Tuesday, 8 December 2009

Injection Disaffection

It’s a common misconception, I think, that being an insulin-dependent diabetic is difficult chiefly because you have to inject yourself several times a day. This is something that most people can relate to, the thought of all those injections and how they must hurt but you have to do them even if you are afraid of needles, and ‘oh, I could never do that!’ I’m sure you get the picture. There are few of us alive today in modern society, of what ever age, who haven’t had to have an injection of some form or another. It may be that the injection hurt, or simply that the anticipation of the pain might even be worse than the actual needle going in. Often, these injections involve rather large needles, and are made into the veins or muscle tissue, which again can make them more painful.

However, insulin injections are quite different. The needles are tiny, usually 6 mm, and the injection is subcutaneous – into fatty tissue rather than a muscle or vein. As you are not injecting deeply, there is rarely contact with nerve endings or blood vessels, just maybe the odd small capillary that might engender a tiny speck of blood. Fingerprick tests to check blood glucose levels are usually far more painful as there are more nerve endings in the fingertips and you are actually trying to produce blood.

So, what is difficult about insulin injections, if it isn’t the pain? The answer is trying to work out every single time just how much you need to inject in order to hit the ‘Goldilocks’ dose – neither too much, nor too little insulin. A healthy pancreas will do all of this without you knowing, and in such finely-tuned amounts that it is impossible to mimic manually by injecting or even with an insulin pump. The insulin starts off at the wrong place too – a healthy pancreas sends most of the insulin it produces directly to the liver for redistribution, an injection will slowly be absorbed through the capillaries directly into the bloodstream. To calculate the dose you need to know precisely how much carbohydrate you are going to eat, and what your resistance to insulin is like at the time of day that you inject. That resistance might be reduced by some previous activity you have undertaken – but by how much? You might also need to consider the speed of digestion of the food you are about to eat, so that you can match the peak of digestion (and consequently blood glucose levels) to the peak of your insulin. There are many, many more factors, but you get my drift.

If you have a healthy pancreas, you cannot comprehend this in the way that a diabetic person does, even if you are very familiar with the concepts and maybe know people close to you with the disease. It is true that a parent will fear for their child if they have diabetes, but that is different to how a comprehending adult will feel. With each injection I feel an anxiety about getting the dose as near to perfect as possible so that my blood glucose levels will fluctuate no more than a non-diabetic person’s would, and thus spare me from the potential awfulness of diabetic complications of the heart, eyes, kidneys, nervous system and limbs. No matter how often I do it, and later find I got it almost right, each injection brings with it this mental distress. This may fade with familiarity, I’m not sure, but for the moment that seems unlikely or at least a long way in the future.

I think that on reflection, my injection disaffection
Is not from when the needle tip goes in,
Or some fearful predilection, or the worry of infection,
For I rarely feel the pinprick break the skin.

No, the pain of the injection is the insulin selection,
And the hundred different things you need to know –
Overlooking one connection in your quest for dose perfection
Could later find you high or find you low.

For each dosage calculation you need flawless information,
If you don’t inject, you can’t really understand,
For you have no real sensation of the fear of complications,
That pervade your life in Diabetes Land!

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