Tips for Successful Continuous Glucose Monitoring

Image obtained from Medtronic.

Location, Location, Location

Choosing the right location is the first important step to ensure you get the most out of using continuous glucose monitoring.  It is a good idea to place the sensor on the other side of your body to your infusion set.  The sensor needs to be sited in a position where it won’t get bent or have pressure placed over it, so keep it away from areas covered by tight clothing, such as a waist band, or an area of your body that you tend to lie on at night. If you sleep on your back, wear your sensor on your stomach. If you tend to sleep on your stomach and sides, the upper part of your bottom would be the better location.  Those people who get the most extended wear from a single sensor -the longest being 9 weeks – use their thigh or arm.

Remove the tape first

Once you have loaded the sensor into the One Press Serter, turn the inserter upside down and gently remove the paper backing tape.

Insertion

Have the thumbprint on the inserter pointing to the ground when inserting a new sensor. This way the transmitter sits on top of the sensor, rather than on the side, resulting in less movement to the sensor. Remember to use gentle pressure and don’t push the inserter too firmly onto your skin as this will increase the risk of bleeding.

Calibrations

Each time you insert a sensor it will go through a warm up period. This can take up to two hours. Your pump will then tell you it’s time to calibrate. The first two calibrations are SO important because they set up the sensor life.  Do the calibrations before you have something to eat, when your blood glucose level is more stable. It is also important that you use the Contour Link meter when calibrating.

It is best to do the first calibration as soon as the pump tells you to. If you have just eaten, you can insert the sensor and wait for the sensor to be recognised. Then turn the sensor settings on your pump OFF. Turn the sensor setting ON when you are sure your BGL is stable.  Give the pump some time to find the sensor and it will then ask for your first calibration- warm up will be skipped.

A second calibration is required within 6 hours of the first.  We suggest you do the second calibration as soon as pump has finished processing the first calibration. Doing the first two calibrations back to back improves the accuracy of the sensor.

The sensor needs at least one calibration every 12 hours so if you don’t want to be woken up in the middle of the night always calibrate before bed.

Once you have your sensor up and running you should calibrate three times each day

  1. When you first wake up (before breakfast)
  2. Before lunch
  3. Before bed

You can also calibrate before dinner if you like but DON”T use every BGL reading to calibrate if you are checking your blood glucose levels more frequently than this.  Calibrating after a meal, when your glucose level is changing quickly, will only stress your sensor (and you)!

Are you eating enough fruit and veg?

A new survey by the CSIRO of nearly 146,000 Australians has found that we’re still falling well short of the recommended intake. In fact, the survey found that only one in five of us are meeting the guidelines of two portions of fruit and five portions of vegetables a day. Hopefully the guide below will help you to become one of those five.

 

Travelling with Diabetes

I am currently spending half my life on a plane, travelling up and down the Eastern seaboard giving talks at various conferences. You would think that I would have the security check thing down pat but I am always setting off the alarm or leaving something behind. Imagine if I had diabetes and I misplaced my insulin pump!

Thankfully you don’t have to disconnect your pump or your continuous glucose monitor to walk through an airport metal detector – they won’t trigger the alarm. Don’t be tempted to detach and put your pump or CGM through the x-ray machine as the x-ray can cause damage.  Likewise, with body scanners, although you are only likely to encounter these if your travel overseas. Ideally you should avoid being scanned and ask for an alternative pat down screening procedure. It is a good idea to carry a letter on you stating that you have diabetes and that you are wearing an insulin pump and/or CGM, even if you are only flying inter-state.

There is some concern that the change in pressure as the plane takes off and lands can result in some of the air that is trapped in your insulin forming a bubble. A sudden decrease in pressure causes the bubble to expand so that ‘extra’ insulin is forced out of the reservoir and along the infusion set. It depends on how sensitive you are to insulin as to what effect this ‘extra’ insulin has on your blood glucose levels. I know lots of people who wear their pump all throughout their flights, but to be on the safe side you might like to consider disconnecting from your pump for take-off and landing. You should be safe to reconnect when the plane has reached cruising altitude or touched down. Check your line before you reconnect and give a small bolus (you can use the fill cannula option on your pump) to check you have a flow of insulin. And don’t forget to change your time and date setting if this has changed.

 

Written by Jane Overland

Finding the right diet for you

I really don’t like the word ‘diet’.  It implies we follow something for a short period to lose weight and then we go back to ‘normal’ eating and the weight just piles back on.  What we eat isn’t just about weight loss.  It is about feeling good now, as well as staying well in the future.  It’s about sitting with friends or family and sharing good times over a meal. With this in mind, we should all be adopting a way of eating that fits in with the foods we like to eat, and who we like to eat them with.

A couple of weekends ago I had the pleasure of presenting at the Diabetes Expo 2017, held by Diabetes Australia’s Victorian Branch. It was a fabulous day, with over 3,500 people attending.  Together with some of Australia’s top nutritional researchers, I spoke in a plenary session, Demystifying Diets, which discussed the pros and cons of 5 different diet/eating approaches – Glycaemic Index, Intermittent Fasting, Sugar Free, the Mediterranean Diet and the CSIRO low carb diet. Every one of these diets has been shown to help lower blood glucose levels as well as help with weight control. They also have a positive effect on blood pressure and blood fats.

So, what is the right approach for you? It’s a bit like buying clothes – one size does not fit all.  Seeing a dietitian or other diabetes health care professional, such as one of the Total Diabetes Care team, can help you find what would work best for you. If the truth be known, there are some common features across all approaches; eat nutritionally rich food, eat to appetite, make sure you enjoy every mouthful of what you eat, and don’t waste calories on junk.

I have included a couple of the key points of each of the diet approaches below.


Glycaemic index

The Glycaemic Index or GI ranks carbohydrate foods based on their effect on blood glucose levels. The lower the GI, the slower the rise in blood glucose.

  • Low GI foods are foods with a GI less than 55.
  • Intermediate GI foods are foods with a GI between 55 and 70.
  • High GI foods are foods with a GI greater than 70.

As with all the sensible eating plans, no food is forbidden. You can include food with a high GI in your diet but, where possible, try to choose food with a lower GI. There are often low GI options for the things you like to eat.  For example, basmati rice and wholegrain or sourdough bread are low GI and can be used to replace jasmine rice and white, fluffy bread which have a high GI.  Trying to include a low GI food in each meal can help reduce how high and how fast your blood glucose level rises after meals. It can also help you feel fuller for longer, which is helpful if you are trying to lose weight.

For more information visit http://www.gisymbol.com

 

Intermittent fasting

Intermittent fasting involves lowering your food intake to about 25% of what you usually eat, usually between 1 to 4 days a week.  This equates to about 500 calories a day for women and 600 calories a day for men.  A popular approach is to ’fast’ for 2 days a week, and eat to appetite for the rest of the week.  There are several cookbooks around that provide example meal plans, such as the 2-Day Fast Diet by the Australian Woman’s Weekly.

In my research, participants used OptifastTM  shakes,, a medical grade meal replacement to replace all their meals for 2 days a week. As with any change to your food intake, you will need to talk to your diabetes team before you start an intermittent fast as your diabetes medications may need to be reduced on fasting days.

For more information visit https://thefastdiet.co.uk

 

Sugar free

There are numerous versions of the sugar free diet. The more extreme diets restrict all foods that contain added sugars, such as sugary drinks, cakes, biscuits, ice cream etc) as well as fruit and any vegetables that contain natural sugars.  Less extreme forms restrict food with added sugars but allow the inclusion of fruits and vegetables, but not fruit or vegetable juice.  The natural sugar in whole fruit and vegetables is ‘packaged’ with lots of healthy fibre and other nutrients and should be included in any healthy diet. Fruit juice, on the other hand, has had the fibre removed,
or reduced, so it is more calorie dense with less nutritional value.

 

The Mediterranean diet

The Mediterranean diet is not a single diet, as each of the countries that surround the Mediterranean sea has a unique style of eating.  Following the Mediterranean diet is easy if you follow these tips:

  • Use olive oil as your main added fat
  • Eat vegetables with every meal (include 100g leafy greens, 100g of tomatoes and 200g of other vegetables a day)
  • Eat at least two legume meals a week (250g per serve)
  • Eat at least two serves of fish a week (150-200g per serve), including oily fish such as salmon and sardines
  • Eat small portions of meat (beef, lamb, pork and chicken) less often (1-2 days a week)
  • Eat fruit every day and dried fruit and nuts as snacks or for dessert
  • Eat yoghurt every day and cheese in moderation
  • Eat wholegrain breads and cereals (limit amount if you are watching your weight)
  • Drink wine in moderation (1-2 glasses) and always with meals
  • Have sweets or sweet drinks for special occasions only

Adapted from ‘The Mediterranean Diet’ by Catherine Itsiopoulos, Pan Macmillon Australia.

 

The CSIRO Low Carbohydrate Diet

Based on emerging research from around the world, as well as original CSIRO research recently conducted in Australia, the low-carb diet has proved successful in managing unhealthy weight gain and type 2 diabetes. The diet lowers the proportion of carbohydrate relative to protein and unsaturated ‘healthy’ fat, and encourages participants to follow a regular exercise routine. The diet’s higher proportion of protein, balanced with low GI carbohydrates, helps to control hunger and prevent muscle loss during weight loss.  Grant Brinkworth, a leader researcher at the CSIRO, together with Pennie Taylor, have recently released a book ‘The Total Wellbeing Diet’ that provides menu plans and recipes to get you started.

Adapted from ‘The Total Wellbeing Diet’ by Grant Brinkworth and Pennie Taylor, Pan Macmillon Australia.

 

Written by Jane Overland

 

Frustrated by high blood glucose levels after meals?

Frustrated by high blood glucose levels after meals?  Want to get your glucose levels under better control?  Read on…

It is normal for the level of glucose to rise after you have something to eat, even in people who don’t have diabetes, but the rise tends to be small.  If you are reading this I am sure I don’t need to tell you that having diabetes means your blood sugar can shoot up after meals and having a high blood glucose level can have a big impact on how you feel today. It can also contribute to your risk of long term health problems in the years to come.  The trick to feeling your best, and staying health in the future, is to recognise and try to stop the spike.

It is all a matter of timing.  In a person who doesn’t have diabetes, as soon as they eat, their gut and pancreas release hormones to slow the movement of food through their gut, so the glucose is absorbed more slowly, and any glucose that moves into the blood stream is quickly packed away into the different cells of the body to be used as energy later.  If you have Type 2 diabetes your body still makes these hormones, just not enough. In Type 1 diabetes, you don’t make ANY insulin so you are relying on this insulin you inject to pack the sugar way.  Stopping the spike can be about WHEN you take the insulin rather than HOW MUCH insulin you take.

A bolus or injection of rapid acting insulin takes around 15 minutes before it starts to work and between 60 to 90 minutes to peak. If you take your mealtime insulin just before you eat the chances are you don’t have enough insulin available when the level of glucose in the blood starts to build up. Once the insulin finally kicks in it needs to drag your glucose down from a much higher level and that can be hard to do.

The exact timing of the post meal rise can vary from person to person but the blood glucose level tends to reach its peak at 1 to 1½ hours after eating. Taking your mealtime bolus or rapid acting insulin injection half an hour before you eat can better ‘match’ the insulin to the blood glucose rise, although it is important to make sure your blood glucose level is not too low before doing so.  Some meals, such as pizza, which have a ton of carbs and fat, are probably better addressed by taking the meal time insulin as a combination or dual wave bolus, if you are using a pump, or taking your meal time injection just before you eat because the glucose from this type of meal tends to enter the blood stream at a much slower rate.

Checking your blood glucose before, as well as 1 and 3 hours after a meal will help you work out the right dose and timing of your insulin for your meals.  You might also like to try continuous glucose monitoring (CGM).  CGM uses a tiny filament inserted just under skin which is then attached to a transmitter. Depending what system you are using, the transmitter sends information to your smart phone or a CGM receiver. The sensor measures the glucose in the tissue under your skin every few minutes and provides a trend graph that makes it easy to see exactly what happens to your glucose levels after meals. It also lets you know if you are dropping low or spiking overnight.

At Total Diabetes Care we are lucky enough to have several CGM systems that we can loan you and we are currently offering you the chance to trial CGM for just the cost of the sensor ($100).  We will also spend time with you after you have worn the sensor to help you and your referring doctor identify strategies to smooth out your blood glucose levels. Send us a message or contact us via our website if you are interested in doing this.

 

Written by Jane Overland

5:2 Diet

You would think with all the cycling I have been doing I would be fading away, but the truth is that weight loss is 80 to 90% about the food you eat. There are countless diet approaches out there, some are nutritionally sound while others are not.  The trick is to find the right (nutritionally sound) one for you.  The CSIRO diet works for some, others swear by the Mediterranean diet, while others have had great success with the traditional ‘just eat less everyday’ approach.  For me, because my social life revolves around catching up with friends for a coffee or a meal, it’s intermittent energy restriction. The 5:2 fast diet, a form of intermittent energy restriction, became all the craze a few years ago after Michael Mosely, a UK based medical reporter, was featured on the ABC Catalyst program. The 5:2 fast diet involves lowering your food intake to 500 calories a day for women and 600 calories a day for men, 2 days a week, and then eating to appetite the rest of the week.  Enough of the people I see were interested in trying this diet that I joined with colleagues at the Royal Prince Alfred Hospital and The University of Sydney to conduct a pilot study to see if intermittent fasting was safe for people with diabetes. We hope to present our results at this year’s American Scientific Meeting in San Diego.  So far we have had good success with intermittent fasting, in both people with type 1 and type 2 diabetes, but it is important to work with your diabetes team if you want to follow this diet.  You will probably need your diabetes medication adjusted. You will also need to keep a closer eye on your blood glucose levels, although these two things are true of any change in your diet. Let me know if you would like to know more about the 5:2 fasting approach or if you want help finding a diet approach that is right for you. If you live in Victoria, I would love for you to join me at Diabetes Victoria’s Diabetes Expo on Saturday the 25th of February.

 

Written by Jane Overland

“Normal” blood sugar levels

Just because you feel okay with a blood sugar level of 2mmol/L does not make it safe.  In the last week I have seen a number of people with type 1 diabetes who have been striving to keep their blood glucose levels as close to normal as possible to try to reduce their risk of long term complications, but at the expense of severe and sometimes life threatening hypoglycaemia.  Aiming for an HbA1c of 6.5 to 7.0% may be doable in the initial years of living with type 1 diabetes but your ability to recognise low sugars, and your body’s ability to protect you from them, starts to lessen over time.  Achieving an HbA1c around 7% in the first five to ten years will lay down a solid foundation.  We know from research that this will help to protect you from long term complications for many years, if not decades, to come.  But after that you may need to change your goal.  New technologies, such as insulin pumps or continuous glucose monitoring, can also make it easier for you to stay safe.  You should talk to your diabetes team about what the right goal and the right treatment is for you. You are also welcome to contact us at Total Diabetes Care.

 

Written by Jane Overland

Integrative Health Coaching

It is only day two of the New Year and I have already broken my New Year’s Resolution. Chances are I am not alone; only 8% of us are able to successfully stick with our pledge.

Integrative Health Coaching has been shown to significantly increase our chance of success. That’s why we are delighted that Fiona Capstick is a member of the Total Diabetes Care team. Fiona worked for many years as a Diabetes Nurse Consultant at the internationally acclaimed Royal Prince Alfred Hospital Diabetes Centre in Sydney before traveling to the United States and branching out into Integrative Health Coaching.  She underwent extensive training and certification at the Integrative Medicine Centre at Duke University.  Fiona is highly regarded by those who know and work with her. She has kindly provided us with this post talking about Integrative Health Coaching and whether it might be right for you.

When it comes to making impactful changes, many of us have tried in the past, but for a variety of reasons have not been able to sustain those changes beyond “an initial burst”. Lets face it, if bringing about long term change was easy then we would all be walking around at our ideal weight with a perfect blood pressure and no stress in our lives!

An Integrative Health Coach works as your partner to help you plan and make positive changes to your health. We help you think about what is important across all aspects of your life, including your health. We work together using a practiced process to help you to develop a personal health plan and to set realistic goals based on what is important to you. Working one-on-one, usually over a three month period, you receive support, develop practical strategies and get the resources you need to work towards make long lasting change.

People partner with Integrative Health Coaches for a variety of reasons.  Maybe you feel stuck or overwhelmed and you are now ready to try new approaches to making lifestyle changes. You might feel that now is the time to take charge, make a plan and get the support you need to live a fuller and healthier life. Perhaps something new or exciting is on the horizon, such as the beginning of a relationship, a new job, or you are planning to get pregnant and you want to take some time, in a structured and supported way to look at all aspects of you health and be better prepared for the next phase. You may have just been told you have diabetes or you are beginning a new phase in your treatment, such as starting a new medication, and you decide to take some time to look at your diabetes and how it fits with the rest of your life.  Integrative Health Coaching could be right for you for these and many other reasons.

 

Written by Jane Overland