Wednesday, 22 July 2009

Wide-Eyed World


I went for my annual retinopathy scan this morning. One of the serious complications of diabetes is when the blood vessels in the eyes grow or rupture. This can affect the macula, a tiny region on the retina that is hugely important for vision. The scan involves taking photos of the retina with a special camera. These photos can then be examined for any changes that may need further treatment. In order for the photos to be of the best quality, it’s important to dilate the pupils of the eyes as much as possible – and often this is achieved with special eye drops. These can sting a little at first, but the biggest consequence of having them is that your pupils remain enlarged for several hours afterwards, so even the dimmest and dullest of days can feel like bright sunlight! You feel like you have the light-gathering power of an astronomical telescope for those few hours!

Welcome to my wide-eyed world!
Where lurid fires around me swirl,
And dullish clouds that clothe the skies
Are floodlit in my lucent eyes!

Do I perceive the reddish glow
Of far-off galaxies that grow
Beyond the sight of beasts or men?
My universe expands again…

And distant stars will live and die,
Imprinted on each gazing eye,
Where sunlight spells out double trouble –
Blinding me, the Human Hubble.

Oh curse the Sun, the Moon, the stars!
The planets and the plains of Mars!
Please lock me in a darkened room,
Where all is black, and all is gloom!

This once-a-year spectacular
Preserves each precious macula,
So I’ll endure the searing light
And cherish this, the gift of sight.

Tuesday, 21 July 2009

The Liver Dump


Something that diabetics might encounter is an increase in blood glucose levels in the morning, above what they might expect when taking account of their bedtime levels and what they have (or haven’t) eaten for breakfast. People who don’t have to regularly test their blood glucose levels might be oblivious to this – if you don’t know the numbers then how can you compare? So, what’s going on? There are two possible reasons that have been put forward – the ‘Dawn Phenomenon’ and the Somagyi Effect’.

Put simply, the dawn phenomenon results from the liver releasing extra stores of glucose to give a person a ‘boost’ as they wake up and face the day. The ‘Somagyi Effect’ results from a person dropping very low during the night, and stress hormones released in response cause the liver to ‘dump’ extra glucose into the bloodstream to bring the levels back up. Sometimes, the liver does more than enough and the person wakes up with high levels. Some people experience these effects more than others. Personally, I have always been fine in the mornings, even on the low side in the early days, but it is interesting to learn yet more about the way the body works, that I previously took for granted.

There’s a great, more detailed, explanation here:

http://www.diabetes-support.org.uk/joomla/dawn-phenomenon


‘Come on Bill, it’s nearly time –
The Sun’s just coming up!’
‘I’ll be there in a minute Spike,
Just let me drink this cup!’

Billy Rubin and Spike Mackay
Were on the early shift,
Their job to stoke the levels high
With a liver glucose lift.

‘We’ll get this fella up to speed
And ready for the day
With all the glucose he will need
So he can work and play!’

‘Remember how, the other night
His level dropped right down?
We called in all the guys on site
And really went to town!’

‘Aye, how we laughed when we found out
His levels went so high!
He didn’t have a clue about
The real reasons why!’

‘But not today, I’ve heard he tests
His blood at three each night,
And if he’s low he snacks and rests
He’s putting up a fight!’

‘We might find out our jobs are gone,
And we’ve been superceded!
There’ll be no Dawn Phenomenon!
We’ll be no longer needed!’

‘Don’t worry Bill, it might get slow,
But there’ll never be a slump –
There’s always work, I know it’s so,
Here at the Liver Dump…’

Monday, 20 July 2009

Pumper Mums!



Being an adult with diabetes can be a worry at times, but how much harder for parents caring for a diabetic child? Should my blood sugar go high or low, I am aware of the sensations and can act accordingly. Only on rare occasions have I had to seek help and experienced difficulty in communicating my needs. I can only imagine how difficult it must be to be constantly on the alert for possible signs of an imbalance in a child. Children don’t necessarily understand the need for injections, or being denied the freedom to eat as they choose on special occasions like Birthday parties, when all the other children are happily filling their faces with cake and jelly. They may also be subject to growth spurts, when hormones go to pot and have a huge influence on insulin levels. Or they might succumb to one of the many childhood illnesses that we have all been through, but for them may lead to a potentially dangerous rise in ketone levels.

Some of these concerns, from what I have read, are greatly alleviated by the fitting of an insulin pump for the child. They’re not an easy option – the first few days and weeks, possibly even months, require frequent and accurate testing of levels, counting of cabohydrates in foods consumed, setting basal (background) levels of insulin that may vary throughout the day, adjustments for increases (or decreases!) in activity, illnesses – the list goes on, but you get the idea! The enormous benefits, though, become apparent very quickly: improved blood sugar levels day-by-day, increased freedom for the child to play and eat as his non-diabetic peers do, and huge increases in confidence for the parents who can worry less about night-time hypos, and be more confident of a long and healthy life for their children.

You can read the story of one child's experience with a pump (the girl in the picture) at http://www.childrenshospital.org/dream/dream_ss2002/diabetes.html

This poem is about Pumper Mums, but could equally apply of course to Pumper Dads or Pumper Guardians, who all do magnificently well – but it wouldn’t have rhymed so well!

Pumper Mums! Pumper Mums! Let’s give a cheer for Pumper Mums!
Now, there’s a bunch of ladies who can really do their sums!
They can bolus for a biscuit, or a piece of apple pie,
And adjust a temporary basal rate if levels are too high!

They can dual wave a pizza so the levels don’t go spiking,
And tweak in tiny increments so the setting’s to their liking!
And when the DSN says they must learn to trust the pump,
Then they’ll use the bolus wizard to avoid a nasty jump!

Hurrah, hurrah for Pumper Mums
Up and down the land!
They’ll be prepared, whatever comes,
And always in demand!

Sunday, 19 July 2009

Come, dine with me!



It’s all about food of course. We need food as much as anyone else, but need to be aware how that food is going to affect our blood glucose levels. One of the biggest misconceptions about diabetes is that we can only eat a limited range of foods, or specialist ‘diabetic’ foods with artificial sweeteners to replace the real stuff. Not so at all! All we need to do is follow a healthy, balanced diet, which is actually no different to what most people would be advised to follow. Cakes and chocolate are allowed, but in moderation either as a treat or taken with a meal – that goes for alcohol too. All we need to do is be aware of how food and drink affects our levels and plan accordingly. My diet hasn’t changed dramatically since diagnosis – I guess it was pretty healthy before – but I have learned a lot more about how the body works and how to keep myself fit and healthy. A hundred years ago diabetes was a death sentence – a hugely restricted diet, leading to emaciation, malnutrition and a pitiful end. With modern knowledge, equipment and medication, I am probably healthier than many of my peers, and aim to remain that way!

Come, dine with me – drink wine with me!
Everything will be fine, you’ll see,
For though I have the dreaded ‘D’
I still take sugar in my tea!

I’m not averse to cake or sauce,
And I’ll eat chocolate mousse (if forced!)
Moderation is the key, of course,
Though sometimes I could eat a horse!

No polyols please, for they make
My nether regions gurgle and quake,
Much better, for my stomach’s sake –
A healthy wholemeal pasta bake!

Diabetes can be a curse,
But there are many things much worse…
I’ll follow the guidelines of my nurse –
Delay the day I’ll need that hearse!

Saturday, 18 July 2009

Goldilocks and the Three Bears


Not many people know that the story of Goldilocks and the Three Bears is actually much more complicated than the ‘eat porridge, break chair, sleep, flee’ version, as told to generations of children. The bears have been grossly misrepresented, and Goldilocks had Type 1 diabetes! Here is what actually happened…
(this is a bit of an epic, so you might want to make a cup of tea first!)
It was eight o’clock in the house of the Bears
And the occupants started to stir.
While Father Bear looked for his other red sock,
Little Baby Bear brushed down his fur.

Already downstairs was that fairest of bears,
Known as Mother Bear to all that she knew.
She was early to wake – she had porridge to make,
And give tea in the pot time to brew.

Now, I think it’s common knowledge that before a bear eats porridge
He would like to void his bladder if he could,
And lacking sanitation, he will feel an obligation
To relieve himself in private in the woods.

So with breakfast on the table, and as soon as they were able,
The bears would go discreetly out of doors.
Father Bear would do it standing, for he found it less demanding,
But Mother Bear preferred it on all fours…

Little Baby was still learning, and he often missed the turning
Which would lead him to the safe secluded spot,
And when Father finished p*ssing he would see his son was missing,
He was angry, as this happened quite a lot!

In the search for Baby Bear, they always started where
The forest path diverged and went three ways.
Father went off to the right and so Mother thought she might
Explore the left side of the forest maze.

Now, it came to pass that day, someone else had lost their way,
A girl called Goldilocks, with yellow shining hair.
Despite her mother’s warning she had spent the early morning
Playing in the forest without a care.

As she wandered in a tizzy, she began to feel all dizzy,
And her heart was pounding fast as it could go!
Panting breath and sweaty palms, the poor girl feared she’d come to harm,
It was obvious her sugars were too low!

She had left her home in haste, for she didn’t want to waste
A single moment playing in the wood.
Oh only if she’d thought to bring those sugar mice she’d bought
For now’s the time they would have done her good!

As she fell down to the ground, Father Bear appeared around
The corner of the path they both were on,
He knew he must act quickly for the girl appeared quite sickly,
So he scooped her up, and quickly both were gone!

As he hurried to his lair he called out to Mother Bear,
‘Come quickly Mother, help me with this child!’
For you see, these bears were kind, and I think that you would find
They were civilised, and not the least bit wild!

As they rushed into the house, Ma said ‘Find a sugar mouse!
For this girl is lacking sweetness in her veins!’
Father Bear said, ‘That’s astute, and that’s why I find you cute!
I’m glad I wed a bear endowed with brains!’

Baby Bear (for he’d been found) brought the sugar mice around
And asked his mother what else could be done?
‘It seems the girl is ailing and the sugar mice are failing,
So you’d better go and fetch the glucagon!’

Baby did as he was told, though he wasn’t very old,
He knew exactly what he had to do.
He’d encountered this before and would probably see more,
For Father Bear had diabetes too!

With the glucagon injected and her liver thus affected,
Goldilocks began to slowly stir
And boy, was she surprised at the sight that met her eyes –
To see three bears gathered around her!

‘Now hush my dear, there, there! You gave us quite a scare!
We’ll soon return you to the world of men.
You should thank your lucky stars that your path crossed ours,
For Mother is a qualified DSN!’

‘Please, will you take a seat, for I think you need to eat
Some porridge to prevent you going low.
We’ve got three different sorts, so please let us know your thoughts.
Then you can rest before it’s time to go.’

The first bowl that she got was a little bit too hot,
The second bowl, a little bit too cool.
The third, she thought was fine, and Baby said ‘That’s mine,
But you must eat it all up, that’s the rule!’

The porridge and her proclivity for all fresh air activity
Had made poor Goldilocks extremely tired
‘Please Bears, I think you said that you had a comfy bed,
Could I go there for an hour now?’ she enquired.

Following the bears, Goldilocks climbed the stairs,
And first she went to lie on Father’s bed.
But uncomfortable springs (amongst a host of other things!)
Made her look for somewhere else to lay her head.

She then tried Mother Bear’s, but a host of moulted hairs
Made the poor girl wheeze and sneeze and sneeze!
And to make things even worse, it seemed Mother Bear was cursed
With a mattress that distinctly smelled of cheese…!

But Baby’s mattress was so deep, Goldilocks was soon asleep
And Mother Bear said ‘Go now dear, and hurry,
We will leave the girl alone, and Father Bear please phone
Her mother, so she knows she needn’t worry.’

So, now you have the truth, that these bears were not uncouth,
They’re the kind of bears who’d help you if they could!
And if you’re ever asked the question, you can offer this suggestion:
It’s a proven fact that bears go in the woods!