Diabetes Wise

Moving On...

I feel a need to write this post, because six weeks on, I don't want heartbreak to be at the top of the page anymore. And it's also about time I thanked everyone for all your comments and support on my last entry. Your comments, as always, really meant a lot to me and brought light in to a dark place.

I've spent the last six weeks in that strange post-relationship landscape that anyone who's ever had a relationship end will surely always remember. I've certainly walked this street before. Looking back and sorting through tangled emotions whilst getting on with day-to-day life and trying to think about moving forward. But what starts out bleak, tough and upsetting eventually ends up something close to liberating.

I've cried a lot. Especially in the beginning, using countless tissues and finding myself unable to stop even though I've been aware it wasn't making me feel any better. Taking the train to Liverpool one last time to retrieve my belongings was particularly hard, despite that fact that I didn't even see Rob. The only thing that seemed different when I arrived was the absence of my cards and notes that he used to keep beside his bed.

I've gone through the helpless soul-searching 'what's wrong with me?' moments. I've felt lost and lonely, watching the 'Liverpool life' of which I'd been a part for so many months, continuing - through the photos appearing on Facebook - and dealing with the fact that it wasn't part of my reality anymore. And I've dealt with the loss of more than just my relationship with Rob, realising that certain people I'd thought were friends no longer see me that way now that I'm no longer half of a couple. It's good to find out what people are really like, but that doesn't mean it doesn't hurt. In some ways the loss of friendships - and I  include in that my friendship with Rob - and the lifestyle we had together have been the hardest parts of the whole split. The distance magnifies things. I don't go to Liverpool so I don't "bump-into" these people. I miss people.

But there is a positive slant. Last week I finally felt ready to pick up the phone, if only to try and cement some closure. Rob and I talked for three quarters of an hour and I came away knowing that the man I had loved was still inside there somewhere, that I hadn't imagined it all. Neither of us wants to exclude the other entirely from our lives, and I'm feeling positive that we've managed to break up without hating each other.

And the very distance between us has perhaps made it easier to move on. I'm not simply living the same life minus a partner. I'm living a new, different life. I've done a lot of things in the last six weeks. I've spent more nights at the pub than I should. I've gone out with friends and stayed up all all night to watch the sun rise in the morning. I've stayed out in the rain until I was soaked through to the skin, but had a good time anyway. I've had lunch with two amazing women, one in her eighties and the other in her nineties, both of whom were friends with my grandmother when they were younger than I am now. I've drunk more alcohol than I probably should on more than one occasion. I've aggressively pursued my rock climbing, pushing the grades I can climb, free of fear of not measuring up. I've made several new friends, one of whom in particular has rapidly become very close to me.

I'm making plans for the future too. I'm planning for trips abroad, I've made decisions about my professional future. Next week I'll be ditching my skis to try snowboarding for the first time.

I feel strangely free, with an incredible amount more time on my hands to rediscover my beloved city, instead of jumping on a train out of it every other weekend.

With distance, with the support and perspective of others, I can also see that there is nothing wrong with me. It was the right thing for this to end. In fact, some of the anxiety that had begun to plague me prior to the split has actually been lifted and in several ways I'm a happier person. In a way I can't quite condense into words, though, I still love Rob. Being in love is what held me with him and made the end so painful, but inside I think knew it wasn't going to be forever.

Most importantly though, I don't regret a single moment of our time together. How can I, when it was utterly right at the time and enriched so many of my days beyond measure?   

Which Way Out of Heartbreak?

This is a difficult post to write, especially on Valentine's Day.

The day after we arrived back from Italy, Rob stayed down in London with me. I had to get up and go to work the following morning. I left Rob in bed, still half asleep, giving him a kiss and a cuddle and reminding him I much I love him.

I didn't know that would be it. The end of the road.

Last Saturday, Rob reached inside my chest, grabbed out my heart and squeezed it until it broke. Or at least he may as well have done. I've been left scrabbling around on the floor, trying to fit the pieces back together.

I spoke to Rob on the phone at two thirty in the morning last Saturday. He told me, as always, how much he loved and missed me, how he couldn't wait to be with me again the next weekend.

Eleven hours later we spoke. He told me again that he loved me but then, like a bolt from the blue, told me that it wasn't enough, that he didn't want to go on with our relationship.

In that second, standing in a hot overcrowded room at a professional conference, my world began to unravel and nothing has been the same the since.

I have no idea what changed in the space of eleven hours. I'm perhaps more scared that nothing did. The love that Rob expressed to me in the middle of the night seemed as genuine and sincere as always. But Rob is a terrible liar, completely unable to hide his true feelings. Real love has no off switch, and I refuse to believe this was a snap decision, he must have already known at half past two what he planned to do when the sun had risen. If he didn't mean it when he told me he loved me then, that leaves only one logical conclusion.

He never has meant it.

The man who made me feel all this. My buddy, my rock, my partner in crime. The person I wanted to share my highs and lows with. The person who understood me and what makes me tick. The guy who was always there, at the end of the phone line, at the end of the train line. The one person who never failed to make me smile, make me laugh, make me love.

Now all he makes me do is cry. All he makes me feel is hurt. In an instant, it's all gone and I'm left wondering if it was ever there in the first place.

I can't find the words to describe how hurt I am, not simply by what has happened, but also the way it was done. Ending a long term, serious relationship over the telephone, even if you are 200 miles apart, just isn't fair. If I meant anything at all, I think he owed it to me to break the news face to face. This is the anger that tempers my tears.

I feel a little like I'm turning in an emotional spin dryer. I can't bear the thought of speaking with Rob, or seeing him again right now. I'm afraid I'd lose my dignity. I'm afraid it would hurt more than I can bear. But at the same time, the thought of never seeing Rob again, of him no longer being a part of my life at all is terrifying.

I'm still not sure that I really know how to get through this, how to find my way out of this heartbreak.

On Monday evening, I went to take my frustrations out on an indoor climbing wall. It's a hobby which, ironically, I took up because Rob loves it so much.

Halfway through a top-roped climb I found myself stuck, unable to figure out my next move, the only logical step for my right foot feeling insurmountable. I looked down, wanting to shout "I can't do it." In that unnatural position, arms and legs spread hanging on to an artificial rock face, I realised that climbing serves as something of a metaphor for life.

You can't look down or backwards. The only way is onwards, upwards, even if you have to push yourself through the pain to do it. You have to trust your belayer not to let you fall like you trust your friends to catch you when life gets tough.

And when you reach the top of an indoor climbing wall, the only way is down.

With heartbreak, the only way is through.

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.

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.

Reflections on Practice

From the moment I tossed my mortar-board hat in the air and spun around beneath it, laughing giddily, on graduation day, I've had the importance of professional development drummed in to me.

To me, at least, it's about so much more than recording a few courses you've attended, or articles you've read and then submitting a return of your hours once a year. It's about growing as a professional and as a practitioner. Which is why, from the outset, I've adopted the habit of reflective self assessment.

Looking at the way I do things now and why. Looking at what is and isn't working. Looking at the evidence. Looking for new techniques and solutions to old situations and problems.

Perhaps I'm good at this after so many years of doing it with diabetes and blood sugar management.  If that is the case, it is ironic that one area of my professional practice that I hadn't regarded in this way was my management of patients with diabetes.

This post started the process.

Jenny is right. We are - I am - too closeted, at least in my professional arena. I stand by the judgment that most of the time my diabetes isn't a relevant disclosure to make, but where other people with diabetes who happen to be my patients are concerned, it is probably time to change that.

I, too, would love to meet more health professionals who "get it" without me having to make painstaking explanations. I've realised through reflection that it is possible that I do. Perhaps they just aren't telling me.

And perhaps I continue to assume their ignorance by the way they act.

This post from Penny made me think in to this further. In her own comments section, Penny writes:

"Then, his dentist asked me yesterday if Riley's sugars were well-controlled. I just looked at her and nodded my head. What do you say to a question like that? It really depends on which day you ask."

I hate as much as the next person how uninformed medical professionals (or those I perceive to be uninformed) phrase questions in ways that are impossible to answer. I hate when they imply they know all about diabetes, when the way they ask their questions implies otherwise.

But I'm guilty as charged.

Although disclosing that I have diabetes will make an immediate difference to how my patient's with diabetes perceive me, I still need to go further. I need to be more explicit in my questioning. Make clear that I'm looking for the general picture, the most recent A1c value if they know it, and the aspects of diabetes management that could most influence their oral health.

I need to go further because, on reflection even people with diabetes can be guilty of acting in the ways we all hate. When I wear my professional hat, it seems I definitely can.

 

Blurring the Boundaries

I've been a pumper for more than half a decade. Yet everyday I deliver more than a dozen injections.

They're not injections delivered subcutaneously, through tiny needles. They're not injections of insulin. Most importantly, they're not injections given to myself. They are local anaesthetic injections, given to  my patients just as routinely as I once gave myself insulin.

There are really few similarities between local anaesthetics and insulin injections. The differences reflect the size of the boundary I like to keep in place regarding every aspect of the relationship between my diabetes and my dentistry. I like to keep them very separate.

I don't disclose to my patients that I have diabetes. Partly because it normally simply isn't relevant. But it's also in part down to fear. Fear of being judged. Fear of people losing their confidence in me, or believing me to be unfit to do my job. I've nothing to base this on, but I don't want to take a chance. As I write this, I realise how crazy it sounds. Anyone of you reading this could in future be a patent of mine and I've no problem discussing diabetes here. But still...

I've repeatedly found myself cringing when I meet a patient with diabetes and I find myself asking "How is your control?"

It's a very important question. Poorly controlled diabetes can increase the risk of dental disease, in particular periodontal disease. Conversely, poorly treated periodontal disease can worsen glycaemic control. I know that people can easily lie, saying what they think I want to hear. And I also know how feel when a perceived uninformed medical professional, or other person, asks me about my control.

Who are they to judge? I think. What do they know anyway?

I've certainly met this wall of defence when I've questioned patients before, no matter how sensitive my approach. I've longed sometimes to break down my barriers, share a conspiratorial smile and say "It's ok, I get it. I understand."

I've also been met with a degree of curiousity before now. People who regard me warily, as if trying to figure out how a dentist would know so much about diabetes and blood glucose values. Some even seem impressed. I wonder now how may might have guessed correctly how close my relationship to diabetes is.

Outside of the professional-patient relationship, I'm very open about diabetes. I'm excited when I meet others wearing insulin pumps, eager to share stories and experiences.

Two days ago, the boundaries blurred.

"So how do you feel your diabetes control is?" I asked the young man sitting in my surgery.

"Well, good, you know. I wear a pump...."

I wonder if he expected me not to now what a pump was. I wonder if he was expecting to be questioned, or to have to explain as we've all done countless times before. In all the time I've been pumping, I've never had a patient tell me they have a pump too.

My reaction was more automatic that considered. I smiled, flicked up the corner of my tunic to reveal my pump, clipped to my waistband.

"Snap."

The world didn't end. The patient didn't leave. Instead he just knows that his dentist really does get it.

For Father's Day

I've never been able to find a way to put into words exactly how much I love my dad. I love him simply for who he is and I love him for all that he has done for me.

When I was a kid, testing my blood glucose was often handled by my dad. He was often the one who crawled half asleep from his bed to test me in the middle of the night and the person who sprang to life when I wandered into my parents' room complaining of feeling "wobbley".

For years, I used to get up in the early mornings with my dad who, rose a full half hour before anyone else in the house. He'd be the one who would check my blood sugar before settling me down with something to do. I have vivid memories of him setting up a television in the spare bedroom during the 1988 Olympics. Given that Seoul is several hours ahead of UK time, the sports would be in full swing by 6.30am. I sat and watched equestrian sports with the faint babble of Radio 4's Today programme emanating from the bathroom opposite.

Later, when getting up early was no longer my thing and I was far more likely to ignore the alarm, turn over and pull the duvet over my head, it was always my dad who made sure I got up. Long after I was capable of testing my own blood sugar, he'd still do that first morning test for me, giving me a few extra precious minutes of sleep. My insulin pen would be ready and waiting for me on the breakfast table.

I remember too an occasion when I experienced severe hypoglycaemia at school. My dad, the world's most careful driver, the man who will set the cruise control so he doesn't accidentally exceed the limit in a 30 zone, rushed down the motorway not caring if he got a speeding ticket, just to make sure I was ok.

My dad had dropped everything at work and rushed to be with me  more occasions than I care to count where I've been admitted to hospital, or too ill to cope on my own. He has supported me unconditionally when everything seemed to be gong wrong and it felt like the word was against me. He is never, ever more than a phone call or email away and has never thought twice about sacrificing his own needs for those of his children.

But my relationship with my dad is about far more than just diabetes and illness. He carried me on his shoulders through crowds. He taught me to ride a bike, running behind me, hanging onto the back of the saddle and saying "I won't let go, I won't let go" then moments later "you can do it!" Years later, he sat next to me in my little red mini, and patiently taught me to reverse park. He has shaped me as the person I am. From silly rituals like face pulling and silly sayings, to teaching me right from wrong. From helping me with my tax returns to teaching me how to love.

For years, I've watched my mum and dad as a couple -  a couple who celebrated their 33rd wedding anniversary on Friday - and known exactly what I wanted from a relationship. I blame my dad partly for my long years of being single. My parents' relationship has given me high standards, and it's been hard to find anyone who even comes close to matching up to my dad.

My dad has given me so much, but if he were to go and leave me just one more thing, I'd want his words. He is a brilliant speaker. I'd want from him the words he'd most want to say about me, perhaps the words he would say if I were to get married tomorrow. I'd want to hear those words  to know that I've made my dad proud of me.

And the one thing that I would want to give him back is the realisation that he can only be proud of me because of who he has made me.

My Face On...

... Flickr.

I'll admit it: I'm shy.

Really shy, which probably explains something about why I've never shown my face here on my blog.

And that aside, most of the pictures that I post on the internet have absolutely nothing to do with diabetes. If there is one problem with the title of this blog, it's that I feel, at times, a little restricted in mysubject matter. At least, it is a good excuse to kid myself that no one who ventures here to read this is even remotely interested in any of the other details of my life although human nature dictates that you probably are...

Some of my photos do feature diabetes as a theme, though. It was Art Sweet who invited me to join the Diabetes Made Visible Pool on Flickr by leaving a comment on an old (and truly awful) photograph of me with my 511 pump in Chicago. Today I finally got around to taking the plunge.

And furthermore, I really should be promoting Flickr at least a little here since my brother does work for them, and so far most of my real-world friends have steadfatly refused to embrace the digital age, despite my frequent nudges towards getting Flickr accounts!

Stop by and check out all of the great photos in the pool, by many familiar names.

Then sign up to Flickr and join in!

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.

I Don't Do That!

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

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

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

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

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

She could see my point.

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

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

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

A Free Gift

More than twenty years on, the autoimmunity that gave me diabetes has decided to reward me for my loyalty with a free gift: Addison's Disease

And so ends ten days of nightmares.

It began on Saturday July 1st. England lost to Portugal on penalties in the Quarter finals of the World Cup, but it was still a good day. I'd met a friend after the game for a single drink and something to eat. I was on my way into Whitechapel Tube Station on my way home, probably around 11pm and alone, when the world switched off.

I'd like to tell you what happened, but the truth is simple: I can't because I don't know.

I've filled in some gaps from information given to me by the paramedics. Witnesses said I'd simply stopped, fallen to the floor and started having a seizure. Certainly, I'd bitten my tongue, as I woke up with blood in my mouth and smeared across my face.

The paramedic who attended first tested my blood sugar at 1.2.

1.2 mmol/l

That is 22 mg/dL

A few minutes before, I'd been walking (ok, on crutches) along the street feeling fine.

A few minutes before that I'd given a friend a quick hug and said goodbye.

And perhaps ten minutes before that I'd tested my blood sugar at 6 mmol/l (108)  with no insulin active in my system.

It didn't make sense.

Certainly not then, when I came round to a sea of strange faces asking me questions I could neither understand nor respond to. Not a few minutes later as I struggled to articulate simple words on my arrival at the A&E Department of the Royal London Hospital (fortuitously located almost directly opposite Whitechapel Tube.) And it still didn't make any sense to me around half an hour later when the post-glucagon vomiting started.

It still didn't make sense the following morning, when I realised my blood sugar had never at any point, even after Glucagon, been recorded at higher than 6 (108). Overnight I'd had less than a single unit of insulin and still my blood sugar remained within range.

It had been late when I'd arrived at the hospital and I had accepted that I would be better to stay until morning but fully expected to have recovered by then and to go home to figure out the cause of my spectacular low. I didn't expect to feel so absolutely horrific. To be unable to stand up without the room spinning, to feel sick and to have so much unexpected pain from my still plastered ankle.

I've had bad hypos before.  I've had seizures before. I've had Glucagon before. But I've never felt this bad afterwards before.

The one consolation seemed to be that I'd been cured of diabetes.

Running basal rates of around -80% (by which I mean 20% or normal ratesl) I was still almost continuously hypoglycaemic. My own Diabetes Specialist Nurse (DSN), who is based at a different hospital, has told me since that the doctor treating me at The Royal London had actually contacted her on that Sunday and asked if I really did have Type 1 Diabetes!

I proved a problem to the diabetes team at The Royal London. They fully admitted to being unfamiliar with pumps, as they don't support pump patients. I've also never been a patient there before, and they had no idea of my diabetes or general medical history. I wasn't it much of a state to help. Tired, frustrated and permanently hypo despite continuous carb consumption, I just wanted to go home, regardless of what the consequences of doing so might be.

I spent last Monday alternately lying flat to reduce my dizziness, or being violently sick. I had to push the staff to get my plaster cast removed to check for a wound infection, as my whole leg burned with pain. At one point, I had an intravenous dextrose infusion and my pump switched off, yet was still recording blood sugars of less than 4 (72).

By Tuesday my leg had proved to be fine, the vomiting had diminished and I seemed to be able to avoid hypoglycaemia by taking just 0.05 units of insulin per hour (Down from an average basal of 1u/h.) Seemingly out of ideas for what to do to better stabilise me, the team at The Royal London let me go, in order that I could return the following day to my own diabetes team.

I spent Tuesday night waking to the alarm every 90 minutes to check my blood sugar and eat sugar as required. By Wednesday lunchtime I was exhausted and my blood sugar had slid back to 1.6 (29) with no symptoms at all apart from being sick, which had been happening regardless of blood sugar level anyway! I remember clearly lying on my bed trying to swallow tubes of glucose gel without being sick. I remember panicking because I knew I was going to be late for the appointment with my diabetes team, but I don't remember clearly the details of the journey to the hospital, (or, sadly, how I came to lose my Oyster Card)

When I arrived, I sat in the waiting room, resting my head on my knees as the only way to stop the world from turning around me. My name was called by the lab tech who takes bloods, but by the time I'd stood up, she had disappeared. I reached the front of the waiting room before falling forward....

It might seem mad, but when my consultant, seated but stooping to reach eye level with me as I lay on a couch, patiently and compassionately explained they would have to admit me and that there was no way I could go home, I started to cry. As terrible as I felt, I just didn't want to stay in hospital again. But if I'd gone home, who knows what might have happened.

Over the next 24 hours, I got through around 3 litres of Lucozade and 8 tubes of glucose gel, yet my blood sugars, tested hourly by staff, remained steadfastly low. At times I remained below 2 mmol/l (36mg/dL) for several hours at a time. What amazed nursing staff was that I felt exactly the same when my blood sugar was 1.5 as I did when it was 5.5. The same was, unfortunately, terrible, but I definitely had no indications of actually being so low - unsurprisingly I guess.

On Thursday afternoon, the SHO came to see me and explained that, as they'd suspected, my adrenal glands are no longer working correctly. My morning cortisol level that day had been less than 40, where normal is 200-250. Cortisol is a major antagonist to insulin and my persistent hypoglycaemia, as well as my other symptoms, were down to the lack of this hormone.

The SHO touched my arm and asked if I was ok.

I didn't, honestly, know how to answer that question.

I was relieved to have a reason for the way I had been feeling, and for the hypoglycaemia. At least it would be corectable, now we knew what was causing it. And at least Addison's is relatively strightforward to manage.

But who wants another chronic condition? Who wants something else to squeeze onto their medical ID tag, more tablets to take, something else to think about during illness or travelling?

Not me.

Damn you autoimmunity. I didn't want your bonus gift.

Twenty Three Things

This comes from Kassie  whom I must thank, as it has provided me with an opportunity to lift the mood a little from some of my recent posts where diabetes, and everything else for that matter, has clearly been getting on top of me. Time to be more positive: Twenty three pretty cool things I've done since I was diagnosed with diabetes. 

1. Went away from home alone at the tender age of eight - to diabetes camp, of course!

2. Set two county athletics records

3. Got straight A/A*'s in my GCSEs

4. Passed four A-Levels , winning a science prize along the way

5. Was accepted in to Dental School

6. Moved to London and lived it up as a Fresher, burning the candle at both ends and managing not to let diabetes get in the way

7. Worked at diabetes camp

8. Survived meningitis, and the subsequent diagnosis of epilepsy

9. Survived encephalitis

10. Obtained my first degree - a BSc(Hons) in Pharmacology with Biomaterials Science

11. Fought prejudice to continue with my dental training

12. Started pumping, and really took control of my diabetes

13. Organised a National Conference for over 200 dental students, raising over £15000 in the process

14. Started living alone

15. Fell in love (cool) and had my heart well and truly broken (not so cool.) Later on I took my own turn at doing the breaking (not cool either)

16. Was elected as President of a National Student Organisation, and travelled all over the UK.

17. Travelled to many places in Europe and North America, sometimes alone and sometimes with great friends, making fantastic memories.

18. Graduated from Dental School and registered as a Dentist with the General Dental Council

19. Attended an ADA Day Camp in Houston, Texas where all the kids thought my accent was "Cool" (That's a cool thing, huh?!)

20. Moved to Plymouth in Devon for a year, despite not knowing a soul in that part of the country, and successfully completed a dental training year there, despite spending much of the time with my leg in plaster

21. Achieved my lowest ever A1c of 5.2

22. Established a career in dental politics, alongside clinical practice

23. Started this blog - is that "cool"? You tell me...

If you want to play along, the rules are simple. Number of cool things = number of years with diabetes.

Getting Personal

It wouldn’t take great powers of observation to realise that I’m being pretty generic here. I’ll hold my hands up. I’ve been deliberately avoiding giving too many specifics. In short, I’ve been hiding.

I’ve got my reasons, though I guess they may not seem very compelling to anyone else. I don’t want, or at least haven’t wanted up until this point, to bare myself for judgment from people who know me in my offline life. Yes, I worry too much about what other people think of me. And yes, even if they think this is junk, or a waste of time, I’ve got good reasons for doing it, which is what matters. But I guess I wanted to establish myself before giving identifying clues to people who could pick up on them.

Now, anonymity is stifling me.

And now, I have begun to give clues – narrowing the very generic ‘England’ down to the (only slightly) more specific ‘London’ and clues through the tag game, for example – that along with my name and age would probably be plenty enough to reveal me to anyone that knows me well, who happened to pass by.

So I guess now is time to get a little more personal. Honestly.

My name is Caro, I’m 26 years old, and I live in London. That much you know.

Caro is short for Caroline. I have a brother, who lives in San Francisco.

I told a small lie in the 'Tag'  post, in that I actually grew up in Kent, not London, and I have also lived in Plymouth, Devon. When I put that post together I wasn’t committed to coming clean, and that is a pretty specific combination of places. I hate lies, but I see this more as an omission, than an out and out lie. I hope you’ll forgive me.

I’m a qualified dentist, but I hope that you'll forgive me for that too! How I came to be a dentist is definitely a story for a whole other time! I don’t want to give you my full name, because people who know me recognising me is one thing, but I don’t particularly want my patients googling my name and reading me here. Believe me, some of them would, and for the most part I don’t actually want them to know that I have diabetes, because it isn’t necessary to our professional relationship.

That is about it for now, although more will almost certainly follow in the natural course of my posts.

Because I’m not hiding anymore.

And I’m not caring about being judged anymore either. I’m in this for me. The real me and anyone who cares to read me.

Seems I'm 'It'

Tagged by Kassie. I guess this makes me a proper part of the O.C!

Four jobs I’ve had in my life:
1. Shop assistant
2. Bar staff
3. Lab technician
4. Volunteer diabetes camp leader

Four movies I can watch over and over (defined as movies I cannot channel surf past):
1. Rainman
2. 28 Days Later
3. ET
4. Girl, Interrupted

Four places I have lived:
1. London
That is it.. sad huh?!

Four TV shows I love to watch:
1. ER
2. Friends
3. Family Guy
4. Strictly Come Dancing

Four places I have been on vacation:
1. Whistler in Canada
2. Chicago
3. Venice
4. Paris

Four of my favorite foods:
1. Chocolate, specifically Chocolate Fudge Cake
2. Cheese Fondue
3. Tiger Prawns. Oh, and Mussels (am I cheating here?!)
4. Bacon, the English way

Four websites I visit daily:
1. The O.C
2. Yahoo.co.uk
3. BBC News
4. This Is London

Four places I would rather be right now:
1. In a warm bath, with a glass of wine
2. Skiing
3. With my family
4. Cruising in the Carribean

OK, I tag:
Sandra
Scott
Tiffany