Question from New Zealand:

I have type 1 diabetes, type 1 von Willebrand disease, and type 1 Osteogenesis imperfecta. I find that with frequent testing my blood glucose control is excellent, and my A1c is always between 5 and 6.4, however, even the tiny pricks for blood testing are a nuisance at best, to stop from bleeding. I find I need to apply pressure (I’ve had a break from this) and usually something cold for at least 10 minutes after a test, and, if I so much as pick up a hot drink, for example, with that hand anytime that day and sometimes the next, it will re-open and bleed a lot. I alternate hands for testing with a few days on each, to avoid not being able to enjoy something as simple as a coffee without a “free” hand to hold it. I don’t often bleed from shots, but I do usually bruise though. I’m on MDI (Multiple Daily Injections) of five to eight injections a day, which works brilliantly for control aside from a strong dawn phenomenon, but involves a LOT of bruising and the occasional bleed. Fewer injections resulted in what I feel was unacceptably poor control, and stress from the strict regime. Easy bruising is common with both Osteogenesis imperfecta and von Willebrand disease. I regularly have someone check my injecting technique and it is correct. I also change my needles faithfully and use the finest size appropriate needles. I’ve been told by doctors before that I “must be doing something wrong”, until I encouraged them to look up the conditions.

Are there any internationally available, reliable testing means that don’t require blood, that are suitable for someone with both diabetes and a bleeding disorder? Is it okay so test the fingers of an arm that has been set for a break? Sometimes it’s very hard to use the other one. I don’t think I’ve seen any alternate site testing meters/strips here. Are people with mild-moderate bleeding disorders able to use pumps? I don’t often bleed at injection sites, but the multiple bruising from MDI is uncomfortable and ugly, I’d also love the advantage of being able to address my strong dawn phenomenon with a pump. Perhaps I could get a trial a pump, to see if it was okay with my von Willebrand disease.

Can you suggest a good way of explaining that I have a combination of disorders that need to be allowed for and treated appropriately when in hospital, particularly at an Emergency Room where staff might not know me? I often have to carry a letter from my regular doctor at all times. I also already wear a Medic Alert bracelet at all times, and still have to explain repeatedly my entire medical history before staff will accept that I know my specific treatment needs for the multiple illnesses with which I live. Often, I receive no treatment, or pain relief for breaks, etc, until I’ve convinced the staff that all three have been diagnosed in one person. I find the stress of this often compounds the problem by affecting my blood sugar.