Diabetes Wise

I Don't Do That!

I had coffee this evening with a friend from dental school who is currently working as a Senior House Officer (SHO) in Maxillofacial Surgery. I haven't seen her for a while and this was the first time she had seen me wearing the Guardian RT. Since she was interested, and already familiar with my pump and the concept of infusion sites, I showed her the sensor and transmitter.

"I'm not sure I could cope with wearing all that stuff" she said.

I guess this could almost be perceived as an equivalent to the people who exclaim "I could never inject myself!". The standard retort to such a ridiculous suggestion being "Between death or injections, which would you choose?" It's a no-brainer.

But I don't think this is the same.  After all, using an insulin pump and wearing a continuous monitor are choices that we make in a way that we can't with the idea of simply taking insulin. And many people with diabetes who are hesitant about pumping feel that way due to a fear of being attached to something twenty-four-seven. Maybe she wouldn't cope with it.

I put it to my friend though that, yes, I have two things stuck in me and carry two monitors around and, yes, the transmitter is bulky, but for my quality of life this is totally worth it. I can see how people, looking in from the outside, would think carrying around a pump, or having the Guardian sensor attached would interfere with life. Would be a hassle and an annoyance. But the good control and the peace of mind those things afford me is priceless. Far from interfering with my life, they allow me to lead my life on my terms.

She could see my point.

Time passed and we chatted about other things. Another SHO, the SHO on-call tonight, came in. While she chatted briefly with us, one of the two bleeps clipped to her waistband began going off. As she left to answer it I joked that "wearing this stuff [pump and monitor] isn't much different to wearing hospital bleeps, even down to them screaming at you at inopportune moments."

My friend replied "Yeah, but I don't wear my bleeps during sex."

I couldn't do anything but laugh, and concede that she probably doesn't wear them in her bra either!

A Typical Banana

Can anyone out there wiser than I enlighten me as to what exactly constitutes a 'Typical Banana'?

I couldn't quite believe my eyes when I saw this! I've never bought bananas prepackaged in a plastic bag before. In fact, on the whole, I tend to try and avoid buying fruit and vegetables in Tesco Supermarkets, where most things are prepackaged. I'm not a food snob. It's just a ridiculous waste of plastic packaging, and another thing I have to collect up for recycling. But I was in Tesco, I needed bananas and bagged bananas were all they had.

It struck me as particulalrly ridiculous given that the bananas in the bag varied very considerably in both size and... er.. bendiness!

Low and Alone

I'd intended on an early night last night. I was exhausted from those ridiculous highs, caused by a failing infusion set and prolonged by my stubbornness - choosing to rage bolus rather than take a shot or change it at around 1am. I gave in at 5am when I met that second peak, along with a bunch of ketones and I spent the day with a tired, hungover feeling.

But the early night never happened.

Instead I became mesmerised by tracking the progression of this flat line low, that saw my blood sugar stay under 4.0 mmol/l (72mg/dl) for over six hours, as I shovelled carbs into my mouth until I thought I would surely burst. For the first time since I started using it, I wanted the Guardian to be wrong, to be misreading the numbers and misleading me. I made my way through more than 10 test strips in my quest to catch it out. The Guardian just wailed sweetly at me, the technological equivalent of a smug smile. If it wasn't for the fact that it was actually doing me a favour, I'd have hurled it against the wall.

I didn't want to go to sleep until I could see an end to this. I pulled back my basal rates dramatically and watched trashy TV, waiting for the carbs to hit, and the decreased basal to take effect. Eventually, a little after midnight, a finger stick yielded 8.3 (150) and then I must have drifted off.

I was awoken around half an hour later by the insistent alarm of the Guardian. I was back to 3.9 (70)

Lying in the darkness, the window open just a little, I could hear the distant screaming of sirens. An ambulance, perhaps, racing across London's streets. Of course I was thankful that it wasn't coming to me, but at the same time I was acutely aware that even if I had needed it, it wouldn't be coming. Because there was no one else there to call it. Just me, on my own.

Twenty minutes later the Guardian stirred to life again. As I simultaneously reached with one hand to silence it, and with the other to my testing kit, I couldn't help but wonder if there would ever be anyone there; if I will ever find someone who will happily tolerate these rude awakenings; who will sit with me as I eat my way through the entire contents of the kitchen in a single midnight feast; who will share a bed with not only me, but also my pump and all the leftover crumbs.

I know that there are so many people with diabetes out there who have successful, supportive relationships. In fact, I wasn't going to share any of this here, feeling it may be somehow a step too intimate. Until I read Kerri's story tonight and found myself overwhelmingly unable to hold back the tears.

Even I am shocked by the intensity of my emotion. I've never felt before like I needed someone so much as I did last night. I've always been a very independent person, who likes my own company. I have a good network of friends, but despite spending the evening with several of them, I've been unable to confide any of this, because that isn't what I'm looking for. I need more than I can ask my friends to give.

I feel again now like I did last night as I continued to lie in the darkness listening to the distant sounds of a city that never sleeps: that finding what I'm looking for might just be an unreachable goal.

I Guess Everyone's A Suspect

I was travelling on the Northbound Jubilee Line, being watched. At first it was furtive, surreptitious glances, out of the corner of her eyes. The sort of glances that are pretty commonplace on public transport. But they soon progressed to an unabashed stare and eventually she was virtually craning her neck to look at me.

I peered down at myself, to check that I hadn't accidentally left the house wearing my breakfast down my front or, worse, wearing my underwear Superman style. I wasn't.

Less than a minute passed. She turned to the girl travelling with her. "What is that?" she said, quite audibly.

This wasn't a curious 'Well isn't that strange, I wonder what it could be' enquiry. The edge to her voice betrayed that she wasn't asking her companion a question; she was confiding her fear.

The travel companion's eyes flashed at me with a slight panic that was also evident in her voice as she said "What, that thing under her clothes?"

A couple of other heads in the carriage whipped round to look.

I knew what they were thinking.

The train rattled noisily into my station. I diffused their panic by slipping off.

When I got home I stood in front of the mirror. I saw my pump in my pocket, a loop of tubing going to my tubeguard and tubing snaking from there up under my clothes. On my arm the Guardian sensor was just visible, its grey wire feeding up under my sleeve. The outline of the transmitter on the back of my shoulder was clear through my shirt. The Guardian monitor was clipped into the mesh pocket on the side of my backpack. I reached into my backpack to look at it...

It doesn't really surprise me that people were suspicious. The terror threat has been dragged brutally back to the forefront of everyone's minds - not that it was ever far away - by today's foiled terror plot, the banning of aircraft hand baggage and ensuing airport chaos and the raising of the UK threat level to critical.

And I clearly remember how just over a year ago, after the 7/7 bomb attacks and subsequent Stockwell shooting, a friend told me, with genuine concern, to make sure I kept my pump well concealed and most importantly without the tubing hanging out while on public transport.

Because, I guess, these days everyone's a suspect.

Tuesday Top Three

1) Today, I was a prisoner in my own lounge.

Mr Gas Man was sprawled across the central hallway of my flat for two hours, replacing the burnt out immersion heater in my hot water tank. And I chose that two hour window in which to be low.

No access to the kitchen (obvious source of carbs) - that is right where he is lying.
No access to my bedroom (glucose tabs kept by the bed) - that is right where he has piled all his tools.
No access to the bathroom (glucose tabs in the cabinet) - a large tube is draining the hot water tank into the bath tub.

And all the stubborness and irrationality of a low blood glucose preventing me from just asking the guy to move for a moment.

So today's number one is most definitely the Quick Fix Keychain

Clipped to my meter case and containing 16g worth of glucose tabs. I got my carbs without having to give in and ask. A win-win situation!

2) Also today, I dropped my pump. Twice.

So today's number two has to be Tubeguard

After my bad experience with EZ-Wrap, I love this even more. Not only does it keep my long tubing tidily away from those pesky door knobs while it isn't needed, but it also takes the place of a 'safety loop'. You know, that thing they told you at your pump training about taping down a loop of the tubing so that the infusion set doesn't get pulled out if you drop your pump. That thing that kind of negates the point of quick-to-detach infusion sets. That thing that no pumper I've ever come across actually does. But with the Tubeguard firmly clipped to a pocket or waistband, that is what takes the strain if you drop your pump.

Which I do. Far too frequently.

3) Today's number three...

... is apple flavoured hypo treatments.

After years of orange and lemon or 'original' (for which read'yuck') flavoured Lucozade, they've just brought out an apple flavour, which is delicious. It also compliments the great 'Sour Apple' Dex-4 glucose tabs, brought over from the US.

They're what I use to fill up the keychain!

Heigh-Ho, Heigh-Ho...

I went back to work today.

It was strange. It was exhausting. But it was good.

It was great to be totally absorbed in the needs and problems of my patients. It was great to be focused on what I was doing - a bunch of fillings, some root canals, new patient exams. It took the focus off me, off diabetes and off illness. I felt more 'normal' than I have in over a month. And it felt good.

The stress, or maybe just the change of routine, sent my blood sugars up to a cruising altitude of between 12 and 13 for most of the day (215 - 235) but even so I wasn't particularly pre-occupied, or frustrated, by the numbers. I needed to avoid lows at all costs - for my patients' sakes - and had even thought I may need a basal reduction to do that. And the good thing is that I was pretty steady all day. If this keeps up I'll be able to do an across the board basal increase for the days I am at work, just to run on a slightly lower level.

From the moment I got home I've been dropping nicely back in to range!

In other news, I saw my diabetes consultant and nurse specialist yesterday. I chatted with my consultant again about this and he assured me that something positive had come out of my hospital stay other than the fact that I was better. Apparently there is now an ongoing dialogue between the diabetes specialist team and some of the general staff as a result of some of the issues I raised. Which is, I think, excellent news.

I've also been recommended (although I think there is actually more of a concrete expectation) to bring my A1c up before it is tested again in four weeks. Apparently if I eliminate all the lows a rise of between 0.5 and 1% is possible in that time. It is just such an odd instruction! I'm usually focused entirely on keeping my A1c down!