Showing posts with label #Diabetes T one.com #Diabetes information. Show all posts
Showing posts with label #Diabetes T one.com #Diabetes information. Show all posts

Friday, 5 June 2015

INJECTING INSULIN, IPORT ADVANCE HSE REPORT, NEEDLE TIPS, BRUISING,TRAUMA, NEEDLE TECHNOLOGY AND A SUMMARY OF NEW INJECTION RECOMMENDATIONS


THE IPORT AS SEEN HERE IN POSTION AND READY FOR USE IS NO BIGGER THAN A 2 EURO COIN






Since being launched in 2014. Pharmed report that 

  • 410 units of the iport has been sold in the UK. That's (41 packs of 10)
  • 2060 units of the iport has been sold in Ireland. That's (206 packs of 10)

I'm not sure where to start here, iv only just read this report from the HSE after their consideration about whether or not to include it in our LTI Scheme ( Long term Illness ) which would have meant people injecting insulin with type 1 or type 2 diabetes could have had access to the Iport for injecting their Insulin.
The iport is a type of cannula that can be injected into For 3 days and nights, after which we would remove it and replace it with a new one. This would mean piercing skin / flesh only once every 3 days instead of 6 plus times a day ( once instead of 18 plus times over 3 days )


It's distressing, upsetting, and condescending. YES I said CONDESCENDING ! To read this report.

While reading through this document I found myself realising that people in offices, obviously NOT injecting insulin every time they eat something and then injecting again to correct because the last injection didn't quite do the job.  I say condescending because they are presuming to know better than someone who actually lives a type 1 diabetic life all day and night, every day and night.
Instead of sticking a few people / children on it as a trial why on earth did they not just ask those clearly using it ? 
O Ye, that's because those buying it and using it would say they find it extremely beneficial, for both control and for comfort purposes.

It's actually beyond logic........
When we get to hospital sick, the first thing they do is insert a cannula IN CASE they need to administer drugs, in many cases this is both a waste of time and a waste of money as it's not always needed. 
Injecting diabetics are GUARENTEED CUSTOMERS who will always need to inject so it's never ever a waste of time or money.


A Child with Type 1 Diabetes bruises because of injecting insulin


Injecting insulin several times a day means breaking skin each time we inject. We are advised to rotate the sites we inject into, in order to avoid Lipohypertrophy ( lipos - a build up of insulin in the injection site which causes a lump and effects of blood glucose control ) but even though we follow all the advice and instruction there seems to be no getting away from the general trauma to the areas we inject to. 

Unsightly bruising left as a tell tale sign that we'v injected in that spot would be all too obvious if we wear clothing that doesn't cover it. 

Children or indeed adults can have a fear of the injection / needle making it all the more traumatic.

Sometimes when we inject a drop of blood will appear, that will mark or stain clothing so wearing white especially if we are going out, is something to be considered before we dress.

But how many of us know that injecting correctly, rotating correctly and using a right kind of needle tip on your pen can all lead to tighter blood glucose control, less trauma and less insulin injected, as correction injections can be less frequent. 

We all pay attention to articles about the artificial pancreas, pumping, and stem cell research, but while we're waiting for all the magic to happen do we research needle technology and ways to improve the life we are living right
 now ? 
Do we inject for a life with little trauma and bruising, less pain and stinging or burning when we inject some insulins ?




Needle technology has come a huge distance from the earlier days of filing and sharpening a needle for further use, ( yes this actually was the case ).


  • Yes a lot of us have attended a carbohydrate ( carb ) counting course, but Have you ever attended a talk about injecting correctly ?
  • Do you prime your pen when you switch to a new one ?
  • Do you prime before injecting ?
  • How do you know your getting insulin if you don't prime ?
  • What size needle tip are you using to inject ?
  • Is it bigger than a 4mm or 5mm ? Why ? 

Unfortunately we all have different opinions on the above points, mostly based on what we'v been told, but just allow yourself to employ logic for a while. It's your life, your body, your type 1 diabetes. I always think the worse thing we can do, is just do as we are told, without also helping ourselves by doing a little homework too.





SUMMARY OF NEW INJECTION RECOMMENDATIONS AS TAKEN FROM BD's WEBSITE. 
⇒Choosing Pen Needle length: ( yes it's your choice )
  • Initial therapy should begin with shorter pen needles.
     
  • There is no medical reason for recommending pen needles longer than 6 mm.
⇒Pen Needle Injection Technique:
  • A 4 mm pen needle may be inserted at 90ยบ without pinching up the skin. Slim individuals may need to pinch up, especially when using a 5 or 6 mm pen needle.
     
  • Patients should count slowly to 10 before withdrawing the pen needle from the skin in order to get the full dose and prevent leakage. Counting past 10 may be necessary for higher doses.
     
  • To safeguard normal tissue, consistently rotate injection sites.
     
  • Use pen needles only once and dispose of after use.
⇒Efficacy and Safety of 4mm pen needles:
  • A 4 mm pen needle will reliably deposit medication in the subcutaneous space.3
     
  • The depth of injection (shallow versus deep subcutaneous tissue) does not appear to affect the absorption or pharmacokinetics of insulin.
     
  • Equivalent glycemic control is achieved when comparing 4mm pen needles to longer needles.4
     
  • The 4 mm pen needle has been proven safe and efficacious, even in obese patients.5
     
  • No consistent evidence of increased leakage of insulin in patients using short needles.
More information here

For those with a needle phobia, your GP can request the auto shield, and your pharmacist can provide and fill out the necessary forms to request this be included in your LTI, it's not generally included but can be applied for.




There's no doubt that wearing an iport advance solves these problems as rotation is not an issue, Just remove the one we wore for 3 days and pop the new one on the other side or in a different position.


Trauma is less of a problem as we would only pierce skin every 3 days, after removing the iport the only tell tale sign that one was there would be the Dot where the cannula had Been and maybe some sticky on the skin which is easily removed.

That drop of blood that can stain clothes would not be an issue any more. Blood glucose testing generally gets a better result because every drop of insulin has been delivered even the familiar drip on the end of our pen needle, is no more. 



However the latest news from the Health Service Executive ( HSE ) is that this in NOT included in the list of supplies covered on our Long a Term Illness ( LTI ) scheme at the moment. Buying it can end up being quite costly at €195 per month. 
That said it is undoubtedly effective. It could be seen as a stop gap between injecting and pumping insulin, sort of a half way house between the two for those on multiple daily injections (MDI) .

But employing logic here for just a moment. When we end up in a hospital for a few days the very first thing they will do is position a cannula some where on your body. This presumably allows the nursing staff to administer medications & drips without delay. It means for our stay with them they just inject what ever is necessary directly into a cannula instead of flesh every time. Yes I know this goes into a vein, BUT then we have a situation where a type 1 diabetic is injecting several times a day into flesh, why is there no cannula.
Using the same logic I'd have to ask, why on earth we don't have access to some form of cannula, just like a type 1 on an insulin pump would have. 


Real Children, Real Lives


Yes in my mind this defies logic !

NO, I'm not a professional, just a type 1 diabetic with an opinion.


Davina



























Monday, 25 May 2015

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 :

Another Dental article








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 


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