Mother’s Day

I’m waking up to breakfast in bed and homemade presents. Whilst lying in bed reading various social media posts about diabetes.

When your child has diabetes you become better at investigating than the MI5. What did he it eat? why did it do that? What are the carbs in this and the list goes on.

As a mother and a nurse my ongoing investigations have been, what is the latest possible cure for T1 diabetes. We can hope can’t we?

It is quite the joke of the diabetes community that the cure is 5 maybe 10 years away. We have been living with the condition for nearly 3 years now so not that long left to wait.

I joke but the mother in me still holds out hope that this will be cured one day. One day my son will be able to say I formerly had type 1 diabetes.

He is 10, very smart for his age especially in science. He came into my room today to tell me he thinks he knows how they will cure type 1 diabetes. He went on to tell me how we just need to change the look of the beta cells that produce insulin. We need to make them look like something that isn’t attacked then the immune system will stop attacking it. Nobel prize here we come!

As a mother I feel so proud that he has the excitement and knowledge to even think about this in such a scientific way.

One day he is going to become a brilliant scientist, having type 1 will not hinder this. Having type 1 and his attempts at trying to find the cure may even make him a better scientist due to his passion to find an answer.

We have had many discussions about trying out treatments on mice with diabetes, then moving on to humans when it’s safe. He is so excited about it I hope that it continues.

However I must state that he is also looking into string theory, black holes and he currently has a dead spider under the microscope.

I love my children

Happy Mother’s Day to all the other T1 mums out there, you do a fantastic job, today is your day.

Diabetes is for life, not just for Christmas

Diabetes at Christmas

On Christmas Eve, we just finalised the last minute touches. Over to the Great-grand parents to drop off and collect presents. Girls get sweets and my boy gets a puzzle. Why do you think this is? does he not like sweets? Yes he loves sweets. Did he ask for a puzzle? No, no he didn’t. This is because he has T1 diabetes. It’s funny that relatives are very to happy to fill your non diabetic children full of fat and sugar but he can’t have any because he has diabetes.

People with Type 1 diabetes can eat sweets, granted it can be a little trickier to calculate and correctly bolus for them but it’s doable. I would not suggest eating the whole jar of chocolate as that will surely lead to issues like vomiting 🤮 but then no children should have vast quantities of fat and sugar for a “treat”.

Diabetes doesn’t break up for the holidays, there is no escape from it 24 hours a day, 7 days a week 365 days a year. No Christmas break no Easter break, not even a break on your birthday!

Christmas Day for example was full of #badmum moments

we pre-bolused 4 units for breakfast as always then got overwhelmed with presents that we forgot to actually make him eat breakfast and so ended up needing to treat a low blood sugar mid present opening. #badmum1

It doesn’t end there, I was so busy cooking dinner for 7 that I forgot to tell him to bolus for lunch until half way through eating it so I couldn’t weight the food and had to guesstimate what he’d already eaten. Usually I weight it out before he gets it but on Christmas it’s a free for all. #badmum2

Then he had a hypo in the afternoon whilst eating party rings so we waited to see if the party rings would bring it up or if we’d need to properly treat it, then forgot and ended up at 10 and rising, #badmum3

Christmas cake, we trusted the carbs and cals app but alas as it was grandma’s homemade recipe the app was wrong….wait for it………..blood sugar 23 #badmum4

An evening of random carbs and boluses and Pictionary, spot on blood sugar levels, who knows why the gods of diabetes are now playing fair. Off to bed, nothing too bad overnight only woken up twice for cgm alarms lost connection.

Then we had the week of limbo between Christmas and new year, a week of where is my son going to go today while I go to work and what is he going to be fed. The answer to that is mostly Christmas cake, chocolates and a uncut bread . A trio of difficult calculations which for the less practised grandparents was a challenge.

New Year’s Eve which also happens to be grandads 70th birthday. Toby carvery………handy portable scales to the rescue, (no I didn’t really do that 😂) Best guess is all I have Especially when the child orders chocolate fudge cake for afters.

New Year’s Eve party next, beige buffet of various carby treats, I do my best but sometimes you still have to correct the highs and manage the lows.

Christmas is full of highs and lows, but in all this we mustn’t forget that it’s just a week, a week that may be out of range. A week that we are not going to be in the perfect 4-7. Life is for living, Christmas is for celebrating, diabetes is for life, not for Christmas.

Type 1 Abroad 

What’s it like going on holiday abroad with a child with Type 1 diabetes. We never get a holiday from diabetes it’s always going to be there niggling away in the background but with some careful preparation it doesn’t have to stop you doing anything.  

However the amount of stuff you need to bring with you just to keep him safe, has its own cabin size bag! Cannulas, reservoirs, lancets, strips, sensors, charger, insulin, frio pouch for insulin, hypo treatment, extra food, batteries, adhesive stickers to keep various devices on, pens in case of pump failure, cartridges that fit in pens, spare meter, ketone meter, spare pump if you’re lucky, needles, wipes, and I’m sure there’s more……….
The airport 

Getting through customs, so many different people give you so much different advice about what the pump can or can’t do through airport security, best advice is to follow the letter that your healthcare professional provides you with as it can all get a bit confusing. Don’t do what I did and drop all of the vials of insulin on the floor because you’re panicking about the cattle herding experience that is the “family friendly” (term used lightly) security through Gatwick airport. Luckily they didn’t smash or the trip would’ve ended there. With Security over, I needed a drink but as I also needed to keep my wits about me that didn’t happen. I settled for a Diet Coke and a burger.  
Lunch
And the carb counting estimating extravaganza begins. In the UK we are quite lucky as many restaurants have the nutritional information on their website. This one didn’t, luckily my son does tend to go for the same sort of food when we eat out so I can roughly work out the carbs for what he eats. Then there’s also the back up of the carbs and cals app or my fitness pal, which aren’t always right, but give us a basis to estimate carbs.  
The flight 

The changes in pressure can cause issues with insulin delivery, air bubbles etc. So the pump was disconnected for take off and landing. The sensor at this point also decided to stop working so we were left with finger prick readings for the duration of travel. This was obviously too much for the guy sitting next to us as he asked to be moved! Some people are so squeamish you think this is bad you should see a cannula or sensor insertion! At one point his blood glucose went down to 1.9! Not entirely sure why, luckily it came up quite quickly thankfully otherwise I’m sure the squeamish guy would’ve fainted with a shot of glucagon show. 

Through to baggage claim, I wasn’t letting that lifesaving carry on bag of diabetes paraphernalia out of my clutches. I couldn’t care less if my clothes didn’t arrive I had the most important thing, we can replace everything else.  

Onto the coach, I wouldn’t let the bag out of my sight. On a crowded bus it had it’s own seat, no way was I letting this go into the storage, what if someone took it into another hotel, it doesn’t bare thinking about! Even with the separate supplies my husband was carrying we wouldn’t have enough to last us all week if we lost this, made me think we probably should have had 2 carry on bags and split it equally between us, but then we would have needed 2 spare meters 2 spare ketone meters etc etc I think maybe I’m just being a neurotic mother? 

At the hotel, just in time for dinner, all inclusive buffet……the carb counting extravaganza continues. How do you carb count 1 prawn cracker, some crisps, a handful of chips, various cream filled cakes some peaches and a slush puppy……..well apps and calculators and a bit of T1 mummy experience (aka educated guessing). We did alright not too bad blood glucose only went up to 11.  

Basal rates
Well these are all out due to all the timings of everything we do being up the creek. The growth hormone surge that usually effects us at around midnight is now delayed to 3am as bedtime is later, the breakfast spike is delayed, dinner is delayed leading to potential afternoon hypos, the list goes on basically the week consisted of temp basal rates galore. 

Swimming 

How do you keep 2 adhesive devices attached in the water? not very well in our case. I know there are various things like vet tape etc etc however with the already giant bag of stuff we had to take with us this was the last thing on my mind. So the transmitter came off and stayed off. The cannula came off and due to the amount of swimming, stayed off and was replaced by injections for the first day. Day 2 and it was taped down with so much adhesive that we needed industrial strength adhesive remover to get it off ( only joking don’t use this on skin) we have stoma adhesive remover which works really well, another thing that was in my carry on bag of tricks 😃

Breakfast 
Buffet style all inclusive = multiple trips with multiple plates to calculate, some of which did not get eaten. We find it easier to bolus a little bit then top up boluses as the food gets eaten, or do a dual wave that way you can stop the bolus if he decides the 3 croissants are surprisingly more than he can handle 😂

Excursions all come with added preparation and planning, luckily mum had it under control so he can just get on with the most important bit, having fun! 

Evening drinks, is it Diet is it full of sugar? Ive heard people use their spare meters or urine dip sticks and put a little of the questionable drink on it, if it comes up high it’s likely full of sugar. Luckily he only really drinks water and apple juice so quite easy to work out for us. 

Night checks, with no sensor on we went back to phone alarms midnight 3am and 6am, not great when you’ve been to the all inclusive bar the night before 😉🍹🍷🍹

Diving trials, this threw up all sorts of questions. Can a person with type 1 go diving? What happens with hypos, how deep under water can you go? With the help of twitter I found the answers, turns out yes people with type 1 can go diving…..looks like our new hobby has begun. 

The flight home was very uneventful thankfully, it would seem Spanish security are a lot more pump friendly than London. 

Back to normality, well until our next holiday that is 😉

Diaversary……acknowledge it or ignore it, that is the question? 

It’s our 2 year diaversary today. (23rd August)  I have mixed feelings about this.  On one hand I just want to forget about it, dwell on it, sulk about what might have been and pretty much wallow in my own self pity.
However it’s not my diaversary it’s his.  He is the one who has had 2 years of living with this condition and he is the one who will continue to have it affect his life in so many ways.
I asked him what he wanted to do, did he want to mark it or just ignore it.  Swayed by his elder sisters he decided he wanted to mark it.  Ok how shall we mark it? I ask, “I don’t know” was his response.  His older more cunning sisters had other ideas.  “Tell mum you want macdonalds she has to say yes” 😂😂 this then got him thinking about food.  After a short deliberation he chose burgers & chips and then chocolate birthday cake for dessert.  This concoction which will enivitably make for a diabetes nightmare of highs, lows and nocturnal wake up calls felt quite fitting for this event.  So that’s what we did.  He is now on a four hour dual wave bolus and I’m waiting for the high later around 2am.  Why is it always 2am?

It’s a weird thing, only people with T1D or parents of children with diabetes will know how it feels.  Diaversary! Celebrating a diaversary can look very weird for non T1D onlookers.  I saw a cousin in Morrisons when buying the cake and I mentally came up with a lie in my mind to say if she asked whose birthday it was.  Luckily she didn’t ask as I’m rubbish at lying.

We are not celebrating the fact that he has diabetes it’s more about making a point that he has done so well over the past 2 years despite having to manage his diabetes everyday. Now that’s what I should’ve said! Diabetes is not going to hold him back and a celebration about that is what it is about. Diabetes has to have some perks, 2 birthday cakes seems like a good start 😃

Positive thinking 💭 

On social media if you spend enough time in diabetes forums you often get the feeling that everyone has good glucose control bar you (or your child).  
There are talks of hba1cs in the 30s and low carb diets that don’t seem to make a dent in the glucose profile of the person tweeting about it.  
It can all make you feel a little bit envious. How do they do it? What are they giving up to get that straight line? Are we even meant to have straight lines? These are the questions going through your head.  
You worry, you get the feeling that you’re somehow not doing enough. This can be really stressful when you’re caring for a child with a long term condition such as type 1 diabetes. Worrying makes us feel we are not doing enough to get that line straight, it makes us only see the blips in glucose control and doesn’t let us focus on the good things we do every day to keep our children safe. 
When did you last start a conversation about all the things you’ve achieved despite this condition? Human nature is that we tend to focus on the negatives. We are doing our best but we are always searching for that bit more. Sometimes we lose sleep over it. What’s the blood sugar? Do the pump settings need adjusting? And so on. 
Every child and adult is different. What works for one doesn’t always work for others. For instance breakfast!! The dreaded Himalayan mountains we see after a bowl of cereal. This is the bane of parents who have children with diabetes lives. How do you stop this breakfast spike? This is a post that is regurgitated every other week in forums and yet no one really has an answer that works for everyone. Except maybe eggs and bacon but who’s got time to do that in the morning and what would the effect be on cholesterol long term…….another worry. 
The thing that has made me feel bad recently and is kind of the reason behind this post is sensor rash. The cgm has caused a painful rash on my son’s bottom. We’ve used savlon but now it’s getting to the point that it’s not healing by the time the next sensor is due to be put back on that cheek. He is so full of holes due to sensors, cannulas and finger pricks it’s really making me feel guilty. I’ve put all these devices in him, I’ve feel like I’ve injured him.  
Why do I choose to dwell on these negatives instead of focusing on the positives? He can now sleep without being woken up by finger pricks due to this sensor. He can now know when a low or high is coming before it even gets there helping us to prevent it. He can have 3 different things to eat one after the other without having to have 3 injections. He can bolus for meals without having to hide away in the broom cupboard at school. He can go swimming, go trampolining, go abroad, lead a normal life despite this condition he lives with. 
I am going to use a different approach to stop me dwelling on the negatives and focus more on positives so on that note 

I have now found a barrier cream which we’ve put on last night before the sensor adhesive to see if that improves things. We also used loads of adhesive remover the last time we took the sensor off, Fingers crossed 🤞 it seems to be working so far 😃.

Diabetes Week 2017 

Day 1
The week started on a Sunday with a random 179 views of my blog, I don’t really know why but I think it may have been shared in a forum on Facebook.  I really should work out how to use this app properly. 

Day 2 

The inpatient ward round, my favourite part of the job. People tend to be happy to see the diabetes nurse when we arrive on the ward. People with diabetes (PWD) like to see us because we understand what they’re talking about and staff like to see us (unless we are doing an audit) because they find diabetes complicated to manage. The inpatient ward round is basically a problem solving challenge. PWD are referred to the DSN usually with “erratic blood glucose”. I spend time assessing the history and talking to the staff and PWD to find out what the issues are.  
Issues I may find usually involve either hypoglycaemia or hyperglycaemia. 

Hypoglycaemia

There can be many reasons for this such as 

1. Treatment of infection without reducing insulin levels or in severe cases amputation of the infected area. 

2. Change or reduction in diet, sometimes due to hospital food or simply not wanting to eat due to illness.

3. The PWD is now receiving the medication they have been prescribed by the GP, whereas at home they do not always take it. 

4. Change of injection site now avoiding lipohypertrophy (lumpy bits) leading to better absorption of insulin. 

Hyperglycaemia 

1. Steroids, we give them for all sorts of issues, respiratory, rheumatoid issues or for treatment of cancer. These have a big impact on pushing blood glucose levels up and we will often see a typical steroid pattern which looks a bit like a mountain range on the blood glucose chart. 

2. Infection 

3. Stress 

4. Feeds or supplements 

5. Omission of medication 

6. Transfer off IV insulin 

Are all reasons we may find for hyperglycaemia and I’m sure there are many more. 

Day 3 

We spent day 3 teaching 25 nurses on the diabetes inpatient management course while simultaneously running a type 2 awareness/ prevention event for staff, answering the inpatient phone queries and seeing urgent patients on the ward. I do like to multitask! 

The inpatient course was day 3 of 3 and this day included many guest speakers which meant we were able to float between the two rooms to ensure both ran smoothly. The prevention event was really popular. We had quite a few staff come to have their risk of type 2 diabetes scored and some staff were referred on to the type 2 diabetes prevention program.  
We had music playing encouraging dancing to the usual cheesy party tunes that everyone knows the moves to, Saturday night, macerena etc etc. Granted it was usually just me and my colleague dancing but we had fun. We had a hulahoop competition to highlight the risks associated with carrying extra abdominal fat……..harder than it looks! The staff champion managed 19! I could only do 3 at best.

We had a competition for a limerick about stairs encouraging staff to avoid the lift. My colleague and I counted all the stairs in the hospital to encourage staff to use them when they can. We made a sugar board to show staff how much sugar is in popular drinks, cranberry juice drink coming out at the highest with 9 teaspoons in one bottle! We invited the local gyms and they gave away free vouchers to staff for various sporting facilities across the neighbouring towns, i got a free family swim. We had the free Nordic walking program encouraging staff to uptake this new hobby. The community diabetes team had a stand focussing on nutrition. And to entice them in we offered free pens and post-its, everyone loves a free pen especially nurses. Then if this wasn’t hectic enough I got stuck in a 6 hour traffic jam on my way home, I was exhausted. 


Day 4 

The inpatient ward round, some new referrals some repeat reviews from changes we’d made Monday and Tuesday. 

Day 5 

Stand in the main entrance 

We had every single leaflet we could get our hands on about diabetes available. Last year we ran out of type 2 information so this year we over ordered. We now have enough leaflets left over to last us out the rest of the year! 
We saw so many members of the public during our time on the stand. It always amazes me how many people are affected by diabetes, the stand was never without customers. We also invited the type 2 prevention program to spend some time on the stand with us. This worked out really well as people who were worried about their risk of type 2 diabetes had their score done by the prevention program and if they already had diabetes they had advice from us.  #bestofboth 
Type 2 diabetes is the most common type of diabetes yet due to low symptoms in early diagnosis some people tend to ignore the fact that they have it. Sometimes It’s only when they come across a stand like ours that they engage in education. I have no doubt that we have motivated some people to find out more about their condition and start to take control of it #knowdiabetes #fightdiabetes 

Day 6 

The inpatient ward rounds and then we spent some time developing our poster on Variable Rate intravenous insulin infusion ready for the hospital patient safety conference. We’ve never done a poster presentation before but have found this experience really good fun. We’ve got graphs, pictures and info-graphics galore. I didn’t even know what an info-graphic was until we did this poster #stilllearning 
Also as part of the research for the poster I sent out a freedom of information request. I now have 200+emails to sort through to get the data to finish the poster. Did I mention I like multitasking! #busybusybusy 

Day 7 

Saturday. Most DSNs wouldn’t need to do anything for diabetes week on this day however as I have a child with type 1 diabetes my diabetes week does not end at the weekend. The day consisted of a trip swimming (using our free family swim). This can sometimes be problematic with hypoglycaemia but we managed to avoid the dreaded lows and had a lovely time playing with inflatables. Then we went to an event that included lots of walking. We had dinner out including a dessert with no carb information on menu or website so we had to guesstimate it.  Then there was a funfair, a fireworks display and we mustn’t forget the candy floss. In other words a carb counting nightmare, but we managed it. With one hypo post dinner likely due to all the exercise walking round the funfair with active insulin and then later in the evening a high of 14 likely due to the candy floss. All in all not too bad considering the guesstimating and calculations needed. 

So that was my diabetes week for 2017, now to plan hypo week and world diabetes day 😃

CGM round 2………..

So we’ve had the cgm for about 2 months now and we’ve gained a bit more of an understanding of how it works, still not perfect but better.

What I can now say about it, is that I can finally go to sleep without worrying. I’ve stopped waking up at 3am for no reason.
We are loving the warning before high or low, it puts you much more in control than before. Setting changes are so much easier to decide with a full picture to look at. Turns out his insulin requirement between midnight and 3am are a lot less than the rest of the night, who knew! I’ve got a feeling his next hba1c will be improved as we’ve rarely had a high above 15 as we get a warning before it gets there. It’s so much easier to predict what’s going to happen without having to test all the time and his fingers are improving from less finger pricks. I also like that in the night I can just read the pump instead of disturbing him with a finger prick.
We’ve almost eliminated breakfast highs that we didn’t really realise we’re as bad as they were as we weren’t finger pricking every minutes like the sensor reads. Usually by morning break time they’d come down a bit and by lunch they’d be a normal level. However with this new information now we have managed to adjust food and settings to not spike at all! For now anyway………T1D doesn’t always play fair.
We’ve not had any sensors come out now since we started using the secure tape that we should’ve had with it the first time we tried it.
Only a few snags, sometimes due to his low basal rate the low suspend can take a while to take effect, then he may go high later due to lost basal. The sensor stays on for 6 days and when it comes off sometimes the area can be sore, this may just be the weather though as it has been hot. We’ve had a couple of faulty sensors which Medtronic have replaced free of charge. The problem being the sensor bit recoiling when pulling the insertion needle out. Remembering to calibrate can be an issue so we’ve turned on the auto calibrate, only trouble with this is when it’s really high or low it might not calibrate or if it does it might affect the accuracy.
All in all I am very pleased with it, just wish the technology was available for all type ones, one day maybe it will be.

How low do you go? 

What is hypoglycaemia? This is when the blood glucose levels drop below 4mmol. It’s rare that people will just drop to the floor, usually they get a bit of warning first, unlike how you’ll see it portrayed on a television programs. Being a parent of a child with T1D I’ve never actually experienced a hypo first hand but I have witnessed a fair few in my son. He describes hypoglycaemia as feeling awful. At 9 years old his vocabulary doesn’t extend much past this. He describes the colours changing in his vision, going more yellow. To look at him he goes pale, all the colour withdrawn from his face. He often wants to lie down until it’s over with. Occasionally when really low he acts very silly, laughing and rolling around a bit like a drunk person.  

Hypo can happen at anytime, often without much warning. It’s more common after exercise or when he’s still got active insulin from a meal. Sometimes it happens overnight, we are lucky to have continuous glucose monitoring as he does not wake for hypos at night. The dreaded alarm going off at 3am to alert you that he’s low is a sound that will make your skin crawl. We have the same pumps at work and every time the alarms go off I get the feeling of dread in my stomach. Sleep walking into his bedroom he will sleep eat dextrose tabs followed by a drink of water to wash down the powdery substance. Sometimes he remembers in the morning but quite often not. It’s a lonely time 3am, the whole house is asleep, occasionally there’s another mum up on Facebook doing the same thing as me and we’ll discuss how tired we are while we try to stay awake for the 15 minutes we have to wait till recheck time.  
Summer weather can increase incidences of hypoglycaemia not just because of the heat but also because we are generally more active in the nice weather, swimming, walking, cycling the list goes on.  

Hypoglycaemia can be quite annoying for a child, he’s missed break times, PE lessons and parts of swimming lessons treating a low. If he’s low at meal time he has to wait 15 minutes after taking dextrose to recheck and if it’s then above 4 he can eat his food. As you can imagine this is really hard to do especially in a busy restaurant or at school. The problem with just eating his food before he comes up is that the fat will slow down the absorption of the sugar leading to a longer hypo episode.  
Recently there’s been a lot of talk online about glucagon, thankfully I’ve never had to use it on my son. Glucagon is used during severe or stubborn hypo episodes. It’s an injection which helps to release the stores of glucose from the liver. Many parents have had to use this, it’s quite simple to use and I would advise refreshing yourself every now and then with the instructions. Also check expiration dates regularly to ensure it’s not past its use by date in an emergency. Ambulance crews will also administer it if they are called to a child or adult for that matter with severe hypoglycaemia but it’s best to have your own supply and for someone to be trained how to use it just incase. 
Hypoglycaemia can affect cognitive function for a while after it’s treated. A hypo before an exam can be a problem, again not something we’ve had dealings with yet, but I’ve heard children can get extra time incase this happens. You’re not allowed to drive a car for at least 45 minutes after treating a hypo so sitting an exam straight after is not great. 
Treating hypoglycaemia takes sugar if you think it’s a low blood sugar so to bring it up it makes sense to take sugar. There have been many tv programs who’ve got it totally wrong and given injections of insulin which would cause even further hypoglycaemia and could even be fatal. Not all sugar is equal though. Sugar in the form of chocolate can be difficult to absorb due to the high fat content, so treating a hypo with a mars bar it’s not the best idea. We tend to use dextrose tabs or fruit pastels, he doesn’t really like sweets or fizzy/juicy drinks so our options tend to be limited to these. Other people use jelly babies, skittles, Coke, glucojuice, lucozade (be careful with the new ones as lower sugar and some now zero sugar). There are many more the simplest being 4 teaspoons of sugar mixed in a little water, easy to get hold of (any cafe nearby) and cheap but I’m told it tastes disgusting and sometimes the sugar just forms a gloopy mess in the bottom of the cup if not stirred continuously.  
Hypoglycaemia can make them feel hungry, on MDI we were advised to give second line treatment. This is another longer acting form of carbohydrate of around 10-15 grams that is not bolused for. However on a pump we are advised to bolus for all snacks bar first line hypo treatment.  
Yesterday we made a joke as he was about to go on the dodgems, are you 5 to drive? Turns out he was 4.6 and dropped to 3.9 so we gave some dextrose while waiting in the queue, luckily he came up before he got on the ride. Other children in the queue were watching us finger prick take dextrose then check again. Children don’t hide their inquisitive minds I’m just hoping he doesn’t start trying to hide his diabetes as he gets older and the peer pressure increases in teenage years.  

Sun, Sea, Sand and Blood Sugar

Managing children in the heat can be a challenge, add type 1 diabetes into the mix and things get a little bit more difficult.
Why I hear you ask, well Hypos for a start. The heat can make people with diabetes run low. There can be a few reasons for this such as a change in diet, exercise and just the heat in general causing increased metabolism.  People tend to eat a lot more salads and less food due to the heat and so the reduction in carbohydrates will mean less insulin will be required. If you’re not carb counting, if you’re on fixed doses of insulin or a mixed insulin regime it can be difficult for you to work out how much to reduce by.

Summer tends to come with more days out, playing with friends, going for long walks, water fights, extra sports at school including sports day and swimming lessons. All of these increases in exercise may cause hypos if insulin doses are not adjusted.  And then one of the symptoms of hypos is sweating when you’re already sweating due to heat you might not notice the hypo straight away.

Beach days may mean sand on the pump, You also need to ensure the cannula is kept clean, trying desperately not to get suncream on the dressing. Then there’s the conundrum of where do you put the pump when you go in the sea? Many of them are waterproof but I can imagine it’s not very comfortable to swim with. Then considering it’s worth over £2500 you don’t want some light fingered idiot mistaking it for a phone and stealing it from your belongings while you’re not watching. Also if you leave it on the beach in a beach bag will the insulin get too hot? Another issue that may affect older children on the beach is their peers. They will not want to have anything on show to avoid the inevitable questions and to avoid getting a cannula, sensor or pump shaped tan line.

When it’s really hot the Spi belts can get uncomfortable and sweaty round the middle in the heat. And then there’s the different outfits like Shorts and t-shirts or summer dresses, where do you put the sensors/cannula etc so they are not on show?
Spontaneous Ice creams vans, how many carbs? Very rarely do 99s come with carb info so it’s a guess with the help of carbs and cals app. Then there’s drinks, ice lollies, slush puppies and ice poles are they sugar free? Who knows?

Growth spurts,  I’m sure the sun leads to these too. A bit of sunshine and suddenly you’ve got yourself a night hormone spiking highs with day hypo situation going on.

Insect bites, diabetes can affect wound healing. My son has a couple of these I told him a joke that it’s because he tastes sweet, he found that hysterical, but now I’m wondering if there’s any truth in that, let me know if anyone has heard of a study on it.

Then there’s the all important summer holiday. Getting the pump through checks in the airport can be tricky depending on where you’re flying to. We also need to make sure we keep spare supplies of insulin cool. Then there’s the time difference to work out……the list goes on.
Then in all this sometimes you’ll get a random high blood sugar, come on diabetes play fair please. Highs could be due to the heat causing bubbles in pump reservoirs, dehydration or it could just mean that slush puppy wasn’t sugar free after all.
As summer begins mornings get brighter and sometimes the birds singing at 4am can make you think there’s a pump alarm going off. When they wake you, you can hear it’s just birds however I’m sure there’s a mocking bird out there trying to wind me up.
There is one small perk through all this though, in theme parks sometimes you can get Fast passes to avoid long waits in the queues as they might have a hypo. But be careful not to leave the pump connected on rides with excessive Free falls as this can cause issues from the powerful electromagnets.
I’m sure there’s other things but I can’t think of anything at the moment and that’s enough to give you an idea of what it’s like to manage type one diabetes in the sunshine 🌞

DSN vs Mum 

Nursing day got me thinking about why I became a diabetes nurse. My older brother has type 1 diabetes, he was diagnosed as an adult so I didn’t grow up with it in my childhood. However since starting my nurse training knowing his condition, every mention of diabetes and I was all ears. I actually corrected one of my university lecturers when she said that sometimes people start as type 2 diabetes but when they start insulin they turn into a type 1. This made me so mad I reported her to the head of nurse education 😂 goody two shoes that I am.
During my training I spent time on an endocrine ward on placement. My mentor at the time showed me how to do a sliding scale now known as Variable Rate Intravenous Insulin Infusion (VRIII). I was hooked. I think it was the logical part of me, the mathematic within that realised that diabetes, especially type 1, is logical (or so I thought).
I started my career as a staff nurse on an endocrine and gastroenterology ward. This ward taught me that there are a lot more gastroenterology patients than endocrine and if I really wanted to develop in diabetes I was going to have to become a specialist nurse.
This is not the easiest of jobs to get into. People who work in these departments tend to stay there until they retire, when a job finally comes up it has a high rate of applications.

I continued to work as as band 5 staff nurse for 18 months.
Then a secondment job was advertised to implement think glucose on the wards. I chanced it and applied but alas I did not have the experience and a more senior nurse got the job.
At this point in my career after a high staff turn over on the ward I became one of the senior staff nurses. There was a band 6 clinical sister vacancy so I applied, never in a million years did I think I would get it. But I did! I did courses in leadership and attended university to upgrade my diploma to a degree. I worked in this role eagerly learning the skills of leadership for a year or so.  Then my younger sister was diagnosed with T1D, suddenly I realised how much I did not know about the condition. How could I help her if I didn’t really know the day to day management? All I knew was acute care, which luckily she did not require.
4 years into my career as a nurse my senior sister went on maternity leave. I was asked to cover the ward for 6 months until she returned. However she did not return, and so suddenly I was then the permanent senior sister of the gastroenterology and endocrine ward.
This job was very demanding and very rewarding but it was not my dream job. I wanted to become a DSN. Every time the DSNs came to the ward I would follow them round learning all I could, joking, but not joking at when they were going to give me a job. Then the day came, a band 7 DSN job advert went out. I applied however I was no where near experienced enough to get a band 7 position. Unsurprisingly I was not shortlisted. However neither was anyone else! Then a lifeline…..the post was re-advertised as a band 6 development post. I applied even though it meant a drop in banding. And I got it! I got a phone call on the ward and I couldn’t hide my excitement. I did feel bad for leaving the ward who had cared and nurtured me into the nurse I had become for the past 5 years. But I had to follow my heart…my destiny.
First day on the job and it felt like I was newly qualified again. Learning the ropes of the inpatient DSN role. At this point I realised how little I actually knew. I had a steep learning curve which included masters level modules in insulin management, leading advanced practice and research.
Then 10 months into my new job my son was diagnosed with T1D. (See first blog) This completely opened my eyes to the real world of diabetes.

Looking back I think this led me to become a better DSN.  Empathy is a powerful thing. Real life experience, knowing what it’s like and how unpredictable it can be even when you do everything you’re told to. My knowledge of T1 diabetes improved tenfold! A silver lining maybe to this unfortunate condition that is affecting my baby boy.  Maybe it has made me a better nurse and maybe through being a better diabetes nurse I am more equipped to care for him too.
However there is a line that sometimes I think I cross. I really have to watch what I say at home, this is the dilemma I have everyday. My ‘foot in mouth’ comments really make me feel like a bad mother! I mean what other T1D child has to put up with stories of inpatient diabetes at the dinner table?
I just don’t think of him as being part of that, my glass half full attitude helps me to live in my own little world where as long as I do as I’m told and keep his hba1c in a good range, the difficult things I see are not applicable to him! Call it nieve or call it a coping mechanism, whatever it is, it stops me connecting some of the things I see at work and him.  I’m just hoping my “you’ll never guess what I saw today” mishaps don’t have a long lasting psychological impact on my family.
Ever the optimist I do also see it from another perspective. I mean how many children with type 1 have a parent with daily access to the opinions of endocrine consultants, dietitians, pump specialists, paediatric nurses, educators and podiatrists. Not many! If you were going to choose a condition I think the one your mum specialises in is probably the one to go for!