Jobsworth

Unfortunately, there are a lot of very poorly-informed people around who are in positions where they can wield their power to make life difficult for us. Recently, a member of the forum recounted how she had gone for an appointment with a Job Centre official who proposed that, since using insulin might be a barrier to obtaining a job involving driving, why didn’t she stop using it and try diet and exercise instead? I’ll leave it to you to imagine the collective response of other forum members to this ridiculous and dangerous suggestion! Did the official think that using insulin was a ‘lazy’ way of managing diabetes? I despair!

Yes? Who’s next please? Ah, come and sit down!
It’s just a few questions, so no need to frown!
I’ve had lots of training, so you’ll be in good hands,
I’m well up on vacancies and market demands!

It says on your form you’re diabetes, type 1?
Can you just let me know how long that has gone on?
I know all about it – the same as old Uncle Bob,
But it never stopped him from getting a job!

Or was his type 2? Well, they’re pretty much the same –
They’re both diabetes, so what’s in a name?
But you’re using insulin to keep levels low?
Uncle Bob never used it, as far as I know…!

So why don’t you try? Give the insulin a miss?
You need to try harder – much harder than this!
Uncle Bob, I recall, only took the odd pill,
You could do the same, you just need the will!

What’s that? Oh that’s nonsense! Of course you won’t die!
You’ll never find out if you don’t even try!
If Uncle Bob could do it, then I think so can you,
Or I’ll cross you off our list without further ado!

The Doctor will see you now...

I’ve been reading too many stories lately about people being called in to see the doctor and when they get there he’s got no idea what the appointment is for, has the wrong notes which he hasn’t read anyway, and makes wholly inappropriate assumptions or rude and thoughtless comments. Why do such people join the medical profession in the first place? Not for the money, surely?

Now, why have you made an appointment?
‘You asked me if I would come in!’
And why did we ask you to do that?
'I can’t think what the reason might have been!'

Well, let’s have a look at your records…
I see that you’ve had a few tests.
That must be why we want to see you -
To decide what to do for the best!

This test says you’ve just become pregnant!
That’s odd for an eighty year old!
I must say that you’re looking well though,
It’s the hormones that do that, I’m told!

Ah! This test says you’re diabetic!
I’m guessing you must be Type 2,
For Type 1s, it has been my experience,
Are much slimmer and younger than you!

What’s that, you’ve been Type 1 for decades?
You’re not pregnant because you are male?
Well then, please would you go, for I’m busy you know,
And I don’t have the time for your tales!

Too old for Type 1!

A member related on the forum today how his practice nurse had insisted to him that he couldn’t possibly have Type 1 diabetes as he was too old! Erm…I was 49 when I was diagnosed, and recently a new member joined having been diagnosed Type 1 at the age of 65! No doubt this is a cunning money-saving exercise – by reclassifying the adult Type 1s as Type 2 the doctors can withdraw test strips and other medication on the basis that only insulin-dependent Type 1s need them!

Note: there isn’t a word of truth in any of the following poem!

Mr Jenkins? Your appointment has been rearranged,
And since you’ll have turned 40, your diagnosis has changed!
We know that we told you that you were Type 1,
But now you’ve got older, I’m afraid that is wrong!

Type 1 diabetes affects only the young,
And you’ve got a foot on the middle-aged rung –
On the ladder of life, I’m afraid you’re too high,
And your fountain of youth is decidedly dry!

So, because you’re too old, you’ve been reclassified,
There’s no point in complaining, though many have tried!
You’ll be very pleased to learn that you’re a Type 2,
That’ll be cheaper for us, if not better for you!

You won’t need to test, so you won’t need those strips,
And you’ll no longer suffer those low sugar dips!
We’re withdrawing your insulin, you’ll be diet-controlled…
What’s that? Don’t blame me sir – it’s because you’re too old!

Looking diabetic

People often say ‘you don’t look diabetic’. What do they expect? A tattoo on the forehead? An extra limb, horns and a tail? Well, of course they usually mean ‘you’re not fat, how can you be diabetic?’ The public are continuously being misled into believing that diabetes is somehow a lifestyle choice – that if only we’d looked after our health better and maybe not eaten so many pies and sugar, then we could have avoided it. Not so. Although there is clear evidence that obesity can precipitate diagnosis of diabetes, particularly Type 2, it is not always the case – there are many, many obese people in the world who do not develop diabetes, and around 20% of those diagnosed with Type 2 are not overweight at diagnosis. Indeed, there is the possibility that the extra weight may be gained because of diabetes, and not the other way round, since abnormal insulin production to try and overcome insulin resistance can cause weight gain.

So how are the public to recognise diabetics if they are slim, active and otherwise healthy? A new government initiative reveals how…

It’s confirmed – you’re diabetic, so please join the queue,
The surgeon should be on his way,
It shouldn’t take long, there’s only a few…
What’s that? Do you have something to say?

Oh, didn’t they tell you? It’s really no good!
We must make you stand out in the street!
Some try to disguise it by wearing a hood,
But you can still pick them out by their feet!

Here is the leaflet, I’m sure it’ll explain,
And there’s a picture of what they attach.
It’s free for the ‘standard’, but if you are vain,
You can pay extra for attachments that match!

A moment if you please, you must sign this release
To donate them back when you’re dead…
Now hurry along, you’re next on the list,
Would you like to have green ones or red?

Oh dear! Does it hurt? That’ll soon go away,
And you’ll learn how to sleep on your back.
You’ll be able to walk, but not quite the same way –
I’m sure that you’ll pick up the knack!

Mild or Severe?

There used to be a time when there was only one kind of diabetes. In the pre-insulin days, diabetes would manifest itself as acute, usually in young people who lost weight rapidly and slipped into coma, or age-onset, which was generally perceived as milder since survival might endure for many years. At that time the different causes of the disease were not clearly known – lack of insulin would cause the acute symptoms, whereas a gradual decline would be due to resistance to insulin action.

Somewhere along the line, the descriptive terms ‘mild’ and ‘severe’ crept in. These terms distinguished those who were in DKA, coma, going blind, kidney failure, amputations from those who showed few outer signs of the disease and were able to manage their condition to some extent by dietary and other lifestyle modifications. These latter cases would succumb eventually to the more dreadful complications, just as their ‘severe’ counterparts had.

In recent times, the adjectives have been used to describe a distinction between Type 1 and Type 2 – with Type 2 often falling into the ‘mild’ category as it may be treated by diet and lifestyle changes in many cases, or with tablets rather than insulin injections. This is nonsense – both types require vigilance and present different and, in my view, equally difficult challenges.

The terms ‘severe’ and ‘mild’ persist to this day in some medical practises or publications, but I think they are very misleading. People with diabetes have diabetes. All forms of diabetes are ‘severe’, since all can lead to awful consequences if they are not properly treated and managed. This is a life, limb and sight threatening,disease and no-one diagnosed with it should be misled into complacency by being told that theirs is ‘not so bad’. Nor, in my opinion, should people be told they don’t need to test, to find out how dietary and activity changes affect their levels so that they can achieve the best possible control. There’s an argument used that knowing how things are going might lead to depression at the sight of an occasional high reading – what nonsense! People need to be able to learn how to use these readings to adapt and enhance their chances of staying free of complications. It is criminal to deny anyone who wishes to test the means to do so – once a year HbA1c tests are an additional tool, not a substitute!

Whatever your Type of diabetes, and whatever your stage, you must never think that it needs little consideration because ‘yours is not so bad’.


Now, calm down, you’ve no need to worry my dear,
I can tell you right now that you’ve little to fear,
For you’re much better off than a lot of them here,
Diabetes for some folk can be classed as severe!

What then is the difference, for I see you have filed
My details and blood test under ‘Diabetes, mild’?
I was wondering if maybe you might have compiled
Some simple distinctions – pretend I’m a child…

Well, if it’s mild, then we’ll see you perhaps once a year,
To see if you’ve gone blind, and that your urine is clear,
But if it’s severe, and if you were to cough,
Then there’s every chance that your foot might fall off!

Thank goodness it’s mild then, and I won’t need to test,
For knowing my levels might make me distressed…
I’m happier not knowing, until the day that I’m here
And you tell me I’ve caught the type that’s severe!

We know best – no need to test!

Internet diabetes forums frequently raise the issue of blood glucose testing for people with Type 2 diabetes, especially those not on medication but following a diet and exercise regime to keep their levels under control. The issue, more often than not, boils down to one thing – money. Test strips cost the NHS around £13 for 50 strips. Multiply that by the millions of people with diabetes and it amounts to a not inconsiderable sum. If you are on an insulin regime, particularly multiple daily injections (MDI) or insulin pump delivery, then there is normally no question – you must test your levels before decding how much insulin to inject. However, for those not on insulin, and maybe not on any form of medication for their diabetes (i.e. diet and exercise), the issue is not as clear cut.

Many doctors do not support regular blood testing for such people, arguing that it will not improve control and is therefore an unnecessary expense. Accordingly, they will not prescribe strips, often as a general policy which excludes all Type 2 diabetics, regardless of circumstances. In many cases, this may be true. If a person is allowed to test but then makes no adjustments to diet and activity levels in response to the readings then the test was virtually worthless, possibly even causing increased stress and anxiety if the result was high. On the other hand, however, if a person tests in order to discover how certain foods or food combinations affect their levels and then acts on this to make dietary adjustments, then the test is extremely valuable!

The alternative often provided to testing is a three or six monthly HbA1c blood test, but this cannot show how a particular meal proved particularly good or bad to the person – that information is impossible to determine. So the person is left knowing something has gone wrong but never knowing what. Improved control will not be achieved in this way, and the person may eventually be placed on increasing amounts of medication to control their levels, finally progressing to diabetic complications costing the health service thousands of pounds to treat.

It is arrogant and insulting for a doctor or nurse to deny a person the means to improve their health by suggesting that their treatment is a financial burden where corners can be cut, when that person is willing and capable of working hard to maintain a full and healthy life.

You what, my dear? You test yourself four times every day?!!!
We’ll put a stop to that right now, that’s really not our way!
I think you’ll find those strips you use cost us too much money –
The doctor saw the price one day and came over all funny!

You must agree with me my dear, it’s really common sense,
You’re not on drugs, so it is an unnecessary expense!
What is the point of testing? Perhaps you like the pain?
I tried it once, believe you me, I won’t try that again!

You’re not a health professional dear, so take a tip from me,
Let us decide what’s best for you, I’m sure one day you’ll see,
Although you may succumb one day to losing sight or limb,
We’ll save the NHS some cash – our budget will be trim!

Before you go, please don’t forget to eat with every meal
A lot of rice, or spuds, or bread – don’t worry how you feel!
We’ll test your blood two times a year, so there’s no need to fuss,
Where would you diabetics be if it wasn’t for people like us?!!!

Second honeymoon!

It’s not unusual for people with Type 1 diabetes to experience a period of remission in the months following diagnosis. It is thought that, once treatment with insulin is started, the beta cells of the pancreas may recover some of their function and start producing insulin again. This may last for months or even years, and will vary from person to person. Some may not experience it at all, but for those who do it can be time when blood glucose control becomes easier and remains more stable. This is because, even though it may only be in small amounts, the pancreas is responding to higher than normal levels by putting out a little insulin which helps to regulate things. Without this ‘help’, the person is fully dependent on getting the levels of injected insulin just right to counteract rises in glucose levels.

It may be that I am currently in this ‘honeymoon’ period, as I do seem to have pretty stable levels, and rarely hit double figures on my blood glucose monitor. I have no idea how long this may last. It is possible to have a test called the ‘C-peptide’ test which can measure the amount of ‘natural’ insulin a person is producing. C-peptides are a by product of natural insulin and as such are released in equal quantities to insulin. They are not present in injected insulin, so therefore provide an accurate measure of any remaining pancreatic function. The test is too expensive, however, to perform on someone like me who has been diagnosed and is already receiving treatment. It is used primarily to distinguish between diabetes types – Type 1 will not normally have much, if any, c-peptides, whereas Type 2 may be producing lots of insulin but suffering insulin resistance.

We’re in our second honeymoon, my pancreas and I,
It seems that we’re a pair again for many months gone by…
We separated for a while, about a year ago,
Oh Pancreas, how could you forsake me, when I needed you so?

I don’t recall when first we met, for I was very young,
We grew and shared our childhood games – those days were filled with fun!
And as the decades came and went, and I took you for granted,
I never thought our relationship would ever be supplanted!

But then last year in summertime, we hit a rocky patch,
That virus and your beta cells were not an even match…
As you began to fade away, I realised too late
How much you meant to me that day, and what would be our fate.

Now months have passed and I began to treat you with respect,
Please stay with me forever – there’ll be no more neglect!
To all of you whose pancreas may not be with you soon,
Cherish that relationship – enjoy your honeymoon!

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!