Diabetes Wise

Learning the Hard Way

The door slammed shut. The lock clicked. Suddenly, after all the struggling, there was nothing. Then it started, as if from far away. At first a barely audible, silver thread of a whisper, but rapidly building into a crushing, breathtaking, ear splitting roar.

It was coming from my lungs, and out of my mouth.

The door was no longer just a wooden panel in the wall between one room and the next. Now it had a mini, superhuman tornado hanging from hands on the handle and with feet walking up towards the same point, determined to get through.

They were my hands and my feet.

This was a hypo.

A low of epic proportions.

I was five years old. I can’t blame the teachers who left me in that room for not knowing that I wasn’t simply a child with a temper throwing a monstrous tantrum. They didn’t know that the strength behind the little fists that pummeled them, and tried to wrench that door off its hinges, belied my depleted energy sources. They didn’t know that I was possessed by a beast that stalked in without even the courtesy of a warning, to steal my personality and lend me new, hitherto uncharacteristic, features; to steal my voice and have me instead utter its own words.

It didn’t steal my spirit though. That was still there when, a minute or so later and enlightened, they opened the door to find me in a spent heap on the floor, clammy with sweat and barely lucid. I accepted their sugar. And when the beast had gone, I smiled at them.

Next time he came, they were ready.

Exuberant?

No, I’m not. Amy over at Diabetes Mine has already expressed quite well some of how I feel about Exubera, the inhaled insulin that has received approval, both from the FDA and in Europe.

I just don't understand a lot of the hype.

Firstly, and quite simply, Exubera is just another way of getting insulin into the body, and on it’s own won’t improve diabetes control. Doses that can be delivered by Exubera can already be delivered by injections via a syringe or an insulin pen. Admittedly there may be some value for those who are very needle phobic but since Exubera is a short acting presentation, injections of long acting insulin at least once a day will still be required. With this in mind, it strikes m that Insuflon is equally valuable, with just one "injection" required every three days or so.

Exubera will also not replace insulin pumps. The two are simply incomparable. Insulin pumps deliver a continuous infusion of insulin that can be adjusted to match variable requirements throughout the day, with additional boluses given to cover food or bring down high blood glucose levels. Exubera can only replace the bolus part. The injected long acting insulin can't match the variable insulin sensitivites as a pump can. I reiterate that Exubera is just another way of getting insulin into the body - the regime is identical to that possible with multiple injections.

Exubera also won’t address the bag size issue. People with diabetes would all like to carry less stuff around, but we need to face the fact that it isn’t going to happen. Insulin pens take up room. So do meters and the back up supplies required by pumpers. However, in my mind, nothing holds a candle to the size of this:

All this  is quite aside from the fact  that we don't yet know of potential long term effects on respiratory function, and that the device is unsuitable for use by anyone with chronic respiratory conditions, including asthma.

Don’t get me wrong, I think Exubera is exciting, if for no other reason that it presents a complete change of direction in insulin technology. I can also see the value for people with Type 2 who are reluctant to go onto insulin therapy, when it would offer potential for a great improvement in their glycaemic control and quality of life, simply because they fear injections. A few blasts of short acting insulin each day will surely be better than nothing at all.

I’m just tired of the hype. And tired of people, who don’t know enough to understand, asking me if this means that I can get rid of my pump.

The answer is very definitely no.

Love

I don't love this.

I've lost count of how many times I've read of people declaring how much they love Lantus, or how much they love their insulin pump. I don't.

I need to be clear; I like my treatment method, I like the pump that I use and the meter that I've chosen. But I only like them out of the alternatives, the possibilities. I choose a pump over multiple daily injections. I choose insulin over death.

But love is just too strong a word. Deep down there is no denying the fact that I wish I didn't have to have any of this at all. I wish that I, and everyone else in this boat, didn't have to do this.

I can't believe that love for an insulin or for an insulin pump is enough to stop hundreds of kids and adults with diabetes, hundreds of parents of people with diabetes, hundreds of people who understand about diabetes and what it means from wishing that none of this were relevant. From wishing that it simply didn't exist.

But we have to live with it. We don't have to love it. We don't even have to like it. But we don't have a lot of choice.

I Can Turn Anything Around

Sadly I haven't quite managed to turn pear-shaped control around yet, but I'm still working on it!

No, what I mean is that I can manage to turn pretty much any subject round to the topic of diabetes. So far we've had television programmes and beverages. Believe me, at the risk of sounding obsessional about diabetes, this could just be the tip of the iceberg. Today's subject of choice: mail order catalogues.

Not that I thought, when I discovered the soggy cardboard package that the delivery person had so thoughtfully left on the front pathway in the rain, that it would make me think about diabetes in any way. I certainly didn't think that when I found a slug attached to the bottom of the package either!

The package was the new Next Directory. For those outside the UK, and unfamiliar with Next, it is basically a good quality, dependable if a little boring, clothes shop. This is mid-price, reliable stuff. No matter what the occasion, if you are desperate, you know Next is going to be able to come up with something, from work suits to party wear to comfy stuff to relax in. They have actual physical shops all over the country, and also sell online, but the Directory is a luscious 1000 page, hard covered book with their entire seasons range for Women, Men, Kids and Home.

When it arrives, I savour it. I do really enjoy flicking through it, even if the edges of the pages are a little curly from the rain. You can bet I'll probably always end up ordering stuff, but an even surer bet is that I'll fall into 'The Beautiful Catalogue Trap.' By this I mean I'll be lulled, by the good lighting on the photography, the beach backgrounds and glowing skin of the models and the fact that everything fits perfectly, into thinking "I could be like that too".

Don't get me wrong, I have no hang-ups about my body. I'm a UK 12 on bottom and UK 10 on top, and Next clothes do actually fit me well, but nonetheless I fall right into their marketing trap. This time I was very concious of it. I tried to avoid falling into the trap.

And it made me think about diabetes - the marketing thing.

Have you ever noticed how pictures of blood glucose meters in advertisements always show ideal results. In mmol/l it generally tends to be a 5.3 or 5.8. In mg/dl it seems to be something like 102 or 104. I guess they think 100 is a bit too obvious, huh? I sometimes get the impression from these ads that they are trying to sell a whole lot more than just a blood glucose meter. The accompanying background pictures always seem to be of beautiful smiling people frolicking in the meadows (or at least riding a bike!) As a type 1 friend commented once - "you'd think just by buying these meters your diabetes would miraculously come under control with no effort at all. You'd think you will always see numbers like that."

Clever marketing? I don't really think so. After all, I count a blood glucose meter as much of a necessity as insulin. They don't need to try so hard.

The Next Directory is a different matter of course. I resisted the clothes and ordered two Mongolian Wool Cushions instead!

Economics: At the Expense of Independence?

As a kid I liked to be involved with my diabetes care. Helping out with blood tests by pricking my finger quickly gave way to doing the whole test myself. Doing my own injections came at the tender age of four, and was later followed by drawing up my own insulin. I wish that I'd had a pump as a kid, and I'd like to believe that if I had, I would have wanted to be involved in programming boluses and changing infusion sets.

At times I made mistakes. I wasted test strips through not doing the test properly - using too little blood, forgetting what I was doing and messing the timing up or forgetting to clean hands contaminated by sweet stuff. I dropped syringes and even whole vials of insulin. I contaminated the clear insulin with cloudy, and we had to toss a whole, almost new, vial. If I'd been changing infusion sets, you bet I'd have dropped some, bent some and otherwise wasted some.

But I got so much out of it. I was interested in my diabetes care, and motivated to do my bit. My parents fostered that interest, and that can only have been beneficial in the long term. These were my baby steps towards independence in managing my own diabetes. Independence that had to come along some time, but was able to come at my pace. Independence that, when I got it, was wanted.

Diabetes supplies are, without a doubt, expensive. I'm fortunate that I'm not in the situation of so many of having to pay for all my own supplies to keep me alive, or even pay a percentage of the cost. (In these situations the issue I'm attempting to explain would probably be even more complex, as personal choices and sacrifices become involved.) However, even where supplies are provided free of charge to the patient, as in the UK, there is a pressure to keep use down in order to keep cost, to the health service and hence the taxpayer, down. Many patients find their test strips rationed, or awkward questions asked if they should want a few extra infusion sets one month, above some pre-defined number that all too often has no basis in reality anyway.

It therefore makes economic sense to reduce wastage, but when I consider it, I can't help but keep on coming back to the conclusion that had my parents been under pressure to make every last piece of diabetes equipment do its job, to not waste a single strip because there wouldn't be any more until the next month, the kinds of pressures I hear about all too frequently today, and had bowed to those pressures, then the cost would have been a much greater one. My interest and learning curve would have been suppressed and I would have remained dependent on my parents help and guidance for much longer. Suppose this had led to me feeling disheartened and disinterested and suppose that, after my initial efforts had been snubbed, I never got that desire back, never went on to look after myself well, independently. The ultimate cost would then be so much greater both personally, in terms of the personal health problems it may have created, and also in a wider sense, as I became a financial burden on the very health service that is so intent on saving money.

This is a choice between saving money now, at potential cost, financial and otherwise, later, or spending a little more now to save later on. I've chosen the example here, of cost-driven fear of waste in young hands leading to lack of motivation, as an illustrative one only, because I was reminded recently of my childhood interest in my diabetes and was reflecting on the benefits that had had. There are many other situations to which this same choice applies, including the reluctance to provide insulin pumps due to the increased short term costs, without consideration of the benefits and potential long term savings.

It can be an advantage that the National Health Service takes this decision on spending out of our hands since individual circumstances and ability to pay don't come into it. However, the wrong choice won't promote the best possible health for people with diabetes, and I don't believe it will help kids grow into motivated, responsible independent adults with diabetes either.

 

What the...?

Incident Number One

Feeling a little on the low side, I grab my trusty Freestyle Mini (aka Flash) to test.

Result? 5.9 (106)

Note: I've been descending into impaired hypoglycaemia awareness for a while, and really don't trust how I feel too much right now. But I do feel odd. Let's repeat that test.

Result? 1.3 (23)

What the...?

To be honest, I'm surprised that I was still concious. This wouldn't be so mad if I hadn't done the repeat test using the same finger, without washing my hands and only 30 seconds after the first test. Otherwise I'd just have laughed that I must've had something on my hands to give a screwy reult.

I didn't hang around to do a third confirmatory test, figuring I could be dropped on the floor before I even got the result. But considering that 15g, probably more like 20g, of carbs and 15 minutes later I was still only at around 3.3 (60) on two different meters, I'm guessing that 1.3 was on the money.

I'm with Allison  on this one!

Incident Number Two

Just over two hours after dinner, I test.

Result 9.8 (176) but my pump tells me that the insulin-on-board will bring me down to a nice 5.5 (100) or thereabouts before bed.

Fast forward to bedtime, around an hour and a half later. Test again.

Result? 16.6 (298)

What the...?

Let's get this straight. This was no high fat or high protein dinner. This was straightforward food I cope with everyday. There was no stress or anything else going on. Just a perfectly normal evening. There is no air in the pump tubing, the infusion set is around a day old and has been working fine. Looks fine, feels fine. I bolus 3 units, and fall asleep.

Fast forward to 3am: I wake up with that thirst that is indescribable to anyone who doesn't have diabetes. Fumbling for the test kit beside my bed, getting the back light on so I can avoid turing on the main light, I test.

Result? 20.1 (362)

What the...?

I have to give in, put the light on, check the pump all over again. Still seems fine, even give it a good prime. Damn. Get a syringe and Humalog out of the test kit case. I am not changing the infusion set at 3am, when I'm half asleep. (Did I tell you I'm stubborn?) So I whack in eight units. My correction factor below 11mmol/l is 1:5, this should rise to around 1:2.5 at these kind of levels. This technically means my eight units is enough to knock me down to nothing.

It is the middle of the night. I'm not sensible enough to check for ketones on my trip to the bathroom. Nor am I sensible enough to set an alarm for a couple of hours time after downing two glasses of water. I go back to sleep and wake up at 7am with a desperate need to pee. But the first thing I do is test.

Result? 14 (252)

Now I'm really serious: What the fuck?

I took EIGHT units of insulin, with a SYRINGE!

How can I possibly be 14?

I finally relented, and changed that infusion set. There was nothing wrong with it when I took it out. No kinks, no blood in the cannula. So I'm currently cruising along at a basal +50% with around 8 units on board waiting for a big crash anytime soon.

I have no idea wether incident one and two are somehow related, but that was a crazy 24 hours.

Damn, I hate this thing at times.

Orange

I knew I was hypoglycaemic as I struggled to form words into intelligent sentences to leave a voicemail message. With a stubborness and irrationality born out of having too little sugar in my bloodstream, I attempted to continue, somewhat hopelessly, the list of tasks I had scheduled.

It was, therefore, with shaking hands, and a blood sugar of just 2.4mmol/l (43mg/dL) that I eventually reached the kitchen and opened a cupboard, reaching in for a bottle of orange Lucozade. It was with shaking, clumsy hands that I dropped it and watched it roll rapidly across the floor.

It was with judgement clouded by my hypoglycaemic state that I reached to where it had rolled and, crouched on the floor, opened it. Even as the bright, fizzy, orange liquid frothed and foamed over my hands, I continued to turn the cap, opening the bottle still further and encouraging a full fountain to emerge to spray the cupboards and paintwork beside me. It coursed over my wrist and arm, a bright stain appearing on my sweater, a lake forming on the tiles below, running into rivers at the joins between them, pooling round the base of the kitchen counters.

Later, when I had mopped up the syrupy river and wiped away the sticky orange residue, when the washing machine was turning my sweater round and round, washing out the lurid orange stains, when my blood sugar was back in range...

Later, I laughed.

And resolved to switch to the Citrus Clear brand. I can't legislate for my actions when I'm low, but at least it would be less damn orange!

Names Stick

It's funny how names, slogans and phrases can stick, the one most commonly cited being 'hoover' for vacuum cleaner. Hoover, was of course a brand, but to this day many people still 'hoover' (with a small h) their carpets.

In my parents' house there are certain phrases that can't be uttered without someone quipping a continuation. "Let's go" is invariably followed by "British Caledonion" in reference to a 1980's ad for British Caledonian Airlines. If anyone mentions what they will be doing "an hour from now" someone always reminds them "you'll wish you'd had one" referring to an ancient slogan, shown prior to the start of films in the cinema, to encourage you to buy, I believe, a hotdog. I say I believe, since this pre-dates my birth, but even I've picked it up.

It isn't much wonder then that names for blood glucose testing can stick. The original home, and indeed hospital bedside, testing strips, the ones that took a huge drop of blood were made by a company called Boehringer Mannheim and hence were called BM Strips. Testing your blood glucose therefore became 'doing a BM'. (Don't even say it, I know what you're thinking!) To this day a number of people, particularly hospital staff or parents who were responsible for their child's diabetes care only during the BM era and have never moved on, still refer to BMs.

If today's blood glucose meters had been the front runners things would be different, quite aside from the fact that it would mean I'd have had the experience of those that went before me, of growing up without the ability to test blood glucose levels at home. Instead of testing blood glucose, or doing a BM, we'd all be 'doing the One Touch' or, better still, 'Freestylin'!!

Just for the Taste?

No, it was more than that.

I was diagnosed with diabetes the same year that Diet Coke was launched in the UK. This was, in many ways, a good thing. Leaving aside that, even without the sugar, Diet Coke is a major threat to your teeth, (thanks to the phosphoric acid,) and leaving aside any debate about the safety or otherwise of artificial sweeteners, (because I just don’t want to go there,) it was a viable alternative for me when all my friends were drinking the regular stuff at birthday parties, or wherever. It made me feel ‘not different’, because I was drinking basically what they were and because I didn’t have to suffer feeling ill for doing it. I didn’t need an extra shot, or have to be embarrassed because I had to run to the toilet twenty times in the course of an evening - due, you understand, to the sugar in the Coke, rather than its volume.

I still drink Diet Coke. I feel a funny kind of gratitude to it, for giving me those ‘normal’ times that water just couldn’t have done. I wouldn’t drink the normal stuff even now because the blood glucose spike it would give me is way too high and rapid to be avoided, even with a timely bolus. I guess I do, in my own way, fit their marketing philosophy, no matter how pretentious it sounds, that Diet Coke “empowers people to… feel their best.”

Aside from that, it is basically a bunch of empty calories, and I’m not doing extra hours at the gym for a bottle of drink, no matter how shapely and beautiful the bottle! So no, if I want a vodka and Coke, it’s a vodka and Diet Coke, thank-you-very-much, and a friend who won’t ask for that at the bar for me won’t be a friend for very long!

Since the day they took the sugar out of Coke and Diet Coke was born, there have been a lot of twists on the theme. With lemon. With lime. With Vanilla. (But of course you always want what you can’t have. My personal favourite is Diet Cherry Coke, sadly unavailable in the UK, along with raspberry and Splenda versions.) They also took the caffeine out, to make a caffeine free version, and even experimented with taking the calorie out, calling it Coca-Cola Zero, which kind of makes you ask what was left. Just the (uh-huh) taste of it – of course!

The latest Coca-Cola invention is not a twist on Diet Coke. In fact it puts the calories, and caffeine, right back. Coca-Cola Blak, a coffee infused cola launched in France this month, has ‘twice the caffeine of regular coke’ (but apparently that’s a third less than your average cup of coffee) and is up to, um, 47 calories!

Is it just me, though, or does coffee coke sound really bleurrrgh? I certainly won’t be drinking that for the taste of it!

Er...

Episode 1 of ER Season 12 premiered on E4 here in the UK last night.

I like ER. Actually I love ER. It is my favourite television show ever, although I'm not so stubbornly protective and defensive of something I like that I can't admit that it has gone steadily downhill since season 10. I like the reality - the medical and emotional accuracy - and really appreciate that amongst the sea of poorly over-dramatised and idealised medical dramas given airtime (although not, I hasten to add, any of my time.) But most of all I love that I really care about the characters. I can identify and empathise with them. They all make mistakes and have tough days like the best of us, but that makes their triumphs, the times when they seem perfect, both believable and enjoyable. I've lost count of the number times I've actually been disappointed to see the end credits roll. But perhaps the reason that I feel there has been a recent decline is that I no longer feel that this always holds true. More and more of the original characters, whose lives I followed for years, have left.  I suppose I don't care so much about many of the newer bunch of characters.

I knew ahead of time that the main storyline in last night's episode involved Sam's twelve year old son Alex, who has diabetes, running away from Chicago to attempt to be with his dad. In true style, the story was pretty medically accurate. He didn't seem to have taken any insulin with him, and so they were searching for a kid in DKA. The questions between mother and son when reunited touched on what could have happened, reflected well the anger that only comes about when you really love and care for someone.

But I didn't feel anything.

I don't know what I expected, but I didn't feel anything about the storyline. I didn't even feel any kind of empathy.

This could be because I don't, as I said above, care all that much for some of these characters. Diabetes or not, Alex is an annoying, whingy kid most of the time. And his mother isn't much better. Anyone who attempts to have a romantic liaison with Luka Kovac gets what they deserve!

Or it could simply be because it's a television programme.

This isn't reality. Inevitably I feel at least some degree of empathy with most people who have type 1 diabetes. We may have absolutely nothing else in common with each other and our personal experiences of diabetes, our particular journeys through the condition, all vary, but we do all know what this thing can do to you, and how it can make you feel. A scenario on ER, no matter how medically accurate, no matter how well written and dramatised, isn't the same.

So the question then becomes, why did I expect to feel anything?

The answer could quite well be that I'm just too obsessed with diabetes. But I honestly don't think so. How can you not be at least a little bit obsessed with something that demands your attention so frequently, and is affected by everything and can have an effect on everything you do? It is true that anything in the media regarding diabetes, be that factual or fictional, written or performed, tends to catch my eye and draw me in. Is that wrong? Things in the media about other facets of my life tend to have the same effect. It is, after all, natural to have an interest in things with personal relevance.

So I think the answer to that question - why should I expect to feel anything about a storyline concerning diabetes - is that it is simply another symptom of how all-consuming diabetes can, at times, be.

And Some Things Don't Really Change

Some things keep on forever and ever. No chance to forget.

It seems that since before I can remember I've been getting my blood glucose checked. I've even been doing them myself since before I could do a whole lot of other things like spelling my own name or tying my shoelaces.

Sure, a lot about the process has changed. I was lucky in having a home testing machine from pretty much when they started being common. It was the size of a brick, no kidding. My entire kit - machine, lancer, strips, insulin, syringe, spare cartridge and infusion set, plus some other junk besides takes up less room than this beast did, and doesn't weigh so much either.

The finger pricker was more like an instrument of torture. An arm that swung down, lancet unconcealed, undeniably similar to a guillotine.

The strips took a drop of blood ten times the size of what I need now. The 'brick' took two minutes to count down, with a buzz at one minute to wipe the blood of the strip, and another at two to tell you to shut the big ole door that made up most of the front of the meter. And if it turned a horrible murky blue-green that indicated over 17mmol/l (306mg/dl) you had to add another minute to the whole process to see how much higher it would climb.

But when it comes down to it, the bottom line, I still prick my finger (although with the much kinder Multiclix) at least five times a day, squeeze out a drop of blood (albeit much smaller than it was back in the day) touch it to the strip and wait to see what comes up (although it takes just a few seconds, on a machine that easily fits in my pocket.)

And guess what? I'll be doing this every day if I live to be a hundred, unless a cure comes along in that time. The strange thing is, I guess a small part of me would find that really strange and would probably miss it in at least some small way.

The Routine

Some things you never forget.

The routine of getting out the little plastic box. Out of the box two more boxes, and out of these boxes two tall thin vials, one with a blue stripe and cloudy contents, the other with a yellow stripe and contents as clear as water. Rolling the cold thin vial of cloudy liquid back and forth between the palms to mix it, clicking softly against bracelets or rings.

Taking out a syringe, pulling off the ridged orange cap and drawing the plunger back to the right number of units, filling it with fresh air. Inserting the needle, all 13mm of it, through the rubber stopper into the blue vial and pushing down on the plunger, pushing in units of air corresponding to the units of insulin to later be withdrawn.

Removing the syringe and inserting it into the yellow vial, pushing the plunger to inject the remainder of the air then flipping the whole lot upside down and slowly pulling back on the plunger to the right number, plus a little - perhaps a unit - extra.

Then came the flick. A firm flick with the back of the middle finger, with its permanent slight bruise beneath the nail, to dislodge any little air bubbles to the top of the syringe where they would be expelled along with the extra insulin.

Carefully inserting the syringe back into the blue vial followed by the flip upside down. This time extra care taken not to introduce any air, trying to avoid the need to flick and expel, in case units of the first insulin were lost and the dosage inadvertently altered.

Then came the final step. The wiping of the skin, the pinch up of scarce flesh between thumb and forefinger, the quick stab as if with a dart. The slow depressing the plunger all the way down. Counting - one, two, three - before withdrawing the needle from flesh and pushing it instead into an orange plastic device. Clip. Snap. The needle gone. All done...

...until twelve hours later.

It is 17 years since I switched to multiple daily injections and began using an insulin pen. Four years since I traded pens for a pump. But the routine of mixing insulins in a syringe twice a day remains etched more indelibly in my mind than how to ride a bicycle or drive a car.

If I live to be hundred, if I live to see a cure, I won't ever, ever forget.

Pear-Shaped

I wish... I wish...

I think what I wish is that the title of this blog reflected me as a person, rather than what I seek to be. That is to say, I would love to be so wise about diabetes that this blog would be nothing more than a means to share my wisdom and insights, to give encouragement and just maybe a little sprinkling of inspiration. But it isn't like that. Diabetes will never be like that. No one will ever have all the answers, because the questions keep changing, and sometimes I'm reminded of that in the most surprising ways.

There was a programme on BBC2 last night called Balderdash and Piffle, which aims to explore the etymology of common words and phrases. Words fascinate me. For as long as I can remember I have played with words, turning them back to front or exchanging letters, even making up entirely new, entirely nonsense words. So Balderdash and Piffle seemed right up my street. What I wasn't expecting was that it would pull me up on how I feel about my diabetes control right now, something that, in all honesty, I've probably been avoiding confronting for a couple of weeks. I wasn't expecting a TV programme to force me to confront the fact that the goalposts have moved again.

The first episode of the series focused on the 'P' words. Among them was pear-shaped (a phrase more than a word, I guess.) In line with the current trend for being "interactive" the programme has invited viewers to contact them with documentary evidence of the origin of the various words that pre-dates the evidence currently available to the folks at the Oxford Dictionary. Suggestions for the origin of pear-shaped ranged from loop-the-loops in aeroplanes to glass blowing, but in a moment it hit me that I had a definition. True, it didn't pre-date the requirement of pre-dating the currently available evidence of origin, but my definition could have been the origin if the phrase did not already exist.

Pear-shaped = my diabetes control.

When I say pear-shaped, I mean it quite literally. Imagine if I drew blood glucose control as a continuous line, joining itself where it began, and imagine very good to perfect control as a neat circle, with midnight at 12 on the clock face and midday at 6. Now imagine the drawing of my control as it is right now. It would look more like a pear, wider, much less circular and out of control at the bottom than at the top. My blood sugars between around 10am and 6pm are so hopelessly varied that the lack of pattern is the only pattern.

So there we are. It is said now. I wrote on January 1st that I don't have an concrete reason for getting down to this right now, but perhaps, albeit subconsciously, I do. Perhaps the gradual slide out of control is a good reason to be doing this; to seek support and focus on things. Last year I had A1cs consistently in the sixes. Not any more, I don't think. So I am back to the only too familiar ground of seeking solutions to the problem of good control. Looking for more answers to how my diabetes works.

With regards to the level of diabetes wisdom that can be achieved, I guess I need to remember the words of William Faulkner:

"The end of wisdom is to dream high enough to lose the dream in the seeking of it"

In other words if I dare to dream that my control will always be perfect, I'll never achieve it. And that  won't give me any kind of wisdom.

Beginnings

I hate beginnings. In days gone by, when paper diaries were the thing, I always hated the fact that I had to spend precious time in the latter half of Decemeber transferring telephone numbers, notes and mad scribblings from the 'forward planner' into a new diary and begin again. I hated the very fact that new diaries began on January 1st. You couldn't choose to start at some other time that was more convenient unless you got a mid-year 'academic diary' starting in August, which was just as bad for being busy (or possibly on holiday) and with a million things usually already scheduled for September and October hardly more convenient at all.

It is perhaps ironic then, that when I moved to a Pocket PC, I began on January 1st when I could have picked any day from then until eternity. And it is perhaps just as ironic that I finally chose to get going here on January 1st, when I could have chosen any day.

I hate beginnings for another reason: for not knowing where to start. This lingers on from writing essays at school, where composing the opening paragraph seemed to take longer than writing all of the other paragraphs put together, the empty white page glowering at me for what felt like hours.

I don't have an amazing story to tell about how I found out I had diabetes. I simply don't remember it, as diabetes has been a part of my life since before I was routinely making memories. If I really stretch, I could probably say my stay in hospital was pretty much one of my first memories, but the disjointed fragments probably won't make for an eloquent, interesting or inspiring read.

I also don't have an inspiring tale of why I have begun to write here at last, although I suspect many of my reasons may mirror those of the countless other diabetes bloggers out there. I chose the title because I get asked with relative frequency "How are things diabetes-wise?" (As opposed, I suppose, to things in other areas of my life. Diabetes can be all consuming at times, but I hope there is more then that to me!) Some of what I write will undoubtedly go towards addressing that question. However, the title also reflects the inescapable fact that to effectively manage diabetes you have to get pretty wise about it, and here exists a forum for sharing and exchanging words of wisdom.

So I guess that concludes my beginning, and from here on in things must get easier... and better!