Summer and Diabetes

Woah! All I did was blink and summer is almost over! Between my sailing trip, flying back to Egypt to visit family and staying at a beach resort I was fully occupied with adventures. As fun as summer is things can get a bit complicated on a diabetes level for three main reasons:

Holiday Mode:
-Routines really help keep blood-sugars more stable. While on holiday having a routine can be tough. My workout timings and food aren't the same everyday. The amount of sleep I get is usually very minimal...although these changes sound minor it can really throw me off my control as blood sugars become unpredictable at times. In addition being on holiday is meant to be a relaxing time period which can cause individuals to slack with their diabetes care...I know that definitely happened to me during my trip.

Exercise:
-My passion in life is staying active and exercising. It's a way for me to escape from life and does magical wonders to my blood sugar. However, when on holiday working out can be a bit tough. (I know I can workout at home but that's just boring). Having different exercise levels throughout the summer affects bgs greatly. For example I can be active for 3 days straight and have tons of lows and than my activity level can drop for the next week and I'll start having stubborn highs that can be extremely frustrating at times.

Food:
-Before anyone gets me wrong on this...yes type 1 diabetics can eat whatever they want as long as they take their insulin but just like everything else there are good food and not-so good food. As a picky eater I eat the same food pretty much every day so I'm no expert at carb counting. I usually have low carb and 'healthy' food for the most part. On holiday this can be difficult as your control of food is limited. Being invited to people's houses every other day you have no idea what they will cook and how many carbs are in the food so it's a "guess the carbs and bolus" game which can mess up blood sugars big time. In addition, Egyptian food is fat rich and that can have a huge effect on my numbers.

There are minor topics such as stress level, excitement, jetlag...etc that I haven't mentioned. I decided to stick to the main once that affected me

Controlling blood sugars during the summer time can be difficult due to a hectic schedule and feeling out of sync but I always try and remind myself that it's important to breath and enjoy the moment

Full of laughter on my sailing trip

Family time and cousin love 

Rocking the banana boat 

Living With Type 1 In The Middle East

Prior to moving to Canada I lived in Saudi Arabia for 9 years. Being diagnosed in the Middle East had its own experiences. To begin it all off in Saudi Arabia there is no such thing as a family physician/doctor...if you feel sick you just make an appointment and see the specialist or if it's urgent you go sit in the waiting room in hopes someone doesn't show up or cancel their appointment. Their is no such thing as a "children's hospital" so ultimately you had the choice to go to any specialist in any hospital in the city.

Access to insulin is accessible to those with insurance or else families would have to pay out of pocket as the government puts no help in assisting those in need. However, access to technology was less accessible and only those who could afford the cost of a pump 100% out of pocket or young diabetics with insurance could have a pump. At 12 years old my insurance said I was too old for a pump and the only way I could get a pump was to pay for it 100% out of pocket! (12...too old? Crazy I know). And if I was able to get a pump my choices where only limited to Medtronic. I am not sure if CGM (continuous glucose monitor) are more popular now but living in Saudi Arabia I've never heard of it at all and I can assure you if I go back and ask my endo about it she would have no clue what i'm taking about.

As part of my religion there is a month called Ramadan, in which we are expected to fast from dawn to sunset. By fasting I mean no food, water or anything that pleases the body. It is controversial wither diabetics should fast or not, God stated that those who are suffering from an illness, travelling, are elderly, pregnant, breastfeeding, diabetic or going through menstrual bleeding are exempt from the fasts. However, out of the 7 endos I had (I know I had my share of doctors) only 1 has told me not to fast show the rest left the choice up to me in which I chose to fast. While on shots things were tricky and numbers remained high through the fasting period (high 300s...17s) due to the body being put in starvation mood. Things got a bit easier on a pump along with a CGM as I had more flexibility and could easily adjust ratios while monitoring my numbers closely using the sensor.

The Middle East lacks support for individuals with diabetes. They have no organization such as JDRF that hosts events for kids or annual walks. In addition, there are no support groups something in my opinion is important for every diabetic

A couple things different in regards to the diabetes team in Canada and the Middle East is...firstly, in Canada each person has a diabetes team which consists of an endo, nurse, dietician and social worker. Contact between the patient and nurse is through email in order to adjust ratios. In Saudi Arabia there is an endo and a dietician if you chose to see her and contact between the endo and patient is by phone call biweekly to adjust ratios of needed. The second difference I noticed is the approach to tackling this disease. Doctors in Saudi approach it through diet, more like a type 2 approach...adjusting your food to your insulin needs. I was put on a special diet with certain foods to eat and timings. I was told to eat protein whenever I am hungry and try and limit carb intake and only have them in main meals. In comparison to the approach in Canada where we are taught to adjust or insulin to our carb intake.

Pump Break

December 8 2014...a day I shall always remember. It wasn't the day of my diagnosis or anything...it was the day I finally started on an insulin pump. I was super excited to go from having to take 6 shots a day to changing a needle placed in my abdomen every three days. Despite the flexibility and better control it offers a year later and it was time for me to have a pumpcation...a fancy word for a pump vacation. 

Personally I believe it's needed for me to get disconnected from my pump and go back to shots for anywhere from a day to a month. There are quite a couple reasons why I need these vacations which I'm sure many individuals with diabetes can relate too. 

1) Attachment Break 

Although the pump has many benefits having something attached to you 24/7 can get frustrating at times. The only times I detached from my pump was during swimming or a shower and that was for short periods of time. When I first went back to insulin shots it felt weird because I always felt like I left something behind at home. When I went to the gym I would always panic thinking I left my pump at home and that I was getting no insulin in me. 

2) Old School 

A pump is basically my life saver of embarrassment because it does all the math for me. All I need to do is push a couple buttons and it figures out how much insulin I need to correct my blood sugar if it's high and how much insulin I need for my carb intake. Going of a pump for sometime allows me to refresh all the old school fashion diabetes ways that they taught me upon diagnosis, this can be useful incase my pump decides to malfunction than I know how to do the basics of diabetes. 

3) CGM break

Since my CGM connects to my pump, having a pump break also meant having a CGM break. This can be beneficial if I was off the sensor for a long period (over 2 months) which I was not. Being off the sensor allows you to be in-touch with your body more in the sense of feeling your low and high blood sugars. My experience with this though wasn't successful for a couple reasons: firstly the longest I've been off the pump was 3 weeks. Secondly I feared having lows since I can't feel them that I let my bgs run higher than I usually like them to be. Being off the sensor also made me have to wake up every night at 3am to check my bloodsugar to insure it was in good range. 

4) Carb Break 

This is a bit more of a personal reason that very few can relate too. With my pump gives me the option of seeing my carb intake which became an obsession with me. I ended up insuring that my carb intake was no more than 40g a day so going on a pump break made me relax a bit from obsessing over my carbs as I didn't track them therefore, not knowing how much I ate in a day. 

5) Special Occasions

Life is an adventure full of events. On special events like graduation, prom, weddings...etc where I will where a dress and be all fancy or even beach days I detach my pump and go back to shots just for the day. This gives me a peace of mind as I don't have to worry where I will put my pump

Overall, a pump break has it pros and cons but I believe it is needed. Definitely one of the disadvantages is having to record my blood sugar numbers something my pump and meter did automatically. 

A couple things I noticed is when switching from pump to shots and back to pump something my team and I noticed were that my numbers were drastically lower during the first 2-3 days of switching. After my 3 days my insulin dosages went back to normal. Switching to shots though needed more adjusting in order to prevent highs. 

Correcting blood sugar with insulin shot

Blood Sugar records (if I have to use it I gotta make it look pretty ;)

The Hardest Part

Very often when people find out I have diabetes they respond with something around the lines "Omg I would never survive having to take needles/shots everyday" 

However, although this may vary for some, the majority of diabetics have agreed that the shots are the easiest things this disease has to offer. A month into diagnosis and it pretty much becomes a routine: I wake up and reach for my meter to check my blood sugar, bolus before a meal and even treat a low while half asleep. 

6 years into this disease though and the struggle isn't the physical aspects of this diabetes as much as the mental impact it can have on ones emotions. To know that no matter how hard you try numbers won't be perfect, to live the emotions that a high and low blood sugar has to offer, the constant thought of this won't go away and I will have to take care of it for as long as a cure is available, to know the future of this disease if you don't take care of it and the burden it offers can sometimes become over whelming and frustrating. Let me clarify, not every day is lived overwhelmed, in fact it rarely occurs...I'm just like every other teenager a goofy, sassy, athletic and full of life 18 year old

On the flip side diabetes help empowers a person and through a life of shots and pricks it has its positives.