Let's Talk #Oral and My #Diabetes

Let's Talk Oral,and My Diabetes 

Yes iv used the word "Diabetes" all on its own because I'm talking about both Type 1 and Type 2 Diabetes.

Taking our Type 1 or Type 2 Diabetes seriously is something we all must do if we want to live long happy and healthy lives in the hope of skidding to the finish line rather than arriving in bits.

We hear all about the danger to feet, limb amputation, eyesight and retina problems and deterioration of Hearing, to name just a few among many other complications. I remember after diagnosis of my T1 coming home with only a small amount of information, only discovering later the vast amount of other things I needed to know.

Nobody ever mentioned "Oral Problems"

My oral hygiene has always been a little OTT and brushing vigorously 2-3 times daily would be my absolute minimum, yep me and my toothbrush are never far apart. 

We use our mouth for many things like breathing, eating, drinking, smoking, talking, smiling, and kissing etc lol. We ladies outline it with lip liner and slap on the lipstick hoping we look great. 

You men pucker up without the lippy and hope you'll get lucky.

In the dead of night when I reach to the bedside locker to treat a hypo without even getting out of bed and then falling straight back to sleep, do I brush first ? 
NO .......  

I wouldn't even be thinking, I'm shaking,sweaty, and desperate for sweet stuff so I can see yet another day. I never totally wake in a hypo, I sort of move and react while still sleeping, yep that's it, I sleep eat.......

Then I wake up in the morning with an awful sickly sweet taste in my mouth, honestly that's when I realise iv treated a hypo through the night, and only then do I brush.

Do we ever stop to think about what our diabetes is doing to our Oral status?

I sure didn't.......

As I am a regular 2-3 times a day brusher, it never even entered my head. Until Christmas week when a tooth started being a bit more than sensitive.

First week in January straight after new year I treated myself to a trip to the dentist, did I tell you I HATE going to the dentist ( probably why I brush so much ) the only consolation was, he was young, good looking, had a lovely smile and a great bedside manor.

I even joked with the receptionist about it being ages since I'd had someone that good looking talking Oral to me ...... ( well that's not exactly what I said lol )

However, my tooth was causing grief so I opened wide just like I was told to, the result was a crack in the molar that he'd try to save with a big filling. It was a long shot and I knew it, but we took the shot and lost. It continued to cause problems and 2 weeks later it had to be removed. 

The root broke off during the procedure and a little digging was needed. ( it wasn't good )

I went back a week or so later to have stitches removed and it was then, he said he was surprised that the healing wasn't as advanced as he had hoped. He suggested because I was a diabetic a really deep clean done in his office would be advised, and I took his advice, starting 2 weeks later. 

Cutting a long story short here, iv had to have more "work done" than I hoped. We discovered not only is my healing not good, but my gums are inflamed. The result of my diabetes, the work done and a lack of healing.

The local anesthetic he gave me at 9.30 in the morning, had managed to remain in place until between 8 - 10 pm and all day as I sipped my coffee in one side of my mouth it spilled out the other side and down whatever top I was wearing this time. Eating wasn't pretty ......

I felt like I belonged in a comedy show, yes it was hilarious to look at, my sense of humour however wasn't great. 

Another thing, the anesthetic for my molar had now numbed me from the base of my neck to my hairline and just to keep things balanced out it also totally numbed my ear, enabling me to stab myself while putting on my glasses without pain, or as another option just miss my ear target and wear the glasses sliding down my face. 

I did bump into my Mr 50 shades of Dentist at the shop in the afternoon, he was more than a little surprised that I was still talking with a sort of "spit and drool" action. No he hadn't given me too much. The reason ??? My metabolism and my diabetes, meant the anesthetic was acting differently, and not wearing off too quick. Yep you could have punched me anytime through that day and I wouldn't have felt a thing.

I also spent a full 24 plus hours, eating ( everything ) and not injecting insulin just trying to reach a (5. Plus) on the BG meter and CGM, I did manage it just once for about 40 minutes but I very quickly dropped back to the 2s ( no sleep was had that night ) just my T1 system reacting to local anesthetic. 

That was January and guess what ? Iv still got another molar with a crack, just filled but the issue is not resolved. Iv got a lack of enamel now and dentures are now on my bucket list for this year.

I'm thinking diabetes has a lot to answer for, and more regular check ups are advisable for those with diabetes. 

The only good thing is, my Mr 50 shades of dentist, can't and doesn't  say "don't eat sugar" to a diabetic and when it comes to treating a diabetic, their protocol is to be guided by the patient and what they need, they will only work on us if we are happy with the BG numbers at the time. His exact words were " the diabetic knows best " ( music to my ears )  now that's one very clever man, my 50 shades of dentist.

How my Dogs will think when i get my new set of dentures. 

That of course is if Princess Kate does'nt eat them on me.

Some wise words from the dentist here :

http://www.diabetestone.com/our-dentist.html

Another Dental article

http://www.informationaboutdiabetes.com/lifestyle/lifestyle/why-your-dentist-is-part-of-your-diabetes-treatment-team

Just a Type 1 Diabetic sharing experience
Davina

The Twists and Turns of Type 1 Diabetes - Where Do We Start?

If only there was a complete list of Do's and Dont's but unfortunately Type 1 Diabetes is not like that. It's not as simple as taking a paracetamol for a headache, sticking a plaster on a wound, drinking plenty of water before going to bed to avoid a hangover.

In fact although we all have our regime, "the Holy Grail of life as we must live it with type 1 diabetes" doesn't really exist.Yes we have our ratios, and our DAFNE type courses, but there are just so very many variables, absolutely everything we do, and everything we eat impacts on our blood glucose in different ways, all effecting our blood glucose readings at various times of the day and night and for various reasons.

I'm going to attempt to highlight some of these, but only as a type 1 diabetic, I'm not a professional. Please discuss any of the content in this blog with your diabetes team, and seek their advice in relation to your own type 1 management. This is just a guide to questions you'll need to ask.

First let me say other than not producing our own insulin causing us to be type 1 diabetics, our diabetes basically leaves us with an intolerance to carbohydrates, which by the way is sugar in another form. Most foods have carbohydrate ( carbs ) so not only do i consider the food I'm eating when I'm calculating my insulin dose for that food, I'm also considering what form that food is in. (whole, mashed, pulped, cooked etc ) because yes this makes a difference. Il also take into account what my blood glucose reading is at the time, whether I'm going for a walk soon, going to do a lot of housework, whether or not I'm sick, is the weather very hot or very cold, so it's not just eat and apple and inject xx amount of insulin. It's really about understanding your food, not just knowing it.

The all important carb counting :

We all have an insulin to carb ratio.That's the amount of insulin we take per gram of carbohydrate (carb) we have our correction ratio,
(a means of using our insulin to correct a blood glucose that's higher than our recommended guidelines) and our sick day plan (a plan to manage our blood glucose and insulin while enduring a vomiting bug or other illness. NO you don't stop injecting if your vomiting and not keeping food down) Your sick day plan is a special set of instruction given to you by our Diabetes team. If your not clear about yours then ask them for it. Its a very specific set of rules to be followed. Children, pumpers and people on multiple daily injections ( MDI ) may all have different instruction of what to do in this situation.

A food / carb EXAMPLE ONLY :

Bread roll 30 gms carbs

Insulin - carb ratio 5/1 ( that's 5gms carbs to 1 unit of insulin )

That big bread roll would mean 6 units of insulin in this example 
( 30 divided by 5 = 6 ) 

Simple Ye ?

Now let me bring you further on this journey......

Slap a thick couple of slices of my favorite cheese in that bread roll. Even toast it or melt it if you like. 

The cheese has no carbs, so it's still only 30gms carbs for what's now a delicious cheesy bread roll, however things have changed a bit now. 
But why?

My cheese has a high fat content, fat slows down the impact the carb in the bread roll has on my blood glucose (BG) I may find if i inject just as i start to eat, that after my insulin ( fast acting / bolus ) has peeked and is now becoming a distant memory that my blood glucose is still rising​! I haven't reached the magic 2 and a 1/2 hour period (insulin peek time) 
since i last injected, so 

I​ 

can't really safely inject again just yet, but still the BG numbers climb higher. So what could 

I​ 

have done differently?

Split the insulin dose ......

Using the same delicious cheesy bread roll example 30 gms carbs / 6 units of insulin.

​Il take ​3 units as I ​start eating and 3 units when iv finished. Giving the effect of the insulin longer to work. In other words it will be longer before my much needed insulin peeks and then starts to dwindle away, giving the insulin iv injected a longer period to work or lengthening its effect. (Seek advice from your diabetes team about this)

​​

Now to a sample list of foods that have this effect : 

• Pitza.
• Garlic bread.
• Chinese takeaway.
• Battered foods that are deep fried.
• Chips,
• Pasta ( in some people ).
• Ice cream.
• Milk Chocolate.
• White chocolate.
• Cakes with a butter icing or frosting

There will be other foods you'll come across that have a high fat content, these are just the ones I can think of. Everyone's diet is different.

Fruits Vs smoothies & juiced fruit :

Let's take some fruits as an example : 

1 orange 7gms carbs

1 Apple 20 gms carbs

2 pineapple rings 8gms carbs 

All containing fibre when eaten whole and much needed nutrients, the fibre content will slow down the impact of the sugar that the fruit contains, if I​ inject as instructed then im​ sorted.

Now pulp, mash, liquidise those same fruits, 

​Iv​ taken out the fibre, Iv​ still got the nutrients, but because of the lack of fibre ​Iv​ now got high speed sugar, coursing through my veins before 

​my​ insulin gets a chance to cop on.

Potatoes, 

• Eaten whole, are high fibre and impact our BG, on a sort of normal time frame.
• Eaten mashed they become a quicker carb hit, rising ​my​ BG faster than the whole potato.
• Eaten fried / chipped become high fat, impacting my​ BG a lot slower than the whole potato.

Basically ​im​ eating the same potato, so the same carbs, but in different forms, all having a different impact on your blood glucose, over different time fames.

Ice cream. 

Now this I can eat with out any rise in BG, and without insulin, BUT 2-3 hours later my BG will start a steady climb because of the fat content.

Chocolate. 

Ah yes chocolate. Now and then at 8pm watching the soaps. Now here's a real sneaky one, choose the bar. Inject the insulin dose, eat the chocolate. Delicious ...... And everything seems to be going to plan. 

2am and your awake to use the loo, you'v maybe got a headache and you test your BG. It's in the teens and I​ was 8ish going to bed, I would​
be fairly safe to blame the chocolate this time, it's because of the high fat content.

Infection / Illness / stress

Sometimes when Iv​ got an unusually high BG with nothing obvious to blame, it could be my​ first warning to an infection, a 24 hour bug, or an oncoming illness of some kind.Stress because of work, exams or just everyday life stresses.

Treatments

Even a dental local anesthetic can effect my​ BG. To either rise it or more usually drop it.I ​need to allow for this one when undergoing treatment. The dentist is guided by the diabetic, they rightly presume you know your stuff, so please​.......​ know your stuff !

Heat and Cold weather

Yes the weather eff​ect'​s my BG, but people react differently to this one. I would run low in the heat having to keep an extra vigilant eye on my BG in case of hypos.

I would run high in the cold weather, needing a little extra insulin to meet my chosen target.

Exercise

Remember when you exercise you burn off sugar first, to continue that exercise you need to compensate by replacing that sugar, which is why type 1, exercising and weight loss  can be a fruitless challenge. Special care and training is needed for marathons etc.

Hoovering, window cleaning, children running around playing all qualify as exercise.

Foot tips

Check feet daily for blisters, cuts etc daily,  keep feet clean and dry. Never moisturise between the toes. Wear socks inside out to avoid the seam rubbing the toes. (a chiropodist who is also a type 1 told me this) 

​I ​Wear 2 pairs of socks in my trainers to reduce the risk of blistering. If you notice cracks, cuts, blisters or anything else unusual seek medical advice and don't be tempted to stick on a plaster and ignore it.Take professional advice on nail cutting and removing hard skin.

Skin

Skin problems and slow healing is quite common in people with diabetes of any type.

Alcohol

Now here's a tricky one, yes there's carbs in alcohol, but we don't count them, why ? Because the day after drinking, the alcohol can drop your BG and leave you prone to hypos. It's advisable to eat a carb before going to bed after drinking alcohol. 3 alcohol free days a week is what I was advised on diagnosis and iv stuck to it.

Coffee

Now here's a dark horse if ever I found one, I get up in the morning, With a BG of maybe 5-6, I have a coffee, just a regular black instant coffee, with a small drop of low fat milk. (no insulin I hear you say) well you'd be wrong. Coffee acts like speed, stimulating the body, or more precisely the liver. 

Just over a 1/2 hour after drinking my morning fix I'd have a BG of at least 9-10 if I'm lucky (that's without injecting insulin) so my morning cuppa is always accompanied by a little insulin unless of course I start off low. If your a coffee drinker you may know what I mean.

Hormones

Hormones Of the general teenage, menopause, puberty, post natal varieties can all effect your BG. So either speak to your diabetes team or T1 people experienced in this area. I'm also pretty sure pregnancy and childbirth take their toll but likewise speak to someone who knows about these things.

Lack of sleep, trauma, worry, exhaustion the list of what effects a diabetic, ( particularly a type 1 ) is endless. Basically every part of our lives and our very being, whether it be emotionally or physically has an impact on how your body copes, therefore can have an effect on your blood glucose.

Treating Hypos - lows - hypoglycemia

We all have our favorite hypo treatment, yes you heard me our favorite treatment. Lucazade is not your only option. This is my big chance to have something I wouldn't normally get to eat, so for me it's jelly beans or jelly babies. Some use fruit juice, full sugar soda, or glucose tablets there are no hard and fast rules to which high sugar treatment you prefer to use to get those blood glucose numbers back up fast. Your diabetes team will advice you about how much of your chosen hypo fix to take, or check out the carbs and cals app or book.

WE DONT TREAT A HYPO WITH CHOCOLATE BECAUSE IT WONT IMPACT ON YOUR BLOOD GLUCOSE FAST ENOUGH TO FIX IT 

( REMEMBER CHOCOLATE IS HIGH FAT ) & TREATING LOWS NEEDS HIGH SUGAR.

Finally.

It was my Diabetes Team who said NEVER go to bed with a BG below 8, and that's something iv never forgotten and stick with to this day. 

After doing research of my own I started a lower carb diet than the diet I was previously on, substituting some of my foods for a lower carb alternative. I did this to reduce the weight I'd gained after diagnosis, to gain a tighter more manageable control, and to reduce my HBA1C.

I achieved these things and have chosen to continue with this lifestyle, feeling generally healthier with more energy.

Write out your questions so you won't forget them. Bring them to you next diabetes clinic and discuss and question those things you may not understand right now. Education and learning is the key to living at ease with your Type 1 Diabetes. 

Lack of knowledge NEVER EVER takes away the facts, the risks, or the disease.

EVERY DIABETIC IS DIFFERENT SO WHAT WORKS FOR ME OR YOU MAY NOT WORK FOR OTHERS.

SEEK - QUESTION - IMPROVE are 3 very important words when you have any type of diabetes.

• SEEK : More information than you may already have, and support from others living with type 1.
• QUESTION : Everything you don't understand.
• IMPROVE : Your knowledge, your management and your understanding of type 1 diabetes in order to improve your life.

Davina 

A Type 1 Diabetic 

​

See us on face book https://www.facebook.com/DiabetesT1Ireland?ref=hl

Co-Founder of http://www.diabetestone.com/

Follow us on twitter @T1Ireland

Just One of my Days with #Type1Diabetes to #StayWell

L

I wish I could explain to people what living a type 1 Diabetes life is like and make them understand.

Some personal sad news threw me into a line of thinking from the past recently​, and a door I had firmly closed, ​sort of got unlocked so I could re-hash and see again the stuff I so badly​ wanted to keep buried.

The result of this was a few days of kit-Kats and a large Cadburys Puddle, a new bar, big, and packing some serious comfort.

Yes I injected the appropriate amount of insulin to cover anything I'd eaten but because of the high fat content in my chosen treats, long after the novo rapid ( basel ins​ulin ) had​ peeked and finished its job my blood sugar was 

still​ climbing at a steady pace. Yes I corrected, but no I couldn't stop the climb. 

​ ​

Hitting an 18.2 is no joke at 3am when you've gone to bed on an 8 and​ no matter what I did I could'nt​ seem to fix it. The result ? A serious hangover feeling and all the effects and results of high blood sugar.

So my next day bl​ood glucose started on 12.0 BG. Now I kno​w this is self inflicted to a point, yes I fed myself but my Type 1 ​D​​iabetes wasn't self inflicted in any way.

This was how my day went :

• Injection no 1 was at 8am to correct that 12.0 and then it was back to bed to sleep it off after a coffee and some paracetamol
  ​ for that bloody awful headache.​
   
• Injection no 2 was at 11am to correct what had now become 12.2 BG, still no food yet​, I'm determined to start the drop before i actually eat.
• Injection no 3 was at 2pm, 6.5 BG so its lunch time.
• Injection no 4 was at 5.30pm a correction for a 10.2 BG
• Injection no 5 was with dinner BG was 5.2 and holding steady.
• Injection no 6 was to cover supper
• Injection no 7 was lantus - Basel insulin.

All this was about 10 finger pricks, before my CGM (continuous glucose meter ) arrived, and 7 injections ​but this was a relatively good day because i knew what was causing the problem and i did manage to correct it​.

Not being well, stress, upset and other medications means a much more difficult situation to try to control and manage, these things are not self inflicted, they are beyond our control and as long as they are actively playing a part in our lives​, they continue to play a part in our diabetes and ultimately our blood glucose, making managing our diabetes and our daily routine more difficult.​

The food planning, clock watching, and carb counting is relentless, the carbs & cals app is always with me ( on my iphone )​ and my handbag and bedside locker stash of jelly beans is always kept topped up. 

Leaving the house there's always a rice cake or two with an apple  put in my handbag along with the BG meter pouch which carries ​my blood glucose meter, test strips, a finger pricker, lancets, an insulin pen, needle tips, and a small container ​(​for the used strips, lancets and needle tips.)​

 

The all important hypo kit,  GlucoGen, is also brought, well it's no good in the fridge at home if I collapsed when I'm out.

No I don't bring a bottle of any kind of fluid because it doesn't fit in the handbag, I might leave it down, walk away and so get separated from it and that just wouldn't do at all.

I "​TREAT"​ with jelly beans, now that's treat a hypo ( low blood glucose ) not treat,​ as in having a treat. Jelly beans are like tablets to me and I take :

• 1-3 if I'm in the high 4s. 
• 3-5 if I'm in the low 4s.
• 5-6 if in in the high 3s, 
• 6-9 if I'm in the low 3s

​Basically the amount or dose differs and depends on what my BG (blood glucose) reading is.​ A​ny lower than those (3s) and it's party time, ​I jus​t scoff rather than count​. 

Thinking is gone out the window so I have a tube that carries a certain amount of jelly beans so when I say scoff it's not a big bag or anything like it, it holds about 20 in total or (​36 - 37 gms carbs)​ to a t1 like me.

12 jelly beans has aprox 22gms carbs in them so each 3 represents a treatment of 5.5 gms carbs.

• 6 = 11 gms 
• 9 = 16.5 gms
• 12 = 22 gms

The aim of this is to catch it early and treat with no more than 6 jelly beans the overall effect is when 

I'm very low, although in one​ sense I'm out of control, I'm actually still in control, if you see what i mean.

Back in the early days when I used fluid to treat, I'd just drink, and I would always drink too much, 

carrying measured drinks was'nt an option​, and seriously​, ​who carries a fluid measure with them. 

Imaging measuring out fluid in a moving car while disoriented during a hypo, or carrying several small containers of fluid, Ridiculous right ?

Once I'm all packed, then il do one last BG check to see am I ok to head out and how long I have before the next action plan of food and insulin.

​ 

A​h yes i remember the days when i just walked out of the house without a second thought about food, or anything else for that matter. Every moment of every day is a decision now that has to be made​.

• Will I have that scone and coffee with friends?​
• ​Will i go for that nice long walk?
• Will i get get into spring cleaning ?​ 

​So its prick, check, calculate, decide, then either inject, treat or leave​ for the moment......

Some days everything goes to plan, but on other days it doesn't and for no obvious reason. There are also days when I just get sick of it all and just do what I want regardless of the numbers, but yes still inject the insulin, just not be quite so strict.

On these days I always end up regretting it because that sick feeling is so hard to shift and once iv upset the delicate balance of blood glucose numbers and insulin it's so hard to get it all back on track and even when I do it takes even longer to actually feel well again.

Bedtime is another tricky one, 8 is a good number for me to go to bed on ( i​ts what was recommended to me ) ​by my diabetes team.

• any lower and I might go low through the night, 
• any higher and il wake high in the morning and start the day correcting from the day before. 

So it's check about an hour before bedtime, if I'm below 8 il work out just how much to eat to bring my blood glucose (BG) up to 8 + ish, then inject my lantus ( that's Basel, or long acting insulin ) and go to bed.

However if I check an hour before bedtime and I'm over 8 already it's either no supper, or I can eat supper and inject ( bolus ) for that food. Still taking the lantus (Basel) at bedtime..

Either too low or too high going to bed is not a good idea. 

• High has long term risks and makes me feel really awful
  ​ with the addition of a blinding headache.​
• Low, I could hypo through the night and wake up feeling really awful, or worse again just sleep through it.​

​Its always on my​ mind that​ a bad hypo could kill me so my fear of sleeping 

through a hypo is very real.

This was just going on a sort of typical day, but absolutely everything we do and go through any day effects what our blood glucose readings will be.

• If your trying to lose weight. 
• If your training for a marathon, or 
  some other event that involves physical exercise.
• If the weather is very hot or very cold.
• If ​your pregnant.
• If your going through hormone changes.
• If your ill in any way.
• If your stressed or upset.
• If you'v had a bad shock.
• If you'v had a couple of glasses of any kind of alcohol the night before.
• If your extremely tired for any reason.
• If your routine is broken.
• If you have an anesthetic even a local one for a dental procedure.
• If your taking medication for an illness ( ex steroids ).
• If you change your diet.

After living as a Type 1 Diabetic for a period of time these things become sort of automatically thought of, as we cruise on through any day in our lives. It becomes our normal, still a challenge every day, but a little less mentally time consuming. No im not complaining or even looking for any kind of sympathic groan........

However what i would like is for :

• Consideration when i say no thanks.
• Id like understanding when i say im tired.
• ​Id like not to have to explain why i need to stay home sometimes.
• Id like, not to be thought of as fussy, when i insist on a bottle of diet 7up as a mixer for my drink and when i wont eat high sugar foods and deserts.
• Id like not to be called unsociable for living the life i must live​.

Id really love if people understood why my brain gets so tired sometimes that it just cant cope with any more stuff.

I wish they could see a plate of food like i do with, portion size and carb content first, calculations and insulin second, and then see that plate of truly delicious, lip smacking, finger licking food that i finally see when theirs is half gone already.

I also wish they didn't rob the food off my plate because they have finished theirs already, because that food they are robbing has already been accounted for with the insulin iv injected. Seriously some day someone will lose a finger and Im guessing nobody will understand when it happens........

This is how a meal looks to someone with Type 1 Diabetes:

Dinner as i see it 34gms Carbs 

And for Desert as i see it: 36 gms Carbs

                                                       

Total for this meal, calculated before eating, if i was to eat this it is 70gms carbs and now id work about how much insulin it will take to deal with it.

Just my thoughts on a day in life, living with Type 1 Diabetes.

Davina