Tuesday, 29 June 2010

All you need is cash (and gullibility!)

Money can’t buy you everything, but there are always charlatans around ready and willing to persuade you otherwise. Unfortunately, there is not as yet a cure for diabetes – progress is being made on a number of fronts, but a method of expunging the disease is still some years away. It is, of course, possible for many people to manage the disease successfully using a combination of the right diet and keeping active, but should they waver then the effects of the disease will return. Others may not have this option, as their insulin production may be inadequate or non-existent.

People live in hope though, and many are convinced enough by elaborate claims to part with their hard earned cash, thinking that they have discovered something that the whole of conventional medicine has either failed, or refused to recognise. Pseudo-science and unreliable, manipulated or even fictional evidence may be used to back up the claims. I don’t think the claims in my poem are any more ludicrous than the idea that energised water or lettuce can cure it…!

I met a man who, thrice a week
Ate seven pickled eggs…
Another man I came across
Smeared treacle on his legs!
And yet another squeezed the leaves
Of Himalayan plants,
Then quite obscurely poured the juice
Into his underpants!

When asked what led them to perform
These strange and worrying acts,
They paused, and with a knowing wink
Apprised me of the facts:

It’s well known on the world wide web
That, for a pound or two,
Enlightened gurus will divulge
A means to cure you!
But, as we are all different,
With wealth and needs diverse,
A tailored cure must be devised
That suits your tastes (and purse!)

‘For me, eggs steeped in vinegar –
As long as it is pure –
Will neutralise sugar in my blood,
And thus provide the cure!’

‘An egg cure wasn’t right for me,
But treacle smeared just so
Will draw the glucose from my blood,
And keep my levels low!’

‘And you?’ I asked the man in pants,
‘Your cure’s the strangest yet!’
‘Indeed! My pants, the guru claimed,
Must be forever wet!
But not just any liquid goo
Would fix my pancreas,
But only that extruded from
Expensive mountain grass!’

And with these words I took my leave
And slowly backed away,
For I was sure there is no cure
However much you pay!

Monday, 28 June 2010

Ghastly Green Jelly Babies

My favourite treatment for when my blood sugar levels drop low is two or three jelly babies – they’re tasty, quick to act and a welcome compensation for the hypo sweats and shakes. However, there comes a time in the life of every box of Jelly Babies when you realise that, with racing heart and blurring sight, you’ve eaten every colour except the green ones! From that point on it is a battle between your rational mind knowing that they still contain the same amount of precious sugar as all the other colours, and will do just as good a job, and that nagging voice in your subconscious telling you that they are evil transdimensional denizens of some dark nether-universe, here to wreak anguish and madness on all who bring them to their lips…

It cannot be so far away,
When dawns that dreadful, fateful day
As, reaching to treat my hypo shocks,
I find just green ones in the box!

Oh, tell me Mr Basset please
Why waste your time producing these?
Tart on tongue, and jealous hue,
An aberration! Shame on you!

For lusty red, beguiling black
I could consume those by the sack!
Bright orange, sunny yellow too –
I’d even accept a baleful blue!

But green brings foaming at the mouth,
One eye looks North, the other South,
Gripped by a kind of emerald rabies,
The Dark Lord of the Jelly Babies!

Tuesday, 22 June 2010

Where do you lie on the Curve?

People have different reactions to diabetes, and management of blood glucose levels can span a broad spectrum. Some people may test levels compulsively, a dozen or more times a day and worry over every tiny detail so that they are constantly battling for perfection which is very hard, if not impossible, to achieve. At the other end of the spectrum, there are those who will rebel against diabetes, or deny its existence, never testing and taking a wild guess at their blood sugar levels before injecting an equally unscientifically calculated amount of insulin. Some may not even bother with the insulin.

I tend to lie on the ‘cautious’ side of the curve. I’m still very much aware of all the horror stories about diabetes and what devastating effects it can have. I admit to feeling slight disappointment this morning when my level read 6.7 mmol/l (120 mg/dl). Even though this is within my target range, it was about 1 mmol/l (18 mg/dl) above what it might normally be. I spent a moment fretting over whether my basal insulin might need changing a smidgen. The moment passed though! It’s something that you can become too obsessive over, to a point where it can dominate your life, and when that happens for any protracted period of time, then that’s not really living.

Those who choose to ignore their diabetes management, however, are the ones putting themselves at risk – the very real risk of complications like nerve or kidney damage, blindness or amputation. Not knowing what your levels are for days, weeks months on end means you will either be keeling over from a hypo or, more likely, your levels will be so high as to be causing damage hour by hour, possibly giving you short term problems like DKA, and undermining greatly your quality of life.

Find the middle way, the point of the curve that shows you care enough to pay attention and spend those few minutes each day to do the best you can. But don’t let those minutes turn to hours and take over your life.

Where do you lie on the Curve
Of caring and couldn’t care less?
For some, tight control’s an obsession,
For others their levels are a mess!

Some are driven by fears of the future,
And each reading that’s just out of range
Brings panic and deep disappointment,
And confusion about what needs to change.

Yet others will choose to ignore it,
Burying heads deep in the sand,
No testing, and guessing at insulin,
Activities and meals all unplanned.

So you mad, and you bad, diabetics,
Strike a balance as you live out each day,
Be respectful of your diabetes,
But don’t let it stand in your way!

Tuesday, 15 June 2010

Hyper Slugs

It’s a little known fact that diabetics need to keep their distance from slugs. I read recently on the forum about a poor lady who chanced upon a slug that had crawled onto her cooker during the night and so distressed her that her blood sugar levels shot up and stayed high for several hours afterwards. I can only speculate that there is some form of chemical message that is given off by the noxious slime they leave in their wake, stimulating stress hormones in humans, and raising blood sugar levels.

Caution should therefore be observed when these creatures are in the vicinity, and the age-old defences of salt and beer should be administered immediately on sight, before any harm is done…

It may befall you, late at night, to wander through the house,
But be beware of things that lurk, like spider, slug or mouse!
What’s that you say? A mouse is known to scurry through the gloom,
And spiders too may weave their webs in corners of the room…
But slugs? You speak in jest my friend! What fears do they inspire?
They’ll hardly leap from out the murk, or breathe on you with fire!

But slugs have powers little known – the slime that they exude
Can raise the sugars in the blood, playing havoc with your mood!
Emitting powerful pheromones, they signal to your brain
To flood your blood with cortisol, until the slug is slain!
So arm yourself with salt and beer, to keep the beasts at bay!
And slay the ghastly gastropods – despatch them on their way!

Monday, 14 June 2010

Basal and Bolus, the bane of my life?

I’m on an insulin regime known as ‘basal/bolus', also known as MDI (Multiple Daily Injections). Basal insulin is slow-acting, and one injection lasts around 24 hours, in theory at least. Bolus insulin is given to match the carbohydrates in a meal or snack, or to correct a higher-than-I-feel-comfortable-with level, usually double figures for me, although I have only made three such corrections in two years.

Sounds pretty straightforward, yes? Well, for me, I’m lucky that most of the time everything seems to be fine. Just lately though, chiefly due to my enforced withdrawal from the running fraternity due to my injured knee, things have been going a bit all over the place. My levels generally crept up, so I had to try and estimate how much additional insulin I needed for each 10 grams of carbohydrate (known as a ‘ratio’), and also if I needed to increase my basal insulin to keep me steady and in range when I wasn’t eating.

After a few weeks of doing this and getting mixed success, I’m now back exercising, which means I’m now having to reverse the trend and start decreasing my insulins – more mixed success! Currently, it appears that I’m taking too much insulin, as my levels have dropped low several times over the past few days. Basal insulin is harder to deal with, as its effects can take a couple of days to manifest so you need to try and see into the future! Life would be much easier on an insulin pump, since adjustments can be made in tiny amounts and at very short notice, but my chances of getting a pump are virtually zero due to my overall good control and the expense of a pump.

Still, it could be far worse! I have pretty good control compared to a lot of people, and whilst not perfect, the adjustments I make seem to be fairly close to the mark. It’s just hard having to think ahead and pull numbers out of the air day after day! Hopefully, once I am back in regular exercise, everything will settle back down again.

Basal and Bolus, the bane of my life!
One day they’ll work fine, the next they’ll cause strife!
For it’s not just a case of injecting four shots,
But having to think of the ‘do’s’ and ‘do nots’.

I do need more basal if I should awake
On a level too high for my night fast to break,
But if I should wake with my levels too low,
That’s a sign that some of my basal should go.

But how to predict it? And how to react?
There’s no way of knowing each pertinent fact!
For our bodies are so complex, and our methods so crude,
It’s hard to outguess both our liver and food.

Bolus, you’d think, would be easier to know,
For we just need to use the correct ratio…
But if we don’t weigh every grain, every gram,
Then in truth, it’s an estimate, maybe not worth a damn.

And basal? That’s bothersome in a different way.
You can only adjust every two or three days…
And between now and then, what will happen? Who knows?
I can only adjust and then see how it goes!

I may whinge, I may moan, how my life’s so unfair,
And envy those others who don’t have such cares.
But the bottom line’s this, it has to be said –
I’d rather have this than be lying there dead!

Sunday, 13 June 2010

The Weigh In

We happened to be talking on the forum about the nurse who had spent an entire consultation relating her own troubles and woes (see Nurse Ne’er Do Well), and another member related the story of how she met a similarly insensitive and rude nurse at her diabetic check up. Apparently, the nurse was an agency nurse who normally worked at a Harley Street weight-loss clinic which promoted an extreme diet of yoghurt and soup for two weeks. Without a thought for the lady’s feelings, or even her need for such a diet, she continued on…here’s what happened:

Off for my check up, weight, BP and wiz,
It’s an agency nurse who’s conducting the biz,
So as you might do, in a jocular way,
‘I hope I haven’t gained any!’, I happened to say.

She raised her right eyebrow, in Roger Moore style,
And pursing her lips, looked down at my file.
‘Just take off your boots please, and stand on the scales,
Haven’t seen so much blubber since I went watching whales!

I found that offensive, and was about to say so,
When she spouted forth wisdom she thought I should know.
She put down her pen as she warmed to her cause,
And gave me no chance as she said without pause:

‘You don’t have to be big and hefty my dear!
I know that for women your size that’s a fear,
There’s an easy solution you really must try –
Either that, or grow fat, so fat you might die!’

‘Two cans of soup, the Weight Watchers kind,
Plus six natural yoghurts, and I think you will find
That after two weeks you’ll have lost thirty pounds,
And be able to walk without shaking the ground!’

At this I was speechless, for what did I see?
But a twenty stone nurse who was talking to me!
‘You should take your own medicine, for I strongly advise
That you give up the booze and stop eating the pies!’

Saturday, 12 June 2010

More Byetta Limericks

There was a young man from Valetta
Who liked to eat Wall's Viennetta,
But it spiked up his blood
So he thought that he should
Take a regular dose of Byetta!

A woman who once got a letter
Saying she should start taking Byetta,
Said it caught in her gizzard
At the thought of the lizard,
And she hoped that the doc would forget her!

A woman who wouldn't be denied
Demanded some exenatide,
Her levels improved
So her doctor was moved
To approve any others who applied!


Friday, 11 June 2010

Lizard spit

There's a treatment for Type 2 diabetes called exenatide, marketed under the name of Byetta. This drug has a remarkable history, as it is actually a synthetic form of a hormone found in the saliva of the Gila Monster lizard - hence the affectionate moniker 'lizard spit'! It works a bit like glucagon, which is a hormone that helps regulate insulin in non-diabetics, hence its use as a diabetes treatment. It also appears to have the additional benefit of helping people to lose weight, rather than gain it (which can be a consequence of insulin treatment). All very interesting and useful, but I just like the idea that people around the world are injecting lizard spit to help combat diabetes!

A woman whose doctor once let her
Start taking a course of Byetta,
Began to lose weight,
Saw her levels abate,
And soon felt considerably better!

A woman whose dress didn't fit
Was advised to inject lizard spit.
'I'll have some of that please,
For I have diabetes,
And my last pair of knickers just split!'

Thursday, 10 June 2010

Nurse Ne'er Do Well

Some nurses are excellent. They listen to your troubles with a caring ear, and dispense useful, practical advice in words you will understand, yet without being patronising or condescending. However, a lady on the forum recently spoke of her encounter with a nurse who spent an hour relating all her own personal problems until eventually the lady walked out! I imagine the scene went something like this…

Ah! Come in my dear and please sit over there.
No, not in the comfy one – the grey plastic chair!
I have to sit here, it’s been quite a while
Since my bottom’s been sore on account of my piles…

Now, you’re diabetic, I think it says here.
My eyesight is awful, it’s not very clear…
Uh! You’ll have to speak up dear, what did you say?
I’ve been deaf as a post for a year and a day!

Since you’re diabetic, perhaps you will know?
I wake in the night and I just HAVE to go!
It may be my bladder, perhaps it’s my age,
Would you do my job on this miserable wage?

My throat feels quite dry, I might have some tea,
You probably wouldn’t cope if you had troubles like me!
Some patients are awful, they just ramble on,
Now let me just see where your…oh! She’s gone!

Blooming roses!

The roses are blooming beautifully at the moment. There must be some combination of the late Spring following an exceptionally cold, poor Winter that has resulted in such prolific and beautiful blooms. And they smell gorgeous!

Tuesday, 8 June 2010

Casually Consuming Crisps

Before diabetes I was a lover of crisps (aka potato chips to my American friends!). In the UK they have always been a popular treat, generating a huge range of, sometimes bizarre, flavours over the years. Famous examples have been hedgehog flavour, squirrel flavour, baked bean flavour – the list goes on. My personal favourites used to be salt and vinegar and smoky bacon. The best crisps ever made are Seabrook crinkle cut, made in the Yorkshire town of Bradford.

The thing is, since my diagnosis I have weaned myself off them. Not sure how it happened, but I think that, in the early days at least, I was so scared of my blood sugar levels going up above ‘normal’ that I would only eat them at mealtimes, when I was injecting insulin. In time, I came to prefer other food at mealtimes, and the crisps became an ‘extra’ that I didn’t want to inject extra for. I know that, as an insulin-treated diabetic I can, in theory ‘bolus for a biscuit’ – or, in this cae, a bag of crisps – but I’ve never got into that habit. The only time I inject for food is at proper mealtimes, or very rarely if I need a correction dose because I miscalculated the dose for my meal (only happened three times in two years!).

So, crisps are now a bit of a luxury. I can’t just casually munch away on a bag on a whim, I have to consider either injecting, or letting my levels go high. I also consider the salt and fat content of them these days, as these may affect my blood pressure and cholesterol levels. I find it’s a bit like in the first couple of years after I stopped smoking. I would see someone just light up, and feel all sorts of emotions – that I was being denied something I once enjoyed, that it wasn’t fair for them to be able to get away with it and I no longer could! Of course, those feelings faded with time and now I appreciate that they probably are doing harm to themselves, at least to their wallets. Yet I was surprised that similar emotions were awoken when I passed someone cramming crisps into their face on the street…

As I was out walking, I happened to meet
Someone casually eating some crisps in the street.
Now, that’s not remarkable, I hear you all say,
For it’s something we witness almost every day!
Well, that may be true, but I think you may find
Diabetes brings thoughts of a quite different kind.
The thoughts may be angry: how dare she do that!
Just stuffing her face at the drop of a hat!
The thoughts may be jealous: I wish it was me,
Enjoying those crisps so entirely carefree!
Or, maybe some sadness: I remember the time
When I would eat crisps, oh the taste was sublime!
Now that one simple act that the girl took for granted,
For me, is a sin that must now be recanted.
The carbs in the crisps would send my blood sugar high –
It’s hard to resist, but I really must try!
But once in a while, I may admit defeat,
And casually consume some crisps in the street!

Monday, 7 June 2010

Sir Alan of the Northern Territory

On the diabetes forum where I am an Administrator, I was recently dubbed 'Sir Alan of the Northern Territory' by member Rossi Mac, and was touched by this poetic tribute to me from the lovely HelenP - thanks Helen!

STUPID DIABETES we all shout -
Some of us thin, some of us stout.
The Big D doesn't discriminate;
It can hit you early, it can hit you late.

It doesn't matter who you are,
Shop assistant, or superstar.
You might be useful on the pitch,
Or quoting Shakespeare's made you rich.

Whatever we do for our daily jobs,
We all have pancreatic probs.
As much as we'd all like to ignore 'em,
They are what's brought us to this forum.

And here we've met the nicest man
Who'll always help you if he can.
So, how shall he be known henceforth?
Arise! Sir Alan of the North.

Friday, 4 June 2010

Going Solo

There have been a lot of interesting 2nd anniversaries for me this week. On this date two years ago I was embarking on my first ever day managing my own diabetes, doing my blood checks and administering my own injections. I had been discharged on 3rd June, in the late afternoon, with instruction but no practice (on any kind of fruit) on how to use my two insulin pens. And so, on the evening of June 3rd, at exactly 19:22, I gave myself my first ever injection of novorapid - 16 units, before my evening meal. My pre-meal blood glucose was 10.0 mmol/l, a little on the high side I realise now, but back then it hadn't really sunk in what was 'good' and what was 'bad'. I had, after all, been 37 mmol/l at diagnosis and remembered several readings in the high 20s, so 10 didn't look that scary. Also less scary was the lancet I used for the BG reading - far less painful than the multi-purpose, discardable ones the nurses had used, but a little shock nonetheless.

How do I remember all this? Well, I don't need to because I recorded everything in my BG diary, something I have maintained to the current day. As a fan of history, it's interesting to look back through these diaries, to see how my levels became better tuned over time, and also to see how my insulin requirements changed over time. I started out on a regime of 16, 14, 16 novorapid before meals, and 20 lantus at night. The breakfast one and the lantus have changed most - yesterday I had 8 novorapid before breakfast and 10 lantus at bedtime. I'm glad that I received early instruction in how to adjust my insulin, as it has made life a whole lot easier. I can't imagine how people manage on mixed insulins or fixed doses. My early days on fixed doses are shown in the diary to have resulted in many more highs and lows than I experience now.

Diabetes is a difficult disease to manage. There are so many variables involved, chiefly due to the fact that blood glucose affects every single part of the body, including the brain. On the outside, people with diabetes often look very healthy, but it's hard to explain to someone who hasn't experienced it just how all-encompassing and overwhelming it can be at times - the panic of a low, or the disappointment, fear and confusion that can result from an unexpected high. I've done pretty well over the past couple of years, so I'm grateful for that, and part of knowing how you are doing is keeping those records - not only so you can spot trends or remember how things were, but also so you don't become complacent!

Tuesday, 1 June 2010

June already!

And little sign of the Sun! Very gloomy today, whatever happened to 1976 and spontaneous brushland fires from the unbearable heat? My levels have been creeping up - I think they were expecting it to get warmer, but it hasn't, so now I'm left with higher insulin requirements. Cheers, diabetes god, just when I thought I had it sorted! I have to go for some blood tests this week, first time in 6 months, and expect that my HbA1c will have risen from the previous 5.6%. As long as it isn't above 6.5% I'll be happy. I've had far fewer hypos lately, and my fasting levels have, on the whole, been a couple of mmol/l higher than they have been in the past - so 6+ rather than 4+.

Weather is supposed to be brightening tomorrow, so I may have to go and mow the lawn which will be good for my levels. The old reliables are blooming - aquilegia and pyrocanthus - and my roses are about to burst into life. The rhododendron is doing much better than last year, with some big flowers about to bloom, and the day lilies look like they are about ready to put in an appearance. But where is the Sun?