Shoot Up or Put Up

Edinburgh - bloody drafty

In between slaving away writing posts for your beloved soaraway Shoot Up I have a day job. That I’m actually employable may come a surprise to some of you – but there we are. Anyway, I won’t bore you with the details of my job as it usually requires a plethora of pencil-drawn diagrams to explain what the hell I actually do, but I will – instead – tell you about our office.

I work in the west end of Edinburgh, within a World Heritage Site and in a Grade One listed building that was built in around 1825. As the whole street is heavily protected it’s a wonderful example of classical Georgian architecture with the massive, imposing and somewhat gothic St Mary’s cathedral dominating the far end of the street. Which is nice.

However, every silver lining inevitably has a cloud. The Grade One listing means that we can’t really do anything major to the building – like have wonderful modern things, such as central heating, or double-glazing, or windows that actually fit into their frames. As the rooms in our office are all double-height and we have floor to ceiling sash windows this is somewhat problematic come winter. The bitter Scottish wind simply blows through the massive gaps in the frames, around my feet and chills me to the very marrow. Unfortunately, the massive marble fireplaces have been blocked up and so we can’t even warm ourselves in front of a roaring fire.

Anyway, now that November’s here we saw the first heavy frosts and really cold weather coming in this week. It was cold enough to see my breath in front of me – while in the office. This was undoubtedly a Bad Thing.

As usual I had lunch at my desk and was so fed up with the cold by the early afternoon that I paused and thought whether to put in a few less units of humalog, therefore letting my BG go really high and thereafter enjoy the inevitable hot flush that I have whenever my BG is off the clock.

It was sorely tempting and it came down to a choice of having my toes amputated through frostbite or amputated through neuropathy brought on by high BGs. It was a tough choice but in the end I opted for the amputation through frostbite option; it’s much more manly – I must be the Captain Oates of the diabetes world!

We’re all sensible people here. Well, most of us are.

By that I mean that we all know how we’re supposed to behave as good diabetics. We know that if we’re on MDI we should use a new needle each time we inject and we should rotate our injection sites. If we’re on a pump we should change the cannula every three days.

All of us, regardless of insulin therapy method, should use a new lancet each time we finger prick to test our blood glucose. Which, of course, we do regularly (remembering to throw in the occasional random check to make sure there’s nothing untoward that we’ve missed).

We also know that sharps should be collected and disposed of properly – bloody used needles shouldn’t chucked in the office paper recycling bin because we can’t be bothered taking them home.

We all know this stuff; but, and be honest now, how often do we find ourselves slipping into bad habits? Being late to the party I’ve only been a member of the diabetic club for four years and I’ve noticed more and more that I just can’t be arsed changing my needles all the time and putting a new lancet in just seems a bit too much like hard work.

However, I’ve noticed a pattern and for your benefit I’ve plotted this over time using the hugely scientific method of rough guesswork:

Scientifically generated graph of bad habits over time

As you can see, plotted over time, bad habits do gradually get more frequent; but this is then offset by occasional bouts of guilt. These are brought on by any number of sources – a concerned wife asking about sore-looking eyelids (always a sign of bad BG control with me); a couple of days feeling rough, or just a revitalised determination to manage things well and be top of the class at the next trip to the clinic.

I suppose as long as the bad habits don’t drop beneath a certain level things will be fine. But I wonder if this pattern continues indefinitely – until we get so bad we’re using rusty, three month old needles to inject into our eye as we can’t be bothered moving off the sofa to inject in our blubbery, overweight stomach. I don’t know, maybe some of you old hands can comment.

It appears my expectations of my own diabetes don’t always match other peoples’ expectations.

I went for my annual torture session at the opticians recently. The “sit there while I shine a bright light into your dilated pupils until you cry” appointment. OK, its not that bad really, it just feels wrong that I go into the opticians with perfect vision and come out unable to read a computer screen for several hours.

Anyway, I have a couple of small bleeds in my right eye that have been there for about 5 years. We’re keeping an eye on them (can you believe I wrote that?) and so far they’re stable and not too much of a concern.

The optician, ophthalmologist and I all agree they don’t need treatment at the moment and the best course of action is to maintain great control to prevent them from getting worse.

The interesting bit is the attitude of the optician depending on who I see. With Mr A we assess there’s been no change and agree that continuing good control and regular monitoring is the way forward.

Last year I saw Mr B. He said similar things but his attitude was completely different. He said retinopathy is to be expected as I’ve had diabetes for 25 years. STOP RIGHT THERE. That may be factually correct but let me manage your expectations. That might be an acceptable statement if I was diagnosed aged 65 and am now approaching 90. But I’m not. I’m 30.

You need to understand, I’m not in denial. I know complications are a possibility. But I believe mental attitude is a big factor with diabetes – if I see complications as inevitable then I won’t view a small bleed as a wake up call to tighten my control, I’ll just see it as one of those things that happens and won’t take the necessary action. With that approach what state am I going to be in at the relatively young age of 54 when I’ll have had diabetes for 50 years?

I’m not dreaming, I know this is doable, I know people who’ve lived with diabetes for over 60 years. They’re fit, healthy and pretty much unblemished by the experience.

So I find myself having to help my health care advisors by managing their expectations of my diabetes. I have high expectations when it comes to my diabetes. I’m not aiming for ok or average, I’m aiming for great because I have a life to lead and diabetes will not be the thing that stops me. Please revise your expectations accordingly.