You Can’t Eat That!

Thank you so much for your contribution here Alex. Might anybody else like to share like this, please feel free. Im sure many other people can relate to many of these things that Alex writes. Im also sure that writing your thoughts can be of benefit to others who have just been diagnosed with diabetes and are reading this, or have had diabetes and are nodding their heads in agreement. Kind Regards, David Diabetes Educator @ Diabetes Counselling Online

Living with Type 1 Diabetes How do you explain to someone what it means to be living with type 1 diabetes? You could use words like frightening, painful, vigilance, hard work, frustrating, dangerous, annoying, but these same words could be used to describe many things, such as driving a car in the city. Maybe not “painful”, but certainly all of the others. So how do you communicate effectively the kaleidoscope of emotions and dramas that a person with type 1 diabetes goes through every minute of every hour of every day of their life, in a way that enables the other person to truly understand what is involved with living with this condition? Maybe I could start by describing the first 5 minutes of the day after the alarm has woken me up. For a normal person they might get out of bed and put their dressing gown on, then wander to the toilet, then wander out to the kitchen for a cup of tea. They could sit there for the next 2 hours drinking tea and catching up with the day’s news on the internet. For a person with type 1 diabetes, in this case me, the first 30 seconds is the same. Get out of bed, have a stretch, put my dressing gown on and wander to the toilet. But that’s where the similarity finishes. You see, the diabetic must now take out their blood glucose measurement kit and get it ready for a test. This involves testing strips, adjustments, settings etc, as well as preparing the finger pricker. Next I choose which finger is the best to use. This involves a number of quick decisions, such as which finger did I use last time, and which side of the finger tip? I need to avoid punishing the same part of the same finger too many times as this could lead to the finger getting too sore, or infected, or toughening up so it is no longer useable as a testing site. Once these decisions have been made, I need to do something that other people would talk about as an “unfortunate event” over a cup of tea with their friends. I need to press the button and prick my finger with a sharp sliver of steel, in order to cause it to bleed. If it doesn’t bleed enough, producing a nice, rounded drop of blood, I need to choose another spot and do it again, until I have a good drop of blood to apply to the testing strip. Then the wait begins. It might only be 5 seconds, but in that 5 seconds I am wondering how good I was with my food last night and whether this morning I’ll be congratulated with a decent reading, somewhere between 4 and 7. If it comes back too high, let’s say 10, it means that over a long period of time I am open to the long term negative effects of poorly controlled diabetes, which are too devastating to consider. And if it comes back too low, let’s say 3 or below, it means I am in imminent danger of slipping into a hypo, and the immediate danger that involves. So too high, long term danger. Too low, immediate danger. Amount of control I as a diabetic have over this situation? Well, when you take into account the factors that I have little or no control over, such as the weather, the season, my stress level at work and in my private life, the amount of rest I have been getting over the last few days and the amount of work, physical and mental, and exercise I have done over the last week or so, limited. And all of these questions and emotions rush through my head in the 5 seconds I stand there until the reading comes up. 8.3 It’s a little bit high, but not too bad. It’s a reasonable start to the day. At least I are not in any danger of collapsing on the bathroom floor. So now, with this new knowledge, it’s time to prepare for my morning insulin injections. There are modern, new ways of managing type 1 diabetes, as well as older methods, all of which require the injection of insulin. The method I use is now considered old fashioned, but it is what I’ve done for 40 years and it’s worked for me so far. So I have my standard dosages of two insulins for each morning, which remains the same each day, unless there is a serious reason to change them. This could be situations such as an expected physical activity coming up during the morning, or suffering from an ailment such as a cold or flu, which changes the dosage requirements of insulin significantly. However there is also the opportunity to adjust the dosage by small increments if the BGL test I have just done shows a radical reading. This would usually be a radically high reading, which would prompt me to consider changing the dosage of one of the insulins up by a very small amount. But, and this is very important, the adjustment of the dosage in this way needs to be done in a thoughtful and calculated way. Too much insulin unnecessarily will leave me open to serious problems later in the morning if I get it wrong. So after considering the many decision points, by thinking ahead and anticipating what the day ahead holds in store, I take out the first insulin pen and prepare it. This involves taking the cap off, taking one of the disposable needles and peeling the paper covering off the back, then screwing it onto the end of the pen. I then prime the pen, by winding on 2 units, then depressing the plunger and letting the 2 units of insulin spray into the air. This removes any air in the pathway and checks that the needle is not blocked, meaning that the next time I depress the plunger it will be just insulin going through. Next comes the choice of where to inject. After having something like 40,000 injections, at 3 per day for 40 years, it is important to spread the injections around. It is a subcutaneous injection, meaning it goes into the fat underneath the skin, so it needs a place that has enough fat to inject into. But there’s the issue that, over an extended period of time, the insulin, or the act of injecting, can react with the fat and turn it into a hard lump. When this happens it becomes impossible to inject into, being hard and painful. But more importantly, it also becomes pointless to inject into, because the insulin can sit in the lump unabsorbed, thereby making it ineffective. So it is important to vary the place where I inject. I decide on which of the four areas I have to use this morning, so pinch up a roll of skin and slip the needle in. Being so fine, and the site being carefully managed over time, the needle slips in quite easily. But that does not negate the opportunity for a blood vessel to be in the way and punctured. As the blood vessels are surrounded by nerves, it is always quite painful if I stray too close to one. It is also potentially dangerous, as to allow the insulin to enter the blood vessel directly is to cause the insulin to act too quickly, dropping the BSL dramatically. Over the 40 years, this has happened more than once. But luckily is a rare event. This process is repeated with the other insulin, after considering whether to maintain the standard dosage, or to alter slightly for some reason. With a BSL reading of 8.3 and a standard day of activity coming up, and with the weather set to be 24C and no emotional upheavals, such as a funeral or hospital visit for a friend, there is no reason to alter the dosage up or down. The diabetic has been out of bed for 5 minutes so far, and has already been through this process. If this was a oncer, or went on for a few days until “they got better”, like having the flu or a cold, or even pneumonia, it might be acceptable. But this routine happens every morning, as it has done every morning for the last 40 years. There have been slight variations in that time, such as the magical introduction of the injection pens with their ultra fine needles, as opposed to the old disposable syringes and their comparatively thick and painful needles, or the much worse glass syringes that came before them. But the basic routine, and it’s accompanying urgency and importance, hasn’t changed in all that time. Plus, as it stands, it will be going on for the next 20 or 30 years. That is just a description of the first 5 minutes of the day. Similar situations exist throughout the day, with finger pricks, testing and injections. Plus there are the many moments of decision such as the choice of food for each of the 3 main meals and the 3 snacks that happen at regular intervals throughout the day. There is the constant monitoring of how I feel, how I’m responding to people in meetings, or on the phone, or in ad-hoc social situations. Am I finding it difficult, or my comments, questions, responses somehow not quite appropriate to the moment? If so then could the reason be that the sugar is low? Do I need to test? Do I need to eat some of my emergency food immediately to ward off a looming crisis? There are a constant set of questions always demanding to be asked and answered. How do I feel? What time is it? Do I need to eat? How long until I eat? Do I have enough time and sugar level to perform that impromptu, unplanned for activity? Do I have enough food? Do I have my emergency food? Is it enough to cover unexpected needs? Is it the type of food that can be carried easily and will survive intact through whatever conditions are likely to occur? And this is for a standard day. When something out of the ordinary is coming up, like a two day drive to Brisbane, or a trip to the football that means travelling during the normal time for the evening injection and meal, the unknown to be managed escalates. So when a well meaning relative, friend or acquaintance offers advice, try to smile and say thank-you. They mean well but really haven’t got a clue.

Well said!! You should pass this on to newly diagnosed and families! This is a terrific insight that is important for others to read!

Brilliant!

Living with diabetes How do you explain to someone what it means to be living with type 1 diabetes? You could use words like frightening, painful, vigilance, hard work, frustrating, dangerous, annoying, but these same words could be used to describe many things, such as driving a car in the city. Maybe not “painful”, but certainly all of the others. So how do you communicate effectively the kaleidoscope of emotions and dramas that a person with type 1 diabetes goes through every minute of every hour of every day of their life, in a way that enables the other person to truly understand what is involved with living with this condition? Maybe I could start by describing the first 5 minutes of the day after the alarm has woken me up. For a normal person they might get out of bed and put their dressing gown on, then wander to the toilet, then wander out to the kitchen for a cup of tea. They could sit there for the next 2 hours drinking tea and catching up with the day’s news on the internet. For a person with type 1 diabetes, in this case me, the first 30 seconds is the same. Get out of bed, have a stretch, put my dressing gown on and wander to the toilet. But that’s where the similarity finishes. You see, the diabetic must now take out their blood glucose measurement kit and get it ready for a test. This involves testing strips, adjustments, settings etc, as well as preparing the finger pricker. Next I choose which finger is the best to use. This involves a number of quick decisions, such as which finger did I use last time, and which side of the finger tip? I need to avoid punishing the same part of the same finger too many times as this could lead to the finger getting too sore, or infected, or toughening up so it is no longer useable as a testing site. Once these decisions have been made, I need to do something that other people would talk about as an “unfortunate event” over a cup of tea with their friends. I need to press the button and prick my finger with a sharp sliver of steel, in order to cause it to bleed. If it doesn’t bleed enough, producing a nice, rounded drop of blood, I need to choose another spot and do it again, until I have a good drop of blood to apply to the testing strip. Then the wait begins. It might only be 5 seconds, but in that 5 seconds I am wondering how good I was with my food last night and whether this morning I’ll be congratulated with a decent reading, somewhere between 4 and 7. If it comes back too high, let’s say 10, it means that over a long period of time I am open to the long term negative effects of poorly controlled diabetes, which are too devastating to consider. And if it comes back too low, let’s say 3 or below, it means I am in imminent danger of slipping into a hypo, and the immediate danger that involves. So too high, long term danger. Too low, immediate danger. Amount of control I as a diabetic have over this situation? Well, when you take into account the factors that I have little or no control over, such as the weather, the season, my stress level at work and in my private life, the amount of rest I have been getting over the last few days and the amount of work, physical and mental, and exercise I have done over the last week or so, limited. And all of these questions and emotions rush through my head in the 5 seconds I stand there until the reading comes up. 8.3 It’s a little bit high, but not too bad. It’s a reasonable start to the day. At least I are not in any danger of collapsing on the bathroom floor. So now, with this new knowledge, it’s time to prepare for my morning insulin injections. There are modern, new ways of managing type 1 diabetes, as well as older methods, all of which require the injection of insulin. The method I use is now considered old fashioned, but it is what I’ve done for 40 years and it’s worked for me so far. So I have my standard dosages of two insulins for each morning, which remains the same each day, unless there is a serious reason to change them. This could be situations such as an expected physical activity coming up during the morning, or suffering from an ailment such as a cold or flu, which changes the dosage requirements of insulin significantly. However there is also the opportunity to adjust the dosage by small increments if the BGL test I have just done shows a radical reading. This would usually be a radically high reading, which would prompt me to consider changing the dosage of one of the insulins up by a very small amount. But, and this is very important, the adjustment of the dosage in this way needs to be done in a thoughtful and calculated way. Too much insulin unnecessarily will leave me open to serious problems later in the morning if I get it wrong. So after considering the many decision points, by thinking ahead and anticipating what the day ahead holds in store, I take out the first insulin pen and prepare it. This involves taking the cap off, taking one of the disposable needles and peeling the paper covering off the back, then screwing it onto the end of the pen. I then prime the pen, by winding on 2 units, then depressing the plunger and letting the 2 units of insulin spray into the air. This removes any air in the pathway and checks that the needle is not blocked, meaning that the next time I depress the plunger it will be just insulin going through. Next comes the choice of where to inject. After having something like 40,000 injections, at 3 per day for 40 years, it is important to spread the injections around. It is a subcutaneous injection, meaning it goes into the fat underneath the skin, so it needs a place that has enough fat to inject into. But there’s the issue that, over an extended period of time, the insulin, or the act of injecting, can react with the fat and turn it into a hard lump. When this happens it becomes impossible to inject into, being hard and painful. But more importantly, it also becomes pointless to inject into, because the insulin can sit in the lump unabsorbed, thereby making it ineffective. So it is important to vary the place where I inject. I decide on which of the four areas I have to use this morning, so pinch up a roll of skin and slip the needle in. Being so fine, and the site being carefully managed over time, the needle slips in quite easily. But that does not negate the opportunity for a blood vessel to be in the way and punctured. As the blood vessels are surrounded by nerves, it is always quite painful if I stray too close to one. It is also potentially dangerous, as to allow the insulin to enter the blood vessel directly is to cause the insulin to act too quickly, dropping the BSL dramatically. Over the 40 years, this has happened more than once. But luckily is a rare event. This process is repeated with the other insulin, after considering whether to maintain the standard dosage, or to alter slightly for some reason. With a BSL reading of 8.3 and a standard day of activity coming up, and with the weather set to be 24C and no emotional upheavals, such as a funeral or hospital visit for a friend, there is no reason to alter the dosage up or down. The diabetic has been out of bed for 5 minutes so far, and has already been through this process. If this was a oncer, or went on for a few days until “they got better”, like having the flu or a cold, or even pneumonia, it might be acceptable. But this routine happens every morning, as it has done every morning for the last 40 years. There have been slight variations in that time, such as the magical introduction of the injection pens with their ultra fine needles, as opposed to the old disposable syringes and their comparatively thick and painful needles, or the much worse glass syringes that came before them. But the basic routine, and it’s accompanying urgency and importance, hasn’t changed in all that time. Plus, as it stands, it will be going on for the next 20 or 30 years. That is just a description of the first 5 minutes of the day. Similar situations exist throughout the day, with finger pricks, testing and injections. Plus there are the many moments of decision such as the choice of food for each of the 3 main meals and the 3 snacks that happen at regular intervals throughout the day. There is the constant monitoring of how I feel, how I’m responding to people in meetings, or on the phone, or in ad-hoc social situations. Am I finding it difficult, or my comments, questions, responses somehow not quite appropriate to the moment? If so then could the reason be that the sugar is low? Do I need to test? Do I need to eat some of my emergency food immediately to ward off a looming crisis? There are a constant set of questions always demanding to be asked and answered. How do I feel? What time is it? Do I need to eat? How long until I eat? Do I have enough time and sugar level to perform that impromptu, unplanned for activity? Do I have enough food? Do I have my emergency food? Is it enough to cover unexpected needs? Is it the type of food that can be carried easily and will survive intact through whatever conditions are likely to occur? And this is for a standard day. When something out of the ordinary is coming up, like a two day drive to Brisbane, or a trip to the football that means travelling during the normal time for the evening injection and meal, the unknown to be managed escalates. So when a well meaning relative, friend or acquaintance offers advice, try to smile and say thank-you. They mean well but really haven’t got a clue.

From another LinkedIn connection, a dietitian: "Love your article"

from one of my a LinkedIn connections: "Great reading and so very true, whenever you have a condition, you always get so called experts who are experts because they know someone who has the same condition and this is how they deal with it, so of course it's fact, "You shouldn't be doing that, you NEED to do ti this way" Really? and what do you know!? My advice to anyone is, if you have a condition of any kind, educate yourself as much as possible and work based on your own knowledge and if you don't know, ask a professional, then you will know. My Partner has mastered all the effects of my diabetes and she is amazing."