Shoot Up or Put Up

We diabetic types can be a grumpy bunch. I can whinge for hours about how inefficient my GP’s repeat prescription service is and how my repeat prescription rarely includes what I actually ask for, but plenty of stuff I didn’t (why would I need hayfever tablets in December?).

Changing an infusion set sometimes feels like an overwhelming hassle, and I’m never happier than when I’ve started a new box of test strips so I know I don’t have to fight with the packaging again for another week or so.

In case you hadn’t guessed, I find the minutiae of diabetes a little tedious to say the least.

Imagine my horror when my beloved (ok, not quite beloved, more “basic model that fulfils all my requirements”) Optium Xceed glucose meter decided it needed a new battery. Oh the hassle. I need to find the box that I’ve filed away safely but can’t remember where, then no doubt fill out forms in triplicate and send off my birth and marriage certificate along with glucose readings dating back to 1996 just to get a new battery from those darn meter makers.

How wrong could I be? In a last ditch attempt to avoid having to find the meter box or call a helpline and answer 101 irrelevant questions about my diabetes just to get a new battery, I went to Abbott’s website. At this point I discovered I am nothing but a weaselled old cynic. They have a free online ordering system for replacement batteries. It’s quick and easy to use and collected an acceptably small amount of data for marketing purposes. And my new battery arrived the next day.

How simple is that? What a refreshing change from the usual quagmire of diabetes admin. Thanks Abbott. Online replacement battery ordering is a small thing, but it makes life so much easier.

Right, I’m off to go and get irritated about having to make an appointment for my eye check

It’s been a while folks what with work being a bit manic and then the husband and I heading off to South Africa for a marvellous holiday, but I’m back! 

And what pearl of wisdom did I discover during my little break? Diabetes can be an excellent way of attracting leopards.

We’d had a great game drive, we’d seen elephants and rhino, lots of impala and a dung beetle but no luck with the leopard. Our ranger radioed the lodge to let them know we’d be back in 10 mins for breakfast. I decided to be a good diabetic and bolus for breakfast immediately so it had a little time to start working.

I’d delivered 6 units of insulin when the call came over the radio – a leopard had been spotted about 5 minutes from us. This was too good an opportunity to miss, breakfast was cancelled and we set off through the bush to track the leopard. I cancelled the rest of my bolus, had a couple of fruit pastilles and spent the most amazing hour following a leopard as it wandered through the bush.

The moral of the story? If you really want to see something on safari, give up all hope and bolus for breakfast. The chance to cause a hypo is too good for any self respecting leopard to miss and they appear almost immediately!

A needling problem

Avid readers of your soaraway Shoot Up will know that I’m currently on an 18-month long NHS waiting list for a pump. You’ll also recall I’m not too chuffed about this for obvious reasons. As, on the whole, I’m generally a pain in the arse I’ve been writing polite letters to everyone concerned about this sorry state of affairs.

I’ve generally had sympathetic replies from my MSP, the chief pump honcho at the hospital and the Chief Executive of the health board wrote to me the other day to say he’s asked someone to investigate and report to him about pump provisioning. It does seem that people are generally supportive, which is nice to know but – of course – not actually of any practical help to diabetics.

Certainly in my area the main sticking point appears to be the lack of funding – not, as you might expect, for the pumps and supplies themselves but for the training required for new pump users. I do agree that pumps are slightly more complicated than administering MDI, as there seems to be a greater possibility of complete cock-up with a pump compared to MDI. Though, as we all know, it’s very easy to utterly mess up with MDI – I do it quite often!

My health board undoubtedly has some great DSNs and the training I received when I was first diagnosed was relatively brief but was of a very high standard. But, unfortunately, there just doesn’t seem to be enough of them to go around. Currently their policy is to train about 5 or 6 new pump users every two months. This just isn’t enough throughput to increase Scotland’s woefully low number of pump users up to levels that are on a par with the rest of the country, let alone the rest of the western world.

If training genuinely is a bottleneck (and not just a slightly cunning feint to avoid funding new pumps without breaking the rules) then there seems to me to be a possible solution in the form of a public-private initiative in which everyone could win.

So here it is – what about the NHS partnering with the pump manufactures to provide training? The pump manufacturers will, obviously, know exactly how their pumps work, how they’re best used and will have a wealth of experience in supporting their customers in using their products. Everyone knows that diabetes is a nice earner for our favourite pharmaceutical companies and so the cost of training could be recouped on a cost-recovery basis or even as loss-leader set against the ongoing purchase of pumps and supplies.

Pump manufactures would surely have a reasonable amount of available resource to chuck at training (especially if it benefited them through long term and ongoing sales) and such an arrangement would free up NHS staff to do what they do best – supporting diabetics.

But might this lead to reduced patient choice? If, for example, Small Manufacturer A wasn’t able to supply training while Large Manufacturer B did, then might there be an inherent bias in the NHS to encourage diabetics to get a pump from Large Manufacturer B as they could then save on training costs?

I don’t think so, as any such arrangement would necessarily reduce the training overhead for the NHS allowing them to concentrate their resources on supporting patients who wanted, for whatever reason, to use a pump from Small Manufacturer A.

In this scenario everyone wins – patients get training and pumps quickly; the NHS’s training costs are reduced; the pump manufacturers get a loyal and going supply of lucrative diabetics.

But what about the issue of the bifurcation of training? After all, training from a pump company might not be at the same standard as NHS training? (Of course, it might be better). But given that standards of training and pump provision vary wildly around the UK, I can’t see that this would make any significant difference from the current position.

Generic pictorial filler

Well, it’s that time of year again – today was time for my seven-month review at which I’m poked, prodded and vampiric amounts of blood removed from my arm for analysis. My feet were jabbed and I was blinded by the flashes of the retino-eye-camera-blindy-thing-whatsit (I’m sure it’s got a slightly more formal name).

Anyway all that aside, the figure we care about is, of course, the A1C – the roughly three month average of how good, or bad, a diabetic you’ve been. This time, mine was 6.3 – down from 6.5 in March. And all done on MDI – none of this pump malarkey. As Alan Partridge would say, “Back of the net!” Top right hand corner! I give you permission to bask in the glowing glory of my personal A1C magnificence!

While I was there, I also had a chat with the doc about my peaky mornings (I start at about 5, put in 8 units of humalog 20 minutes before a small breakfast and still end up at 13 two hours later). So we’re having a crack at using the slightly newish Apidra -  which is made by the same chaps as everyone second favourite long-acting insulin Lantus.

Apparently Apidra kicks in a bit quicker than Humalog (which is pretty quick in itself) so it might be useful for trimming the top off the morning peak. Anyway, I’m going to give it a go and see what happens. Rest assured, beloved readers, I’ll report back with the results in due course.

Pretty sweet

For the last few days I’ve been suffering from a slightly sore back. Nothing so bad as to make me retreat to lie on a hard wooden floor or be tortured by a chiropractor; but enough to slightly annoy me.

You’ll no doubt be thrilled to discover that I soon traced the problem. Being pancreatically challenged (as you’re no doubt aware) I carry a funky man bag with me wherever I go to transport my diabetic-supplies and miscellaneous other guff I need to live on a daily basis. Needless to say, being a Good Diabetic, amongst this stuff I always have a small cache of sweets in case of an inopportune hypo.

Speaking of which, I wonder if it’s possible to get an opportune hypo? I suppose hypos could be feigned to get out of awkward situations – for example, blind dates where your expectations haven’t exactly been met; a smelly, fat guy coming to sit next to you on the bus; or arrest by angry armed thugs and countless other socially difficult circumstances. Thinking about it, I really should try it sometime.

Anyway, I’ve been pretty busy recently so every time I’ve been rushing out the house I’ve automatically picked up another handful of Fruit Pastilles and shoved them in my bag. Fortunately, my levels have been grand and I haven’t had need of everyone’s favourite hypo cure. This has had the results that I’ve now built up the world’s largest supply of Fruit Pastilles (pictured above) which I’ve consequently been lugging about for days and days and which must have caused my sore back – they do actually weigh a suprisingly large amount.

So this is yet another of the myriad hidden costs of diabetes – sore backs from carting hypo cures around. At least I don’t carry great bottles of Lucozade around like I used to; but still, I curse you God of the Pancreas! *shakes fist at heavens*

Funky snake and stick combo

I’m a bad person. I’m bad because I don’t carry any form of diabetes-related ID on me at any time. I don’t have a laminated ID card, medical bracelet, one of those emergency button things, a lapel badge saying “Ask me about my blood glucose” or even a huge tattoo on my forehead reading “I’M DIABETIC”.

I was reminded of this fact as I was rummaging through my woefully large pile of filing recently and found an ancient ID card that I was given when I was first diagnosed. It listed my address (two house moves ago), the insulin I use (since changed) and who to contact in an emergency (wrong number); so it was almost entirely useless. The obvious fact that it was at the bottom of a pile of unfiled paperwork rendered it as utterly pointless as Anne Frank’s trombone.

I just think that medical ID is pretty pointless unless it’s so huge and obvious it renders it embarrassing. I could carry around a small laminated card in my wallet, but what use would that be? If I’m found unconscious on a bus, it’s likely that I’ll be TASERed by the police as a suspected terrorist or refused treatment for being drunk before anyone ventured forward to check the inner recesses of my wallet. In any event, if anyone did open my wallet they would be blinded by the flock of panicking moths making their escape.

So to really be useful, medical ID needs to be really obvious. Some people wear watches decorated with the Rod of Asclepius (the proper name for the stick with snake round it, fact fans) which might work, but then I would have to give up my fancy Titanium Seiko which Katie bought me. As I’m clearly not going to replace said Seiko with some mangy, cheap watch decorated with a cartoon snake, this isn’t really much of an option. Similarly bracelets a just rubbish and clearly wouldn’t fit with my metrosexual man-about-town image (such as it is).

In the most extreme cases, I have seen some diabetics submitting to the needle and getting medical ID-style tattoos done. This, obviously, is just silly. Imagine your embarrassment if some Nobel Prize winning genius suddenly came up with an overnight cure for diabetes (it could happen, optimists tell me) – you’re stuck with some stupid permanent tattoo saying “GIVE ME SUGAR” (no doubt illustrated with a snake on a stick) for the rest of your life. Not so good.

So until someone comes up with a good idea for medical ID that’s actually useful and practical then I’m just going to wing it and hope I don’t get TASERed.

A property that is, sometimes, intellectual

Such is my continuous life of glamour, I’ve got back from a conference of intellectual property practitioners at the World Intellectual Property Organisation (or  L’Organisation Mondiale de la Propriété Intellectuelle if you prefer its French name)  in Geneva. You’ll be pleased to hear that I won’t bore you with the details of the conference or give you the latest developments in the Internet arbitration and dispute world. Frankly I don’t want to lose all our readers in one fell swoop.

What was more interesting was, of course, the issue of diabetes management. The conference itself started at 8.30 in the morning and went on to six in the evening, followed immediately by cocktails in the lobby, followed by a dinner. The lunch break was only an hour and there were no breaks for coffee in either the morning or the afternoon.

Not only was this quite a strain on the bladder, it was also gave rise for thought on how best to manage it along with my wonky pancreas. I opted for a “keep it high” policy and put in little less insulin than normal for breakfast with the idea of letting it ride fairly high for the morning session to avoid any hypos – which I find are always a pain if you’re trying to concentrate on someone’s learned presentation.

This worked pretty well and my figures stayed around the just-into-double-figure level for the morning. However, even with them not being too high I was wildly dehydrated and longing for a glass of something to unloosen my tongue from the roof of my mouth. Despite this, I aimed to keep the figures high for the afternoon session and carried them high right through to the evening cocktails and dinner (I had a salad to start, followed by perch and chips, followed by an espresso, if you’re interested (which I suspect you’re not)).

It was therefore with some relief that after an extremely long day I was able to get back to the hotel and bring everything back down to normal levels; have a good read and a good night’s sleep.

So that’s my way of dealing with a long day without easy access to food or drink – what’s yours?

As everyone knows, all the cool kids go to the annual(ish) Lothian Diabetes Representative Group‘s annual conference. This year it’s being held at Napier Craiglockhart Campus in Edinburgh on Saturday 31st October 2009.

There’s a bunch of workshops (some of which look quite interesting), some discussions and some speeches (some of which look quite dull). For a crisp tenner you get all this along with a slightly disappointing lunch. What could be better? I’ll be going and if you are too drop me an email and we can sit at back and heckle with all the other cools kids. Yay!

You can download a booking form and if you have any queries about said conference  you can email Bonnie, who’s been lumbered with getting emails about it from the great unwashed, at Bonnie.Crichton@luht.scot.nhs.uk

Scottish readers (and I know you exist) will be interested that Scotland’s SIGN Diabetes Management Guidelines Consultation is now taking place. Aileen at IPAG Scotland reminds us that any responses from the pancreatically challenged hoards need to be submitted before 16th October 2009.

In particular, the section on pump therapy (4.3.1) looks like it was written back in the Dark Ages of diabetes care and isn’t all that helpful to anyone in Scotland considering taking up pump therapy in the next ten years.

So have a look at the draft guidelines at http://www.sign.ac.uk/guidelines/drafts/diabetes.html (especially that thrilling 4.3.1 bit) and bash in a response giving them your views. Our beloved health authorities need our help and guidance to make sure they get it right!

Stock footage of glucogen injection - too fatigued to find a better picture...

Every once in while, each member of the pancreatically challenged hoard comes up against diabetes fatigue. This manifests itself through the victim running themselves down into a slough of despond, shaking their fist at the heavens and generally cursing their wonky pancreas. I’ve been suffering for diabetes fatigue recently and it’s not entirely fun.

I suppose the thing that gets me down isn’t really the fact that there is unlikely to be a cure in our lifetimes (unless you’re an immortal member of the clan MacLeod – but then I suppose fictional immortals don’t tend to have problems with their internal organs. Or do they? If you go by Jonathan Swift’s version of immortality in Gulliver’s Travels then those immortals tend of have terrible problems – probably with Type Two more than Type One, given their great age. But I digress somewhat).

No, it’s not the lack of cure thing that gets me down; it’s the sheer downright tedium of diabetes. You have to admit that constantly checking your blood glucose, injecting or pumping, keeping a vague eye on what you eat, calculating how much insulin to put in after going on a bike ride, explaining to taxi drivers what Type One is, and on and on and on is extremely and brain-numbingly boring.

I wonder whether it would be different if the symptoms were more varied? For example it might be less dull if a lack of sugar gave diabetics a rather pleasing green – mottled with purple – tinge to their skin rather than just boring old sweating and the shakes. Too much sugar could lead to any number of random symptoms – the ability to briefly hover, the power to crush girders or the superhuman skill to change energy supplier in ten minutes flat. If these symptoms were utterly random, as Forest Gump says “life would be like a box of chocolates”, which would be far more entertaining than the boring old fact that said box of chocolates requires 16 units of humalog to balance the carb intake.

Sadly, though unless we get some very cool scientific breakthroughs in the next year or so, we’re not going to be able to vary our symptoms when we screw things up. So we’re stuck with the terrible tedium of diabetes. Booooooo!