It’s no secret that I’m Jewish and I have a Muslim husband. So he fasts this month (Ramadan) and I feast. In fact, I probably feast enough on Rosh Hashanah (Jewish New Year), that I can easily make up for a whole month of eating lots of carbs, in just one night.

Not to worry, we can atone for our eating sins (amongst others) at Yom Kippur, just 10 days later, with a 24 hour fast.

It’s also no secret, however, that I’m a bit of an atheist, despite my background, my involvement with my local Jewish community (on the board), and my very sentimental tie to my cultural if not religious heritage.

Rosh Hashanah is traditionally accompanied by lots of sweet food, so you’ll have a sweet year. That’s the theory, or close to it. It’s nice to have an apple dipped in honey, and challah (bread, sweet at this time of year), also dipped in honey, and carrots drowning in honey, or kugel with a double dose of sugar and honey.

Almost everything you eat on Rosh Hashanah is ether dipped in or drowned in something sweet. Just a bit of overkill. Seriously folks, did the Rabbis not ever consider people with diabetes? It’s all just not the same with Splenda!

My mouth waters just thinking of the food that will be laid out tonight in a community event for Rosh Hashanah, that expects around 150 people. I had a hand in preparing some of it today and will continue tomorrow afternoon. Not sure my aching legs can take any more but there’s no way I’m not going back to that kitchen!

Oh what a hypocrit I must be – a Jewish Athiest who cooks for and partakes in traditional Jewish Holiday meals? You know what? I don’t care! Call me names but I love it all! I love the craziness around this time. I love seeing people I might not have seen all year. I love the spirit of community and the happy flavour (excuse the pun) of the holiday. I especially love it when the Israelis all start to sing, much to the delight of the rest of us who are too shy to get into such merriment.

Weighing up options is a fact of life with diabetes. I can let my BLGs go to hell in a handbasket, (insulin pump or not – there’s no way I can account for every last carb) or I can sit there like Miss Goody-Two-Shoes and pick a piece of dry chicken and some nutrient-free lettuce and maybe a tomato.

Maybe I don’t have to do all-or-nothing. Maybe I can have it all, in very tiny portions?  My carb-load will probably still go to blazes but it’ll be slightly easier to manage. Missing out totally is a very poor alternative.

What would you do?

When using an insulin pump, part of the process is entering your blood glucose levels (BGL) from your meter after testing. Some pumps have a meter attached so the process is automatic. The Animas Ping, for example, does this, but it’s not available in Australia yet. I have the Animas 2020 – basically a Ping without the meter.

Entering your BGL during the day, and then entering BGL with the grams of carbs you’re about to eat, will allow the pump to accurately suggest how much insulin it should give. It’s done on an incredibly complicated algorithm and it also knows how much bolus insulin you still have active at the time. This is called Insulin on Board (IOB). It figures this amount into the insulin-suggestion calculation.

On some pumps, you can just accept the suggested amount. On the Animas 2020, you have to enter the amount yourself. I rather like this idea because the pump has no idea what I’m going to do next – exercise, sleep, eat more, suspend the pump after the bolus and many more possibilities. I can then give less or more according to my needs over the next 3 hours.

The pump can be set to remind you to test your BGL. I have mine set to remind me every two hours after entering my BGL, which I test several times a day. After any entry, the reminder comes on screen for you to confirm it or change the reminder time – 1 hour, 2 hours and so on. When I sleep, I set the reminder to zero hours, so it doesn’t do the reminder alarm and wake me.

Because of what the pump records and the reports it produces, I have not yet needed to record anything manually.

Once a week, I upload the data from the pump to my computer via an infra-red cable. I produce the reports as PDF documents that I email to my medical team. They can then see trends, averages, total insulin and more, and perhaps suggest  adjustments.

The sample report below is just one of a number of reports available. It’s the one most people with diabetes will recognise – it’s very similar to a handwritten log. Yes, it’s my log for last week, with reasonably OK numbers (only reason I’m sharing).

Looking at the report, I see if any adjustments need to be made to any of the pump settings. Of course I’d probably look at a week or more of data, not just a couple of days.

Last week, I made a huge effort to keep my carbs fairly low, lower than my usual under 120 grams per day. It certainly paid off for me.

You’ll see the following:

The time of day across the top. Each day has 3 lots of data: BGL, Grams of Carbohydrates Eaten, Insulin Bolus.

At the far right, you’ll see the average BGL for the day, the total carbs for the day and the total insulin bolus for the day.

At the bottom of the report, the last 3 rows are the averages for the time of day, and the averages for the week on the right.

Note that the BGL measurements are in mmol/L, the standard in Australia. To convert to the USA standard, multiply by 18, or see the chart at the end.

There’s another report hat shows all the BGL testing data. You might test more than once an hour, eg if you’re low, or after a site change. The log book only has BGL value in any given hour – the average of all tests done in that hour. You can’t see in the chart below how many times I might have tested for any one BGL shown.

I’d love it if my HbA1C would be done on just the four days showing! Now, wouldn’t that be nice! Almost everyone I know in the diabetes world, has highs and lows. The days shown aren’t typical for me. I’m still having a problem going high between 11pm and 1am. I’m slowly tweaking the pump to take care of this. It’s not easy because I tend to go low in the early hours of the morning. I don’t want that to happen while I’m sleeping, so any insulin I have between 11pm and 1am will still be active 2-3 hours later.

I wanted to share because it was something I wanted to know and see before I decided which insulin pump to get. As you may have already read, I totally love my pump and I’m extremely happy with the choice I made.

This chart shows HbA1c and what your average BGL would be in both mmol/L and mg/dl. It’s such a handy chart, I use it all the time!

In 30 years of diabetes, which has progressed, sometimes become better-managed, and has changed over the years, I’ll profess my avid interest in its treatment.

I thought I knew a lot until I started the preparation for going on an insulin pump earlier this year. Since then, I can’t tell you how much more my poor brain has been filled with extra information. Every week it seems I learn something new. Whether it’s about managing the disease, research, reading other people’s experiences, it’s still learning.

My averages had been creeping up over the last couple of weeks. I can put it down to a number of things including another kilo on my already overweight frame (I still manage to just scrape in to the ‘overweight’ category with Body Mass Index (BMI)).

We had visitors and were eating out a lot, in places where whatever was on my plate was sometimes difficult to carb-guess. And the kicker was the extra exercise. Like some, I’m not textbook when it comes to exercise. I don’t do enough of it (knee needing replacement) so I go high during exercise – contrary to text book advice – and have to bolus more. More bolus = more insulin = more weight for me. Going high during all the walking we did meant extra insulin.

So, whatever the reason or combination of reasons for my averages going up, I felt I had to break the cycle. Three days last week, I did very-low-carb. This week, I’m doing lower-carb. It’s done the trick. Don’t take this as advice – it’s just my experience.

Under no circumstances did I want to increase my TDD of insulin, which would put on more weight. What I did, worked nicely for me. I’m back to carb-watch-eating and my numbers are way better. In the process, I also shed a couple of pounds, for which I’m very grateful. The extra weight seems to be super-glued to me, and getting it off is a battle.

In passing, my endo, a few weeks ago, told me not to worry about the extra weight, considering how well I’ve done since I went on an insulin pump. I didn’t think much of it at the time. My thoughts were of fashion and vanity.

In a twist of fate, I subsequently read about some latest studies which suggest that BMIs under 18 and over 30 are associated with a greater risk of death. What was apparently surprising to the researchers was that the overweight category BMI: 25 to 30, was NOT associated with any significant greater risk. And the most surprising was that the underweight category BMI <18, was.

We all thought that calorie restriction was the way to go. Apparently not. From what I’m reading, going into the twilight years with a little extra padding, isn’t all that bad. What is vitally important, is your fitness. If you are normal weight and not fit, you do worse than someone overweight and fit.

If you have the time, watch the video below. It outlines some of the latest research.

Obesity: Ten Things You Thought You Knew

So maybe my endo had seen these same studies.

That still doesn’t let me off the hook as far as off-the-hook fashion goes. And yeah, I’m not all that fit. I hope to change that.