Saturday, 27 February 2010

If Disney did Diabetes

In tribute to the very funny notion of Disney tackling the difficult topic of chronic disease, as expressed by Shoot up or Put up, I thought I would play out the postulate in poetic form…

If Disney did diabetes,
What a wonderful thing it would be!
For cute woodland creatures would all rally round,
And test strips would all grow on trees!

And hypos would sparkle like sunshine,
The meters would all dance and sing!
And a lancet called Burt would never, ever hurt,
And Lantus would no longer sting!

Insulin would be gathered from dewdrops,
Sucked up into colourful pens,
Metformin and gliclazide would be speckled eggs
Laid by clucking and magical hens!

Imagine if Minnie and Mickey
In the spirit of rodent romance,
Allowed you to see your HbA1c
Expressed through the medium of dance!

At the end of the heart-warming story,
We would all shed a tear when we hear
The Fairy Queen say that a cure’s on the way,
Diabetes? We’ve nothing to fear!

Saturday, 20 February 2010

Lady Lantus and the Lord of Levemir

Insulin is great! It stops my blood sugar levels from climbing ever higher and allows me to live a full and normal life – without it I would be dead by now. Great advances have been made since the days of Banting and Best, and mashed up animal pancreases from slaughter-houses - we now have synthetic ‘human’ insulins produced by the great pioneering companies such as Sanofi-Aventis, Novo-Nordisk and Eli Lilly. I personally use Lantus from Sanofi-Aventis as my ‘slow-acting’ background insulin, injecting this once a day, but many people use Levemir from Novo-Nordisk. I also use Novorapid as my ‘fast-acting’ insulin to cover the food I eat. Together these noble concoctions keep the diabetic beast within me under control…!

I’ve heard it told in days of old,
In a distant, far-off land,
The Lord of Levemir sought to win
A fair young lady’s hand.

But first a dreadful obstacle
The Lord must overcome –
A being that could strike men blind,
And limbs could render numb!

Betwixt the land of Levemir
And Lantus to the East
There roamed the awful terror
Named the Diabetic Beast…

The Lord sought counsel far and wide
How victory may be won?
The Beast must feel the glargine sting
At each setting of the Sun!

To the Sparkling Springs of Sanofi,
Where elixirs caught the light,
He drew syringes long and full,
And set off for the fight.

Across the raging Novorapids,
Three days and nights he rode,
And the Gnomes of Novo-Nordisk
Beside our hero strode!

And there, the Beast lay lurking -
They felt his fiery breath!
So sweet and sickly, thick and foul,
A harbinger of death!

But Levemir was not dismayed,
He plunged the syringes deep!
The Beast at once lost consciousness,
And for the day would sleep.

And thus was Lady Lantus free
To wed Lord Levemir,
The Beast subdued by Sanofi,
Once daily, in the rear!

Tuesday, 16 February 2010

Chocolate Chickens and Diabetic Eggs

Well, Christmas is over, and no sooner had the New Year started than the Easter Eggs began lining the shelves of the shops and supermarkets up and down the land. One particular variety is the ‘diabetic egg’, ostensibly produced to satisfy the niche market of those poor souls amongst us that cannot tolerate real sugar and real chocolate. How are these eggs produced? In factory farms, with row upon row of unfortunate chocolate birds with their pancreatic ducts tightly ligated? A scandal! And you will find whole sections, particularly in pharmacists, dedicated to ‘diabetic chocolate, sweets and cakes’, giving the impression that people with diabetes can only enjoy specialised products that need to be set aside from the treats of the general public. Or have I got it wrong, and it is the chocolate itself that is diabetic, its pancreas removed during manufacture in order to make it palatable to some ghoulish section of the community?

My eyes weep for the plight of those skilled, but dreadfully abused diabetic members of the Belgian nation, forced to work long hours in dark, squalid chocolate factories – in stark contrast to the luxuriously packaged edible nirvana we see adorning specialist shop windows, proudly proclaiming their origins as ‘Diabetic Belgian Chocolates’…

This madness must end! Let the chocolate chickens roam free and lay normal-sized crème and truffle eggs that we can all enjoy with a clear conscience! Let no more chocolate suffer the pain and indignity of having its pancreas torn from within for the sake of a specialist market! And let the diabetic Belgians out into the sunlight, to make ordinary chocolates alongside their non-diabetic compatriots!

How does a chocolate chicken lay a diabetic egg?
It’s something I have pondered for some time,
They must be enormous chickens, and decidedly bow-legged,
It’s not normal, and must be a poultry crime!

Does chocolate have a pancreas? For I saw once in the shops
A section for the diabetic kind…
Are they made that way on purpose? Then if so, please call the cops!
That’s as bad as making a Venetian blind!

Are diabetic Belgians especially employed
To make the staples of that nation’s fare?
Do they work in chocolate sweatshops the authorities avoid?
Does the chocolate-eating public really care?

Let us shout a cry of ‘freedom!’ for I think the time has come
For those labelled ‘diabetic’ to break free!
We’re no different from the masses, and far healthier than some,
And no more chocolate chickens should we see!

Monday, 15 February 2010

Running whinges and twinges

My ambition to run 1,000 miles and cycle 1,000 kilometres this year is hitting a few rough patches. Obviously, I started the year full of ambition and determination, but old age, laziness and faint-heartedness have so far severely interfered with my targets. Probably, the faint heart has been the biggest obstacle, when faced with sub-zero temperatures and biting, North Easterly winds – what kind of fool would go out running in that? Not this one! Consequently, I have clocked up a mere 0.5% of my annual target for running, midway through the shortest month of the year. I’m behind, but much more in touch with, my cycling ambition – currently about 8% completed – about half what I needed to have achieved by this time of the year, but still ‘doable’.

After the total no-show of January, I finally decided that enough was enough and I was just going to have to be brave, so I started back out running again during the past week. I’m still reasonably fit, although I do appear to be carrying a bit of extra ‘winter’ weight, which certainly makes things harder. I am, after all, having to carry that extra weight with me everywhere I go, and it also affects my tendons, muscles and joints with every footfall. The resultant impacts are taking their toll on my lower limbs, which is very frustrating. After a couple of miles I am perfectly capable of continuing much further, but for one particular area on the inside of my right calf muscle. This small area protests with every stride, particularly on downhill stretches, and threatens something far more serious than an ominous twinge should I dare to ignore it. As a result, I have simply not been able to complete the mileage I had hoped for, and am capable of on the most part.

Better to build up slowly though than risk exacerbating things. An injury would put me out of running and cycling. I’m pretty sure that this is related to the biomechanical instability in my leg, introduced by the femur break and subsequent repair operation. The surgeon did an excellent job, but it’s not quite as it was before. A quick search of the interweb tells me that it is likely an injury to the gastrocnemius muscle. Things should improve as I strengthen the surrounding muscle and get more endurance and stamina into the tissues, so hopefully I will start my ambition on a whimper but build to a bang!

One thing that I still struggle with from time to time is getting the insulin right. When I went for my last run I started with a level of 7.2 mmol/l, but finished on 10.8 mmol/l. My levels had still not come back into normal range (4-7) two hours later, although they had come down to 7.8 mmol/l. Really, I would have expected a much lower reading after the exercise, but it seems that I don’t start increasing my sensitivity to insulin until several hours after the exercise. This can then go on for up to 40 hours. What I’m trying to work out is, were the post-exercise levels due to an insufficiency of circulating insulin? Should I have had an extra unit with my breakfast? Or was it due to a stress response that caused my liver to release glucose and push the levels higher? Sometimes it all becomes far too complicated and you just have to accept it.

Sunday, 14 February 2010

My Darling Diabetes

It can take a while for it to sink in that diabetes is with you for life. When I was first diagnosed and was in hospital for a week it didn’t even dawn on me that I would have to inject myself with insulin when I left. It’s only in those first few weeks and months that the full import starts to hit home, as you realise the complexities involved, the compromises to be made, and the constant, underlying presence of something that impinges on your every waking – and sleeping – hour of existence. The brain needs blood glucose. The body needs blood glucose. But as Goldilocks would appreciate, neither too little nor too much. My good old pancreas used to sort all that out for me, with never a word of thanks or even a casual nod of appreciation, but now I have to do it myself, Most of the time it appears as though I’m doing quite well at it, but I’m under no illusion that, after eating, my levels are peaking higher than if I didn’t have diabetes. Between meals, my levels can also drop lower, causing my brain distress (and who can blame it?).

But, I’m not really the type of person to deny it’s there. Until a cure is found, I guess we’re saddled with each other…

My darling diabetes, don’t you dare deceive me dear!
When first we met you promised me you’d leave within a year.
But now I fear you’re clinging on, and may refuse to go,
And if you should, then that’s not good, and would distress me so!

You promised me that, from the start, we’d be the best of friends,
We’d share each day, at work and play, until the friendship ends.
And when I asked you when you thought that day may one day be,
You said next year, on Valentine’s – you did! You promised me!

So now, be gone! Get out of here! You’re far too hard to please!
You said that you would fit right in, we’d both get on with ease!
But I have had to think of you and always put you first,
How can you be best friends with me, when you are quite the worst?

I’ve shut the doors and changed the locks, the music’s turned up loud,
And I won’t hear you if you knock, so please don’t come around.
My goodness, it feels wonderful now you have finally gone!
Oh! I dreamt it? Ah well…I guess that life goes on…

Friday, 12 February 2010

Dear Doctor Valentine

With Valentine’s Day approaching, a sorry tale of a close relationship gone badly wrong, due to the ignorance, laziness or ineptitude of one of the parties…

One topic that crops up time and time again is the topic of the prescription of blood glucose test strips to people with diabetes, particularly in the case of diet-controlled Type 2s but also for those on medication and even, occasionally, those on insulin. The root cause of doctor’s reluctance to prescribe is generally cost – these strips are expensive, currently working out at about £0.50 per strip. The denial of strips is usually supported by reference to some largely outdated survey which purported to show that testing for Type 2 diabetics was unproductive and unnecessary. The survey concluded that knowing levels led to depression and no significant reduction in overall levels. However, what is not emphasised is that those in the survey (only consisting of 453 patients) had an average age of 65. The conclusions, therefore, were based on150 people who were testing and provided with education. In fact, this group did show an improvement, and whilst the numbers may appear small in such a small group, apply that to the 2.5 million with diabetes and you get an improvement for thousands of people. Interestingly, the person in charge of that survey (Andrew Farmer) is involved in the SMBG (Self Monitoring Blood Glucose) International Working Group. This is a group which is attempting to set guidelines for testing not just for the UK, but for diabetics everywhere. Their latest report is available by clicking the download at and the conclusions are very much in favour of encouraging testing when accompanied by a structured education and patient/professional approach.

If people don’t want to test, then that is their decision and many are happy with this (particularly, perhaps, those in their later years of life). But if a patient shows will and determination, then they should be given the opportunity and fully supported.

Instead of daily self-monitoring, for those not on insulin, it is often believed that the three- or six-monthly HbA1c test is sufficient to show progress. However, this merely shows and average over the previous 6-12 weeks, and does not inform the person how certain foods and activities directly affect them so they can act on the information. Logic and evidence shows that if you know what foods to avoid, and act on that information, significant results can be achieved. This knowledge also enhances quality of life as the person is no longer constantly worrying in anticipation of their next Hba1c test, and anxiety about the possibility of developing horrendous complications is reduced enormously.

Some doctors are more enlightened and can see the benefits of testing, on whatever regime, and will duly prescribe strips and arrange education so that their patient knows how to react to the information gained. Many however, constrained by budgets, see it as an opportunity to reduce spending and are not foresighted enough to realise that happy, well-controlled patients are at far less risk of much more costly treatment in the future should they need major treatment such as dialysis or amputation.

There is tremendous anger generated by this short-sighted attitude – and rightly so! One forum members has set up a petition to persuade the government to reassess this discrepancy and penny-pinching approach. Please sign it, more than 500 signatures and the government have to respond.
For people on insulin, testing is even more essential in order to determine doses, check that levels are safe before driving, before and after exercise, fr lows and highs – the list goes on. Unbelievably, the need for strips is often questioned! ‘Why do you need to test so much?’ ‘You’re being obsessive!’ The most ridiculous – and dangerous – one recently encountered was for a pregnant lady whose online prescription service informed her that she had exceeded her allocated amount and could not have any more for several weeks! Pregnant women are in even more need of regular testing in order to keep their unborn child safe, and levels will be far more difficult to control as the pregnancy develops, so this amounts to a criminal disregard for both patient and baby. No-one, under our health care system, should have arbitrary restrictions placed upon them, in these circumstances in particular.

Do these doctors think that stabbing your finger several times a day with a painful lancet is some kind of perverse pleasure that must be discouraged? Let them walk a day in our shoes! So, today’s poem is rather barbed in response to those know-it-all, petty, uninformed, uncaring doctors who put misguided and erroneous ‘savings’ before patient welfare – a metaphorical death by a thousand fingerpricks!

Oh, let me hush those dulcet tones,
Your voice so warm and tender,
And crush your hand between these stones,
And stick it in the blender!

What? No, my love, I am not cruel,
Just close your pretty lips,
I’m crazy like a lovesick fool
When you deny me strips!

I cannot know as well as you,
So white coat worldly-wise,
But let me take this superglue
And squirt it in your eyes!

I’m flushed, I’m shaking with desire,
Let no more words be spoken,
It will be hard when you’re on fire,
And every bone is broken!

If only you had shown me love,
And let those strips be mine,
You’d be my fluffy lovey dove,
My Doctor Valentine!

Tuesday, 9 February 2010

Facing up to the Double-D’s

It would be a pleasant prospect if indeed the double-Ds in question were those adorning the chest of some amply-bosomed lingerie model, but sadly, no such luck. Diabetes and depression often go hand in hand, as with many other chronic conditions from which there is ‘no escape’. Add to that the cold, dark, dreary days of winter with a bit of extra-befuddled brain chemistry, and the result can be true misery where the world closes rapidly in on the tiny speck of light still penetrating your personal pit of doom. I’m sure there’s a joke in there about a ‘cup only being half full – a double-B, perhaps (not sure how these things are calculated). Double-B – perhaps bipolar and blood glucose?

Well, it happens to me from time to time (not the lingerie model experience), and it happened this past week, but I feel I am coming out of the other side. It happens most years, and each winter I keep promising myself a light box or something, but procrastination always leads to it not being worthwhile since Spring is rapidly approaching. Winter – hideous, hateful season. Spring – all things bright and beautiful!

Tuesday, 2 February 2010

Diet Drink Awareness Campaign

Someone on the diabetes support forum expressed their anger at being sold full-sugar coke in a pub despite asking for the ‘diet’ version. Now, this may seem like an unfortunate, but not particularly dangerous thing to do. In the majority of cases, that’s probably true, if a person is merely trying to reduce calories. But if you have diabetes then there is a real risk that it could cause serious harm, or at the very least make the person feel very unwell. Full-sugar coke is the kind of drink you might reach for if your blood glucose levels were particularly low (hypoglycaemia) and you needed an instant boost, for the sugar hits your system almost instantly.

However, imagine the scenario where a person with diabetes has been feeling under the weather. Illness – even a mild cold or cough – can cause blood sugar levels to rise, and as they rise the body will feel the need to flush the excess sugar out of the system, making the person dehydrated and thirsty. Let’s say this person then tries to quench that thirst with a drink from a pub or fast-food restaurant – and they are given the wrong kind, whether mistakenly, or as some sort of ‘joke’. Their already high levels will almost instantly go stratospheric and place them in extreme danger of a life-threatening condition called DKA (Diabetic Ketoacidosis). This can lead to hospitalisation, possible coma and even death. Not so ‘funny’ now then?

Numerous tales have now arisen about this happening, so it is not a rare occurrence. Whilst it may often be a mistake, there have also emerged tales of how staff have deliberately switched the hoses on the drink dispensers so the full sugar version is dispensed from the ‘diet’ tap. We need to raise awareness of the dangers of this practice so it can be treated with the gravity it deserves. To this end, we have started a Facebook group ‘The Diet Drink Awareness Campaign’, so anyone reading this please join and lend your support. One member of the forum has approached the agent of Dom Littlewood (of BBC ‘The One Show’ fame). Dom has Type 1 diabetes himself so hopefully he will feel this is an issue he would like to help with. Watch this space!

‘Here’s a laugh – let’s see their face,
Those fussy patrons of this place!’
‘It must be diet’ – where’s the harm?
How could sugar cause alarm?
It’s just a prank, a jolly jape,
It’s hardly murder, theft or rape!

No, that’s not true you stupid man!
There’s every chance that sugar can
Make diabetics very ill
And even a risk that it could kill,
You’ve never heard of DKA?
I’ll just explain it if I may…

Imagine someone who is cursed
With sickness and a raging thirst –
Their levels are already high,
Your ‘joke’ will send them through the sky!
And poisons build up in their blood
Since they don’t know your drink’s no good.

This isn’t just some petty fad,
A vanity that sugar’s bad,
But represents a threat to life
As deadly as a gun or knife!
So find another form of ‘joke’
That can’t cause harm to innocent folk!