When I was diagnosed with diabetes, I was ignorant to the disease, and I was naive. When I spoke to the nurse on the phone the day previously, I asked if I could see her when she was in Queenstown the following week, rather than driving an hour each way to see her at the hospital. She said that sometimes it isn’t safe to wait. That’s when fear kicked in. Although I was brushing aside the possibility of being a diabetic, I was scared for the strong possibility that I just might be.
At diagnosis the following day, my blood sugar surpassed 30 mmol/L (a normal level is 4-8 mmol/L). Little did I know you could enter Diabetic Ketoacidosis (DKA) at over 13 mmol/L. DKA happens when the body cannot use sugar (glucose) as a fuel source because of the body’s lack of insulin to transport the glucose from the blood stream to the muscles. Fat is used for fuel instead. When fat breaks down, a waste product called ketones are produced, and these build up in the blood and urine. In high levels, ketones are poisonous, which makes DKA a serious life-threatening problem for diabetics as they may fall into a coma and die. Quite often a diabetic is only diagnosed once they have reached the DKA stage. For this I’m thankful for listening to the nurse and going to the hospital when I did. I’m also thankful for myself for acknowledging the symptoms and going to the doctors, no matter how much I wanted to pretend I was okay. I was getting sicker and I knew it.
Initially, I thought I would inject myself with the insulin pen the nurse gave me once a day, at night, and that would last 24 hours. I would later learn that this is called basal insulin.
Basal insulin is also known as ‘background insulin’, and it’s a 24 hour slow release insulin to keep blood glucose levels steady during fasting.
Little did I know that the nurse was easing me into the mammoth task that my illness would require of me everyday for the rest of my life. She told me to ‘eat as normal’, and that she would start me on more insulin another week. I was diagnosed on the Friday, and after a brief cry, I was back to my normal self, stating that I was about to work all weekend. The nurse said I should take the weekend off, that I needed to get used to using the insulin. I called my Manager as soon as we left the hospital, and she said it was fine. I said I’d be back on Monday.
I spoke to my nurse over the phone just before I had lunch on the Monday. She said I’d be fine having a ‘light lunch.’ I had a chicken wrap with some fries. It was only small, and in my eyes I thought it was quite ‘light’. Two hours later I was back at work, and I felt really sick and unwell. My blood sugar monitor read over 30 mmol/L again. I had to sit down and call my nurse, who instructed me to take my fast acting insulin straight away to bring my blood sugar down to a less dangerous level. This, I’ve since learned is called Bolus dosing.
A bolus dose is an injection specifically taken at meal times to keep blood glucose levels under control.
Bolus insulin needs to act quickly to keep up with the food that is being digested, and so a fast acting insulin is used. Bolus insulin may also be used without food to bring high blood glucose levels down.
What I had eaten, I learned, was not a light lunch. It was then I realised I would require a bolus insulin shot before every meal and every snack. I would have to inject myself multiple times a day for the rest of my life.
I regularly test my blood glucose with a finger prick test in excess of 10 times a day – maybe 20 if I’m exercising or having a bad day. That means I make myself bleed 3,650 times year. Give or take a couple hundred. It’s the first thing I do when I wake up, before every meal or snack, before, during and after exercise, two hours after meals and it’s the last thing I do before I sleep. Sometimes I have to set alarms in the night to check my levels if I’ve taken fast acting insulin within two hours of sleep to prevent me from falling too low and never waking up. I have to inject myself with insulin 5-10 times a day as well, which means I poke myself with a needle anywhere between 1,825 and 3,650 times a year. It sounds like a lot, doesn’t it? I guess it is. But 100 years ago, being diagnosed with diabetes meant being given a death sentence – the diabetic would be put on a starvation diet and given months to live. It wasn’t until 1922 when a patient was given the first medical administration of insulin. I’m lucky enough be born in age where Type 1 Diabetes is a manageable illness, and while we have yet to enter the age where it’s curable, I’m thankful for having the insulin that keeps me alive.