The Midnight Purge

It’s about 3am when I suddenly awake. Something just doesn’t feel right, I lay there in bed for a few minutes feeling so drowsy and exhausted but my body refuses to fall asleep again. It that hits me that the exhaustion and drowsiness isn’t sleep deprivation, it’s symptoms of a low blood sugar! I get some energy to turn over to my night stand and check the dexcom app ... 3.6 mmol it says.

I lay in bed a little while longer knowing exactly what I have to do but feeling so helpless and out of energy to actually do it. I lay there hoping maybe just maybe my alpha cells will kick in and boost my sugars up and I can get back to sleep. 20 mins have gone by now and my phone beep again ... low blood sugar alert ... I peak at my phone ... 3.3 mmol. I give myself a little pep talk that I need some sugar now as I reach my arm to my treatment drawer and pull out 2 rockets. I quickly scarf them down finally giving my body exactly what it needed.

As I scarfed down the rockets I thought how impressive it was that I felt my low so early ... at 3.6 mmol (which really isn’t a normal for me). While I laid there waiting for the sugar to kick in so I can start feeling better something just didn’t feel right. My symptoms just did not quite match what my dexcom said. I felt weaker and weaker as every minute passed by. I reached out and grabbed my meter to test... 1.8 mmol it says. 1.8??? My body freaks out at that point .... I NEED SUGAR!

I try and convince myself that i’m okay and the rockets will kick in any second but my body isn’t quite convinced. I slowly get out of bed and zombie walk to the kitchen. I WANT FOOD.... not sure what exactly I want. Some peanut butter, chips, almonds, bread, cheese .... anything in sight, knowing well I will regret everything by the morning. But my body is in SOS mode! I gather them all and sit on the kitchen floor putting some peanut butter on the bread, topping it with the almonds, chips and cheese. Delicious right? 🤢🤮

Looping

So its been a while since i've started looping...figured its time for a new blog. Over the past week i've been getting quite a bit of questions about looping so I figured i'd do two different blog posts. 

Looping in short is a DIY closed loop system.
So what looping does is it connects my medtronic pump and my CGM to a mobile app called loop. In that app the pump and CGM are able to communicate and adjust basal rates by decreasing or lowering them depending on the algorithms BG predictions attempting to keep you in range more often.

Setting up the loop wasn't too bad, you definitely don't need to be a tech genius. The coding is all done for you and you can access it all on the loop docs, a great document, very easily designed with instructions and pictures of a step by step set up and all the trouble shootings possible.
To set up loop you need a Riley link an old Medtronic paradigm pump, a CGM (either a dexcom or a libre with a transmitter...I totally recommend the miaomiao).

Once you have the app all set up it should look something like this.



As you can see at the top tool bar there are 5 icons. The first is the green circle which means you are currently closed looping. If an error occurs the green circle will become red. Also, if the circle is a semi circle that means you are open looping which I will discuss later on.

Next you can see you blood sugar reading. This information is derived from the spike app. Which reads my miaomiao transmitter every 5 minutes.

The third icon shows the current basal changes happening at this current time. As shown in the picture my predicted blood sugar is 6.2 therefore loop has chosen to keep the basal set on my pump. Any basal changes done with your current pump basals as a starting point therefore, its vital in my opinion to have an accurate basal set before you start looping...maybe some basal testing too!

Lastly the 3rd and 4th icon is your pump reservoir and battery. Which is super cool because I get an alert to both my phone and apple watch when either of them go low!

The bottom tool bar has another 5 icons which are pretty handy! The first green one on the left is where I bolus for meals from. Simply inputting my carbs and loop calculates the amount of insulin needed based on your I:C ratio and once i confirm my pump starts bolusing. Pretty cool because I don't even need to touch my pump...just straight off my phone. And my apple watch too!

The following green on and the blur heart are pre set targets. The green on is for pre meals...if I want to be at 4.5 before a meal I will press that icon about an hour or two before my meal so loop can target my blood sugars to my desired setting. The blue heart is a similar idea but for exercise.

The orange double triangles in between them is a bolus option that doesn't include carbohydrates. So if I am correcting or over riding my pump by giving additional insulin.















So how does loop help exactly? the picture above you can see under insulin delivery...each block is a basal increase or decrease that loop adjusted my pump too throughout the day as it aims to keep me in my set target range. Loop adjusts basals in U/H (units per hour) rather than percentages

The picture on the left at the top tool bar you can see that there was a current basal decrease of -0.0625u per hour to prevent me from dipping too low. Loop adjusts if needed as it gets a new blood sugar reading every 5 minutes from my transmitter.


While being closed loop is awesome, a few situations seem to work better when i'm not looping.


When the circle is no longer fully closed that means you are in open looping mode. As you can see that while on open loop the app won't change your pump basal setting however, it will still show you its recommendation 

I go to open loop when I override my pump which probably happens more times than i'd like to admit. The reason for this is because loop starts calculating I will be very low so it starts suspending my basal which defeats the purpose to my rage bolus.

Another reason, however I haven't experienced it often is when loop causes my blood sugars to become a yo-yo, going high than low than high than low...you get the point. Not Fun! This happens because the pump suspension causes the spike than a correction causes you to crash back down which makes loop suspend basal again and so on.
Going off closed loop allows you to break the cycle so you can fall into range and than go back to closed loop.

I've been looping for about a month and I think its been great! so here is my take on it with some pictures to back me up.

Definitely been in much better range over all with great over all stats! Now loop might've worked against me over the fact that i get even more anxious than before when I go high...just because since I started looping how high I go has decreased quite a bit. It also definitely reduced the amount of lows I have, although if I stop myself from overriding it would be better for sure

A Week Of Looping Stats

A Day Of Looping
Targets: 4-7.5

That Time I was Vulnerable

Writing things out is one of the ways I deal with any bitterness, emotions, and anger towards my diabetes. I've always had a journal I write in about it all...and every now and then I'd blog about it, it sure does help me. And I always have hope it helps another diabetic out there or helps me connect with others.

Last week Saturday, of what seemed like a normal morning, where the sun was shining and the wind was blowing, a beautiful breeze it was. I was contemplating if I should go out running or go to the YMCA.

It was the first time in a few days in which I had no lows all night, the previous days I would have up to three lows a day and it sure was EXHAUSTING! Anyways, I woke up at a beautiful blood sugar of around 6. Perfect for a workout! I usually avoid breakfast till after my workout so I don't have any insulin on board...nothing new!

I went to a step cardio workout at the gym, the room was HUMID! Like really humid! I felt my blood sugar crash (and that rarely happens). I felt dizzy and nauseous, I scanned my libre and it was 3.8! No biggie had some skittles and decided to push through the workout but that didn't go as planned. I felt my blood sugar drop more and more, I was out of skittles so I had 2 dates...tested again and it was 3.7.

I decided to leave the room, firstly it was cooler outside, much cooler and secondly, I hate having to sit aside and wait for my blood sugar to rise so I might as well leave. I went and sat on the floor near the couch. For some reason when I'm low I like sitting on the floor, not too sure why? Anyone else?

I sat with my head into my knees trying to keep my composure because I was getting mad at myself for going low. Trying to understand why I all of a sudden felt my low. I tested again and I was at 3.7, why isn't it rising? Am I crashing fast and just don't know it? 
My friend finished the workout and came around to make sure I was alright and keep me company, It was maybe 15mins later and my blood sugar was still at 3.7, but for some reason, I felt like I was 1.3.

I felt light-headed, very low in energy, I was sweaty but also shivering. I could barely form words to say and when I did I had very little energy to say it. I was getting drowsy and wanting to fall asleep but I knew I shouldn't so I kept my mind focused on the rhythm of the sound of a basketball bouncing in the court below me, eventually, that sound was too loud for me. In fact, the sound of a normal voice felt like yelling! Tested again and I was STILL 3.7! No freaking way, blood test and I was 3.8. My libre died out, perfect timings, right?

My friend grabbed another juice box from the first aid kit in hopes it will help! I was so mad at myself, I was furious, I wanted to help myself, I was feeling crap, my body felt so weak but I kept telling myself just hold yourself till you get home, just get to the car, just get to the car. But I had no energy to get up...and when I did I felt dizzy and sat back down. I broke into tears (and trust me I'll only cry in front of people if I trust them or I'm at a breaking point). Just imagine a 19-year-old crying in public? That never looks good. So for me to break down into tears just said how bad I felt...maybe its because it was my first time in a long time to feel low so I've forgotten how bad it felt? But I felt so weak and vulnerable. I just wanted diabetes to be gone and for me to feel better quickly. Maybe a hug too? Hugs are MAGICAL! 

They eventually called my mum and she came by to pick me up. And while my bg finally came up an hour later, my body took half of the remaining of the day to recover and feel better. But through my awful feeling of me being low, despite not a very low blood sugar ... I saw the love of a community and the love of people. From my friend to those working at the gym, to my mum. Each are special to me. While I hated feeling weak and not being able to brush it off and keep going like I often try to do, I did appreciate every part of their help offered.

BluCon Review

I'm a total fan of searching, trying and knowing every possible thing about diabetes and all the technology that's out there!

About a month ago, I came across the blucon. Blucon is a small device that works with the libre to transmit to your phone. Ultimately, I was super interested in the device to get alerts for night time lows and why the heck not try it out...seems like something cool.

The blucon is a small circular device that fits on top of the libre sensor. It is slightly bulky upwards. It's the size of 3 libre sensors on top of each other.

The device costs $110 Dollars. However, it's a onetime purchase, unlike the Dexcom transmitter. The blucon lasts much longer as the battery in it is interchangeable. A little downfall is that the device is not waterproof. (so don't be forgetful like me and jump in the shower with it)

There are a few ways in which people attach the blucon on top of the libre, my favourite is using velcro dots. Other options are tegaderm on top of them to keep them in place or a blucon armband.

The following apps that I will mention, in which the blucon transmits reading too are all still "apps in progress". None are perfect but, I definitely prefer some over others.

Let's start off with the actual blucon app LinkBluCon. The application is definitely still a work in progress. I personally wasn't a fan of it due to connectivity issues, however, many have said it works well for them. While the libre and the blucon read differently due to different algorithms the app reads super accurate. The blucon has both a share app and links up to the apple watch. While the blucon is accurate without the need of calibrations both the main and share app are super basic. The alarms are loud, so you're sure to hear them, however, super annoying and repeat every 5 minutes with every update until you're back into range. The app does not have a solid graph, the graph creates itself using your highest and lowest blood-sugars during the selected hours of graph preview. Personally, I wasn't the greatest fan of that. I would rather have a graph showing my range targets. With the blucon app, I am a fan with how it is displayed on the Apple watch. It has the target zones you set and is even colour coded. The blucon app seems to convert the blood sugars from mg/dl and display them in mmol/l and hence it shows blood sugars in 2 decimal places.

The second application I tried is spike, I would    say this app seems to suit my needs better and has a much better set up. While once again its a work in progress and infect in order to download it, you need to download it through test flight as it isn't available in the App Store yet. 

The application, similar to the blucon doesn't have a set graph, it creates it as your numbers fluctuate. Something I really like about the app is the ability to colour code the graph depending on blood sugar ranges. ex.  I colour coded anything below 4.5 is in red, anything above 7.5 in yellow and anything above 10 to be in orange. That way at a glance I have an idea of how my blood sugars are doing, big picture. Also, at the bottom, there is a pie chart which is a neat way to present the data. You are able to customize your alarms and determine the snooze timing of it. Another thing I like about the app is that it shows you the difference in your blood sugars to 2 decimal places. This gives me a good idea of how fast or steady I am climbing or dropping. Having an idea using numbers helps me think ahead and avoid overriding a pump I can see I am not drastically climbing. This app needs a calibration every 12 hours and 2 calibrations once a sensor is started, similar to Dexcom. For the people in the US who need to change their libre out every 10 days, the blucon will continue reading numbers up to 14 days using the app. So while you can not use your libre meter the past 10 days the blucon will work the full 2 weeks.

Unlike linkblucon, at this current moment spike does not have a share app.

Other apps that people use that I have not tried are night scout, night guard, and xdrip. Some are better features on the android phones than iPhones due to security reason on the iPhone. However, as the apps keep developing they will function better and better with fewer bugs. And eventually be available in the app store

Ketones?

Earlier in the morning, my pod fell off in my sleep without me realizing and I ended up waking with moderate-large ketones. According to google ... "Glucose is the body's main energy source. But when the body can't use glucose for energy, it uses fat instead. When fats are broken down for energy, chemicals called ketones appear in the blood and urine." The amount of ketones I woke up with was the most I've had to deal with. As I tried to stay calm and stay awake I decided to write out how I was feeling. 


You wake up at 5 am, body completely aching, mouth tasting gross and completely dry, and the sudden urge to pee. While you contemplate if you can hold it in until the morning or not, you can feel your heartbeat in your head. Your head feels heavy and about to explode as every heartbeat echoes. BOOMBOOM BOOMBOOM BOOMBOOM. The symptoms finally click in as you reach for your meter, very slowly as you feel your muscles ache. Muscles that you never even knew existed. As you reach for your meter you feel a lump under you, which you later discover was your insulin pump. But for now...you focus on your mission. Get a hold of that meter. And finally, with every achy muscle, your fingertips get a hold of that meter and you check your blood sugar. 27.3! THATS NOT GOOD...you tell yourself. You throw out a few curse words towards the pod and diabetes as you force yourself to get up and head to the washroom. Afterall if you aren't on that toilet in 3 secs...you're gonna pee your pants. Test ketones! Moderate-high! AHH, CRAP...thats the darkest colour you've had to experience. For the first time, you can smell the "sweet" pee everyone has mentioned (TMI?...oops sorry) Your head is still pounding but you try to clear out the fog inside and focus on getting these blood sugars to come down because after all the last place you want to end up is at the ER.

As you sway side to side, slowly twaddling back to bed, leaning on everything to support you because you feel like you're about to pass out...you finally make is back into bed. Slowly change out the pod, praying and hoping that this pod behaves and stays on. Firstly because you hate and avoid site changes and don't want to do anymore. And also because you don't want to end up with more ketones and high blood sugars! 

Ketones

You turn up some Ed Sheeran, curl up into a ball, inject some insulin through a syringe...hoping it works fast! Meet your new best friend, water. And your other best friend, the washroom (in which you've probably thought so many times so far "why can't I have a surgically attached toilet so I wouldn't have to leave my bed every 3 secs) 
You chug on water, go pee it out, curl back into a ball, snooze off for a bit, test blood sugars, test ketones. You're full of emotions, tears, frustrations. You feel weak, with every muscle ache. You don't like being out of control of your body. It's only 5 am...but you're all ready for this day to end. You planned on going to the gym with friends...but hey, diabetes had other plans and you can barely move. So you cancel your plans as you dedicate this day to spending it in bed.


All you need right now is LOTS OF INSULIN, water, and the washroom.

Omnipod thoughts

Happy New Year! Its been a while since I've done a blog post...so here's to hoping I'm productive enough and write more blog posts this year!

I'm a Medtronic pumper, however, over the past two months I've been using Omnipod for a clinical trial I'm participating in.  Through my experience of using the Omnipod I've noticed some disadvantages and advantages about it....so thought I'd share it.


The Omnipod consist of a PDM (personal diabetes management) and a pod.

The PDM is both a blood-sugar meter and your "remote control". All communication to the pod is done through the PDM....boluses, temp basal, carb ratios, ...pretty much everything.

The pod is basically the pump. Unlike Medtronic, the Omnipod is tubeless, which is something I've personally love about it. The pod holds up to 200 units, with a minimum requirement of 80 units. In my personal opinion....it is slightly bulky but is a relatively small size and you can easily be discrete if you want to hide the pod

The biggest disadvantage I'd say about the Omnipod is the PDM. I'm not the biggest fan it. It's large, bulky and pretty old school. The buttons are annoying to press and make a squeaky sound. If I want to just carry the meter on me without my diabetes bag (which I do often) it barely fit in my jeans pocket and make the pocket so bulky. However, Insulet is working on a new touchscreen PDM...which I think will look super cool once its out.

Comparing it to the Medtronic pump, I like that you can bolus from the pump...which stays on my 24/7. Unlike with Omnipod, you can't bolus from the pod. This may not be a disadvantage for many...but for a forgetful person like myself who always leaves her PDM in the car, at work, or at home it might be a slight disadvantage. While the pod still administers basal insulin if the PDM isn't nearby, you can not bolus or put a temp basal without the PDM.

Changing out the pod has to be every 72 hours (+ 8-hour window) ... now, this is definitely a good thing for insulin sensitivity and skin integrity. With the Medtronic pump, the pump continues working after the 72 hours (3 days), therefore many change their site every 4 days rather than 3. However, with Omnipod...the pod alarms at 72 hours and gives you another 8 hours before the pod expires and stops working. 

Now while this hasn't been an issue for me, many of my fellow ponders have complained of having issues with their pod due to static. During the winter weather, the static electricity results in pod failures. This often happens when wearing wooly fabrics over cotton. Hearing about pod failures taught me it is really important to carry a syringe or a spare pod with you at all times because if a pod fails (which doesn't happen often) ... then you can extract the insulin in the pod using a syringe or change out your pod. 

Inserting the pod is super straightforward and easy. The pod self-primes. Requires no inserting of needles or pokes. All is done automatically by the pod. My only comment in this area is, while the pod inserts the cannula it makes a "loud-ish" sound. 

While the pod is recommended on certain areas of the body...compared to Medtronic, you can be very creative in which areas you apply the pod. While the back of my arm is my favourite, I've used my calf, love handles, upper and lower back upper ribcage and abdomen. Be creative! To add on, being able to rotate my pod to so many areas has kept me insulin sensitive and avoided a buildup of scar tissue. This results in better blood sugars!

Comparing the Omnipod to Medtronic, I love the tubeless feature. It has brought so much ease not having to worry about any tubes.  The Omnipod is also waterproof....and while the new 640G Medtronic is also waterproof, I'm not too sure if I would want to swim or shower with a tubed pump, but, with the Omnipod its no hassle at all! 

Lastly, and probably the top reason I like the pod is I get to design it and make it look fancy. I always say, if I have to wear it, it better look good! Overall, I'm a total fan of the pod and enjoy the features it provides! I would totally stick to the Omnipod. 

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