Shoot Up or Put Up

I’m currently reading Michael Bliss’s excellent book “The Discovery of Insulin” (a full review coming soon, book fans!) which is a genuinely fascinating and sometimes thrilling account of insulin’s discovery and its path to mass-production. As someone with Type One it’s been very interesting and occasionally thoughtful look at the major breakthrough insulin undoubtedly was.

In 17th century England diabetes was known as “the pissing evile” (I think it should still be called this) and until the early 1920’s was completely incurable. A diagnosis of diabetes was a sentence of slow, inevitable death – with life expectancy for us Type Ones reckoned to be about a year or two at most.

Prior to the work carried out by Banting, Best et al in Toronto the best medical science could come up with was a diet pretty much free from carbohydrates. Dr Frederick Allan was the most well known advocate of this starvation diet and patients would be reduced to an intake of as little as 750 calories a day. In comparison we usually cram about 2,500 down our necks most days. Diabetics were reduced to living skeletons, but at least they survived, for a while.

Without treatment, the diabetic body would be unable to metabolise carbohydrates properly and in the later stages fats and proteins couldn’t be dealt with either, after which the victim’s system became clogged with partially burned fatty acids known as ketone bodies, which we occasionally test for if we can be bothered.

When large amounts of ketones were detected, doctors knew the patient didn’t have long to live. The patient would then fall into semi-consciousness and the lungs would heave desperately to expel the by-product of ketosis – carbonic acid in the form of carbon dioxide, with the victim taking great gasps of air known at the time as “air hunger” or “internal suffocation”. Thankfully, perhaps, a deep diabetic coma would follow, closely tailed by a merciful death.

Apologies for the lack of hilarious gags in this post, but as a Type One I found the descriptions of pre-1922 diabetics utterly horrifying. It was a lingering, unpleasant death that was equally unsatisfying for the medical profession to treat, as there was literally nothing they could do to put off the inevitable past a year or two.

Reading these chapters put my diabetes into perspective somewhat. When I was first diagnosed I had a few months of, to be honest, fairly mild suffering. I did feel ill with the classic symptoms, but I didn’t lose so much weight I clocked in at less than 100 pounds and comas were certainly never a realistic possibility.

As we all know, diabetes nowadays has its highs and lows – both physically and metaphorically. But I find remembering that pre-1922 it led to a lingering death both sobering and positive. So maybe that 10.3 reading doesn’t seem so awful after all.

We’re back from our long weekend in Venice, it was all the things they tell you in the guide books – romantic, beautiful, lots of bridges, water, gondolas etc and one thing they don’t tell you – carb heavy.

I’ve thought for years that as well as eating low GI foods reducing the number of carbs I eat gives me better control. When I got my CGMS the data showed that I had much better readings when I ate fewer carbs. This is of course logical, if you’re trying to cope with a massive plate of pasta the margin for error in insulin dosing is far greater than if you’re eating a small green salad. This isn’t rocket science.

I do keep an eye on how many carbs I eat and reduce them wherever I can and overall I do ok. But it’s not easy. I like food that contains carbs. And I now think it is physically impossible to have a low carb weekend in Italy – all that fresh pasta, risotto, pizza, ice cream, tiramisu (yes I know they do delicious grilled fish and marvellous salads and I tried, believe me, but they really do specialise in scrumptious carbs!).

I find pizza in the UK to be the root of all diabetes evil so I rarely eat it. Its high carb and also high fat so it’s absorbed quite slowly into my system. I need buckets of insulin to deal with the carbs but not straight away because the fat slows down how quickly those carbs get in. Since I’ve got the pump, I’ve mastered the dual wave bolus which allows me to put some insulin in at the start of the meal and stagger the rest of it over the next few hours. Bingo, pizza without the immediate low or hours later high.

Thankfully proper Italian pizzas have an incredibly thin base so middle of the night highs following pizza for dinner weren’t a problem last weekend. The first one did catch me out though after I was a bit gung ho with the insulin guessing and it appears I needed half a bucket less than I’d thought. And that brings me to the final great thing about Italy – there’s a very tasty ice cream stall on every corner just waiting to help you deal with that low.

I’ve used a Medtronic Paradigm insulin pump for the past 2 years. Pumps are getting more and more popular in the UK and I get asked a lot of questions. Inspired by Shelley of circleD fame here are the top 11 questions I get asked about using a pump (sorry, I tried for a nice round 10 but couldn’t quite manage it).

How does it work?
The pump is about the size of a mobile phone and contains a cartridge of short acting insulin that drips into your body 24/7 via a tube attached to your body via an infusion set.  It works like a pancreas giving you a constant  background drip of insulin called a basal rate and when you need extra insulin for food, high blood sugar etc you press a button to deliver a bolus. Most pumps have a calculator on them to help you work out if your glucose is X and you’re eating Y you probably need about Z units of insulin.

Do you still need to take injections?
Not unless you really want to in which case I’m sure you could inject water for fun. You need to change the infusion set every 3 days which is like an injection. You can put your infusion sets pretty much wherever you have fat – I swap mine around between my stomach, back, thighs and bum.

Are they hard work, do you need to blood test more?
A pump isn’t going to solve all your problems. I think it’s a great tool but you’ve got to put the effort in. Personally I think you need to be testing at least 4 times a day to get a good idea of what’s happening and be able to use your pump to get maximum control.

Aren’t they hard to get?
They shouldn’t be but they can be – it’s a real postcode lottery. The National Institute for Health and Clinical Excellence (NICE) basically says that insulin pump therapy is recommended as a possible treatment if you can’t reach your target HbA1c without experiencing disabling hypos or your HbA1c is above 8.5% despite you carefully trying to manage your diabetes. The first step is to talk to your consultant. INPUT is an insulin pump support group and have some great advice on how to go about getting a pump.

Can you fly with them?
No, you still need to use an aeroplane; pumps can’t generate enough lift to transport a human. But you can take them on planes with no problem at all. You can go through the airport security scanners with it on and it doesn’t set them off. If security spot it they often think it’s a mobile, a quick explanation usually sorts it.

Can you swim with it on?
My pump isn’t guaranteed to be waterproof, some other makes are. Personally, I take it off to go swimming if I’m going to be in there less than an hour. If I’m going to be longer I take a bit of extra insulin before I take it off. I’ve also got a waterproof cover for it that I used when I went white water rafting.

What do you do with it when you ahem, blush, you know with your husband?
Personally I take it off. I know some people leave it on. It’s completely up to you.

What’s it like being permanently attached to something, doesn’t it get in the way?
You get used to it surprisingly quickly. If I’ve left the tubing hanging out it sometimes catches on door handles but it doesn’t hurt. If I’m trying on loads of clothes in a shop changing room I sometimes disconnect it for 5 mins and put in on the side so that I don’t have to worry about it. Most of the time it’s clipped onto my waistband or my bra and I don’t know its there.

What do you do with it in bed?
I sometimes leave it loose next to me in bed, I toss and turn a lot but it just follows me. Sometimes I put it under my pillow or clip it to my PJs. If you’ve ever had long hair, it’s a bit like sleeping with that, you catch it sometimes but you move it automatically in your sleep.

What’s the worst thing about the pump?
Two things. Firstly on a serious note, if you get a blockage in your infusion set you need to change it quickly as you’re not getting any insulin so your sugars rise really fast. It’s happened to me once in 2 years; I spotted it pretty quickly and changed the set. It’s easy to deal with but important to be aware of.

On a more frivolous note, it can lead to the occasional childish tantrum when I’ve found a beautiful dress and then have to figure out how to hide my pump when wearing it. It’s doable, there are loads of tricks, it’s just irritating at times.

What’s the best thing about having a pump?
I’m going to cheat and have three best things. Firstly the ability to adjust my basal rates so I can set it to increase at 3am to solve my early morning highs, increase them if I’m having a lazy day, decrease them if I’m planning a lot of exercise etc. Secondly because you get insulin at the push of a button I now take a few units 20mins before a meal to help flatten out the peak and more through the meal as and when I’ve decided what I’m eating. Third is the fact that I no longer spend half my life thinking “have I got my pen with me” because it’s attached – I wasn’t expecting that to be a benefit.

So, that’s my view on the things people usually want to know, if you’ve got other questions or views just leave me a comment.

I’ve just emptied the washing machine (stick with me, it does get  marginally more interesting I promise). There’s a nice clean load of  washing ready to be hung out. Except for one small problem. It’s  covered in slime. Every item of clothing has different coloured sticky  goo on it, and there are bits of paper all over the place too.

Sadly this isn’t the first time I’ve had this washing machine slime  issue. It’s a diabetes complication caused by using fruit pastilles as  my preferred “I’m a bit low need something now” treatment. They’re in  most of my pockets and most of my husband’s too. Most of the time we  remember to take them out before we put the clothes in the wash. As I
said, most of the time.

Top diabetes tip readers – fruit pastilles should never be washed at 50 degrees, they can’t take the heat.

Shooting up in public always seems to be a controversial and emotive topic. This was highlighted recently by the letters page of this month’s Diabetes UK magazine Balance, which was crammed with missives about the pro and cons of injecting in public.

I’m not exactly shy and retiring and I’ll happily shoot up in front of all and sundry. My family and friends are very used to it and if anyone new is around I will ask if they have a wild needle-phobia that might result in panic-attacks, vomiting and fatal collapse before whipping out the old humalog.

Some people seem to think that shooting up in public is distasteful and off-putting. I think, however, that squirting insulin into your body is something natural and therefore best done out there, externally and in public. I think that non-diabetics whose working pancreases squirt away furtively and secretly, hidden away behind their stomachs are ever so slightly sinister. What are they hiding from us and why do they have to keep things concealed like some Austrian father?

Anyway, sneaking away to the kludgy (Scots = toilet; for example “hey pal, will youse keep an eye on ma pint o’ heavy – am off tae the kludgy for a pish”) when in a fancy restaurant or whatever just makes you look like an extra from some terrible druggie film, so my view is shoot up whenever and wherever. If our pancreatically-advantaged friends don’t like it, they can lump it. Just because their organs are all present and correct doesn’t mean they can rub our collective faces in it.

My view has of course led to shooting up in a few interesting places. Possible the most public was the opening ceremony of the Tour de France, which was held in Trafalgar Square in the centre of London a few years ago. (Yes, I know it’s odd that a race around France started in London; but that’s the French for you).

Anyway, we had a pleasant afternoon watching top cyclists, only slightly marred by the irritating guy next to us who kept shoving us to get a better view and making stupid comments. Bah! However, despite these interruptions the clock soon clicked round to 7.30pm and the approximate time I shove in 40u of lantus. So I whipped out the kit, inserted a needle, up went the souvenir Tour de France t-shirt and in went the oh-so-sweet life-giving insulin.

I looked up to see the annoying chap had gone white, was backing slowly away while looking – with fear in his eyes – at my friends for help or support, who looked back blankly as they’d, of course, seen it all before. The lack of reaction from my chums just increased his fear. Had he inadvertently stumbled into some hideous drugs-posse who were going to kidnap him, get him addicted to hard drugs, ship him in a container lorry to Eastern Europe and then pimp him out to tattooed Baltic sailors as a white, male go-go girl?

I have to confess that this actually was our plan, but sadly he made good his escape and disappeared into the crowd.

I daresay you can all add your, infinitely better, stories of shooting up in public in the comments below. So I’ll end with a list of places in which I plan to shoot up in the next year:

•    At the top of the Chrysler Building in New York
•    In a hot air balloon over the Cotswolds
•    While scuba-diving around a rusting, sunken German U-boat in the Scarpa Flow
•    Bareback on a rodeo stallion in Texas
•    In front of the Queen

P.S., by the way cycling freaks might be interested in Team TypeOne – a professional cycling team, all of whom have Type One. Lucky them.

This post is an extract (actually an entire copy to be honest) of an article from the About Diabetes page over to the right there. Feel free to add your comments, criticism and general bile at the bottom under the comments.

Anyway, there’s a lot of nonsense talked about what you can and can’t eat as a diabetic. This blog focuses on Type One diabetes and those lucky enough to have Type Two might find their experience differs. But probably not much.

When I was first diagnosed with Type One a few years ago, part of my crash course in diabetes was a session or two (easy there!) with a lovely dietician called Debbie.

By the way, it’s worth noting at this point that “dietician” is a protected term in the UK – much like “solicitor” or “architect”. You can’t call yourself a dietician (or a solicitor or architect) unless you are suitably qualified. However, the same is not true for the term “nutritionist” in the UK (it’s different in other countries though).

Essentially any old snake-oil merchant, quack or loony can call themselves a nutritionist in the UK. This is why pretty much anything written or sold by a “nutritionist” in the UK can almost exclusively be discounted as complete rubbish.

Anyway, that aside, Debbie and I had a lovely time and mainly chatted about my homemade Baileys ice cream and spoke about carbohydrate counting and a diet made up of foods with a low glycaemic index. I’ll talk about carb. counting in another post so ignore that for now, but the glycaemic index thing is worthy of mention as I think it’s possibly the most relevant part of the Type One diet.

Glycaemic index

As you probably know when you eat your deep fried mars bar or delicately sautéed fois gras your digestive system breaks down the foody-goo and releases its various constituent parts. Of interest to us diabetics are the carbohydrates or sugars which are released into our blood stream.

All foods are not equal in terms of the rates at which your body can process them and release them into your ruby-red blood. Essentially, and very broadly, the more pre-processed the food the less your body has to do and therefore the quicker it will be broken down and released in to your bloodstream (and so this food is said to have a high glycaemic index). The less processed it is, the longer it will take to be broken down and released (a low glycaemic index).

So why do we diabetics care about this? While it’s not entirely vital to your well-being, the theory is that low GI food makes managing your food / insulin balance easier. Rapid acting manufactured insulin, like humalog, kicks in pretty quickly – but not as quickly as your own stuff. Therefore if you iron out the peaks and troughs life will be easier.

This wonderful diagram shows the sharp Matterhorn-peak of high GI in red and the low rolling hills of low GI in blue.

There are number of GI-related books and web sites which give you the relative GI values of various foods. But a general and quite useful rule-of-thumb is the colourfulness of foods. The more colourful the better (by better I mean lower) in terms of GI. Though this rules does break down when we get into extremes of lime green and violent orange.

For example, wholemeal pasta (generally nice and brown with bits through it) is lower GI than boring, white pasta. A nice green apple is better than processed, clear apple juice.

Okay, the rule isn’t perfect – but you get the idea.

Eating every day

For the purposes of this article I’m going to assume that you too are not some sort of half-wit who doesn’t know how to boil an egg and lives off deep fried pizzas, so I won’t chat about the basics.

Because my wife and I like cooking we’ve got a load of cookbooks – both general cookbooks and those specifically for diabetics. Having cooked from both, I don’t really notice any significant difference in content between the “diabetic” books and the non-diabetic books, so there’s no point in specifically splashing out them.

Books by people like Nigel Slater or Nigella Lawson are great if you want to show off and Madhur Jaffrey is bloomin’ marvellous if you want to cook for large groups in style.

But we’re more interested in every day normal cooking and I like the following because they have quick and easy recipes for the busy young professional and you can knock ‘em up in twenty minutes or so while swilling back a glass of wine and chatting the day over with your loved one:

* Cool Eating by Louise Pickford
* Good Housekeeping – 1001 Recipes
* BBC Good Food – 101 Meals for Two
* BBC Good Food – Low Fat Feasts

Interestingly enough, as the wife and I are both control and organisation freaks, we organise our food by sitting down on a Sunday evening and working out a menu for the week ahead. This is actually quite fun. No, honestly, it is one of the less-onerous household chores.

What it does mean is that throughout the week every night you know you have something healthy and tasty in the cupboard or fridge and you won’t be tempted to pop down to the chippy for another deep-fried pizza, which can only be a good thing.

Anyway, use and abuse the comments section to tell the world about your favourite cookbooks and your slightly-anal domestic arrangements.

http://en.wikipedia.org/wiki/Nutritionist

http://en.wikipedia.org/wiki/Glycemic

The teeny-tiny UltraEasy

Received opinion says that good things come in small packages.

This is clearly not true, I can think of loads of things that come in small packages which are simultaneously small and completely rubbish.

Chief amongst these would be a certain ex-girlfriend of mine who was somewhat height-challenged. She was a small package but she most certainly was not good. Think of a ball of seething, dwarfish spite and misery. A hateful being who sapped the joy out of every situation whatever the circumstances. An absolute delight in other words.

Other small things that leap to mind are wasps (hateful little bastards), midges (a source of misery for me and my apparently oh-so-tasty flesh) and jockeys (nasty people who whip horses – the best of all the animals).

So it was with unmitigated surprise that I actually quite liked LifeScan’s teeny-weeny OneTouch UltraEasy blood glucose meter.

In terms of features, it doesn’t really do all that much. Essentially, it sucks your blood and spits out a blood glucose reading. It doesn’t come with the usual useless back-light, but it can give you average readings over a few weeks or so, which is quite handy when you want to be smug about how good your averages are.

The main feature, attribute and benefit for the LifeScan OneTouch UltraEasy (do they not believe in spaces between words?) is therefore its size. It’s very, very small and so can be easily concealed; much like the hidden handgun and swordstick you carry to guard yourself against ambush by rival cartels. So that’s handy.

Not being the leader of an international drug gang (mores the pity) I actually keep my UltraEasy in my cycling backpack, which I keep constantly ready with a meter and a stock of sweets and Lucozade, etc. Just in case I want to sit in the garage looking at my bike. In a deckchair. With a glass of wine.

The meter uses LifeScan’s standard test strips, which require a fairly small sample and suck up your precious life-gore very easily. The finger-pricking device is small, looks quite funky and is also nice and compact.

But it gets better – the UltraEasy comes in different colours! You might think I’m being sarcastic (for once) but this is actually quite a good feature. I test my blood glucose four, five or six times a day and, frankly, I get bored to tears looking at the same meter over and over again. That’s probably why I use so many meters – sheer, unadulterated boredom.

While you can get the UltraEasy in standard primary colours, I think there would be a huge market for clip-on fascias for all meters – just like you get for mobile phones. So sign me up for a Union Jack cover for mine! Oh yeah, baby!

So in summary:

Sample size > 3/5
1.0μL

Test time > 3/5
5 seconds

Test strip calibration > 2/5
Yes, it’s required with each batch

Test strip slurpiness > 4/5
Very good

Memory > 3/5
500 tests

Sexiness > 4/5
Small and sleek

Beeping > 5/5
Yes, can be turned off

4am test > 2/5
No backlight

Grand total: 26/40

Read about our tests and criteria.

Recently I was delighted to be invited on a weekend away.

I was delighted for two reasons, first it was the stag weekend of my chum Ru and it thus marked the fact that his and HP’s three-hundred year long engagement was finally coming to an end and they would, at last, become man and wife. If that isn’t a source of delight I don’t know what is. Hurrah!

The second reason for my delight was the fact that I would be travelling to a remote Scottish pile with the intention of partying the weekend away with a bunch of like-minded people. Double-hurrah!

I’ll spare you the details of the weekend’s debauchery – there’s nothing duller than hearing people’s puking-in-bucket stories – so I’ll only say that it involved a lot of Guinness, flagons of cider and a veritable lake of sweet Greek red wine. And I woke up extremely hoarse and with a very sore hand from playing the bongos all evening.

Some people like to go away for detox-weekends to get wrapped in honeycomb & seaweed balm and have warm stones needlessly put on their backs. But this weekend was universally agreed to be the polar opposite (and infinitely more fun) and so was duly christened the “retox weekend”.

Sadly, perhaps, I’m not eighteen any more and I have to confess that the weekend did take it out of me. I even managed to fall asleep on the way back in the passenger seat of Brian’s fancy two-seater. With the roof down. In the cold Highland air. With Brian’s not-exactly-pedestrian driving.

So all well and good – a few Alka-Seltzers later and I was feeling fighting fit again.

The day after saw me making my usual pilgrimage up to the Edinburgh Royal Infirmary for my seven-month MOT. After the usual tests I was ushered into the registrar’s room to be congratulated on my Hb1ac of 6.5% (down from 6.1% last time, bah! (yes, I am very smug about it)) and to be told that my urine sample had shown traces of blood.

I’m pissing blood? Oh crap!

My registrar told me this was nothing much to worry about but I couldn’t help fretting about impending liver failure or the imminent and catastrophic destruction of my kidneys (don’t lie, we all do that at 3am). But she suggested we re-did the tests in a fortnight or so just to double-check.

So that’s what we did and, dear readers, you’ll be relieved to hear that all was absolutely fine.

They say that diabetes is one of the healthiest afflictions to have – after all, who else gets very regular hospital check ups and has their eyes checked twice a year? But the weekend made me think of all the damage we do to our bodies every time we have a drink.

Should I stop drinking – or maybe reduce my intake to a small glass of champagne at Christmas and maybe a few liquor chocolates on my birthday? It would be far, far healthier.

But then I though “fuck it”, rang round our friends and organised a piss-up in pub tomorrow night. The evening will probably involve lots and lots of sweet Greek red wine. Cheers!

Ladies and gentlemen this is a live blog update from the Virgin trains service to London Euston

(wireless internet on trains, nice move Virgin).

I was sitting here quietly trying and failing to do something clever with Excel when my ears pricked up, the man opposite me uttered the D word.

As ear wigging on trains is pretty much compulsory, I listened carefully. Whilst simultaneously stirring 3 sugars into his coffee and eating a bacon sandwich the larger, older gentleman opposite me  explained to his friend that his doctor was very worried about “the diabetes” and as the tablets didn’t seem to be working he might have to start taking “the jabs”. There was apparently nothing else he could do about it.

Now, I hate it if people comment on what I eat – I know the impact of food on my diabetes and make my choices accordingly. I know certain foods will raise my blood sugar and I make the decision whether that particular cake is worth the extra insulin or not.

So what dear readers do we learn from such an encounter on a high speed train? For me it reinforces my belief that education and a sense of personal responsibility are the key things when it comes to living successfully with diabetes. My diabetes is my problem and I need to take responsibility for it, rather than see it as an issue for the Dr to deal with. On top of that I need sufficient quality education to understand the consequences of putting 3 sugars in my coffee. At that point I can then decide whether its worth it.

“So what happened next?” I hear you cry. I wrestled with whether I should have a chat with the man, sharing diabetes knowledge etc but by that time his friend had got off at Nuneaton and the man promptly put his iPod on and fell asleep. I’ll get back to my spreadsheet then.

After having reviewed a few blood glucose meters (don’t worry, there are yet more in the pipeline, review fans!) and reading Caroline Parker’s recent posts about the truly horrific, medieval machines she used to use, I started designing the perfect blood glucose meter in my head while waiting in the queue for my lunchtime sandwich.

At first, naturally enough, I gave it all sorts of useful but perhaps unwieldy (or even unworldly) attributes – such as the ability to wake me up with a cup of tea; paint the fence (which I really, really don’t want to do) or help me change energy supplier.

None of these things are possible even by the best brains in the world, especially the latter. So hoping they could be achieved by a small, portable machine is clearly too much to ask.

So I set my sights lower.

I would really like a blood glucose meter that could check your blood without actually taking any blood from you. I don’t know about you, but my finger-tips are covered in tiny dark pinpricks of a zillion-and-one blood tests over the past years.

Finger-pricking doesn’t really hurt that much (unless you’re completely feeble) but if shoving a sharpened stick of stainless steel into your oh-so-vulnerable flesh could be avoided I would be the first in line.

Even half-human half-cyborg diabetics with their continuous blood glucose monitors still have to finger-prick and they also have to jab sensors into themselves like a junior initiate of The Borg from TV’s Star Trek. It’s the first stage of assimilation I tells ya.

However, understandably enough, I think blood is going to remain a major element of blood testing for the time-being.

So I set my sights much, much lower.

First off, I would love a meter that actually lit up the test strip. The fancy, cool-green backlights standard on most meters look great but they’re as much use as Anne Frank’s drumkit when dealing with the wild, unadulterated joy of 4am hypos.

A tiny LED positioned so that it shone down the test strip would be bloody marvellous. Lifescan, Wavesense and all – invent this, get down to the Patent Office and let’s see it in the next generation of meters.

New meters with graphs and the capacity to memorise your last seven million tests are all pretty handy, but the Holy Grail for me would be a universal test strip.

Like lots of gadget-obsessed diabetics I have a dozen meters, all of which use different test strips from as many different companies. Luckily for me (but maybe not the British tax-payer) most are available for free on the NHS.

But I always end up running out of strips for my cool spanky-new meter and have to resort to the drudgery and early-naughties technology of my backup meter. Nightmare, I know.

If we had a universal strip that worked in every meter that would be brilliant – no more worries about running out, no more worries about packing the wrong meter. Simple.

But you know and I know that this will never, ever, ever happen.

Like crack-dealers on a run-down Liverpool estate, pharmaceutical companies (altogether now “booooooo!”) give you your first fix free (does anyone actually pay for a meter nowadays?) and then they get you hooked on their brand of strips. While big pharma won’t come round in their blacked-out BMW and break your kneecaps if you stop using their strips (though I wouldn’t put it past them) they all use the same marketing model. So whichever way you turn, you’re stuffed.

As I reached this conclusion, I became depressed – was there nothing that could make the perfect meter?

Then it hit me! Build in a Tamagotchi-style game into the meter with a teeny-tiny on-screen diabetic whom you have to keep alive with regular injections of insulin and fistfuls of carbs. Focussing your attention on the tiny collection of pixels that is your pancreatically-challenged alter-ego would surely distract us from the daily despond of diabetes. Build that big pharma!