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Verbal contracts

Balancing act – high and low blood sugar

In the UK, a verbal contract is binding. If you say something will work in a certain way, that is binding.

That makes presentations vital. It also makes what is said to you equally important as what is written down.

When it comes to my diabetes, I use a Powerpoint presentation (other tools are available) to explain some of what happens to me and my body because I cannot make my own insulin and I use a pump to give me my insulin.

One of the key slides is this one, discussing the balancing act:

If a non-diabetic has high or low blood sugar, the imbalance is really small and easily corrected by giving a micro-dose of insulin (in the case of high blood sugar) or glucagon (in the case of low blood sugar) to get things back where they need to be.

Non-diabetics can have a clinical hypo’ with some types of blood pressure medication or if they fast (but still have water) for more than three days.

The reason this slide has the title “Why bother: just take the levels prescribed by your doctor, surely?” is because I tune my insulin to the amount I eat and my physical and mental activities.

I won’t talk about how I change my dose depending on my food intake and activities or how I cope with stress.  It’s five minutes of talking I give with this slide.

After that discussion, I discuss what physically happens when I am hypo’ (aka low) or hyper’ (aka high).  These are the extremes, 80% of my readings are between 4mmol/l and 10mmol/l when I am testing my blood sugar and 63% my interstitial levels.

Hypoglycaemia

Physically, I have more insulin than I need and my blood sugar drops below 3.9mmol/l (although I can feel ill if my blood sugar 8mmol/l if I have a large amount of insulin on board – that is I have bolused for a meal or food and got the amount wrong, I can feel hypo even though, at the moment, my blood sugar is within an eyglycemic range – that range is generally considered to be between 3.9 and 7.2mmol/l as per ).

It can make me feel drowsy, a little “spaced”, docile.  I can have difficulty concentrating and even putting together a sentence when talking (usually that doesn’t happen unless I am below 3.2mmol/l).

I can be disorientated.  I do not like to sit down, it’s actually better for me to be standing or even walking – physical activity can mean my muscles are releasing sugar stores and that can mean I can tolerate a lower blood sugar than if I am sitting down.  If I don’t have sugar to hand, I may act excited, again that’s to get the fight and flight responses in my body to work and they will release sugar stores to allow me to be active.  That is not good practice but can get you out of a hole.

I find it quite easy to doze when I am low and if I am tired, that can be a real pain.  Food tends to wake me up!

Because I inject insulin, the second the insulin is in my body, it is working for the next 4 hours.  If I inject an unit of insulin (1/100th of a ml), I use 0.25 units every hour until it has been used up.

This means if I get my dose wrong for a meal, I am dealing with the consequences up to four hours since that last dose.

Likewise, unless I am very low, it makes no sense to switch my pump off.  My pump gives me a microdose every 3 minutes and the insulin I had 3 minutes ago (up to 3hours 57 minutes) is still working.  For a prolonged, overnight hypo, that’s a good thing to do but doesn’t generally help if I am 3.8mmol/l and my last bolus was 4.5 hours ago and it’s 3pm.  The pump being off will only raise my blood sugar an hour after it was switched off.

If I have the hypo overnight, I can wake up to sodden sheets where I have had the sweats.  I can fit in these circumstances – I usually tell if I have a mouth ulcer after I wake up.

Hyperglycaemia

This is my natural state as I don’t produce my own insulin.

It is caused by a lack of insulin: not giving enough insulin for my food and drink, caffeine, doing sport (while I am doing sports, my blood sugar will be raised by my muscles releasing their stores of sugar and fat), not doing sport, an infection (especially colds), not getting my insulin delivery for food correct (pizza is the obvious example – if I give a single dose for a pizza which is providing 30g of carbohydrate just before I eat the pizza, I will be hypo in the first half hour and my blood sugar will be three or four times normal in an hour’s time), not bolusing for protein (more than 100g of steak for example), stress and worry – exams, job interviews, moving house, etc, issues with my insulin or my pump and of course trauma.

When talking to a non-diabetic, I ask if they do long distance running: being high is like hitting the wall in a marathon.  Every movement is an effort, it’s like walking through mud.

It makes me feel awful: the excess sugar builds up in my blood stream causing blockages, called microaneurysms, in the eye, brain and kidneys.  I produce ketones when my blood sugar gets above 11mmol/l.  Ketones are normal in non-diabetics when fat is burned for fuel – if you are losing weight, you will produce ketones.

In my case, that happens even if I am not dieting and my blood sugar is high.  I produce β-hydroxybutyrate, which is unique to type 1s.  Because my blood cannot use the sugar in my blood (as there isn’t enough insulin for it), it needs to burn muscle and fat to function.

Even low levels of β-hydroxybutyrate cause me pain: headaches, nausea, pain when moving my long muscles (walking and lifting) and thirst as my body wants to get rid of this toxin.

When I am above 8mmol/l at night, I cannot sleep.  I am not producing a huge amount of β-hydroxybutyrate, but it’s enough to cause insomnia.  If the cause of the high is my pump’s cannula failing (bent or blocked tube inside my body), damage to the tubing, damage to the insulin, the insulin being old, heat damage to the tubing or insulin then the high can take hours to come down.  It’s not uncommon in these circumstances for me to get only 3-5 hours of sleep.  As a kid, I used that time to read (it’s just a waiting game to get the levels back to where they should be) or do home work.  I listened to a lot of radio.

Feeling this bad can make me quite irritable and much less articulate.  If there are other stresses, I am likely to seem unreasonable and may be aggressive.

Wow!

Yeah, not a great thing to have.  Then you get the combinations: I had a prolonged hypo in April (jet lag and residual long acting insulin) following a high 14 hours earlier and had to be in work, once in a lifetime learning opportunity.

The next couple of days, I ran high to get my stores refilled (pretty standard approach) but couldn’t shake the headache and was not sleeping well because of the highs.  Work-wise, I was put into a difficult meeting situation.  Not a great combination.  Of course, while they know I am type 1, they forgot the discussion we’d had about high blood sugars.

C’est le vie!

The great thing about the UK is that type 1 is recognised in the Equality Act 2010.  In the USA, it’s a disability full stop (we’re missing an organ so classed with amputees).  That should give us equality of opportunities, only in practice this is largely ignored and our educational and employment opportunities can be dramatically reduced even though we only need a small accommodation.

What is protected

My bike ride yesterday made me think about recovery, both physical and mental.

I had a serious accident and I needed surgery to recover from it.  The bones then needed time to heal.  In practical terms, bones take six to eight weeks to heal enough to be whole.

The soft tissue damage takes much longer.  When I snapped my radius in half, I only stopped the physiotherapy five months after the cast and k-wires were finally removed and another 13 or so months before the bone stopped hurting.

18 months plus the 8 weeks in a cast.

Because the radius is a major bone, capable of supporting weight, I naively thought that the bones in my face would take much less time.

Guessing that’s not the case?

Obviously, I had the fixation plate for the zygomatic removed (actually the plate was between the cracked line on the image from Wikipedia and the “frontal” label), which has stopped it catching on my facial muscles round the eye while re-injuring the bone.  It’s healing really well though I am very conscious of it when I am tired.

The maxillary sinus break was a bit more of an impact initially.  This has probably healed the best although there is some nerve damage.  When I close my jaw, I get a stab of pain which is again much worse when I am tired.

The muscles and nerves seem to have recovered (again the op’ to remove the fixation plate has put things back a little but now the swelling has gone down, my smile is much more even without having to concentrate on it).

The thing that still bothers me in my upper set of teeth.  All my own, although the front incisor broke its root in the accident, so my first filling ever was root canal work.  My dentist is a marvel.

My skin seems to have healed well, a couple of white patches from where I lost a couple of layers of skin on my back but otherwise not too bad.

Not 100% sure I see the chase of this post?

With hindsight, I should have taken a couple of months off to heal.  During this period, at work a colleague new to the team asked the question, “how old do you think I am?”  He is less mature than he looks and when you feed back your estimate, he offers to “rearrange your face”.

I don’t remember my accident, but having had my face rearranged, I think that’s quite a nasty thing to say to someone for something so trivial.

At least I now know that wasn’t a personal threat to me as he did this to someone else while I was present a couple of weeks ago.

Getting going

One of the downsides to the Palace to Palace ride is that it is happening in October.

October is properly autumn; the weather could be anything from a balmy 20℃ to a chilling 2℃.  Then there’s a chilly north sourced gale to a gentle shower with little or no wind.  Or, of course, fog.  It could be foggy.  Or sleeting…

Climate’s what you expect, weather is what you get?

Exactly.  Yesterday I was cycling in 13℃ and it was much harder than cycling a couple of week’s ago when it was 15℃, not least because of the rain.

I bought a poncho a couple of months ago and while great when walking, unless it is going to be very cold, I’m going to cook in it.

I’m considering eye wear too.  I have some ski googles and am tempted to wear them while training to see if they offer protection from the elements and dust.

I was cold.  I could carry a hot drink so I don’t lose energy to keeping warm, but need to give that some serious thought.

You’re not disabled

In the UK, type 1 diabetes is recognised as a disability in terms employment law.

When my blood sugar is normal and predictable, this seems a little heavy handed.  By colleagues, I have been given a look to say you must be joking.  It’s all in your control and it doesn’t need protection under law.

I love this post, which  introduces the idea of type 1s embracing the disabled term.

With medication, though, you’re normal

We should talk about the medication in a bit.

This introduction from, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867999/, states what we’re dealing with:

“The plight of people with type 1 diabetes changed dramatically with the introduction of insulin therapy in 1922 (). Type 1 diabetes was transformed from a uniformly fatal disease in the preinsulin era, with mortality occurring either acutely from diabetic ketoacidosis or subsequently from inanition owing to a chronic catabolic state, to a chronic degenerative disease. In the first 15 to 20 years of insulin therapy, a host of complications that had never been seen before was discovered in people with long-term diabetes (). These complications, affecting the eyes, kidneys, and peripheral nervous system, were collectively called microvascular complications, to distinguish them from the less diabetes-specific but highly prevalent macrovascular disease complications. Microvascular disease and peripheral neuropathy resulted in blindness, kidney failure, and amputations (); and macrovascular disease, exacerbated by renal dysfunction and autonomic neuropathy, increased the risk for myocardial infarctions and stroke to levels that were 10-fold or more than in the age-matched nondiabetic population (,).”

Type 1 Diabetics produce no insulin, so our blood sugars, without treatment, cannot fall in the euglycemia or normal blood sugar range, which is 70 to 130 mg/dl or 3.8mmol/l and 7.2mmol/l.  Above this range is call hyperglycaemia (anything above 7.3mmol/l) and below it is called hypoglycaemia (below (3.8mmol/l).  With a mix of CGMS and insulin pumps, type 1s are meeting that normal range: I’m not quite there, I pretty reliably keep my blood sugar between 4mmol/l and 10mmol/l, 80% of the time.  That gives me a glaciated haemoglobin reading of between 6.2% and 7.5%.

I have an autoimmune disease.  It has these consequences:

  1. I am on my fifth type of insulin.  For various reasons but mostly because the insulin produced by human beings will only last for 10 minutes or so before it breaks down.  I have been on bovine insulin, porcine insulin, “human” insulin and finally I’m on an analogue (think left handed sugar).
    After a while, the insulin stops working as well.  Probably because my body starts attacking it.
  2. I went through the menopause, completely, at 37.  I am now on HRT because the stress of it caused may background insulin requirements to be 4 times what they had been before I stopped producing oestrogen and progesterone.  I had an evens chance of that happening because I was diagnosed before the age of 5.
  3. I have a 13% chance of diabetic retinopathy despite my blood sugars largely being normal.  if they were not normal, I would have a 87% chance of that developing.  The diabetic complications control trial in 1993 demonstrated the benefits of good blood sugar control.
  4. Sleep patterns.  I talk about my ability to sleep when my blood is above 8mmol/l.  I find it really difficult and I am not the only one.  If my blood sugar is around 6mmol/l before I go to sleep I tend to sleep well, if it stays that way.
    If my cannula gets blocked, or I’m stressed about something, or there’s a knot in my pump, my blood sugar can rise dramatically.   I tend to wake up at 9mmol/l.
    A hypo can also wake me up.  Above 3.7, I tend to treat with a temporary reduction in my basal rate (70% instead of 100% works really well), otherwise I treat with 150ml can of coca-cola if above 3mmol/l or 250ml if I am below that.
    I try not to give glucagon unless I am below 1.7mmol/l, but that is by far the easiest way to bring it up even if it makes me feel sick and not like sleeping.
    Some diabetics talk about their diabetes as if it were a small baby.  It demands attention late at night and won’t rest until it’s done.
    If I’m above 12.3mmol/l, I have to wait nearly 2 hours for it to drop low enough for me to be able to sleep.  I try to test before 10, so I can guarantee that by midnight I can sleep.
  5. Friends and lovers: people do not like being round sick people.  We’re not considered fun, clever or energetic.  At times we’re not.
    It’s 24/7 every day.  No breaks, no remission, there are easier times but there are also crippling bad times.  There are times when my blood sugar can climb (bad site, bad cannula, bad tube, bad insulin, infection, stress, got my bolus wrong, forgot to bolus…) and I haven’t spotted it quickly enough and I am now bringing my sugar down from 20+mmol/l at 2am and it won’t come down.  For whatever reason, the insulin just isn’t doing what it should.
    I can pass for normal if I really want to but I always think that’s mean.   If anything goes pear shaped, that would be a bit of a shock.
  6. Work: assumptions are weird.  What do you need?  I don’t know.  If I knew, actually I wouldn’t need it because I would know what was coming and I could model it correctly and get my blood sugar perfect.  The pump gives me a lot of flexibility but it is much less tolerant if insulin is interrupted for any reason.
    I’ve had long acting insulin injections fail, but only a couple and some of the insulin from the injection before were still active in my system.  When a cannula fails, the consequences are much more dramatic.
    I’ve gone home with normal blood sugar and been fighting highs or lows less than four hours later.  Then I’m at work with fair less than my planned 6 hours sleep to do my job the next day.
    One manager asked me for consistency.  I’d love that!  My condition is not a consistent entity and the impact is not consistent!

I’ve busted 1000 words so I am stopping for a breather.

Running a Leaf (when you own the battery)

Running the Leaf between the 10th August 2017 to the 9th August 2018

If we’re talking about power consumption, we need to discuss the Leaf.  How much is it costing us to run, bearing in mind we are now funding every mile from our home electricity supply?

Month Distance travelled

(miles)

Energy economy

(m/kW)

Power consumption

(kWh)

CO2 (kg) Cost at £0.1507 per unit Cost per mile
July 251.5 4.2 59.7 70 £9.00 £0.04
June 200 4.2 47.6 55 £7.17 £0.04
May 260.4 4.2 61.5 72 £9.27 £0.04
April 146.2 4 36.8 40 £5.55 £0.04
March 388.1 4.2 92.8 107 £13.98 £0.04
February 395.4 3.9 103 109 £15.52 £0.04
January 413.4 3.9 106.5 114 £16.05 £0.04
December 353.2 3.6 97.2 98 £14.65 £0.04
November 348.3 4 87.7 96 £13.22 £0.04
October 375.8 4.4 84.9 104 £12.79 £0.03
September 303.9 4.4 68.9 84 £10.38 £0.03
August 198.9 4.3 45.5 55 £6.86 £0.03

At 15.07p a kWh, being more efficient makes a difference to our pence per mile.

There doesn’t seem to be much we can do to reduce our costs below 3p a mile without dramatically changing our “Energy economy”, where as doing 4.4 kWmiles  or using our solar panels to charge the car.  We do reasonably and often earn a “Platinum” badge from Nissan during the winter months but fail to regularly get above 5miles/kW (although I did that today 🙂 ).

We generate about a third of what we use: we live in East Anglia, not one of the really flat bits, but there’s not a huge gradient on my normal journey to work.

The majority of my journeys are to work: 14 mile round trip for 56p or £2.80 for the week.  I work 47 weeks a year, that means I spend £131.60 on my annual commute.

Getting 5.2 miles/kW

Concentrating on smoothness, planned acceleration and no sudden braking mean 5.2miles/kW is achievable.  I was lucky with the traffic – we live in blue light central with ambulances coming from the hospital along the main routes pretty much throughout the day.  Many drivers stop to allow them past.  I would get that as a great to do if it weren’t for all the traffic islands dotted about the A1214: if a driver doesn’t pay attention and remove themselves completely from the carriageway, the poor ambulance is not helped at all but stuck fast like the rest of us.

You need traffic islands to help pedestrians cross busy roads so there must be a better way for the traffic to work in these situations.  If you’re able to do the speed limit, isn’t the ambulance better off moving with the rest of the traffic?

The other option to getting more out of the Leaf could be to see if we could make use of Ovo’s offer as per this article.  Having just got out of a leasing agreement, not sure I’d want to sign up for another!

 

High life?

How on a minute, is there something you want to tell me?

What do you mean?

Well, you’ve blogged once in a blue moon the past year and this week, this is your fourth…

Oh, I had an operation last week and while I am not up to my usual fettle (I am sleeping nearly 9 hours a day at the moment), it’s a bit boring.  I am not up to the normal hurly burly of my job yet, but it is nice to catch up…   May I get back to the story, please?

OK, yes, please do.  What do you want to talk about?

Culinary adventures

I’m going to let words paint a picture (as I didn’t get my camera phone out in time): steamed salmon fillets with egg fried rice.

The solar cells are outputting an average 1kWh and our smart meter (and my blood glucose meter) suggest now is the time to cook this feast.

Sunday lunch is a big thing in our house.  We cook from scratch, something we love.  If there are three of us (as a min) we do the whole roast thing, but my husband is out and about today.

So what?

I’m setting the scene.  The great thing about this meal is that it takes less than 15 minutes, has some manual intervention but is otherwise simple.

Boil the water, add the rice, 5minutes later add the frozen peas and chop up some baby sweetcorn and add that a minute later.  Put on the microwave steamer with turbo cook: salmon for two is typically 220grams,so takes just under 6 minutes.

Fry up some spring onions or a finely chopped small onion.  When pinger goes for rice, drain rice and veggies and add an egg to the onions then tip in the rice and peas and baby sweetcorn.

When the pinger goes on the microwave, serve up the egg fried rice and salmon.  Tasty, simple, quick.  Not too bad on the washing up, especially if you do it while the plates are still warm.

So what?

This peaks out at 3.5kWh!  True the whole thing only takes 12 mins in total to cook, but that was a bit of a surprise.

3.5kWh for 10 minutes is 0.6 of a unit (8p), but still!  Boiled rice and vegetables would have been a maximum of 2.2kWh.

Should restaurants and ready meals take this into account for each dish to help us make ecological choices?  Should we do that ourselves on top of our other eco choices?

Microwaves are incrediably efficient – they do not heat anything up, but vibrate water.  I love them for cooking fish, I can cook a trout in 2minutes in my microwave and it’s delicious perfection.  As a student, this gave me high nutrition (especially protein and low in fat), was a bit special and simple to do.

Compared to a chop, it’s a bargin not only to buy but also to cook.

Enough to put you off your cuppa?

We had our smart meter fitted today.  Not only do we generate our own electricity (honestly, even today when the showers are continual, we are generating 140W) but we can see when to make the best use of that electricity.Smart meter

Given this has been a good year: from 1st January 2018 to the 9th August 2018 we have generated 2.8884 MWh but because we haven’t been able to match our consumption to our generated values, we’ve not been able to make the most of our generated power.  I’m happy to feed in but it would be good to lower the bills at the same time.

I get that, I definitely get that.  The smart meter will help you close the loop?

Absolutely!  I’m sitting in the kitchen, watching the rain pour outside seeing that we’ve used 0.55kWh of electricity and 1.28kWh of gas.

How are we using gas at the moment?  Oh, the boiler is getting back up to temperature from the power being disconnected.  Might be worth lagging the pipes in the garage for next time…

The kettle is frightening.  I made myself a cup of tea to settle down to write this blog and our consumption jumped up from 139Wh to 1.6kWh (not a bad kettle).  Chewing up 3p of electricity.  Not doing that too often in a day!

139Wh…  shouldn’t the house be zero during the summer?

Matching usage to consumption

Matching usage to consumption

Many background tasks go on in a house.  The fridge is on 24/7, cooling your food (and insulin) to keep it fresh.  I would expect that to be a good 70-150W of our 139Wh for two hours usage.

My husband works from home, so his computing equipment is another 30-60W.  Mine, today, doubles that and my son is also on his computer looking for a summer job.  Call that 100W or so.

The heating and pumps for the plumbing and the telephone system and chargers probably make up the remaining 10Wh or so.

If 2hrs of background tasks make 139Wh, 12 times that gives our background levels: 1.7kWh or 2 units, roughly 30p.

On a good charging day during the summer, we cover that for 9hours a day.

The hob uses 1.2kWh, the kettle nearer 2kWh as does the microwave.

At no time during August does the solar panels cover our hob.  Time for an induction hob and soft drinks over the summer?

Sounds like a plan 🙂

I have strict instructions from the family to “not get obsessed with the smart meter”.   I find it interesting.  A useful tool.

How much does it cost to have everylight in the kitchen?

Ray of sunshine?

We bought our Nissan Leaf on the 27th January 2014 out right apart from a 5 year lease on the battery, which gave us ownship of the battery at the end of the lease.

Only two years later we were told we were on a “Flex battery lease” which has no end date 😮

And we couldn’t get out of it, until last year.  This video from the Electric Vehicle Man (I know he’s in an ICE for this video, ignore it, that’s not the point) states that all cars on the Flex plan have this captured in their V5.

Except, ours doesn’t.

We also do not have a copy of the lease agreement from the Nissan dealer we bought the lease from.

I have raised a complaint with Nissan on this subject and asked what our status is, because we have nothing (including a statement from Nissan Finance) saying we’re on a flex plan.  Unless you ring them up.

We didn’t sign up for an indefinite lease: we tend to own cars for their life not trade them in every couple of years.  So if the car lasts for 39 years (it should get to 200,000 miles before the battery degrades to 20kWh instead of 24kWh and we’re doing 5,500 miles per annum at the moment), we’d have paid out £16,800 on the lease for a car worth no where near that for a battery originally worth £5,000.

By our understanding, we should have £1,900 to pay to own our battery.  Big difference.

We do really love the car, we really don’t love how it was sold to us and this confusion.

(What’s really irritating was we could have bought the battery on the day we bought, we had the cash).

Update

So having phoned Nissan UK, we had a call from our local dealer who gave us a closure amount of £2203.48.  We did that yesterday.

Our Leaf is 100% ours.  😀

Lighting up my world

I ended up with a day on my hands. I could have spent it feeling sorry for myself (and did start down that route) before I picked myself up by the scruff of my neck and gave myself a shake down!

Get to the chase?  So what?

Over the past 5 years, I have had many entries in this blog regarding the installation of LED lights to replace halogens.

Yesterday, after 5 years, I realised the last part of that journey.

Not so hard was it?

Figure 1: Connection box

Figure 1: Connection box

Indeed not.  Every six months or so, I visited shops and on-line stores and finally found that the solution I was looking for did exist.

Cabinets lighting, in particular, downlighting spots: such lamps did come out a few years ago but having an existing solution in place I did not want to replace more than just the lights.  When we first moved in I assessed what we had and knew I wanted to keep my life as simple as possible.

Last weekend, I found what I was looking for.  Downlights.co.uk supplied so many options I ended up using a pair of callipers to work out what I had and my approach.

What was the approach?

Figure 2: The driver

Figure 2: The driver

We had some G20 bulbs in situ.  They were 63mm in diameter and about 30mm in depth.  My husband and I worked out how to remove them and then I looked at how they were wired into the mains.

Most of them went through a “connection point”.  Doing anything different (and I could go straight to the mains) would increase the complexity, so I went for the Leyton TOP6 connected 2W LED spots.  Dimensions looked great as they should make use of or cover up the existing fittings perfectly, see Figure 1: connection box above.  In turn that was connected to a “driver” in LED parlance (a transformer for the halogens) seen in Figure 2.

I made my order (for the record we had 12 20W fittings we were replacing.  That’s 240W an hour consumption – we never used the lights more than 10 minutes at a time).  The bulbs turned up on Monday!

I chose three connection points, basically, I went a little more cautiously and had 2 15W ones and a single 6W.  With an afternoon on my hands, I decided to make a start.

Taking out the old

Basically, a flat head screwdriver was my friend and I prised off the lamp holder from the fittings reasonably easily.  That exposed the screws attaching the holders to the cabinets.  Towards the end, it was taking 3mins to remove one.

As the halogens had a similar connection to the transformers, I un-clipped the lamp from the connection point and pulled through the wires.

I popped out the LED lamps from their holders and fed then through the wire channels and finally killed the power to insert the LED “driver” for this part of the circuit.

The first run of four took just shy of an hour from start to finish.

Easy-peasy then!

Figure 3: Lit cabinet

Figure 3: Lit cabinet

Inadvertently, I had chosen the easiest ones to do but the second set were pretty straight forward too.  A similar job, made slightly easier by the fact there were no “in cabinet” lights in Figure 3.

The last set were the hardest.  The four lights were integrated in to the mains by the weirdest method possible.  Two of the lights seemed to be connected directly to the mains.

I simplified the wiring circuit, moved the connector to being on top of the units rather than attached to the bottom  of a set and got my husband to pull out the old wiring (bless him).

Connected the pattress and switched on the power.  To find nothing on the lighting circuit was working.  D?^*.  The fuses seemed fine – had I managed to not wire in the mains?

I disconnected everything and tried the power again. Still nada.  What was going on?

My husband finally noticed the RCD had switched so flipped.   I opened up the pattress and properly shielded the earth (I know, it has been hot here the past view weeks and the 20th July was no exception) it back up and low, there was light.

The one pattress I had kept in circuit was ditched and we tried one of the others (though I think it was dimensions more than anything else).  It then worked.

Was it worth it?

Last night we sat in the kitchen after watching a movie with the cabinet lights on and none of the ceiling lights.   Absolutely 😀

The 11 lights now use 22W electricity so an unit of electricity in 45 hours (or 12p to run the lights for 45 hours).

Writing your business case for a Freestyle Libre

After self funding for a year, I went to my GP and got my Freestyle Libre on prescription.

For me, it costed in like this.

Costs of running my insulin replacement therapy on blood tests

Item Cost per item Number of items Total cost per month
Freestyle Optium strips £19.89 4 (I know, that’s 200 blood tests a month) £79.56
Type a lancets £8.99 1 £8.99
Grand total £88.55

(It should be born in mind, type 1 diabetics do not pay VAT for equipment essential to looking after their diabetes and post and pack is from the Pharmacy – we’re not taking into account what the tax payer pays per prescription).

Results

Typically, my Hb1Ac is between 7% and 7.9%.

Costs of running my insulin replacement therapy with Freestyle Libre

Item Cost per item Number of items Total cost per month
Freestyle Libre £35 2 £70

Price update: This is from a high street drug store, Superdrug who are selling this at cost to them (and the price charged to the NHS – you cannot order on line and it needs to be a Superdrug with a pharmacy.  Please remember to fill in your VAT form.

Results

Between 6.2% and 6.5%.

It’s actually cheaper?

Yep, that’s right.  There is a shortage in the UK, but as opposed to doing 200 odd tests a month, or an average of 8 during the working day and 4-6 on the weekend, I am doing 14 odd scans a day.  I test when I wouldn’t normally.

If things had been going well recently, it probably wouldn’t be as many as that if I am honest, much closer to 5 or 6.  It has allowed me to tune my basal rate really accurately especially over night where normally that is a best guess.

I can see that losing 5lbs in weight has reduced not only my basal requirements but also my meal ratios and tuning my ratios against my food has become trivial.

It does not mean I am not diabetic, but filling in the gaps between tests is priceless.

You’re a fan then?

I’ve tried three different CGMS systems (from Medtronic, Dexcomm and the Freestyle) and I love it.  When I meet new diabetics, I am often surprised they are not given this at least initially to help them tune their doses.

In hospitals, it reduces the need to wake diabetics up to test them which allows them to recover better.

It does not beep and it tells you what has happened not what is happening though.  All current CGMS use interstitial fluid not blood so it’s about 10-15 minutes behind.

But, yes, I’ve been using it for a year and it has helped me enormously.  I wish I’d known my phone could have been used instead of requiring the reader.

If I didn’t have funding, using a sensor while restabilising was the approach I took.  If you mixed a matched, say 6-8 sensors a year, that would bring the costs down and give you the information you need to make qualified decisions.