Shoot Up or Put Up

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by Alison

The hypo portfolio

17 February, 2011 in Living with diabetes, Mildly amusing

A hypo is a hypo is a hypo. Low blood sugar, sweaty, fuzzy head, confused, weak, dizzy, argumentative (yes, even more so than usual) etc etc. But even with all those similarities I think there is a virtual smorgasbord of hypo types.

  • The nice hypo – you feel yourself going low, you eat, you rise. Job done, move along please people, there’s nothing to see here.
  • The thieving hypo – you’re in a shop, you’re low, and you have no food. Theft by eating produce before paying for it is the only option. A mid hypo altercation with an overzealous security guard can turn this into a full on criminal hypo.
  • The embarrassing hypo – any low that involves crying, arguing, falling over, spouting rubbish or generally humiliating yourself in public fits into this category.
  • The “why now?” hypo – you’re in a rush, you need to drive, you’re in an important meeting where gobbling fruit pastilles like a secret sugar addict isn’t really an option and a hypo comes along. Perfect timing.
  • The sporting hypo – your swim times have slipped from near Olympic standard to something a toddler would be ashamed off. You’ve missed 7 out of the last 10 shots in a game of tennis. Your sporting prowess has evaporated along with all the sugar in your body. Something a little stronger than half time oranges is required here.
  • The middle of the night hypo – this species normally turns up on nights when you’re sound asleep with a full day ahead of you. Bonus points are awarded for treating the low without getting juice or glucogel all over the sheets.
  • The “I knew it was coming but was hoping for a miracle” hypo – you’re sitting watching TV, you’ve been feeling a bit low for a while but going to get some food seems like such an effort, so you give it another 20 minutes in the hope that your body is going to discover a bit of sugar down the back of its virtual sofa and you won’t have to bother moving.
  • The “I’m cured!” hypo – you’ve been chasing lows all day and three juice boxes and a tube of glucogel have just raised you to the blistering heights of 4.1. The only logical explanation for this is that your body must have started making its own insulin again – you’re cured! Of course there could be a more boring answer, like your basal rate is too high or you over bolused for breakfast, but where’s the fun in that?

There must be more, which hypos have I missed?

Applications of continuous glucose monitoring and insulin pump therapy in the prevention of diabetic hypoglycemia

1 February, 2011 in news

Everyone’s second favourite online academic journal covering hypoglycemia – http://www.hypodiab.com – has an interesting article on the benefits of CGM and pumps to avoid hypos after exercise. The article notes that:

The authors concluded that CGM is a useful approach in people with type 1 diabetes who perform an exercise program by potentially allowing the detection of nocturnal hypoglycemia resulting from intermittent high-intensity exercise performed in the afternoon.

There’s then a quite interesting commentary on how difficult it is to objectively show in a study the benefits of pumps and CGMs to us diabetics. Which is a pity really because this dog thinks that CGMs and pumps (and good software to analyse the resulting data) are the way forward for good control.

Source: http://www.hypodiab.com/article.aspx?volumeID=13&issueID=18&articleID=87 (free registration required for the full article).

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by Alison

Pancreatic poker face

26 January, 2011 in Living with diabetes

I often (well, only really when it gives me a theme for a post, but go with it) think that playing at being a pancreas is a bit like playing poker. You need confidence. You have to bluff your way through and show no weakness when it comes to gambling on that extra bolus to bring down the high. Show no fear at giving that extra unit.

My pancreatic poker face has slipped slightly lately. I’ve just started some new drugs for something or other and they don’t play nicely with the broken pancreas. The one advantage I have is that I’ve been here before and survived it so I have experience on my side. Sadly at the moment that doesn’t seem to be worth a lot.

Previous experience shows a few extra buckets of insulin are required to deal with the drugs. But last weekend, by the time I was up to 4 times my usual bolus ratio the stakes felt pretty high and I wasn’t sure I wanted to carry on playing my hand. At this point, all the extra insulin had managed to keep me at a kidney-frying, eye-blinding 18 for a whole day. The CGM had been alarming that much it was begging for respite.

So, by early evening I celebrated having halved my blood sugar to 9 and decided that was as low as I was willing to go for now. The drugs have a habit of creating huge insulin resistance and then falling asleep for a bit allowing service to return to normal for a while so I didn’t want to be caught running too low when that happened. If we were playing poker, this is the point where I would have banked my winnings and left the casino but there was no one to take over my hand so I had to carry on.

At 3am, the husband was awoken by a screaming CGM and a sweaty, rambling wife who when she finally submitted to a blood test was enjoying the hallucinogenic qualities of being a 1.3. After an hour the glucogel finally fixed the problem and the husband changed the sheets (what is it about diabetes and sheets?). Apparently he doesn’t like sleeping in a bed full of glucogel slime. He’s so fussy. 

And so, I feel like I took as safe a gamble as I could and still got badly burnt. Which means my poker face has slipped and I’m a bit nervy about this high stakes game I’m in the middle of. I hesitate to double or quadruple my insulin even though I know that’s what’s needed. It’s tough getting straight back on that horse when you’ve just fallen off.

I think that’s where I’ll stop for now. A metaphoric mixture of falling off horses whilst playing poker in casinos with sticky sheets is enough to undermine anyone’s confidence!

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by Alison

Picking my battles

21 December, 2010 in Living with diabetes

Last night we went to see comedian John Bishop at Liverpool Arena. He was hilarious. Liverpool Arena, like most others, has a very simple business model. Charge high ticket booking fees, get them through the door and then screw as much out of them as you can for food and drink. It’s a pretty standard model which I avoid involvement in by surviving a whole 2 hour show without buying a drink. Madness I know but somehow dehydration doesn’t set in.

As we were going through security last night all of a sudden my ears pricked up and my pancreas twitched. Someone uttered the words “but I’m a diabetic and I need it”. I was on the verge of pulling out my lycra superhero outfit and transforming into “Diabetic girl” to run to the assistance of a fellow pancreatite. Then two things stopped me. Firstly, it was -8 in Liverpool last night and there’s no way the lycra would go over my tshirt, jumper, jumper, fleece combo without unsightly bulges and a significant risk of stretching beyond repair. Secondly though, when I looked, the bloke was trying to bring in a 3 litre bottle of Coke in case he had a hypo.

I was expecting the security guard to reply with an educated and interested response along the lines of “how fascinating kind sir, you know I’ve been meaning to ask a diabetic for a while…do you find an increased overnight basal to be the answer to dawn phenomenon or is the secret in the evening meal bolus/carb ratio?”  Shockingly dear readers what he actually said was “sorry mate, it’s not comin’ in”.

Regular readers will know I’m not shy about the whole diabetes thing and have been known to fight my corner over the years to get what’s needed. However, there’s always a risk of wearing out the lycra superhero suit so I like to pick my fights rather than engage in every battle I see. While my diabetic peer was unsuccessfully pleading his case I couldn’t help but wonder who would consider a 3 litre bottle of Coke the most appropriate hypo treatment to take to a gig. Guns, knives and petrol bombs are mildly disapproved of on the door, but food and drink are an absolute, definite, big fat no. They undermine the money making machine and as such will not be tolerated.

I’d  wandered through security completely unnoticed with a couple of tubes of fruit pastilles in my pocket. I don’t see the point in picking a fight with a disinterested security guard whilst trying to convert him to the diabetes cause. If stopped I’d have had the argument about medical necessity etc and escalated up the management chain but I’m not going to walk in like a sugar coated suicide bomber, flaunting my sweet contraband for the world to question me about.

So, the lycra goes back in the cupboard for another day and I’m left to ponder why some people make life so difficult for themselves.