It’s such a mixed phrase, welcome back.

Thing is, if there has been a long period, life moves on. When this site died in early January, Christmas was coming to an end and because of my situation we were still being VERY careful.

Today, there’s cautious optimism as one of the vulnerable, I got my Astra Zeneca injection last week (though I am waiting on the date for my second dose).

First 24 hours were fine, then I started to react – my temperature rose and I felt like I’d had an argument with a ten ton truck!

That doesn’t sound good!

True, but it’s just for a few days and if I’d reacted that badly to the vaccine, what would covid-19 have done for me? (At least I am now 100% I hadn’t had it yet).

All exciting in your world then…

Don’t be sarky! Life is always interesting. Look outside the window (bad example, February in the UK is giving us a dull and overcast day), buds are springy from the ground while the snowdrops are nodding in the wind.

When did you get poetic?

Sorry, I’ve missed this.

I’m just finishing the last of six days off and am raring to go. And my server is rebuilt, with a new certificate server and all feels good in the world. Not least because instead of spending a few hundred quid to get my certificate signed I did so for less than fifty quid.

Bargin.

Speaking of which, I just need to include the certificate bundle. Have a good one.

Gas, not electricity.
Four weeks ago, we noticed that our boiler light was red and the unit was definitively not heating anything: not the floor or the water which (during the summer) is its sole raison d’etre.

Oh dear, we said, how annoying or words to that effect 😮

Still, the sun was shining and we had a chance to fix it afore autumn arrived.

Afore?!!

Sorry, I’ve done many, many crosswords during lockdown.  My vocab is wide, my spelling and typing still bad…

Any way,  We had some time, only it did become much colder after the plumber turned up and said it would either be a case of swapping out a sensor or needing a new boiler.

The plumber who did the first and final fit of the house chose an unusual boiler for the UK, so parts are not easy to find.  No worries, there’s a bit of space and after all, we have the solar electric heating the water during the summer when we have more power than we can usefully use.

Now my husband has his shower in the morning and the first week, got up at 5am to turn on the emersion heater!!!

We had a power cut in the area that weekend and the clock on the box that turned on the electric heater in the hot water tank when we have a great deal of energy being generated needed to be reset.  I had a quick work through the menus and not only set the clock but it has two “automatic” timers – we now have a programmable heater in the hot water tank – one first thing in the morning and one in the evening for a bath and washing up.

How civilised and now we had a chance to get the sensor fixed in the boiler.

Only, time was ticking by and still no sensor!  Phoning our plumber on Monday to chase it up we found that they hadn’t received it and had started to chase it up only to find the order had been fluffed 🙁

Could they pop round and check the part numbers.  Of course, please do.

They came today and disabled the sensor which allowed the boiler to start – so that’s great news and they’ve got the right part and it’s in stock.

Hopefully, we’ll have a working boiler by this time next week.

OK, so what?

Two main things.  Obviously, we’ve not used any gas since the first week of August which has saved about £15 just in heating the hot water.

But we have been using electricity to do that instead.  And indeed we are spending a bit more, but that’s being offset by the money we’re earning from the vehicle to grid and the solar generation.

Of course, it’s significantly better for the environment being carbon neutral at that point and all the convenience of gas…

Sounds goodish

The modern alternative to a gas boiler is a heat pump: the options being air or ground source.

Living in the UK, air heat pumps are OK during the summer but not so good during the winter.  Leaving a ground source heat pump.

Now, cost wise these are £3-4k pounds more than a gas boiler and teamed with solar and v2g, which cost in.

Only installation is significantly more than a gas boiler or air pump.

Ouch.  We’d better get saving.

I wrote my first code in 1986 on a Vic 20. In those days, printers were tremendously expensive compared to multi-purpose computers, so “publishing your code” meant writing it down by hand or saving it to a cassette your friend or client could then use, if they had a tape drive.

But back to printers and hard copy for humans. I got my first bubble jet printer in 1993 and my world was transformed. I could now work on documents at home and print them out and hand in my assignments. I even had a programme for drawing circuits, so there wasn’t anything work wise I couldn’t do with my trusty Amiga at home. FredFish disks meant software was affordable.

This trip down memory lane reminds me there are always other ways to approach how to get to the solution you want.

Recently, I’ve been working on modelling tools to enable augmented delivery (assisted not automated). Which has been great until someone asked for that to be delivered out to a Word document.

Microsoft Word, the industry standard word mangler with many interfaces to it including Powershell to allow automation.

Microsoft have gone one better though and produced Flow: a means of orchestrating tasks including, through a 3rd part add-on, “Creating docx from template”.

This looks like gobbledygook, but taking in a templated document and some input you can produce a new, instantiated in seconds. Reasonably easily.

Sounds like a lot of fuss…

Magically, it’s not.

Say I want to print out an invitation to an event. I could do a traditional mail merge or I could transform my address book in JSON format.

Each field would be very simply defined as “header”:”content”; “surname”:”Watkins”, “title”:”Ms”.

The headers I want to use would be placed into the document as {{surname}} for example.

In a couple of minutes, I’d have my Flow reading the template, applying the JSON formatted data and producing a new document.

All without having to touch Word to do this once the template were set up.

Back when I launched my first web service, I came across the SSL Labs. This is a free service that allows you to check the status of a website in terms of its encrypted transport layer

Eh?

You know, the little green or grey lock symbol on your web address bar that let’s you know the traffic between you and that site is encrypted.

Fundamentally, you probably don’t care about this unless you are buying something with a credit card over the web or asking your bank to do something.

People discuss that you should ALWAYS have encryption to establish trust but actually, all people say and do stupid things sometimes so for me it’s more about ensuring someone who shouldn’t have my data doesn’t have it.

Anyway, when I first set up these protocols on my server, SSL labs gave me an A+.

I’m guessing you lost it?

Yes, as time moved on, standards naturally rise but as a hobbyist, it became non-trivial to keep up the good fight. Especially as my chosen OS doesn’t natively support the latest and greatest protocol.

Which means heading off into new water.

If you’re playing with Centos 7, this site is really useful and helped me get my A+ back: https://zurgl.com/how-to-get-a-100-score-on-ssl-labs-red-hat-centos-7-x-apache-lets-encrypt/.

The past few weeks have been fun and games recovering from a cracked rib – 12 weeks it took in the end, which is a little quicker than the average type 1 but still significantly more than I’ve ever given a broken bone to heal…

I caught a cold/cough while the rib was painful which meant despite wanting to shift a load, nothing was happening.

I’m also one of the groups who should get a flu vaccination and mostly, I do. The caveat being that I like to be reasonably healthy before it happens as in past experience, the vaccine can be a little unpredictable if I’m under the weather. This aligns with NHS guidelines too.

Feeling way better than I have in weeks, I make the call to the surgery.

“Can you come in for 14:24?”

“In 34 minutes time?”

“Er, yes. Is that too soon?”

“I’ll need to bring the car to guarantee it,” wind, cold and showers being my concern (I know, I’m a wimp), “but yes, I can make that.”

I grab my wallet and head out the door and arrive way too early. Book an appointment to discuss my HRT (another interesting conversation) and settle in for the wait – bang on 14:24, I get called have the conversation about being able to do the shot myself and have enormous difficulty relaxing the muscle (it is prefered to go deep into the muscle) enough to break the skin.

The nurse really wants to do it for me which isn’t helping and I just drop the muscle – nice and floppy, I break skin and drive the punger home.

My fledgeling has left the nest: after nearly 19 years we’re back to just being a couple. My husband and I have been moving towards this for a while now but we were a little surprised how strange the house felt without our teenager. A little concern for how he was going to get on though we did meet up for a coffee yesterday morning.

Being a man, our Ken (he’s moved up north, so we get to use such terms now 😀 ) has left his childhood room behind with little to show that anything has been removed.

I remember leaving home – I made the bed with fresh sheets and ensured anything I wasn’t taking with me was homed in cupboards, shelves and/or boxes.

Not so with my lad. There is stuff everywhere and as we’re entering a cold and damp autumn, I cannot help but notice how many jumpers are strewn about his room.

I appreciate there are differences between men and women but this is beyond that, surely?

Given my last couple of posts, it was with some dismay I approach my half yearly review.

Yet, my Hb1Ac (that’s glycated haemoglobin to the uninitiated or how much glucose has stuck to a protein in my red blood cells) came back as 6% (or 42 mmol/mol) which is a stunning result given what’s been going on.

• 

Analysts have worked out that’s an average of 7mmol/l (126mg/dl) over a three month period.  Which bring Disraelli to mind and his phrase: lies, damned lies, and statistics.  Because I have not had a constant blood glucose of 7mmol/l, especially the past 6 weeks.  Life has not been plain sailing in terms of my diabetes, it has been extremely stressful and a feeling defeat over constant hard decisions, fasting and shear battles.

Ellen Langer spoke about the Illusion of Control when speaking about compulsive gamblers and for me, given the image from my last post, it seems especially so for type 1 diabetics.

We can set everything up and it can work exceptionally for a few days but it is a truly chaotic system: a small change can have a big impact on out levels and requirements.

This is what makes us disabled not unabled. If we have enough insulin and equipment, we can deal with this and lead near usual lives, but it is not the same as not being diabetic.

I truly hope you are well. And this is not your state of affairs at the moment…

As a type 1 diabetic, it’s really easy to see your own body as a war zone especially when your beautiful control goes awry for any reason. (Actually, I love this from pinterest, although it seems to have gone!:

)

I’m not talking about getting an odd food bolus wrong – that’s really easy to spot, correct and carry on. No, I am talking about the stress events, the things that get the stress hormones going and kick the body off into a wild ride of highs and lows with no rhyme or reason to them.

I’ve had a virus the past few weeks (obviously a virus because I haven’t shaken it yet and generally with bacterially infections, I am a reasonably good fighter unless they’re lurking somewhere odd, like my sinuses).

So, I’ve had the increased basals, the sudden lows and an basal that just isn’t working without some intervention.

Sleep interrupted by highs that just won’t come down.

Blah! And this just a cold. Something minor. Isn’t it time for my flu vaccination?

Like many, I am sitting here with a cold: the first nasty cold of the season.

I get immunised against flu each year, so I know it’s just a cold. Viral, but limited in its impact to my upper respiratory system and of course my head.

It’s not a pretty picture and from the look of my results it’s been brewing up for a while but I am finally on the sneezing and coughing bit.

Brewing for a while?

The past four weeks have been utterly poor in terms of my basal rate and carb ratios working. Completely unpredictable. Very high blood sugars followed by devastating lows, Fun and games.

And of course the coughing is causing my rib to hurt again.

🙁 At least everything else is coming up roses. Or is that noses? Where did I put the vapour rub?

If you discuss type 1 diabetes for the first time with a newbie to the area, there are two fears they discuss.  Injections/wearing a pump and hypos.

Hypos have a bad press for good reasons: people do die from them, especially the young.  Of course your average non-diabetic has thousands of these a year because a hypo is any time your blood sugar is below 70mg/dl or 3.9mmol/l.  A non-type 1 diabetic doesn’t have to get their “insulin dose” right: they are dealing with such small doses they can self-correct with glucagon.  Everything is in a roughly 10 minute cycle (depending on the person) and unless something is badly upsetting the cycle, like not having any nutrition for 3 days (but obviously having water otherwise, you’re in bigger trouble than the hypo) or certain blood pressure medication, everything works seemlessly.

As a type 1 diabetic, things are a little different.  Our insulin is typically delivered into our subcutaneous tissue rather than into the stomach cavity, so our insulin works for considerably longer than 20 minutes.  To save us from injecting every 10 minutes, we either where a pump or take insulin via injections.  Injected insulins can last up to 48 hours, which means potentially two days before I’m at this moment, I need to have judged exactly what insulin I need.

Which is why I’m on an insulin pump, it makes my life much easier.  I’ve been pumping since December 2002 and my life would need to change dramatically to go back to injections (or my idea of smart insulin, where you inject infrequently and the insulin is released according to needs as required).

Instead of a 48 hour cycle, I’m on a 4 hour cycle, which still may mean I get things wrong occasionally.

Basal

I talk a great deal about basals: this is the foundation on which my insulin replacement therapy works.  If nothing else is happening, this is as solid as a lump on concrete.  If I have an infection, the wrong bit of my menstrual cycle or a huge amount of stress, my basal does not automatically change to cater for that change in requirements.

This is why many are looking towards the The open source artificial pancreas system: taking readings from the CGMS I wear and controlling my pump based on those values.  The promise is that if your basal is good, it should be able to stop hypos (by shutting off the delivery of insulin) and prevent highs (by turning up the basal rate).  This is called closing the loop, making the pump an automated system.

Sounds great, are you doing this?

Not yet.  Bear in mind if I stop my insulin for 15minutes now, it’s potentially the blood sugar result in 4 hours that is going to suffer and my basals are anything but flat.  The impact when I’m using basal rate 4 of stopping my insulin between 4am and 5 am is going to be much more significant that if I do the same thing while using any of the other basals.  But the same is true for basal rates 2 and 3 between 8am.  Increasing my dose between 10 and noon would be impacting me just before I hit rush hour.

The impact could be huge.

That sounds very dramatic, but my Hb1Ac has always been below 8% since diagnosis.  If I’m high, I generally correct so that rarely lasts more than 6 continuous hours.  My lows, when I’m awake, are generally felt and dealt with – I have few lasting more than 30 minutes if I’m awake.  Using my Abbott Freestyle Libre, I can now make real decisions about my overnight basal without skewing the results (that makes a huge difference).  It doesn’t mean I am “not diabetic”, but it means the impact of my diabetes on my health is greatly reduced.

But it’s hard work and very stressful.  I’d love to close the loop but this has to be acting quickly enough to make a difference.

But that’s not the reason for my post.  I was talking about hypos.  The odd hypo once in a while is normal and I am beginning to look at closing the loop on my pump with my flash glucose meter.

I’m using a tool called Glimp (on android) to do that and it classes hypos according to your blood sugar level – so anything above 3.7mmol/l is classed as mild, 3.6-2.6 is moderate and below that is severe.

For me, that isn’t really how it works.  If I have got a meal bolus wrong, say I’ve had a big meal and an hour after food my blood sugar is 6.7mmol/l (this happened once).  I’d had 7.5iu to cover the big meal so I still had 4.8iu of active insulin working over the next three hours and I felt as if my blood sugar was below 2mmol/l.  I treated with 40g of CHO and in three hours time, my blood sugar was 7mmol/l (I’d obviously slightly over treated).

It would have been a “severe” hypo but technically speaking, at the time it wasn’t.  Indeed, if I’d been wearing a CGMS at the time, things would have looked really promising and only my experience would have told me how much trouble I was in (this was before I was using my insulin on board calculator).

I’m fairly high functioning when low, when I was in my 20s, I’d missed a drop and been happily working when I thought things aren’t right: my blood sugar measurement was 2.2mmol/l!  I treated and went back to my work (I’m a computer programmer) and apart from the last couple of minutes, you wouldn’t have been able to tell.  If I’d been in a meeting and talking, I’d have picked it up much sooner, but sitting at my desk, quietly plugging away, everything still worked.

Which has always made me very nervous and probably why I test as much as I do.

Lily Nichols is a non-diabetic who wore a Libre for a few days and talks about it here.  The interesting thing here for me isn’t her diet but the number of “hypos” she has and the duration as seen in her graph.  For us Brits, 180mg/dl is 10mmol/l and 70mg/dl is 3.9mmol/l – so she’s not going that low but the duration is surprising on the fourth day.

Her analysis is not bad although she doesn’t know what her body is doing in the background.  I hear many people rave about oatmeal (Lily’s had it with honey which almost certainly accounts for the spike and her body potentially wasn’t used to have such a meal at this time, so it probably caught it unaware: do not dismiss this, the human body adapts very quickly.  She runs low night: I wonder if she went out that night or was active in some other way that didn’t usually happen causing the dip.  If Thanksgiving was a day she usually had a big meal, her body may not have batted an eyelid.  I see this from my own results, not just from my insulin doses but how the body digests the food: My Sunday lunch, I eat 5 times the amount of carbohydrate that I normally do during the week, but rarely get high blood sugar from it.  I think that’s because, that’s my normal.  I do seem to “store” that energy in terms of muscle refilling as typically I do a lot of exercise on a Saturday.

Just a thought…