Last year I wrote about giving myself permission to let my hair down and the risk of mental stress and burnout which can come from obsessing with food. Today is again my diaversary and I write this in the early hours (travelling to ATTD 2023 in Berlin last week has made me an early riser) with the day ahead of me. Am I going to go big this year and “release the steam valve”? Actually, no.
A Year Is A Long Time In Diabetes
A lot has changed in the last 12 months. A little under a month after writing last year’s article I got my HbA1c results and they were trending the wrong way. While my HbA1c was “only” 6.6%, I had already drawn my line in the sand as 6.4% with 7.0% at the outside so I began using insulin. I went through the usual process of working out my “numbers” but really did not find success in multiple daily injections and, by the start of August, began looping via AndroidAPS. Today I am using a Dexcom G6 and an Ypsopump, connected via CamAPS. It has been quite the journey.
So Why No Blowout?
The fact of the matter is, for me, the looping rig has removed almost all the management. Pre-insulin, especially towards the end of that phase, every meal had an element of stress to it. I follow a lowish carbohydrate regimen (I do not carb count but avoid the foods which will spike me or eat them in moderation) but, despite this, was seeing big numbers. Using multiple daily injections was not much better. Estimating carbs was not a big deal but getting enough insulin in to get past the insulin resistance AND keep the numbers flat was difficult with lots of sugar surfing.
Looping has addressed all of this. With some residual pancreatic function still in play I can set the pump looping and do not even have to declare meals. If I stray from the path of lowish carbohydrate my numbers go up but the loop responds and they soon come down again relatively quickly. The only management I do is an insulin cartridge change every couple of days and an infusion set change every 3-4 days. I check in on my glucose levels throughout the day but this is more curiosity than anything else.
I literally go for hours every day without thinking about diabetes, seriously.
Without the shadow of diabetes hanging over me, the latent stress is gone and, while a milestone of sorts, today is just another day. I imagine, as it is Friday, we will go out for a nice meal but I doubt I’ll go much more wayward than having a cheeky dessert.
What About Your Numbers?
It is well and good lauding looping but the proof is in the low-carb pudding. How are my numbers holding up? I had an HbA1c test a couple of weeks ago and it came back as 5.5% which is a great turnaround. My Time in Range (70-180mg/L 3.9-10 mmol/L) moves between 90-95% and my Tight Time in Range (70-140mg/L 3.9-7.8 mmol/L) generally sits between 75-80%. I will be writing a separate article on Tight Time in Range which was a big topic of conversation at ATTD 2023.
Is there room for improvement? Absolutely, and with zero hypos (I did stray a little low once with all the walking around Berlin but generally none ever) I am slowly making the loop more aggressive by setting a lower target (currently 5.4 mmol/dL) and adjusting the IC ratio.
Why Looping Is So Exciting
Burnout is a big deal for people with diabetes. Suicide is a big deal for people with diabetes. I could quote numbers but you can Google just as well as I can.
While it should be noted that there was much talk at ATTD 2023 of the next generation of looping eliminating the need to bolus for food, I am an exception. The majority of the loopers I know, who have little to no pancreatic function, still need to declare meals/bolus. Nonetheless, if looping can bring some of the mental relief to others as it has to me I have no doubt it will impact suicide rates, meaning less dead people with diabetes and also impact burnout rates meaning better control/management and less long term complications. The jury will be out for literally decades on whether my hypothesis is true or not but I am hopeful.
Next Year?
It is hard to say. I have no doubt my residual pancreatic function will dwindle over time but with the pump pouring insulin into my body, my pancreas is working a lot less than it did a year ago which should help maintain it. Assuming my pancreas holds up, my seventh diaversary should be similar to this one. If not, by then the looping algorithms will have improved and, as I am still using Novorapid, there is also the option of the faster acting insulins to assist. I am hopeful for my future and the future of all people with diabetes.
The Practical Diabetic 