Tuesday October 25th 2011

Time seems to be passing by in a blur at the moment! Where has the last week gone?

I spent the weekend, after my post on Saturday morning, pretending not to be diabetic… I have come to the conclusion that micro-managing my blood sugars doesn’t provide the answers so I thought I would try the opposite: letting go of the reins slightly. Turns out that’s not the way to do it either!

I’m sure not everyone with diabetes struggles to the extent I do. But I can never work out why I do. Sometimes I think it’s a personality flaw; like I said above, trying to control it so tightly that it’s impossible to control it at all Other times I think it’s my career choice. What makes teaching such a great job is the fact that no two days are ever the same. Unfortunately that has dire consequences for me in terms of my diabetes. I’ve often thought about trading it in for a more sedentary, more predictable, daily grind and while I know that it wouldn’t keep me on my toes I can’t help thinking that maybe, just maybe, my health is more important? Yet other times still I think it’s just the way it is: maybe my body just won’t do what it’s told. I am an Arian after all and I whole heartedly second Bette Davis (a fellow Arian) when she said, “I don’t wish to be told what to do.” And, I guess, that takes me full circle, back to that good old personality flaw…

So as I said, I spent the duration of the weekend burying my head in the sand, as I genuinely think is sometimes called for. I can’t recall my BG levels (although I did test and take my insulin; unfortunately I have to do these even when in denial!) but I’m pretty sure they weren’t pretty. I had one too many beers on Saturday evening and got a McDonalds on the way home (why oh why are they 24 hour here?!) although I did only eat half of it as on my return from a toilet trip my Shanghai McChicken Burger had mysteriously disappeared…

Today my BG levels have actually been ok. I’m still at a loss as to my overnight levels though: on Monday night I woke up at 5am mid-hypo, a sure-fire sign that my overnight basal dose is too high. This morning I woke up with NG levels that were also too high. Not ketone high but high enough not to be good. So this poses the same question again: am I hypoing in the night? More 3am testing is the only answer.

I came home today after school with intentions of going to the gym. I made an executive decision not to test before I went. Only because I find it very easy to talk myself out of exercising. Although writing it down now does make me realise this is not really a sensible way to do things. I got into the gym, warmed up, ran a little and started feeling very dizzy. I almost made myself carry on as I thought it might be due to high BG levels or even lack of water today, but something made me stop and I’m glad I did: my BG was 54, well within hypo limits. I slowed the treadmill down and drank my juice fully intending to carry on (I was in stubborn I’m-here-and-I-don’t-want-to-be-defeated-by-my-blood-sugars mode) but slowly I realised that continuing would be a very silly idea. I had visions of fainting and the outcomes were not to be entertained. I went back upstairs with my tail between my legs. I will try again tomorrow. If I have the energy after Parents’ Evening that is…

I have been thinking over the last few days about the effect writing this blog has had so far. I can only think of the positives. So far I don’t feel under pressure to write (even though tonight’s post is feeling a little rushed; I’m absolutely exhausted!) and writing things down is having a somewhat cathartic effect on me. Writing things down has always helped, but as I said in my first post, I’m not sure my writing outlets have always been healthy ones…. Also I have had so many positive comments, online and in person, from people who have read my posts. If I can make more people aware of diabetes (although I hope not in a negative way, I wouldn’t want people to think that diabetics need constant sympathy or monitoring – even though I think, maybe, that is the way my posts make it seem!!) then I feel I have done something worthwhile in my writing. And finally, the communications channels that have opened up as a result make it worth it on their own. Having honest, meaningful discussions with people I know helps me no end. And I’m not sure that I would be able to start those without this.

Saturday 22nd October

And so, at 10:30 on a Saturday morning I’ve already been on a rollercoaster ride of emotions!

Yesterday was my lovely mum's birthday. This morning I received an email from her and it really made me wish I'd been able to spend at least some of her birthday with her. The pros and cons of being so far from England I guess...

The last couple of days have been a bit funny; I began the week tired because of the school camp followed by a weekend away and I ended the week absolutely exhausted because of bouncing blood sugars.

On Thursday evening I went to the gym again. But this time I had a snack and covered it with insulin in the hope that the insulin would prevent my BG rising, as I explained in my last post. It worked in the short term, when I tested after exercising my blood sugars were on the low side of perfect, absolutely fine for before dinner. I ate and injected, reducing my RAI dose by 10% to allow for the exercise and when I woke up in the night I was, again, sky-high. I still don’t understand why this peak is occurring in the night.

Yesterday I had an almighty hypo in the afternoon. As often happens after a hypo, my BG then shot up: before dinner I was in the high 200s. J and I went to a colleague’s house for dinner (and had a lovely time!) but due to the hypo and possibly eating a little too much I woke up this morning with a BG level of 324: way out of range. As usual, this made me feel awful, both physically and mentally. For the last few days my eyes have been feeling ‘funny’: just slightly strained and out of focus. It might be that my prescription has changed but in my head it’s always the onset of diabetic complications. This morning was no exception. My eyes felt blurry, my throat was dry and my head was thumping. It was half 7 so I got up, did my basal injection and took a shot of RAI to correct my levels before going back to bed. I dozed off and on for a couple of hours but couldn’t really relax; I was feeling very frustrated. It seems that the more I try with my blood sugars the more confusing it all gets and the more out of control they get. At that point I was ready to give up.

Often, at this point, I let myself wallow and I end up getting upset and being moody. But today I remembered my blog and I decided that today was not going to be one of those days! I was lying in bed, listening to the music J had put on, dozing and willing the insulin to work. I was frustrated as I’d planned to go to the gym when I woke up, but rather than getting annoyed I decided to go later. Small things you’re probably thinking, but when my blood sugars play up I can find it very difficult to be rational where my mood and my diabetes are concerned.

About an hour ago I tested again, and this time I was 174, still a little high but much better than 300. I used my App to email myself the data from and am going to spend a little time later trying to see any patterns in my BG levels. Then I had breakfast and decide to write this short entry before the day starts properly. As if to match my mood, the weather has been horrible the last day or so: constant driving rain, grey skies and cold! Tonight, the firework festival in Busan starts, if it is not too wet! Hopefully later we will go and watch the show. I am undecided as to whether I will drink: alcohol affects BG levels and at the moment I feel like they’re just bad enough already.

Wednesday 19th October 2011

The last couple of days have been an examples of the “quirks” that diabetes can throw into the mix, just to make things that little more complicated!

In my last post (or maybe the one before?!) I said that exercise lowers blood sugars. Now, this is the theory! Aside from a known exception this is the effect exercise SHOULD have on the blood sugar levels. Unfortunately, my body doesn’t seem to be aware of this! I’ll explain from the beginning, but before I do I will explain a little about how insulin works and the effects of exercise… In the words on Jennifer Aniston, “Here’s the science bit, concentrate!”

We eat food to give us energy and in our bodies that food is broken down into glucose. Glucose gives our cells the energy they need to function. But in order for our cells to utilize the glucose they need insulin: insulin acts as the key to allow glucose into the cells, without it the glucose floats around in the blood system doing all sorts of damage to the body’s organs.

As a diabetic, I need to give my body just the right amount of insulin to let the glucose into my cells; your bodies cleverly do this for you to an amazing level of precision. When the glucose can’t get into the cells a diabetic will feel lethargic and, if left untreated will start to lose weight rapidly as the body tries to get energy from whatever sources it can, beginning with the fat surrounding more muscles, before eating away at your muscles and eventually the organs themselves. The levels of glucose in the blood will rise to a dangerous level, generating ketones (which are a by-product of your body burning its own fat) and can eventually lead to a coma. When I was diagnosed I was very close to being comatose. My BG was 44.4; incredibly high!

But that’s an aside… A diabetic should only exercise when their BG levels are near to ‘normal’. This is because when you exercise, your cells use up energy. In order for the glucose in your blood there needs to be enough insulin in your body to allow the glucose into your cells. If a diabetic exercises when they do not have enough insulin to take the energy from the glucose available, the body begins to use the fat stores for energy, not a problem in itself for this short period, but it results in the BG levels rising instead of falling. A bit complex, and to be honest I think it does my good to write all of this down again; it’s easy to forget!

So now onto the last couple of days:

On Monday night, as I said I would, I tested my BG before bed, during the night (at around half 3 when a motor cyclist decided to do laps around our apartment building) and in the morning. This is what I found: before bed on Monday my BG was 269 (14.9), far too high so I corrected by giving myself 1.5 units of RAI. On waking I was 170 (9.4), still a little high but roughly consistent with my 3am test, which was 138 (7.6). I have converted into mmol/L because I still find it easier to analyse them in this format.

Given that I think my correction factor is 3mmol/L for every unit of insulin, giving myself 1.5 units of insulin with a BG level of 14.9 should mean that my BG levels stabilise at around 10.5. Mine went down to 7.6, which is a little lower than I would have anticipated. This, on its own, may mean my correction factor is incorrect and that actually 1 unit of insulin lowers my BG by more than 3 mmol/L, or, because it was more than four hours since my RAI dose, it could mean that my overnight basal dose is too high. (Rapid Acting Insulin has a profile of around 4 hours and the basal insulin’s job is to keep my BGs stable without food or RAI, the two work together as the graph below shows:)

BUT then, on waking, my BG had gone UP again, by 2 mmol/L which, on its own, would suggest that my basal dose is not high enough. Together, I have no idea what to do with these two bits of contradicting information! I need to continue as I am doing, and hopefully some sort of pattern will come to light.

But it doesn’t stop there. Last night, when I got in from work I went to the gym. I tested before I went and I was 166, a perfectly acceptable level to go to the gym on. So I went, and afterwards I was 169. I ate dinner and gave myself my RAI according to my App, reducing it by two units to allow for the exercise, the effects of which can last up to 24 hours.  Before bed I was 202, a little high but again because of exercising I decided not to correct, thinking my BGs would fall over night. But when I woke up at half past two and tested I was 334! And I have no idea why… It could be to do with my basal dose not being right, but 132 is a massive rise, much bigger even than the previous night. My App told me to correct, so I did and I woke up with a BG of 155: much more respectable but still a little higher than I ought to be.

So basically, as it stands, I’m a little stumped. I am going to try and repeat my tests tonight and see what happens. The only way to know for sure is to build up data over a period of time. It’s just frustrating, especially at this point, when it doesn’t look like there is any rhyme or reason to any of it! Even just in the space of 2 days my App sstats have changed. My % of hypoes has gone down to 9% but my ketone warnings have increased from 0 to 2%. Although it’s easy to be sneaky and try not to test at the times which may result in unwanted readings! For the sake of this bog at least, I will try to be honest with myself.

I was just thinking too how, psychologically, the new units of measurement give me a larger window of acceptable blood sugars: in mmol/L the acceptable range is 4 – 7; in mg/dL the equivalent is 72 – 126! While I know that they are the same a margin of 54 seems much easier than one of 3!

Monday 17th October 2011

A few days have passed since my last post; I thought that might be the case what with a school camp and a weekend away. As it’s been so busy it’s passed in a bit of a blur, and I always find it hard to reflect accurately on the ups and downs of each day. I even find it hard on a day to day basis to be accurate I guess… Once I’ve gotten over a drama it can be quite hard to revisit!

The camp, in terms of my diabetes was quite challenging. I had a lot of hypoes. But then I was expecting this. It’s happened before and my daily control is not good enough on a normal day, let alone on one that as far out of the norm as a school residential, to enable me to pre-empt the effects of what I am doing. It's not that I'm not trying, but I do find it difficult. You see stress plays a major part in my control. The hormones your body releases when you are feeling stressed inhibit the action of the insulin, thus making blood sugar levels rise. But then exercise (or constantly being on-the-go) has the opposite effect: yet more variables to add to the balance and ones I find almost impossible to work out as it stands.

The good thing is that I’m getting to grips with the new units of measuring my BG levels. I am almost completely weaned off my old (wonderful!) BG meter and am now relying on my new simpler meter combined with my App. I am still being very diligent in recording everything on the App, which is where I usually fall down after a week or so. But a week in and I am still going, maybe there’s hope?!

The weaning process has been slow and I have been well and truly out of my comfort zone. At first every time I looked at the screen and saw a 3-digit number I panicked! Slowly the reverse is becoming true! Now, a 2-digit number is starting to represent a hypo so I am getting there! I am, at the moment being very general with my understanding of the readings: a number below 100 is heading into the hypo regions; a number in the 100s is acceptable and anything above 200 is bad.  This is not strictly right, but a ball-park figure is good enough for me at the moment.

The App is great for three reasons:

 1, when I enter my BG reading into it, it automatically tells me how much insulin I would need to take to correct it back to an acceptable range. If it is too high that is. If the correction dose is small I can tell that it’s only just out of range without really understanding the exact value of the reading in old money. Going the other way, once the reading hits 72 mg/dL a red warning flashes up telling me to eat – quickly!

The second reason is that when I open the App it tells me immediately how much insulin is still acting in my body. This is approximate s it is highly unlikely that I set the meter up perfectly to begin with, but again, it gives me some sort of idea. If I am hypoing and I still have 6 units of insulin, say, on board, that is not a good thing! It means if I don’t eat enough I will be more than likely to have another hypo later. It is very clever though. It logs my hypos and if I have had a hypo within the last 6 hours is adjusts my dose accordingly by giving me slightly under the dose it would normally recommend (there is also a box to tick if you have had “More than 2 drinks in the last 4 hours”; normally at that point I am no longer testing my BG!)

Thirdly, it does all sorts of number crunching with the data. So far it is looking like this:

·         My average BG reading is 147 mg/dL

·         Number of readings: 46

·         Ave no. of readings per day: 6

I have always been told off for testing too much. I never really understood why this was a bad thins, other than the possibility of micro-managing my BG levels, until I did 5-day DAFNE – dose adjustment for normal eating – course where I was told how precious our finger tips are. Without actually saying it, I think the nurse was referring to potential future eye problems and this scares me. I now never use my index fingers to test. In her words, “they are too precious.”

·         Ideal readings (72-144): 39% (At least there are some!)

·         Ketone warnings (>306): 0%

This is a good things. Ketones are nasty little blighters. They lead to something called ketoacidosis which causes a diabetic’s blood to turn acidic and it has all sorts of dire consequences. Ketones are a problem when BG levels are high and often occur when we are ill. Being ill is a lot more complex for someone with diabetes, especially where vomiting is concerned: not being able to hold down food is a big problem.

·         Hypo warnings (<72): 12%

This needs to be lower. Ideally 0%.

·         Estimate HbA1c: 6.7%

Now. This is good. But as my doctor once told me, just having good numbers doesn’t mean it’s actually good. It could just be this low due to the number of hypoes I’ve had, the good old law of averages!

According to www.diabetes.co.uk your HbA1c is:

“HbA1c occurs when haemoglobin joins with glucose in the blood. Haemoglobin molecules make up the red blood cells in the blood stream.

When glucose sticks to these molecules it forms a glycoslated haemoglobin molecule – also known as A1c and HbA1c. The more glucose found in the blood, the more haemoglobin will be present.

Due to the fact that red blood cells survive for 8-12 weeks before renewal, by measuring HbA1c ,an average blood glucose reading can be returned.

 For non-diabetics, the usual reading is 4-5.9%. For people with diabetes, an HbA1c level of 6.5% is considered good control, although some people may prefer their numbers to be closer to that of non-diabetics.

 People at greater risk of hypoglycaemia, may be given a target HbA1c of 7.5% to prevent too many low blood sugars from occurring.

HbA1c refers to glycated haemoglobin, which identifies average plasma glucose concentration.”

Basically, it measures the amount of glucose that is being carried by the red blood cells in the body and because they live for around three month it gives you an average picture of your BG levels over this time. If your BG levels are consistently within range, your HbA1c will reflect this. Unfortunately, if your BG levels bounce from hyper to hypo, your HbA1c will also, more than likely, be close to being within range. Therefore, the bouncing is the thing to avoid…

So. From here on in, my targets are to avoid hypoes and (still!) to get my morning BG levels down to within the acceptable range. This morning they were high (around 14 in mmol/L, I did test in mg/dL but the numbers escape my brain on recall!) Tonight I am going to test before bed to see what happens over night. And, if I remember, I will leave my meter in the loo so if I get up in the night I can test. We’ll see!

Tuesday 11th October 2011

Today has been one of those rare days where (so far, fingers crossed!) my blood sugars have been mostly within range all day. By range I mean the window of safety between 4.0 and 7.0 mmol/L. When I woke up my reading was 7.6 and I always find this has a profound effect on how my day starts. Recently I have been waking up with BG levels in the high teens and twenties. Physically this makes me feel unwell, I liken the symptoms to that of a hangover: headachey, thirsty, exhausted. But it also has an effect on my attitude towards my day. I feel miserable when my blood sugars are that high and, until I get into work at least, I find it very difficult to focus on anything else. Luckily, when I get to school and work takes over it gets pushed to the back of my mind.

But today I began the day at a decent 7.6. My target for today was to begin the weaning process from my snazzy do-all mmol/L meter to my Korean mg/dL meter. This has meant that for most of the day I have done two blood tests every time I wanted a reading. I have sore finger tips – and I’m pretty sure I punctured the same hole twice on a couple of occasions, not a pleasant experience – and I don’t really feel any closer to knowing but I need to be realistic. Rome wasn’t built in a day! By break time I was 6.6 and before lunch I was 4.3. Pretty perfect really.

I have been finding the diet here quite hard to get used to. In England I ate ‘brown’ everything. I have managed to find brown rice and pasta which we have at home but the school dinners rely heavily on ‘white’ carbs, as do all restaurants. I was finding that I felt bloated and horrible after eating all the white stuff so I decided at the end of last week to try to skip the carbohydrates at lunchtimes. Whether or not type-1 diabetics should eat low-carb meals is a contentious issue and I have had many a debate on the pros and cons on various online forums. However I have been finding that it’s definitely got its positives, so I’m trying it out. Brown bread is something I am really missing; Korean bread is very white and very sweet. I miss the good old English granary!

At the end of the school day my BG levels were 6 still. I got the bus home and went to E-Mart to buy some food for lunch tomorrow (I am going on the Grade 5 camp – always an interesting blood sugar event!) and on the way home I started getting hypo warning signs. A hypo is when your BG levels fall below the safe limits. Apparently, from the outside, a person experiencing a hypo acts drunk. When I am experiencing one myself I don’t feel drunk but I have seen another diabetic have a hypo and I found it very interesting! It was like watching myself and I couldn’t help but have a little giggle to myself! Again there are symptoms associated with a hypo. There are the physical reactions: sweating, shaking, hunger, blurring eyesight and a general feeling of confusion. Other feelings that go with it can vary. If I am reading I find I will have to read and re-read a line over and over and it just doesn’t make sense.  Or sometimes I feel like I’m walking through mud and everything around me is moving on a fast forward button. And sometimes my brain thinks about exercise but it feels like a foreign concept; it just can’t compute the idea of running! Funny things hypoes… So when I got home I tested my BG and it was 4.3, just on the verge of a hypo. At this point I got a little frustrated; I had toyed with the idea of eating something before I left school but decided against it. Also, I was planning on going to the gym, something I won’t do following a hypo.

The reason for a dip on blood sugars at this time of day is another thing to try and work out. As well as being a balancing act between food and insulin, diabetes also requires a balance of sorts between types of insulin. Every day I inject two different types of insulin: Levemir, a long-acting basal insulin and Novorapis, a short-acting bolus insulin. The job of the basal is to create a platform for the bolus, the idea being that  if you don’t eat, or inject, your BG levels stay stable. The job of the bolus is to counteract food, it is this insulin I have to calculate the doses for with my meals. Bolus insulin has a profile of about 4 hours, so a hypo within 4 hours of taking a dose is normally due to a miscalculation of either food or insulin dose, while a hypo more than 4 hours after a meal is usually down the to the basal dose not being right. So bearing in mind that today I ate and injected around 12:45 and I hypoed around 5:00pm it is hard to tell which insulin is responsible! I will need to keep a record over the next few days and see if any patterns occur: the reason for this blog! But then the basal dose in itself is a whole other ball game: it is the first port of call and the thing I NEVER get right. In order to check the dosage over night , I need to wake up at 3 am to check the stability of my levels comparing the bed time level with the waking one. During the day I need to fast over a meal time and test my blood sugars every hour to check how stable they are. Neither one of these are events to look forward to, especially on a work day/night!

I think enough for today. I will be interested to see what happens over the next few days, being away with the children.

And thanks for all the positive comments. Knowing people have read what I’ve written so far gives me a bit more motivation to keep writing more!

Monday 10th October 2011

And so, here I am, trying this blogging malarkey again.  I tried it once before, a few years ago and I didn’t quite manage it. But here I am again!

I need to be clear about my intentions from the outset. I want to use this space to make myself clearer about what living with diabetes means and not to spiral downwards into a self-indulgent pit of self-loathing and self-pity.  I want to try and discover patterns in my behaviour and my blood sugars that I am missing at the moment. Writing them down, in what could turn out to be a more public way, might be the key.

Me and diary-writing have a very long and very established relationship. I first started keeping a diary when I was 13 years old, in Year 8 at school. It was a narrow, week-to-view Whinnie The Pooh diary; one page of each week was taken up with a picture of the friends in Hundred Acre Wood, the other page was invariably filled with your typical 13-year-old drivel: love hearts, declarations of hatred and a diligent record of who was number one in the charts. Over the years my diary writing took many forms. One year (1997?) my diary was a fluffy zebra print notebook I affectionately named Elvis. Another year it was a scrapbook, sometimes it was a series of Word documents, sometimes a simple exercise book. All of these diaries have one thing in common. It started very abrubtly with an entry which I’m sure stood against everything Pooh Bear stood for, although maybe not so much Eeyore. The entry simply said, one day in Year 8, “I hate myself.” Ever since then my diaries have been an outlet, and perhaps not a very healthy one.

When I was around 15 my boyfriend told me that keeping a diary was sneaky, and that I shouldn’t go around writing about people behind their backs. Little did he know that other people were rarely the subject of my writing. But that said, I am beginning to think he had a point. Maybe it’s time to be honest about how I feel. I am no longer at school, at least not in that sense of meaning, but I still find that my feelings – especially where diabetes is concerned – can be overwhelming to say the least. Moving halfway across the world, to Busan in South Korea, has sparked something in me. Maybe it’s just a normal thing to want to reach out to those I’ve left behind and others; I’m not the first person who has moved abroad and started a blog. Maybe it’s the fact that I have been diabetic for such a long time now and being stuck in an endless cycle of hope and depression is just becoming too exhausting to cope with day-to-day without at last trying something new to break the cycle.

Anyhow, here goes.  But where to start? 16 years is a long time to recap! So I think I will just start with today, and the events that made me decide to try to log my thoughts.

Today I went to Haeundae Paik Hospital for my first diabetic clinic Korea-style. The hospital is clinical. As you would expect. It is a gleaming multi-storey masterpiece. On the basement level are three trees. I think they are real but I couldn’t tell. They are growing up from a carpet of synthetic grass and are bedecked with fairy lights. In Korea you visit a specialist for every ailment; there are no GP practices but ‘Endocrinology and Metabolism’, Contagious Disease’ and ‘Cancer’ centres. In-patients shuffle around in matching pyjama sets displaying various shades of greyness and often tugging a drip stand behind them.

My first stop this morning was the ‘Haematology’ Centre. I gave my piece of paper (scrawled all over in Korean, with the date and time of my appointment, for which I paid 400,000 Won) to the receptionist, took a ticket numbered ‘67’ and watched the numbers rise to match my panic. I hated having blood taken. At home, I’ve almost passed out on a number of occasions. My veins always ‘hide’ and I normally come out with the crook of my elbows black and blue. In the two minutes I waited I downed almost a litre of water to plump up my veins. I was pleasantly surprised at the speed and lack of discomfort that ensued! My veins behaved (thank you, water!) and before long I had a tiny plaster covering the hole. Next a urine sample and then a two hour wait for my appointment. As I was fasting I went to Paris Baguette on the first basement floor and bought the only thing that looked savoury: a bread with slices of sausage stuck in it. I ate it and amused myself with my iPhone while I waited.

It was there I decided to start a blog. And there I had a brainwave. In England we measure blood glucose levels in mmol/L, in Korea they use mg/dL. I am used to decimal numbers and here the numbers are 3-digits. One of many things I need to get used to, and quickly. A few months before I left England I was given a new meter to use to test my blood glucose levels. It was an Accu-chek Aviva Expert: the best thing that ever happens to me. It (as if by magic!) told me how much insulin to take with each meal! Diabetes, you see, is a juggling act. On the simplest level it’s a balance between the food I eat (specifically carbohydrates) and the amount of insulin I take: too much food and my blood sugars rise too high; too much insulin and my blood sugars fall too low. Lots of toos. It sounds easy. It’s not. Anyway, the point of me mentioning this meter was that it was amazing. It means I no longer have to do calculations as my appetizer. But they don’t do the meters out here, or the test strips to go with it. So I am going to have to relinquish my hold on it soon…

So. I searched for an App to solve my problem. There is literally an app for everything! And, lo and behold, there it was! An insulin calculator. I downloaded it and started the set-up procedure. Just 15 steps. See? Not so easy! In order for it to calculate my insulin dosages it only needed to know the following (minus a few administrative steps like picking a user-name, blah blah blah):

1.       Decide on my carbohydrate units (I chose grams)

2.       Choose between mg/dL and mmol/L for the blood glucose (BG) units

3.       Enter in the smallest RAI (rapid acting insulin dose) – 0.5 units (the smallest increment available on my insulin pen; although I was to find that this would no longer be the case)

4.       Enter in the BG drop per unit of insulin (at home it would be 3 mmol/L but working in mg/dL it would be 54. I think)

5.       Enter in the units of RAI needed to cover a CHO (carbohydrate unit), given that 1 CHO is now 1 gram this would be:  0.15 at breakfast, 0.18 at lunchtime and 0.15 at dinner time. I think)

6.       Decide on my target pre-meal BG levels (breakfast 99-135, lunch 81-135, dinner 117-144, night time 117-144. I think)

7.       Decide on an ideal BG range (72-144. I think)

8.       Decide on my hypoglycaemic warning BG (72)

9.       Decide on my hyperglycaemic warning BG (306)

10.   Enter in the % insulin dose used each hour after it is taken (What?! I decided on 30% for the first 3 hours and 10% in the 4^th hour, at my app’s suggestion)

11.   Enter in the % reduction in RAI for exercise (I left this. For now)

12.   Enter in the units of basal insulin (BI) taken at different times of the day (am – 10, pm  - 18)

Phew. If it sounds like a foreign language that’s because it is. Every time I eat the above calculations/ formulae/ whatever go through my head. Eating a meal can be one of the most complicated points in my day. Hopefully, with this app, if all the above is entered in correctly, I will no longer have to think. But I will still have to estimate how much carbohydrate is on my plate and enter numbers into my phone before I can sit down and enjoy my food. It’s safe to say diabetes is always on my mind. So if I bore you, I apologise! I bore myself, but unfortunately I can’t get away from it!

Anyway. After all of this it was eventually time to make my way up to the ‘Endocrinology and Metabolism’ Centre. First it was my eye test. One day I will go into the complications diabetes can offer. But now I will suffice to say that blindness is one of them. A white-coated man led me into a darkened room and motioned for me to sit down in front of what could have been a medieval torture device. Luckily I have been confronted with the same machine a hundred times. It fills me with dread, but only because of the results it might yield. I put my chin on the chin rest automatically and listened to stilted commands in stilted English. The light flashed into the back of my eye and images of my retina appeared on a computer screen. I never did find out if there’s anything to worry about.

Then I was asked to go back out and sit in the waiting room. Eventually I was called into the doctor’s room. He speaks some English but I found it very hard to understand him. It turns out that the levels of TSH (something to do with my thyroid – I can never remember what exactly it stands for) in my blood are too high. My current thyroid tablets are no longer enough. My HbA1c (a type of ‘average’ of my blood sugars over the last three months, well, not exactly an average but that will do for today) was 8.4%. My target is 7.0%. So that’s what I’m aiming for.

But today at least, I was given no idea of how to achieve that. So it looks like I’m on my own. 16 years has given me some ideas to work with. But I fear that all I’ve done is learn bad habits. So with the help of my blog I am going to try to be more disciplined and to unlearn my bad habits and learn new, better ones.  A diabetic should lead a healthy life: a low sugar, low fat diet and exercise. At the moment I am working on 0 out of 3.

I left the hospital today another 300,000 Won lighter and feeling very lonely. But, tonight at least, I feel hopeful and determined. For now, all I need to do is build up a picture. I need to record my blood sugars and log my feelings. Then maybe, slowly, I will get where I’ve been trying to get to for the last 16 years.