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Thank you, google

Go back to last week and it became obvious that while I’d been backing up my data regularly I hadn’t actually tested that backup.

That has been rectified, but I had suffered some data loss.

Thankfully, not a huge amount not least down to Google taking a cached copy of my site reasonably regularly.  It may look like I’d been a busy bee today but that is all thanks to Google keeping their cache.

I’ve lost three pages, as far as I can tell.  Not too bad considering I’ve got 20 back through Google.

Looking at the world in a different way

One of the things I do everyday as a software engineer is look at solving problems.

That skill comes in handy in real life too.  We’re having our bedroom remodelled – we’re taking out a dressing room, which isn’t very useful and freeing up some space in the main entrance way for a large cupboard.  We’re also taking out a Sliderobes unit and replacing that with some matching units.

Of course, our existing cupboards are holding our things.  While the building work is going on, what should we do?

Well, a while ago, we reconfigured the dressing room to double the hanging with a double rail mobile clothes racks, with some wheels.  Buying a matching pair at the time, means my clothes came out relatively simply.  But the beauty of a cupboard is that it keeps light and dust off your clothes.  I still have suits that are classics and do not show a year of their age.

Buying some dust covers that are UV protecting means the clothes racks are fine temporary homes while the bedroom is being worked on.

Closing the loop

’ve been using tools and mathematical models to establish my insulin requirements for a while.  I keep the links to these calculators on my pump pages and thank my lucky stars for first wifi and then 3 and then 4G mobile networks.

Most of them I have produced myself while allowing them to be tailored for any other insulin user.

The most useful one, IMO, is the basal rate estimator.  By fasting (and testing) you can tweak your basal rate in the tool until you get a smooth line. It’s a beautiful piece of code.  It’s also why I use my Roche pump as it has a basal programme that sets the amount of insulin I have each hour.

I use a simple spreadsheet to record my basal and the blood sugar results and do the comparison.

But it is not closing the loop.

For me, using interstitial readings with a subcutaneous pump is not closing the loop because the insulin I had 3 hours and 57 minutes ago, whether by basal or by bolus, is having an impact now.  If I stop my pump, it is going to hurt me in an hour’s time and that impact will last for four hours.

That’s if the interstitial readings are correct.  The sensor is not meant to be used for clinical decisions.  Indeed, if I get an unexpected result, I do a capillary blood test to see what is actually happening now rather than 10 minutes ago.

Time is the killer?

Exactly.  I would be happy if my pump were not a constant subcutaneous insulin infusion (CSII) pump but a CIPII (continous IntraPeritoneal insulin infusion) could allow the loop to be properly closed.  The Accu-Chek Diaport looks really interesting for that – with the insulin going straight into the stomach wall rather than subcutaneously.  The action of the insulin is sharpened considerably because the insulin isn’t going into fat.

It’s not quite as good as IV, but it would be enough to close the loop easily.

Classification of diabetes mellitus

In the case of diabetes mellitus, a rose by any other name does not necessarily smell as sweet.

As a young child growing up in the seventies, very little was generally known about diabetes mellitus and in many ways the definition of type 1 and 2 helped identify that age was not a factor in the condition being diagnosed.

Since then, our knowledge of these many and varied conditions has increased dramatically. But the classification and naming of these conditions has not helped in allaying some of the biases and struggles we encounter everyday. Not least for the less commonly occurring conditions such as type 1, MODY, neonatal and LADA.

I am proposing a new naming convention that should remove some of the confusion, help medical personnel form appropriate treatment plans and help diabetics across the world. It would help the media to highlight important research to the target audiences. I appreciate I am in 0.2% of the world’s population, but the consequences of misunderstandings by medical and lay personal can have dire consequences for me.

I have experienced such issues myself, in hospital environments and in the work place. Many type 1’s are in similar situations given the media confusion over type 1 and type 2. This is my idea on how to remove such issues. What are your thoughts, please?

Autoimmune acquired diabetes (AAD)

Currently this would be the vast majority of type 1 diabetics. For some reason, often triggered by a virus or other infection, our beta cells die along with our ability to create insulin. Which causes us to die if we don’t have insulin replacement therapy.

LADA (latency or latent autoimmune diabetes of adults) would come under this classification too.

Gene function diabetes (GFD)

Typically this is called MODY (maturity onset diabetes of the young) but would also cover neonatal diabetes. Depending which gene is causing the issues impacts the effective treatment options, sometimes diet or tablets, sometimes insulin assistance therapy.

In neonatal circumstances, the children may only have this for a short period and recover full function depending on the genes in question and effective treatment being given. Calling them type 1, even if they require insulin for a short period, may do them more damage than help them long term!

Insulin resistant diabetes (IRD)

Largely, this is the majority of type 2 diabetics. For whatever reason, they cannot produce enough insulin for what they are doing when diagnosed.

It can be transient: so dieting, exercising and losing weight can mean drug treatment may never be needed. But it never goes away.

For some IRD, medication may be necessary, not least insulin, not because they were “too lazy to stick to the diets” which isn’t the case for many. In the case of GFD, it is obvious why! But naming the two differently makes it easy to distinguish where the diabetes sits and the appropriate treatments.

Gestational diabetes (GD)

This is another transient form of diabetes and may completely go away or evolve into IRD, even if insulin was required during pregnancy. Again, the names can help determine the appropriate treatments.

The beauty of these terms is they are tangible, if someone is overweight but GFD, the weight is not the cause! No doubt losing weight would help the diabetic but they do not need to be stigmatised for their diabetes because it is not their fault.

It is obvious that IRD does not develop into AAD because the causes are different. I appreciate that some forms of IRD may be present in AAD, especially where weight is an issue, but again, it is easier to have the conversation with patients when symptoms occur.

Diabetes is rarely fully transient, and this can be communicated to more than just the endocrine specialists by use of these terms.

These terms aim to be short and to the point.  They describe what is happening to the individual concerned.

Would this help?  Does this help you to understand what is going on, please?

Procrastination is the thief of time

Since the long ride last week, I’ve been focusing on sub 10 mile runs but my training plan says today is my last day and given most of my riding has been in East Anglia the past six weeks, I need to ensure I am ready for them there hills of Berkshire.

Where I live is not bad for that, given a stop watch and a direction to head off in, I should be able to fill two hours easily.

But I am finding things to do instead.  What is wrong with me?

I’ve proven I can do the distance, I’ve lost some weight with the training, I’ve even got a small spring in my step.

Today though, my brain is prioritising other things.  Focusing on minute details that normally don’t matter.  I even washed up lunch rather than get in to my ever so comfortable cycling shorts.

The sun is shining, I seem to have kicked my cold, to quote Lemmings™, “let’s go!”

Things I have learnt the past four weeks while riding

Route 51 has taught me a few things, not least how to make best use of my bike and its gears.

There are a few facts I have picked up on the way which I would never have found out otherwise.

Great Barton railway crossing

Is surprising: not least in how cyclists and horses make their way into Bury St. Edmunds.

Route 51 crosses the A14 as it heads west from Thurston towards Bury and Cambridge.   It also crosses a railway line and has an amazing crossing bridge for use by riders of cycles and horses and pedestrians.

The satellite view shows it beautifully.

Amazing bridge, screen grab from Google Maps.

Stuck in the middle of no-where, horse riders are asked to “please dismount” and there is a raised platform to assist.

Old crossing, screen grab from Google Maps.

As a cyclist, the ramp of the bridge and the corners are gentle and easy to ride up.  No cars are approaching from the east, so it’s an easy ride up, negotiate the turns and end up 4 miles east of Bury.

The first time I did this, it was a bit of a surprise, but even as a novice it’s simple to work out.

But it’s such a weird structure in the middle of no-where.

Thurston is a reasonably sized town, population of 3,300 odd people and presumably, allowing people a simple, safe means to get into Bury (pop 41,000) cuts down dramatically on congestion and hence pollution.

I mean that literally.  The bridge replaced this crossing which looks much more precarious.

Looking into this on the web, I found the The Anonymous Widower, a great blog covering, amongst other things, unusual railway crossings.  He has some lovely pictures of this structure. Their blog highlighted that in the centre of Thurston, a simple traffic light system is in use by pedestrians. The “monster bridge” is dedicated to cyclists and horse riders.

The Anonymous Windower links off to a report in the East Anglian Times, which dates the bridge opening to just after November 2014 and quotes the cost of construction being £1.5M.  Indeed, the project’s closure was proudly written up in January 2015 by the construction company, Kemada’s civil engineering team.

I’m guessing the cost of this bridge will ensure it remains reasonably unique!

Route 51, part 2

I cannot sleep: with my last set of training, I learnt how my body performs muscle filling, so I went to bed at 22:34 and fell asleep pretty soon after having set up a 70% temporary basal rate.

When that completed at 01:36, I woke up, found I was a little low and treated with a Soreen Lunchbox malt loaf.  I’ve been awake ever since.

Eh?

Yesterday, I completed a 45 mile(ish) trip on Route 51 between Ipswich and Bury St. Edmunds with a partial return trip to Stowmarket.  Call it silly, but I really didn’t fancy covering the ground where I’d had my accident last year.

I’d had a chat about my plans to go to Newmarket and my husband asked “why not just do a round trip to Bury?”  He had a point, so with the sun burning brightly yesterday morning I got on my bike at 10:10.

Essential kit – clothing

While it was sunny, it was not warm.  I wore a cycling long trousered dungaree, a cycling top and a new piece, a “showerproof, breathable” cardie 😀  Socks, helmet and cycling gloves completed my look along with a snood.  I had a waterproof poncho in my kit along with my testing kit and phone (for testing and directions).

Essential kit – the carbs

Again, learning from last week, I planned stops every 10-15 miles.  I had my Camelbak “hydration pack” (basically a 1.5L water bladder which slips into a ruck sack), 5x150ml cans of coke and 2 Soreen Lunchbox malt loaves.  I had 92g of CHO in my panniers ready to go and an extra bottle of water.

Very prepared.  Can I go back to bed, please?

We’re getting there.  Same as before, I stopped at the community centre in Onehouse for a coke break (just the one) and a quick check of my blood sugar.  All was well.  The 14 miles had taken 61 minutes.  I didn’t bother stopping the clock.

The route, part 1

I also didn’t use the fit bit for anything other than my heart rate.

That meant not only did my phone use less battery (I turned off the blue tooth), but I have the whole route saved as you can see.

Excluding the break, the journey took 2 hours 39. Not bad. The return to Stowmarket, 15 miles, was considered to take 1 hour 15 minutes.

I tried to take my blood sugar: “glucose not available, sensor too cold” came up on the reader! I was a little chilly and soaked through with sweat but really? I’ve been skiing with a sensor and it has been fine.

Given what I knew from last time, I took a pair of the cokes and a malt loaf. And tried to retake the reading. Finally it gave me a grumpy result of 7.6mmol/l. That would do.

Only, I couldn’t quite find my way back to Route 51. I was so glad I had the phone with me as the signs in the opposite direction just weren’t as well laid out. Or I was too knackered to read them! I got back the Onehouse eventually and followed my nose to Stowmarket, giving my husband a quick call to let him know I was OK.

I had trouble going back through the church yard and onto the cycle route and difficulties in the first few villages.

The second stint took a painful 8mph average but I finally rode in to Stowmarket’s railway station.

That’s when the pain struck. Since receiving my first insulin shot one evening in December 1977, I’ve had a few high readings and needed to do exercise, but that was nothing compared to the shooting, deep muscle pains I had waiting for the train (delayed because of trespassing on the track round Bury) in Stowmarket.

My sugar wasn’t too bad, so I had my second malt loaf and my penultimate coke. I had to make it back from the railway station in Ipswich after all.

I got on the train. Thankfully there was a space on the carriage and I set up my bike and pull down the seat to keep an eye on it. Just outside of Needham Market, the bike toppled on to my left thigh. I gave a small exclaimation. Two of the guys on the train rushed from their seats to help me, but I’d already pushed the bike back on to its wheels and instead they checked I was OK. I told them what I was doing and why. They told me how brave I was and how impressed they were with my progress. They wished me luck for the 7th and pointed me in the right direction home.

How kind?

The next couple of days will be recovering (hopefully with some sleep!) and then hill training until Monday. 5 days off before the 45 miles on Sunday 7th October 🙂

Route 51, part 1

Scary gravelly bit

Don’t you mean route 66?

No, National Cycle route 51 is a part shared, part dedicated cycle route from two of the larger towns in Suffolk, Bury St. Edmunds and Ipswich.  In fact, at either end it completes within a mile or two of the railway station, allowing you to complete the circuit by letting the train take the strain.

Actually, it’s a little more than that, covering five counties, but lets start with the bit I did on Wednesday.

Ipswich-> Creeting St Mary -> Needham Market -> Stowmarket -> Onehouse -> Woolpit ->Tostock -> Drinkstone -> Thurston -> Bury St Edmunds.

With the wind howling from the South, the first bit of the journey was not trivial.  Especially when I found myself up a gravelled bridle way outside of Creeting St Mary (red marks the gravelly bit!).  Not too bad for the first 100 meters but just off screen it starts to go up hill.  My road tyres were not up to the task!

But I covered 14 miles in 61minutes (OK, it was mostly flat and downhill) and was ready for my first break in a small village just outside of Stowmarket called Onehouse.

I grew up in the area and Onehouse has grown a great deal in that time.  I chose to have a quick break, check my levels and have a couple of cokes, check my bearings and ensure I knew the rest of the way.  That’s the moment my mobile’s screen went blank.

Oh dear (or words to that effect)!

You’re in the middle of no-where without a mobile?

Or cash.  I’d packed a credit card but I tend to use my mobile as cash so I don’t carry that much with me on the bike.  I took a full 120 seconds to decide that I wasn’t going to go back the way I came.  It would mean my support system (my brilliant husband) would not be updated and next time I would definitely carry a power pack with me, but if there were signs the whole way I could get to Bury.  I had water and a coke and a testing kit.

If I could get to Bury, I could ask directions and I could get to the railway station and get the train back.  The train station might even have a phone.

I’m a cyclist in possession of the native tongue, I could do this, if I needed assistance, I could get it.  After all, the past 14 miles had flown by very smoothly; apart from the scary gravel bridle path and how many of those would there be?

I set off and was surprised at the quality of the cycle path.  In some places, it was a dedicated path away from cars and in others it was along single track roads of good quality.  Largely, pedestrians and motorists were friendly and despite the wind, it was dry and reasonably warm.

As I came to Woolpit, it all felt good.  It’s not a short distance and I wasn’t going that quickly: just an average 11mph: but I was covering the miles.

I did consider jumping on the train as I saw a sign for Elmswell (off the cycle route) but hung on for Thurston and the signs that said Bury was only 4 miles away.

Thurston has the most amazing railway crossing bridge that was possible to ride up so the only bit I hadn’t cycled was the bridle path outside of Needham.

In Bury proper, as I didn’t know where the cycle route would land me, I sought directions and found that I would exit the route outside the Angel Hotel.  I have fond memories of that place, but that’s a very different story!

When I got through the door at home, my husband said he’d lost track of me on Thurston which was odd because my end, my mobile was dead.

What’s next?

Route 51, part 2

Newmaket is my next stop on Route 51.  It should be 46 miles but relatively flat so I’ll do some hill climbing as my supplementary training.

I could always avoid the bridle path next time!

Sponsor me please at https://www.justgiving.com/fundraising/samj-watkins.

What does exercise do to your blood sugar levels?

The first time I do an exercise, especially if I am heavily learning skills and techniques, will drop my blood sugar while I am doing the exercise. If I have had a big break for an activity that also holds true.

But that only holds true for that one time. After that the following happens:

Small amount of exercise, especially short duration

If I’m having food, that food needs to be bolused fully as while I am exercising, my body is digesting the food and releasing stores of sugar from my muscles.  I may even need slightly more insulin short term.

The second I stop, it helps to have 16g of carbohydrate (CHO from now on) in a quick acting form – once the muscles stop releasing there may be insulin floating round my system that needs to be fed.

Nothing more needs to be done typically, but keep a close eye on everything – if I’m not using a CGMS, I test every 45 minutes,

Moderaate amount of exercise, longer duration

Again, food is dealt with normally, but hydration is key.  I like water and that reduces the stress on my body.  As a middle aged woman, I sweat and that liquid needs to be replaced.  As I have a western diet, water works well.

On the hour, I take 16g of CHO.  150ml can of coke is ideal for this – takes me 10 seconds to drink and works almost as quickly.

On the 2nd hour, I also have 17g CHO in a slower absorbed form: I like Soreen lunch box malt loaves.

I sip water constantly.  This seems to level out my blood sugar without having to resort to basal rate adjustments which just seem to make me incredibly high a few hours later.

This works well for cycling continuously for 45 miles with a half hour break before doing a further 1.5miles to ride up the hill to get home.

Next day

I breakfast 50g CHO without needing to give extra insulin to cover the meal.  I keep an eye on everything until the evening.  Typically, overnight I don’t seem to have any issues if I run on a 70% basal ceasing at 5am. (It alarms which is really annoying, definitely wakes me up and even though my sugar is normal, I cannot get back to sleep).

I don’t feel hungry for lunch.  I keep my fluids up and my salt intake – peanuts are a could source of protein and salt if you can eat them.

And the next day

Last week I could see the impact for three days: my insulin requirements were much reduced.  I will play it by ear rather than planning round that – as I said, the first time I do something, it makes me low the second time doesn’t have the same impact…

Apologies

Internally to our network, we’ve had some issues with the routing to the webserver.
You have our sincere apologies for the interruption to this service.