A blood test tale

Diabetics inject ourselves because we have to, we tolerate the pain from infusion sites and finger pricks because we have to. We're brave, but only because we have to be. I've always generally been ok with needles thankfully, I'm not actually that bothered by them and I think the fact that I once had 3 ABG tests in one wrist all on the same day with out flinching shows that I can handle a needle or two.

However, that's not to say that I don't get the slightest bit nervous, even inserting an infusion site, something that I have done hundreds of times, can cause my heart to race a bit! It's the thought, it's thinking about it hurting that makes you nervous- I've learnt to jump straight in and just do it without giving it a second thought.

Today I had to have a blood test done, I've had many many blood tests in my life that I can't actually count how many I've had. Yes they're more invasive than the finger prick tests that I do multiple times a day, but I'm ok with those too.

I'm ok with them when the phlebotomist knows what they're doing.

Now, don't get me wrong, everyone has to practice at some point but when the person is literally shaking and loses your vein it's a bit unsettling. I don't think I've ever perspirated quite so much during a blood test. It went a little bit like this:

*Trainee phlebotomist and expert phlebotomist both look at me*
"Do you want numbing cream?"

Me: No, I'm fine.
*Both nervously laugh*

I should have known, I just should have known she was learning! Maybe I should have asked for the numbing cream...! Anyway, it took them both a good 5 minutes to find my veins, there was lots of talk about my veins being "very deep" and "narrow" like, oh good, not even the expert phlebotomist can find my veins how is the trainee going to. So they found a good vein, on my right arm, and he lets her take it away.

To be fair, I did feel sorry for her because she was visibly nervous. But she could have made an effort to look less visibly nervous! She was literally shaking and then she lost the vein and was about to stab me in an area with no visible veins and the other person had to stop her and direct her back to the correct area. At this point I was sweating, quite literally.

Me: "Are you learning?"
Trainee: "Yes, I'm new"

I mean, the signs were all there, she was not going to get any blood out of my arm, even if she tried, which she did. Ouch.

So I braced myself, and she braced herself clearly...and in went the needle. So slow. It was highly uncomfortable and I didn't want to make her feel bad so I just sort of went with it and let her get on with it- she has to learn somehow! But oh my was she slow. She basically pushed the needle in, at a sloth's pace and I could just feel a lot of resistance from my arm and it wasn't cool. The other phlebotomist told her that "should be enough" when the needle had only made it in a quarter of a millimetre. Low and behold, no blood. Zilch.

"Just pull it back slightly" Were the words from her trainer, so she did. She practically pulled the whole thing out of my arm and all I could think was please please don't try and push it back in. So I said it, I just had to say;

"That's hurting me"

I felt bad! I felt bad saying it because I felt sorry for her because she was really trying but my arm just couldn't take the butchering any longer. It even hurt when she pulled it out. All in all it was a bit of a train-wreck, but she tried, and although she failed she'll get blood from someone's arm one day.

All I can say is, I'm glad for her that she got me as her practice patient. She could have got someone like my sister who would probably cry. I'm glad for her that she got me because at least I was nice about it, and I let her have a chance, and to be honest she's lucky that I can handle blood tests in a level-headed manner. Anyway, the trained phlebotomist tried my other arm and luckily got it on the first try. The irony of it is, however, is that the arm that was attempted by the trainee actually hasn't bruised that much, the main predicament on that arm is the mark left from the adhesive...and the arm that bled straight away for the phlebotomist, has a mighty purple bruise on it!

Left arm

Right arm

So I'm not sure what the moral of the story is, I guess just be kind to trainee phlebotomists even if they are slightly butchering your arm, I guess...and diabetics aren't immune to needle fears! I felt fear during a blood test for the first time really, I'm comfortable with needles when I am confident in the person's ability to handle it- I can inject myself because it's under my control, and I can handle a blood test when the person knows what they're doing because that way I know it won't hurt. 

However, the idea that someone who is training is going to be having a go at one of your veins and that it's probably going to hurt, is really quite unnerving and it's hard to be totally brave with needles all the time. 

-Ellie

I have a job

This month I started working in a local supermarket- I'm not going to say which one purely for privacy reasons! My most recent appointment with my consultant, basically went a bit like, him telling me I should probably get a job to get some routine back to my life now that school is finished. Both me and him could see it in my blood sugar that I was getting lazy! However, I was in the process of a job application at that time anyway, because my parents and the rest of my family, and me, have been telling me to get a job- which is fair enough! I needed a job so I went and got one. It's a Christmas temp job with the chance they might extend my contract.

It wasn't handed to me on a plate obviously. I had to fill out an online form, an assessment/quiz and to go for two interviews before I actually got the job. This job application was the first big company that I have applied to and to be honest I didn't even think I would get past the online assessment part of it! So to be called for an interview was surprising, especially since I was actually beginning to forget that I had even applied because it took them over a month to get through all the applications as there were so many.

Of course, diabetes had to be mentioned. I took the opportunity to mention it at the interview stage, I wanted to get it out there and explain it all there and then and give the interviewer the opportunity to ask any questions they might have. In fact, I actually used my Type 1 Diabetes to my advantage...

Interviewer:"Why do you want to work for us?"
Me:"(Spouting random ramblings)...this company has a strong belief in equality in the work place, which is really good for me as I am actually a Type 1 Diabetic"

Nailed it! Got her attention even more, and it actually led to a more casual and open conversation which allowed me to relax slightly! However, I feel like I had to downplay my Type 1 slightly. I didn't want it to seem like I can't do anything. All of the phrases like "It can be physically demanding" "Do you have to eat at certain times?" etc. started flowing and I mostly answered with "No, I'll be fine. As long as I'm looking after it I'll be ok" And we all know diabetes isn't as simple as "looking after it". I did tell them that my blood sugar can go low and I might need to take an extra break if that happens, and that my blood sugar can go high etc. All in all the interviewer understood and made sure that she gave me hours that won't affect my diabetes too much. For example she didn't give me the job role that requires 5am starts because I said that might affect the timings of my insulin rates on my insulin pump.

Overall, I used diabetes to a slight advantage at this job interview, I also used examples from when I went to Parliament with JDRF and Diabetes UK to make me seem more interesting when asked certain questions! Although Type 1 Diabetes can seem like it's something that is hindering, it is also something that you can use to impress people sometimes. My message to the interviewer basically was yes, I have Type 1 Diabetes, is it going to stop me from getting a job? No. Is it going to hold me back in anything that I do? No. Here I am, an 18 year old with a potentially life-threatening disease, but I'm applying for this job and as serious as it is, I'll be alright.

The only issue with me handling a box isn't my diabetes but my lack of upper body strength.

-Ellie

Transitioning

I haven't written a blog post in such a long time, I know these "I haven't written a blog post in such a long time" introductions are starting to become very routine for me! As it's diabetes awareness month in November I figured that I really need to start getting back into the swing of things. I suppose the questions in people's heads at this point may be where I've been...nowhere, actually! I've been being lazy in terms of blogging, and that is naughty of me! But here I am, I'm back and I'm ready to get blogging more routinely. 

I thought I would take this opportunity to have a little bit of a reflection on where I am in terms of my diabetes. My most recent HbA1c was 9.6%...2% up from the clinic appointment before that but it's ok. My consultant and I decided on the fact that I have finished school and don't have that same school routine is perhaps the reason that my control might have slipped a bit, which is a very feasible explanation so I'll go with it. Basal rates were changed and overall it was quite a productive appointment. Ironically, my basal rates were lowered (despite my elevated HbA1c!) but that is because, I am growing up. I am no longer in that stage of adolescence where hormones are raging, things are settling down as I mature into adulthood and so I don't need so much insulin any more. It's bitter-sweet, I'm glad to be having less insulin but also feeling a little bit disgruntled at the fact that I am pretty much an "adult" now and that's scary! 

Also, being an "adult" means moving on in the world of diabetes. 

I'm currently in the stages of "transitioning", this is the process of your current diabetes team handing over your care to the adult diabetes team. I'm moving hospitals next year- my current diabetes team are amazing but unfortunately the brilliance resides only at children and young adults clinic, I haven't heard much good stuff about the adult team at my current hospital so I am moving hospitals where the adult team is known for it's excellence! It's a whole new chapter in my life with diabetes and it's quite daunting...and I find it crazy how fast these past 5 or so years that I've been with my current diabetes team have gone. It's difficult when you build up trust and a relationship with a HCP and then you have to say bye and you no longer have that support from them. I recently said bye to my psychologist, she is going on maternity leave and by the time she goes back to work I will have moved to adult clinic...she has been a huge help and she is a reminder of how unfortunate it is that a lot of people don't get access to psychological services, it has been a great help to me. 

My first appointment at the new hospital is in January and then I go back to see my current diabetes team in March, and then I suppose after that we will be parting ways for good. I'm sad that I have to say goodbye to my current diabetes team and I can only hope that my new team will be brilliant also. 

-Ellie

I would rather see a Spider

There has been much speculation in the media recently about the warm weather bringing more spider sightings. Most people are afraid of spiders, spiders are weird and their eight legs are spindly and ugly and they're all round not nice. I've held a tarantula before, it wasn't a pleasant experience but it wasn't a bad one either, it was actually a little bit cute in all it's fur. A little bit. I'm not going to say I'm not afraid of spiders, because I am, but I would rather see a Spider than a Wasp.

I'm tempted to compare low blood sugar to how I feel towards Spiders,in fact, I'm not even tempted I'm just going to do it...they scare me, but thankfully are relatively easy to get rid of...and the majority of them are pretty harmless, unless it's potentially poisonous. Much like hypoglycemia...it is fairly simple to treat and to bring your blood sugars up for the majority of the time, but sometimes it can be scary and not so simple and it can be dangerous. And much like the warm weather brings Spiders, it can also bring hypos.

And now I will compare high blood sugar to how I feel about wasps. I hate wasps, and I am convinced they're going to sting me at every opportunity...they make me want to run away and they're notoriously difficult to get away from you once they arrive. A bit like high blood sugar actually, I strongly dislike high blood sugar (who doesn't?!) and it's far more difficult to get rid of than a Spider a.k.a a low blood sugar, and much like a wasp once it's arrived once, it's hard to make it go away and it's threatening to do you some damage every second that it's around...and if you want to keep a wasp away it often involves lighting various candles etc. like a diabetic needs insulin to keep high blood sugars away. It's all quite complicated really. And much like food and drink attracts a wasp, it also attracts high blood sugar.

Both high and low blood sugar are not nice at all and both scare me, but in my eyes both have varying degrees of difficulty. A low blood sugar is easy to get rid of most times, is relatively harmless and although it makes you feel rubbish while it's there it's not as hard to keep away- like spiders, unless you get a poisonous spider, in which case would be a really bad hypo. A high blood sugar is not so easy to get rid of, and once it's arrived it's hard to keep at bay and carries the threat of complications every second that it's around- like a wasp, it threatens to sting you while it's buzzing around in your face and it's hard to get away once it senses your food or drink. But there are times when a high blood sugar goes away relatively easily too.

All in all, I think I would rather see a Spider. (A non-poisonous one)

I thought it would be interesting to do this little comparison because I have been seeing so much about spiders and encountered many wasps this summer that I delved a little deeper into my feelings towards these creatures...and came up with this blog post! I hope you found it interesting too.

My Hummingbird tattoo

Yesterday I got a tattoo. It's a hummingbird. I love it! I got a few questions as to whether or not there is a link to diabetes in my tattoo and the answer is yes. It's not a coincidence that I got tattooed on my arm the very animal that used to be the Diabetes UK logo, but I've also generally just always wanted a Hummingbird tattoo.

I'm happy that I chose a Hummingbird and I'm even happier that it has so much meaning. I really enjoy the fact that it's not meaningless, I don't think I would want to put myself through having a tattoo if I didn't feel like it was worth it. It's beautiful and the artist did a wonderful job designing it and it came out far better than I expected!

Why a Hummingbird in relation to diabetes?

I took this paragraph from a website that I read whilst searching about the Hummingbird and it's relationship with diabetes.

"What we can admire about the hummingbird is it's incredible ability to efficiently manage all the crucial aspects of it's life. Individuals with chronic diseases understand better than most people as to how essential it is not be in control with certain aspects of their lives. For hose with diabetes, their diet is simply one factor they must take into consideration on a daily basis."

In a nutshell, the Hummingbird is a busy bird! It has lots going on at once yet retains it's beauty and composure and it has the remarkable ability to adapt to everything around it. I know the other link to diabetes through the Hummingbird is the way it's body processes sugar, however, that bit is a little bit boring so I didn't put that in the blog!

Pump upgrade: Medtronic 640G

Since I last posted on my blog, a few things have happened...I turned 18, booked my first driving lesson, and yesterday I got my new insulin pump!

June 14th marked exactly four years with my purple Medtronic Veo, or as I liked to call it, Maurice. Maurice and I had a good four years together, there was a slight love-hate relationship going on but on the whole I loved my Veo. It had been through a lot...I dropped it in the bath accidentally a couple of times, dropped it on the floor countless times, let it swing from my body many times, accidentally bashed it on cabinets and door frames and experienced the dreaded 'Button Error' which thankfully did not amount to anything more. Through all the rough and tumble, it survived all four years with no replacement pumps! I did return a very scratched up pump to the hospital, but it was my original pump and it proved to be a very robust pump indeed.

I've moved on from my purple Veo, Maurice, and have a new insulin pump- the Medtronic 640G! I went to the hospital yesterday to get the pump along with a couple of other people who were also upgrading their pumps and we spent from 2-4pm learning all about the 640G and it's different features. In general, I love the look and feel of this insulin pump, it's sleek and it looks modern and the buttons have a nice 'click' to them, if that even makes sense! The colour screen is a huge improvement from the older Medtronic pumps, it no longer looks like an old Nokia phone with the game 'Snake' installed. The fact that it is waterproof really excites me, I mean, my old pump did come into contact with water more times than it should have done...but it was ok, and so I like to think that the old pumps are water resistant to some extent. I'm looking forward to plunging my 640G into the sink one day to really test out it's "waterproof-ness" (That's not a real word I'm sure), but I won't be doing that any time soon, it's too new!

In terms of the actual functions of the pump, they're also pretty cool. I love that you can stop a bolus. If you change your mind about how much you're going to eat or if you want to eat more then you can stop the bolus, the pump will tell you how many units it had already given you, and then you can go ahead and set up a new bolus. On the old pumps if you wanted to cancel a bolus you had to suspend it which in turn suspended everything, including your basal rates, whereas with the 'Stop bolus' feature, it just stops the bolus, nothing else...your basal will continue and won't stop either. Whatever it has just given you, will go straight into your 'Active insulin' which now shows up on the home screen, unlike on the old pumps were you had to press 'ESC' to bring up the screen and then scroll down to see your active insulin. You can also change the volume of the alarms, and set it to vibrate or sound...it's a bit like a mobile phone in the fact that you can see what sound setting you have on in the status bar. To save battery you can make it "sleep", so you can make the screen go off and it won't suspend insulin delivery or anything. If you're wearing a sensor then the home screen will display the sensor graph, if you're not wearing a sensor then it will show your most recent BG for 12 minutes, the Medtronic rep told us that they chose 12 minutes as the time frame to display your BG because after 12 minutes you might have checked again if you were low and after 12 minutes your BG will have most likely changed.

The buttons light up which makes it so much easier to use in the dark, the carbohydrate and bg screens are all on one screen now, whereas with the older pumps you had to enter your BG, then press ACT and then move onto the carbohydrate screen and if you wanted to go back a step it would make you re-enter the carbs. If you're on the menu you can just hold down the back button and it will take you all the way back to the home screen, but if you don't want to go back to the home screen then just press back and it will take you back a step...but if you're changing insulin settings or anything like that you just have to make sure that you press 'Save' before going back to the home screen! I also enjoy the fact that it has little icons up in the status bar such as an insulin vial icon that is green and turns red when you're low on insulin, it also has a green battery icon that will turn red when you're low on battery.

Last but not least, this insulin pump has 'Smart Guard' on it. This feature is activated when you're wearing a sensor with the pump, it will suspend insulin delivery when the sensor detects a downward trend in your blood sugar. You set a 'Low limit' on the pump, which is something like 3.4mmol, and the insulin delivery will be suspended when your blood sugar is 3.9mmol above your low limit and it detects that your blood sugar is falling...it will then resume insulin delivery once your blood sugar is back to normal, or your can resume it manually once you know your blood sugar is back to a safe range. What I learnt yesterday during the upgrade that this is a very sensitive sensor and it can fail or end early. For example, the Medtronic rep at the pump upgrade told us yesterday that if your blood sugar is not stable at the time of calibration it can reject a calibration and will tell you to do it again, two rejected calibrations in a row will make the sensor end because it will suspect that something is wrong with it and tell you to put in a new sensor. Another tip the Medtronic rep told us yesterday was not to calibrate it too much or it will get confused, the best times for calibration are before meals or at a time when you know your blood sugar is stable. My sensor ended yesterday after two failed calibrations and so I am yet to experience the Smart Guard feature as that was my last sensor until I order more, but I will be sure to blog once I have a sensor on and once I experience the Smart Guard.

That is all I have to say about the pump and it's features so far, but overall I really like the pump and I think the fact that it still has tubing is made up for with it's really cool features.

-Ellie

Low blood sugar

Since getting my blood sugars back under control I've noticed that I tend to experience low blood sugar more often than not, it's not a major issue but I would preferably not have to worry about low blood sugar more than I do under normal circumstances. My consultant reduced all my basal rates by 10% when I last had clinic and that is a really positive step for me because it shows that my body is using insulin as it should be and isn't putting up any resistance anymore.

In light of the subject of low blood sugar I'm going to talk about what I now know to be my first ever low blood sugar experience. This particular experience took place before I was diagnosed, I can't remember exactly how long before my diagnosis it was but I don't think it was long before. I know you're probably wondering how it was possible to experience a low blood sugar if my beta-cells were being killed off by my immune system at that very moment...and I wonder that too, but it happened and I am certain that what I experienced was low blood sugar- although I actually really had no idea what was happening to me at the time.

We had just arrived at my auntie and uncle's house in Clacton after a drive that was about an hour and a bit. I felt funny but ignored it. As soon as I got out of the car I immediately felt weak and my legs were shaky- I had never ever felt like that before this moment so I was a little bit disturbed but to be honest I didn't think anything of it...I put it down to sitting in the car for a long time. I had the sense that I needed to eat and thank goodness it was lunchtime! I couldn't make any sense of the situation, all I knew was that I felt terrible and I needed food- and so I ate (loads!) and I felt better right after lunch. That confirms it even more that I experienced low blood sugar at that moment, but I didn't know.

What I didn't know was that this feeling would soon become something that I know and can make sense of, what I didn't know was that the horrible weakness and jelly legs would be a sensation that I would and will experience many more times in my life. I still remember being quizzed by the nurse at the hospital after I was diagnosed, I was going home that day and she asked me questions about the symptoms of low and high blood sugar...I found this so daunting because I wasn't exactly sure and couldn't really differentiate between the two just yet as I was still taking in my diagnosis of T1! Needless to say I didn't quite manage to answer the questions perfectly, but I soon became to know the signs and symptoms that my body gives me if my blood sugar is high or low.

I feel like I might aswell tell you about my lowest ever blood sugar- my lowest ever blood sugar was 1.9mmol, I know there are people who have had blood sugars lower than this but this was a particularly unsettling experience that I wish not to repeat. I didn't feel too horrible at first, I felt shaky and knew I had to check my blood sugar but I didn't think I was as low as I was. So I picked up my testing kit and went to sit on the sofa and I opened my testing kit and set up my finger pricker and put the test strip in my meter but I couldn't get any further than that...I tried to align the blood on my finger up with the test strip but I was shaking so much that this was an impossible task and I was beginning to experience tunnel vision and getting dots in my vision so I gave up and I called my parents in to test my blood sugar for me and I just laid on the sofa waiting for the reading to flash up on the screen. It was not a nice experience at all, and I remember literally eating so much for dinner in order to bring my levels up and make sure they stayed up.

Recently my body has been exhibiting a couple of new symptoms of low blood sugar such as experiencing a wave of nausea (really annoying symptom because I don't immediately realise that I'm low when a low presents itself in this way!) or it just doesn't give me a sign at all until they reach the 2's and then I start to feel light headed- also very annoying. I also tend to get a numb/tingly mouth, it's hard to describe it and it's very strange.

The experience of low blood sugar seems to be ever changing. New symptoms, new hypo treatment ideas...It's the blood sugar extreme that scares me the most, it makes me anxious and it's the most irritating because it always makes you stop whatever you're doing. But it comes along with the insulin that keeps me alive, and it's paired with the high blood sugar that tries to damage my organs, and it is all in all part of the "gift" that no beta-cells a.k.a T1 diabetes provided me with the day I was diagnosed.

I deal with it...and it introduced me to the "original" version of Lucozade...which by the way is not my cup of tea.

-Ellie