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July 2024
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Some days are much harder than others

This is a piece about what it’s like to be diabetic when nothing is working.

“Life is pain, Highness. Anyone who says differently is selling something,” Wesley to Buttercup from the Princess Bride movie.  We all have those those when nothing seems to be going right, whatever we do doesn’t work and it just feels like a struggle.

When you have something like type 1 diabetes, anything that changes the playing field can literally be painful, if it causes high blood sugar, or a frightening game of catch-up if your blood sugar is low.

Most of the time, life ticks along simply enough.  There are a few moments when things aren’t quite smooth sailing, but mostly a simple correction straightens everything out.

Last year, Adam Brown shared the 42 factors that affect blood glucose.  When I wrote my book I grouped these into three main influencers: stress, ingestion and insulin.

Insulin generally speaking lowers blood sugar.  Although it isn’t quite that simple because a very small hypo may self-recover.  As my control tightened with the long distance bike riding that was really noticeable and it was really important to understand my basal rates and insulin on board (from boluses) before over treating with carbohydrates.  Over night, the body can self correct to such an extent that there can be a high although I’ve not observed that since I’ve been using pump therapy and been much more closely aligned to my basal needs compared to long acting insulin.  What do I mean by a very small hypo?  Well, if my blood sugar is above 3.8mmol/l but below 4mmol/l – indeed if we take the accuracy of the testing methods into consideration, I may not actually be hypo at all.

Insulin on board?  I take a bolus of insulin to cover the food I eat on top of my normal basal levels of insulin.  That insulin last for approx. 4 hours for me.  If I had 4 units 2 hours ago, I have used a couple of units worth and still have 2 units of insulin working in my body for a couple of hours or so – for me, that can lower my blood sugar by 5mmol/l so unless my food taken at that time is still being processed and absorbed, I may need 10g or so to ensure I am not hypo in two hours time and I would tend to do that with something like a mini-coke or very small glass of fruit juice.

Ingestion is food and drink.  This can do either, although the only thing I’ve found that lowers my blood sugar meaningfully is alcohol which is why no-one should drink on an empty stomach.  Food and drink is a highly complex subject and in this I am not including painkillers or other medication, otherwise it really does but very complicated very quickly.

Stress, for me, is everything else.  Your circadian rhythm shows the stress your body is under from your bodily functions and queues from the sun.  The way you get excited before your favourite food turns up, is a kind of stress.  The nervousness you feel before sitting an exam or driving test, is your mind asking your body for some help during a stressful time and in response, your body releases cortisone and adrenaline in response to a request from the hypothalamus or your body gearing up to fight the cold virus your nearest and dearest have given to you.

If you’re not diabetic, that response is not always useful, but you respond to the cortisone and adrenaline by dumping stores of glycogen from your liver and muscles and your pancreas ensures there is enough insulin to make use of that extra energy.

I don’t do that, I feel grotty, test my blood sugar and then treat the resulting high blood sugar.

Sounds like a plan

When fighting an infection, my body, like a non-diabetics, releases glucose stores ready to produce a fever.  Only that doesn’t happen because there’s nothing to make use of the energy.  The feedback loop then gets twisted and because my body is under stress and short of energy, it can release more cortisol and adrenaline, raising my blood sugar further.  Meanwhile, the infection is still there, now with a load of unaccounted food for it to feed off.

It’s a mess, this is a war zone, with no areas without conflict.  Except, I am trying to fight the good fight and dose up with insulin.

Which can alleviate the stress, which then causes a drop in levels of the stress hormones and I am then dealing with a massive hypo.

And that’s if my body is able to fight the well feed infection: bacteria and viruses are simple, when there is food, they multiply.

Somebody gave me a cold four weeks ago, when I find out who…  In the meantime, my control has gone out of the window.  I’m eking by, largely by fasting and watching it like a hawk, going from high to less high to low, but I am so knackered.  The nausea when I drop is the pits.

Medicine which soothe the symptoms are great and can lower my blood glucose but I end up in a “dipping cycle”, as they wear off, my blood sugar climbs, as they become effective, it drops.

It feels like I am running a marathon 24/7.

Of course, I am not externally showing any signs: the odd sniffle, sneeze and cough, but not obviously sick.

On with the game.  Enjoy yours 🙂

Oh, and a reminder to all those with a compromised immune system out there: get your flu shot this year, please.  Because however bad the cold is, flu is a killer for us.

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