that I know my food didn’t really leave my stomach (or the majority of it anyway).

This, compared with other days, has been a relatively easy day. For the past few weeks since I’ve had the CGM and been able to see exactly what my glucose is doing, I’ve become increasingly frustrated and scared when seeing my glucose levels. I have lows not long after eating and highs much later, this is due to stomach emptying as described above. I have tried to adjust to this by taking my insulin after I have eaten and spreading the delivery out over an hour or so. Sometimes this is effective, sometimes it isn’t. My stomach will, at times, empty like it should, meaning that I then have a high followed by a low, due to taking insulin later.

It’s almost impossible to take insulin to cover food as I never know when or if my stomach will empty. How can I predict that? I can’t. It’s opening up a whole new world to me and along with that come more and more questions. How will I manage this when I don’t have CGM in 3 weeks time? What will my a1c be like? Will I be able to have an a1c that will be safe enough for me to have children? Will this cause my retinopathy to progress? Will this cause me to have further complications related to uncontrolled glucose levels?

Taking it each day as it comes seems to be the only option with something this unpredictable. I’ve started medication as prescribed and I’m self-managing as best I can from information I have found on the internet. I had always thought that I quite liked spontaneity, not planning ahead and seeing what the future brings. One thing I have learnt over the last three weeks is that when it comes to my health, this is the opposite of what I want. It’s frightening, it’s depressing and it’s still something that comes as a huge regret.  

Take care of your diabetes as much as you can, and hopefully it will take care of you.

Ninjabetic x 

It's complicated

I’ve written and re-written this blog so many times today. It has been a day of mixed emotions and with each of those came a different blog. I woke up and I read the letter that has caused these emotions over and over again, which lead to me writing an angry blog. I then became tearful as I looked in the fridge for something to eat, that lead me to write a slightly depressing blog. Now, as I sit at home, feeling hungry but once again not knowing what to eat, I’m just feeling incredibly confused.

Yesterday was the day I had been waiting for… I had waited 6 years for this letter to arrive and I knew what it was going to say, but that didn’t stop me from sobbing to myself all the way home. I have yet another diabetes complication.

You see when you’re diagnosed with a complication you tend to know that there’s a problem long before any health care professionals do. You know your body well enough to feel that something isn’t quite right, even if you can’t put your finger on what that might be. For me the tell tail signs were nausea, vomiting and abdominal pains, however these were intertwined with fatigue and fluctuating blood glucose levels. Six years ago when I started to experience these symptoms I knew very little about diabetes and delayed stomach emptying, in fact I don’t think I knew about it at all. Off I went to the professionals to look for advice, only to be told I was suffering from symptoms relating to stress. Back and forth I went for the next six years when the symptoms had caused me to take time off work, but eventually I gave in, knowing that my attempts to get to the bottom of what was wrong were falling on deaf ears.

I’m not going to lie, I’m feeling quite angry about this, not only angry but also let down and saddened. As many of the people reading this will understand it’s incredibly hard to trust others to look after us and we need to build relationships that are based on trust. Knowing that the trust I gave ended with me not being diagnosed when I should have is possibly the hardest part of all of this. That trust has now been taken back. It sounds strange but after a while I even convinced myself that I was making it up. If health care professionals couldn’t diagnose the problem then maybe there was nothing wrong… surely they must be right?

So I got by for those 6 years with my symptoms, however last year I went through 4 months of near constant daily vomiting. I would wake during the night and spend hours lying awake on the sofa, running back and forth to the bathroom bringing up undigested food. I would avoid leaving the house as often as I could and struggled my way through nursing placements working 14 hour shifts, determined not to let whatever it was bring me down. My other half and my family became increasingly worried – They knew that I was vomiting and in pain but there was nothing they could do because there was nothing I could do. I looked terribly pale (even more so than usual), I had no energy or enthusiasm and I tried to hide it from them as often as I could. It’s always easy to paint on a smile.

I was admitted to hospital four times in the last two years in DKA, once vomiting for 5 days in a row. Each time I told the people looking after me about my symptoms but I was told that they didn’t need investigating, it was expensive and my nausea was settling. On my final admission when in resus, through tears and pain, I told my nurses that I had had enough and something needed to be done.

Now that something has finally been done and I have my results I should feel better, right? Well, it’s 50/50 really. For the last 3 years since I’ve been in ‘recovery’ from my rebellious diabetes years I’ve tried incredibly hard to gain control over my blood glucose levels. I often looked at other peoples HbA1c results and couldn’t understand why I wasn’t achieving my goals. I was doing everything I should be, but at the back of my mind I was always wondering… “Is my stomach emptying later that it should be? Would that explain the mystery hypos & highs that I was experiencing?” In the end I decided that it was down to me, that I was the problem and that I just wasn’t good enough at having diabetes. In a way I think I was right – I know I wouldn’t have this problem if I had taken my insulin and tested my blood glucose as I should have. If there is any blame about the cause of this complication then I accept full responsibility and I will tell myself that every day, every time I eat and with every high or low that I see. I know I shouldn’t… but I can’t help it.

It actually feels quite strange to be finally talking about this. After having symptoms for such a long time I’ve become quite used to them (on the good days) and have come up with quite a few strategies to cope with them. I always felt that unless I had been diagnosed I shouldn’t talk about it because I was playing a guessing game and there was no evidence to back me up, just that feeling that I couldn’t quite put my finger on, oh and years of nausea, vomiting and pain.

So what’s next? I’ll have a follow up with the wonderful (he really is wonderful) Gastro consultant who I saw during my initial consultation, he’ll talk to me about how I can manage it. He’s also said I need to maintain as much control over my blood glucose as possible (easier said than done, eh) so I’ll need information about managing my insulin and I think I’ll need dietary advice too. It’s a brand new diagnosis and it’s incredibly scary to know nothing at all about it – I feel very much how I did when I was diagnosed with diabetes, but hopefully I’m a little wiser now (we can only hope!). Only time will tell. 

For information on Gastroparesis (delayed stomach emptying) see here and here.

Ninjabetic x 

Low carb and diabetes. A success?

Recently I had great news from my consultant... 

"Your HbA1c is 7.9%" 

"So you can send that data to the CCG then? Does that mean I can keep my pump? Will my trial be over from now? Do I need to do anything else?"

I'm sure I asked many more questions, just to be sure, but a letter came through my post box this week confirming that Iain the pump will be remaining firmly by my side (although according to the letter my a1c is 6.3% I think this is a typo). 

Success!! Or was it??

At the back of my mind is a nagging thought... When I was advised that my A1c needed to come down further I changed to a low carbohydrate diet. I was anxious that I would lose my pump and from hearing of other people's experiences I thought this would do the job. It did...

Sitting in my appointment my consultant leaned back in his chair and asked; "What's your secret? I've never seen your blood sugars like this before" and for the first time in 2 years he looked at his computer screen and said that he wasn't going to make any changes.

I told him that I'd changed to a low carbohydrate diet... I waited for his reaction... I didn't think this would go down particularly well. However he was supportive that I had made a choice and that, for now, it seemed to be working in my favour. The pump was clearly doing a great job as my blood sugars were always within my target of 5-10mmol/l. My basal rates were perfect throughout the day and night and I'd had no hypos at all... Good old Iain the pump. 

"Do you think you can keep this up? How is it making you feel?" My consultant probed a little further.

I knew what he was getting at. I'm sure from his side if the office I looked awful. I recall barely being able to stay awake during the appointment... and I knew I couldn't keep it up. 

"I'm so tired and I have no energy. I'm struggling to concentrate and my memory is terrible at the moment." I told him, feeling grateful that he'd asked.

Not only that but it was affecting people around me as well; I wouldn't eat the same food as my partner, my mum would offer to cook me dinner but I would turn it down, I cancelled nights out with friends if they were going out for meals, I avoided going to the pub because alcohol would play those wicked games on my levels, I even tried get out of going to my works Christmas party because we were having a three course meal that would be loaded with carbs. I knew that people were worrying and I didn't blame them... The big dark circles under my eyes were a give away. 

I agreed with my consultant that if I was to go back to eating carbs I would ease myself back in gently to save me from having those big bouncing high blood sugars. And that's what I did... I gradually introduced carbs back into my diet. Even on Christmas Day I was careful not to get too excited and eat everything in sight (though I wanted to).

Unfortunately since re-introducing carbs back into my diet my blood sugars have soared, my weight has increased and as a result of both, my mood has dropped. I carb count, I use the multiwave and extended bolus functions on my pump, I test before I eat, I take my insulin 20 minutes before eating, I test after I eat, I try injecting to see if that makes a difference, I have a range of insulin:carb ratios to use throughout the day that have been adjusted time and time again... I still can't seem to get my blood sugars under control when I eat. 

Occasionally I have a splattering of "good" days, but this is very occasional. When I look back over my data the highs are so glaringly obvious that my heart sinks a little as I know that it must be something I'm doing wrong, I just don't know what that something is. 

Now I'm toying with the idea of low carb again. I desperately don't want to, especially as I'm starting a 7 week placement from next week, but thinking about my next A1c and knowing that each day the result is creeping up is becoming incredibly frustrating. 

Helping You Find Healthy

Helping You Find Healthy is a campaign which is run by Bupa. As part of their mission to help you find healthy, they have designed and created apps and devices which can help people to review their current health, assess their situation and gives advice on ways to improve or maintain that.

As I was researching the health content online I immediately started thinking about what I wanted from a heath app and what it could bring to my life that I didn't already get from my doctor’s surgery, diabetes clinic, podiatrist appointments and eye department. I want something fast, accessible, convenient, informative, educational, fun and easy to use! You could say that I'm difficult to please, but when it comes to my health I want the best that there is, and with technologies advancing and improving every day should I expect any less?

When I saw the words 'free' apps I was dubious about just how 'free' they would be. I expected to reach a certain point in the process and be stopped in my tracks to find my laptop demanding I crossed its (virtual) palm with silver before I could continue. It took only seconds to realise that I was wrong, and with a quick copy and paste of a link I was there, on my way to free apps and trusted advice galore!

My first impressions were that this campaign was, in short, impressive! The design and layout was clear, easy to navigate, user friendly and all in all looking pretty good! I quickly counted up 37 apps and then looked through the titles, 32 I could probably use at first glance! and the rest I could definitely recommend to others!

My eyes were drawn to the colours, the graphics, the familiar logo and the menu bar, all were very visually appealing. My first choice was the diabetes app, however I quickly moved on when I saw that the blurb read "Find out how to lower your risk of contracting diabetes." Now I'm not going to rant and rave about this, but I will point out that it should read: "How some can lower their risk of contracting Type 2 diabetes." This is of course an ongoing issue which needs addressing, if anything to educate those who aren't knowledgeable in the topic and who believe that type 1 diabetes is preventable.

Moving on I decided that I would look at one of the biggest issues in my life, stress. Diet, nutrition, BMI and exercise all contribute to my raised stress levels so obviously this seemed like the perfect choice. However I already knew what result I would get, I'd been feeling it all day, all week.

The fact that I was giving information to a machine made this easier as a machine wouldn't judge me, it wouldn't give me a disappointed or disapproving look, it didn't care about what I told it, but it would help me all the same. The assessment took me all of 1 minute and my result - bad. That's what it said and it told me nothing that I didn't already know. Work, lack of sleep, relationships and money worries are all contributing with the way that I feel, which I wasn't consciously aware of, I just knew that I felt stressed. What struck me most was that health wasn't mentioned once, yet I have always blamed stress on my diabetes. Now that I had seen my answers in black and white I was shocked to see how many other factors are contributing.

Next I looked for the assessment's partners: 'Beat Stress' and 'information on stress'. Now this is one tiny niggle that I did have about the layout and that is the apps have been scattered. I didn't take me long to find the related apps (around 3 seconds) but for me it would make more sense to have them grouped together. The next two stages gave scenarios, causes, treatments, tips and information, all of which I was glad to see. Dealing with stress can be difficult when we don't know how to approach it, but having it laid out for us makes life that little bit easier.

Next up were my nemeses: BMI nutrition and exercise! All major factors in diabetes care and all can become confusing, frustrating and sometimes de motivating. The BMI calculator would be first in my plan and I was shocked to see that I was only just in the 'healthy' bracket. Now I have no problems at all in telling people that I'm a size 10, I have curves, I have wobbly bits and I do the jeans dance when things get a little too tight. Seeing that I'm almost touching on 'overweight' got to me and upset me. I don't have the healthiest relationship with food and exercise at the moment, so maybe it's time to see what these apps can offer. Once again I was informed, educated, supported and pleasantly surprised!

What I would suggest is that you give them a try for yourselves, don't just take my word for it because these tools do have something to offer to everyone. My results were accurate and reflected on my lifestyle, and information and tips were given tailored to my specific results and needs. There is no purchase necessary, all you will need is 5 minutes here and there at a time that suits you! The beauty of the internet is that you don't owe it anything, but it will work around you. You don't need to show it commitment and it fills that gap between check ups. I hope that Bupa continue to build on this campaign because I think it could really contribute towards me getting back on track with my diabetes and my health in general.

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