Friday, 31 July 2009

The Ketone Cops

There are two main types of diabetes – Type 1 and Type 2. Type 2 is something that normally develops slowly, and is largely due to ‘insulin resistance’. This is where the person is still producing their own insulin, quite possibly in large amounts, but the person’s body is not able to use it efficiently. Type 1 tends to be far more dramatic in its development, as it is caused by the failure of the beta cells in the pancreas to produce insulin, and this total lack of insulin can lead to a life-threatening condition called Diabetic Ketoacidosis (DKA). With no insulin available, the cells in the body are unable to use the glucose in the blood and will turn to using the energy stored in fat instead. A by-product of this process are something called ‘ketones’, which can alter the ph value of the blood and turn it acidic.

In order to process the ketones you need insulin, and since this is absent then the ketones will build up to dangerous levels. Ketones are produced in non-diabetic people through a process called ‘ketosis’, and this is the basis for diets such as Atkins, which ‘force’ the body to use fat stores by depriving it of carbohydrates, resulting in weight loss – however, non-diabetics are able to process these ‘starvation’ ketones as they have a healthy supply of insulin.

I was admitted to hospital with DKA when my pancreas failed. I lost 17 pounds in weight in three days and could not eat or drink without being sick, although I was going to the toilet regularly, despite not being able to hold any liquids down. This was because my body was trying to flush the ketones out through my urine. My breath smelt of pear drops, or acetone, as this was another way that my body was trying to expel the ketones, and caused rapid breathing. I was exhausted because my cells were not getting any energy, and the glucose levels were building higher and higher all the time.

Thankfully, I called the emergency services and after some tests in hospital it was confirmed that I had diabetes. My blood sugar was at 37 – normally it would not go above 7 in a non-diabetic person. Immediately, I was placed on an insulin drip, and within 24 hours I no longer felt sick, had boundless energy and a ravenous appetite! I learned an awful lot about the workings of the human body that week and in the weeks and months that followed. I never want to experience DKA again – it is the worst I have ever felt in my life! The one danger that remains is that, should I get ill, with flu for example, my insulin requirement will increase. I would need to increase my doses in order to prevent ketones from developing, and this is an uncertain science. For this reason, people with diabetes need to take very special care when they get ill, and regularly check for ketones using either urine or blood ketone testing strips.

Send officers quickly, there’s been a calamity!
I’m beginning to think that I’m losing my sanity!
I’ve lost so much weight that I’m light as a feather,
And I’m sweating profusely, though it’s hardly hot weather!

I keep throwing up, with an insatiable thirst –
Do you know what it is? You can tell me the worst!
I haven’t stopped p’ing from dawn until dusk,
And soon I’ll be looking like an old dried out husk!

My breath smells of pear drops – that acetone smell,
Oh please come and help me, you can tell I’m not well!
I’m panting and wheezing and my heart’s fit to burst,
I feel helpless and dizzy and wretched and cursed!

Don’t worry, stay with us, for help’s on its way!
We’re thinking that maybe you have DKA…
We’ll get you some insulin and you’ll be right as rain,
And tell you how to make sure it won’t happen again.

If your blood sugar’s high and your insulin’s low,
It’s likely that ketones will soon start to show.
You need to be vigilant – keep them on the hop,
And we’ll make you an honorary Ketone Cop!

Thursday, 30 July 2009

The Blood Sugar Spike Correction Facility

Controlling diabetes can be an arcane art at times as there are so many variables to consider. In a non-diabetic person, the body is able to sense exactly when the blood sugar levels are getting too high and will instantly produce more insulin to ‘mop up’ the excess glucose in the blood. This can be extremely subtle, and it will switch off production the instant that levels are back in ‘normal’ range, so the levels don’t drop too low. A person with diabetes, however, does not have this fine level of control. Type 2 diabetics may still produce their own insulin, and not have to inject, but due to ‘insulin resistance’, it may be that the process is insufficient to ‘track’ and overcome the peak of glucose entering the bloodstream through food digestion. Those who inject insulin can have similar problems. They have to try and inject so that the peak action of the insulin being absorbed from the injection site coincides with the food digestion peak. If the timing is wrong, then the person’s levels can drop too low (if insulin ‘hits’ before food), or too high (if food ‘hits’ either before the insulin peak, or after – the latter being often the case with some foods).

Some people will counter this effect by testing their levels at 2 hours after eating, and adding a ‘correction’ dose of insulin if levels are too high. Sounds straightforward enough, except that there may still be active insulin from the original dose taken with the meal, resulting in an excess of insulin overall for the food consumed. This then has to be rectified by adding in a snack so the person doesn’t fall too low! Insulin pumps are particularly useful in these scenarios, as it is possible to either ‘dual wave’ or add in a correction dose without an extra injection. The dual wave splits the meal insulin dose so that there is sufficient active insulin circulating to deal with the late peak of glucose. Correction doses are also easier with a pump, as there are ‘wizards’ in the pumps that calculate how much insulin is already on board and adjust accordingly.

Welcome you inmates – and show some humility –
To the Blood Sugar Spike Correction Facility!
You’ve all been brought here, I think you know why,
For sending the blood sugar of people too high!

Pasta! Step forward! I don’t mean next week!
You seem to like dodging the Insulin Peak!
And you can stop sniggering Baked Potato and Beans,
You’ll be next to find out what the ‘Correction’ word means…!

Now, get in that stomach and don’t misbehave,
We’re going to subject you to a pump dual wave!
And Beans – on your own you seem to be fine,
It’s with Baked Potato you step out of line!

And all of you others – the Pizza and Cheese,
You won’t get away doing just as you please!
We’ll hose you with Insulin till you realise the futility
Of ending up here at the Correction Facility!

Great South Run – training diary, day 2

If you’ve been following my Stockholm Marathon story, you’ve probably built up an idea why I take my training very cautiously these days. Since my last run on Sunday my legs have been feeling quite sore – almost back at square one! I’ve waited until they feel OK again before continuing. This is usually the way after I’ve had a couple of weeks of laziness, I’m sure I’ll be able to fit in more runs each week before long.

It was a relatively cool morning today, although the Sun was shining and the skies were blue. As I set out through the park and along the river’s edge there was a strong breeze pushing against me. There’s no point in fighting the wind, so I just relaxed into it, picking up my pace only when a couple of young lady runners passed me going in the opposite direction – male pride, eh? There were quite a few people with dogs that I had to dodge around. Somehow the dogs and their owners seem to have severe vision defects and don’t notice you are there. Actually, what is worse is when someone clearly sees you and makes no effort to give you some space as you pass. This happened this morning as I was running up a small rise and approaching a cyclist coming towards me. I was at the side of the path and stuck to the edge, as it is generally difficult to predict what people will do, and if I make it clear I do not intend to deviate then they take their cue ad move to one side. This cyclist did not observe this courtesy and continued to ride straight towards me. The closer he got, the more confusing it was likely to be if I changed course, so I stuck with it – eventually it became like a game of ‘chicken’ and I had to step aside at the last moment or he would surely have hit me. As he passed I expanded his knowledge of Anglo-Saxon expletives and made a suggestion of where he might like to insert his head…

I decided to run a little farther upstream and was rewarded by the sight of a family of ducks waddling across and dipping off the path into the water. By now, the Sun was in my eyes, and I looked forward to the turning point so it would be at my back. On the whole, my breathing was fine, but my legs were once again beginning to tire, so it was somewhat of a relief to get back home – and made it just before a heavy shower soaked the land in an instant!

Now, have to get ready for Kate Bush, it’s her birthday today and she’s coming round for tea…

Thursday July 30th, 2009
Distance 3.11 miles
Time 30’ 20”
Calories 355
Blood glucose before N/A (forgot!)
Blood glucose after 8.1

Wednesday, 29 July 2009

Diabetic Jam!

There’s a myth about diabetes that you can’t eat sugar. Like many myths, this has some basis, in that previously it was thought that sugar, and sugar alone, was the ‘cause’ of diabetes and was therefore some kind of poison as far as people with the condition were concerned. Now we know that this isn’t the case. True, it is important to eat a healthy, balanced diet, and that means that we shouldn’t be continually stuffing ourselves with sweets and cakes – but that is true for non-diabetic people too. Sugar, like any carbohydrate, will affect blood glucose levels, causing them to rise. If combined with other food though, for example, by eating a piece of cake or ice cream after a main meal, the effect on the levels is reduced by slowing the conversion of the sugar to glucose in the blood.

Some companies produce so-called ‘diabetic’ food, in which the sugar content has been replaced by artificial sweeteners called ‘polyols’. OK, no sugar – but these foods still contain carbohydrate, so need to be considered when administering insulin doses, for example. Moreover, the polyols can have a rather unfortunate laxative side-effect in some people, which makes them unsuitable in any form of diet! Diabetes UK and most healthcare workers will recommend that you do not eat ‘diabetic’ products, as they have no nutritional benefits over ‘ordinary’ foodstuffs, and are generally considerably more expensive, so really it is about time that such things were removed from the shelves. A market for them probably only persists because well-meaning friends and relatives of people with diabetes buy them as ‘treats’, or uninformed or newly-diagnosed people with diabetes buy them thinking that the normal versions are taboo.

Ah! You’re diabetic? Well, don’t worry my dear,
We’ve got all sorts of goodies that are suitable here!
There’s diabetic chocolate and diabetic cake,
And diabetic jam – took me ages to make!

And diabetic sweets in all sorts of flavours –
For someone like you they’re heavenly saviours!
So don’t feel deprived, they’re especially for you!
I’ve heard sugar would kill you – is that really true?

Now you might find the sweeteners are rather emetic,
But you’ll just have to suffer since you’re diabetic…
I should also mention they cost twice the price
Of ordinary sweet stuff, but don’t taste as nice…

What’s that? You’re declining? Well how can that be?
But you can't eat normally, like people like me!
You can? Well, my goodness, I’ve learned something new!
My business is finished, and no thanks to you!

The Stockholm Marathon and me, part 3

One of the first problems I had to overcome was that fact that my bedroom and bathroom were upstairs. I could barely walk across the room on the crutches, so tackling 15 steep stairs was quite a challenge. I managed to work out a method that involved two set of crutches – one pair downstairs and one up. I could then climb the stairs with one crutch and holding onto the banister. At the top of the stairs I collected another crutch that allowed me to walk to the bathroom. – I would then reverse the procedure on the way back down. Another problem I had was getting my meals from the kitchen to the front room where I could sit and watch television whilst I ate. Initially, I solved this by putting the plate on a tray which I then pushed along the floor with the crutches as I walked. I upgraded this concept later when I found a little wheeled platform, ostensibly for moving heavy plant pots around in the garden, but ideal for moving along the floor across the room and with less effort and spillage than the tray!

One thing I did have a problem with was the blood-thinning injections I had been told to administer by the Swedish hospital. In some countries it is normal practice after an operation like mine to take such a substance to avoid a potentially fatal blood clot from developing. The drug needed to be injected into the tummy, subcutaneously. However, I found that I developed a very sore area with the injections and they became painful to administer. I asked my doctor if I needed to continue with them and he said I could stop, so that was a relief. Funny to think that, now I have diabetes, I inject myself four times a day, and often in the very same place as those blood-thinning injections! However, insulin pens have much shorter needles, and rarely hurt.

About two weeks after returning I had the staples removed from my leg. The nurses commented on how neat the surgeons had been, and it is true because now the scar is barely discernible. I was off work for three months. During that time I gradually moved back into the ‘real world’, but it wasn’t until three months that my consultant allowed me to put weight on my ‘bad’ leg. I had become quite adept at caring for myself, although the support of my friends was always there when I needed it. I developed a technique of shopping at the local co-op which involved putting the basket on the floor and pushing it around the store with my crutches. Many times I was asked if I needed help, but I always declined. What people didn’t realise was, that this was an adventure for me – the chance to see a little bit of the world, to browse the shelves and select whatever caught my eye – so I didn’t really want people to just fill my basket and speed my purchases.

Something that I found quite remarkable during my recovery was the amount of food I consumed! As a person who now has diabetes, I think back on that time with horror, amazement and envy. Horror at the thought of what all that food would do to me now, amazement at the fact that, even though I was consuming probably 6,000 calories a day with barely any activity at all, I actually lost weight – and envy at the thought of the loss of freedom I now face to consume whole battenburgs or boxes of jaffa cakes without penalty.

Tuesday, 28 July 2009

Breakfast at Tiffany's

I’m not a person who wears jewellery, and it’s a peculiar thing to start contemplating at my age. However, I have been thinking about it fairly seriously of late, with my new-found status as a fully-fledged, insulin-dependent person with diabetes. I think it’s fairly common knowledge amongst the general public that a hypo, or low blood sugar episode, in a diabetic person can make them appear drunk. Unfortunately, it’s also fairly common for people to actually be drunk and not diabetic! So, how do you tell them apart? Many people wear a medical dog tag or bracelet which gives brief details of the person’s condition and possibly also allergies. Should the worst happen, this information can then be used by first-aiders or paramedics to ensure that appropriate treatment is given – usually just some quick-acting sugar like full fat coke or jelly babies, or glucose tablets if the person is carrying them – if the person is still conscious. Unconscious people should not be given anything to eat, as they may choke, but instead they can be given an injection of glucagon which will persuade the person’s liver to release glucose into the bloodstream.

I can usually tell when my blood glucose levels are falling below my normal range, but I have occasionally gone very low without realising. This is known as ‘losing hypo-awareness’, and it’s possible that a person can drop so low that they are unable to communicate coherently. Thus, it’s wise to wear something so that, should the worse happen, people will know how to act appropriately. Bring on the bling!

It was while I was having my breakfast at Tiffany’s
That a troubling thought crossed my mind.
A portent perhaps, a personal epiphany,
(I don’t get too much of that kind!)

It had been on my mind, but on the periphery,
But now it came clear in a flash
That I needed some bling – but maybe not Tiffany,
I didn’t have that kind of cash!

For what if, one day, I got my dose wrong,
And injected too much for my meal?
It’s an easy mistake, and it wouldn’t take long
For a low that perhaps I won’t feel!

Should I suddenly drop and lose all control,
And my powers of speech had all gone,
I’d need a way to inform any passing kind soul
That I’m insulin-dependent, Type 1.

So, bracelet or tag, I must get me some bling
So that people around me will know
That it’s not due to drink, but a low glucose thing,
And give me some sugar pronto!

The Stockholm Marathon and me, part 2

At midnight on Sunday they took me to the operating theatre. I was sure that I had asked for the general, but they asked me to lean forward on the operating table so they could give me the local anaesthetic injection in the spine. This would ‘put my legs to sleep’. I still had my doubts as I lay back down, but then I looked up and noticed that they had my leg raised up in the air and were examining it. I had felt nothing! It was a bit disconcerting having no feeling below the waist, and a little fear that the feeling may never return. After a short while of trying to observe what was going on…I fell asleep! I found it hard to believe afterwards, given the amount of metalwork in my leg and the amount of cutting, banging and hammering that must have gone on! But on reflection, I had just run the best part of a marathon, had virtually no sleep for 30 hours and been drugged up to the eyeballs, so maybe I was a little tired, if not exhausted. I’m sorry I missed the interesting parts of the operation though!

When I woke up I was being wheeled into the recovery room. I remember seeing a clock and that it said 2:20, so the operation had taken just under two and a half hours. I was kept under observation for a few hours there and then returned to my little room. I remember that the took scans of my bladder and recorded how much urine I passed afterwards, to check that my organs were working correctly after the operation.

Finally, I got some sleep! After the operation I was confined to my bed throughout Monday. A man from the marathon committee brought me the clothes and valuables that I had left at the marathon start point. He had obviously heard what had happened, and jokingly also gave me a t-shirt. With a big grin he translated the wording on the shirt – it said, ‘I’m training for the 2005 Stockholm Marathon’! We both laughed!

I was extremely well looked after by all the Swedish nurses, doctors and domestic staff. We had fun trying to identify some of the food I was being given as the kitchen staff could not speak English, and my Swedish certainly wasn’t up to the task. I had a frequent visitor too – the young man who had called for the ambulance came and visited me several times during my stay, to check that I was OK and also just to give me some company to help pass the time. It was so kind of him, and endeared me even more to the Swedish people.

By Tuesday I was able to finally stand and walk very slowly on crutches. I finally had a shower, three days after running the best part of a marathon! By this time, I had missed my flight home, so was having to negotiate with the insurance company to arrange a new flight and also transport from the airport to my home. We finally got a flight arranged for the Thursday morning, with a taxi to the airport and another to take me home from Heathrow. The Swedish taxi driver was a very cultured man, in a very smart car (a Mercedes, I think). He was more like a chauffeur than a taxi driver! The staff at the airport were great, and I got particularly close attention from the air stewardesses, which was nice. The only worry was that I was in an aisle seat, and the two passengers sitting to my right decided that, rather than me getting up to let them through, they would climb over me to get to their seats – a very anxious moment, as I couldn’t bear the thought of anyone even touching my leg at that time.

Things became very British when we landed at Heathrow. The ground staff had been expecting me, but had brought the wrong sized wheelchair to take me off the plane, so I had to walk down the aisle. After that though, everything proceeded well. The taxi driver had a large people- carrier, so there was plenty of room for me to sit with my leg stretched out, as I was unable to bend it much at this time. I phoned ahead and a dear friend of mine was there to meet me. She had prepared everything for me, making sure I had plenty to eat and drink, some cheap joggers to sit around in, and a warm quilt to wrap around me as I recovered in front of the television.

Monday, 27 July 2009

If all the test strips that I used…

Injections are one thing when you are an insulin-dependant person with diabetes, but fingerprick testing is another thing entirely. Taking blood glucose measurements can hurt more than injections (in fact, it usually does – in my case, at least!), and you also tend to do it more frequently. I will test before every meal, then again if I am going for a run, and when I get back. I might also test if I want to know how a certain meal has affected my levels – did my blood sugar ‘spike’ and go high above ‘normal’ range? Then again, I might need to test if I feel my blood sugar levels are dropping low, so that I know whether, and to what degree, I need to treat myself to some jelly babies – and no, I don’t let it go low on purpose! Another time I might test is to ensure that my basal (slow-acting) insulin is at the correct dose and working correctly. This might occur in the middle of the night, or several times during the day if I am ‘basal testing’.

All this testing leads to one thing – a huge pile of used test strips! I throw them in the bin, but they still seem to occasionally find their way into my socks, which can be an uncomfortable shock, to say the least! So let’s just quantify the magnitude of all those test strips…

If all the test strips that I used
Were laid out tip to toe,
They’d stretch the length of England’s coast
From Kent to Plymouth Ho!

And if those strips were all piled up,
They’d climb into the sky
And form a constant hazard there
To pigeons flying by…!

Consider then, upon each strip
A drop of blood must fall.
There’d be enough, if gathered up
To fill the Albert Hall!

But what about the missing strips,
That give us sleepless nights?
You’ll find them hidden in the feet
Of socks and ladies tights!

How they get there, who can tell?
It’s one of life’s unknowns,
Perhaps transported on the waves
Emitted by our phones?

Or maybe in the quantum world
Where all dimensions meet,
They can’t resist the attractive force
Of diabetic feet!

The Stockholm Marathon and me, part 1

Woke today with aching limbs! Not a surprise really, as it had been some time since my last run and even though it was a ‘gentle’ one, it still took quite an effort! It normally takes me a week or two to get up to speed – I’m expecting to be running around 5-6 miles at around 8’30-9’00” pace in a couple of weeks…we’ll see.

I am always conscious of how my legs are feeling, and no longer do the 10 miles a day I might have done a few years ago. Five years ago I was running in the Stockholm Marathon. I had enjoyed it the first time in 2003, but had returned hoping to improve my time. It’s a beautiful city and, although it was a little too hot for marathon running, I was enjoying the sights and the atmosphere. I was gearing up for the final three miles – the end practically in sight – when I heard an enormous crack. I didn’t associate it with myself, but when I next put down my right leg I noticed that it was a strange shape. Then, as my weight came to bear on it, my leg collapsed from under me. I was very confused. There was no pain, but it looked like my knee had ‘popped out’. I tried to get up, but quickly realised that the leg wasn’t going to support me, and I crashed face-first onto the tarmac. I had broken my femur, the longest, thickest and strongest bone in the human body!

A young man who had been watching from the side of the road immediately rushed forward. He was Swedish, in his mid 20’s, and as soon as he saw me he got on his mobile phone for an ambulance. They arrived very quickly. By now I was pretty much aware of what had happened, as I had broken my arm a few years previously, and I could feel the pain coming. I was still facedown on the tarmac, not wanting to move, but the ambulance men said that they had to move me so they could administer morphine and get me into the ambulance. I was swearing and, being English and polite, apologising for swearing! The pain became unbearable, despite the morphine. I was loaded into the back of the ambulance and driven quickly off to the hospital. I remember that they had taken my running shoe off and asking if they still had it.

The next thing I remember was being in the Emergency department, being examined by a lady doctor. I began to shake uncontrollably as the shock began to set in. I could see on a heart monitor that my heart rate was over 200, which is pretty much off the scale for a man my age – my resting heart rate at that time, because I was very fit, was around 40 beats per minute. More drugs, and I eventually found myself in bed in a room, by myself and still wearing my running clothes (minus the shoes!). Bear in mind that I had just run 23 miles in hot weather in these clothes, they would not have won any ‘fresh aroma’ awards! The one small benefit was that the morphine had relaxed my muscles, so I didn’t feel any of the stiffness and soreness from the run!

I was scheduled for a operation that night and the surgeon came to ask me if I wanted it with a local or general anaesthetic. The local was better, he said as there were fewer risks. However, I wasn’t sure I wanted to be awake for the operation. He said I could change my mind later. As it happened, I couldn’t have the operation that day (this was now Saturday evening), and had to wait until the following day. That meant no food or anything to drink until the operation, although I was on a drip for fluids. I had a tearful night, thinking that I might never run again and how could it have happened. No-one knew, but my speculation was that I had had a stress fracture which had held together most of the way, but then gave way somewhat catastrophically.

At midnight on Sunday they took me to the operating theatre. I was sure that I had asked for the general, but they asked me to lean forward on the operating table so they could give me the local anaesthetic injection in the spine. This would ‘put my legs to sleep’.
Part two continues tomorrow...

Sunday, 26 July 2009

Just do it!

As it says in my profile, I was a keen runner before I was diagnosed with diabetes. In fact, I was due to run a marathon in Stockholm the week after diagnosis, but sadly didn’t make it. Once out of the hospital I was determined to try and get back to my former levels of fitness. There are many examples around of people with diabetes achieving remarkable things, so I was inspired by this and never once thought that I couldn’t do it. What I hadn’t realised was how complicated things had suddenly become! Exercise is extremely good for diabetics, helping to keep the blood sugar levels close to the normal levels enjoyed by those without the condition, so it is very much encouraged. However, there is a great deal to take account of before, during and after the run top make sure that your levels don’t go dangerously high or dangerously low.

Before diagnosis I used to get up early in the morning, before the crowds, traffic and pollution started filling the streets, have a quick cup of tea then go out for my run. I’d eat on my return. The run would wake me up for the day, fill me with energy, build up an appetite and give me that lovely endorphin rush that exercise brings. Now I have to check various things. I have to eat and take my insulin, then wait for the food to digest and for the insulin to begin absorbing so that it is ‘circulating’ and available to the cells in my body. Without this, I cannot use the glucose in my blood to give me the necessary energy. Then, I must check that my blood glucose levels are within a fairly tight range so that it is safe to start exercising. For me, that usually means above 7 mmol/l and below 13 mmol/l. If it is less, then I have some fast-acting carbs like orange juice. If it is higher I must wait until it declines. Then I can go for my run. Whilst I’m running the cells in my body become more ‘switched on’ and sensitive to the insulin. This is not just confined to the time I am running, however. These insulin receptors can remain highly sensitive for up to 40 hours after a period of exercise, which means I have to be careful to adjust my subsequent insulin doses to prevent going low. There are guidelines to achieving this, but it varies so much between individuals that you have to learn your own particular pattern through trial and error. – and there is no guarantee that those patterns won’t change the next time you run!

So, Nike – nice slogan, but you might want to modify it for people with diabetes to something like ‘Just do it in an hour or so, once your levels have settled into an appropriate range’. I agree, not as snappy!

‘Just do it!’ say Nike, just go out and run,
Well I used to ‘just do it’ – back then it was fun,
Arising at dawn and hitting the streets
My only concern to look after my feet.

Now, before I just do it, there’s more I must do,
I have to make plans - I must think it through!
So, breakfast and insulin, then waiting an hour,
Till both hit their peak and give me the power.

I must take my levels before I can go
They can’t be too high, and must not be too low.
If everything’s fine then I’m out of the door,
And instantly depleting my glycogen store!

But now that I’m running my cells start to change,
More insulin receptors will come into range
And lap up the glucose released in my blood
By the carbohydrate conversion of digested food.

And when I return then I must check again
That my levels are normal, like ‘ordinary’ men.
Even if they’re high, then they may drop down low
For the next forty hours, it’s not easy to know.

So Nike, your slogan doesn’t quite fit the bill –
But I’m going to get there, I know that I will!
Despite diabetes making me plan
I’ll once again be a marathon man!

Great South Run – training diary, day 1

Well, I have just realised that it is exactly three months to go to this year’s Great South Run. I’ve been rather lazy recently, so it’s time I bucked my ideas up and got into some regular training!
Today I decided to do a fairly short run at a comfortable pace. Nice and easy, to get me back into the swing of things. The weather is good for running – not too hot or cold, slightly overcast with some occasional hazy sunshine poking through. There is a light breeze, just enough to keep me cool enough once I start to heat up!

I always find the first couple of minutes running a little difficult and stressful, even though I’ve been doing this now for over 25 years. Getting the lungs and heart up to speed, some slight inclines to run up, and a few potentially busy roads to cross can feel like hard work sometimes! As it’s Sunday though, there are few cars and people around, and I have a clear run across the roads and into the park. The park runs alongside the River Itchen, and the river is very subject to tidal forces from the Solent downstream. This morning the tide is well and truly out, leaving a narrow channel of river water between the wide, muddy banks on either side. Being so close to the sea, the river has a seaside smell to it, with seaweed clumping around the edges and gulls hovering noisily above.

Always a delight are the many swans that have made their homes here, and as I run along the path I spot a pair with two young cygnets, still clad in their grey, fluffy feathers and not yet regal and graceful like their doting parents. Across on the opposite bank I can see many more swans, maybe fifty in all, picking out tasty plants, insects and small fish exposed in the little rivulets left by the receding tide. I can also tick off ‘mallards’ in my I-Spy book of aquatic birds, as they group together beneath the small jetty and sift the morning mud for breakfast treats.

I feel quite relaxed, breathing easily and my legs have become readily accustomed to the demands of the run. I’m certainly getting warmer after ten minutes or so, and my breathing becomes more rapid as I turn away from the river and run up a small, but steep incline towards the playing fields. Dodging and weaving between dogs and dog-owners, taking care not to fall victim to their inconveniently placed trip-wire leads, and eyeing each creature to look for signs of sudden interest that may turn to aggression, I circle the playing fields and begin to head back home.

Other runners on an opposite course jog past, faces hot with sweat and breath panting with exertion. I’m sure that I don’t look like that – they must marvel at how calm I appear, how strong! I think not, for now I too am running with laboured breath, and what started as a small sensation of weariness in one small part of my left calf, now envelops my legs in their entirety. I try to speed up and appear impressive as I pass two pretty girls – thankfully, they do not swoon at the sight of my magnificent legs…!

Sunday footballers are laying out the apparatus for their early training session – cones, poles, nets – not a game that I particularly enjoy. I must remember to time my runs earlier on Sundays once the season gets underway, otherwise I will have to run the gauntlet of distracted spectators lining the fields, and the occasional volley of an errant pass that lands hopelessly out of play.

The final stretch takes me back along the riverbank and up the steep slope to the road. I always have a silent prayer that the traffic lights will be green, so I am ‘forced’ to rest and catch my breath before continuing up the hill and back down the road to home. Today, my prayer is ignored, and I have no choice but to cross and continue running up, despite the strong protests of my legs and lungs. Just a little further, and I am home, sweat streaming and lungs bursting, heart pounding and legs aching. Remind me again why I do this?

Within a few minutes, my breath has returned and my heart calmed. Endorphins are flooding my brain, and I feel great! That’s why I do this!

Sunday July 26, 2009
Distance 2.83 miles
Time 26’ 42”
Calories 315
Blood glucose before (1 hour postprandial) 8.7
Blood glucose after 8.9

Saturday, 25 July 2009

Challenge Poem!

Some time ago, I decided to try and raise some money for charity by setting myself a poetry challenge. Members of the support forum I visit were asked to give me words or phrases related to diabetes and treatments, and my challenge was to weave them all into a poem. The members would then make a donation to charity if I used their words. This is what they came up with – the poem follows …

keep taking the pills for this and that.
it's a pain to inject
Being diabetic means I'm sweeter than most.
wee on a stick?
counting the carbs
changing your ratios
38 on diagnosis - is that bad?
whats ketoacidosis?
tablets or injections?
walk in centre
have you got your insulin bag?
jelly babies
back to school
diabetic nurse
slow release
quick release
can i have a pudding?
Who's Dafne?
Am I normal?
Gimme gimme gimme I want sugar now

Challenge poem

Keep taking the pills, the good doctor said,
That’s easy for him, lying snug in his bed!
His brain isn’t bursting with all of those names
Of drugs and concoctions that all look the same!
Candesarten and ramipril – too many to mention,
That all promise cures for my bad hypertension,
Or statins and aspirin that both do their bit
To keep all my organs and arteries fit.

And now, whilst I’m at it, and I’ve got your ear,
Let’s just take a look at this medical gear!
There’s needles and meters, please just take your pick!
You even expect me to wee on a stick!
Believe me, sometimes, it’s a pain to inject,
When you’re worrying about bits you just might infect!
And who on Earth’s Dafne? A  diabetic nurse?
And please, am I normal? Or quite the reverse?

What’s ketoacidosis? The word should be banned!
You shouldn’t use language I don’t understand!
That consultant I saw said there’d be no more sweets!
Does he think life’s worth living without any treats?
Gimme, gimme gimme! I want sugar now!
Can I have a pudding?
Let’s not have a row!
Get counting the carbs, just hand me the scales!
I’ve worked out my ratio and it never fails!

 And down at the clinic they’re so proud of me –
‘Cos I’ve got a near normal HbA1c!
When I have a hypo, I just need a snack,
It’s highly unlikely I’ll fall flat on my back!
If someone asks‘Have you got your insulin bag?’
Then I’ll smile and I’ll nod, and won’t find it a drag.
Tablets and injections, if this is my fate,
I’m an all-conquering hero like Alex the Great!
Now, I know it’s immodest, and sounds like a boast,
But being diabetic makes me sweeter than most!

Friday, 24 July 2009

Riding the Beer-O-Coaster

Alcohol can have quite an effect on you when you have diabetes – it’s a far more complicated situation than just getting drunk! After I was diagnosed I didn’t drink alcohol at all for several months – not because I was scared to or anything, just didn’t fancy it at all. Eventually, though, life started to return to normal. I found that I had little choice when drinking in a pub, as nearly every drink contains sugar of some sort. Really, the only drink available in most pubs is diet coke, which I do not enjoy drinking. Even then, you cannot be sure that the barman has actually given you the diet version – getting the ‘full-fat’ version without knowing could have a big effect on your blood sugar levels without you knowing and accounting for. So, I decided that I would only drink something that was ‘predictable’ – beer! It expands my choice, and I know what’s in it and what effect it has on me and my levels.

The unusual thing about drinking beer when you have diabetes, however, is that in spite of the sugar/alcohol content of the beer, it can actually cause your levels to fall, and if you aren’t careful then you could have a hypo. Even worse, should you have a hypo whilst drinking, people may just assume that you are drunk and not accord you the necessary assistance. When you drink, as a rule, your blood sugar levels will climb. However, as your liver then begins to process the alcohol, it will be diverted from releasing the steady, low level of glucose that it normally constantly produces (the reason why we need ‘basal’, or background insulin). So, as a consequence of this, your levels will fall. Moreover, the liver will suspend this glucose production long after you have stopped drinking, and may continue through the night as you are sleeping, leading to the risk if a night-time hypo.

The solution is to make sure that you snack on carbohydrates as you drink – crisps, chips, kebabs etc. This will give you a store of glucose to keep your levels up without your livers assistance. Once again, you need to use ‘trial and error’ to determine just how much you can drink and need to eat in order to keep your levels within range – a tricky balancing act, and not always successful after a few beers!

Come, climb aboard the Beer-O-Coaster,
You’ll find it an exciting ride!
First you’ll find your levels rising,
Just before that rapid slide!

The Beer-O-Coaster makes you dizzy,
Are you high or are you low?
It will keep your liver busy,
Help reduce the glucose flow…

Through the night and through the morning,
Feel your sugars hit the floor!
Better heed the doctor’s warning –
Build a carbohydrate store!

When you ride the Beer-O-Coaster,
Eat some food with every drink,
And before your senses leave you,
Make sure you stay in the pink!

Thursday, 23 July 2009

Doctor Dim

Unfortunately, it seems that the healthcare professionals charged with our care are of variable quality up and down the country, particularly General Practitioners. Some are excellent, with an up to date knowledge of the latest research and treatment methods, very supportive of their patients and concerned primarily for their welfare. Others, sadly, are more concerned with budgets, reducing costs and restricting appointment times rigidly to a measly ten minutes. These latter GPs are also likely to be the ones who are still operating on the knowledge they gained in an afternoon as a student, twenty years previously. I have a good GP who understands that I know about my diabetes better than her, as I deal with it every day, but she is supportive, listens to my concerns, and prescribes the things I need. However, some GPs are loathe to prescribe blood testing strips, particularly to Type 2 diabetics who are not on insulin, on the grounds that they cannot use the information effectively. This is not true, as all diabetics need to know how food affects their blood glucose levels so that they can make necessary adjustments to their diet and lifestyle – the only way they can do this is to test and ‘learn from their meter’. We can only do our best in the face of such ignorance, stand our ground and use the logic of our arguments to ensure we get the level of care we need.

It looks to me as if you’ve let
Your levels get too low,
Trust me, I’m a doctor,
So I think that I should know!

I think you need to test your blood,
But only once a week,
There is no need to test it more,
You’d be a testing freak!

We have to save the pennies here,
And strips are too expensive
For you to test at every meal,
That would be too intensive!

Now, insulin – I’ve noticed that
You’re using far too much!
I’d like you to reduce it please,
You only need a touch.

What’s that you say? I can’t be right?
I think you’ll find, my dear,
Even though you think you know,
That I’m the doctor here!

I’m sorry, but the buzzer’s gone,
And now your time is up –
I haven’t had my coffee yet,
I’m gasping for a cup!

Come back again in six month’s time,
And please take every pill,
We’ll check your blood and find out if
You’re diabetic still…!

Wednesday, 22 July 2009

Wide-Eyed World

I went for my annual retinopathy scan this morning. One of the serious complications of diabetes is when the blood vessels in the eyes grow or rupture. This can affect the macula, a tiny region on the retina that is hugely important for vision. The scan involves taking photos of the retina with a special camera. These photos can then be examined for any changes that may need further treatment. In order for the photos to be of the best quality, it’s important to dilate the pupils of the eyes as much as possible – and often this is achieved with special eye drops. These can sting a little at first, but the biggest consequence of having them is that your pupils remain enlarged for several hours afterwards, so even the dimmest and dullest of days can feel like bright sunlight! You feel like you have the light-gathering power of an astronomical telescope for those few hours!

Welcome to my wide-eyed world!
Where lurid fires around me swirl,
And dullish clouds that clothe the skies
Are floodlit in my lucent eyes!

Do I perceive the reddish glow
Of far-off galaxies that grow
Beyond the sight of beasts or men?
My universe expands again…

And distant stars will live and die,
Imprinted on each gazing eye,
Where sunlight spells out double trouble –
Blinding me, the Human Hubble.

Oh curse the Sun, the Moon, the stars!
The planets and the plains of Mars!
Please lock me in a darkened room,
Where all is black, and all is gloom!

This once-a-year spectacular
Preserves each precious macula,
So I’ll endure the searing light
And cherish this, the gift of sight.

Tuesday, 21 July 2009

The Liver Dump

Something that diabetics might encounter is an increase in blood glucose levels in the morning, above what they might expect when taking account of their bedtime levels and what they have (or haven’t) eaten for breakfast. People who don’t have to regularly test their blood glucose levels might be oblivious to this – if you don’t know the numbers then how can you compare? So, what’s going on? There are two possible reasons that have been put forward – the ‘Dawn Phenomenon’ and the Somagyi Effect’.

Put simply, the dawn phenomenon results from the liver releasing extra stores of glucose to give a person a ‘boost’ as they wake up and face the day. The ‘Somagyi Effect’ results from a person dropping very low during the night, and stress hormones released in response cause the liver to ‘dump’ extra glucose into the bloodstream to bring the levels back up. Sometimes, the liver does more than enough and the person wakes up with high levels. Some people experience these effects more than others. Personally, I have always been fine in the mornings, even on the low side in the early days, but it is interesting to learn yet more about the way the body works, that I previously took for granted.

There’s a great, more detailed, explanation here:

‘Come on Bill, it’s nearly time –
The Sun’s just coming up!’
‘I’ll be there in a minute Spike,
Just let me drink this cup!’

Billy Rubin and Spike Mackay
Were on the early shift,
Their job to stoke the levels high
With a liver glucose lift.

‘We’ll get this fella up to speed
And ready for the day
With all the glucose he will need
So he can work and play!’

‘Remember how, the other night
His level dropped right down?
We called in all the guys on site
And really went to town!’

‘Aye, how we laughed when we found out
His levels went so high!
He didn’t have a clue about
The real reasons why!’

‘But not today, I’ve heard he tests
His blood at three each night,
And if he’s low he snacks and rests
He’s putting up a fight!’

‘We might find out our jobs are gone,
And we’ve been superceded!
There’ll be no Dawn Phenomenon!
We’ll be no longer needed!’

‘Don’t worry Bill, it might get slow,
But there’ll never be a slump –
There’s always work, I know it’s so,
Here at the Liver Dump…’

Monday, 20 July 2009

Pumper Mums!

Being an adult with diabetes can be a worry at times, but how much harder for parents caring for a diabetic child? Should my blood sugar go high or low, I am aware of the sensations and can act accordingly. Only on rare occasions have I had to seek help and experienced difficulty in communicating my needs. I can only imagine how difficult it must be to be constantly on the alert for possible signs of an imbalance in a child. Children don’t necessarily understand the need for injections, or being denied the freedom to eat as they choose on special occasions like Birthday parties, when all the other children are happily filling their faces with cake and jelly. They may also be subject to growth spurts, when hormones go to pot and have a huge influence on insulin levels. Or they might succumb to one of the many childhood illnesses that we have all been through, but for them may lead to a potentially dangerous rise in ketone levels.

Some of these concerns, from what I have read, are greatly alleviated by the fitting of an insulin pump for the child. They’re not an easy option – the first few days and weeks, possibly even months, require frequent and accurate testing of levels, counting of cabohydrates in foods consumed, setting basal (background) levels of insulin that may vary throughout the day, adjustments for increases (or decreases!) in activity, illnesses – the list goes on, but you get the idea! The enormous benefits, though, become apparent very quickly: improved blood sugar levels day-by-day, increased freedom for the child to play and eat as his non-diabetic peers do, and huge increases in confidence for the parents who can worry less about night-time hypos, and be more confident of a long and healthy life for their children.

You can read the story of one child's experience with a pump (the girl in the picture) at

This poem is about Pumper Mums, but could equally apply of course to Pumper Dads or Pumper Guardians, who all do magnificently well – but it wouldn’t have rhymed so well!

Pumper Mums! Pumper Mums! Let’s give a cheer for Pumper Mums!
Now, there’s a bunch of ladies who can really do their sums!
They can bolus for a biscuit, or a piece of apple pie,
And adjust a temporary basal rate if levels are too high!

They can dual wave a pizza so the levels don’t go spiking,
And tweak in tiny increments so the setting’s to their liking!
And when the DSN says they must learn to trust the pump,
Then they’ll use the bolus wizard to avoid a nasty jump!

Hurrah, hurrah for Pumper Mums
Up and down the land!
They’ll be prepared, whatever comes,
And always in demand!

Sunday, 19 July 2009

Come, dine with me!

It’s all about food of course. We need food as much as anyone else, but need to be aware how that food is going to affect our blood glucose levels. One of the biggest misconceptions about diabetes is that we can only eat a limited range of foods, or specialist ‘diabetic’ foods with artificial sweeteners to replace the real stuff. Not so at all! All we need to do is follow a healthy, balanced diet, which is actually no different to what most people would be advised to follow. Cakes and chocolate are allowed, but in moderation either as a treat or taken with a meal – that goes for alcohol too. All we need to do is be aware of how food and drink affects our levels and plan accordingly. My diet hasn’t changed dramatically since diagnosis – I guess it was pretty healthy before – but I have learned a lot more about how the body works and how to keep myself fit and healthy. A hundred years ago diabetes was a death sentence – a hugely restricted diet, leading to emaciation, malnutrition and a pitiful end. With modern knowledge, equipment and medication, I am probably healthier than many of my peers, and aim to remain that way!

Come, dine with me – drink wine with me!
Everything will be fine, you’ll see,
For though I have the dreaded ‘D’
I still take sugar in my tea!

I’m not averse to cake or sauce,
And I’ll eat chocolate mousse (if forced!)
Moderation is the key, of course,
Though sometimes I could eat a horse!

No polyols please, for they make
My nether regions gurgle and quake,
Much better, for my stomach’s sake –
A healthy wholemeal pasta bake!

Diabetes can be a curse,
But there are many things much worse…
I’ll follow the guidelines of my nurse –
Delay the day I’ll need that hearse!

Saturday, 18 July 2009

Goldilocks and the Three Bears

Not many people know that the story of Goldilocks and the Three Bears is actually much more complicated than the ‘eat porridge, break chair, sleep, flee’ version, as told to generations of children. The bears have been grossly misrepresented, and Goldilocks had Type 1 diabetes! Here is what actually happened…
(this is a bit of an epic, so you might want to make a cup of tea first!)
It was eight o’clock in the house of the Bears
And the occupants started to stir.
While Father Bear looked for his other red sock,
Little Baby Bear brushed down his fur.

Already downstairs was that fairest of bears,
Known as Mother Bear to all that she knew.
She was early to wake – she had porridge to make,
And give tea in the pot time to brew.

Now, I think it’s common knowledge that before a bear eats porridge
He would like to void his bladder if he could,
And lacking sanitation, he will feel an obligation
To relieve himself in private in the woods.

So with breakfast on the table, and as soon as they were able,
The bears would go discreetly out of doors.
Father Bear would do it standing, for he found it less demanding,
But Mother Bear preferred it on all fours…

Little Baby was still learning, and he often missed the turning
Which would lead him to the safe secluded spot,
And when Father finished p*ssing he would see his son was missing,
He was angry, as this happened quite a lot!

In the search for Baby Bear, they always started where
The forest path diverged and went three ways.
Father went off to the right and so Mother thought she might
Explore the left side of the forest maze.

Now, it came to pass that day, someone else had lost their way,
A girl called Goldilocks, with yellow shining hair.
Despite her mother’s warning she had spent the early morning
Playing in the forest without a care.

As she wandered in a tizzy, she began to feel all dizzy,
And her heart was pounding fast as it could go!
Panting breath and sweaty palms, the poor girl feared she’d come to harm,
It was obvious her sugars were too low!

She had left her home in haste, for she didn’t want to waste
A single moment playing in the wood.
Oh only if she’d thought to bring those sugar mice she’d bought
For now’s the time they would have done her good!

As she fell down to the ground, Father Bear appeared around
The corner of the path they both were on,
He knew he must act quickly for the girl appeared quite sickly,
So he scooped her up, and quickly both were gone!

As he hurried to his lair he called out to Mother Bear,
‘Come quickly Mother, help me with this child!’
For you see, these bears were kind, and I think that you would find
They were civilised, and not the least bit wild!

As they rushed into the house, Ma said ‘Find a sugar mouse!
For this girl is lacking sweetness in her veins!’
Father Bear said, ‘That’s astute, and that’s why I find you cute!
I’m glad I wed a bear endowed with brains!’

Baby Bear (for he’d been found) brought the sugar mice around
And asked his mother what else could be done?
‘It seems the girl is ailing and the sugar mice are failing,
So you’d better go and fetch the glucagon!’

Baby did as he was told, though he wasn’t very old,
He knew exactly what he had to do.
He’d encountered this before and would probably see more,
For Father Bear had diabetes too!

With the glucagon injected and her liver thus affected,
Goldilocks began to slowly stir
And boy, was she surprised at the sight that met her eyes –
To see three bears gathered around her!

‘Now hush my dear, there, there! You gave us quite a scare!
We’ll soon return you to the world of men.
You should thank your lucky stars that your path crossed ours,
For Mother is a qualified DSN!’

‘Please, will you take a seat, for I think you need to eat
Some porridge to prevent you going low.
We’ve got three different sorts, so please let us know your thoughts.
Then you can rest before it’s time to go.’

The first bowl that she got was a little bit too hot,
The second bowl, a little bit too cool.
The third, she thought was fine, and Baby said ‘That’s mine,
But you must eat it all up, that’s the rule!’

The porridge and her proclivity for all fresh air activity
Had made poor Goldilocks extremely tired
‘Please Bears, I think you said that you had a comfy bed,
Could I go there for an hour now?’ she enquired.

Following the bears, Goldilocks climbed the stairs,
And first she went to lie on Father’s bed.
But uncomfortable springs (amongst a host of other things!)
Made her look for somewhere else to lay her head.

She then tried Mother Bear’s, but a host of moulted hairs
Made the poor girl wheeze and sneeze and sneeze!
And to make things even worse, it seemed Mother Bear was cursed
With a mattress that distinctly smelled of cheese…!

But Baby’s mattress was so deep, Goldilocks was soon asleep
And Mother Bear said ‘Go now dear, and hurry,
We will leave the girl alone, and Father Bear please phone
Her mother, so she knows she needn’t worry.’

So, now you have the truth, that these bears were not uncouth,
They’re the kind of bears who’d help you if they could!
And if you’re ever asked the question, you can offer this suggestion:
It’s a proven fact that bears go in the woods!

Friday, 17 July 2009

The Podiatrist Who Tickled My Toes

Podiatry, or chiropody as it used to be called – not sure of the difference! – is an important aspect of diabetic care. The feet are particularly vulnerable to microvascular damage from elevated blood sugar levels, so it’s important to have them checked regularly by professionals. The treatment usually involves a variety of procedures: checking for visual signs of damage, checking the pulses to ensure a good blood supply, and checking for nerve damage by gently pricking the soles and toes to look for any lack of sensation.

My feet are very important to me, as a runner, so I make sure I never miss my appointments!

The podiatrist who tickled my toes
Didn’t do it because it was fun.
She did it because it was part of her job
To ensure that I keep every one!

The podiatrist who played with my feet
Didn’t do it to give me a thrill.
She did it to keep each appendage complete,
For I want to have TWO boots to fill!

The podiatrist who pressed on my foot
Didn’t do it to cause me alarm.
She did it to test that each pulse was correct,
In order to keep me from harm.

The podiatrist who said ‘Close your eyes’
Didn’t do it, whilst wielding a pin,
Intending to give me a birthday surprise,
But to say where the pin had gone in!

So I’m thankful to her for her skill,
And the attention she paid to my feet –
Let’s make it quite clear, for at least once a year,
The tickling of feet is a treat!

Thursday, 16 July 2009

Do you love the smell of lantus in the evening?

I use two kinds of insulin to control my diabetes – a fast-acting (bolus) one called Novorapid, and a slow-acting (basal) called Lantus. Both have their own particular ‘scent’, but the Lantus is probably the stronger. It’s not an unpleasant aroma. You pick it up when you do an airshot to make sure there are no bubbles of air in the needle. You do this, not because injecting air would do you harm, as it’s only under the skin and not into a vein – but because injecting air means you’re not injecting insulin and therefore not getting a full dose.

Estimating the dose can be an incredibly complex task, as there are so many factors to consider, but in time you begin to get a feeling for what’s right without too much complicated mathematics!

Do you love the smell of lantus in the evening?
Especially when the glucose reading's high?
But too much of it could mean going hypo,
And a late night feast of lucozade and pie.

Do you love the taste of porridge in the morning?
If it's covered with a bolus that's just right.
But working out just how big a bolus
Would even give the Vorderman a fright!

You have to take account of waking sugars,
And if you're going to run a mile or so,
And if that dreaded man-flu you've been feeling
Will need corrective treatment on the go.

Do you love your meter when the reading's normal,
But wish you didn't have to squeeze out blood?
Those fingers, sore from constant piercings
Would rather miss the testing if they could...

Do you sometimes think your body must be stupid
To turn against your pancreas that way?
But thankful that it's something you can manage
If you keep your wits about you day by day.

So, if you've just found out you're diabetic,
As I found out a few short months ago,
Then try to keep your spirits on the high side,
And do your best to keep your 'numbers' low!

Tuesday, 14 July 2009


I felt the need to challenge myself, not to write some long, elaborate poem,
but one that would use the word sulphonylureas – it’s a type of drug used in the treatment mainly of Type 2 diabetes. A couple of other quick limericks sprang to mind whilst I was pondering it, but I managed it eventually! I’m still looking for a rhyme for thiazolidinediones though…!

A man went for retinal screening
Without really knowing its meaning,
'You'll have drops, then you'll wait
Till your pupils dilate,
Then we'll know if you need laser healing!'

There was a young man who was vexed at all
This talk about lowering cholesterol.
He packed animal fat in
And took simvastatin,
Now he has a fine level of HDL!

There once was a man who was furious
That he'd been prescribed sulphonylureas!
He took gliclazide,
Saw his blood sugar subside,
And concluded it wasn't injurious!

Monday, 13 July 2009

Five Point Six

Blood glucose meters are a pretty fundamental part of any diabetic’s kit these days. They allow us to test and hopefully confirm that our blood glucose levels are within a normal range, lowering the threat of complications from the condition. In most parts of the world, meters measure blood glucose in millimoles per litre and a non-diabetic person will stay within a range of around 4.0-7.0 mmol/l.

Thus, an ideal figure to encounter when testing your blood is somewhere in the middle of this range. Practically all the companies that manufacture meters appear to have agreed on a figure of 5.6 mmol/l, and proudly display this coveted figure in all their meter adverts – but I’ve been looking back through my diary and it’s seems this level is about as rare as chicken lips!

What a magical number is five point six!
What a heartwarming figure to see!
But elusive and mythical, impossible to fix,
A number you are unlikely to see…

For the meter will show just too high or too low,
Or may even show an extreme,
But to see five point six on my little box of tricks –
I’d be like the cat with the cream!

It’s a subliminal ruse that the companies use
To persuade us their meter’s ideal,
And help us to choose, and believe we can’t lose –
Just imagine how much better we’d feel!

But I won’t give up hope, and I think I can cope
If the figure I see’s five point seven…
For it’s just within scope of that slippery slope
To a number that’s blood glucose heaven!

Saturday, 11 July 2009

Eye Noon

One of the scary ‘complications’ of diabetes is retinopathy, which affects the sight and can lead to blindness. As I understand it, poor blood sugar control causes the tiny blood vessels in the eyes to become narrowed and rupture. The human body being the remarkable thing that it is, new vessels are then formed to ‘re-route’ the blood. Unfortunately, these can then affect an area of the eye called the macula, and it is this that can cause the blindness. If caught early enough, the condition can be treated with lasers, preventing further deterioration. For this reason, all diabetics in the UK should go at least annually for a retinopathy scan – I’ve got mine due in a couple of weeks. A special camera is used to photograph the retina, and this can then be compared to previous scans for any changes or progression of problems.

So, this poem is a bit weird, and a bit allegorical – hopefully it’s not too difficult to work out what it’s all about!

Now, Eyeball was a mean old town,
A perilous place to be!
An evil trio ruled the roost –
The Rhettin Hopper Three!

They ran the bar ‘The Sugar Vole’
And challenged any man
Who dared to drink their whisky sour
To see straight if he can.

Across the road was Inn Sue Lynn,
Whose business once was fine,
Run by a gal called Pam Creeyass,
Now sadly in decline.

The sheriff of that sorry place,
A man called Mack Yoolar,
Was powerless to uphold the law,
Despite his sheriff’s star.

And then one hot and dusty day,
A stranger came to town,
Confronted by the Hopper gang,
Who laid the challenge down!

‘Don’t listen!’, cried out Pam Creeyass,
‘Their drink affects your sight!
It’s cheap and nasty syrupy stuff
That turns the day to night!’

The sheriff stumbled across the road
And took the stranger’s arm.
‘I’ll lock you in the Beta Cells,
To keep your eyes from harm!’

The stranger shrugged the sheriff off
And drew aside his coat.
The crowd all gasped, they knew the score,
His chances were remote.

He walked into The Sugar Vole
And scrutinised the scene.
He saw the jars of whisky where
The soft drinks should have been…

Rhettin Hopper taunted him,
‘No stranger frightens me!
As long as we have whisky here,
This town will ne’er be free!’

The stranger drew his gun real fast,
And in a flash of light,
Each vessel stored behind the bar
Was blasted out of sight!

‘You’ve saved us all!’ cried Pam Creeyass,
‘And now that we are free,
There’ll be no future in this town
For the Rhettin Hopper Three!’

And so, the stranger married Pam,
And they became sheep farmers,
They reared some tiny Andean sheep,
Called micro-vascu llamas!

Thursday, 9 July 2009

Bolus for a biscuit!

I’m in two minds about insulin pumps. I can get through my days reasonably well and my blood sugar levels are extremely good. But since I became tied to only eating if I inject, and only exercising if my levels are just right, then worrying afterwards if they’ll fall too low because the basal insulin I injected 12 hours ago is now too high – I’ve been becoming more and more seduced by the flexibility that a pump would bring. The downside for me at the moment is whether I really want to be permanently attached and dependent on a sophisticated electronic device. Injections seem to be so much simpler, but do limit your lifestyle considerably compared to a non-diabetic’s. Pumps can make such tiny and rapid adjustments that they much more closely mimic a fully-functioning pancreas. However, because of the expense involved, it’s unlikely to be a choice I’ll have to make any time soon…
One hundred and twenty five monthly injections,
One thousand, five hundred a year,
And virtual abstention from sugary confections –
Now which do you think you’d prefer?

If your other choice was, instead of a pen,
To wear a device day and night
That pumped constant insulin under your skin,
Can you say? Do you think that you might?

What if the tubing should get pulled loose
As you toss and turn in your bed?
Or coils itself into a hangman’s noose,
And then you should wake up dead?!

Imagine though, if you were offered some cake,
When at one time you wouldn’t dare risk it,
The tiny increments you’d be able to make –
And bolus for a biscuit!

So if your levels swing from low to high,
Or possibly go ballistic!
Then let electronic wizards show you why
The future’s optimistic!

Wednesday, 8 July 2009

The Three A.M. Club

Low blood sugar can occur at any time of day or night, but it can be the night-time ones that are the most troubling, as often the symptoms do not awaken a sleeping person so that the hypo can be treated. It can be especially worrying for parents of a diabetic child, as you might imagine. For this reason, it is often suggested that blood sugar levels should be tested during the night to ensure that levels are not dropping too low. Generally speaking, three in the morning is when levels are likely to be at their lowest, so this is the most appropriate time for testing – what fun! Imagine all those bleary-eyed adults and sleepy children being pinged with a finger-pricker just at the time when you’re all comfy and snug and dreaming your favourite dream – oh what fun to be a member of the Three a.m. club!

At dead of night when all are sleeping,
Shadows through the room come creeping,
Seeking blood from those who slumber,
Hoping for a perfect number.

What beasts are these, with hair so wild,
Who would disturb a sleeping child?
What brings them at this witching hour?
What misbegotten, ghostly power?

Some phantom from the nether lands
With sharpened lancets in their hands?
A ghoulish, half-lit apparition,
Intent on some demonic mission…

In other houses, adults sleep –
For them, their slumber is so deep
Alarms will wake them with a shock…
Synchronised at Three O’ Clock!

Three is not a time for resting!
Three’s the time for glucose testing!
Join us till we sleep again,
The club that meets at Three A.M….!

Tuesday, 7 July 2009

The Pump-O-Dyne Eight

There’s a lot of talk about insulin pumps these days. Over in the US, they are fairly common as they tend to be financed by private health insurance, but in the UK it can be quite a battle to get them funded on the National Health Service – you have to prove that you would benefit significantly from having one, rather than using the much cheaper method of MDI (Multiple Daily Injections – now sometimes called BB, or Basal-Bolus). Usually, that would mean that you were finding it very difficult to get control of your blood sugar levels, leaving you at greater risk of diabetic complications.

I have very good control, so the only way I would probably be considered for one would be if, say, a rock-bottom model were to emerge that cut costs significantly. If probably wouldn’t be as elegant as some of the more expensive models, and possibly a bit more unwieldy. Probably something along these lines…

Hello, will you sit down? I’ve something to say.
You remember about pumping? How we said we can’t pay?
Well, I’m happy to tell you that we have found a way,
For a new pumping company has entered the fray!

Now, please don’t be shocked, for I know it looks cheap,
But the cost of those others would just make you weep!
And we’d love to provide them if the costs weren’t so steep…
So, just close your eyes now – and promise you won’t peep!

Tada! There you have it! The Pump –O-Dyne Eight!
With its own little trolley (because of the weight),
And here is the thing that straps onto your back,
With the steam-powered motor in its own special pack…

Now here, let me hold that, and you climb aboard!
Let’s get you strapped in with this thick nylon cord…
Don’t spill that jug where the insulin’s stored!
Come on! Are you thrilled? Let's hear you applaud!

Monday, 6 July 2009

Things that go low in the night…

In the early days after my diagnosis I would frequently wake up with a thumping headache – and that, without the benefit of an over-indulgence in alcohol! It took me a little while to realise that what was happening was that my blood sugar levels were falling very low during the night, but recovering by the morning. At that time I was on 20 units of Lantus as my slow-acting insulin and, although it is not supposed to have a ‘peak’ in its action profile, it seemed that for me it was peaking around 2-3 hours after taking the injection.

The first step was to determine if I truly was dropping low during the night. For me, the symptoms are very different from a daytime hypo. During the day I would get hot and cold sweats, thumping heartbeat, shaky limbs and hands, and blurry vision. At night, as far as I’m aware, I just sleep through it – but then wake with that headache. Some people experience a ‘bounce’, so that the levels are much higher in the morning than expected. I don’t – I’ve always woken up ‘in range’. So, the only way I could find out what was happening was to do the dreaded 3 a.m. tests. Sure enough, I found that I was often dropping low at this time. Gradually, over a period of weeks, I adjusted my Lantus dose, observing and recording the effects. It seemed that, every time I reduced it, it needed reducing further – I began to think I had hit on a bizarre ‘cure’!

Now, I’m happy to say, my overnight levels seem to be completely stable after reducing my Lantus by 55%. But that’s for now, with diabetes, you never truly know what might happen tomorrow…

Things that go low in the night…

Things that go bump in the night will often alarm us and give us a fright,
But since diagnosis, there’s one thing I’ve found –
It’s not the creaks and the rattles that make my heart pound,
But something quite different, if control is too tight,
And that’s when my levels go low in the night…

Things that go low in the night: the temperature’s one, due to lack of the Sun…
And because there’s no Sun, then you’ll find there’s less light,
For despite it’s best efforts the Moon’s not as bright
But it’s none of these ‘lows’ that would give me a fright,
It’s a dip in my sugars, or the thought that they might!

So I’ve worked on my basal, and I’ve tuned it so fine
That my overnight levels stay just over the line,
But there’s always that chance, it’s a diabetic’s plight
That out of the blue, I’ll go low in the night…