The magic little button

I got told I was diabetic when I was 17. For the next 12 years I managed that news with a little finger pricker and some test strips. It was a faff. Not only was finger pricking uncomfortable, more importantly it looked weird and made me anxious in social situations.

Often, to avoid potential embarrassment, I just didn’t do it. Bad diabetic.

On top of that, it was also a lot of stuff to take out with me. I needed needles, the pricker itself, test strips and a meter to read them with. If I had a bag with me that was fine, but if I just wanted to go out without bulking up it was a nightmare. I longed for winter where I could wear coats with more pockets, just to make the process easier.

But then something incredible happened - The Freestyle Libre. This new button sat on my arm and let me check my blood sugar using Bluetooth. It felt like a game-changer, something that would make my life so much easier and diabetes management so much… cooler.

And it did, for a bit.

When did things start going wrong?

As with all new technology, problems started to occur. The Libre sensor would often fail if the weather got too hot or too cold, or sometimes just for no reason at all, leaving you without the information you needed when you needed it most. This often happened just as I was about to go to the gym or go to bed, causing me anxiety at crucial times. No-one wants to stay awake for an extra hour waiting for an app to start working, especially not my wife.

The Libre 1 also lacked alarms. This meant if I dropped low in the middle of the night and my body didn’t wake itself up, I’d be screwed. This happened a couple of times - fine when I checked before bed, low in the middle of the night. Eventually I was swapped to the Libre 2 which came with alarms, but still had those same connectivity issues that impacted its performance.

What had started off feeling like a game-change was now feeling like it was holding me back.

Last month, though, I got an upgrade. Technology moves rapidly, and less than a year after I’d been put on the Libre 2, I was moved to a Dexcom One. Welcome to the world of continuous glucose monitoring.

What is a CGM?

A CGM is a continuous glucose monitor. It does exactly what you’d expect to - tracks your blood sugar all the time, sending updated figures every minute without you needing to do anything at all. Don’t ask me how it works, because I’m just a guy who wears it, but what I do know is that it’s wonderful.

I don’t have to do anything other than open the app on my phone to get an accurate reading. On the Libre, readings would be about 15 minutes delayed, whereas the Dexcom gives me readings every 60 seconds. They’re also 99% accurate, making it almost as good as a proper blood test.

What about the app itself?

The app is proper simple. There are three screens - your glucose readings, some reports about your averages, and the settings of the sensor. That’s all you need, really. The Libre had loads more, which looked exciting at first, but realistically I never used them after the first couple of weeks of exploration.

There’s still the odd hitch - occasionally readings will be unavailable for no obvious reason, but it fixes itself nine times out of ten if you restart it or leave it for a few minutes.

The alarms are better too. On the Libre 2, the low glucose alarm was a heart-attack waiting to happen. You couldn’t miss it, which I guess is a good thing, but sometimes it would make me wish I was nearer a toilet. Saved my life? Sure. Cost me a good pair of jeans? Shame.

On the Dexcom, you can change the alarms to a sound that suits you. Mine is currently a funky little tune that sounds like a Mexican dance number. It still wakes me up, but in a happier way.

Can you get Dexcom on the NHS?

Of course you can, otherwise I wouldn’t have it. For a while you had to pay a subscription, but my generous diabetic specialist at Sheffield Hallam sorted one out for me and got it added to my repeat prescription. There are still a few technical details that need sorting out though. For example, the Dexcom One is two separate parts: One, the sensor you apply to your arm, and two, the transmitter that clicks into it. You order the sensors through your GP and the transmitter via the pharmacist, and so far the two don’t seem to be talking to each other.

I await with baited breath to see how long that takes to fix.

But apart from that, I love you Dexcom One. You’ve made it possible for me to be even lazier with my diabetes management, which is exactly what I want. The less I can do and the healthier I can be, the better life is.

Sometimes we fall

If you work in the martial arts gym at the top of my road, you’d have witnessed a 32 year-old man fitting next to a brick wall the other week. Not your average Tuesday, I imagine.

So first of all, thanks to those guys (and my wife) for making sure I didn’t smash my head into anything solid. And secondly, let’s look at why that fit happened, and how I’m gonna go about getting over it.

Hypos happen. Sorry.

Fitting isn’t something I do very often. In fact, I went a whole five and a half years without doing it, making my doctor very proud in the process. But as a type 1 diabetic, hypoglycaemia is something that can always strike, no matter how careful (and good) you think you are.

For me, on that fateful day outside the martial arts gym, it happened because of the heat. We’d gone on a walk after work, at which time my blood sugar was reading 10. A little high, so I corrected. That was my first mistake. The heat was a horrible 36 degrees, far too hot for my pale complexion and my non-responsive pancreas.

The walk started fine, but as we started to make our way back home I noticed my vision was going a bit blurry, and I was seeing spots. I know these are signs of low blood sugar, but I assumed because it had been high just moments earlier, it couldn’t possibly be the case. IDIOT BILLINGHAY. BAD BAD BAD.

What happened next is a little hazy to me, but I’m informed I did eventually sit down and take some sugar, before falling to the floor and making a scene. I’d acted too late, and made the kind of poor decisions I’d not fallen victim to for over half a decade.

I felt foolish. I felt embarrassed. But ultimately, this is the life I live. It’s happened before, it may well happen again. It’s how we move on that matters. So…

How do you get over having a hypo?

It would be easy to wallow, wouldn’t it? And when you’ve got marks from where you unconsciously punched the floor, settling for the sympathy vote would be the obvious option. But that’s not my vibe. I’m more about ignoring it and denying it ever happened to anyone who asks.

However, the sensible way to get over having a hypo is to learn what caused it and make sure you don’t let that same cause happen again. In my case, it was a combination of the heat and an over-enthusiastic correction dose.

But Ash, why can heat cause hypos?

Basically, the hotter it is, the faster blood runs around your body. This means any insulin you take goes around your body faster too, making a much more immediate impact than it usually would. Amounts you’d normally take can suddenly make a far bigger impression, leading to you surprisingly ending up on the floor.

When it’s hot, try lowering your units. Your body will thank you.

How do you explain what happened to other people?

My least favourite part of any kind of medical emergency is having to explain it. I HATE the attention. It reminds me of a time when my diabetes was out of my control, where I’d regularly be in an ambulance, and when people just knew me as a fit risk. (Not in that way. Only my wife has ever known me as that kind of fit, for which I am eternally grateful.)

Now I like to be known for other things, like being a great copywriter, or a cracking husband, or a top gardener who only occasionally over-waters his houseplants. Sadly, when your hands are covered in cuts and you look like you’ve lost a fight with concrete, you can’t really hide it.

I was at a wedding a few days after my fall, and had lots of curious questions to answer. As much as I wanted to run away from them all, I knew they were coming from a genuine place of concern, so I did a very similar thing to what I’m doing here - talked people through the occasion in a very matter of fact way.

This is what happened. Here’s why. Aren’t I bit of a tit?

We laugh, we learn, we move on.

When you’re diabetic, hypos will happen. Most of them will be easily resolved, but when the odd one gets the better of you, it’s best just to accept it and face up to the facts. That way you can hopefully stop it from happening again, and leave those martial artists to keep kicking each other.

How to deal with night time hypos

Last night, or should I say very early this morning, something happened that hasn’t happened in a long time: I was woken up by low blood sugar, dripping in sweat and desperate for cake.

Night time hypos can be a serious problem. Not only do they leave your bed sheets feeling too damp to be enjoyable, but they often cause your levels to slip much lower than they would during your day, activating your body’s emergency mode and requiring immediate treatment.

Here’s how I deal with them, and a few tips that you can follow too.

Why do hypos happen at night?

Night time hypos, or nocturnal hypoglycemia if you want to sound fancy, can be brought on by a few different things. Too much basal (background) insulin can catch up with you while you sleep, while physical activity in the evening can cause your blood sugar to spiral low.

Eating just before bed can also be dangerous, as your fast-acting insulin will still be active as you shut your eyes.

Finally, watch what you drink. Alcohol is a big cause of night time hypos, and your body’s sensitivity might be lowered by too much of a good time.

What are the symptoms of night time hypos?

Unlike with hypos during the day, night time low blood sugar can creep up on you, causing a much more noticeable reaction from your body.

• Sweat. You’ll wake up absolutely dripping, with wet bed sheets suggesting it’s been happening for a while.

• Confusion. You’ll not know what’s going on or why you’ve woken up. You may struggle to get your bearings.

• Irritability. You’ll be angry, and not just because you’ve had your sleep ruined.

• Tiredness the following day, for obvious reasons.

How can you prevent night time hypos?

To reduce the risk of night time hypos, you need to pay attention to what you do during the day. Try moving your evening meal an hour earlier, or going to bed a little later. Insulin can be active in your body for up to two hours, meaning it might still be working as you go to bed.

You should also chat to your doctor about reducing your background insulin, as this might be the guilty party.

Check your blood sugar before bed, and be sure not to over correct any highs. It can be tempting to have more insulin if your first corrective dose doesn’t look like it’s worked, but trust me, it’s working as hard as it can!

Having a second dose can lower your blood sugar too much. Bad times await.

How to be prepared for night time hypos

No matter how well you look after your diabetes, night time hypos can still hit you. Hard.

Here are my top tips for how to be ready to take them on:

1. Have some sugar nearby.
   Have a packet of Dextro by the side of your bed. You’ll be confused when you wake up and might not be able to find sugar anywhere else. Make things easy for your sleepy self.

2. Give yourself time.
   Don’t rush it. Give your body time to get over the shock, and make sure you’ve had enough sugar to fix the problem. Three Dextro is normally enough to fix a regular hypo, but you might need to take more when you’re blood sugar has dropped so low.

3. Consider a shower.
   Waking up dripping in sweat is no-one’s idea of fun (well, no-one that I know of…) and it can make getting back to sleep uncomfortable. Take a shower and sleep on the other side of the bed, or change the bedding if you’ve got the energy. Sleep is important, don’t let blood sugar ruin it.

Basically, night time lows are pricks. If you’re smart, they don’t have to happen often, but if like me you let your standards slip for ONE DAMN SECOND they can launch a surprise attack.