Stop messing with my head, accursed Diabetes Fairy!

Haven’t done a post about my running for a while, partly because it seems to have been very hit and miss this year. Had a poor month in February, great month in March, lazy again in April, and really starting to get back into it in May. Things have changed from my March regime though, principally the fact that, as the day begins much earlier I have been getting up at around 5:15, thus generally getting my run in before 8:00. As I now need to eat and inject before going for a run, and allow time for the food to digest and the insulin to start peaking, I usually step out around 90 minutes after eating. All well and good, but what I consequently have to deal with is that my regular lunchtime is now around 7 hours after my breakfast, a long time to go without food or further injections.

So, I have been trying a little experiment over the past few days. On the first occasion, a few days ago, I decided that I would eat some toast and inject a small amount of insulin to cover it, shortly after completing my run. The result? Hypos all the way through to lunchtime! On the next occasion I decided to see what would happen if I ate the toast but didn’t inject for it. Result? My level prior to eating was 6.8 mmol/l (122 mg/dl) and by lunchtime it was 5.7 mmol/l (103 mg/dl) – I didn’t need any insulin for that toast! I have just repeated the experiment today, after a much shorter run. I was 7.0 mmol/l (126 mg/dl) after the run, ate some toast, and then was 5.2 mmol/l (94 mg/dl) before lunch! So the scenario with me seems to be:

1) Eat nothing for breakfast, levels normally creep up to the 7s/8s by lunchtime.

2) Eat breakfast, no run, levels usually in 5s/6s by lunchtime

3) Eat breakfast, go for run but eat nothing after, levels in 7s/8s by lunchtime

4) Eat breakfast, go for run and have toast afterwards, levels in low 5s!

Nothing’s ever simple is it?

Food glorious food!

One of the main problems with diabetes, putting aside the horrific and debilitating complications that it may bring, is that it affects one fundamental aspect of your daily life – eating. You may be able to get away without eating at all for a day or two, although that isn’t to be recommended, but sooner or later you are going to have to face food. With that comes the inescapable fact that everything you eat, whatever it is, needs some consideration – ideally careful consideration. Principally, you are concerned with the amount of carbs in the food, and this will then be further refined by a consideration of the type of carbohydrate and what other food types may be consumed with it. The amount of fat is a consideration, particularly saturated fat, as it is thought to contribute to cardio-vascular disease – something diabetics are already at greater risk of- plus, it will delay digestion of carbohydrate. Salt is another consideration: diabetics are advised to keep their blood pressure at tighter and lower levels than the non-diabetic public, and salt can contribute to high blood pressure.

So, there is no escaping having to think about diabetes each time you eat, if you are to succeed in keeping your blood glucose at healthy levels. Most people can live with this most of the time, but on occasion the fever grips you and you feel compelled to rebel – to eat all the stuff you shouldn’t and reassert your authority over the dastardly disease!

It was with this in mind, therefore, that I recently decided to have ‘Day of Indulgence’. I was prepared to inject whatever vast amounts of insulin were required to cover the outrageously sinful food I intended to consume, although I hadn’t really set out much of a plan about what that food would consist of. First meal of the day was a ‘blowout breakfast’ – egg, bacon, beans, fried bread, extra bread and a large mug of tea:

By lunchtime I wasn’t particularly hungry, so settled for two slices of melted cheese on toast, a chocolate cream éclair and ten pieces of dark chocolate:

Evening meal was a large Cornish pasty with chips, peas and carrots, followed by another chocolate cream éclair and a strawberry Muller rice:

 

Surprisingly, my blood sugar levels were fine throughout the day. I took measurements before each meal and two hours post meal and never rose higher than 8.9 mmol/l (160 mg/dl). This was probably due to the large amount of fat in each meal, which would have caused the food to digest more slowly. I was surprised also that, following my instincts only, I had indulged mainly by eating fatty foods rather than sweet ones – although obviously there were sweet foods consumed. I had imagined beforehand that I would want to sate my cravings for whole cakes or boxes of jelly babies, but apparently not!

This is not an experiment I intend to repeat in the near future. Despite ‘missing’ this type of food generally, I found that, in practice, it was far too fatty for my palate these days, so it looks like I have trained myself to be a ‘good’ diabetic!

Run-Fail-Why?

Run - fail :(

I was all set this morning for a good run of around four miles or so up and down some of the local hills – blood sugar was at a good starting point (9.3mmol/l – 167 mg/dl), legs had recovered from Friday’s run, I had food in my belly and the weather appeared good, overcast and a little humid, but dry. However, within half a mile of setting off I felt absolutely awful! For some reason, as soon as I set off I felt a surge of adrenalin course through my body. Adrenalin is fine if you’re a sprinter, but for long distance, aerobic running it’s something that you only really want when you need to pass the runners in rhino costumes at the end of a marathon to save you from humiliation! The effect of this was to make my heart start racing, my breathing to become por and erratic, and the muscles of my legs to fill with lactic acid, making them instantly weak and devoid of energy. Within half a mile, I felt I had no choice but to stop running and try walking for a while whilst I recovered. By now, I was feeling very hot and light-headed. After I had recovered a little I tried running again, but very quickly the sensations came back and I took the decision to turn round and return home.

I absolutely HATE giving up on a run! It’s this stubbornness that has got me to the end of many a race, often miles past the point where something was telling me I ought to stop – most notably in The Hague half marathon in 2008, the year of my diagnosis. I’m sure that, had I known my blood sugar levels during that race I would have been flagging down the ambulance – but I made it! So what happened this morning? It has taken me a good hour or so to feel fully recovered, although I still feel a little light-headed. My blood sugar had remained largely unchanged at 9.6 (173) on my return so it wasn’t a sudden rise or fall in that. Thinking about it, I appear to have suffered all the symptoms of a panic or anxiety attack, but with no discernible cause.

The only thing I can attribute it to is that last night I took the first increased dose of my blood pressure medication, so I’m wondering if the symptoms were a result of a sudden rise then fall in my blood pressure at the start of my run. I’m tempted to go back to the old dose of medication, as I know my blood pressure has been improving and I suspect the slightly high reading the doctor took last Thursday was high partly due to the anxiety of having it checked. Given the huge changes in my blood sugars and insulin requirements over the past couple of weeks, it’s perfectly reasonable (in my head!) that I might also be getting a significant improvement in blood pressure that simply wasn’t indicated in the single test performed by the doctor. However, since I don’t have any equipment to accurately test my BP at home – I have a wrist monitor that invariably shows the same figures! – this can only be speculation. I’ll have to weigh up the options of whether it is worth ignoring the doctor’s advice and not increasing the medication.

So annoyed that I couldn’t complete my run!

Ups and downs – hills and blood sugar!

Cobden-Glenfield

I’ve managed to get out for 5 runs in the past 8 days, which is a huge improvement over my previous efforts. Not running very far, as yet, but the runs are challenging nonetheless, involving some very steep ascents and descents that test the legs and lungs! I’ve come to the conclusion that I run much better on such varied terrain. This shouldn’t come as a surprise to me, as most of my early running days were on the big hills of Sheffield and the Peak District, but I think I had started to forget this and have been, until recently, only running through the park where the terrain is only ever so slightly undulating.

Cobden-Mousehole-Peartree

This fact was proven to me in the fourth of my recent runs. For the previous three, I had run a demanding and varied hilly course and had thought that to then run on the flat would be a piece of cake – far from the truth! I found it much harder, not so much on the heart and lungs, but on my legs which quickly tired and left me aching for two days afterwards. It seems I’m much better suited to the effort and challenge of a hill, followed by the relief and recovery of crowning it and running down the other side. I think I also get a bit bored now running through the park as I have done the same route countless times over the past 10 years, so the change is very welcome!

Riverside Park-Mansbridge

My fitness is improving accordingly as is, I hope, my health. I had a visit to my doctor this week and there has been an improvement in my blood pressure, although it is still a little on the high side so my medication has been increased slightly. I also asked about my recent retinopathy scan and the worrying news that I now have ‘moderate diabetic eye disease. The doctor had a letter that provided more detail – apparently, what I have is still the background retinopathy reported last year, but the specialist had observed deposits rather closer to the macula than might be hoped for. Really, it’s the luck of the draw as these deposits can form anywhere on the retina, it just so happens in my case that they are potentially threatening the one area that is chiefly responsible for central vision. I don’t know yet if I will require any treatment for this, so I have an anxious wait until my aapointment at the eye hospital comes through.

Cobden-Midanbury-Woodmill-Riverside Park

There has been another, rather profound effect on me from my increase activity levels – my blood sugar levels have started to drop at such a rate that it has been hard to keep up by lowering my insulin doses. Two nights in a row I was awoken with hypos of 2.1 mmol/l (38 mg/dl) and 2.7 mmol/l (49 mg/dl), despite having snacks before bed. Thanks goodness I woke up! I have been lowering my basal insulin (lantus) as well as lowering my meal boluses (novorapid), but still battling lows so the effect of the exercise is even more profound than I can predict! I seem to be just about getting it right now, having reduced my lantus from 8 units to 5 and being very sparing with my meal bolus. My total daily dose is now around 30 units, with my basal comprising less than 20% of the total – normally, the split should be around 40-50% of TDD! Perhaps I’m nearly cured!

Hoping for another, longer run tomorrow, I’m already feeling a lot healthier and have much more energy, although I’m still a little on edge when going to sleep at night because of those hypos as they were the first night ones I have had for several months.

Thank you Mr Map – not!

I was itching to get out for my run this morning – I had the route running through my head all of yesterday and was looking forward to the challenge. Back on Monday I reconnoitred a route that would involve even more monstrous hills than the ones I ran last Sunday, which now appear positively Lilliputian by comparison!

It’s still fairly early on in my efforts to get back to running decent distances, so I was a little apprehensive about how things might go. The start of the run took me up the same road as last week, but this time instead of turning off I kept running upwards. I had a quick glance at my Garmin as I reached the crest of the hill and saw that it was exactly half a mile. Gradient on this section was 14%, which may not sound much, but go out and find such a hill and you’ll understand that such a hill would not be found in Holland! More was to come. I was happy that my breathing was good - I have a good sense of how to pace my efforts, whatever the terrain, after 30 years of running experience.

The hill was followed by an even steeper descent. Many people might imagine that, slow as the climb might be expected to be, surely you would make up time on the descent, but that’s not quite true. Going up stresses the muscles of course, but the main limiting factor is the heart and lungs – you have to be able to take in enough oxygen to feed those muscles. Going downhill, however, brings a different set of problems. You can recover your oxygen debt as gravity assists your downward trajectory, but the impact stresses on muscles and joints is far more extreme. Over three times your body weight will be the impact force with each footfall, and given that I am currently heavier than I have ever been, this is considerable for me at the moment. I also bear in mind that my leg once snapped due to such stresses and that tends to temper my pace!

I then had a flattish stretch, just a slight incline before coming to what I expected to be my biggest challenge – a huge uphill section that was at an incline of 28%! I was struggling towards the top, I will admit, and thankful for the subsequent flat section before running steeply down again. I had expected that that would be the end of my need to run skywards, but not to be! I had taken a quick glance at a map beforehand, and estimated that I could escape the traffic of the main road over the last section by running down a side road, connecting to another road at the bottom and then having a flat remaining run home. Stupid map! Significant detail had been omitted (as I discovered later when looking online), meaning that I now had little choice but to run back up to the summit of the original hill that I had started from, this time from the opposite side. On this side of the hill the incline was 22%, so a real lung-burster at this stage! A final long descent then brought me home.

I was very pleased with my achievement. Although it again appears slow, the hills involved were huge and yet I still managed to keep going all the way. I’m sure that, as my fitness improves, I will be moving much faster up them so my overall pace will improve considerably. The run has given me great confidence to start extending future runs – just hope I can stay injury free for the duration! Love those endorphins! Hoping my legs won’t suffer quite so much as they did last week! Blood sugar levels weren’t bad – 8.1 mmol/l before (146 mg/dl) and 9.4 mmol/l after (169 mg/dl).

Apologies for no poetry lately – the Muse has deserted me for the time being! I have one or two ideas though, so hope to include a few over the coming week. Please look back through the archives!

Getting better, slowly!

My legs have finally recovered from Sunday’s hills sufficiently to tackle another run this morning. Thought I would try a slight extension to my recent runs through the park. I’m not worrying about times at the moment, apart from time on my feet, as I need to get some stamina and endurance built up. Going into oxygen-debt by running faster than I can currently sustain is pointless, so I just ran the route I intended, staying well within my aerobic capacity.

Things were fairly quiet – it’s strange how so much of the road traffic disappears when the school holidays start, I can only imagine (not having kids) that much of the rush hour congestion is caused by over-protective two-car parents driving their little darlings to the school gates rather than let them burn off any precious calories with a bit of a walk...

The air was cooler than of late, and still, meaning that I quickly began to heat up. The riverbanks were exposing their muddy banks, dark brown dotted with white where seagulls foraged for worms amidst the traffic cones and shopping trollies. Actually, it’s not that bad, the river is pretty clean. It’s very tidal, so when the tide is out just a narrow channel remains, revealing just how shallow the river is, despite its broad expanse. As I ran the Sun began to burn off the cloud cover and I began to heat up some more!

Thankfully, I wasn’t overwhelmed with dogs on the run, just a couple of mongrels more interested in the saliva-soaked balls that their owners were casting around for them to chase. It seems that modern dog-owners have cottoned on to just how gross a dog-spit drenched tennis ball is, so they no longer throw them by hand, but employ some kind of plastic launcher – such are the advancements of modern civilisation…

My legs were rather heavy over the last half mile, but that means that they managed the previous two and a bit without too much distress, which is an improvement as it means I’m gaining a stronger base. I’ve found in the past it takes me about three weeks to get back into being able to run a regular 5-7 miles, although as I’ve got older it does seem to be closer to three weeks rather than two! I’ve wondered about the diabetes too, whether that is having an effect on my endurance and recovery, or if I’m just finding that an easier thing to blame than the fact that I’m not the Spring chicken I used to be!

Levels were 7.9 mmol/l (142 mg/dl) before the run and 7.3 mmol/l (131 mg/dl) afterwards, which I was pleased with. I don’t adjust my insulin before the run, although I know of some people that either take none or at the very least reduce it by a considerable amount. For me, the effect comes afterwards, so that’s when I change my ratios – although it’s a completely subjective, finger-in-the-air adjustment, based largely on instinct and experience. I’ve also taken to injecting about 15 minutes before eating, as I’ve discovered that I often spike early, however GI-conscious I’ve been with my food choices. This morning’s readings indicate that I got it just right. 362 calories burned, but I’m not shifting any weight at all. I’ve got a doctor’s appointment next Thursday to see if my blood pressure has improved – if not, I’m likely to be threatened with more medication, which I’d really rather not have, so hoping staying off the booze for the past couple of weeks, plus the exercise, will have me nice and steady at 130/80e

Who needs a psychic octopus when you've got diabetes?

Recently, I’ve noticed that my blood sugar levels have been higher than I’m normally used to seeing, plus giving myself extra insulin doesn’t quite seem to do the trick. For example, this time last week I had a total daily dose (TDD) of 28 units of insulin – yesterday I had 43 units, but still ran high levels for part of the day. How to explain this? Well, with diabetes (and the ability to measure your blood sugar with a meter) you can see how your body is beginning to fight an infection before you feel any other symptoms. In my non-diabetic days, the first I would have known that I had caught a cold or stomach bug would have been when I started sneezing, sniffling or feeling poorly. Now I can become aware of it at least two or three days earlier, effectively seeing into the future! Of course, my pre-cognition only extends as far as personal illness is concerned, not predicting the outcome of World Cup Finals, so Paul the Octopus still has his niche! But I’m working on a way to get my diabetes to help me predict lottery numbers – perhaps my meter is trying to tell me something…!

Who needs a psychic octopus,
The future to foretell?
A cold Cassandra cephalopod,
When I can do as well?

Who needs a mentalist mollusc,
Who crawls the ocean floor,
To tell us what the future holds,
When my meter tells me more?

For, blessed with diabetes
My predictive powers are strong,
And unlike squid or nautilus,
I’m very rarely wrong!

So when my levels start to climb,
But nothing else seems wrong,
Then be assured that I will be
Quite ill before too long!

Before this foul disease took hold,
I lacked this inbuilt sense,
Consulting eight-limbed oracles
For my fate a few days hence.

But now I plan to make me rich –
My meter holds the key!
And when I get the numbers right,
I’ll win the lottery!

Hurrah for diabetes!

Quantum Diabetes and Schroedinger’s Hypo

I’ve always taken a layman’s interest in physics, from cosmology all the way down to particle physics and the quantum world. Sometimes, if I’m feeling a little down about my diabetes, I can take solace from the knowledge that the many worlds theory suggests that somewhere, in another universe, there is a ‘me’ who does not have diabetes. In fact, he’s probably a world-class marathon runner and polymath, admired and adored by all who hear his name, and happily married to Kate Bush.

The other day I was testing my blood, chiefly to see what my levels were before I partook of a tasty snack, and not for any reason of feeling that my levels might be low and in need of attention. I was therefore shocked and surprised to see a figure of 2.7 mmol/l (49 mg/dl), well below the point at which my world should have been swimming before me in a jittering, blurry haze! So, I was 2.7! Therefore I should be feeling quite pronounced symptoms, right? The instant I recognised this, the symptoms immediately set in and I was scrabbling for the jelly babies!

What can I conclude from this? That there is yet another type of hypo I can add to my ever growing list of experiences: the quantum, or Schroedinger’s hypo – one which only manifests itself when it is observed! If you don’t know who Schroedinger was, he was a physicist who proposed a thought experiment in the mid-1930s in response to the Copenhagen interpretation. Basically, the experiment went like this: place a cat in a sealed container which also contains a poisonous substance and a small amount of a radioactive element. The poison will be triggered by the particle decay of an atom, which may or may not happen, and therefore may or may not kill the cat. It is only by opening the container though, that the true state of the cat can be discovered. The act of observation fixes the quantum state – prior to that the state was in quantum flux and undefinable. (the experiment can be read in greater detail here)

Thus, a hypo which only generates symptoms when the blood sugar level is observed clearly operates on the same principle! I need to refine my theories a bit, but there might be a Nobel prize in this somewhere…

We’re all subject to the laws of physics,
I don’t think you’d argue with that!
So it follows that our dear diabetes
Might behave just like Schroedinger’s cat!

For a cat that is sealed in a container
May be subject to quantum events –
It will either survive and remain quite alive,
Or poof! In a flash, heaven sent!

It’s only upon observation
That we can learn of the poor moggie’s fate,
As we lift up the lid, did it die? Yes it did!
For we just fixed the true quantum state!

Likewise, with the strange quantum hypo,
That a random blood test may produce -
From out of nowhere, the hypo is there,
For reasons bizarre and obtuse!

Then once you have glanced at the number,
All at once your defences will slip,
And reality swirls as your neurons unfurl,
And the universe loses its grip!

To restore such a quantum imbalance
Take sugar as soon as you can!
For its fine crystalline carbon structure
Is the best antidote known to Man!

Nearly cured!

Back in April, with the warm spring weather revitalising me after a particularly cold and harsh winter, my insulin requirements had suddenly started decreasing at an alarming rate. Each night I would reduce my dose of Lantus, but each morning I was waking to blodd sugar levels bordering on hypoglycaemia. My daily novorapid doses with my meals were also decreasing, although not at quite the same rate. Eventually, I seemed to settle on a dose of 8 units of Lantus which allowed me to both go to bed and wake within range, without additional snacking.

I’d been expecting, now that the colder weather and darker days have arrived, that I might experience a seasonal increase in my insulin requirements to match the decrease I’d had earlier. Not so. My requirements have started declining again, now to six units of Lantus. I can only surmise that I have recovered some residual beta cell function and am producing a low level of ‘home grown’ insulin to supplement my injected doses. Certainly, when I read of others’ experiences, I seem to have far fewer problems with keeping my levels within range, and certainly never experience the frighteningly high levels that some people get.

I don’t really think I am on the way to being cured, but it’s a nice thought to have! It is more likely a cure will come from the good work of the Juvenile Diabetes Research Foundation

Since diagnosis there’s been the allure
Of a highly unlikely spontaneous cure!
For my insulin doses have shown such a fall
That maybe one day I won’t need them at all!

I started on twenty of Lantus as ‘slow’
But in April discovered that this sent me too low,
So I started decreasing it, two units a night,
But still a month later it just wasn’t right!

Now I’ve reduced it by seventy percent
It does make me wonder where the rest of it went!
From twenty units to six, and should I need fewer,
Then surely that constitutes a virtual cure!

Perhaps it’s my pancreas that’s been resurrected,
With beautiful beta cells no longer neglected,
Pouring forth insulin, potent and pure,
I’ll take that for now! It’s nearly a cure!

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?!!!