Finding the chase and cutting to it

I use fedora: I like it, there are a great many cool things you can do for very little effort.

OK, don’t know what you’re talking about…

Linux – there are several key flavours of Unix out there, and as a preference, I like the ones based on the Fedora definition.  I get some powerful tools, such as disk encryption and the main webservers all packaged up and held ready for me to install if I want them.

Most interestingly, it has an Active Directory like server for IAS (identification and authentication services) called FreeIPA.  This works out of the box but it’s obvious that the producers of the toolset are not focused on a home set up like mine!

What do you mean?

In other areas of life, you buying a white loaf bread does not make it impossible for you to buy some rye or brown bread.

FreeIPA assumes it is sitting on a dedicated, probably virtual, server.  Which is great if you can do that, but I am definitely running a single, non-virtualised server and it is running many web servers and the like to provide some of the tools I use to manage various aspects of my life.

That has caused a bit of disruption to my web presence over the past 24 hours and I still don’t have FreeIPA up and running!  Joy.

How so?

FreeIPA wants to install its own tomcat server.  50% of my services are supplied via tomcat – that’s hidden to my users through use of a proxy and a firewall.

I have a couple of other web servers too making it easy for me to deploy the right tool in the right location.

While FreeIPA cannot be configured to run else where, my servers can and this is the stage I am now at: everything has stepped asside ready for FreeIPA to do its thing.

Not sure I get the why and wherefore…

I am not a huge fan of Windows but Active Directory is pretty wow.  It provides a network with a means of authenticating all users and machines access a domain (a closed network).

It’s had few competitors in the PC world and indeed for Unix.  This is where Fedora comes in: think of Fedora and being the equivalent of a Windows Server.  Other Unixes are more like Windows PCs with some server capabilities and often “home cooked”.

The most famous versions of Fedora are RedHat Enterprise Linux (recently bought by IBM), Oracle Enterprise Linux and of course Amazons Linux available on their cloud servers.  The opensource version is called Centos.

RedHat kicked off development of IPA and released it through Centos.

Which is where my server comes in.  I have moved all my public services (30 minute job) but cannot get FreeIPA to install and run effectively.  Back to the drawing board!

I hit the gym today.  I’ve been a little lackadaisical in hitting the gym which would be great except for the fact winter has struck.  When I say winter, I mean the English version – dull, damp and decidedly chilling to the bone.  It’s not been foggy but that kind of damp, lacklustre effect is permeating the air.

The gym is the obvious place to work around the English weather.  Air conditioned, no traffic to fight and there are options; cross trainers, treadmills, rowing machine, spinning and static bikes, low intensity weights.

Last year’s cycling helped me lose weight and now what is left is still too high in fat (35%).  If I can turn the fat into muscle and maybe lose another 5kg, I’ll have a much better chance of having readily available stores for the ride and of course be that little bit lighter.

I had a walk through the equipment at the gym.  I love cycling and rowing but can take or leave the treadmills.  I am aiming for 10.5K steps a day or 10Km, which should leave me in good stead for base fitness.

I did ask about how much protein should be in my diet.  I weight 70Kg, so the figure I was given by Brad at Riverhills Spa is 0.8g per Kg, so I should be eating 56g of protein a day.

I am not managing that with my current diet.  The obvious thing to do is up my nut and bean intake – kinder to the planet and my cardiovascular system.

As they had a deal on, I had a lovely massage too.  Just off for a bath to finish off the relaxing.

Anyone for Brazils?

Analysis of today’s food

To do 100 miles, I am going to need energy and most of that should come from carbohydrates (aka CHO or carbs).  Which makes my life much easier – carbs are really simple to count and for each 10g I give 1iu (because that’s how my ratios work out) (or 0.1iu per 1g of CHO).

If a meal has more than 5g of fibre in it, I subtract the fibre from the carb count.  Shreddies are my favourite example of that: if I have 40g and milk, I would have 34g of CHO but I only bolus for 29g because that meal would have 5g of fibre.

My diet today:

Which does make it 54% from CHO, 24% fat and 22% protein (54g).  Which is probably not too bad.

I’m a little worried about the sodium levels, 2.7g seems a bit high?

My family may be forgiven for thinking my life revolves around computers.

I like to think it doesn’t but it’s when you talk to other mums in parents evening that you realise just how far down the rabbit hole you have indeed travelled.

Since losing my computer in early October thanks to difficulty mounting an encrypted hard disk on my server, I’ve been doing some home work.

This is not that uncommon-a-problem and it pays to ensure you have a disaster plan in place for when such things happen.

And test it to make sure it works before things become critical.

Unfortunately, that last bit meant I lost my wiki.  The last perfect backup I had to hand is three years old but it is at least better than nothing!

Only issue has been winding the clock back to a time when that backup would work.

Thankfully, I have a couple of Raspberry Pi’s and they are proving to be most useful.  I have mysql 5.4 installed and an older version of apache and a copy of php 5.4.  Just waiting to extract the actual wiki backup (the db is already running) and then I can start to move the backup forward to a much later version of the wiki software that will work on my main server.

For the security minded, thanks to the firewall configured on the network, this Pi though old should not be able to act as a backdoor to the network and the machines behind it.

I have learnt from my lesson too: periodic disaster recovery plan walk throughs once a quarter from now on, no excuses!

You’re talking about security here, what exactly do you mean?

For me, security is about four aspects: integrity, non-repudiation, appropriate confidentiality and immutability.

You should be able to trust what you are seeing and that no-one who shouldn’t see that data has access to it.

There are various mechanisms for achieving this.  I use four key ones: TLS for traffic over the web, PKI for non-repudiation, confidentiality and immutability and I use PKI to ensure no-one has access to my servers who shouldn’t have it.

My base disks are then encrypted too, just encase some gets keen enough to break into my house and take the server.

Suitable passwords are used on top of this to ensure things are protected and I have also use a secure wiping system to ensure deleted files are protected where possible.

I don’t store anyone’s data but my own.

I make use of virus checkers for all my machines and firewalls.

I don’t think that means everything is safe.  I am just doing the basics.

JDRF are doing some pages to allow people to produce their diabetic statistics, how many blood tests they’ve done etc.

Being “an old diabetic”, mine is a little unconventional:

Which gives a grand total of:

• Injections: 31,000 (round to nearest 1,000 to cover vaccines, etc)
• Tests: 87,000 (not including sensors as this is a bit meaningless)
• Cannulas: 1,900 (rounded to nearest hundred)

Pump tools

Back in 2000, I met someone with an insulin pump.  I’d had difficulties controlling my blood sugar with long acting insulin since I was a teenager and I didn’t have the tools to be able to tune my background insulin levels by using long acting insulin.

Unfortunately, I was “too well controlled” to gain pump funding (the highs from the long acting insulin not lasting long enough and requiring an extra shot of insulin followed by the frequent hypos at 2am because the insulin I need to cover the early morning were way too high for my two o’clock in the morning body to cater to but you know, doing great!) I self funded.

Which gave me unrestricted access to the pump company and the calculations and tools they had to hand.

At the time this was all passed on with paper charts and by mouth.

I soon realised, I was not in Kansas any more.

Kansas!?

The game had changed.  The rapid acting insulin had a pretty reliable behaviour which meant it could be modelled.  Models allow calculation tools to be built and given my new appreciation of a basal rate, I made those tools for me.

Through Insulin Pumpers Org (International), I learnt that not everyone had my ratios and indeed, my ratios may change.  Some people measured their blood and interstitial glucose in different units.  I evolved the calculators to cater to those needs.

I was keen to ensure that privacy was maintained for the users.  There are no cookies, very little javascript and the user doesn’t need a fancy browser.  This tool kit is designed to be simple and just work.

I’ve even made sure the colours and sizes can be changed if the user has visual issues.

When I was learning, the Insulin requirements calculator and Carbohydrate calculator made my life much easier.

If I’m hypo, the Carbohydrate calculator helps me get back to normal.

My newest tool is the Insulin on board calculator.  I use this most days to ensure I avoid highs and hypos if I don’t get my boluses right and when I do get it right. not to lose faith and give anything extra.  Along with my Freestyle Libre I can make meaningful decisions early.  I have perfected bolusing from experiences using this tool as well as you can begin to appreciate the patterns.

Eh?

Let me explain.  When a non-diabetic eats, their body can provide appropriate insulin levels in tiny doses to keep their blood sugar within a euglycemic range; that’s between 70 and 130 mg/dl according to the ADA or 3.9 and 7.2 mmol/l else where in the world.

As a type 1 diabetic, I’m not expected to be as tightly controlled because of the limitations of my treatment.  Again according to the ADA, euglycemic for a type 1 diabetic on multiple daily injections (or MDI), euglycemia is considered to be around 10mmol/l two hours after food.

With a pump, because our basals are closer to what they need to be, we can actually shorten that period down and on odd occassions, keep well below 10mmol/l without going hypo.  That’s the dream.  Today, having proven my basal rate yesterday, I am living the dream (today).

Living the dream

Normal basal all day.  No correction boluses.

Breakfast was 15g Rice Crispies (13g of CHO), 30 ml of milk (2g of CHO) and 250ml pink grapefruit (25g of CHO) – 4 units bolused as ratio is approx. 10g to 1iu.

Morning snack Soreen Lunchbox Loaf (8.6g of CHO).

Lunch was a bacon and egg sandwich (60g of CHO) and 250ml orange juice (25g of CHO).

Boluses: 4iu for breakfast (09:15), 2.5iu for lunch (12:20) with a further 6iu given over 15minutes.

Today, why is this qualified with Today?

Because tomorrow is the undiscovered country and the game is similar but not the same.

Food is something I care about.  I have to, not understanding how food works in the body is not possible for a type 1 diabetic.

I do not diet per se.  I do count my carbs, that is the foundation of my bolusing decisions: if I am not aware of what sugar, protein and fat is in a food, I cannot hope to get the bolusing correct.

Bolusing?

That’s the extra insulin I give to cope with food digestion and sometimes with the release of glucose stores when exercising or when stressed.

When I say food, that’s anything with sugar, fat and protein.

I don’t necessarily give insulin for fat but a higher concentration of fat makes the carbohydrates I eat act behaviour differently in my body.  Very few foods are purely fat, sugar or protein.  All mammalian meat has some stores of fat and sugar because that’s how mammals work.  We store energy in our muscles. Birds and fish do this in a suitably different way. Beans also provide some fats and sugars along with the base proteins.

What you end up with is a wonderfully tasty mix that’s hard to quantity in terms of what sugar is entering your body at any one time.

Honey’s there – I don’t count honey as sugar

It works with my insulin exactly as sugar does.  It might provide some trace elements, but I need to bolus for honey exactly as I do for sugar.  Weight for weight.  Sorry, but I have the bolusing facts to back it up.

I don’t produce insulin any other way, so it’s pretty conclusive.

Hmm, OK, we’ll leave that there.  Bolusing decisions?

Fibre does make a difference, if a food is very fibrous I take off the fibre from the carb count and bolus the difference.

Fat slows absorption but doesn’t affect the amount I bolus.

Protein is a whole different and fun ball game.  Hard to measure and harder to know when it will act.  I keep my protein count down low to keep things easy, about 100cals spread throughout the day.

Complicated!

Yes, yes it is.  I didn’t get it right when counting a new home made recipe and ended up fighting to get my blood sugar down most of Sunday evening.

Butternet squash soup tastes great but needs bolusing in a suitably different way to my approach on Sunday – I propose giving the bread bolus over a 15minute extended bolus and the soup needs more quick bolusing – possibly 40g of carbohydrate for a bowl of soup.

Wow, you’ve completely lost me!

Have a great evening 😉

Flower in our garden

Being diabetic, I have a bigger footprint than the average person on the planet.

As a household, we’re making an effort.

The Electric Car

According to the New Scientist this week, in the UK, a fully electric car has a much lower carbon emission footprint than a hybrid petrol/electric car this year and on-going years.  This is as the UK moves towards more nuclear and renewable energy generation compared to gas and petrol.  This is aside from microgeneration.

The Leaf is one of our big consumers for electricity.  Each mile costs us less than 4p at the moment (especially during the winter) if we charge from the mains rather than our solar cells.

Household usage of electricity

The majority of the halogen lights in the household (and most compact fluorescents) have been replaced by LEDs.  We’re also using remote controlled lights to keep the footprint down as much as possible.

Cooking and refrigeration are the two areas we’re still struggling with: we have a plan over 2019 and 2020 to swap out our older units with more efficient ones.  We did the microwave last year and using that in place of the main cooker is keeping our generation usage down considerably.

Thought goes in to how everything is cooked.  When saving food for reheating, we cool the food completely before putting it into the fridge and the same for reheating.

Heating and hot water production

The room thermostats downstairs make a big difference to our heating usage.  If we don’t use a room, we cool it by a couple of degrees – I don’t turn it off completely, but drop the consumption.

I’m looking at swapping our upstairs thermostatic radiator valves to programmable and remote controlled ones.  That would give us the same capability upstairs as downstairs for a fraction of the cost of putting in a system like we have downstairs.

Honeywell do an interesting system for this called EvoHome.

I’d expect a 30% savings as we got from swapping out the downstairs thermostats as a minimum and a much more comfortable living environment too.

Recycling

We do what we can.  Obviously, some things cannot be recycled, but all paper, cardboard and glass is recycled.

We do the vast majority of our plastic through our kerbside collection.  That doesn’t cover plastic bags, but well before the 5p charge, we reused all plastic bags at least 40 times before using them as bin liners.

All of our garden waste is recycled by preference or completely dried out and burnt as kindling for our log burner.  Irritatingly, our log burner will not burn multifuel.  We use the log burner over the weekend, only when the temperature outside is below 15°C and only fuel and kindling that has been matured for 12 months.

Consumables

Aside from CFCs there are various toxins and chemicals used everyday in a western lifestyle.  The toilet is bleached at least once a week.

But that’s the only thing.  We use a steamer to clean the floors and bathrooms.  That uses water.

I do use isopropanol alcohol as a pre-injection cleaner for my blood glucose sensors as they are in my skin for 14 days.  For my other sites and blood tests, I tend to just keep clean.

We paint at least one room in the house a year.  This year, my husband has painted the windows sills round the house.  All the paints we use are water based and we use water to clean out the brushes where possible.

We use aerosols for our deodorants and I use a spray three or four times a month for my hair.  I use a solid stick for sports on top of that.

Garden

We’ve planted 52 tress over the past three years to form a hedge.  We’ve also planted a peach tree.  We use an electric lawnmower.  We collect water to keep the plants hydrated.

The drought this year saw some of these new trees hit hard but we’re waiting to see what recovers over the winter.

Not bad…

No doubt, we could do more.  We’ve insulated without stopping rooms being ventilated and upgraded extraction fans which keep things dry without burning up more electricity than necessary.  I’d like to fit curtains in more of the rooms as that really helps keep the heat in.

We’re trying to keep things simple and not break the bank: we are not early adopters as a result.

Once the kitchen appliances and the TRVs upstairs are sorted, the obvious next things for us to do are upgrade the solar cells (put more in) and potentially get a battery system.

We could also look to lose our diesel car.  If we did that, the obvious thing to do would be to swap the Leaf and the XFS for something like the F-Pace.  We’d really need to clear the mortgage before doing that though!

I love when people talk about things that have happened to them.  My mum was telling me how she had been driving for a long time and got dehydrated and made a mistake in a parking lot and reversed into a car.

Being tired and dehydrated affected her ability to react to her surroundings.  It also made her react badly to having the crash, she swore and it’s really unusual for my mum to swear.

When my blood sugar is above a normal or euglycaemic range (in the UK, that’s 4-7.9 mmol/l according to the American Diabetes Association), I get fatigue and dehydration.

The longer the high blood remains or the higher the value of my blood sugar, the worse the dehydration and fatigue get as my body is desperately trying to wash out the toxin, because that’s what high blood sugar is to me if I don’t have insulin to convert the sugar into energy I can use.

I am always reacting to my blood sugar much more slowly than a non-diabetic person does, because my insulin goes in subcutaneously not directly into the blood stream.

If I’m being grouchy or snappy, let me know.  It’s not normal, it’s not acceptable, but I may be a bit high and need to correct that high.

Now some DIY is out of the way, I am catching up on my blogging.

One of my dreams for 2019, apart from my son getting a university place, is to achieve two long distance cycle rides.

The first is 100 miles for the Juvenile Diabetes Research Fund.  The Prudential Ride London, 3-4 August 2019, is that little bit further than the palace to palace this year, but as a type 1 diabetic, I would be a direct beneficiary not just in terms of getting fitter.

The second is the Palace to Palace run, and the 47mile ride I did in October.

Thought you were mad the first time back in 2017…

I do enjoy it.  I already know I can do 47 miles.

This is my training plan for the Prudential Ride.

1. November – January: 20 miles in the gym 2-3 times a week.
2. January – March: 30 miles in the gym 3 times a week, 10 miles in the gym once a week.
3. March – May: 1 x 45 mile ride outside over the weekend, with 20 miles 3 times a week in the gym.
4. May – June: 1 x 75 mile ride over the weekends (or during holidays) and gym work 3 times a week.
5. July: 2 x 80-90 mile rides, probably over weekends and gym work.  1x 100 mile ride.  A week off w/c 29th July, apart from one session of hill climbing.
6. 4th August: do the ride. Possible start at 05:45!!!

At this level, I need to ensure my diet supports the effort.  I am likely to lose girth and fat but actually put weight on, probably round my legs.

I need to guard against infection and injury.  It’s too far to do on a wing and a prayer.

I heard Sir Chris Hoy speak at IBM’s Think 2018 event and was impressed by the measures he took to ensure he kept physically healthy not just at peak fitness, things I just hadn’t considered.

One of the key learnings I had from this year’s palace to palace was that while my bike was perfect for training, I need something different for the day itself.  How do I achieve that?

Palace to Palace 2019

1. 3rd-4th August: achieved 100 mile run for Pru
2. w/c 5th August 2019, a week off to recover.
3. 12-18 August, 20 mile runs 3 times a week, mostly gym work.
4. 19-25 August, 30 mile runs, outdoors twice a week.
5. 26-1 September, hill training three days a week.
6. 2-8 September, 20 miles in the gym three times a week (aiming for 45 minutes) and then 1 x 40 mile ride
7. 9-15 September, 1 x 40 mile ride and three gym sessions of 20 miles.
8. 16-22 September, hill training 4 times a week.
9. 24-29 September, mix hill training, one long distance and swimming.
10. 30-event, week off.  Sleep keep muscles loose, get mind in focus.

There’s a meme going round showing a young girl with a syringe in her body representing each of the injections she does a month.  She’s on multiple daily injections a month and conservatively the photo represents 120 syringes.

I am on a pump and this is what it is doing for me.

I have a microdose of insulin delivered every three minutes as a background or basal dose. (Each microdose of insulin, once given, is working in my body for the next four hours.)

If I were doing that with a syringe, that’s 480 odd injections a day.  On top of that (if nothing goes wrong) I then bolus for the food and drinks I have, call that 5 boluses a day.

So that’s equivalent to 485 injections a day and let’s say that are 30 days in a month, so that 14,550 injections a month.

That delivers between 57 and 87 iu (international units) of insulin or between 0.42ml and 0.67ml of 100iu/ml a day.  A month, that’s 18 – 30ml of insulin.

I use 3ml cartridges in my pump which deliver the insulin via a tube to a cannula inserted in my body.  The cannula is replaced every 3 days and the cartridge every 5th day on average.

On average, if I’m not using a Freestyle Libre, I do between 4 and 10 tests a day.  A month, that’s between 120 and 300 tests a day – I get 200 testing strips a month from the doctor.  Each testing strip needs a lancet.

If I’m using the Libre as a constant glucose monitoring system, that goes down to 20 tests a month on average.  I use two Libre sensors a month.

This is if everything works like it should.  My dose changes due to infection, stress, what I eat, how much sleep I get, how much exercise I take, if it’s colder, I need less insulin than when it’s warmer.  My period makes a big difference, not least to how my food is absorbed.

I was on injections for a long time, but when the pump and the Libre, I am managing a 4 hour window for how long my insulin lasts compared to 48 hours with long acting insulin.

I’m doing all this every day just to breathe.  No days off, no remission, no break.  When it goes wrong, I have to fix it.  Going wrong can be an air bubble in my pump cartridge or tubing due to changes in air pressure, a kink in the cannula underneath my skin, deteriorations in the plastic in the tubing, cannula or cartridge.  Temperature changes can damage the insulin (though my insulin is pretty tough compared to what I used as a kid).

I was diabetic from the age of 4, that means the majority of my time as a type 1 diabetic has been as an adult.

I have had prejudice, from being deemed not interested in career progression “because [I’m] ill” to people not wanting to be friends because of the responsibilities it incurs.

Some people believe:

• I shouldn’t have had my son because of the risk of passing it on (which is tiny by the way, compared to 0.2% risk of the general population having type 1, his chance of being type one is 0.8%).
• I should not have treatment because “it’s not natural”.  They believe I have no feelings because I inject and BTW, I shouldn’t do my injections at the table because it’s disgusting.  Or in the street or where anyone can see.
• It’s my fault my autoimmune system decided to knock out something critical.
• I should not talk about it because “it’s my health”.
• I’m not disabled because I can walk and talk.
• I’m not affected by high or low blood sugar outside of the inconvenience and distress it causes them.
• I’m in control of what’s happening to my blood sugar.
• It only affects me while I’m awake.
• I shouldn’t have free prescriptions, because I’m healthy.
• My doctor is constantly monitoring and making the decisions about my insulin.
• I’m too sick to do all sorts of things.
• I can’t live alone; I need looking after.
• I’m too busy with this to live.
• I need to concentrate on my health every second of every day (80% of the time, things just pretty much work.  When they don’t, it’s awful but most of the time, it’s OK).
• I should lose weight, not eat carbs, not eat meat, etc, and “[that] will get me off the insulin”.
• I’m too lazy at looking after myself properly (I get told that when I’m fighting the hardest to get things back to a normal keel!  Not by my family or friends who see what I do 24/7, but people at work do that a lot.)

I’m running a crucial part of my endocrine system on a four hour lag at best.  I’m doing really well but I am always reacting and always with that lag.

Even doing really well, there are consequences to the constant stress, medication and development of the disease.

This is what it’s like to live with diabetes.