Gráinne F

Blogger and Diabetes Advocate

My name is Gráinne. I’m Irish and have lived in Ireland for most of my life, except for four years when my Minnesota-born husband dragged me over there to live there. Brrrr. I was diagnosed with type 1 diabetes in 1993 when I was 20. I work part-time in sales, have two children and volunteer any spare time I have toward creating a peer support conference for people with type 1 diabetes called Thriveabetes.

I write a blog about my life with diabetes called Blood Sugar Trampoline. I think that might give you an indication as to how I manage to stay “Between the Lines - with great difficulty. However, even though my blood glucose numbers bounce around a lot, life is much more manageable since continuous glucose monitoring came into it three years ago.

For most of my life with diabetes, I have relied heavily on websites like DiabetesSisters, books, and blogs to learn how to best manage diabetes. The standard of diabetes care in Ireland is very dependent on where one lives, and those living outside of a few specific areas can experience a poor standard of care. This makes living with type 1 diabetes as an adult quite challenging.

However, all of my diabetes medications and supplies are free, so I don’t worry about the financial cost of the disease. It is one of several health conditions that is included in a government-sponsored scheme called Long-Term Illness (LTI). I’m also fortunate that my health service funds my insulin pump and continuous glucose monitor (CGM), but I did have to push hard and work the system to get them. It was definitely worth paying an endocrinologist to insult me for 18 months before she prescribed me an insulin pump.**

While most adults with type 1 have access to a diabetes specialist nurse, it is often not a nurse that has received training about counting carbohydrates. Most of us don’t have access to a dietitian. Clinics in Ireland are chronically understaffed.

I learned carb counting when I was living in America in 2003 before I was pregnant with my first child. I fine-tuned those skills through books and websites because after returning to Ireland, I no longer had access to a diabetes dietitian until 2014. I also fine-tuned my start-up training on my insulin pump by reading as much as I could, including tips and techniques others use.

Not having access to diabetes educators who were trained in carb counting or insulin pumps made figuring all those things out difficult – if I had a question there was no one to ask. Back then, I figure my glucose levels were probably in range 50 to 60 percent of the time. This is a pure guess, as I had no way of knowing because I didn’t have a CGM. So, I would only concentrate on my before and after meal blood glucose readings: if they were out of range two days in a row, I would make adjustments to my insulin intake. If that didn’t work, I tried another adjustment.

As for target glucose levels, I’ve had many conversations over the years with healthcare professionals about my targets. The only time I ever paid any attention to their recommendations was when I was pregnant. My self-imposed targets are a combination of what is recognized as best practice, what’s realistic for the life I live, and whatever the number on the meter is. As we say in Ireland, sometimes, it is what it is, just move on.

I love the convenience and flexibility of my pump: it gives me more options to keep my levels “Between the Lines”, a target goal I have created for my management. I can target the specific time of day that is out of range and do a small tweak in the background insulin programme or adjust a meal bolus. With insulin pens, typically the only option I had was to adjust one of the two doses of long-acting insulin I used to take and hope that it targeted the right time of day.

However, the tool that has made the biggest difference in my ability to keep my numbers between the lines is my CGM. The guidance of real-time glucose information trend arrows is so valuable. I cannot ever imagine going back to finger stick checks alone. I’ve reclaimed so much time lost through hypoglycemia and feeling unwell from high blood glucose, and I feel a lot safer driving.

**We asked Gráinne for clarification on being insulted by her doctor. Here is what she said: “There were no clinical guidelines in Ireland for insulin pump eligibility at that time, so she just had to give a reason why she thought I was a good candidate. She chose to say my glucose levels were not improving using Lantus and I was having a lot of hypos (this was not true). However, the insults really came from the fact that she had her secretary call me with my lab results about a week after my appointment and tell me that "it wasn't good enough." Yet she wasn't giving me support or any ideas on how to improve my glucose numbers. I was really struggling with my diabetes at this point because I was putting in too much effort with little reward, which was why I was looking for a pump. And this happened after every visit, so on the last time it happened, I agreed with the secretary that my endo was not good enough and never went back. I had maintained a relationship with my previous consultant, and she was able to support me and my pump management.“