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.

Basal and Bolus, the bane of my life?

From Diabetes UK

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!

Do you love the smell of lantus in the evening?

I use two kinds of insulin to control my diabetes – a fast-acting (bolus) one called Novorapid, and a slow-acting (basal) called Lantus. Both have their own particular ‘scent’, but the Lantus is probably the stronger. It’s not an unpleasant aroma. You pick it up when you do an airshot to make sure there are no bubbles of air in the needle. You do this, not because injecting air would do you harm, as it’s only under the skin and not into a vein – but because injecting air means you’re not injecting insulin and therefore not getting a full dose.

Estimating the dose can be an incredibly complex task, as there are so many factors to consider, but in time you begin to get a feeling for what’s right without too much complicated mathematics!



Do you love the smell of lantus in the evening?
Especially when the glucose reading's high?
But too much of it could mean going hypo,
And a late night feast of lucozade and pie.

Do you love the taste of porridge in the morning?
If it's covered with a bolus that's just right.
But working out just how big a bolus
Would even give the Vorderman a fright!

You have to take account of waking sugars,
And if you're going to run a mile or so,
And if that dreaded man-flu you've been feeling
Will need corrective treatment on the go.

Do you love your meter when the reading's normal,
But wish you didn't have to squeeze out blood?
Those fingers, sore from constant piercings
Would rather miss the testing if they could...

Do you sometimes think your body must be stupid
To turn against your pancreas that way?
But thankful that it's something you can manage
If you keep your wits about you day by day.

So, if you've just found out you're diabetic,
As I found out a few short months ago,
Then try to keep your spirits on the high side,
And do your best to keep your 'numbers' low!