Diabetes Wise

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.

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.)

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.

The Nature of Fear

Twenty years ago last night, England was hit by its biggest storm  in living memory. The storm that wiped 15 million trees off the face of the country, cut electricity and telephone communications for days and claimed no more than 23 lives only by virtue of the fact that it struck at night when most people were safely tucked up in their beds.

Growing up in the far south-eastern corner of the country close to the Kent town of Sevenoaks, famously reduced to One Oak by the storm, my family was right in its path. The picture here is of nearby Emmetts Garden.

Listening to the then-director of the National Electricity Grid talking on a television documentary tonight about making the monumental decision to flip the switch that would throw the entire south east including London into complete darkness, that would make us literally powerless in the face of the onslaught and that would lead many people to believe Armageddon was truly upon them, I felt the fear. Looking right now at the brightness of the lights just over the river in Canary Wharf and comparing it to the CGI of London that night on the television sends chills running down my spine. Use of the music from the soundtrack of '28 Days Later' was in no way out of place.

I remember that night as though it were much more recent than twenty years ago. Beyond spending the early hours huddled together in my parent's bedroom, our cat rescued from the garden by my dad and celebrating with my brother that there would definitely be no school tomorrow, the biggest thing I remember is the initial total lack of fear.

Back then, I was the kind of kid who wouldn't move from my bed during a thunderstorm that struck at night. Paralysed by fear, I'd stay buried beneath the covers no matter how hot I got, no matter how desperately I wanted to use the bathroom or how low I thought my blood sugar could be. But lots of people were afraid of thunderstorms. I perceived there had to be something to be afraid of.

Waking up that October night in 1987, the noise was like a washing machine reaching its spin cycle with a vacuum cleaner running at full speed over the top. The wind roared and growled around the house. Leaves, twigs and other debris battered the windows of my bedroom and the curtains flapped in the whistling breeze that seeped around their edges.

But I got out of the bed and headed for the bathroom without a thought.

I didn't know what was happening around me and with no preconceived ideas, I didn't realise how very much there really was to fear.

The big storm taught me something very powerful about the nature of fear. I didn't fear it, because I didn't know there was anything to fear.

I didn't fear diabetes either, when I was diagnosed. I didn't know then how much there is to fear.

Examination Questions

Next Monday I'm sitting an exam that will count towards my first post-graduate qualification.

And I'm nervous.

The English school's examination system, coupled with my high desire to achieve and my choice of degree programmes means that I'm no stranger to exams. In fact, they were a summer ritual for eleven straight summers in a row. The moment the weather started warming up and the scent of fresh mown grass and barbecues started drifting in through the windows, I'd know it was time to get my head down into my books. I'd emerge pale, pasty and blinking like a mole several weeks later to enjoy the rest of my summer.

This, though, will be my first exam in three years and that is definitely a contributor to my nerves. The ritual of revision and preparation seems strange, alien almost.

But there is more to it than that.

There is diabetes.

Being diagnosed at such a young age, diabetes has undertaken every exam with me. I'm glad to say, it has rarely been a problem (the odd French and German spoken language exams aside). But then, I've always been in a secure environment. At school my diabetes, and the adjustments that may be necessary to accommodate low and high blood sugars, were common knowledge.

Even at university, where some of my exams were sat in vast, impersonal halls with a thousand other students, my diabetes, my pump, my need for testing supplies and snacks were all listed in my record. Even if an over zealous invigilator should question what the little silver device - my Freestyle meter - on my desk was, as normally happened, I knew it would get straightened out without problem. I never felt that my sitting an exam would be jeopardised by diabetes.

Diabetes being an unregistered candidate for this exam didn't occur to me until I received the candidate information letter.

There it is, towards the bottom:

"mobile phones or any other electrical device are not permitted in the examination hall... Use of any electronic device is not permitted during the examination and regular checks of the hall will be made."

My pump, CGM and testing kit are suddenly prime candidates for getting me kicked out. Even after putting in a call to the examination office, I still feel uneasy.

As if the stress of just trying to  pass the exam won't have a deleterious enough effect on my control!

So the question is, will trying to hide my pump, given that I may want to pull it out to deal with CGM alerts, end up drawing greater unwanted attention than having it "out-there". And would I be foolish to try and rely on CGM alone for the 3 hour paper? Your thoughts are welcome and appreciated.

I Missed It... Because I Was Missing the Point

D-blog day: I missed it.

And every other day for the past two months as well.

I've been busy doing a whole host of things, many of them really exciting and positive. But underneath it diabetes has been wearing me down. For some reason I've engaged in battle, a battle I know I can't win because I know diabetes won't just go away, silently and alone without sharing my feelings here or anywhere else. I've been wallowing in a loneliness not borne of having no one around me, but of having no one to share diabetes with.

I know, I only have myself to blame for being so daft!

I lay in the darkness on the floor of a house in Falmouth, Cornwall, last weekend, listening to the slow even breathing of sleeping people around me. I wasn't sleeping as inside me a tide of rage bubbled angrily and excess glucose coursed through my veins. The anger felt so strong that I physically placed my hand over my mouth to suppress the scream that threatened to release my pent up fury. Fury at the blood sugar of 17mmol that wouldn't come down. Fury that diabetes had had to repeatedly get its voice heard during a weekend away with friends that should have been simply fun and carefree. And all the while a guilty little voice was picking away inside me, nagging that the coke with those Vodkas wasn't diet, that maybe I shouldn't have had a slice of birthday cake despite it being the 30th birthday of a very good friend, that maybe I should have made the time to test my blood sugar just a little more often. I take my eye off diabetes for just one moment and it fights back, showing me who is boss.

Several weeks back I forgot to take two hydrocortisone tablets in a row. Forgetting just two doses of a tiny, bitter, white tablet was enough to send my blood sugars so low that I passed out on the number 42 bus, and was found by the driver at the end of the line, slumped in my seat with my clothes drenched through by my own sweat. The lack of cortisol had sent my blood pressure so low that the paramedics couldn't read it. I take my eye of my medications for just twelve hours, and my body gives up.

And all the while I can't help but feel desperately frustrated by, and even resentful of, people around me. The people I encounter who have diabetes themselves, and should 'get it', but have no care for their own health and are dismissive of my attitude to mine. The friends and the people who just simply don't get it. And perhaps worst of all I'm frustrated by those who have a little knowledge. These are the people I find myself hiding my blood glucose test results from, even when they show an interest as I prick my finger, because they know enough to understand the result, but not enough to understand that highs and lows happen. That they aren't all down to something I did wrong. They aren't all my fault. So I hide my results and most of all, I hide my feelings from these people that I fear might judge me as a failure.
Because I'm also tired of the educating and telling.

The more lonely I have felt in dealing with diabetes, the more I have retreated away from the D blog community. It is easy to find excuses. Like: The simple excuse of "I don't have time right now". Like: If I don't want to think about diabetes, then I'm sure not going to sit down and write about it. And rather like with recording of blood sugars, the longer I've gone without blogging, the harder it has been to return to it.

I've been blankly staring past the obvious truth of the matter: That all the things I'm most frustrated about and that drive my sense of isolation and loneliness don't apply to the D-blog community. Because you are the people who do get it.

The very people I shouldn't be hiding from.

I may be on a different continent to the overwhelming majority of D-bloggers but, despite my occasional feelings of isolation due to the lack of other UK bloggers and the general disinterest and apathy that represents to me, there aren't really any borders, boundaries or oceans where blogging is concerned. We're all one family, and I should have been here saying that on November 9th.

I guess it is my testament and tribute to the group that I have faith that despite my prolonged absence not only from my own blog, but also from the reading of and sharing on the blogs of others, I will still be welcomed home.

This is a community that deep down we'd all rather not belong to, but if we have to have diabetes at all, I'm so thankful that it exists and that there are so many others out there who always understand and frequently share my feelings.

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.

Dispatches From the Home Front: Failure, or Success?

I had an experience at home a few days ago that contrasted somewhat sharply against my hospital experience last week. I traded blood sugars that wouldn't come down for those that wouldn't come up. This is by no means a new experience, and I've written about it before, but this time it just seemed more intense and had an outcome I can never recall reaching before.

I've looked back on it searching for the reasons, the triggers. Trying, I guess, to find fault. To find an explanation. I'd had a deeply stressful day and spent much of it running low. I'd been exhausted and in pain from my foot, so I didn't eat much dinner. Didn't eat many carbs, beyond pure glucose, all day in fact.

Until 11pm, when a quick pre-bed check revealed a symptomless 2.7 (47) In the next hour I consumed:

A whole bottle of Lucozade
Two tubes of Glucogel
At least six Choc Chip Cookies

And in all that time my blood sugars stayed between 1.6 (29) and 2.8 (50). For a whole hour, while I was pouring carbs into myself, my blood sugar stayed that low. I sat in the dark, waiting for the light at the end of the tunnel. It finally came with a reading of 5.8 (105) Only the little light didn't get any brighter. In fact, within moments it seemed the light was already fading and that control of the situation was slipping back out of my hands. Just a few minutes later I'd dropped down to 1.3 (23)

I was at home alone, with my leg in plaster. And so came my unusual outcome. I self administered a Glucagon Kit. One of the kits that usually sits in my fridge until I realise it has expired. One of the kits I had only previously had given to me as a child, or during a seizure.

I can't remember ever having received Glucagon whilst conscious before.

But I guess with just about the last strain of lucidity that I had, I figured it would be better to get it in to myself before I lost consciousness, since I was going to have to be the one to give it.

Around half an hour later, when my blood sugar had risen to 9.5 (171) several thoughts were busy running around my head:

I wondered was there any point in eating the carbs you are supposed to eat following a glucagon injection - in order to replenish glycogen stores and ensure a later dose of glucagon would work - given that I had just used my only kit and given that I knew I'd probably be seeing anything I ate again, later that night. (Sorry, gross)

I wondered what on earth had happened to the more than one hundred grams of carbs I had fuelled my body with in the preceding ninety minutes.

But most of all I wondered whether getting into the situation where I needed to use a Glucagon  Kit represented a failure, or whether having used it, and so avoided a potentially bigger problem, actually heralded the evening a success.

I'm definitely leaning towards the latter. And trying really hard to eradicate this 'failure' word from my vocabulary where diabetes is concerned, because deep down inside I know it doesn't belong there.

Blind Panic

It is always around 4am when it happens. Not that I know that straight away. By the time I look at the clock, after a few seconds of flailing around in the darkness with my heart pounding in my chest, the panic is gone. Because I can see the glowing red digital display, and I know I'm not blind.

It almost always happens in unfamiliar places, outside of London where dark is, well, actually dark. In those moments between full sleep and complete wakefulness, my mind goes into overdrive convincing me that I can't see. That the inky blackness surrounding me isn't real, but just the gap in my consciousness that my eyes have failed to fill in. This panic may be unrealistic and irrational, because I know it would be unlikely to happen 'just-like-that' from fine to blind, but the underlying fear is very real.

I fear losing my sight.

I'm guessing this is probably not that unusual amongst people with diabetes. The potential consequences of diabetes, especially when less than optimally controlled, are continually being drummed in to us in the post-DCCT era.

Even though I know that my parents invested considerable effort in giving me good control as a child, even though I've spent a considerable amount of time working on good control myself, even though I know I'm doing everything in my power to minimise the risk, I still fear it.

Even though my routine retinal screenings have only ever found one tiny 'background spot' and I've generally been told my eyes are in great shape, even though I've passed the magic twenty year marker that supposedly points to having a low predisposition  (for reasons other than those related to glycaemic control) for complications, I still fear it.

Even though I know modern laser procedures are excellent, and I haven't even got onto the long road of any kind of interventions yet, I still fear it.

In my mind I can't help but magnify all the times my control has been less than it could have been, either despite my efforts, or, perhaps especially, because of my efforts or lack thereof.

I think that I fear sight loss because its impact would be so total. I'd lose my job, and so many other aspects of my life that are important to me. It isn't even that I think any of the other potential complications of diabetes would be any easier to come to terms with or to live with, I just find them less  overwhelmingly frightening.

That 4am panic sums it up. Oppressive darkness surrounding me until I feel as though I'll drown in it. Faces swimming into my mind to tell me I'll never see them again, hotly followed by the realisation that I'll never see anything that I haven't already seen.

The only way I know to cope with this, to keep my panic and fears at bay, is to devote as much time and effort as I can to keeping the control that gives me the best chance of staying complication free, and continuing to live the life that I want to lead. My life and freedom are precious, and I'll do what it takes. Therefore it is mainly to end this fear that I dream of a cure, rather than to end any of the daily tasks of blood sugar management, tedious as they may be. 99% of the time I feel 'well' with diabetes. A cure wouldn't make an instant difference to how I feel physically, but it would lift an enormous weight from me, and really change the way that I look into the future. Perhaps literally.

Scared

Let's face it, diabetes can make you scared. Often in a vague, far-off kind of way: scared of potential complications lurking in the future, scared of having, at some non-specific time in the future, a major hypoglycaemic episode.

Sometimes though diabetes makes me scared in a simple right-here, right-now kind of way. And there is nothing quite like the scare that a blood sugar that keeps on tumbling, despite every effort at intervention, can give you.

Last night was a classic example. I tested at around 10.30pm and got a 5.2 (94). I had just the very tail of a bolus on board, so I had around 15 grams of carbs, and got ready to go to sleep.

At 11pm, when slumber was persistently beckoning, I re-tested. I was surprised to see a 3.9 (70) I had another 10g of carbs and struggled to keep my eyes open a little longer so I could test again. Sometimes, when I'm that tired, I wouldn't bother. I've no idea why last night I did, why I had a strong nagging feeling that I should.

I was glad I did. At 11.20pm I was 3.4 (61). This wasn't funny anymore. I went for a full 20 grams of carb in the form of Lucozade , planning to bolus when I went shooting up. Except, I didn't.

11.40pm and my blood sugar was 2.3 (41) This was where the fear really kicked in. I'd now had a full 45 grams of carbs in the previous hour, which would usually require 3.2 units of insulin. I knocked back more Lucozade, probably around another 20 grams, but I'll admit by this stage, with my heart thumping in my chest, and sweat beading my brow, I wasn't counting.

The adrenaline was certainly flowing to fuel my fear, but it wasn't doing anything to push my blood sugar back up. At 11.55pm I hit rock bottom - almost - at 1.5 (27)

I finished off the bottle of Lucozade,  visions of me being found dead in bed by police who had broken down the door after no one had seen me for a couple of days, flashing through my head. Until...

Five past midnight and I was on the up. 2.7 (49).

Ten minutes and a couple of biscuits later 3.7 (67) My heart stopped thundering out a beat, and when I dried the sweat it didn't reappear.

By half past midnight, two hours after I first checked my blood sugar, I was at 5.8 (104). And with what I later calculated to be around 90 grams of carbs coursing through my system, I finally fell asleep.

Of course that wasn't the end of it. The result of these scenarios is almost always the same. Occasionally it might be a collapse that involves spontaneous awakening, or a collapse involving the administration of glucagon, or even something involving blue lights and paramedics. But far more often, these scenarios simply result in a rebound.

20mmol/l.

That is 360mg/dL.

I guess the carbs finally showed up on the scene then!

You've got to wonder really...

Where has the insulin that causes these lows been? They often seem to occur when there is no, or very little, active insulin on board, or perhaps after a stubborn high in which the urge to rage bolus (to steal Kerri's term) has been resisted.

Where does the ingested carb go? Even if that was what caused the later spike, rather than the stress hormones, it still took hours!

And the big one: If I hadn't started intervening when I did, where might I have ended up?

Not much wonder diabetes makes you scared, is it?

What Drives Hypophobia?

This is a good question, that I have been prompted to ponder by Art-Sweet's comment to yesterday's post, Chicken. 

The funny thing is that most of the time I’m actually far more afraid of high blood sugars than of low, mindful of the potential long-term consequences of recurrent, prolonged highs. I'm on a permanent quest to keep my A1c as low as possible, so it really is just in certain situations that I become a hypophobe.

Some of the causes are quite simple, along Art-Sweet's lines. Serious hypoglycaemia at work could well amount to professional suicide, for example. Travelling long distances alone is not best accomplished in a hypoglycaemic state either. But at other times, the reasons are a whole lot more complicated and difficult to explain.

I have a natural fear of night time hypoglycaemia. This is ordinarily kept in check by a combination of the fact that I trust my basal rates, that I am usually woken by hypos in my sleep before they get serious, and that if I feel I am particularly at risk I will set an alarm to wake myself at a suitable point. As someone who usually lives alone this becomes less straightforward when I'm not alone. Strange? Well, yes, but when I stay with people, who may be asleep just the other side of a wall, or even in the same room, I worry about disturbing them either through behaviour caused by actually being hypo, or with an alarm clock going off at 3am.

This, I think, brings us to the real crux of the matter.

I’m a hypophobe when I’m afraid of seeming out of control of my diabetes. This is ironic, since hypoglycaemia is recognised to occur more frequently when control is tighter. But most people don’t know that. They also don’t need to know if my blood sugars are a little high. That is easy to conceal, and hyperglycaemia causing problems that require intervention from someone else takes a good while to develop. Getting up to get juice or sugar isn’t so easy to hide, and hypoglycaemia can very rapidly become a problem requiring assistance. In a nutshell I get afraid of being hypo in situations where I am afraid that people will judge me.

This isn't the same as being ashamed of diabetes. I'm not. I happily tell everyone and anyone, and will gladly try to educate. What I fear is people thinking that I can't take care of it.

To be fair to myself, some of this started from a time when there was another girl with type 1 within my immediate peer group. She was someone who never tested her blood sugar or injected in public and never went low in the company of others. What everybody didn’t know was that her A1c frequently exceeded 10 and she was really anything but healthy. I, on the other hand, routinely tested my blood sugar without pausing in a conversation, wore a pump and sometimes needed juice or glucose tabs as a mater of urgency. I had A1c’s in the 6-8 range, but many people perceived me to be the less in control of the two of us. They told me so, and wouldn’t really be moved by any amount of education.

The people from this group that I would actually call good friends, were, of course, completely understanding of where I was coming from. To this day, I don’t have a problem in letting my really good, close friends, the people who understand, know what is going on, although I'd much rather not disturb them unless I have to.

But inside I have a fear of going low outside of that circle because it gives my diabetes way too much of a powerful voice, one that says "Look at me, I'm the one that is in control and she [me] can't do anything about it." Even when I know that isn't the case. So yeah, sometimes I'm a hypophobe, because I just want my diabetes to go unnoticed.