Howdy folks

As some may know, I have tried to wrangle with my Endocrinologist here in Torrevieja, about moving over to #TeamPump.  If you didn’t, you do now.

I have an appointment with the Pump Clinic in Alicante this coming Thursday, where after a few years I finally have the chance to come face to face with someone that may be in a position to decide whether I get to pump or not!

I only found out about the appointment this morning leaving me with a day or so to perhaps try prepare for the visit.  I must admit that I feel extremely nervous and possibly overwhelmed by it all as I have pushed and kept pushing to get an appointment.

I’ve tried to play down the pump thing since the consultant agreed to get me the referral and to be honest I had expected to be waiting a while so to receive it so soon is great new.

But!  Ah, ha there is always a but!

Some questions I have thrown at myself lately include;  Am I suitable for a pump?  Will my lifestyle meet their criteria?  Do I have the right mindset?  Am I responsible and/or knowledgeable  enough to take my diabetes care to the next level?

I’m not sure what questions the clinic will ask precisely but would be shocked if they did not touch on subjects from above.

Habits?

Other things that I have thought about include;  How I bring my partner in to this?  Is she ready to support me.  It may sound silly, but I’ve never really had any kind of support network in place, partly due to age of diagnosis as I was 20, single and away from home. Partly due to perhaps my lack of openness upon being diagnosed, sure I talked about it with friends, family and colleagues but never did I have at any stage anyone that I felt I could talk too.

Fortunately things are better now, I now personally know other people who happen to have diabetes, heck I even know some of these droid/pumper people!!

For some reason I happen to have placed an enormous amount of pressure on me to do well on Thursday, like I am representing myself at court.  Everyone there to judge you, your lifestyle, your habits (well the bad one’s eh) and possibly your competence.

I’m also aware of the pressure placed upon our clinicians to offer a certain level/quality of care whilst ensuring that budgets are not demolished.  As with many other countries, Spanish healthcare reforms play a massive part of the so called “austerity measures” that have been ratified and as such I see that as the major hurdle I now face.

Alicante

I have a ton of questions that I would like to ask and hopefully I will have a real reason to ask them soon.  One question that I would like to ask those of you who have successfully made the transition from MDI to Pump is about how you approached the topic with wife’s, partner’s, mistresses, close family and friends?

Really though, I’m looking for any advice that you feel may be helpful?

Oh, one last thing!  I am asking everyone to send some “Pump Approval” Vibes to this Hospital!  Maybe we can get them to feel some DOC love!

Until next time

Saludos

Mike

Hi Folks

Firstly warmest greetings from DiS to 2012 to you all! Various reasons for lack of action on the DiS site. Rather personal so will cut to the boring stuff and hopefully bring you all up to speed.

For most 2011 was pretty crappy, although there were some bright and notable exceptions.  The year ended with an enormous amount of pressure not only economically but also physically with one’s own health.

Spain as we know it is in complete tatters and unfortunately it will only proceed to actually get worse in 2012.  The year ended with a Endo appt. in Mid December.  The a1c came back at 8% and although disappointed there were little surprises.

Again I mentioned a pump and spoke enthusiastically about such a device being of benefit to me and my health he agreed to hand me over to the pump team in Alicante to see if they are willing to let me go on a pump.  I do not hold much hope to get one as the current government need to trim 16 Billion Euros off the national budget so the pressure is on Medical teams to think about finance first and health second!  Quality of care will slide for sure.

As with many other countries they have guidelines to meet, to be selected for a pump.  This includes the A1c, lifestyle issues etc..  At times it seems that it can only serve to encourage people to let their health go wayward to get a pump.

Anyway as yet I have heard nothing, so your guess is as good as mine when I will get an opportunity to present my case to the Pump team.   So stay tuned!

Other than that this is a quick breakdown on my life – The key stressors:

• An Embargo has been slapped on us from the State, which now prevents us from paying our Mortgage each month.  I’m sure you can figure out what happens next??
• Employment opportunities are “non-existent” in Spain and now need to consider alternative locations and occupations.
• My other, and most would say better half had her work hours cut with a 25% reduction in salary! Oh, this discussed just 3 days before Christmas!  Thank you!
• I’m still consulting a Neurologist, following up on the Nerve pain in the left arm/hand.
• A surprising referral to the Respiratory Specialists to check for Sleep Apnea of all things.  This came as a shock suggestion at first but after discussing the relation between red blood cells, oxygen levels and nerve sensation/pain it became clear that this could progress soon.  It also gives me cause for concern regards to the crappy nights sleep I have had for years.
• Grandmother at the age of 83 was given the news that she has Breast Cancer.  At this stage we do not have the specifics but a malignant tumour has been confirmed by the Pathological lab. Bugger!

So that it’s from me at the moment, hopefully the above gets me of the hook with everyone.  I’ve done my utmost to stay focused and stay positive but there is very little left in this tank at the moment.  For those that I have been in contact with recently, thank you for your support!

Until next time, stay safe and bolus like crazy!!  :)

Un brazo

Mike

Hey Guy’s n Gal’s

So whilst trying to motivate ones self to write more on this site, it finally occurred to me that I may have open up more.

While it is relatively straightforward to write about diabetes, it not as simple when writing about yourself, for various reasons such as not wanting the bore the living daylights out of people and wishing to keep hold of those inner secrets forever and ever.

Over the last few weeks, there has been plenty of activity on the Diabetes scene with the recent congresses over in the USA, the EASD which was held in Lisbon just a couple of weeks ago.  We have a couple of new products in the pipeline that have now been introduced to all the Diabetic Minions which is the “Daily Dose” from Insulution and Timesulin‘s “Smart Cap”.

For me things are going along, health is a challenge and for once it has nothing to do with Diabetes.  For a little under a year I’ve been various with pain/discomfort/numbness in my left arm, tingling sensation in both my cheeks.  In turn I have also developed a small arrhythmia (at mo, it is an extra heartbeat) which after investigation been noted as non-harmful and that I should make sure it is followed up every year.

So this does not look brilliant on paper and it certainly adds to the stress levels , none more so than when you are “unemployed” and about to face imminent financial disaster.    Not an ideal situation to be in at all and one that I’m desperate to climb out of.

A complication is that I have had surgery on the problematic arm so getting to the cause is somewhat challenging.  So why I am telling you this, well it is easy to forget about the rest of your body.

We all impart so much time and effort trying to be a “Super-pancreas” (Can I trademark that Tim?) that we sometimes neglect our bodies.  Not every pain is diabetic neuropathy, not cut foot is an amputation, not every kidney infection is a fast track to dialysis.

So for no, I am no longer taking any pain medication.  I’m going au-natural for the time being with the support of the Neurologist.  Tests are to be performed to see what is blocked, clogged, broken, trapped or not quite working in the arm/neck and will be revised when that is completed.  More electric shocks, oh joy!

As for the Diabetes, I am still MDI(ing) along with an A1c hovering around 7.6/7.9% over the last year, I am currently irritating my consultant via email to see if we can sort out a referral to the Pump Clinic before we meet up in December and to see if he can grab me a BGstar from our friends at Sanofi.  Here in Spain it is illegal for Pharma to dish out freebies to patients so everything has to go through the clinics.

In the mean time I am trying very hard to stay cool, focus on keeping all the body parts greased, whilst playing “Super-Pancreas”!

So everyone please look after yourselves!

Until next time, Saludos

Mike

Hey folks

It is that time again to hit the blog trail again!  Sadly lacking over the last couple of months, so please do except my apologies.  The 2 lads in the picture have something to do with that!

Personally for me, things are real tough with no sign of relenting.  I find that when times are hard, one’s own health does suffer not only physically but psychologically.  No more than now!

Just the other week I had a Endo appt. which to be honest was disappointing as it felt as though I had wasted both mine and the doctors time.  Hindsight would suggest that the appt. could have taken place via email for example.

It did return a A1c of 7.7%!  Not so bad you say; and I guess it could be worse but we are swinging wildly from the glucose branches at the moment which results in a massive deviation everyday.

I have discussed a pump with my doctor but still face a battle to get him to give me the nod and put me forward for one.  Frustrating to say the least but all I can do is manage accordingly, keep pushing, keep learning, keep advocating and keep trying to look after myself.  ”easier said than done, though”.

In readiness, and to demonstrate my readiness I have even picked up a copy of “Pumping Insulin”, started to read last night and will hopefully help me decide if I am ready to use a pump first off and if ready to be able to hit the ground running.  We shall see!

That said is a little update on me.  If you are facebook please head on over and like my Diabetes in Spain Facebook Page, would appreciate the like love.

Until then salud@s

Mike

Hi there

Today is a special day, most likely for the wrong reasons though.

I have now completed my 13th year with Diabetes which normally makes me reminisce over the years the gone by..  From the fateful day in 1998 to just last night.

For I did something for the very first time last night, which was to accidentally inject my NovoRapid at bedtime instead of Lantus.  I can not recall why or how but I simply reached over for the Novorapid injected thankfully a small amount but enough to do some serious damage had I not realised what had happened!

After the “oh shit” moment, I had to make sure I remained calm and think through the process that will protect me during the night.  It was late, I was tired and this was the last thing I needed to be messing about with.

I’ve not been eating well now for months and the thought of having stuff my face now to cover the insulin was making me feel sick.  Didn’t feel too much better after either.

So after a consuming a vast amount of carbs, I noted what I had, the carb value and time.  I knew I had to wait it out and so I gave myself a minimum of 2 hours before even contemplating bed.

Now midnight, I’m tired and the vast and rapid consumption of culinary delights such as donuts, crisps and pepsi were making its effects known throughout the body.

I was now sufficiently high to contemplate bed, assuring myself that the risk of a nighttime hypo was now at its lowest level.  Although to be cautious I did alarms for 3am, 6am and 8am to check.

Remarkably I woke up at 169 (9.3) which all things considered were a great result.  We will continue to see if there are any knock on effects throughout today mind!

On a side note today is also St George’s Day, and whilst it is mainly associated with England the day is also celebrated throughout Europe and indeed in Spain, specifically the Barcelona area where it takes on a more Valentines Day like celebration.  The 23rd April is also remembered as the day that 2 of the most decorated poets had simultaneous deaths in Miguel Cervantes and William Shakespeare back in 1616.

What ever you do, hope you all have a super Easter!

So the other week I was thinking about the relevance of the a1c, how it is applied in a clinical setting and how we as people with diabetes are often judged by our clinicians and also our peers.

insulin pump

As technology gets more sophisticated such as pumps, cgms’s, software will have access to more data than we have ever had.

Traditionally the a1c is the benchmark that we refer too, we talk about it, we feel guilty about it when it is a higher number than we hoped for and feel pure elation when we get a magic number.

Now I don’t need to explain to many that our control can at times resemble something similar to a Manhattan whilst occasionally it will resemble something smoother, more controlled and it is the latter that we all strive for.

So what the heck are you going on about Mike? Well let’s put this simply. Using the a1c sucks as a measurement. It is next to useless as an informative evaluation tool. Why Mike?

Let’s take person A and person B. Both have a a1c of 7% and they both test their blood at least 4 times a day whilst following similar treatment plans.

So person A has many highs and many lows, so when combined and averaged out equals 7%. It may make person A tired more often, possibly with more complications, whilst possessing lack of confidence maintaining control, not generally not feeling quite as healthy as they would like to be.

Data

Person B on the other hand, tends not to swing so low and keeps the highs at bay which again equates to 7%. The day-to-day deviation is less, which means a graph would resemble more like a subtle wave.

So with that my theory is that the A1c is fundamentally flawed. Everyone who has the same percentage will likely have very different control patterns if we were able to map it out.

So how do we go about measuring our control? Unfortunately I do not have that answer of the top of my head yet? Do we look to advance the A1c test? The technology behind it?

Or do we look for another test? Blood test with different markers? I don’t know if this is even possible. Did I mention that I do not have a degree in biomedical science.

How would you like to have diabetes measured? Perhaps more reliance on cgms’s? If that were an option.

It occurred to me the other day that diabetes is such a numbers based condition requiring skills such as advanced math, a degree in statistics and a masters in advanced analytics.

We are surrounded by numerical data 24 hours a day, 7 days a week.

When we test we have our blood sugar readings, with the majority of meters able to give a mean average over the last 7 days, 14 days and 30 days. The majority will then log these numbers either manually via actual paper or digitally. Some will utilise technology within meters or cgms’s to directly log the data.

Next up is injections, bolus or basal, usually adjusted/amended based on the previous data received, and involving delights such as carb counting, carb to insulin ratios.

Pumpers do have the luxury of even more data, with basal rates, temporary boluses and some having the option to view Insulin on Board.

We then, all reconvene with trips to the doctors, with blood tests notably our A1c’s together with cholesterol and other various tests to make sure we are all fighting fit.

I guess a times the data we have to deal with can be overwhelming, some people are more naturally geared up to deal with this than others. Some people have the benefit of using there professional skills to help deal with this information overload and some unfortunately do not.

I wonder if we could agree to another standard format to make the decision making easier, the ratios easier to deliver, the results clearer and easier to understand and/or simply allowing for a reduced level of data which in turn provides us better information.

Hey everyone, a happy yet belated New Year to you.

It’s been really quiet the last few months regards to this blog and as we all know there are periods where we find that life moves along at such a rate that we fail to focus on what is important.

So what happens when diabetes does not occupy top spot? When life’s priorities dictate that you need to earn money to support your family. When life dictates that Other people require your immediate attention and care.

Combine that with a complete burnout with the diabetes, actually think inferno would be more appropriate and we get to stage when every hour whether awake or not is a challenge.

My problem is that I eat poorly and perhaps allow myself to feed myself crap when 1) I know better and 2) I know that it would potentially help me not only little bit healthier bit help me Take care of my diabetes.

I guess I’m at the stage where I need to maybe micro manage myself, starting small and working my way up to where I should be. My a1c was 7.6% just a month ago and some may say, well that is ok? To a degree you may be right but in reality that number is just the cut within the massive, aggressive and wild blood sugar swings.

The effects of stress on any person is under estimated and when conjoined with a chronic condition can only inflame matters.

I would be delighted to hear your thoughts on stress, the d-burnout? How has it effected you? What steps did you take to deal with it?

On of the things that I need to be doing more is talking about it more often, my challenge is how?

Until next time be safe and bolus like crazy! (only kidding)

Well the day arrived. Having made the journey from Alicante in south eastern Spain to Geneva via Madrid in time for lunch I was fortunate enough to meet up with both Tim from everyone’s favourite British Diabetes blog and Yoan from everyone’s favourite Health Communication Specialist from Medtronic.

Tim in Lake Geneva

After negotiating the dizzy heights of the train from Geneva to Lausanne we were introduced to our digs for the stay, which was even more welcome after having to climb the mini glacier to get there!

We were frog marched, sorry patiently guided through out the beautiful city of Lausanne and was treated to mini tour via many delights such as the Olympic Museum, the Marina which sits on Lake Geneva.  Thank you Yoan!

Tim & Yoan - IOC Museum

After many hours gallivanting around, being massively entertained by Tim we retired in order to pretty ourselves in order to meet up with the rest of the working party over dinner.

A fun filled evening over drinks and dinner was a great opportunity to sit down and talk openly about diabetes, about what they hoped to gain from the meeting and so forth.

A great time was had by all and Yoan finally was able to retire after making sure Tim and I did not create any trouble or bring Medtronic in disrepute!

Saturday arrived, followed by mountainous volumes of breakfast eaten by all the invited attendees, followed by a mini bus ride that made F1 drivers look pretty poor, and he would certainly not look out of place driving a taxi here in Spain!

We arrived at a rather bland industrial area were shepherded into a vault, subjected to a strip search and forced to sign away our rights in the form of Non Disclosure Agreements.

Medtronic HQ, Switzerland

The meeting began with a short introduction by all in attendance, whilst providing a summary of the days proceedings. The main focus of the day was really for Medtronic to discuss what people think about their company and what can they do about it.  How Social media sites such as Facebook, Twitter can help patients interact directly with a company the size of Medtronic and vice versa.

We were given access to see some of their latest products, their thinking for future development and how they interact with customers on a daily basis.

It was apparent that the team presenting to us were extremely enthusiastic and that said enthusiasm swept through the meeting room all day.  We managed to grab a sneak peak at some the products being developed and given an insight into their way of thinking.  Obviously I would love to say more but I would have to fear for one’s own life I were to say anything!!

Lunch soon arrived and we were given a tour of the fantastic facilities including the “pacemaker” factory and where legend tell us about puppies in the factory!! Want to find out more about Puppies and Lake Geneva.

An important topic of the day was the use of Social Media such as facebook, twitter and other applications that allow for greater interaction with customers.

This is why we were brought in I guess! One of the things I mentioned was being able to use social media sites to not only communicate information/news but also to manage their online reputation/brand.

A thoroughly good day, with lots of great chatter, plenty of laughter, whilst working towards the common goal of improving patient care, improving health care products and improving lives.

Medtronic HQ, Switzerland

We were extremely well looked after by Medtronic, noting that whilst they were hosting the meeting they were keen to demonstrate their unbiased nature of this event throughout.

It was then for us to say Bon Voyage and head back home.

Thanks to everyone that I met, it was a pleasure and a privilege and look forward to the next meet up.

Saludos

Mike

Please note: Medtronic kindly picked up the tab for the flights, hotel and select meals over the 2 days together with Tim’s bar tab!  Not at any stage did Medtronic ask for anything from the attendees nor asked us to write about or champion Medtronics products to a global audience.

Obviously they would expect that we would write about events in Switzerland including the Medtronic Puppies!