Quarantine I Spy

Luna Rossa above. Admittedly this great pic is not mine but the others attached are!

Kia Ora.  Done with my full two weeks of quarantine so I can officially say that I’m a seasoned quarantinee.

I have some tips on completing a 14 day isolation in NZ, some of which are related to diabetic survival and some of which fall into the bracket of general survival.  Two weeks can feel like a long time to stay sane when you are caged in your hotel room!  However, caged is the wrong word for my experience here because rather than feeling like a prisoner, I’ve been superbly and caringly looked after.  I’d go as far as saying that it is almost as if I’ve had a holiday minus the sightseeing although even then we did have a number of eventful games of I spy. We spotted some America’s cup boats (namely Luna Rossa and American Magic) from our room, watched buskers on the street and even enjoyed Auckland Day fireworks.  Wow!  Anyway here are my tips:

Need-le help?  The nurses are the friendly faces who you speak to every day.  I needed to dispose of my stash of needles from my injections that had accumulated over the days as I normally use 4 per day. Upon asking the nurse about sharps disposal, she came back in a hazmat suit with a yellow box for sharps. She and I stood quite a distance apart as I extended my arm to drop my used needles the box. Nothing like a bit of human interaction to break up the day.

Yoga mat, get it flat – ensure that you roll out your yoga mat at least once a day for some type of activity. Stretch it out to loosen those muscles or do some press ups to break a sweat. My family, who are quarantining with me in a bubble, gathered in one of our hotel rooms for an arranged press up afternoon featuring my gym playlist.

Mindful eating – It is actually pretty exciting to have knock at your door signifying the arrival of food but occasionally I do feel a little like a lab rat. The meals have been fantastic and we are certainly well fed. My top tip would be to just make sure that during your stay you keep an eye on your calories as you are probably not doing as much activity as you would normally do. Here we are often treated with a blueberry muffin, white chocolate macadamia cookie, carrot cake or choc fudge brownie. From analysing the nutrition labels of these desserts I can safely say that in terms of carbohydrate content (I inject insulin to account for my carbohydrates), a diabetics best option is the choc fudge brownie. Imagine that, a world where the brownie is the diabetic dessert option of choice.  Steer clear of the carrot cake because that is a carbohydrate and calorie bomb.  Although my brothers are still suspicious as it has carrot in the name.   Consequently, it became the currency of quarantine and was used as a medium of exchange and barter across my family bubble. My Dad now says he is “long” carrot cake – I think that’s banker speaker for saying he has a fridge full of it with only 1 day to go.

Smoking deck is a breath of fresh air, and smoking is not compulsory – I had to call to check that I could visit the level 2 deck. I did not remove my mask but I got to stand outdoors in the cool, fresh air staying at least  2 metres away from others  of course. Glad I brought a jumper because even though it’s summer here wind has been a bit nippy.  Don’t think the cup crews are complaining about the wind though.   

I cannot stress how well I’ve been looked after during my stay. Thanks to all the staff at the Grand Mercure Auckland, NZDF, all the health staff, police and everyone who looked after us.

Bonus tip from my younger brother’s advice is to keep all of your leftover desserts in case you come across a meal you do not like.

Glucose upon publishing: 9.4mmol/L

VIP

Not going to lie, I was a little anxious to hop on board a plane as this was going to be my first time flying with Type 1 Diabetes but a few travelling jitters weren’t going to stop me.  I rejected the idea of being left behind in Malaysia with the dogs. Don’t get me wrong, the dogs are mum’s 2nd children so they should be on their way soon.  It’s just that I refused to be placed in the 2nd children category.

Days beforehand I had completed all my diabetes prep for the journey as well as for the compulsory 14 day quarantine to follow. This meant calculating my diabetic inventory of things such as needles, injections, testing strips, lancets and lots of snacks.

In the airport I’m not allowed to walk through the x-ray machines as it could’ve disrupted the functioning of my constant glucose monitor (cgm). Just a reminder, my cgm is implanted into me and sends live glucose readings to my phone.  Dad likes showing off my cgm as he thinks it makes me look like a uber cyborg human.

To pre-empt any altercations between my cgm vs the staff vs the x-ray machine, I had secured a letter from my Doctor in Malaysia making my situation clear. I felt a bit like a celebrity being plucked from the “regular” queue and escorted past the x-ray.

An entourage of airport staff assisted me as I did this and I think I may have uttered, or at least thought, the words “no photos please…” Unfortunately, my celebrity status was short lived as 5 seconds later, I was reunited with my family. My eldest brother queried whether or not I may have exploded along with the cgm should I have walked through the x-ray machine. He found this a little too funny for my liking.  My younger brothers requested that I went back and walked through the x-ray machine to prove the science. 

When my cgm sends my blood glucose reading to my phone it alerts me with an alarm indicating that my blood glucose level is too high or too low.  I have the freedom to change the alarm sound which is a tiny bit entertaining. Currently my “too high” is a doorbell ringing but I don’t think it was very amusing to the woman sitting across from me on the plane journey.  She looked around quite a few times trying to identify the location of the possible doorbell on a plane.  No doorbell. Just me haha! Sorry lady in 40C. My too low sound was of a baby crying. I changed this when my family wondered aloud whether people thought that I was a teen mum whenever is sounded. Yikes!  (Of course nothing against teen Mums.)

The plane journey was a smooth one. The Scoot and Singapore Airlines crew did a great job of looking after us all. My blood sugar level was relatively stable (though a little high though hence the doorbell). The only challenge on board was changing the time of my basal insulin dose because of the time zone difference. This basal insulin is used to keep blood sugar levels consistent during periods of fasting aka sleeping. I always give myself this basal insulin shot the same time every morning. This morning had to change from the Malaysian morning to the Kiwi morning in mid-air. This practically meant that my insulin regime has no jet lag.

I wonder when Halle Berry (famous type 1 diabetic) gets treated even more specially than ordinary VIPs?

Glucose upon publishing: 5.6mmol/L

Have you ever seen Changi Airport this empty?

“Smaller, smaller, smaller, less, less, smaller, less”

I hope you had a merry Christmas everyone. No doubt that some of your festivities may have been a little different in the year of 2020 with the new normal being face masks and temperature checks.  For me it was face masks, temperature checks and glucose checks.

On Christmas Eve we went to watch the new Wonder Woman movie at the cinema and for the first time ever I didn’t fall asleep.  However, question is, why was this?

  1. The excitement of Christmas Eve?
  2. My diabetes?
  3. The novelty of the cinema being open after months of being shut as part of covid safety measures?

More excitement was to come on Christmas day as it was my first hotel buffet since being diagnosed with T1D and to complicate matters it was a COVID-19 proofed buffet. 

As some of you will know, T1D involves injecting insulin so that the carbohydrates you eat can be accounted for. Administering too much insulin will send your blood sugar soaring downwards and administering too little will send your blood sugar sky rocketing upwards. This is why giving yourself the correct dosage is important. I do this via an injection I carry around with me everywhere.

But it’s Christmas!  Today there was (almost) nothing holding me back.  I let my guard down and went for the carbs: Char siew baos (bbq pork steamed buns), pasta, noodles and roast potatoes with my Christmas Turkey.  And of course I had to hit up the dessert table because of my sweet tooth and worrying love of all things chocolate. There was lots of gesticulating and muffled masked communication trying to get my slices of cake and spoons of pudding smaller and smaller to reduce the temptation of devouring my entire dessert quota for rest of 2020 on a single plate.

I then had to estimate the grams of carbohydrates in each food item I was about to eat and then accordingly inject a specific amount of insulin based on this. This was the tricky part because there are a lot of foods that contain carbs. On that note, I’ll warn you to never challenge a diabetic to a game of “guess the carbs in this food item” because this is an area we specialise in or at least consider ourselves superior in.

I joked that by the end of the day I was a human pin cushion. I am however happy to report that my blood sugar was very well behaved on that particular day meaning that it was relatively stable and kept within the ideal range. A Christmas present in itself!

Glucose upon publishing: 5.9 mmol/L

Diabetic Shark Cage Diver

There is a show I’ve come across on Netflix very appropriately named Sugar Rush but perhaps not for the reason you might first think.

It is a baking competition where pairs of cupcake warriors have to scrap it out through a series of  baking head to heads striving to survive a knockout competition.

Not only will they win cash but being d-éclair-ed the winner is a big deal as the judges are mega stars of the baking world i.e. Adriano Zumbo, an Australian patissier appearing on every season of MasterChef and Candace Nelson, nicknamed the “Cupcake Queen” of the US.

I have found myself binge watching the Christmas themed episodes lately.  The delicate and creative process of cupcake making blended with festive music and yuletide themes is very appetizing to me and I devour every moment (with my eyes).

As Type 1 Diabetic, a cupcake is a black-hole of carbohydrates, unfathomable and hard to quantify.  Even when I make them myself, the carbohydrates within a cupcake and the balancing insulin shot is a complete stab in the dark!  It’s like nature’s special warning to me, “I look beautiful but you better not eat me Antonia”.  

Yet, I can’t seem to stop watching Sugar Rush.  Mum asks me why I do it to myself seeing as every single cup-cake would send my blood sugar level rushing through the stratosphere and could make me sick.

Maybe you can say I’m really brave.  I guess I’m like a chicken obsessively watching a programme on foxes – something that can kill me.  I can’t resist watching the creation of festive cupcakes so you could call me an adrenalin junkie who seeks out danger like a shark cage diver or free-fall parachutist. 

I can’t wait to have my next……rush.

Glucose upon publishing: 8.5 mmol/L

Diabetey McDiabeteyface

Hello!  Long time no blog but I’m back on the scene now as exams are finished. Yay!!!

Now that I’m not revising and taking A levels I’ve started reading more.  I came across an article recently that commented on a recent Diabetes New Zealand campaign that was disappointing Type 1 diabetics. (https://www.stuff.co.nz/national/health/123359777/type-1-diabetics-disappointed-with-diabetes-nz-campaign )

The controversy centred on the grouping together of Type 1 and Type 2 diabetics.  The phrase that caught the ire of some was the new “love don’t judge” slogan.  The suggestion being that Type 1 was somehow reflective of a lifestyle choice and could be reversed with support (which it can’t). 

It was interesting to me to see that even in a country like New Zealand where those who were tasked with spreading awareness were ambiguous in their clarity!

Reading it prompted me to clear up some common misconceptions between the two. Seeing as I am a self-proclaimed Type 1 diabetes black belt (or maybe a more like a purple belt) I feel that it is my duty to attempt to explain and outline these differences. 

Type 1 diabetes:

An autoimmune disease in which your body mistakenly attacks the cells in your pancreas which means it cannot make any insulin. It seems to have a genetic basis and its usual onset is during childhood.

Type 1 diabetics are dependent on insulin which can either be injected or pumped into the body.

At present there is no cure for Type 1

Type 2 diabetes:

People with Type 2 do not make enough insulin or insulin that the body can use properly. The cells in the body become resistant to insulin so more insulin is necessary to maintain a normal blood sugar.

Type 2 can be reversed through a maintaining a healthy diet and exercise regime.

It feels to me that the names of the disease are so close that they are used interchangeably whereas, as you have just read, they are very different.  In NZ there are 250,000 diabetics of which 90% are Type 2s.  So I guess it is up to us Type 1’s to come up with a catchy new name to differentiate. 

Any better ideas than my father’s suggestion of “Diabetey McDiabeteyface” are welcome. I subsequently learnt the inspiration of my father’s natty name for my disease was inspired by the internet competition to name a UK research vessel. See the attached article.

https://en.wikipedia.org/wiki/Boaty_McBoatface

Glucose upon publishing: 5.5 mmol/L

Diagknowsis

With my A level exams closing in fast I have found it hard to get creative on all manner of things and unfortunately I have experienced, for the first time since diagnosis, writers-block.  Even my usually reliable (https://insulearning.com/2020/03/29/nightmare-on-sugar-street/) vivid sugar driven dreaming seems to have settled into a pre-exam funk.  This has spurred me on to say something important that I have been meaning to for some time and post a long overdue, ever so simple yet transformational snippet of knowledge that you can all use. 

If my parents, family or friends knew what I’m going to tell you about spotting diabetes then my diagnosis would have occurred much earlier.  I am so lucky that I found out sooner rather than later; many are not so lucky.  Please read this post carefully.  This is a serious one folks.

Fortunately for me I discovered my condition during an unrelated doctor’s check-up. This is not always the case. Often many parents and healthcare professionals only find out when a child collapses and a life with diabetes begins with an emergency visit to the hospital.

Worryingly, even before a frightening collapse, the child’s ketones levels (aha another blog methinks – take that writer’s block) may have been dangerously high for some time which could have consequently already caused long lasting damage to the organs.

I am really happy to report that I am currently the healthiest version of myself ever and my diabetes management has allowed me to concentrate on my exams (yikes, must get back to revising). In between revising I have grown a little baby bicep that I am working hard to maintain now that I am able to build some muscle. Soon it’ll be biceps! (plural form).

I would like to share my top, relatively unambiguous, less subjective type one diabetes symptoms with you:

If you hear of a child or of someone displaying any two of the above symptoms, then please suggest that they get checked for diabetes. It involves a straight-forward blood test. That’s it.  Simple. 

Please pass this on.

Glucose upon publishing: 5.9mmol/L

PS I must confess that I’ve used some writer’s licence as I don’t have a sister but Diag-know-bro doesn’t work so well.

I need SOAP

“Remember, candidates sitting for the examination are to conform with the outlined Standard Operating Procedures.  In particular, candidates are not permitted to bring in any items that are not required for answering the question paper.”

I have an issue with these SOPs. No matter how much I’d like to be a conforming candidate I simply cannot be. This is not because I am forgetful. This is not because I am not switched on. This is because I have Type One Diabetes.  I must have my very own Standard Operating Amended Procedures!

To be exam prepped and ready I come equipped with my diabetic expedition survival kit. This is literally what I would need if ever I happened to be ship wrecked on a desert (or dessert) island.

With this kit I reckon I could last an extra 2 days, at least from a diabetic standpoint not taking into consideration the threat of a lack of drinking water and dangerous animals.

It also means that I can sit in a 3 hour Cambridge A-Level Accounting exam and survive from a diabetic standpoint not taking into consideration the threat of not having done enough revision.

In the kit, I have my blood glucose meter, lancets, testing strips, sweets, alcohol swabs, sweets, constant glucose monitor reader, sweets, insulin, sweets, phone and a good luck mascot.

In addition to abiding by my Standard Operating Amended Procedures, I must also prepare for a number of situations should they arise.

The feeling of stress is inevitable come exam season no matter who you are. Stress is not a carbohydrate but can affect a Type One Diabetic’s blood in the same way as a carb would.  The experience itself can cause your blood to rise similarly to how eating a carbohydrate would.  How sad is that, my glucose spikes and I haven’t even tasted a thing.

The following table gives you an insight to my stress level, what it does to my blood sugar and what I would have to eat (provided no insulin) to cause the same effect:

A way to reduce your stress and reduce blood sugar spikes is to revise using high quality notes. Big thanks to the team at ZNotes for helping me to reduce my blood sugar during my Cambridge AS-Level exams. You guys helped me smash my Psychology papers.

On a final note, did I mention that I need to bring sweets into the exam hall? It’s not all bad being a Type 1 Diabetic.

Glucose upon publishing: 5.4 mmol/L

Karbohidrat Mengira

Any Type One Diabetic is automatically inducted into the carbohydrate (carb) counting club. A wizarding world of numbers and mental arithmetic that involves a good gut feel for ratios.  A good set of measuring scales really helps too.

We carb count because the digestive system, with the assistance of insulin, breaks carbs down into glucose to be used as energy by the body. With T1D, we need to balance the amount of carbs we eat with the right dose of insulin as our pancreas isn’t producing any.

We therefore need to be able to tell how many carbs are in what we are going to eat. This can be found on a food’s packet and entails reading many, many nutrition labels that bear teenie teenie tiny tiny stats and information. 

You can imagine that this is a little trickier for me in Malaysia where the food labels are often in Bahasa Malaysia (the local lingo). I admit that I need to brush up on my Bahasa Malaysia but I am pleased to report that I’ve gotten better. Pre T1D diagnosis, I could confidently say the word prawn (udang) and hair dresser (kedai guntung rambut). Post T1D diagnosis, I have added the word for carbohydrate to my vocabulary (karbohidrat) and counting (mengira). Yeah! 

Karbohidrat mengira sounds easy but there are extra challenges I face living here. Street food is a big part of Malaysian culture which must be embraced by all, even a Type One Diabetic which is why I wanted to blog on this subject.  Freshly made street food does not come with any labels and clues as to their karb content.

Luckily enough, I was gifted a chart by a Malaysian dietitian outlining Karb estimates for some staple favourites that I’d like to share with you:

The man tou – a Chinese steamed bun said to contain 25 grams of carbs. These buns do not tend to vary in size but do in taste, some sweeter than others. This is where you must be careful because the carb content will differ if one bun is sweeter than another.

Fried chempadak – Said to contain 30 grams of carbs, these are deep fried pieces of jack fruit. Has a very distinct smell. A favourite of my friends’.

Char Kuey Teow – In Hokkien (a Chinese dialect) char means “stir-fried” and kuey teow are “flat rice noodles”. A portion is said to contain 76 grams of carbs.

Nasi Lemak – From Malay cuisine, consisting of coconut rice, crispy anchovies, sambal (chili), toasted peanuts and a boiled egg. 58 grams of carbs in a portion.

Roti Bom – A personal favourite of mine. Resembles a pancake that swims in a puddle of condensed milk. From personal experience with trying to manage the carbs in this one with insulin, it is best to stay away from the roti bom. One roti bom is supposed to have 35 grams of carbs. Roti Bom more like carb bomb.

Gluscoe upon publishing: 6.0mmol/L

Argy-Bargy Onion Bhaji

At the weekend we sat down for a dinner at our favourite Indian restaurant called Sri Ananda Bahwan, an institution in our area.

As a diabetic, it is quite difficult to navigate such an exotic menu. I have to be conscious of the carbohydrates I am eating. Picking dishes that have fewer carbs will make my blood sugar level easier to control with insulin.  

Choosing the right dishes to eat requires will-power.  I have to steer away from that delicious looking naan that seems to somehow call my name…” Antonia, Antonia eat me!” Not today Mr Naan.   

Having been to this restaurant a few times since being diagnosed, I have established a few don’ts for me:

  1. Don’t order a Milo Ice – this is an iced milo, or chocolate drink, that is divine on account of the condensed milk that that the milo drink swims in. Condensed milk is bound to make my blood sugar level go haywire.
  2. Stay clear of Mango Lassi –  a mango and yoghurt drink. Again extremely sweet. Mango has many carbs making it an unsuitable choice. They may even sneak some condensed milk into this one too. Everything tastes better with a bit of condensed milk.
  3. No to the Naan bread – Naan, nah.
  4. Avoid super saucy curries – e.g. Korma killer.
  5. No argy-bargy if you avoid that onion bhaji!

On this occasion, the waiter came over and brought us some complimentary jalebi for dessert, yum. For those of you who don’t know what jalebi is, it is a fluorescent orange Indian sweet that has been deep fried and then soaked in sugar syrup. It took a while for my father to convince my brother that jalebi is not made of carrots (nor is as healthy) and therefore really quite edible.   

The waiter stabbed the last jalebi with a fork and extended his arm towards me. I declined. Never in his years of serving customers had someone declined a complimentary jalebi. I tried to explained that the sugary delicacy was a no go. There was no knowing what such as sweet could do to my blood sugar levels.

He looked at me with the saddest eyes. My Dad thought he saw the waiter’s eyes almost water.  He clearly couldn’t imagine a life without jalebi, however, I don’t think he really understood the issue because a few minutes later he returned with complimentary gulab jamun.  Gulab jamun makes jalebi look like a cake walk for a diabetic.

Glucose upon publishing: 5.4mmol/L

PS I am delighted to report that my tactic of taking my curry beating insulin shot 2 hours after my last mouthful of curry worked a treat and my glucose didn’t go above 10mmol/L.  The timing of insulin shots after meals is one of my new developing skills which I will write about on another occasion.  I think it could be my secret sauce…..

Quiz – which one is which?

Snail versus Schwarznegger

“I’ve sent you an email,” said my younger brother. He smiled. I wrongly assumed that it would be a video of him firing a tennis ball past me from our latest on court battle (which I always win) or details of some trending dance fad. 

To my surprise I found an article attached titled “Snails are helping us unlock faster insulins”.  It was a interesting article about a species of snail called Conus Geographus aka the cone snail.

Let’s imagine a fish. This fish isn’t ordinary. This one is the Arnold Schwarznegger of the fish kingdom.  This fella might be small but he’s got shredded fins and ripped scales. No one messes with him. 

Now imagine a hungry cone snail cruising along in search of a meal.  It identifies the aforementioned “Mr Atlas” of the fish world and goes in for the kill, swallowing Arnie up whole. Hold on!  A cone snail going in for the kill sounds a bit bizarre……

I take a fast-acting insulin at meals times to prevent my blood glucose from soaring upwards causing hyperglycaemia. Although “fast-acting”, the insulin does take time to start working and because of this time lag, my blood sugar may rise and become high. It is quite tricky to get it right. Note that hyperglycaemia is very bad as it can lead to permanent damage to my eyes and other vital organs.

An even faster acting insulin could be more effective but I would need to be careful as it could potentially send my blood sugar way too low causing hypoglycaemia. If I was to go into a hypoglycaemic state I might not be blogging for a long time.

This is where our snail comes in… Amazingly the cone snail secretes a fast-acting insulin that sends Arnie the fish into a state of severe hypoglycaemic shock. In other words, it makes his blood glucose plummet and he becomes temporarily paralysed leaving him unable to avoid being swallowed whole by our snail.  It effectively makes the fish a type 1 diabetic who injected too much insulin! Wow. What an assasin.

The cone snail’s insulin lowers blood sugar much more quickly than my insulin. Its speediness means that it could well be a replacement for the insulin that I currently use. Imagine that, snail insulin in my body ewwww!

Rather unhelpfully my brother suggested I get a snail and lick it whenever I’m about to eat. No thank you.

Glucose upon publishing: 7.3mmol/L