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!

My Glorious Graph!

Despite the excesses of the festive season, I was very pleased when I uploaded my blood glucose meter readings to my computer and brought up the graph for the past month. In 150 tests, I have stayed within my target range of 4-7 mmol/l (millimoles per litre) for 70% of the time. I’ve had a few lows – down as low as 2.2 on one occasion – but nothing I couldn’t handle. A lot of the higher readings are, in effect, ‘false’ readings, as they were taken before and after exercise when I would hope for a slightly raised level before embarking on activity. The main thing is that I have been successfully matching my insulin to my food intake.

In the past month, I have had only two readings in double figures – one of 10 exactly, and one of 10.7. The latter was taken after a lunchtime drink and would therefore have been influenced by the alcohol which can ‘spike’ you fast, then drop you low. I’m very lucky, I think. I know of many people who get highs of 15, even 20 and above, on a daily basis no matter how hard they try. The body doesn’t like these highs – a non-diabetic person would rarely show a level outside of the tight 3.5-6.5 mmol/l range, due to the exquisite fine-tuning of their endocrine systems. For a diabetic it’s a constant battle and a perennial worry, but thankfully I seem to be doing OK – long may it continue!



Now this may sound peculiar, and it may make you laugh,
But just take a look at my glorious graph!
It shows my blood glucose over the previous four weeks,
And there’s hardly a difference between the troughs and the peaks!

The band that’s in yellow would be perfect control –
The desirable range, four to seven millimoles.
A fully-working pancreas would achieve this with ease,
For a non-diabetic it is really a breeze!

But if you’re like me and your pancreas broke,
Your graph will look different to the non-diabetic folk,
And you might expect high points of fifteen or more,,
Or lows below two that drop right through the floor.

Ah! But this graph is glorious, and I’ll tell you for why,
For if you look closely, it will soon strike your eye.
See if you can point out the only time when
My levels exceeded a value of ten!

So I ‘m happy to look at this graph, on the whole,
For although it’s not perfect I’m achieving my goal,
And it justifies consumption of a few pints of beer –
Let’s hope it remains so for the rest of the year!

The Whole Mole!

Blood glucose in the UK and many other parts of the world is measured in millimoles per litre (mmol/l). A mole is the SI unit of measurement, and a millimole is one thousandth of a mole. What we really want to see each time we prick our fingers and take a test, is a reading of between 4-7 millimoles, which is regarded as ‘normal’. It actually represents a tiny amount of glucose per litre of blood, and at normal levels if you were to add that much sugar to a litre of water, you would probably not be able to taste it (Type 1.5 demonstrates this admirably on her blog at Just a Spoonful of Sugar. )

So, how long does it take to get through a whole mole? I invented a (probably entirely non-scientific and spurious) method of calculating it. If we accept that one unit of insulin will lower my blood glucose level by approximately 3 mmol/l, and I take 30 units of insulin per day, then it will take me just over eleven days to get through a whole mole…!

Imagine if, when making that fingerprick hole,
The blood that emerged should contain a whole mole!
It’s highly unlikely, for you’d probably be dead,
And your blood would be glucose, and probably not red!
For each time that we measure we are hoping to see
That most of our blood is entirely mole-free!
Ideally, we’ll find just a whisker or two,
For a nose or a claw would be harmful to you –
That’s too much of a mole to be called ‘good control’,
For it’s thousandths we want, not the whole of the mole!

Pincushion Percy

If there was one little thing that someone could invent that would make diabetes easier to manage, it would be a method of measuring blood glucose levels accurately without having to use blood from a finger prick. There are many different lancets available to perform this task – most claim to be ‘painless’, or more realistically perhaps ‘virtually pain-free’, but I’ve yet to find one that truly is in practice. Some lancets have variable depth settings, however I find that if I have the lancet on a low setting then it might not hurt, but neither does it produce sufficient blood for a test to be performed successfully. There’s nothing worse than pricking your finger fruitlessly, and possibly wasting a test strip into the bargain. Sometimes I may have to prick my fingers three or four times before I can squeeze out enough blood, and it reaches a point where I no longer bother about the pain, but turn the lancet up and stick it hard and deep into my finger just so the anguish will end! Of course, it always seems to happen when I am feeling hypo and the test is that much more urgent!

Sadly, there are people who object to us performing these tests in public, along with injections if we also need to do them, calling it ‘unhygienic’ and ‘disgusting’. Such people think that we should go to the toilets to do it – thus ignoring OUR need for hygiene! We don’t do this because we want to, it isn’t fun or pleasurable, so if you don’t like to see it please look away and think yourself lucky that you don’t have to do it as well. Who knows? One day you might have to.

Pincushion Percy’s the talk of the town,
He’s quite a remarkable fellow!
For he pierces his fingers eight times every day,
You could hardly describe him as yellow!

You might think that Percy’s a mad masochist,
And has chosen a strange way to live,
For who’d give their digits such awful abuse?
His fingers have more holes than a sieve!

But it isn’t by choice that he pricks himself so,
Diabetes is the cause of his woes…
It’s as common to him to draw droplets of blood
As an aardvark eats ants with its nose!

So please spare a thought should you see Percy out
At a restaurant, perhaps, in the town,
And don’t be judgemental, and don’t pull a face,
For a smile is worth ten times a frown!

It may come to pass that one day you might find
That it’s something you have to do too,
And then you’ll be glad that you didn’t get mad
And make Percy prick in the loo!

Meter-ology

Technology is great, and really helps people with diabetes to control their blood sugar, improve their blood pressure and drastically reduce the possibility of developing diabetic complications in the years to come. Probably the best aid to good control recently developed is the blood glucose meter, which allows us to discover in a few seconds, from a tiny drop of blood taken from a finger prick, what our blood glucose level is at that particular moment.

The meters are accurate to within 10%, and the technology is so widely used and reliable these days that it can be trusted…most of the time, at least! There can be occasions when the reading taken does not seem to coincide with expectations – for example a high reading when the person expects to see a low one. There are often reasons for these ‘rogue’ readings, rather than the meter itself failing. The finger from which the reading was taken may have been contaminated with traces of sugar from an earlier meal, so it is important to ensure the fingers are clean before taking the blood sample.

In much of the world, blood glucose is measured in millimoles per litre (mmol/l). The US is out of step in this regard, using units of milligrams per decalitre (mg/dl). So, in the UK a normal ‘target’ range for a person to aim for pre-meal is between 4 and 7 mmol/l. For the US multiplying this by 18 gives the equivalent in mg/dl (between approx 70 and 125 mg/dl). Levels will be higher after a meal, so the aim is to keep that rise as slow and gradual as possible, avoiding ‘peaks’ which may be harmful.

Before these meters became widely available, results from other testing methods were less reliable and much more time-consuming, so I am fortunate to have been diagnosed at a time that technology is available to help me stay healthy with the minimum of fuss and inconvenience. In the UK, blood glucose meters are often supplied free of charge – this is because the meter companies make a considerable amount of money from the proprietary testing strips which can only be used with one company’s meters.

Welcome to the forecast,
Let’s predict the day ahead…
We hope it will be fine and bright
As you rise from your bed!

The meter said this morning
It’s a settled day in store,
With figures neither high nor low
Maximum 7, minimum 4.

No clouds on the horizon,
No stormy, restless skies,
But a day that’s calm and pleasant
To greet your waking eyes!

If we maintain these numbers
As we go throughout the week,
Your mood will lift with nature’s gift,
And your strength will reach its peak!

So why not don your running shoes,
Go out - enjoy the day!
Look to the future, that’s what counts,
And not to yesterday…