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 4th 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.
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