My Diabetes "Tech"

As previously mentioned in my basic rundown of Diabetes, it all revolves around blood sugar levels. Of course, to measure the actual blood sugar level, you need blood. At least, that was the case until a few years ago, and it's still occasionally necessary today.

The traditional procedure involves a small needle to prick the tip of your finger to draw blood, which is then placed onto a special strip of paper. A device measures the blood glucose based on a color-change reaction. This was perhaps the most irritating experience during my initial days in the hospital, both for me and the hospital staff. As a climber, my fingers possess such hard skin, especially at the tips, that it took quite some time to find a lancet device able to penetrate the skin without ruining my fingertip – every climber's worst nightmare.

Hence, transitioning to a modern Continuous Glucose Monitor (CGM) to track my glucose level was a game-changer. This device, usually attached to my upper arm, can be spotted in many of my climbing photos, often covered with a patch of tape to prevent accidental removal. It has an ultra-fine needle that's inserted into the adipose tissue under my skin, where it measures the glucose levels in the interstitial fluid (the fluid between cells). This reading is then continuously sent to my smartphone or even my watch, enabling me to monitor my glucose level continuously and react according to the measured values.

The smart phone app can even activate an alarm based on particularly high or low values. The sensor, though, has to be replaced after every 10 days; I typically alternate arms for this to allow my skin the best possible healing time.

For insulin injections, I use a modern pen, which is a welcome alternative to traditional needles and makes it tremendously easier to administer the right amount of insulin units – it's a subcutaneous injection that I typically apply to my waist. This can be tricky when my body fat percentage is particularly low. I also inject into my upper leg, especially for my nightly insulin dose. Injecting myself isn't pleasant, but it's something you grow accustomed to, and I do it wherever and whenever it's necessary. From the onset of my Diabetes journey, I'd resolved to neither hide nor feel ashamed of my condition. So don’t be surprised if you see me at a table in the restaurant, talking and suddenly lifting my shirt und casually setting an injection😉.

Understanding the types of insulin can be complex because there's an array of differing products with distinct effects. These types are often used in combinations that vary from individual to individual. I've found that the best regimen for me involves three different types – one "basal" insulin and two "bolus" insulins:

1.      I utilize insulin Levemir (a "basal" insulin), which releases insulin into the blood over approximately 12 hours at a constant rate. Such longer-lasting insulin is very beneficial as it copes with the ongoing release of small amounts of glucose into the blood, like from slow-digesting food, the liver or the effects of other hormones, such as Adrenaline. However, it's facile to stumble into a 'low sugar' situation if you've taken too much as it can't be 'turned off,' and you'll need to balance it out by consuming sugar,

2.      The "bolus insulins" help balance out the glucose intake from meals. NovoRapid, one of the insulins, takes around 20 minutes to enter the bloodstream and releases completely over approximately 2-3 hours. As such, it's crucial to take it well before meals or run the risk of temporary high blood sugar levels.

To counteract high blood sugar levels owing to insufficient pre-meal insulin or excessive food, I use another insulin, Fiasp, which gets into the bloodstream almost twice as fast, enabling me to rectify my blood sugar levels quickly.

Originally, I intended to use only Fiasp as bolus insulin, eliminating the need for NovoRapid. However, after experiencing problems with hypoglycemia after big meals due to slow digestion (the insulin was faster to the blood than the carbohydrates being digested), I went back to using both, achieving much better results.

Thus, it's the insulin pens and my glucose level measuring device that serve as the chief and indispensable tools for my daily life. Since the CGM is fastened to my arm, forgetting it isn't an issue. As for my smartphone that displays the values, it practically feels like an extension of myself. However, the insulin pen is an item I have to remember to take with me whenever I leave home, whether it's to train, go to school, or hang out with friends.

For completeness, I'll detail what else I require for prolonged travels:

·        The needle lancet (with enough spare needles) and blood glucose measuring device, with sufficient test strips – in some cases it's vital to know the actual blood glucose value, not just the one measured by my CGM.

·        An emergency drug for severe hypoglycemia scenarios – I carry a nasal spray, which is incredibly easy to use (for the person administering it, certainly not me, as I'm unconscious at that point). Fortunately, I haven't needed it so far.

·        Lastly, depending on the trip's length, I carry reserve supplies, including:

o   1-2 additional CGM sensors,

o   Spare needles for the pens – as I set up to 8 injections per day (usually less), quite a lot for a two-week trip,

o   Insulin reserves for the three different types – it's quite embarrassing how often I prep these reserve ampules in our fridge the day before a trip, only to forget them the next morning! Including a very hectic (but successful) attempt to buy the supplies at the Frankfurt airport prior to my flight to my first Youth World Championship in Russia in 2021 – my Dad now knows where the medical support staff is at the airport and how to run there very quickly😊 

All of this amounts to quite a large package, which must be part of my carry-on luggage when flying, naturally. How I deal with this in more detail is part of an own blog later.