My last Diabetes check up

Last meeting with my Diabetes team I had a really good result of 6.6%. I went to the meeting and got in trouble because my meter had too many hypos on it from the previous 2 weeks.

The annoying thing was that they didn't really pay attention.  There was probably less than half the actual hypos as I often double check or check 10-15 minutes later when I am still coming up, but the meter still registers me as low.

The second problem is a lack of understanding of statistics. They claimed that my good result was not any good because a I had too many lows, therefore balancing out the highs.  A wild extrapolation at best, the readings on my meter were for 2 weeks, the HbA1c test is and average for 3 months. Additionally the amount of time I am high for, when I am high, is usually significantly longer then the amount of time I am low for.  I treat lows very quickly with lots of sugar, and I treat highs very slowly with small amounts of insulin so that I do not end up low. So pretty simple statistics tells us that I would need an extreme amount of lows to balance out a few long highs.  Therefore my control must have on average been better than they were suggesting.

Their final comment on this was that its bad to have too many lows, as you can lose sensitivity to them.  OK fair point, but considering I don't normally have that many lows I think I will be OK.  Then came the knock out punch.  I was told it can lead to problems with the brain if I have too many hypos.  What the hell.  That was new to me.  I am aware what can happen if I don't treat my hypo, then its quite possible that I could cause damage to many of my organs.  But when I refer to a hypo I am just low, nothing too serious.  Still able to treat myself.

Everyone knows about the long term complications of high blood sugar. But now I am learning about the long term problems with low blood sugar too!  According to this article research done states that there are no problems associated with too my low blood sugar incidents and in fact it is preferable, and expected,  if that is the consequence of keeping blood sugar low.  Phew!

to quote the relevant part:
"Researchers also found that intensive management, which often resulted in more frequent low blood sugars, had no negative effects on the minds of patients. You can rest more peacefully knowing that low blood sugars do not seem to have any connection to cognitive impairment."

Do not get frustrated

Having diabetes is frustrating. It just is. While other people are tucking into their food I am sat fiddling with testing equipment, needles and pens. Even worse when I am keeping my logs, I have to type into my phone what I am eating.  Worse still when out with friends it looks rude to be sat there typing on my phone while at dinner, I am not on twitter this is a medical necessity ... mostly.  When we go out to restaurants for dinner I have to ask the waiter what carbohydrates come on the plate.  When we go to friends I look impatient because 5 minutes before the meal starts I am asking them whats for dinner, so that I can get my calculation correct.  And that's just the day to day management.

Then there are the highs the lows and the swings between the two. They are both horrible in different ways. Highs make me feel terrible in a lethargic and fuzzy headed way.  They are not so scary in themselves but I know what long term bad control does to people.  I have seen a lot of complications of diabetes and it is not pretty.  Blindness, kidney dysfunction and worst of all loss of limbs is a horrible prospect.  Especially when I wake up high and I know I have been high all night, that is when I start to remember what I have seen.  It is scary.  The hypos are more scary at the time, they can also have a prolonged effect even after I have recovered my blood glucose levels I am still affected by it later.  The worst is early morning or in the middle of the night.  I wake up, a neat reaction to low blood sugar, so I can deal with it before it gets too bad.  But the interrupted sleep usually messes up my next day.  The additional problem with hypos is other people, some know what to do, some don't, some panic some don't.  My wife knows what to do, she will get up in the middle of the night and get something from the kitchen if need be.  She will also stop me from doing something stupid.  I had a hypo while were out the other day and she stopped me from carrying on and made me sit down and drink a coke.  It must be frustrating for her too.

This reminds me of something that happened to me a few months ago. We were returning from London on a British Airways flight. It was towards the end of the flight and people were being told to return to their seats to prepare for landing.  I started to get that feeling.  Slightly fuzzy head, and tingling in my lips and tongue.  "Uh oh" I said to my wife as I started fiddling around with my BG monitor.  The reading was in the 40s (mg/dl - thats around 2.5mmol/L).  I stumbled my way to the back of the plane.  I said apologetically that I was diabetic and I needed to sort myself out. They were really quick on their feet, water, coke, something to nibble on.  I waited while I recovered and chatted to these two wonderful women.  They said they had had training in how to handle this situation and one of them had been a nurse earlier in her career so was familiar with my condition.  They handed me some more water and coke to take back to my seat just in case.  I was stunned, I mean it was so well handled, no panic, no calling doctors.  Just understanding the situation and handling it perfectly.

So I do what I can to get it right, I am frustrated by what I have to do, and more frustrated when I get it wrong.  I am sure I calculate my insulin correctly then I check a few hours later and find I am really high, or low.  Then I have my recent Hba1c result 7.4%, not terrible but after the training that I had been doing and the loss of weight I thought maybe it would be and improvement.  This is the biggest frustration.  With all the other frustrations one would hope that it would lead to better results.  But when it doesn't it gets super frustrating.  The natural reaction is to say to yourself, its not worth it.  Why bother trying so hard when it makes no difference.  Why test? why exercise so much? why bother trying to calculate how much insulin, take less and just avoid the hypos.  Why not? because its worth it in the long run.  This disease takes practice and a lot of work.  You cannot expect to get it right every time, but you can learn to listen to your body, you can work at every aspect of what you do, and you can get better results.  Getting frustrated and giving up is the worst thing you can do.  If you want to scare yourself into getting it right ask your doctor to tell you about diabetic complications.

It may seem like it isn't but this is a simple problem.  It is.  It is a closed loop, you are closed loop.  Your results can be calculated, what goes in will come out in the result.  It is not as simple as the equation of insulin exercise and food.  That's the starting point, know how your body reacts to these 3 main components.  What changes that reaction; time of day; illness; stress.  You can understand how you end up with the results you do by keeping a log, keep as many details as you can, test often.  Get in tune with your body, accept that you will have bad days and bad results, but don't let it get you down.  Keep going, keep striving to get it right.  Live a long and healthy life.