The Ice-cream Experince

Its summer. Its hot. It humid. Its the perfect time for ice-cream. Oh my love for ice-cream is a never ending fairy tale...although I haven't yet perfected the happily ever after ending. I officially dedicate the past 2 months of summer to ice cream.

Mid June I met a nurse who recently started working with type 1 diabetics and together we've both been trying to figure out how to bolus for ice-cream and avoid any crazy lows and highs. Guys...I don't think I can say this enough but I really love ice-cream. Diabetes just makes ice-cream a pain because every time I go enjoy some frozen yogurt ice-cream, my day always ends up with a sleepless night and chasing blood sugars for the rest of the day. 

I was slowly giving up on ice-cream but I'M NO QUITTER so instead I decided I will go on an ice-cream binge till I figure out how to bolus for it...so welcome to my journey of bolusing for ice-cream. After this experience, I can't believe I will say this but, I think i'm done with ice-cream for a while now.

Trial 1:

Trial 1 was the least successful, but, I guess thats how all experiments go. I had a mango ice cream with 4 oreo pieces, chocolate chips, chocolate sauce and a piece of sour watermelon. 

We guessed a wild 130g, which to both of us totally made sense. I did a square bolus over 2 hours due to the fat content that later spikes me. I was in range before eating the ice-cream and gave a 15 mins pre bolus.

Following ice-cream I usually go for a 15-20 mins walk. I find that even the slightest bit of activity helps insulin work better.

As you can see things didn't go as planned. It was a pretty rough night to say the least! Dex failed on me and gave me a false high which I totally believed and didn't verify by finger prick. (Dex rarely fails on its accuracy) I was anxious about going high and was very aggressive in terms of correction insulin. I avoided treating my low, which isn't a very smart idea but I knew the fat was going to kick in any minute and I was correct. A lovely wake up BG of 19.2

Following the experiment, together we agreed that we will simplify the ice-cream and chose options which we can carb count or carb guesstimate. The challenge to figure out the correct carb count for ice-cream was on.

Trial 2:

So for our second attempt I went simple. Had the usual cup of mango ice-cream, had 3 oreos which made the carb count easier. 24g net carbs for the 3 oreos. And I sprinkled some chocolate chips on top.

We guessed 90g this time and we did square bolus over 2 hours to avoid the spike that occurred last time. Once again I was in range before eating with a starting bg of 5.8. I gave a 15 mins pre bolus to get the insulin working and went for a 30 mins walk as I was eating the ice-cream.

Here is where I struggle. I want perfection. But for perfection I need to be able to see improvement. It was another rough nights sleep, I was up all night treating lows, very very stubborn low.  I had juice, rockets, bananas, dates and toast with jam but nothing seemed to do the trick. And of course after every rough night was a day followed with work early morning. But the improvement is ... I had no stubborn highs and we managed to prevent that nasty spike up to 19.2.

Trial 3:

Pre Ice-cream 

Now  for this trial we had and a few other factors included. When bolusing for ice-cream its not just the carbs that I have to worry about. Lots of other things have to be taken into account like starting blood suagrs and exercise done prior. In this case I had just finished a very exhausting but awesome 2.5 hours of soccer. My starting blood sugar wasn't even readable by my sensor. I was at 2.4 before indulging into my ice-cream. I bought the same exact ice-cream flavour and toppings trying to keep my portion size equal.

We guessed 70g for the ice-cream however, like I mentioned above, because of the other factors acting on my blood sugar such as soccer (which always makes me go low) and the fact that i'm at 2.4 we decided to bolus for 30g of the 70g.

This time though I did not pre bolus because I was already LOW and I did not do the usual 15-20mins walk because I knew soccer is already having an impact on my blood sugars.

All I can say the next day was "I'm so glad I only bolused 30g" because oh boy was the night gonna be much rougher if I had bolused for 70. We noticed that I am no longer having that ice-cream spike that I had the first time. I'm guessing it must've been the chocolate sauce that was causing that spike because frozen yogurt has 0g of fat and both the oreo and the chocolate chip don't have a big amount to cause a spike. Soccer really did impact my blood sugars. I have to admit I was very nervous only giving 30g worth of inulin because I thought I was definitely going to be sky high. But diabetes played  a different game.

Trial 4:

This trial was by far my favourite, most shocking and by far the trial that had my anxiety levels so high because I really wasn't sure what to expect. So similar to the previous experiment I had the same ice-cream. I had just finished another 2.5h of soccer just like last time. So whats different you ask? Well we decided not to give any insulin and I was not to correct any blood sugars below 15mmol/l

I was very nervous to just eat my ice-cream without giving insulin. I thought I was being a rebel by not injecting. A few minutes after eating I started getting double arrows up and it was so hard to convince myself to relax and not correct. I ended up needing to lock my pump to avoid overriding it.

As you can see I spiked to 13.9 and than quickly came down low around 4am. Although I suspect that the crash was due to my 3am basals rather than the effect of soccer. Or possibly a combination.

Trial 5:

Trial 5 was possibly the most successful i'd say. I had no lows, however, its not perfect enough for me. This ice-cream was actually from a frozen yogurt shop in New Jersy so maybe the carb count was different from my usual one but we treated it as if they were the same. Instead of chocolate chips, because they had no vegan ones I put some sprinkles. 

We guesstimated 30g ... although that was an under bolus since just the oreos are 24g. But we both agreed with 30g and went with that. I was in a mall for 7 hours that day...I know how crazy!! So it was a pretty sedentary day. I went for a 30 mins bike ride post the ice-cream to get some exercise in. I was pretty happy with the results considering we underbolused for it. 

So if you are reading this and have a functioning pancreas...go grab some ice-cream and enjoy the blessing that your body does.  Here is to more ice-cream and more summer!

Fasting and Diabetes

It's that time of the year again...the time where people call me crazy for wanting to fast. I can agree with everyone that fasting with diabetes can be tricky. After all ... is there anything mixed with diabetes that isn't tricky? 

I've gotten many questions about the purpose of me fasting, why I chose to fast and how I manage it with my diabetes...so let me answer all those questions for you by starting right from the start.  

A Day Of Fasting

As a Muslim one of the 5 pillars of Islam is fasting and that is done once a year for a whole month. It is a commandment from God that if you are in good health and capable of fasting than you should fast. Only those who are ill, pregnant and breastfeeding women, travelling, women in menstruation, or people of old age are exempt of fasting. And while diabetes does fall under the category of illness, meaning diabetics are exempt from fasting...it is ultimately left as a choice between the diabetic and their diabetes team. For this month Muslims around the world fast from dawn to sunset...so if you're in Australia you would fast around 10 hours (5 am to 5pm). However, if you're as lucky as me and live in Canada, you get to fast for 17 hours (4am to 9pm). 

Fasting for long hours without any food or water can be very tricky on a person with diabetes. 

Working on keeping blood sugars stable to avoid any highs or lows are challenging. While highs are somewhat safer as the person will not need to break their fast ...being high for long periods of time makes a diabetic super thirsty. Definitely not a favourable thing if you can't have water. 

Adding on, it can be very hard to keep hydrated. That is certainly a challenge that I am facing. Especially for a person who isn't a fan of water, drinking enough water in such a short period of time is super tricky. Dehydration causes elevated blood sugar levels.

Can You Guess When I Ate?

Another challenge is going on with your normal day. During Ramadan sleep patterns are messed up. (lucky for me mine have always been messed up so nothing changes here lol) Many stay awake until dawn, where they have something to eat, pray and than go to sleep. That is usually around 4am and than they are up for a long day starting at 8am - 9am. This can leave a person feeling very tired as the exhaustion catches up. As for a person with diabetes, studies have shown that reduced sleep has a reaction with elevated blood sugars.

The last challenge is when I break my fast. You can't blame me for eating fast and not giving my insulin time to work like I usually do... this in return causes a big and fast spike which requires plenty of insulin and takes forever to come back down.

So why do I fast despite all the challenges I mentioned above? Well mostly I feel at peace during this month and seem to feel more connected to God. But other than the spirituality and faith reasons...I am no different than my brother, friend and everyone else that fasts. I don't want to stand out because of my diabetes and I don't want to have to explain at every gathering or to every person that sees me eating 'why I am not fasting'. Secondly, ever since connecting with diabetes I've tried not to let it stop me from doing anything I have done in the past and that was certainly one of those things. If 10 year old me can fast than 19 year old me can definitely fast. And lastly I try not to use the 'diabetes card' unless it is needed. I feel healthy and capable of fasting. My diabetes team agrees with that and so do my blood tests and blood sugars. 

Basal Testing

How do I manage my day? That is a another question I often get. A few weeks before Ramadan I start basal testing. That basically means  not eating for 3-4 hours at a time testing blood sugars and adjusting ratios to ensure I avoid lows. I let my diabetes team know so they are on board. When fasting starts I change my dexcom highs and low limits for 4 mmol/l and 8 mmol/l to 5.5 mmol/l and 10 mmol/l  Having my low limit set high gives me time to prevent a low. I usually put on a temp basal or suspend my pump until my blood sugars have risen. Before working out I usually put a temp basal at a 50% reduction, 1hr before working out and suspend my pump while working out...although this decision differs depending on blood sugars before starting my workout. Corrections can be tricky, because too much can cause a low making me break my fast therefore, when correcting blood sugars I give 50% of what my pump suggests or 0.3u if I notice my blood sugar starting to rise. Having an insulin pump and my dexcom has definitely made things easier with managing my blood sugars and avoiding many highs and lows. Just to point out this is how I manage my diabetes while fasting. While suspending my pump to treat a mild low or working out while fasting which can cause dehydration does not sound safe, I listen to my body and make sure it is satisfied throughout the day. To try and combat dehydration I've been drinking green juices, smoothies and adding electrolytes to my water. The combination of these three ways of hydration seem to be working well

Making My Green Smoothie

Pump Suspended at 4pm to 

avoid going low

Enlite Vs Dexcom

Shortly after getting my insulin pump 2 years ago I started using Medtronic's continuous glucose monitor (CGM) Enlite. It didn't take long for me to absolutely love such wonderful technology. For those of you unheard of a CGM, it is a small wearable device inserted in the interstitial fluids giving me a blood sugar reading every 5 minutes. In addition, with the use of arrows, I was able to plan ahead by knowing which direction my blood sugars are heading. In short, I could see the behind the scenes of my blood sugar that my glucometer simply did not offer. About a week ago after using Enlite sensors for 2 years, I decided to make a switch to another brand of CGM's called Dexcom. Having both accessible to me I decided to test them both out by inserting an Enlite sensor on my left arm and the Dexcom sensor on my right arm and compare the pros and cons of each device.

Enlite Sensor

Dexcom Sensor

Accuracy 

When I first started on the enlite sensors two years ago...they weren't accurate a high percentage of the time. However, over the past year, I have been super impressed with how much it has improved. The Dexcom has always been known for its accuracy, so I decided to compare their accuracy and very interestingly they were both extremely accurate and very close.

But, just like all technology they both have their fair share of pros and cons which I believe should be considered when choosing your perfect CGM.

Here is a summary list below of the pros and cons of both sensors:

Enlite Pros:

• Low Glucose Suspend: 
• This is a feature that is perfect for people who struggle to fear their lows. This feature suspends your insulin pump once the enlite sensor reads the set blood sugar.
• Single Device: 
• The good thing about the enlite sensor is that it is connected to your insulin pump. That means that you do not need to carry another device around with you to view your blood sugars and since the pump is attached to you, you will never forget at home (I hope not anyways lol)
• Accuracy: 
• The enlite is fairly accurate after the warmup period
• Pre-Warning: 
• If blood sugars are getting close to the high or low set limit, the enlite gives you a high or low predicted. This means you can react ahead of time before reaching your set limit.
• Warmup phase: 
• If you decide to reuse the same señsor for longer than 6 days and restart sensor as new the warmup phase is only 15-20 mins long rather than the normal 2 hours

Enlite Cons:

• Sensor Adhesive: 
• The sensors adhesive is super irritative and becomes itchy and causes rashes 3 days from insertion.
• Calibration: 
• With enlite in order to ensure accurate readings you must calibrate your sensor 3-4 times a day when your bg is steady. Another point is if you do not calibrate after 12 hours you stop receiving any BG readings.
• Ripping: 
• Depending on where you insert the sensor makes it more or less venerable of getting ripped out. The transmitters design gives it the vulnerability of it getting ripped out.
• Insertion: 



Insertion Device

• The insertion for it can be painful. However, the worst thing about the process is the insertion device. It is big, scary and makes me cringe every time I had to use it. 
• Transmitter: 
• The enlite transmitter can remember BGLs for up to 15 mins when it is has lost connection with the pump and later fill in those 15 mins once it gains connection again.

Dexcom Pros:

• Sensor Adhesive: 
• The Dexcom adhesive causes no rashes or itchiness around the area
• Sensor Age: 
• The Dexcom can last much longer than the 7 days and still be accurate. Most people seem to get a solid 2 weeks out of them before inserting a new one
• Bluetooth: 
• Having the Dexcom link up to your phone makes it an easy and accessible way to stalk you BGLs. In addition, although this feature is currently not available in Canada, having Dexcom link to your apple watch allows you to know you BGLs by a quick glance at your watch.
• Followers: 
• This can have its benefits and setbacks but having others be able to have access to your BGLs can be beneficial especially at night time if you don't feel your lows. This is extremely beneficial to children as their parents can have access to their BGLs at all time even while they are at school or a sleepover.
• BGLs on Phone: 
• So this isn't really a big thing but I found having the change colours on the screen between yellow for highs, white for in range and red for lows really puts in perspective how blood sugars looked like for the day.
• Calibration:
• For Dexcom to be accurate I seem to only need 2 calibrations rather than the 3-4 like enlite. That means fewer finger pricks for me!

Dexcom Cons:

• Transmitter: 
• Compared to the enlite sensor where you just had to charge the transmitter and you're good to go...with Dexcom the transmitter dies out every three months and you have to purchase a new one. 
• The transmitter does not keep store of BGLs so when you lose connection you end up with gaps in your graph
• Connection with Phone: 
• With the G5 you need to purchase the receiver or else your only access to your blood sugars are through your phone and say your phone runs out of battery that means you no longer have access to you BGLs. 
• I'm not sure if it's a Dexcom problem or the Dexcom app on the iPhone but having the Dexcom for a bit over a week, the app has crashed maybe 5-6 times. It says you need to delete the app and re-download however if you restart your phone it seems to start work fine again.
• In order for anyone following your blood sugars to receive data...you need to have an android or iPhone with you and it must be connected to wifi or data. This point might be a bit of a let down for young kids.
• Accuracy:
• The first 24 hours of the Dexcom can be a bit inaccurate

Growing With T1D

I guess there is one thing we can all agree on...diabetes is not easy! it takes effort, planning and a whole lot of time to manage it. However, with ever age group diabetes presents you with a set of unique challenges and obstacles. 

Here are a few things to keep in mind when growing with type 1 diabetes: 

Driving
Driving gives you your freedom and gives you a sense of growing up. However, for people with diabetes, it is very important to learn about safe driving while managing your diabetes. Firstly know the rules and regulations for driving in your province or country. In Canada, it is a must to drive with a blood sugar level above 5mmol/l (94mg/dl). Ensure that your car is always stocked up with low supplies in case you have to pull over to treat a low. Depending on the temperature keeping a backup meter in the car can be handy. I'm sure we've all left our meters accidentally at home every now and then. Lastly, make sure to wear or have on you some form of medical identification and emergency contact number.

Moving Out/Dorm Life/University
Who's not excited to leave high school and move onto university? Whether or not you are moving out or staying at home, here are a few things to keep in mind before starting university. Make sure to set up exam accommodations to suit your needs and diabetes. Whether that is extra time, unlimited breaks or stopping the clock when needing to deal with bgls. Despite some classes being large in university it is still important to inform your professors about your diabetes in case you need assistance at some point during the lecture. Lastly, know what's around you and where to access the medications you need in case you forget spares or run out. Let me give you an example...about a week ago I was about to devour in a delicious bowl of quinoa salad when my pump gave me no delivery. I was stuck at university for another 5 hours and without insulin, I was sure to end up with ketones. Knowing where the pharmacy is located at my university I managed to go buy some syringes and extract the insulin from my pump and give an insulin injection to keep me going for the next 5 hours. Of course, its a great idea to keep spares on you but we all forget to refill our stock of spares so having a backup plan is a good idea.
If you are living in dorms, let your roommates know you're a diabetic and how they can help if need be. Make sure to stock up on low supplies and food to have on hand for when the cafe closes. Lastly set up a meal plan and ask if they have nutrition information such as the carb count for the foods they offer.

Transitioning
Depending on where you live this might or might not apply to you. At age 18 your pediatric diabetes team prepares you to transition to adult care. This can be a different experience for everyone however, a few things that you should keep in mind. Unlike at children's hospital, you are required to have your blood work done prior to your diabetes appointment. This can be done either at a blood work lab or at the hospital. Your endocrinologist is separated from your dietician and nurse. This means you will need to book two appointments...one every 3 months to meet your dietician and nurse and another appointment every 6-8 months to meet your endocrinologist. Another point to keep in mind is that it is very important to have a supportive and good communication between you and you diabetes team! That means you have the right to switch between endos/nurses/dieticians till you find the right ones for you. Lastly, because you're an adult and have to transition to adult care now doesn't mean you have to attend your appointments alone. Remember that you can always take a friend or family member with you to your appointments. 

Alcohol
Once again this might apply to some and just like driving, if you decide to have alcohol it is important that you are knowledgeable of the effects it might have on your blood sugar. It is very important to be aware that with alcohol in your system your liver is busy processing the alcohol that glucagon will not take effect if required due to a severe low. Make sure to have low treatment and medical identification when out at parties or with friends. Alcohol can cause unexpected changes in your blood sugar so ensure to check before heading to bed and possibly setting alarms to check through the night. After all...better safe than sorry!

Support
Just because you're older doesn't mean you've suddenly managed to get your diabetes under control. We all go through rough times with our diabetes at different stages of our lives AND THAT'S OKAY! It happens to us all...in fact, my first real burnout was early November. What is important when going through a rough time is knowing where to turn for help and assistance. Reaching out to other diabetics through social media is a very nice tool that can help out as they are the people who truly understand you since they have most likely been through it. Other resources are your diabetes team...remember they are always there to help out anytime you need them. At most diabetes clinics there is a social worker or a psychologist that you can book an appointment to see. Lastly, if you are in university visit student services and ask to connect with a social worker or psychologist...those services are there for you, so take advantage of them.  

Travelling
The last topic I wanted to mention is traveling. As you become more independent you will start to venture out on your own. When traveling it is very important to be organized. As you prepare for your trip search up pharmacies and supermarkets near your hotel in case you need to fill up on food or medical supplies. If you require a travel pump (spare pump) make sure to order that 2 weeks prior to you travel date. Carry all supplies with you in your carry-on bag in case you lose your luggage. Oh and don't forget to double up on supplies...more is better than less. Don't forget to change your medical devices ... pumps, sensors, and meters to your destination's time zone once you've landed. Lastly, carry or wear any form of medical identification.

Join our conversation on social media using the hashtag #growingwithT1D to share or learn about the journey of growing with T1D

Leadership Retreat

A little over a week ago I went on a winter leadership retreat that was organized by an organization called I Challange Diabetes (ICD). ICD's vision is to support, empower, and connect people living with Diabetes by providing challenging programs to test the limits of living with the disease, and high-quality services to help them grow and take accountability for their own health.

Personally, I love adventures and outdoor activities so I was more than excited to go to the retreat. However, and more importantly prior to going to the retreat I was facing some hard times in regards to dealing with my diabetes. So I decided to set a few goals to accomplish: first and most importantly, was gaining back my motivation and independence to care for myself and secondly, learn new skills to help empower and support other individuals living with type 1 diabetes.   

Building our tall tower from marshmallows and sticks

After such an experience, I really encourage any diabetics to find an organization or an event to meet up with others who live with diabetes that understand the challenges, struggles, and successes that come from dealing with diabetes. If you're in Canada check out ICD. It was such a great feeling to be surrounded by 25 other people who just like me deal with diabetes day in and day out. It was inspiring to hear their successes, anywhere from competing in the Olympics to finally giving insulin in a new area of their body. It was eye opening to hear about their struggles and how they persevered and pushed through it. It is such a unique feeling to speak to someone who tells you "I've been through it and I understand you". When we went hiking there were close to 8 people that went low at the same time ... it is such a great feeling to feel like "I'm not the only one". Having to test blood sugars before eating was another unique experience that doesn't occur often at home. Everyone testing at the same time and calling out their blood sugar readings. Often people feel judged about their diabetes and at the retreat, there was no judgment at all. There was support and motivation to help others. 

Snow Tubing

While the few days spent was full of adventures like snow tubing, surfing the freezing Canadian winter, experiencing my first-meter error because the weather was too cold. I learnt from others around me how to keep my meter warm to avoid a reoccurrence of that problem and managed to test using a friends meter. In general making new friendships and bonding with people my age, I learned several valuable lessons to better improve my leadership skills. I learned different methods of leadership skills and when each skill is needed depending on the situation.For example, sometimes stepping in to give support where I am strong might disrupt someone's healthy learning process and other times guiding someone through a challenge that would otherwise overwhelm them could give them the critical help they need to succeed. 

Overall if there is one thing I want you to get out of this blog post is find your people ... your tribe! It will be an experience remembered for many years to come!! 

A New Me ... A Better Me

4 units of insulin for breakfast

A bit over a week ago I decided to change my lifestyle and start eating a plant based high-carb low-fat diet (HCLF) The reason you may ask? Well about a month ago things really went downhill with my diabetes care. I sort of gave up and just let my blood sugars run super high several hours at a time. A month of highs completely ruined my fitness level and had me feeling awful pretty much all day with very little energy. However, just like all strong people do after falling down is get back on their feet and push through and that is when I decided to change things around.

First times trying lentil soup
with beans inside

It was really important for me to start taking control of my diabetes so I can have control over my future and more importantly start building up my fitness level again. I have seen a friend and several people on Instagram following a HCLF diet with great success. It always had me inspired but as a picky eater I was scared to try it out...but after a rough month of blood sugars that is exactly what I needed to get me back on track.

320 grams of carbs for the day!

Before committing I started out by tasting quite a lot of foods...really pushing myself out of my comfort zone. I tried a variety of foods for the first time like pineapple, corn, lentils, blueberries, kiwis...and the list goes on. After building a colourful pallet I was really ready to give things a try. Cutting out dairy, eggs, cheese and meats were not a problem at all. I was committed and motivated to get back on track and start seeing numbers in a better target range. 


A week later and I am so excited to keep going after seeing results. My blood sugars are in target range 85% of the time. My blood sugar has rarely gone above 15 mmol/l (282 mg/dl). My insulin requirements have been cut in half ... after taking about 80u a day I now require anywhere between 40-50u a day! Instead of needing 1u of insulin for every 5 grams I now need 1u for every 12 grams. The last time I remember having a ratio like that was in the honeymoon stage (a period of time after diagnosis where the pancreas still produces small amounts of insulin). Most importantly I am eating a ton of carbohydrates (250-350 grams a day, ones that I know are healing my body and making me stronger. I no longer feel guilty for exceeding 100 grams of carbs a day. 

Eating the rainbow for breakfast!