Erika has thrown herself into raising awareness of type 1 diabetes (T1D) since her daughter Violet was diagnosed three years ago. This month, she decided to mark World Diabetes Day by posing a challenge to those game enough, which inspired many of her friends and family to take part. Now she is throwing down the gauntlet to our wider type 1 diabetes community. Could you take on a month of T1D?
Each day, Erika challenges you with a different single focus – but for someone with T1D all of these moving parts are constantly competing for attention alongside work, school, sports and relationships. For those who don’t live with T1D themselves, or have a close relationship with someone who does, it’s hard to imagine just what a constant juggling act it can be!
Day 1: Check your blood glucose levels (BGL) eight times – no real finger pricks needed. Set your alarm for wake-up time, before breakfast, before morning tea, before lunch, before afternoon tea, before dinner, and 2am. Imagine you’ve just done a finger prick each time your alarm goes off.
Day 2: Read the packaging, weigh your serving size and carb count your breakfast – no guessing! Use Calorie King (App Store) or Carbs and Cals (Play Store) if you get stuck or your meal has no nutritional labels!
Day 3: Give yourself an ‘injection’ before everything you eat today (pinch your tummy and count to 10). Coffee and tea (if sugared) count too!
Day 4: Keep a food diary for today. Like many T1Ds, Violet records every single thing she eats in an electronic log. We do this because this information is vital in adjusting insulin doses to accommodate her body’s changing needs.
Day 5: Order medical supplies for next month. For us, this is $400 a month (excluding health insurance). If you can afford it, put $400 aside in another account for the month and see how different your budget looks with that ongoing additional expense.
Day 6: Grab lunch on the go and do your best to accurately guess the carb count. Hint: Try googling the restaurant/ fast food/manufacturer of the food items, or use one of your apps.
Day 7: Wear an ‘insulin pump’ for two hours today. Your mobile phone can make a great substitute, but the catch is that it must be ATTACHED to you. So try tying your phone to your waist and see how you go (but be sure you don’t drop it in the toilet!).
Day 8: Oops! Tonight you accidentally had a little too much insulin with dinner, and you’re going to have low blood sugar, or a ‘hypo’ at 11:00pm. Set your alarm, and then consume 15 grams of fast acting carbs to raise your BGL. This can be juice, soft drink, lollies, etc. After you have ‘treated your low’, set your alarm for 15 minutes later to do another (imaginary) finger prick to make sure that your BGL has risen accordingly.
Day 9: Today, check your feet and toenails for blisters, ulcers or dry cracked skin. Apply moisturiser or change your shoe choice to practical shoes that won’t rub, if needed.
T1Ds have to be very careful with their feet, as normal wear and tear can cause serious health complications if left untreated.
Day 10: T1D involves maths – lots of it! Sometime today, you will experience high blood sugar and you need to calculate the correct dose of insulin to bring you back into normal glycemic range. It is important to get this right, as too much insulin will cause a low, and too little will cause you to remain high. Both of these make you feel physically awful. Your current BGL is 18.2 mmols. Your target BGL is 5.0 mmols. Your insulin sensitivity is 5.3, which means that 1 unit of insulin will lower your BGL by 5.3 mmols. Calculate the dose of insulin that you need to administer to correct your BGL.
Day 11: Record keeping is vital for T1Ds – accurate records are the best way to keep on top of management. Before each meal you consume today, stop and ‘record your BGL’ (between 4.0-6.0 mmols is target range, but T1Ds can be anywhere from 1.5-22.0+!). The amount of entries in your log will depend on how many times you eat (or drink) today!
Day 12: Today’s challenge is a reflection. T1D management is not static – it’s not a set and forget disease. Insulin needs are ever-changing and to achieve good ‘control’, adjustments are required often (sometimes daily!). Today you notice that you have been having elevated BGLs before dinner every day. Reflect back upon your daily activities over the last two weeks considering diet, meal times, exercise, possible illnesses, or any other changes in your routine that could be contributing to this blood glucose trend. Once you’ve identified what you believe to be the culprit – imagine making a change in your diet, meal time or insulin doses to correct the issue, and of course, you would record these changes somewhere for future reference.
Day 13: Think about the future. T1D is a disease with many possible long-term complications. As a T1D, it’s not healthy to dwell upon the very real possibilities too often, but awareness is also important as good glycemic control can minimise and prevent complications. Google ‘type 1 diabetes complications’ to find out more.
Day 14: ‘Be prepared’ could be the motto for T1D! Carrying your supplies with you everywhere is vital, so that you can deal with unexpected lows or highs. In her diabetes bag, Violet carries an iPhone, blood glucose meter, test strips, fingerpricker, hypo treatments, ketone test strips, spare insulin pump supplies and an emergency glucagon kit. Today, pack a small backpack and make sure it stays within arm’s reach all day.
Day 15: Today, you will experience an unexpected ‘hypo’ (low blood sugar). Hypos need to be recognised and treated very quickly. Choose a random time and set your alarm. When the alarm goes off, wherever you are, stop what you are doing for 15 minutes and imagine you are treating a low. (This is the time it takes to treat a hypo with fast acting carbs and then conduct a second fingerprick to ensure treatment was successful.) If possible, don’t’ do anything else for these 15 minutes, because if you were experiencing a low, you would be feeling extremely unwell during this time.
Day 16: More than half way now – congratulations! Today, the challenge is to calculate the insulin dose you would require for one meal. Violet must do this for every single thing she eats. To do this, first determine the number of carbs in your meal (remember your apps). Your insulin to carb ratio (the number of carbohydrate grams covered by one unit of insulin) is 9.
Day 17: Yuck – you’ve come down with a bug and can’t keep anything down. T1D doesn’t give you a break when you’re unwell – in fact, it becomes even more challenging to manage! Insulin will cause you to have low blood sugar if you do not eat, but you need to keep taking it to stay alive. Administering an injection of the hormone glucagon every two hours, around the clock until you’re well is one way to manage a gastro bug without hospitalisation. Imagine getting up every two hours tonight and giving yourself an injection.
If you are super keen and really want the experience, you can set your alarms for every two hours.
Day 18: Today you need to attend to ‘administrative tasks’. You have a regular appointment with your endocrinologist coming up, and you need to attend your GP today to obtain your annual referral to say that you STILL have incurable type 1 diabetes. Imagine setting aside an hour or so to attend this appointment – and don’t forget to set aside the fee for this appointment!
Day 19: Unfortunately, there is a lot of misinformation out there about diabetes especially the different management requirements of Type 1 and Type 2 Diabetes. Today, imagine you are having a coffee and a slice of cake at a local café. You take out your insulin pump to administer your dose of insulin before eating, and a stranger approaches you and says, “Are you diabetic? You REALLY shouldn’t be eating that cake…” Educate them as to why this is not an issue (google it if you’re not sure). Post your response in the comments J
Day 20: You’ve been invited to a formal event and you’ve found the perfect outfit (bear with me gentleman!). Try it on, and now find a place to hide your insulin pump. Use your mobile phone and a string tied to your waist and get creative!
Day 21: When you do your finger prick before dinner tonight, your BGL is high, at 16.9 mmols. You need a corrective dose of insulin to bring your it down before you eat. Insulin takes approximately 30 minutes (or more) to start working. Calculate the dose of insulin you will require, and then put off eating dinner for 30 minutes. (Hint: Remember from Day 10, your target BGL is 5.0 mmol, and it takes 1 unit of insulin to lower your BGL by 5.3 mmols). Hope you’re not too hungry!
Day 22: It’s the night of that event you’ve been looking forward to, but your pump just failed! You’ve ordered a replacement, but you’re back to injections for the night. So that you don’t have to repeatedly inject yourself throughout the evening, have a look at the invite and make a list of everything you intend to eat and drink.
Consider the planning involved in a night out when you have to bring T1D along!
Day 23: Carb counting and accurate insulin dosing are the bread and butter of diabetes management. Practice again tonight by carb counting your dinner and calculating your insulin dose.
Day 24: Unfortunately you’ve miscalculated the number of test strips you needed this month. You’re going to need to buy some today- so find time in your busy day to stop in to a pharmacy to refurbish your supply.
Day 25: Today, I challenge you to contemplate experiencing a very real fear of most T1Ds – a severe low that causes you to lose consciousness and rely on the help of others to save your life. Set your alarm for a random time. When it goes off, wherever you are, imagine that you have suddenly been hit by a severe low. You would feel like you are losing consciousness, most likely be unable to speak and getting assistance will be urgent. If you are home, imagine signaling your family member that you need help with glucagon. If you are out and about, look around you and imagine getting the attention and assistance of strangers to contact an ambulance, bearing in mind that your symptoms emulate those of an extremely intoxicated person.
Day 26: If you have stayed with the challenge this long (congratulations and thank you!), I’m sure you will be getting an understanding of the impact that managing a chronic and invisible illness has on your psyche. Imagine debriefing to a good friend or counselor.
Day 27: Exercise plays a huge role in BGLs, and monitoring when you exercise is extremely important. If you get a chance to be active today, remember to stop and check your BGL halfway through (just pretend). Set an alarm for one hour later to remind you to re-check your BGL after exercise to ensure you aren’t heading for a hypo.
Day 28: At dinner time, do an imaginary finger prick and make up a BGL. Carb count your dinner. Calculate the amount of insulin required to correct your BGL. Calculate the amount of insulin to cover the carbs in your dinner. Add these two together to ascertain the amount of insulin you require for your meal.
Day 29: Congratulations – you have managed T1D for an entire month! Time for your report card. T1Ds see their endocrinologist every three months for review. During this appointment, you will undergo a different type of finger prick that determines your average blood glucose level (or HbA1C) over the previous months. Your HbA1C is the primary indicator in risk for future complications related to T1D. The endocrinologist will go over your food diary logs, BGL logs and discuss recommendations regarding insulin dosage adjustments. How will you go? Are you prepared with your records to show the doctor? Do you think you did your best managing your condition and it will be reflected in your HbA1C test?
Did you take on some or all of Erika’s challenge? Good on you! Let us know your experiences in the comments!