RETURN OF THE DIABETIC JEDI

Another night in the life of the Diabetic Jedi…

While en route to London’s Green Lanes to catch up with a Welsh friend, I realised that I had forgotten to remember my blood-glucose testing kit and all-important insulin pen. Assuming that I would only be away from my peripherals for a few hours I thought nothing of it; there would probably be no food involved (except, maybe Guinness) and while I am still in the dark when it comes to how much sugar content is in beer and wine, I decided that the best course of action would be to pace myself.  This, of course, was never going to happen.

By 2am I the morning I didn’t have a clue what my blood-sugars were doing, but one of the important lessons I have learned in life is to never let a drink go to waste – and there was still a bottle left to be un-wasted. One diabetic high isn’t the end of the world, either; it doesn’t hurt to relax once in a while – I am a total lightweight when it comes to wine anyway, so I was never in any danger of my sugar-levels going dangerously high.

There are side effects to highs, though – even moderate highs. When I’m running high blood-sugars my concentration levels drop and I start to feel fuzzy-headed. I also waffle more than I usually do – making even less sense than I usually do – and I tend to get emotional over silly things (as emotional as a man can be).

Now, I would be exaggerating if I said that I was puring over with emotional turmoil at any point during the evening, but I never fully realised how attached I was to the colour yellow. I don’t know if all diabetics go through the same emotional rollercoaster when swinging higher than Charlie Gilmour (perhaps I’m just a big sissy) but I don’t recall ever being emotionally hijacked before my pancreas packed up. Regardless, I had a very pleasant evening.

There was a brief panic over the realisation that in order to catch my last bus back to Crouch End I would have to muster a degree of physical exercise from somewhere  (quickly); the likes of which had long since abandoned me at the finishing line of my last Comprehensive school cross-country mile. Panic was averted when I was kindly offered the sofa and some more wine. I accepted both, but not nessessarily in that order.

And now the semi-related moral/advisory bit:

My advice to anybody with diabetes would be to help friends and family understand what you are going through.  Diabetes is not an easy thing to live with and sometimes you may find yourself feeling uncomfortable, frustrated, sentimental or sad when there is no reason to be. It helps if people know that it is not always you, but the hold that diabetes has on you – but this is no excuse to be a drama queen!

The side effects of highs are the reason why I try to maintain my blood sugars at a respectable level.  If I have a lot of carbohydrate (sugar) I start to feel out-of-sorts and sometimes get a knotted feeling in my stomach – like the feeling of being dumped by a girl who is clearly too good for you because you look like Andrew Lloyd Webber and your breath smells like a damp badger. Highs are not a pleasant feeling and it takes a while before insulin takes effect and blood levels start to normalise – that’s if you have your insulin pen with you.

Morning highs, however, are a different kettle of students.  I am not a morning person; I never will be. No science will ever rectify my indifference to getting up before 10am. In these diabetic days I endure grating morning highs – the body is more insulin resistant and the metabolism works slower because of the body’s wake-up cycle – that’s one excuse anyway. If I have breakfast at 7am it can be close to 11am before my blood sugars drop to their target levels.

My dark, unapproachable demeanour has become folklore; the only things I’m indifferent towards in the mornings are a cup of strong coffee and some wake-up music – and for the love of Zeus don’t make pleasant conversation with me. if you’re of a sunny disposition, do me a kindness and position yourself away from me.

The morning after the night before, at Green Lanes, I woke up dull and very early on the sofa. High sugars and a revolving room prevented me from getting a good night’s sleep (purely self-inflicted and worth it, I must add). I sought empathy from caffene and hosed myself down with three cups of the stuff. I greeted my friend with the customary morning grunt when she appeared, gesturing ape-like towards a black coffee I had prepared.

Managing to form coherent sentences using primitive dialect a million years ahead of my Neanderthal state I offered my sparkling company for part of the number 29 bus route to Finsbury Park.  Pausing for a moment to assess and collect her thoughts, my friend politely advised me that she is not the best of company in the mornings, prefers not speak and intends to put on her music. It would appear that only dull people are bright in the mornings.

SIC TRANSIT SELF

It’s at times like this (during heavy snow and freezing temperatures) when I am reminded of how careful I have to be as a diabetic – and how much I long to be liberated from the chains of pancreatic deficiency. Sometimes I get hit by mini-moments of panic; suddenly checking that I have enough sweets or snacks on my person – in case I find myself nowhere near a shop – or worrying that my car will get stuck in the snow – that I will have to walk miles to find warmth.

It’s during winter that I feel especially vulnerable. The first time I was exposed to cold conditions I suffered my worse hypo to date. It came out of the blue like a large drinks bill and I ended up on my arse with a Prague monument doubling as a pillow for my back – I am, as a result, not confident in the cold.

I’m not sure weather to call it sweet sensibility, or call myself a sugar plumb fairy, but I decided not to chance driving in the snow today; I caught the bus to work instead. I can’t help feeling a little silly for being so paranoid. Three years ago I would have braved the elements wearing nothing but a cleanly laundered day-sock over my shrivelled modesty. These days I panic every time a gnat sneezes, stock-up on flu tablets, pick a religion out of a hat and prepare to meet my chosen maker.

I don’t like feeling vulnerable (who does?), and even though I don’t engage in pointless displays of chest-beating machismo, I can’t help feeling less of a man for having to pamper myself as much as I do in these diabetic days.  For the most part, I have gotten quite used lugging my life around in a rucksack – or ‘man-bag’ – stocked heavily with all the essentials and contingencies: gloves, hat, waterproofs, testing kit, extra insulin, spare pen, needles, snacks, drinks, cold and flu tablets – not forgetting my netbook, iPad, portable battery pack, headphones and other odds-and-sods a gadgeteer can’t leave home without.

I am no longer a diabetes newbie, but I’m not confident enough to get the sock out just yet – not when it’s brass monkeys weather, anyway.

MY ANNUAL CHECK-UP

As a type 1 diabetic I am examined on an annual basis – it’s a bit like an end-of-term report, but without the cheating. These tests are designed to keep track of my liver & kidney functions, weight, cholesterol and average blood glucose levels – and to detect and prevent the many occupational hazards that come with being pancreatically challenged like neuropathy, hypertension, ketoacidosis, and not being able to ‘get-it-up’.

I was recently summoned to the local GP for my end of term blood test. I was required to fast for ten hours prior to my appointment – which would be more like twelve hours since I couldn’t eat after 10pm and my appointment was at 10am. This was daunting for me because I’ve never fasted before and feared dropping the ground in a hypo before food found its way to my rescue. There was the added complication of shift work as well, which affects my meal times.

Thinking on my hands I worked a way around this dilemma by only taking half of my meal insulin before bed. By morning my blood levels were high enough not to spring any surprises. I arrived at the doctors, promptly late, and presented the nurse with an early morning urine sample that I had saved for this special occasion – it still pains me to know that I’ll be filling cups and samples for the rest of my life.

Speaking of taking the piss, my mother used to pull a prank on her new nursing students: She would fill a urine sample with flat Lucozade and send a trainee away to test the sugar contents. The sheepish student would return with the clinically improbable results and my mum would ‘tutt’ and exclaim that there was only one way to get an accurate sugar result. She would then knock back the contents of the sample. The look on the newbie’s faces must have been priceless – though not as priceless as the look on my mother’s face would have been had the sample ever got confused. My mother also used to send newbies to fetch a nine centimetre diameter cafeters from the nearby nursing home. Anyway, I digress…

A few weeks after my bloods were taken I attended another appointment to discuss the results with my practice nurse. We had met before, but she couldn’t remember; that was until she looked at my results – apparently I’m their best student. I was delighted to be told that my cholesterol, blood pressure and Hb1Ac were right on target. I had put on a few pounds but was probably half-naked and hospitalised the last time I was weighed. She then examined my feet, which is another thing I hate having done – on this occasion my feet could have wilted a Chelsea flower garden. What I was not prepared for was the concern that the nurse was about to show with regards to my tight diabetic control.

The nurse appeared to be going along the assumption that I was letting my diabetes control my quality of life. I immediately jumped to my defence and argued that I keep good control of my diabetes because I know my routines and I am playing the long-game. She gave me a suspecting look; like that of a wife whose husband claims he reads Zoo magazine for the journalistic content. I met her gaze; the gaze of a husband who has just told his wife that he reads Zoo magazine because it’s full of tits. I began telling her how much of a committed perfectionist I am by nature; that I’d gotten the hang of diabetes quite early and that I am in no way restricted by my condition.

By the second month of becoming diabetic I had worked out my own routine. I recall having a conversation with my mother during that time in which she said, “So, you’ve decided to disregard the advice that the specialists have given you and do things your own way? You are definitely your mother’s son!” I pointed out to the nurse that if diabetes was controlling my life, then I wouldn’t be going to all the concerts that I have been going to, or all-night partying in London’s West End. I wouldn’t have passed my driving test, or explored Prague and Paris. I wouldn’t be enjoying fine food or sipping Tequila Sunrises at the Cardiff Mardi Gras - I wouldn’t be the unique, balanced and grounded individual that I am today.

And with that, I clinched the argument.

ONCE A SIMPLE ACT (POEM)

Part of creature habit, he gathers up his feed.
lusting liberal consumption; mealtime simplicity.
Life now lived by numbers; he weighs and shoots up three.
He’ll be hyper-high this evening; overdosed on gluttony.

AN EXERCISE IN INSTINCT

I was my silly fault – forgetting to submit my repeat prescription to the doctors in time, and having to spend the ‘stolen pagan festival’ without testing strips for my glucose meter; guessing whether I was running high or low blood sugars. My only adoptive method was as effective as sticking a moist middle finger in the air while dancing in the shower – If I was feeling dizzy and weak, I was either running low blood sugars, or had drunk too much. If feeling tired, moody and lethargic; I was either running high blood sugars, or just plain knackered because of the Mickey Mouse shifts I work.

There were other spanners in the works too; it was the festive period where mince pies and puddings wake from a long hibernation, and so woke my my intolerance towards resisting them and the purple Quality Street chocolates –  temptingly abundant at my place of work – coupled with the need to comfort eat through sheer paranoia of a nasty hypo while at work, or driving home. I was, to put it as eloquently Valleys as I can, pretty fucked!

I usually test my blood levels before I sleep, when I wake up, before I eat, drive, bath, drink – and especially before I… never mind! It is a tool that I have become heavily reliant upon; a tool that gives me the power to accurately manage all aspects of my diabetes life – diet, exercise, and recreational activities like wine tasting. It was a tool that I would be devoid of when I would be needing it the most. Not one to shirk away from a challenge – at least not the ones I have no choice in not shirking away from – I decided to mentally assume the guise of a ‘diabetic Jedi’ – managing through sheer instinct and oneness with my mind, spirit and body.

It didn’t work!

My mind and I have never been on the best of terms and my body is always playing tricks on me – my legs are particularly partial to the odd yarn at my expense. So instead I decided to look upon this as an opportunity to see just how well I could cope without a glucose meter. For the most part, I managed quite well; I was in my habitual Valleys element with my tried and tested routines and felt neither high nor low enough to discern any problems.

There was one instance that caught and bit me on the arse; my girlfriend and I had arranged to meet a friend for a meal. I had worked afternoons and rose late for breakfast – now more like brunchfast. An hour after injecting my insulin I had to second-guess the contents of a large mixed grill with fries – it was very nice of Wetherspoons to mangle the steak and hang it out to dry for the night before serving it. My mind started playing funny buggers and I started asking myself: ‘Was I was still high from breakfast?’ ‘Had I injected too close to my last injection?’ ‘If so, had I injected too much this time around?’ ‘Will I ever stop asking myself questions that I don’t know the answers to?’

To relieve the paranoia I downed a few Jelly Babies before driving home, followed by a few more before driving to work – where the purple Quality Street were waiting. By mid-shift I was clearly as high as NME’s ‘best album of the noughties’ decision panel. My eyesight was a little on the blurry side and I was feeling rather parched. Normally under these conditions I would test my blood and take a corrective unit, or two – depending on the meter reading. Without my meter, I couldn’t do anything except drink pints of water and wait for what felt like hours – probably because it was hours – for my bloods to come back down – or lead me to believe they had come back down.

I eventually started to feel a little light headed and took this as a sign that my blood levels were now too low. I ate and injected at my normal ratio then carried on as I normally would. If all went to plan my levels would behave themselves from then on – I had eliminated all of the purple chocolates and was back in my routine. I had no more high-low symptoms afterwards, and though I would like to have known what by blood readings were, I was satisfied that under normal conditions I could get along with ignorance being bliss.

The vague outline of a point contained in this blog (if you squint hard enough) is that life never goes to plan – more so for diabetics and the fine lines they tread on a daily and sometimes hourly basis. As a well controlled diabetic – combating life’s dark, edible forces of evil – it is good practice to be ready for any eventuality and to have the right tools at hand should the unexpected arise unexpectedly – as I often expect it to do. You never know when you’ll find yourself walking home in a blizzard, running out of petrol a mile away from the nearest filling station, or tempted to the dark side by a sugar-loaded morsel.

Your blood sugars may plummet because of unexpected exercise – if you’re anything like me, any exercise is unexpected. They may elevate after drinking vats of ale as part of your voracious tendencies; causing your bloods fall again and medical professionals to ask questions later. In either of these eventualities you’ll be glad you packed your insulin, your snacks and that essential glucose meter to tell you what the hell is going on.

A BALANCED BACKGROUND

Much has been said about rapid insulin and the positive benefit it has on diet and diabetic control. But one factor that is often overlooked, and underestimated, is background insulin and its job of maintaining a complex balancing act: The human body produces a constant flow of its own glucose, called glycogen. This glycogen production is counterbalanced by the pancreas which produces just enough insulin to break down the glycogen – like an elegant chemical waltz… for normal people, anyway.

A type 1 diabetic has no insulin production to counterbalance the glycogen production. In addition to injecting rapid insulin diabetics inject a long lasting, slow release insulin. This background insulin lasts up to 24 hours (rapid insulin lasts up to 4 hours). Its main purpose is to balance the body’s natural glycogen production.

When I was diagnosed with type 1 diabetes I was put on a set dose of rapid insulin (Novorapid) and background insulin (Levmir). As previously documented in this blog I quickly worked out my carbohydrate to rapid insulin ratio, thus improving control of my glucose levels. Despite this breakthrough I was finding that even when the rapid insulin was not present in my bloodstream – after a long sleep, for example – I was having to consume around 20 grams of carbohydrate every two hours to prevent my levels dropping too low – my background dose was too high and I was having to snack out of necessity.

During a concert one evening I easily consumed over 60 grams of carbohydrate – the equivalent of a main meal – over the course of two hours without taking any rapid insulin; my blood levels did not raise above ‘normal’ levels during the whole time. It is a little known fact that standing up for long periods consumes more energy than walking does for the same length of time, but not enough to have to carry a bakery in your backpack! After a brief consultation with the Professor of Diabetes at my local hospital I was encouraged to experiment with by background insulin levels.

My initial set dose upon diagnosis was 16 units of background insulin. Every four days I would reduce this by 2 units to see how it affected my day-to-day routines. My method was to spread out my meal times so that the rapid insulin would be absent from my bloodstream at certain times of the day – preferably when I was resting. I would then test my glucose levels every few hours to determine if my levels were still falling without the aid of the rapid insulin.

The final test was to eat a zero carbohydrate breakfast – like chicken or scrambled eggs. If my glucose levels continued to fall during the course of the morning then further adjustment was required. I kept this up for a few months and the end result was quite astounding. At present my background insulin dose is just 6 units – 10 less than the dose set by my diabetic nurses.

I no longer need to snack every 2 hours – which has helped with my diet – and I sleep better knowing that I am less likely to get woken up by a hypo. The pay-off is that I now have to take a few units of rapid insulin when consuming snacks that the background insulin would normally have coped with by itself. But it’s a small price to pay for more freedom!

DIABETIC SMARTARSES

My thoughts on how rapid insulin has made it easier for diabetics to manage:

It has taken many years for me to be considered a smartarse in the school of life, and what better than to become a smartarse at managing an incurable disease. I am, if I do say so myself, a model diabetes student; I maintain good glucose levels, I accurately dose-adjust, I eat a sensible diet (ish), I rarely drink myself to stupidity and I get moderate exercise, bla, bla, bla, yadda, yadda, yadda.

I can’t help but feel that I am pissing on the chips of the more seasoned diabetics when writing about my relatively short lived experiences – nobody likes a smartarse, do they? But had I been diagnosed over 10 years ago – like those whose chips I feel I’m pissing on – my arse would not have been so smart. My diabetes is easily manageable simply because of the development of rapid acting insulin, by medical smartarses.

Rapid insulin does exactly as it says on the veil: it rapidly enters the bloodstream and rapidly breaks down the glucose released into the body after food is consumed. If a certain diabetic smartarse is able to calculate how much insulin to inject in relation to how much carbohydrate he consumes, then he will be capable of sustaining his bloods at near normal levels for most of the time, greatly reducing the likelihood of future complications – or so the smartarse hopes.

Before the discovery of rapid insulin sugar levels ran higher for longer; complications such as deteriorated vision, liver and kidney damage, stroke, amputation, and trouble getting a stiffy were far more common (I know a few veteran diabetics with some stories about diabetic complications that would scare you stiff).

I recently attended a course at the local hospital teaching how to manage diabetes in everyday life. One of the women on the course was in her late 40’s and had been diabetic since her youth. She observed that what she was being taught on the course was – at one time – the exact opposite to the way she managed her diabetes prior to rapid insulin.

Back in the dark age of glass syringes regimes were far more militaristic; one injection covered 24 hours. Excess eating would cause sugar levels to run higher and there wasn’t any easy way to lower them – unless you found jogging easy. Meals had to be eaten at set times and carbohydrate counting was an essential science that had to be carefully implemented in order to maintain acceptable glucose levels – diabetes was like walking across an invisible, moving tightrope.

Good diabetic control is far easier today, thanks mostly to the medical smartarses, and rapid insulin – diabetes is able to be fitted around our lives now; the tables have turned for the better. I am not limited to how much I can eat, or how many rapid insulin shots I can inject myself with. If my glucose levels are high, I simply take a small shot of rapid insulin to bring my levels back to normal again.

The risk of complications may be greatly reduced, but they have not been totally eradicated! Diabetes is, and always will be a disease that must be managed with great care and responsibility – it is a life partner, and just like a marriage it requires a certain degree of give-and-take. It’ll take much more than the cat and your CD collection if you screw with her, too.

I’d rather not have the damn disease at all! But at least the universe has shown some empathy and consideration and left it until now to administer its karma. With the relatively new introduction of the insulin pump, and the positive progress being made by medical smartarses – who have some potentially snazzy developments in the pipeline, such as the oral insulin pill, an artificial pancreas, and the re-coding of the beta cells that attack bodily invaders (like replacement organs) – the future is looking brighter.

The medical smartarses are within a smartarses’ whisker of curing the retched disease all together – it’s just that no one has told them that, yet. Who knows, in 20 years from now people with diabetic symptoms may only require a simple course of tablets: ‘take two- a-day for the rest of the week, and try not to mix it with cake. You’ll be as fit as a fiddle in no time.’

Wouldn’t that be sweet!