Diabetes Wise

I did it!

And I'm really glad that I did.

Sure, there were times when I found myself staring at a blank screen at 11pm, totally devoid of inspiration. But looking back, I'm pleased with the number of sensible, meaningful posts I've managed to turn out in the last 30 days. And overall, I've enjoyed the challenge of writing something everyday. It has been a real motivator. In the past I've let a lot of bloggable moments slip by, but hopefully that wont be the case in the future. I won't be keeping up the everyday pace, but I hope to keep to a semi-regular schedule now that I've proved I can.

Blogging everyday has also brought another, unforeseen, benefit. I actually feel more involved in the community we have here, amongst all the blogs on diabetes. It stands to reason when you think about it, I just hadn't thought about it! The importance of being part of a supportive community when you deal with diabetes should never be underestimated. I sad it was a recurring theme, so thanks again guys!

In other November news: NaNoWriMo, has not been such a success. I made it to somewhere around 24000 words, just shy of halfway. The verdict is that I've just been too busy. I hate to fail. At anything. It isn't usually a word in my vocabulary. The good thing is that I don't think I've really failed at this. I've done some good ground work on an idea I've been carrying around for a while and I do feel motivated to carry on with it. Writing is something I've never been great at finding time for so without Nano, and all my enthusiasm for it at the start of the month, that project would still have a sum total of zero words on the page.

And up for next month, a new challenge. I've made a conscious decision to return to regular logging, at least for a while. I'm still baffled by my 6.6 A1c and I want to really see how I'm achieving it. I've just spent the train journey from London to Liverpool banging my spreadsheets in to shape and manually entering the last weeks worth of data.

So onwards, to Decemeber - Caro blood sugar logging month.

And congratulations to everyone who made it through NaBloPoMo, NaNoWriMo or both!

A1c: Really?

Amongst other things today, I had an appointment with my diabetes consultant. I know full well that I've moaned before about feeling unsupported and not wanting to do it all myself, but honestly I sometimes wonder about the point of these visits.

We spend a lot of time going over the same old ground, about the emotional burdens of diabetes, about hypoglycaemia frequency and so on. But looking back, I can't see the last time anything ever really got done as a result of these appointments. I can't think of a time where I've made changes directly based on what we've discussed.

It's not that that is necessarily a bad thing. I'm not sure that there is really an awful lot that I want to come out of the visits. I don't want my consultant to fiddle around with my basal rates or carb ratios because, quite frankly, what does he know? I'm the one living with this. I'm the one that does it day by day. And even if he made changes that worked for a while, everything will change again long before we next meet. If I were to rely on my diabetes team to make all these changes, I'd be up the creek without a paddle more often than not.

Today felt perhaps particularly pointless because I'm not due for retinal photography, tests on my feet or any of the myriad of blood tests used in the early detection of risks and complications. I had all those things done just a few short months ago.

I did get my A1c, of course.

It was 6.6.

'Really?' was my first thought.

I was honestly, totally shocked. I've seen a whole bunch of wayward numbers lately, and, at long last, fewer hypos. I guess I was expecting those two things to combine and push the result up a little higher than it was. It was good to learn, I guess, that things might have been going better than I thought.

But other than that, what else is there to have got out of today? Am I missing something about professional diabetes care that should be totally obvious?

It Must Be... A Meme

I'm just all out of time and inspiration tonight, but I'm not giving up on NaBloPoMo this close to the finish line. So...

1.  Were you named after anyone?  No. I'm pretty sure there has never been another Caroline in my family

2. When was the last time you cried? Yesterday. I was overworked, overtired, overstressed and overwhelmed. And I was sick. I think those are reason enough!

3. Do you like your handwriting? Yes, when I am writing properly. If I'm taking rushed notes, it looks appallingly messy to me. But people still compliment me on it. Maybe it is just because it doesn't look 'normal' to me when it's not neat. Or maybe it is because I'm a perfectionist! We often joke at work that the only class I failed at dental school was the handwriting one, as dentists, along with doctors, notoriously have very bad handwriting.

4. What is your favorite lunch meat? Real chicken breast. It has to be real. Not processed.

5. Do you have kids?  Nope.

6. If you were another person, would you be friends with you? Oh yeah! I like me!

7. Do you use sarcasm a lot?  Only when there is a letter 'y' in the day!

8. Do you still have your tonsils? Certainly do.

9. Would you bungee jump?  No. No way. Definitely not. The thought of my achilles tendon snapping again as I jumped is one thing that puts me off!

10. What is your favorite cereal? LUCKY CHARMS! Green milk and all. Or Cinnamon Toast Crunch. Neither is available in the UK (although we do have Cinnamon Grahams, a very poor impression). Of UK cereals, probably Crunchy Nut Corn Flakes.

11.  Do you untie your shoes when you take them off?  Not if I don't have to. Getting Timberland boots off without unlacing is tricky. Failing to unlace my shoes in the presence of either of my parents will immediately bring out their parent-of-a-small-child side!

12. Do you think you are strong? Physically, no. Emotionally I'd say so.

13. What is your favorite ice cream?  Anything, as long as it's ice cream! Seriously love the stuff. If I had to choose, possibly Ben and Jerry's Phish Food, or a proper Pistachio flavour.

14. What is the first thing you notice about people?  Teeth! What can I say?!

15. Red or Pink? Pink

16. What is your least favorite thing about yourself?  My occasional lack of self confidence. And my ability to procrastinate and fail to just get things done.

17. Who do you miss the most?  Rob, during the week when we're apart.
 

18. What color pants and shoes are you wearing?  Blue jeans, no shoes. My feet are curled up under me on the sofa.

20. What was the last thing you ate?  A cheese and ham toastie!

21. What are you listening to right now?  The distant sound of traffic, the sound of a boat on the river and the hum of the refrigerator. It is unusual, but I don't have any music on.

22.  If you were a crayon, what color would you be?  I'd be one of those magic rainbow crayons with multiple colours.

23. Favorite smells?  Freshly baked bread, freshly mown grass (hayfever be damned), the sea.

24. Who was the last person you talked to on the phone?  Rob.

25. Favorite sports to watch?  International rugby.

26. Hair color? Dark brown.

27. Eye color?  Dark brown.

28 .Do you wear contacts? Yes.

29. Favorite food?  Erm.. chocolate (shhh!)

30. Scary Movies or Happy Endings?  Love the scaries. 28 Days Later ranks as one of my all time favourite films.

31. Last movie you watched?  30 Days of Night at the cinema two weeks ago.

32 What color shirt are you wearing?  White T-Shirt, purple sweater

33. Summer or winter?  Winter.

34. Hugs or kisses?  Hugs (And of the Hershey's variety too. The Hugs are way nicer than the original Kisses.)

35. Favorite dessert? Chocolate Fudge Cake. Or anything with proper custard. Like Syrup Sponge. (Diabetes? What's that then?!)

36. What is on your mousepad? Mousepad? I don't own one. I use the trackpad on my MacBook mostly, but even when I do use a mouse I don't ever use a mousepad!

37. What did you watch on TV last night?  Nothing. Was busy with other things.

38. Favorite sound?  Waves on the seashore.

39. Rolling Stones or Beatles?  Beatles. No question.

40. What is the farthest you have been from home? Either California or the Caribbean island of Grenada. Not sure which is actually further.

41. Do you have a special talent?  Being me?

Sensible vs Stupid

Sensible Caro: Stayed comfortably asleep in bed this morning.

Stupid Caro: Got up and went out in the cold.

Sensible Caro: Drank cups of tea and watched daytime TV without worrying about anything else.

Stupid Caro: Went to work, because there was no one else to cover and she was worried about that.

Sensible Caro: Chilled out and relaxed.

Stupid Caro: Snapped at everyone and burst into tears because she felt terrible and couldn't cope.

Sensible Caro: Managed to keep her blood sugars somewhat in range.

Stupid Caro: Saw every number from the sky to the floor.

Sensible Caro: Feels much better tonight.

Stupid Caro: Feels somewhat better, but now realises she did herself no favours.

Guess which one is the real me?

I really have no idea what I was thinking when I got out of bed this morning. Perhaps it was simply that I wasn't thinking. Trying to work? Who was I trying to kid, more like!

It would be easy for me to blame it all on the responsibility of my job and not wanting to let people down, but sometimes I'm just my own worst enemy. After everyone so generously sent me their best yesterday, I go and pull my worst on myself!

I am feeling a bit better though, and my eyes in particular are much less swollen and sore. Now, if I could just shake off this damn cough... cough... cough.... cough

Real People Sick

I think it was Allison who coined the phrase "Real People Sick", meaning illness that people without diabetes get. *EDIT* The term actually comes from Kerri. See here for more. 

I'm "Real People Sick".

This is coming to you from my bed (thank you wireless network) where I've been tucked up for the last hour and a half or so. I've got a throbbing headache, fever, runny nose, aching neck and a nasty, hacking cough that makes me feel as though I'm coughing up knives. To cap it all, my eyes won't stop streaming and so swollen that I look as though I've been crying for a week.

So I've beaten a hasty retreat to bed (at 7.45pm!). I've taken paracetamol for the fever, and something a little stronger for my headache. I've got a two litre bottle of water, straight from the fridge, a bumper box of tissues and back-to-back re-runs of Friends on TV.

But that is where "Real People Sick" ends. Because even when I'm "real" sick, I'm still chronic illness sick too.

My blood sugars are behaving like... well the point is they're not behaving. Amongst all those 'ordinary' supplies, I've got my meter for frequent testing and juice for bounce-back lows.

And then there is the reaction to another number. The temperature number. When I checked my temperature earlier and saw 39.2 (that's over 102 in Fahrenheit) blinking back at me, my first thought was that all the shaking I'm doing might not be shivering after all. For someone with Addison's disease, it's definitely time to crack out the extra steroids.

And later on they'll do their own number on my blood sugars.

I feel truly awful.

I want to crawl in to a hole for a very long time. But unfortunately I need to keep checking my blood sugar every couple of hours.

So much for "Real People Sick"!

Dans Le Noir?

Literally: In the black.

I'm talking the kind of blackness that makes you feel like you're swimming in ink. The kind of impenetrable darkness where you cannot see your own hand in front of your face.

That is how we ate our dinner last night, at the Dans Le Noir? restaurant here in London.

The idea of eating in a completely pitch dark room, guided and served by blind staff, is a novel one, at least to me. And it proved to be an experience on so many levels.

The evening began with our group forming a chain, locking on to each others' shoulders as we were led by our waiter, Graham, into the darkness. One by one Graham led us to our seats and, in a complete reversal of preconceived roles, we became totally dependent upon him.

We were asked as we entered the dark room to keep our voices quiet and warned, quite accurately, that our sense of hearing would become more acute. Deprived of vision, we quickly came to rely on our other senses. Unable to simply glance down the table to see who was seated where, we had to use our voices to map out a plan of the table. I quickly developed a need to touch anything and everything on the table, to fill in for the missing sensory feedback from my eyes.

We all learned a lot sitting there in the dark. We learned how to do familiar things, that we  normally take for granted, without visual feedback, such as pouring wine into a glass without spilling it. Placing food in our mouths without being able to see what it was. In this respect, it struck me that we had one important advantage over a truly blind person. We were all blinded. Many of us resorted to picking our food apart wit our fingers and putting it in our mouths, perhaps being quite messy along the way in what might normally be deemed a socially unacceptable manner. But then, no one could see us, so it was easy for us not to let it matter.

We learned about communication and the role that sight plays. In the darkness you cannot read visual clues or body language, but this actually makes it easier to be a little more spontaneous in what you say and makes behaviour more free without the pressure of conforming to accepted standards.

We learned, too, about taste. You do not order specific dishes at Dans Le Noir? Instead, you select a 'surprise' menu, with a choice of meat, fish or both or a vegetarian option. It is only afterwards that you see the actual content of your dishes. Not knowing what food is in front of you forces you to concentrate on taste and texture and removes preconceived ideas about whether you will like a particular dish based on how it appears or what it is called. Without sight, we weren't very accurate at identifying our food. I was completely stumped by an item on my plate that felt like a bird's nest and tasted fired - it turned out to be crispy noodles. Of those who selected the menu containing Guinea Fowl, none identified it correctly. Rob ate cold Parma ham that he would normally have not given a second glance to.

Of course the evening presented particular challenges to me. All objects that can produce light, such as mobile phones, are banned from the dark room. Whether to take or leave my little Freestyle meter was a difficult decision. I actually ended up leaving it in the outside locker, knowing I could get to it at any time if I needed to. My pump, on the other hand, I kept on. But I  then found myself faced with a very difficult problem. I did actually hit the backlight button at one point, ready to perform the preconditioned reflex of bolusing before my food. I left the light on for about 3 seconds, instantly mortified at having introduced even a tiny bit of light in to this experience, and suddenly realsising that without being able to see my food, there was no way at all for me to assess the carbohydrate content.

Looking back, I probably could have arranged with staff to view my meal beforehand, but I'm glad I didn't. It would have ruined somewhat the experience that I've already outlined. I'd had a good reading going in to the meal and so elected to bolus immediately after leaving the dark room with what is a fairly average amount for a restaurant meal for me. Something worked, because by the time we got home, my blood sugar was 4.0 (72).

I learned though, how vital a tool sight is in the management of diabetes. We use it each time we test our blood glucose, each time we bolus and, most difficult of all to find a replacement method for, we use it to count carbohydrates.

I truly discovered the irony of diabetic vision-loss.

And perhaps this principle was the biggest part of the night. That we all learned things about ourselves. Each of us had fears to face in that room. Some were claustrophobic, simply afraid of the darkness. Some had a fear of eating food they could not see.

For me, it was like facing my fear of blindness head-on.

And it was scary.

For several minutes all I could think was that this was what it would be like to have that ultimate fear realised. And for several minutes it seemed overwhelming. I wanted to shout for Graham and have him take me back outside to the light. But then it hit me that if this were for real, I wouldn't have that option. There would be no returning to the light. Rather than freak me out more, that thought made me more determined to stay, to work through it. That was the point at which my hands went in to overdrive, seeking out the missing feedback. Learning. Discovering.

By the end of the evening I realised that yes, being totally blind, living in a world devoid of colour and faces would be awful. But we still had good food and wine. We still had voices and laughter. We found new ways of doing familiar old tasks. I felt safe with the support of others - Graham our guide, and Rob sitting to my left, holding my hand and reassuring me it would be ok.

I learned that if it ever happens, I could find a way to cope. And my little daily worry knot loosened just a little.

No Time! No Time!

I have absolutely zero time to make a proper post today, although I think I've done pretty well to make it to the 24th without making this excuse before!

Just off out to meet friends and enjoy a birthday celebration (not mine!). My lip is healing well and it is a wonder what make-up can do for a girl!

Thanks to those who have commented and emailed. There are several replies owed and I promise they will be coming.

Have a great... whatever time of day it is for you right now!

Friday 'Fings

A couple of things to share on this sunny Friday. Except they're 'fings, rather than things. This is for more than alliteration's sake. I went to high school in a town where a large proportion of the population were unable to pronounce the 'th' sound, using instead a 'ff' sound. Today I sound a little like those people.

Which brings me to:

Fing One

Early yesterday morning I was somewhat abruptly reminded of the perils of hypoglycaemia, especially when you live on your own. The hunger might drive you to the insensible option of eating your own lips. Or more likely your jelly legs might forget how to do the simple one-in-front-of-the-other walking thing (I mean, come on legs, how hard is that?) and put you splat on the floor. Taking a bite of your lips on the way down.

Which is roughly what happened to me.

It appears I smacked my chin on the hard edge of the bed frame and sent one of my top front  teeth through my bottom lip.

Being a dentist is a blessing and a curse if you manage this kind of injury. A blessing in that I was able to simply go to work and get looked after and stitched up by my wonderful colleagues. Who truly were wonderful, even down to pointing out that I was probably shaking like a leaf because  this was a pretty nasty shock and I'd completely forgotten to kick up my steroids.  I really need other people around when my brain flakes out! I've also been able to cheat and use dental anaesthetics for relief at times when the pain has got really bad during the last 30 hours or so.

Being a dentist with this kind of injury is curse because it sparks obvious jokes about being on the receiving end and getting my comeuppance. Oh yes, the patients really do find it funny. (Not that I ended up doing much work yesterday.)

I won't post pictures, because even I  think I look hideous, but suffice it to say that I have some lovely bruising and look a little like I've over-done some lip filler treatments! Please keep my front tooth in your thoughts. It has endured this kind of bashing before and I fear this may be the time it gives up and dies. Come on little tooth!

Fing Two

As if I wasn't unintelligible enough speaking through my fish lips, I appear to have lost my voice this morning. Damn cold  that is doing the rounds. A few hot lemon and honey drinks (through a straw of course) have picked it up a bit, but I definitely sound as though I have a frog resident in my throat.

A frog talking through a fish's mouth. Now there is a thought!

Fing Three

On a more positive note, I was very honoured this week to receive notification that I've been awarded a 'Health Leader Award' by the Irritable Bowel Syndrome Treatment website. These awards recognise sites that are "squarely on the side of the patient." Since that is exactly where I aim to be, I'm very proud to been given this award.

There is a list of other winners over on the site, which are worth checking out.

Fing Four

This article from the BBC came to my attention yesterday.

To say that it makes me mad is an understatement. I've not looked in to it further, and it could be that my own Primary Care Trust is one of those still in deficit, but it makes me angry to hear of so much money essentially going to waste when I'm still being denied any coverage for the CGM technology that has changed my life and allowed me to keep working (for the NHS, oh the irony!).

And it isn't just about me either. Up and down the country patients are having test strips rationed and told that, although they are good candidates, they'll have to go on waiting lists before they can commence pump therapy (actually illegal regardless of resources, but that is a story for a different day). All the while there is money burning a hole in the Treasury's pocket. All this anger without even touching on even bigger issues outside of diabetes care.

I couldn't agree more with John Appleby, who, in the article, states:

"A surplus of that size [is] not necessarily a healthy sign, as the money could have been spent on services. If the NHS does end up with a significant underspend at the end of the financial year, that will be a real loss to patients".

Too true.

Have a great Friday.

 

I Will Still Give Thanks

If you've read my blog for a while, it will surely come as no surprise that I'm a bit of an Americanophile.

It might be because the first time I ever left the UK, as a three year old, the US was our destination. It might be because my Dad is a self confessed Americanophile too. It could be more banal - the influence of TV shows, movies and indeed the internet.

My brother has been making a life for himself in the San Francisco Bay Area for the last three years, and I have no doubt that if it weren't so difficult for me to convert my UK qualifications in to a license to practice in California, or pretty much anywhere in the US, (for difficult read lots of exams and thousands of dollars, nevermind the normal immigration procedures) and if I didn't have very positive reasons to stay right here in the UK, I'd move in a heartbeat.

But that is not the way that things are meant to be, and I'm really alright with that too.

If I could choose just one aspect of American life to import in to the UK though, Thanksgiving would surely be high up on the list.

Sure, it has something to do with the fact that we currently have no public holidays between the end of August and Christmas. The months stretch out long and depressing with ever darkening days and no respite. In addition, the fact that there is really nothing much to celebrate in the autumn months (we've already established that Halloween isn't such a big thing here) means there is no buffer and the commercial powers that be see fit to start Christmas at the end of September.

It's more than that though.

The spirit of the holiday is impossible to miss even just by reading around blogs today. The idea of a holiday dedicated simply to being with the ones that you love, in person or in spirit, and giving thanks has got to be a good thing. Much as I might wish that Christmas would fulfill the same functions, it doesn't.  As Rachel pointed out to me yesterday, Christmas is a very stressful holiday, not to mention a commercial goldmine.

Perhaps the thing to remember is that I don't actually need the public holiday to follow the sentiment and give thanks and, with good timing, that was shown to me today.

I may have had to work today, but I was reminded very starkly this morning of how, despite that fact that working in such a close knit group in a stressful environment causes us to get stressed out with one another frequently, I am blessed to work with a wonderful group of people who will always be there when they are most needed. For that I am very thankful.

I also have a wonderful family, who keep me in mind always, friends I can rely on and a partner who shows me every day how very much he loves me even though we are so often far apart.

I'm also thankful for the community that I am a part of here. The connections I have made with people from across oceans who I have never met in person, yet understand intimately what it is often like to be me. This is a recurrent theme this month.

I hope everyone in the US has a wonderful Thanksgiving holiday. I hope that everyone else is able to remember that we don't need the holiday to observe the sentiment.

Running on Empty

At 8am this morning I had a choice:

a) get up now and refill my reservoir/change my infusion set, or

b) roll over and grab five more minutes sleep.

I chose b.

(Five minutes in fact turned to over thirty and a mad panic to get ready and make it to work for 10am ensued.)

At 8am this morning I had 3.2 units remaining in my insulin pump. Not anywhere near enough to get me through the day, but I made my lazy choice based on the 10-15 'hidden' units at the end of the reservoir. Minimed pumps never show they are there, but I know they are.

And 13-18 units was plenty of insulin to last until this evening.

Or it would have been, had several of us not decided to head out after work for a Chinese meal.

Mmmm... Chinese.

Mmmm... big bolus.

Sitting in the restaurant in Greenwich I contemplated my empty reservoir and the plate of noodles and chicken that I'd just ordered.

I knew what had to be done.

I am very lucky to have work colleagues who don't bat an eyelid when I pull out insulin,  a reservoir and infusion set and proceed to change out the entire thing right there at the table, without even dropping a beat from the conversation.

I know that there are many people who would not do it that way. I know that there are many people who would actually criticise me for doing something so medical in public.

This is the way I see it: I was running on empty. If your car runs out of fuel, you fill it up. Or, a better analogy, if you get hungry, you eat to fill yourself up. To me, insulin in my pump is no different. It was a necessity right then, so that I could go on with my evening in the way that most people take for granted. None of my immediate dining companions objected, and nobody else in the restaurant had any cause to even look at what I was doing. And yes, it was clean and I had already washed my hands.

A girl's gotta do what a girl's gotta do and filling up her insulin pump and changing her infusion set is an important part of this girl's life!

Seven from me

I've been tagged by Pearlsa and also by Vivian to share my seven random facts.

1.     I have an obsession with giraffes. Seriously. I think they are incredibly amazing animals, so elegant and so well adapted, but yet so... daft. I recently saw a giraffe drinking at London Zoo and the memory of its sloppy drinking never fails to make me smile. I have dozens of cuddly giraffes and other giraffe related objects too.

2.    I cover my ears when I'm scared. It doesn't matter what the source of my fear is, it may be entirely visual, but I have to cover my ears to feel safe. I also sleep with my ears covered up, even in summer (although I do leave the rest of me uncovered when it is hot, I'm not completely mad!) 

3.     I can't say the word anemone. I just can't do it. Countless people have tried to teach me, but it never fails to make me sound as if I'm completely drunk!

4.    I only eat cooked cheese. This is partly because I don't like the texture of almost any cheese when it's not cooked. I much prefer the flavour reduced to a stringy, homogeneous blob first!

5.    I grew up in a village where all the houses look the same. Obviously not exactly the same, but each row of houses contained identical houses, each small neighbourhood had houses of very similar style and the entire village had a united look. I think it is this that has influenced my life long desire for uniformity and things that match. All the furniture in a give room of my house has to be in the same type of wood, for example.

6.    I regularly read things backwards. I don't mean prose, or when I 'm reading for an extended      time at normal pace, but when I see a title, or an individual word, or a sign or a brand name, I automatically reverse it in my mind. So Coke automatically becomes ekoc and diabetes is setebaid. I do occasioanlly do it with entire sentences too. I have no idea when I started doing this as I don't remember ever not doing it.

7.   Rob and I make  kissing noises down the phone to one another in lieu of the real thing. He won't, unsurprisingly, do it if anyone else is in the room on his end of the phone, but it was his suggestion that I include this as a random fact!

I'm pretty sure everyone has been tagged, but if you haven't and you want to be, you're it.

The Road Taken

This month marks ten years since my interviews for a place at dental school. It was a dream I cherished and worked towards. It was what I really, really wanted to do. Although I had a very clear idea of where I wanted to end up, I applied to five schools, to give me the best chance of getting a place somewhere. Because anywhere doing dentistry was better than nowhere at all.

My first interview was in Birmingham, and I was offered a place. The second interview that came up was in London - where I wanted to be.

I remember the day clearly, from getting on the train to ending up in a McDonalds, the closest place to hand, drinking regular coke because my blood sugar was low but I was too nervous to eat anything, including glucose tablets. I remember meeting my brother, already a student in London, afterward. We went up to Regent Street, where the Christmas lights were in full blaze and I remember thinking how this was the city I wanted to call home. I didn't want to be a faceless stranger in the crowd, I wanted to be a Londoner.

Two weeks later, a frosty morning in early December, I was woken up by my parents waving a letter bearing the university stamp. I didn't waste time in considering whether the envelope was thick enough to contain an offer. Without even getting out of bed, I tore it open.

And that was the first moment that shaped my future.

The offer of a place at my preferred school meant the interview trail was over. The grade offers I might get elsewhere could not reasonably be expected to be any lower, so I withdrew my outstanding applications and accepted my London offer, examination results pending.

The next decisive moment in shaping my future came on August 20th 1998, the day I received my Advanced Level Exam results. For the first time in my over-achieving life I didn't care about the actual grades. All I cared about was meeting the grade requirements set out for my dental school place.

My dad summed it up nicely six years later when he recalled how I'd phoned him and, rather than telling him my grades, I'd simply said "I'm going to be a dentist."

In retrospect, it's a poignant statement. I didn't have any idea on that day how hard it would actually be to get there. I had no reason to. I'd never struggled academically and although I'd been ill, it had somehow never got in the way of me achieving what I wanted to.

Now, ten years on, I can't help but reflect on the path I chose. The road I took.

Not dentistry.

I love dentistry. It is a job that you can't do well, if at all, if you don't love it. It's too intense, too involved. And I never did really struggle, either academically or clinically, as a dental student either. I emerged from six years of university with an enormous debt, and two degrees. I don't regret any of that.

What I wonder about is how life would have turned out if I'd not chosen London.

Don't read this wrong. I also love London. The seventeen year old on Regent Street is still alive and well inside me. I adore this city, with all its history, its winding streets, its icons of architecture and transport. I'm so glad to have called this place home for so many years, and enjoyed all the opportunities this nation's capital has to offer.

But this month also marks eight years since my life changed.

Being diagnosed with epilepsy had a profound effect on my life. Frequent seizures bring real life to a stand still. I became afraid to go out. My seizures brought out the very worst in some other people, whose lack of understanding and treatment of me drove me deep in to depression. The cruelty I endured is difficult to think about. Impossible to put in to words.

But most of all, I could no longer be sure of becoming a dentist.

I'd taken it for granted, since the moment I opened the brown envelope containing my exam results in my high school car park in August 1998. The thought of not achieving my dream, of failure, was devastating.

You know the ending to this story. You know that I did make it through.

It's looking back on the struggle, all the extra effort, the cruel treatment I received, that makes me reflect on the path I took.

If I'd gone to study dentistry somewhere else, what might have been? Would I have avoided catching meningitis, and so avoided developing epilepsy? I know I can't answer that. No one can. But since, unlike with diabetes, I can trace my diagnosis back down a path of specific turning points, it's natural to question it.

Epilepsy is a tiny part of me now. It remains engraved on to my medical ID bracelet. I still don't hold a driving license.

I still meet people who question. Critcise. Discriminate.

The stigma is still firmly attached.

What if? I can't help but wonder...

 

Diabetes 365

I've been looking at the Diabetes 365 photos from other bloggers, such as Beth, who started the project, Bernard, who started the flickr group, Amylia, Jillian, Sara, Penny and all the others in the flickr pool.

And I've been inspired.

Initially I was going to wait to join the project until the madness of NaNoWriMo (currently at 21, 196 word) and NaBloPoMo.

But then I took this picture.

And I wanted it to be my first.

There is also a kind of neatness to starting and ending 365 on World Diabetes Day.

Speaking of neatness - I've been shamefully bad at using Flickr during the course of the last year. It started when I came back from two weeks in the Caribbean in January with far too many photos to edit and upload. Much like logging diabetes data, the longer you stay away from Flickring, the harder it is to go back! Especially if you're a little anal, like me, about having everything in the right order! I've actually made a start tonight on those Caribbean photos, but anyone looking at my    photostream will find it in something of a disorganised state!

I promise it's a work in progress

So to add to NaNoWriMo and NaBloPoMo we have Diabetes 365 and a major Flickr photostream update!

It'll be worthwhile in the long run.

And I truly believe the Diabetes 365 project could also be very worthwhile, in raising awareness of what it is like to live with diabetes every day of the year.    

Day Off

Dearest diabetes,

Thank you very much. You were most kind today.

When I sat down to lunch, with around 40 members of my extended family, my blood sugar was a healthy 5.5 (99). You must have known, diabetes, that I was so busy with conversation that I forgot to feed you your insulin, forgot to pay any attention to you. I'm sorry for that. You know that I am usually devoted to you, my constant companion and I didn't do it intentionally. I really truly cannot tell you how much I appreciated you disappearing for a while. When, horror struck, I realised my neglect, my blood sugar was at a nice 6.8 (122).

Don't worry about my silly liver, telling you about how you missed an opportunity to send my blood glucose sky high together. You actually did great work today, no matter what he says.

In fact, I've been wondering if you would mind terribly, awfully much taking next Saturday off too? And the one after that? Go on, honestly. Sure, I may miss you and your constant interruptions a little, but if you want to throw in the odd weekday as well, I really won't mind.  I think I may be ready to get by without you.

In fact, I'm hereby increasing your vacation allowance to 365 days a year. No, really. I think you've earned it. Do go on and take them all.

Please?

Ever yours,

Caro

A Long Week

This week feels as though it has been going on for at least a month.

It may be the double whammy of an important personal anniversary on Monday with World Diabetes Day on Wednesday.

It may be because my blood sugars have been carrying on a ridiculous dance.

It may be down to a professionally draining week.

I've sedated a number of patients for treatment this week. I've discussed before about how routine the delivery of injections in patients' mouths has become to me. The conscious sedation technique, however, has more parallels to pumping insulin than injecting it. It involves placing a cannula in to a vein through which a drug is delivered to relax and sedate the patient.

The cannulas themselves are similar to insulin infusion sets in that they have a guide insertion needle and a teflon tube. I'm used to sticking this kind of equipment into my body every three days, but putting it through the skin of someone else's arm or hand, trying my best to hit the vein first time and spare them a repeat performance, is something that I still find slightly tough, no matter how many times I do it. And positioning something in a vein is far harder than just positioning it sub-cutaneously.

I also know what it feels like to be on the receiving end.

Despite a good first time success rate this week, and only one "Oh eek, third time lucky" moment, these procedures still have the ability to take far more out of me than my more routine dentistry.

To finish up the week, I was faced with a six year old child who'd fallen at school and cleanly knocked out his front tooth. He seemed quite happy about it, proudly showing me his gap. Since I spend a considerable amount of time each week taking teeth out, putting them back in is a novel variation. Sadly, the young patient didn't seem that impressed with my efforts, bursting in to howls after we reinserted his tooth and restored his cheeky grin.

I was still happy to know that I may have made a real difference to that kid, even if he doesn't know it yet.

It was a welcome end to a very long week.

Adding Insult to Injury

I came to this blog entry on Tu Diabetes from the Diabetes Daily Headlines.

The question posed is a good one. It inspired a meander back through all the physiology, pathology and general medicine that is stored up in my brain from six years of university study, which in turn inspired this post.

And I realised once again that our bodies don't half like to add insult to injury after developing us diabetes.

This is how it works:

The liver doesn't sense blood glucose levels. Instead, it relies on knowing the level of insulin in the blood. The blood insulin levels in a non-diabetic only become low during periods of fasting. When no food is arriving in the stomach, very little insulin is being released. The liver responds by saying:

"Oooh look, there's no food around. Cells all over the body will be starving! I had better release some stored glucose and make some new glucose and dump it all in to the blood." Cue excited hand flapping and dancing.

Okay, that isn't exactly what happens, but you get the idea. All is well and good in the non-diabetic. The cells get their food. Everyone is happy.

And conversely, when the insulin level is high, the liver gets busy hoovering up all the glucose and storing it away for the next time it needs to release it.

Those of us with diabetes, however, frequently find ourselves in a paradoxical situation.

Diabetes works out fine when a high insulin level following a bolus corresponds with plenty of glucose in the blood to store away. The diabetic holy grail is matching every bolus perfectly with the amount of glucose available.

It rarely happens. The pancreas of a non-diabetic doesn't look at the food sitting in the stomach and go "Ooooh, I think that is about 30 carbs, here have a squirt of insulin <this big>", which is a representation of the way we bolus. Insulin release is much more sophisticated and, because it goes directly in to the portal circulation, the insulin acts very rapidly before being used up. This not only means that the correct amount is always delivered, but also means that insulin doesn't hang around for 2-3 hours to have a effect in the middle of a gym workout.

Our squirty bolus however, wandering slowly as it does through the jungle of the sub-cutaneous landscape, can. We may actually have too much insulin, which drives our blood glucose level low. The liver continues to respond to the insulin level and thus not only doesn't produce any glucose for us, but actually continues to take more glucose out of the blood stream, dropping the blood sugar level even lower.

Alternatively, we may have too little insulin. We may even forget to bolus entirely. In that situation the glucose from digested food builds up in the blood and then the body really adds insult to injury. The liver responds to the low insulin level and says the body must be starving. It releases stored glucose and also manufactures more glucose (gluconeogenesis) pushing the blood glucose level even higher. Like that is what we need.

The bottom line: in diabetes the liver always does the opposite of what we need. And nobody is happy.

Of course, with high blood sugar, the pancreas of a person with type 1 diabetes will never do what it needs to and spit out insulin. Which is why untreated type 1 is fatal.

The good news?

So long as you haven't had your pancreas removed, most people with diabetes can still produce glucagon. The stimulus for glucagon release is the low blood glucose level itself, so glucagon can come to the rescue even in people with diabetes.

The catch?

Well actually, there are two. Firstly the absolute level of available glucagon is not important - the ratio of insulin to glucagon is. So if you have a lot of insulin in your system, glucagon release may still be ineffectual. Secondly I've heard of studies that have shown that the glucagon response tends to wane and become less predictable after several years of type 1.

And all of that, my friends, is just another reason why diabetes really does suck.

Colours of Diabetes on World Diabetes Day

Red: The colour of the blood drawn from fingertips multiple times a day, the best way we have of finding out what a non-diabetic body takes for granted - our blood glucose levels.

White: The colour of glucose that can turn from foe to friend faster than you can say hypoglycaemia.

Purple: The colour of the little pad on a ketone test strip when blood sugars rage out of our control.

Infinite: The colour of the faces of the millions of people worldwide struggling with diabetes day in and day out. The people for whom diabetes is not just one day in November, but every day.

Blue: The colour that unites us all today, on World Diabetes Day.

The London Eye, appearing like a giant version of the Unite for Diabetes logo on the London skyline. (The image is a little blurry as I didn't have a tripod)

Beat Diabetes Button courtesy of  Beth. My buttons arrived, very appropriately, today on World Diabetes Day. Thank you Beth! 

Unlucky 13

I'm not a particularly superstitious person.

Actually, I'm not superstitious at all. To me, a black cat is just a black cat and magpies are just magpies. I'll happily cut my nails, and my hair, when I want and I'll walk over any number of drains in the street. I don't walk under ladders, but that is common sense, not superstition!

Thirteen?

Just a number.

Thirteenth of the month?

Just a day...

Or so I thought. But whether it was the date or something else entirely, the blood sugar monsters have been out to get me today.

It started off badly. At around a quarter to two this morning, I woke up to find my pump and I had parted company. It had made a bid for freedom out of the far side of the bed leaving its tail of tubing trailing in its wake, infusion set still attached, ripped clean from my body.

There was a very big part of me that wanted to leave it there. I wanted to stick two fingers up at it and say "You can't get one over on me. If you fancy a night sleeping on the floor, you've got it!"

The idea of rolling over and ignoring the problem entirely was given more consideration that it surely should have been.

But diabetes invades my every waking hour. I don't want it invading my sleep. I wanted to ignore it so badly.

Of course I didn't. I didn't even really pursue a mental calculation of how many hours until I would be getting up and whether I could get by on a interim shot of Humalog. Instead, I forced myself out from under my warm duvet into the cold of the bedroom to collect a new infusion set. Given that I only had around 20 units left in the reservoir, I grabbed one of those as well and proceeded to replace the entire shebang.

By late this afternoon, I was back wishing I'd left the pump where it was. The infusion set having been placed through a blur of sleep, the adhesive had caught up a little and it has irritated and scratched at my skin all day. And as for my blood sugars, they've soared and crashed from 2 to 20 and back again.

I'm frustrated.

I want to blame my pump because it is a tangible object. I love my pump, but unlike my other love, this relationship is tinged with hatred and resentment. I wish I didn't rely so totally on it. I wish I had a fully functioning body that didn't need it.

That's the bottom line. It's diabetes that I'm frustrated with. It's diabetes that I want to toss out of my bed.

But I can't.

So I'll resign myself to the fact that today was an unlucky day; Tomorrow is a new one.

Going The Distance

For the last year, every other Friday, or perhaps every third Friday, I've rushed from work to Euston station to board the overcrowded Virgin Trains service to Liverpool, approximately 200 miles north west of London. And each corresponding Sunday, I've done the journey in reverse. In short, I've been a weekend commuter.

I hate the journey. The rush to make it to the station on time, the fight to secure a seat, the terrible food and lack of WiFi, the delays and the overpricing.

I do it because I'm in love with the man who meets me at Liverpool Lime Street Station.

It was a year ago today that we took our first, tentative steps on this journey. It's been a winding road of discovery, with highs  and lows along the way. But when I look back, I can hardly remember where I started out from .

Rob, I love you.

Facing life, diabetes and other challenges, with you is infinitely easier than facing them without. With you, the world seems brighter in colour and richer in texture. You make me feel beautiful, special and adored. Until I found you, I never knew what was missing from my life. Now, I can't imagine being without you.

But I am. Every weekday. And although the distance, and saying goodbye every Sunday night, threaten to break my heart, you also make me strong enough to handle it until we're both in a position to make a change.

There so many moments from the last twelve months that stand out. The fun times: The week we spent in San Francisco. The restaurant meals. You squeezing me tight when I was afraid at the cinema. Indulging my passion for giraffes and taking me to see them twice. The things your friends said you'd said about me. The not so good times that you somehow made good: One of the first nights we ever spent together, you got up in the middle of the night to find me sugar. The time you sprinted down the road to find cranberry juice for me. The time you held my hair back as I was throwing up.

I remember the time I couldn't bear to say goodbye, so I got on a train and came all the way back to Liverpool with you, because I didn't have to work the following day.

I remember the moment you told me that you loved me.

I remember realising that I already knew, because you'd already shown me.

Thank you, Rob, for being there for me, even when we're far apart. Even when I'm in a bad mood, stressed out or exhausted. Thank you for understanding. Thank you for going the distance with me and making this work.

Thank you too, for the twelve red roses you sent me today at work. Even though they arrived in front of a waiting room full of patients, I cried. They stood in my surgery all afternoon and I was proud to tell every patient, when they asked, that they were a gift from my boyfriend.

Because he loves me.

I love you too.

Ruined Lie-in

I was woken by R.

"You're going off, babe."

I could hear the screeching siren of a long ignored alarm on my Medtronic pump, muffled somewhat by the fact that it was buried underneath my stomach. Extricating it roughly and unwrapping the tubing from around my body, I glanced at the screen.

LOW 2.6 (45)

"I'm low" I mumbled. I reached across to get my testing kit, but it seemed to take a monumental effort. I let the black nylon case fall on to my chest, unopened.

"Babe."

No response.

"Babe, you were going to do a test." He digs me in the ribs. "Come on babe."

Several minutes later, the low confirmed, juice grabbed from the window sill and my blood glucose beginning the slow upward climb, R is drifting gently back to sleep.

"Seven thirty seven" I say, to no one in particular.

"Seven thirty seven?" mumbles R. "What's seven thirty seven?"

"Too early to be awake on a Sunday morning when we've got nothing in particular to do with the day" I respond. "Damn low blood sugar, ruining my lie in."

iHas iPhone

What can I say?

I'm weak. Very, very weak. But the prospect of replacing my battered 2-year-old-dinosaur-of-a-phone with the super shiny, brand-new-on-the-UK-market-yesterday iPhone was too much. I know I've got no patience and I know I'm like a child wanting the next new thing now. I've heard all the arguments about waiting for the larger capacity model, waiting for 3G and just waiting for a newer iteration where the kinks have been ironed out. But I still couldn't wait.

And to be honest, so far there aren't really any major kinks. The user interface is gorgeous, navigation very straightforward and the speed really doesn't seem that bad.

It was actually remarkably easy for R and I to get our hands on them too. Not only were there no queues this morning, but we were the only people in the shop buying them. Activation caused a couple of minor headaches, but I already have a contract with the UK provider, O2, and when it got to it my number was transferred across in seconds.

My only gripes are that I wish the portrait mode was available in all applications, particularly since this makes the keyboard easier to use. Not that the keyboard is any more difficult than a standard, tiny-keyed smartphone keyboard, mind you. A percentage battery indicator would be nice too, but since that really is all I can find to gripe about at present, Apple have definitely triumphed, at least in my eyes.

It's a masterpiece of design. I only wish the user interface on my pump, which now grates against my eyes in comparison, could be as beautiful.

It's definitely love!

Thank You For Giving Me Courage: D-Blog Day

It takes courage to take on diabetes.

I'm not talking about bravery. You don't have to be brave to stick needles into your skin when the choice is do or die. But you do have to find overwhelming strength from inside to choose to face the challenges it throws at you, to choose to take them on. To run full pelt after control, even when you don't quite attain it.

It is far, far easier to back down. Let it control you. Let it win.

Since the introduction of insulin, diabetes is no longer an automatic death sentence. But insulin is not a cure. Eighty-six years after the discovery of the wonder drug, millions of people worldwide still rely on it as life support. We live in a changed reality, a 'new-normal', attempting as best we can to control and reign in the beast that is diabetes.

I was three years old when I embraced my 'new-normal'. It's no longer 'new'. I don't remember how it feels to be any different. Despite more recent technology - a pump and continuous glucose monitor - I, and the countless other users of insulin, live with the constant threat of hypoglycaemia hitting when we least expect. When we're alone, unprepared or defenceless. It is a risk we run every day.

At the other end of the swing, we live too with the constant threat of hyperglycaemia, the very hallmark of diabetes. Kinked cannulas, spoiled insulin or simple 'user error' can lead swiftly to ketoacidosis. Coma. Death?

But diabetes doesn't have to kill you to take away your life. The consequences of poor control loom over us on a daily basis. Our eyes are threatened. Our kidneys are threatened. Even the feet that we walk on are threatened. My eyesight is essential to my career. I already know what it feels like to be unable to walk, to get around. That is not a life I want.

Diabetes takes a piece of my life every day. It takes a chunk of time in monitoring blood sugars, thinking about food and exercise, changing and maintaining pump supplies, ensuring I don't run out of my life supporting insulin.

Diabetes too, threatens my life in a more subtle way. A year ago , I was deep in the pit of a depression centered around diabetes and the overwhelming impact it has on my life, the sheer size of the task of facing it head on. I felt isolated and alone, the people close to me unable to truly understand what taking on diabetes means. I was afraid.

But I found courage again.

And I found it here. In the community of people who blog about their diabetes.

You are the people who understand. You monitor your blood sugars, think about food and exercise and maintain your supplies alongside me. We come from all walks of life and several corners of the world. But we all share this one thing. I wish nobody had to face this, but for as long as they do, I'm glad to face it alongside this group of people.

Thank you all for inspiring me on a daily basis and helping me to reach inside for the courage to carry on.

Just thank you.

(For more about D-Blog day, please stop by Gina's post. And if you have a blog and are affected by diabetes, please join us on D-Blog day and post the logo above.)

Christmas, Anytime of Year

Okay, okay, I'll admit it. It doesn't matter how many rants I have, via twitter  or otherwise, there is one place (or more accurately something like 48 bazillion places worldwide) where I would be quite happy for it to be Christmas every day. Every. Single. Day.

The place?

Inside a branch of Starbucks.

I know it's bad. I know its oh-so-NOT diabetes friendly, but so long as they have Gingerbread Lattes, Peppermint Mochas and Cranberry and Orange Muffins, they can hold Christmas every single day of the year.

Stepping off a bus outside Borough Station earlier on my way home from a hospital appointment, I couldn't help but notice the snow flakes etched on to the windows of a fairly recently opened branch on the other side of the street. The promise of Christmas inside acted like an invisible hand, guiding me to the crossing, over the road and in through the front door in a blast of cold air.

They had the red cups, the turkey feast panninis and a list of festive food and drink. I was like a kid at, well, Christmas! For a minute, it didn't matter that we're only just out of the first week of Novemeber. It was Christmas and all I cared about was what I could have. New for this year includes Creme Brulee Lattes and Skinny Cranberry and Orange Muffins - does that mean I can eat twice as many?

I know I shouldn't have, but with a healthy 5.3 (95) blood sugar and a morning spent at the hospital behind me, I convinced myself a treat was in order. Who am I kidding? I didn't really need any convincing.

One grande Gingerbread Latte (minus the whipped cream) and 3 units of insulin later, I'm cruising  in the 6's (110-125) range.

Yeah, secretly I can't wait for Christmas. Or at least, I can't wait for Starbucks' Christmas!

A Different Perspective

Almost two weeks ago, when I wrote this, I was thoroughly fed up of the invasion of test strips, pump caps and other diabetes paraphernalia into my life. I joked with a friend that if I ever commit  a crime, I'll make it easy for forensics to find DNA evidence to connect me to the scene: there will be a little trail of discarded test strips, each with a smudge of my blood on.

It does wear me down. Far more than having a pump attached to me. Even more than performing the tests that spawn the strips. I'm not sure why, but perhaps it is because I seem powerless to stop their spread - more powerless even than I am to control my blood sugars!

But today, walking along a busy London street, I glanced at the floor and noticed a discarded test strip. A few paces on and there was another. Then a third.

I knew they weren't mine. They weren't the brand that I use.

Seeing those discarded strips so close to where I spend I my working day, they were just another reminder that no matter how isolated living with diabetes may seem, there are many others close by tackling the same issues.

I'm lucky to have found all the people who blog about diabetes, and found others through various organisations and internet sites, but maybe my own used test strips may send a message of comfort for someone who is struggling with the burden alone.

A very different perspective indeed.

A Small Rant

Diet coke with added vitamins and antioxidants? WtF?

This makes me really mad. It's the kind of marketing crap that perpetuates the myth put about by the junk food industry that it's perfectly alright not to eat a properly balanced diet because you can get all the vitamins you need from a bottle of coloured, flavoured and carbonated water instead. As if it really amounts to the same thing!

Seeing this advert again, for probably the ninety-ninth time, on a full building height bill board on my way home tonight has caused this rant t re-surface after a couple of weeks of suppression.

Don't get me wrong, I'm fond of Diet Coke for all kinds of reasons. But I also recognise that it is a completely nutritionally worthless item and, as a dentist, that when drunk frequently the acid content will lead to erosion of tooth enamel and loss of tooth surface.

But if you're really too lazy to get a proper balance in your diet, you could just try swallowing a couple of multivitamins with a regular can of Diet Coke. It amounts to the same thing!

Working for a Cure

I was rushing around Greenwich in my lunch break weaving through the throngs of people, a mixture of lunchtime shoppers and leisurely tourists, desperate to get to the bank. Mixed in to the crowds are multiple charity collectors and those wielding surveys on clipboards. Greenwich is a prime spot for them, but I just don't have the time in my limited lunch break.

I'm approaching the pedestrian crossing opposite the bank when I make the mistake of letting one of them catch my eye. He's a brave soul, wearing a short sleeved T-shirt with no jacket on this cold autumn afternoon. As I take him in, my excuses ready on my lips, my eyes wander down and read the lettering on the shirt.

Diabetes UK.

In a instant the excuses in my mouth dry out and reform. From one honest explanation about my lack of time to another. This is a charity I already support.

'Good afternoon! Can I...' was his opening.

I shook my head. 'I'm sorry' I said 'But I'm already a life member anyway.'

'Oh. Right' I'd clearly taken the wind right out of his sales. 'Why's that then?' he said, clearly puzzled by this different excuse to move on, not stop, not participate.

It didn't occur to me, in the hurry that I was, to think this question rude or intrusive.

'Because I'm a life member of the diabetes club' I responded. 'I've had type 1 for over 20 years.'

His surprise was written all over his face, but then, as I made my apologies and headed for the bank he called after me 'Maybe it won't be forever. I'll keep working hard to get you a cure.'

I couldn't help but smile. Maybe he meant it literally. Maybe he has another job as a researcher in a laboratory somewhere. Even if he didn't, he really is playing a part in helping to find the cure.

We need as many people like him as we can get on board.

Sunday Working, Sunday Blogging

If I thought a 9-6 day yesterday was bad, imagine the prospect of 8.45-4.30 on a Sunday. I may occasionally blog on a Sunday, but I very rarely do anything work related. Dragging myself out of bed at an ungodly hour this morning, I was very glad that I'd modified my plans last night. Instead of the scheduled night out, I ended up heading back in to Greenwich with my practice principal (i.e. the dentist who actually owns the practice where I'm an associate) where we ate noodles before heading up to Blackheath to catch the fireworks, which were pretty cool.

The second half of our conscious sedation update today went pretty well. You'll be unsurprised to learn that my veins weren't used for any cannulation practice! I was the example of a difficult patient! The session also included good, accurate coverage of diabetes, which is always refreshing to hear.

And no, I still didn't make it back to the scene of the crime.

I've spent a chunk of this evening attacking my NaNoWriMo project. I'm more than 10% of the way there, at 5331 words. I'm a little behind where I should be at the end of day 4, but I'm still hanging in there and finding it an excellent motivation to get writing everyday.

Hope everyone had a great weekend!

Returning to the Scene of the Crime

Today's post, for NaBloPoMo, was always going to be a challenge to write, not only because I rarely, if ever, post on a Saturday, but also due to a hectic schedule. I had a full work-length day attending a course to update my knowledge and kills in sedating patients followed by plans that would take me directly out this evening with no time to stop to make much of a blog post.

What I wasn't really expecting was to hit on a subject I wanted to write about that in itself would present such a challenge. I've been mulling it over on my journey home, and can only hope I don't come across sounding ridiculously emo.

The course I was attending was based at Queen Mary's, University of London in Mile End. QMUL is the university attached to the Royal London Hospital at Whitechapel, in which I spent some time last year, about 10 minutes away.

It only struck me when I was waiting for a train on the northbound East London Line underground platform at Canada Water, that this is the first time I've used the East London Line since that day. It's not hard to let to let 16 months pass without using this particular line. It's currently the shortest on the network, serving just seven stops between Whitechapel and New Cross. But realising that this is the first time I've re-made that journey made my stomach lurch. I can't find the words to describe it properly. It made me catch my breath for a second. It just made me feel weird. I knew it was irrational a daft. After all, it's not like the day was going to have the same ending. But sometimes you just can't help the way you feel.

Arriving at Whitechapel station, I found myself hot footing it up the stairs to the District Line platforms above and jumping on a train to go one single stop eastbound to Stepney Green. True, I was several minutes closer to my destination, but it was beautiful, clear and sunny November morning, I was running a little early and the extra walk would have made a great start to the day.

Instead, I found myself in Whitechapel station, my heart pounding crazily in my chest and totally unable to accomplish the simple task of walking out through the ticket hall. I found myself physically unable to revisit of the scene crime, of which only a brief and sanitized version is really described here, the truth hidden and excused by my unconsciousness at the time.

I don't ever have much reason to visit Whitechapel these days and could quite probably go through the rest of my life avoiding it.

But sooner or later, I need to make myself go back there.  Life after all did go on, no matter how close it came to being a different story.

How much glucose can a glucose sensor sense?

It was Kerri that got me  thinking about woodchucks chucking wood. It was that which gave me the silly title for this post.

And it was a new comment on an old post that inspired the topic. Adil asked:

How long can the sensor actually last?

What surprised me most about this question is the fact that I've not answered it explicitly before. Or rather, that I've not answered it here. I've explained countless times to other folks, on mailing lists, in comments on other blogs and in person, how I prolong sensor life and what my sensor life cycle is, but a quick check of my archives confirms that while I've mentioned it briefly, I've never really explained it here.

So, first the "official answer'. The sensors are designed and approved to last three days. Now that is out of the way we can get in to the real world.

There are several reasons why three day use doesn't cut the mustard for me, not least of which is cost. I'm still not getting any financial assistance for the cost of sensors. I'm told there has been a recent price reduction although I can't confirm as I haven't ordered any sensors recently. I'm working through several "expired" ones I obtained from an acquaintance. [Shh, they are working fine. *knock knock* (on wood).] Previously the UK price was working out close to 50, yes fifty, pounds each. For those of you in the US that is a whopping US$100 per sensor. Every three days? Yeah, I don't think so either.

Admittedly if you have funding or insurance coverage, there isn't the financial incentive to prolong sensor life. But there is another very good reason.

Like a fine wine, sensor accuracy appears to improve with age.

This is purely anecdotal, but it is an observation shared by other CGM users, bloggers included.  I find the first three days of sensor data the least accurate of all and so pulling the sensor out every three days would be somewhat counter-productive.

So the unofficial answer to the question is a little along the lines of how long is a piece of string. Personally I use my sensors for two week stretches. I restart* the sensor at days 3 and 6 and it gets up and running again within 15 minutes. On day 7, I disconnect the Minilink and charge it up, leaving the sensor in place. This typically takes 10-20 minutes. On reconnecting there is two hour initialization period and I'm then good to go for another 7 days, restarting on days 3 and 6 again.

But as with everything diabetes, your mileage may vary. Some users have gone much longer. Others stick to shorter time frames. I know one woman who cannot get any usable data past nine days. I stick to two weeks because by that point I'm usually getting the very beginnings of skin irritation. Who knows whether the length of time that I go is damaging my tissues below the surface Sadly the decision on sensor life for me is in a large part economic.

* To restart the sensor at day 3 or 6: go to Sensor --> Sensor Start --> New Sensor and then press ACT. Don't wait for it to ask you for a Meter BG. Just go straight to Sensor --> Enter Meter BG. It will tell you the sensor isn't ready, but press ACT and put the number in anyway. The sensor will pick it up and use it and it stops it alarming to ask for the number a couple of minutes later anyway.

For more about my CGM experiences, see the archives Knowing My Numbers - CGM

Reduced to Words

"Diabetes, poorly controlled. On insulin"

"Epilepsy. Suffers grand-mal fits."

These were phrases that jumped out of patients' records at work today. Records not made by me, I hasten to add.

These few words, accurate as they may have been, really told me nothing about the people they referred to.  Beyond the fact that there is no mention of what "poor control" means or why the person with diabetes  has it; beyond the fact that "grand-mal fits" is a somewhat out-dated description; these words seemed like such an tiny, unimportant entry of things that no doubt shape the people they describe enormously.

They do nothing to justify the impact of diabetes on that person's every waking decision, from what to eat to how much to exercise. They do nothing to show the time and effort that person may already be putting in to improve their control, or the fear of complications that may grip them.

A short description goes no way to defining how the risk of a seizure can impact on a person's life, the scars on their face a much starker reminder of the force of a condition such as epilepsy.

Reducing a life changing medical condition to a few words is a near impossible task and at the beginning of a month I'm dedicating to the writing of words, it struck me what a poor job words sometimes do.