Friday, 3 June 2016

Run sick-boy run!

There is a stigma around type 1 diabetics... that they can't do much, can't do some exercise, can't be left alone, can't eat anything, can't look after themselves, .. they are sick... very sick... I mean, they have to take injections every day to stay alive. Well, I'm a type 1 diabetic (T1D) and I want to tell you this stigma is all wrong. Yes, we do need extra management 24/7, but that makes us smarter and stronger. My pancreas is not producing any insulin, but that is not going to stop me from living an active healthy life.

My brother and sister-in-law ran the two oceans ultra marathon twice and did well in the Comrades marathon. Inspired by them and Val Opperman (Also a T1D) who ran the Comrades and the great wall of China marathon, I decided to start with a bit of running. I started off not very fit, the last time I seriously ran was way back in 1997. Other than that I just did a bit of hiking and lawn mowing. You can follow my running adventure on strava where I will be giving my T1D details for each activity. I don't know the answer to all T1D exercise questions and will be learning on the go.

Some of the challenges for a T1D before/during/after exercise:
  • Any injected insulin on board the body can not be removed and can cause a rapid fall in BG while exercising. Hypoglycaemia can make you unable to think or move. Even the long acting insulin can cause hypo's during exercise. 
  • Without insulin production, an adrenalin rush will spike blood glucose (BG) quickly to extremely high values.
  • After exercise BG can keep on falling for hours and hours.
  • So, a T1D needs insulin, even during exercise, but it gets tricky to manage. Everyone differs and what works for one might not work for another.
  • It seems that carbs need to be consumed at regular (15-30 minute) intervals during exercise to keep BG stable.


My T1D survival running equipment can be seen in the image, which adds another few kilograms to my weight that I need to carry with me on the road:

A. Dexcom sensor. Inserted in my upper arm.
B. Dexcom transmitter. Connects to the sensor and retrieves a BG value every 5 minutes.
C. xBridge device. Captures the signals transmitted by the transmitter and sends it to my cellphone.
D. Cellphone. Retrieves the BG values from the xBridge device. Reads out the BG values with maximum volume and uploads the values and my location to the internet. I use xDrip+.
E. Emergency power bank in case of any flat battery issues.
F. LifeQ wrist based sensor. Logging raw data and things like spo2, vo2, epoc, blood lactate, ...
G. Garmin watch. Keeping track of my location, pace, distance, cadence, ...
H. Chest strap heart rate monitor. Connects to the Garmin watch.
I. Camelbak dart 1.5l hydration backpack. All the other items are placed inside the pockets of this backpack.
J. Energy bar. Placed in a pocket of the backpack that can be easily reached while running.
K. DexD tablets. Fast acting glucose tablets.
L. Camelbak bladder. Filled up with an energy drink like powerade, energade or lucozade. Can easily take a few sips without stopping. Keep my hands free.
Z. Things not shown in the image. Insulin pen if I need to inject for some reason and glucagon kit in case I can't get my BG up.

Friday, 1 April 2016

10-year diaversary!

I was diagnosed in March 2006,.. that calls out for a ten year diaversary! I have a lot to be thankful for, a lot has happened during these 10 years. I could have been dead, but I'm alive. It is a crappy disease, but I'm more convinced than ever that there is a greater purpose of me being a T1D. The past year has been amazing, I don't really have words to describe it. For the first time in 10 years my HbA1c tested below 6, at a value of 5.9. Below is a screenshot of my desktop, showing the real-time glucose graphs of 4 T1Ds wandering around somewhere in the country (2x in Johannesburg, 1x in Cape Town, and me in Pretoria). If you would have told me a year ago that I will be sitting at my desk and watch the glucose trends of these 4 individuals in real-time... I would have laughed and told you "NO Way! Seriously ? Is that even possible ?!". A year ago I was used to only finger pricking tests, missing lots of highs and lows at crucial times. I knew there were something called a CGM, but it was always way too expensive and not available in our country and it seemed like you need to have a pump to possibly get the CGM. So, my life changed when I randomly (I don't really believe in random, things happen for a greater purpose) stumble across a page that advertised the FreeStyle Libre... thereafter I discovered the Dexcom, xDrip, Nightscout, .... technology explosion..



I've been switching over to xDrip+ (plus). With the plus version you can log insulin and carb intake. The insulin logging is especially useful when you quickly want to see how much insulin is still going to be released and when. Rapid insulin takes about 2-3 hours to completely be used up, if glucose values still rises after that, it indicates that you did not inject enough for the food you ate. Sometimes when injecting multiple times within 2-3 hours can also lead to a stacking effect that can become dangerous if not monitored. The logging helps making more intelligent decisions in order to prevent stacking. xDrip+ can be found here: https://github.com/jamorham/xDrip-plus
Below is a few screenshots of xDrip+ in action. The green line at the bottom shows the insulin on board. The middle image shows a case where values started to go up when the insulin was depleted (in the middle of the night).


I also integrated a wixel and BLE module directly with the battery of a vodacom smart kicka cellphone, which basically replaces the need for a Dexcom Receiver. xDrip runs on the phone and uploads the data to be viewed on a Nighscout website and pebble watch. Image of the integrated device below.


I will end this post with a lame video I made a while back showing the options to get your Dexcom G4 connected to Nightscout for remote monitoring.


Thursday, 21 January 2016

Text-to-speech Awesomeness and Recent Developments

Text-to-speech

It's been a few months since my previous blog post. A lot has happened. A lot has happened with the xDrip android application. The most awesome and amazing feature that was added by Adrian Mittermayr is the text-to-speech feature. This feature reads out loud the glucose value. Why is this so awesome ?

  • I can know my glucose level without looking on a watch or cellphone or perform a finger prick.
  • I can exercise, mow the lawn or drive in a car without taking my eyes off the road and still know what is going on with my glucose levels.
  • It constantly reminds me to be aware of going low or high.
  • The people around me can know what my value is and can better understand my behaviour or know that they should help in-case I'm going low.
  • If I'm unable to speak in case of an emergency, the emergency personal will realize what is going on when my cell-phone tells them my glucose values out loud.

Blood Glucose is NOT constant

Just a reminder for those that don't understand glucose levels, it is not constant and it changes all the time, especially if you are diabetic. If you perform a single blood glucose test and your reading is within the normal range, it doesn't mean that you are not diabetic. Below is a graph (click on it for a larger view) of my glucose levels for a period of 60 days, it was within normal range many times, but as you can see the values were not the same for the entire 60 days.


Sensors can easily last 3-4 weeks

My dexcom G4 sensors are lasting an average of 3-4 weeks. I eat, sleep, walk, swim and shower with them without problems. For those that don't know, you can't take the sensor off and put it back on again, once it's off it's off and you need a new one. My strategy to make it stick goes like this (week-by-week):
  1. Use the sensor as it is, no extra adhesive or anything. I always insert the sensor at the back of my upper arm.
  2. Add tegaderm over the sensor. I first cut a hole into the tegaderm that fits over the transmitter. The tegaderm only sticks to my skin and white sensor adhesive part.
  3. I place a cut open sock on my arm and over the sensor. Whenever I swim I also use this sock strategy.
  4. Just keep on using the sock until I see too much sensor noise or when enough is just enough.

You can remotely monitor glucose in South-Africa

Yes, nightscout works in South-Africa, don't let anybody tell you you have to wait for G5 or that we don't get it here. #WeAreNotWaiting !! I have successfully configured nightscout for many people right here in SA with the standard Dexcom G4. If you don't know about nightscout, have a look at the website http://www.nightscout.info/. If you need help getting it set-up and configured, contact me and I can help, no extra cost, just do it.

Exciting sensor developments

I'm secretly wearing another secret non-invasive set of sensors which is collecting data from my body 24/7 minus some battery charging time. Hopefully this will lead to some exciting useful technology that will make CGM style sensors more affordable to all. Unfortunately I'm not allowed to share much more information regarding this... yes... this is local... going to happen here in SA.... #OnsGaanNieWagNie!