When Big D gets you down.

Nope.

I think that one of the worst parts of having a chronic illness is that sometimes, it breaks you. Maybe you have several bad days in a row. Maybe you just have one really bad day. Whichever it is, you realise you’ve gone on for so long being fine and that today, you’re not. You’re so far from fine that you’re struggling to even move. You don’t know how you made it through work, and you don’t remember how you made it home. You hide in your bed under your blanket all afternoon as the sky darkens outside. But even then, even in the depths of your grief, your illness is haunting you. You can’t sleep easy with the thought that maybe you won’t wake up. You can’t even nap without checking your blood sugar to ensure you’re not going to die. You’re pissed off that you ate some fish you thought was ‘safe’, but in actual fact has sky rocketed your blood sugar. You’re pissed off that an hour later your correction injection has plummeted your blood sugar despite still having an hour left until its peak effect and with an already potentially dangerous level…and dropping. You eat, despite not being hungry. You eat to keep your levels up. You eat to stay alive. You feel like you’re trying to survive in a body that wants to destroy you. You check you blood sugar. Still low. You check again. Still low. And again. Coming up. You’re dosing in and out of your slumber, wondering if this is happening, or if you’re even awake. You’re exhausted. You skip your run. You skip the gym. You skip meeting friends at the pub. You curl up and cry in a ball in your bed instead because your illness has had you today. It’s got its grubby claws around you and its squeezed away your sparkle. And then you grieve. You grieve over the stupid little fish that you ate. You grieve over the simple foods you can no longer eat without your body reacting terribly to it. You grieve over the realisation that you have an illness that will never leave you. You grieve over not being able to eat whatever you want, without it having consequences. You grieve over the life you lost and the life you’re forced to live. You cry until your eyes are puffy and then you tell yourself to pull yourself together. Today is a bad day. It happens. But you will pick yourself up and you will remind yourself that tomorrow is another day, and tomorrow, you will be bigger than your illness.

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5 reasons you should treat a hypo with glucose tabs (and nothing else)

Screen Shot 2015-12-09 at 3.36.17 PMWe’ve all been there: you’re going about your day when a hypo smashes through your body like a lead balloon falling through the sky. You need sugar and you need it now. If you’re at home, there might be a variety of high sugar ‘treats’ on offer, and it’s all to tempting to go for it. And perhaps sometimes, you do; You unwrap the chocolate, scoff it down and before you know it you’ve had 2 or 3 or more with almost no acknowledgment of consuming any of them. You sit and you wait…has your blood sugar risen yet? Have you had enough sugar? Have you had too much? Do you still feel low? You panic at still feeling low and have a whole chocolate bar. That’ll do the trick. But 5 or 10 minutes later the panic you felt about dying has been replaced with guilt as you’re blood sugars are fast heading the other way. You’ve had too much and you now need to counteract the excess sugar with more insulin. And then you struggle with estimating how much insulin you need to bring you down the right amount without still being too high or going too low once again and riding the diabetes rollercoaster. Maybe you level off after a few hours. Maybe you don’t. But either way, you feel like shit. Shit about the high. Shit about the low. Shit about your poor control.

Here’s a different scenario:

We’ve all been there: you’re going about your day when a hypo smashes through your body like a lead balloon falling through the sky. You need sugar and you need it now. You test your blood sugar. Through your murky brain, you work out how much and when you last injected to estimate how much further you’re going to drop. You take the appropriate amount of glucose tabs to bring your blood sugar back up to range. You wait. The symptoms swiftly subside and you’re back to a stable level. You feel okay. A little drained from the low, but you didn’t over correct. You’re back to being you.

I’m a fan of bullet points, so here are 5 reasons why you should treat a hypo with glucose tabs (and nothing else):

1. Glucose tabs are accurate…

You can work out exactly how many mmol/L a single glucose tab will raise your blood sugar, and take the exact amount without having to worry if you’ve eaten enough – or too much.

2. …and fast acting.

Other sugared carbohydrates like chocolate take too long to bring your blood sugars up and within range. This can be dangerous if your insulin is still having an effect on your blood sugars (and thus likely to bring you down to a dangerous level), but also it may increase your hypo-unawareness.

3. They’re not particularly enjoyable.

And they shouldn’t be. If you see hypo-s as an excuse to have a ‘treat’, then you risk using them as an opportunity to be ‘naughty’ rather than deal with the problem in hand.

4. It sets you up for a good day

By avoiding sugared carbohydrates, you avoid triggering cravings for more of them. It also means you won’t have the mentality of ‘well I’ve already had such and such now, I might as well have more!’

5. You were offered a ticket on board the diabetes rollercoaster, and you turned it down.

Stable blood sugars are yours for the taking, congratulations!

Being force fed glucose in hospital as a Type 1 Diabetic.

I haven’t had the best couple of days. Late Friday night, I had fairly bad abdominal pain for the fourth night in a row. By ‘fairly bad’ I mean painkillers didn’t help, I couldn’t sleep, and it really hurt. My breathing had changed to more of a puff like I get when I hypo. So Ben drove me to the local hospital. After a couple of hours and some morphene later, I was examined, had an ultrasound, an overnight stay and blood tests and an X-Ray in the morning. Come 10am, the doctors decided I needed to see a specialist in the nearest surgical hospital, over 2 hours drive away. So there I went strapped in to the back of an ambulance.

When I got there, I was left in A&E for three hours before a doctor got around to me. She said I would need an ultrasound again – (by a ‘professional’ this time – someone who’s full time job is to ultrasound) and so I waited. By this stage I’d gone all day without food. My Lantus had kept me at 5.0 mmol/L from my admission, through to 3pm, which I was impressed with. But after that I dropped slightly to 4.3. I said to the nurse, ‘if I’m not getting the ultrasound soon, I’m going to need just a tiny bit of glucose’. I wanted just a little bit before I had a hypo, but I couldn’t have a jelly bean. She went away and came back with a Glucose drip. Shit. I told her I wouldn’t need much and that I’m really sensitive to Glucose. She either wasn’t listening or didn’t understand. Half an hour later I tested my blood sugar and I’d jumped to 7.9. Panicked, I unhooked the large glucose bag and went to ask her if she could detach me. She went to ask the doctor. When she came back she said that between 4 and 8 is a normal level, so the doctor wants me to keep it on. I said ‘But I’ve just gone up that much in half an hour, it’s just going to keep rising’. The nurse assured me it would level off and that I needed it. 15 minutes later I tested again. 9.4. I started to panic again and said ‘I really think you should take this out’. She said it was fine, that 20 is a normal number and people aren’t harmed at that level. That’s when I burst into tears. I was a Type 1 diabetic being force fed glucose. Because my levels are so good and relatively low for a Type 1, I would enter Diabetic Ketacidosis (DKA) at a lower level than other diabetics…So the glucose in my blood would have kept rising to the point that it would become acidic and put me into a coma, with death as a likelihood. I wasn’t going to sit and let myself be killed by some ineducated nurse. Thankfully, she swapped the Glucose drip for a regular drip, but only because I was upset, ‘not because it’s medically necessary’. I was so angry.

A little later on, they moved me up to a ward where I was met by a nicer nurse. Unfortunately for me, I was still waiting for my ultrasound by 8pm, and my sugars dropped to 3.6, just as we got the call to go down to ultrasound. Dammit. Another Glucose drip went in, but the nurse slowed the dosage. In and out of the ultrasound I went and she stopped the drip when I reached 6.1. By this stage, I was allowed to eat for the first time in over 24 hours but the only available food was a sandwich. I took my insulin and sucked it up, setting my alarm for in 2 hours time for an inevitable correction. I corrected at midnight, setting another alarm for 2am. As it happens, a nurse came to check my blood sugar at 2am just after I’d done it myself because I was being put on ‘nil by mouth’ again (no food or drink) and I was 5.1 mmol/L so she came back with a sandwich. I said I was fine and declined.

Come morning, I was at a nice 4.2 (they didn’t think so) so they put me back on Glucose, but at a lower dosage again. The doctor came around at 9:30am and said I could come off the drip and eat again – but it took 1.5 hours after this for a nurse to come back around and see my notes. She gave me some water but said the lunch cart would be another hour, but offered me yoghurt or toast. I said I don’t really eat carbs. She asked what I’d usually eat and I said ‘bacon and eggs, meat, fat, salad, just not carbs’. She then she offered me fruit. I said I didn’t eat fruit (She’s a nurse, doesn’t she know fruit has high fructose content?!) She said the diabetic food option is probably a bowl of pasta. I said ‘that is not a diabetic option!’ to which she said ‘I know’. So I was on the verge of tears again, telling myself to man the hell up.

A nurse popped by in the mean time and asked if I was diabetic. I said yes. She said ‘insulin required?’ I wanted to say it depended on what the meal would be, but I think what she meant to ask was ‘insulin dependent?’ – either that or I thought I’d end up with a plate and a syringe full of insulin on it.

‘Coffee?’ ‘Yes please.’ ‘Milk or sugar?’ Sigh.

When lunch arrived, I was scared to lift the top off as I saw an orange on the side of the tray. Lifting up I saw liquidy scrambled eggs, one slice of bacon, a tomato and toast. I ate the slice of bacon with my water and sat there for another 3.5 hours before anyone came to see me.

Now the doctor wants to keep me in for a third night. But she said I could leave the hospital for a wee while if I felt up to it. I made a break with it to get food. As soon as I left, my stomach pains increased again, but I had a delicious, decent, meaty, low carb dinner. Because my BS was 5.1 when I left, the nurse told me to be careful and to have carbs. Sigh. I came back with a BS of 5.1. She said ‘you are quite good with your levels aren’t you’. Yes! Yes, I am! Now please have faith in my ability to keep my own blood sugars stable! It’s quite easy to do without carbs! I wish I could’ve said that. Instead, I said ‘yes, they’re always stable. I have the HbA1c of a non-diabetic.’ She said ‘Oh, good’. I don’t know if that meant anything to her. She walked away, leaving my hospital food on the table (Roast beef, gravy, yorkshire pudding, mashed potato, peas and a fruit salad…they couldn’t have fit any more carbs on that plate if they’d tried). 

So here I am, lying in my hospital bed with unexplainable stomach pains, nurses and doctors that don’t have a clue about Type 1 diabetes and an inability to maintain my blood sugar levels without unavoidable carb and glucose intervention. I also just have my phone, which is why my final Diabetes Blog Week post is delayed.

Oh hang on, the nurse is coming around.

‘Hot drink?’…’Coffee please’...’Milk or sugar?’…

The 5 Stages of Grief…

I’m usually inherently positive about diabetes, and to be honest, about life in general. I crack a lot of jokes. I laugh at myself, and I laugh at my illness. Sometimes. Of course, that’s not always the case – like when I was told I had Type 1 Diabetes, I quietly went through the five stages of grief.

Stage 1. Denial and Isolation

Maybe it’s all just a big mistake, maybe I don’t have diabetes. How do they know for sure? If I don’t check my blood sugar I can pretend it’s fine. Ignoring it will make it go away. If I isolate myself I can hide this.

Stage 2. Anger

What did I do to deserve this? Why do I have diabetes? I look after myself, it’s not fair! 

Stage 3. Bargaining

Please take it back, please tell me it was a mistake. I’ll do anything. C’mon pancreas, start working again and I’ll act like this never happened. I’ll run more, I’ll eat better. Please?

Stage 4. Depression

This is it, this is my life. I have an incurable chronic illness. My life is ruled by test strips and insulin shots. I can’t do this. I don’t have the strength for this. I don’t have the mental capacity to do the mathematics to keep my body functioning right. This SUCKS!

Stage 5. Acceptance

The fifth and final stage of grief is the reason I need to ‘clean it out’. It’s part of the reason I got my medical alert tattoo – to accept that this illness is for life. Diabetes turned my world upside down. I went from a low maintenance girl to a high maintenance girl – except instead of needing more time to do my hair, I need a little more time to test my blood sugar and inject insulin. Instead of holding my hair back when I’m sick, I might need you to open a juice box for me instead. Diabetes has taught me that my body is a little more fragile than it used to be. It’s a little more temperamental. It needs a little more care. But diabetes has also taught me that my body is stronger than I could’ve ever imagined possible, and that power was always within me. My body still endures pain, my lips still kiss, my skin still feels, my eyes still see and my heart still beats. I’m still here, and I’m still very much alive. My name is Tamsin and I have Type 1 Diabetes. 

 

Diabetes Blog Week

I wrote this post for Diabetes Blog Week – an annual blogging event designed to share different perspectives over the same topic, and to make connections and better understand Diabetes. Today’s topic is ‘Clean it out’ and aims to let go of something you’ve been hanging on to, physically or emotionally.

Diabetic Problem #3: Having a Hypo 1 hour before your insulin peaks

Jelly BeansThis morning I woke up to a slightly elevated level – 6.1, after going to bed at 5.8 just after eating a carb packed kebab (I’d been out drinking so I ended the night with some carbs to prevent a hypo while I slept). I took my usual correction for this – 1.5 units of NovaRapid and thought nothing of it. When I was tapping away on my laptop an hour later, I suddenly lost the strength to carry on typing. I was tired and drained, so I closed the lid to my laptop and lay my head down. An immeasurable moment of time passed with me staring into space before I broke through the fog and realised I was beginning to hypo. I grabbed my monitor and tested; 4.1. Good. I caught it early but alas, there was still insulin I’d injected into me that was going to peak in another 45 minutes. I had a jelly bean. I lay back down. I had another jelly bean. That would usually be more than enough to bring me up to a healthy range (I’m really sensitive to carbs and sugar!), but how much was I going to keep dropping until the NovaRapid had reached it’s peak? I kicked the covers off me as the hypo sweats began. I blew air onto my face. I had another jelly bean. Tested again. 4.3. Better but still dropping. I had another jelly bean. Was it too much? I never usually need 4. What if I’m over treating? What if I’m still dropping? I put the TV on to pass the painstakingly slow time. The shakes began to slow. The sweats started to dissolve. The strength began to come back. At the 2 hour mark, I was 4.7. Phew. Perfect. So then I  stood up, got dressed, and went to make breakfast like any regular person.

What does being a diabetic actually mean?

InsulinWhen 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.

EXPERIMENT #4: Pretending I can eat carbs like a normal person

I’ve had beautiful blood glucose levels all week. Just look at my graph, staying pretty steady and within the safe lines.Screen Shot 2015-05-06 at 17.35.50

Do you notice anything? Let’s me talk about Tuesday. Tuesday was a good day. We made the 5 hour round trip to Invercargill for my post-surgery follow up appointment. I’d had a delicious breakfast of bacon, eggs and avocado, and the day had been alright. But then we made the long drive home and the decision to go for a curry as soon as we got back. We were so hungry. At the Indian, I made the decision to eat the naan bread with my curry, along with 2 spoons full of rice and some onion and spinach barges. ‘I’ll just cover for it all with insulin’. I said. ‘I’ll test before the 2 hour mark to check I’m not too high or too low’ I said. Well, this happened.

Screen Shot 2015-05-06 at 17.19.24

My beautiful green dots were ruined. It took me 13.5 units of fast acting insulin, 8 hours, 7 finger pricks, 4 hours of abdominal pain, 3 injections and 2 middle of the night alarms to get me back into the healthy range.

The curry was lovely, by the way. And I don’t regret it. But look at the graph. Look at the insulin. Look at the effect of the carbs on my blood sugar and my stomach. Quite simply, they are not worth it.