Better Days

I’ve had better days. In fact so far today, everything that could go wrong, I think it probably has.

It started innocuously enough. One of the daily tasks in my getting up routine is to test my sugar. I posted about diabetes a little the other day. I mentioned the word test, but beyond that, I didn’t elaborate. I shall do so a bit here, and also tell you why it went wrong this morning.

There are various ways of testing your sugar. The most lo-tech is just peeing on a strip. The strip goes different colours depending on your sugar. As you can imagine, because you pee on it, it is totally painless. It’s also not very accurate. So most diabetics don’t rely on it. I don’t even have the strips.

By contrast, the most hi-tech is a full-on blood test. You go to your doctors surgery, there is a needle and syringe, they take some blood, send the sample off to the lab, and the next day you get your results. We’ve probably all had this test as part of a standard blood test, but if the value is in the expected range, generally nobody says anything.

There is a middle way, one favoured by most diabetics. It’s in the privacy of our own bathrooms, so there’s a big advantage straight away. It’s still a blood test, but only a drop of blood is required. Just like the image. You push the drop of blood onto a (nother type of) strip, and this goes into a machine called a glucometer. These things are tiny, easily fit into the palm of your hand, run off batteries, nice and portable. In about 5 seconds, the glucometer will tell you how much sugar is in your blood at that time.

I don’t know how they work, but it has got to be something electrical, because the machine is basically a circuitboard with a screen. At a guess, the drop of blood makes a circuit, they measure the voltage across the blood, and I guess that thanges with your sugar level. So they probably do a little conversion, and the number is on the screen.

Did you note back there I briefly mentioned pricking your finger? That in itself has become an art-form. I mean, you could start with a knife and cut yourself, but that’s way more blood than required, and way more pain!

So these machines have evolved where you pull a kind-of trigger, and they thrust a piece of sharp metal about 1mm into your skin! You know, shallow enough that you only bleed a drop of blood. But at the same time, that’s all the machine requires.

Now, these little pieces of sharp metal are called lancets. They come out of the factory sterile, and that’s just how they are intended to be used – a new lancet every time. But most diabetics don’t bother. I am the only person who uses my lancing machine, so I’m not particularly worried about catching something (new 🙂) from the last person who used it! So, the measure of when to change one of these lancets besically becomes when it gets blunt. Normally every month or so.

So, as you can imagine, all sorts of various finger-pricking contraptions have come along. They’re only really a bit of plastic, so every glocometer comes with one – the glucometer is the smart device here. It’s a bit like the wild west – every manufacturer, and pretty much every model, does its own thing.

And that’s what started the ball rolling this morning. I decided that the lancet was a bit blunt, so hunted out my stash of new lancets. It didn’t fit. Or rather, it did fit, but the bit of metal was too short to come and poke me. Even on maximum. You’re using the wrong lancet with that device, my wife says. I’m pretty sure I’m not, but I check anyway. So I raided a brand new glucometer. Fresh finger-pricker, fresh lancet. Same result. Thirty minutes of faff, and at that point the hammer came out – well at least that gave me some closure, made the outcome a bit more final! So, a big Thank You to Onetouch, for their totally shitty finger-prickers.

Not to worry, I have a backup. I measure myself twice a day, it is important so I keep backups of backups of backups… Basically, I take a new glucometer every time it is offered, and with every glucometer comes a finger-pricker.

I go to the bathroom to find the backup – not there. Well, it’s not where it is meant to be. It might be somewhere, but there is so much crap in there… So, I’n searching on my hands and knees – I’m never too sure I can get back up from there! In the end, I find the backup – some dozy twonk has put it in another cupboard, safe and sound. And, that dozy twonk might well have been me!

So, not quite midday – we still have things to do today – and all I really feel like doing is going back to bed.

Anatomy of a Hypo

What is a hypo?

A hypo is hypoglycaemia. hypo = low, glycaemi* = blood sugar. Stick the two together, and, hey presto!

My body is not much good at regulating my sugar, and when I measure it, it can easily vary 300% during the course of a single day. Ideally, it should be a low value anyhow, and shouldn’t vary much beyond that.

I take insulin to lower my sugar, and it works brilliantly, except if I’m not careful it works too well! I can dip too low. So, I also need to stay high enough – which means I need to eat regularly, to keep my sugar above that lower-limit. Not, like, every 10 minutes, but I can’t afford to skip meals. Insulin is quite powerful stuff, because if I our sugar does go too low, we go kaput. Too much is fatal, too little is fatal. So if I suddenly stop posting one day, that’s why! (unless I was really pissed with someone the day before 🙂).

Over the years I have spotted trends. If you’re diabetic, I really can’t recommend that enough – to measure your sugar, learn how your body responds to different foods. A few times, I have measured myself every hour, all day, just to build a picture of how my body regulates (or not) itself. My lowest points tend to be in mid-afternoon (so I can’t leave lunch too late) or the middle of the night. I’m highest around six o’clock – just before my evening insulin – especially if I eat a larger lunch than I ought. I tend not to get lows very often, because I like my sugar to run at maybe 25% higher than a non-diabetic. I can tweak my insulin to take account of what my sugar is, and what I want it to be, but it’s not an exact science.

Foods which I consider good (i.e. they don’t much raise my sugar) are things like nuts and cheese. I enjoy tofu and stir-fried vegetables, this is also good. Foods which are bad are things like bread (white bread in particular), pasta and potatoes. Basically, carbohydrates. Ironically, chocolate or candy don’t make much of a difference – I guess that’s because (a) I’m very aware of eating them, and (b) when I do eat them (and who can resist a bit of chocolate now and again?), it is just a few grams, so it doesn’t make a big difference. Crisps (chips) although generally not sugary, are potato and therefore quite bad. In case you’re wondering, corn chips tend to be just as bad as potato – I’m not too sure why this is. But there is this impression, fuelled by the media, that links sugary food to diabetes, and that’s way too simple a model, although there is a passing resemblance.

So, a hypo. Despite not having them often (at least that’s the plan!) there have been two times recently, and several in the past, where I thought I could feel a hypo coming on. You can feel them coming on – you recognise the feeling, it’s like the rumble of distant thunder. If you’re asleep, you can wake for no apparent reason, and then you feel the rumble. In fact, two distinct feelings inter-mingle.

First, there is that feeling of exhaustion. That you just want to drop, to rest. Yep, even if you just woke up. You have to fight this feeling like crazy, because if you give in to it and don’t take any action, you’ll just continue to go lower.

Second, you feel ravenous. As in, eat everything in the house ravenous. It really is an effort not to eat everything in the house! And, bear in mind that when you do eat something, there is a lead-time before it gets absorbed into your body. For that lead-time (which varies depending on the food you eat, but most people on insulin will keep jelly babies – a fast hit – to hand) your sugar is still low, so you have to train yourself to eat, then to stop eating.

When you mix these two effects, it gets interesting. Imagine being really hungry, but being too tired to eat. I know, it’s perverse, but that is what happens. Do you know sometimes when you eat a meal which involves lots of chewing, and you sometimes just need to stop chomping and give your jawbone a break? Again, it is mind over matter. You tell yourself that you have to eat something before you crash out.

One other effect of a hypo is loss of co-ordination. The food you eat needs to be ready-prepared, or at least quick to prepare. You don’t want to bake a soufflé here! You can’t be doing intricate things with your hands, and sometimes even walking is difficult. The closest I can think of, ironically, is drunkenness, where that straight line is oh so elusive.

Hypos are not limited to insulin. With any med that actively lower your sugar, you run the risk. It gets complicated because not all diabetes meds are aimed at lowering sugar – some are aimed at promoting your body’s natural sugar-combatting abilities. If you don’t combat sugar much anyway, these meds are pretty ineffective, but they won’t cause a hypo.

And, it is possible to have phantom hypos. All the feelings are there, but you measure your sugar, and there is no need to worry – it’s not gonna be fatal. I suppose your body gets used to a certain sugar level, and if it dips below that, these feelings start to kick in. Withdrawal.

In fact, the medical advice is, as soon as you feel a hypo coming on, to measure yourself and check. With respect, bullshit. That’s fine for the text books, but when you feel one coming on, you have one urge, to eat. You can worry about the numbers later.

All of this is a very long-winded attempt to explain why I was eating jelly beans at four o’clock the other morning 🙂.

To Put it Simply…

I had an interesting discussion with my wife yesterday. She started, telling me about an appointment that hadn’t gone to plan. Her patient was borderline diabetic with a blood reading (HBA1C) about 5% over what a doctor would consider normal.

I mean, the first thing here is to get another test in a few months, to hopefully be more conclusive. On this, we agree.

At this point, though, we diverge. As somebody who has been diabetic for 25 years or so, I’d advise to test yourself, get to know your body, get to know how certain foods affect it, what’s safe and what’s not. I’d make no assumptions about certain foods being good or bad, I’d let the patient discover that for themselves. If they see peaks from their own blood tests, it’s more likely to sink in that such-and-such a food is best avoided.

My wife, however, has a problem with “test yourself”. Because testing incurs a cost, a cost which the British NHS is usually unwilling to meet. So because of this, she talks about diet instead. I guess that’s reasonable because it is such a borderline case.

The patient’s reaction? But I don’t eat sweets! And there’s the problem. Very conveniently, the media propagates the story that sugary foods equate to high blood sugar (i.e. diabetes). That’s what people think, because it has been drummed into them over the years, but that’s very simplistic. The reason why the half-hour was unproductive? Because the patient had this fixed idea, and talking more fundamentally about nutrition just bounced straight off.

In fact, diabetics have to be wary of all carbohydrates – one way to think of diabetes is carb-intolerance. In just the same way as something like gluten intolerance. Yes, sugar is a carbohydrate, but just one of many. For me, potatoes, bread, pasta…can all put me high. And there’s very little sugar in some ready-salted crisps (chips), but they’ll do the job every time.

So the patient, who said quite readily how they enjoyed their pasta quite regularly, left the surgery nonplussed. I only hope they have the drive to test themself and to find out more about the disease. Although in my case, that didn’t happen until things got much worse.

One of the criticisms I have of the NHS, I particularly found this with the stroke, is that if a solution is not actually provided by the NHS, then patients tend not to be told about it. I don’t buy for a moment that somebody at “consultant” level (the most senior clinicians) would not know about such treatments. But they’re not mentioned, presumably because somebody would have to go outside of the NHS to receive the treatment, which would, of course, mean paying somebody privately. But so be it! We’re all grown-ups, we all realise that the NHS is strapped for cash and that certain treatments are beyond its means. But that’s probably the subject of another post…