The stress factor

The stress factor. How do you measure that? Any ideas?

We were first aware of the 'stress factor', as new parents, one of the most stressful times in your life I suppose, though at the time you are far too tired to notice. Patterns begin to emerge, hypos with no sensible explanation. There is no way of knowing whether it is stress that caused those hypos, that is just our own theory. I will describe the events that caused us to make this assumption, and you can decide for yourself.

Picture the scene, one exhausted wife, Ellen aged four (talking non stop), Beth aged two (constantly running off, talking to strangers and potty training), one diabetic husband, Saturday morning, Asda. To be honest I could probably leave it there and you would already agree this is not looking good for the stress levels, but I will go on. To let you understand quite how stressful this whole situation was for Mike, I also need to mention that I hate shopping. All shopping. I have a very precise, well planned list to work from to ensure that the deed can be done in the minimum amount of time necessary, and at the time, we were on a pretty tight budget, so any extra purchases had to be applied for and approved by, well, me. No, there is nothing fun and spur of the moment about shopping with me.

Ellen, bless her, did talk incessantly when she was four. It was very sweet, but unbelievably distracting, and after a while you want to say "Shush." Even if you do, when they're four, it doesn't work, so there's not a lot of point. Beth was, shall we say, entertaining, aged two. She ran everywhere in a very determined way, while Ellen walked very slowly, talking. Then there is potty training. When you hear those wonderful words, "I need a wee." you have to drop everything and run to the nearest loo, there is no time for dilly dallying. You have a trolley full of shopping, a four year old with no sense of urgency and time is ticking. An extra pair of hands at a time like that is a godsend, so we went as a family. Within the first five minutes of every shopping trip we attempted, Mike went low. I would be listening to the steady hum of Ellen yabbering away by my side, keeping one eye on Beth's whereabouts and the other eye on the shopping list, and would turn round to realise that Mike had disappeared. We would have to backtrack until we found him, usually standing by a shelf lifting something off and repeatedly replacing it. Then I would open the pack of funsize chocolate bars I'd put in the trolley and start feeding them to Mike, while answering Ellen's questions, saying that yes technically it was stealing but we would be paying for them when we got to the check out, and they would understand because it was a medical emergancy, and no she couldn't have one, Daddy was only eating it because it was his medicine, and even if she wasn't feeling very well it wouldn't be the right sort of medicine to make her better because she wasn't diabetic and yes I did know that for a fact and right about now Beth would say, "I need a wee."

We tried the shopping just enough times to establish this was a repeated pattern, and then gave up. Over the years Mike has recognised a number of activities that seem to have the same effect on his levels. Whatever you may call it, stress, nervous tension, whatever it is, probably causes different reactions in different people depending on how you deal with it. I'd call it an impossible science, but I am seriously chuffed to say that since we've started blogging, and Mike has been chatting to people and researching solutions to some of the problems he was facing, the necessity for me to intervene and sort him out has reduced dramatically. Life is good.

Jane

Morning person

I am not, as Jane will tell you, a morning person.

It's not, I hasten to add, that I am at all grumpy(!), rather that until something approaching 9 or 10am you are lucky if you get more than a grunt out of me. And then there's the sighing and yawning. Lots of that.

Over the last few years, mornings have also had an added complication in that it has not been unusual for me to wake up a little low. More often than not it's just a case of something sugary with my coffee and all is well, but it's never a good start to a day. A few times a year I am not only low, but my levels are dropping, and Jane has had to intervene.

Since we've been blogging about our experiences of living with diabetes this has been a nut I've been trying to crack. I've tried dropping 2 units of Lantus which seemed to throw my system into a high-sugar tantrum. I've tried dropping 1 unit of Lantus, which involved getting hold of a new, slightly different Autopen. I've tried various amounts of carbohydrate at suppertime to stave off the morning low.

None of these has been particularly successful.

So now I'm trying something something suggested by a commenter on this very blog. I've moved my Lantus injection to the morning rather than last thing at night.

Although Lantus is often said to have a 24 hour peakless profile in reality many Lantus users find the graph is a bit more complicated than that. Indeed this graph on lantus.com shows a slightly flattened version of what I believe happens in my case. It shows a period of onset rising to a mini-peak 4-6 hours after injecting; followed by a slight drop and levelling off; then a fall-off of activity at around 18-28 hours (which I believe can be more or less depending on the person). If my morning lows are due to Lantus's higher level of activity in the hours after injection - at the time when it appears I need less background insulin - then a move to a morning injection should match the fall-off of activity with my reduced need.

It's only been a few days yet and I've not had a chance to run any basal tests to see how things are going, but so far I've not had a pre-breakfast low and levels through the rest of the day have been pretty much what I'd expect.

So far so good. I'll let you know how things progress.

Update: Timing is everything

Thanks for the Memoir-y

First of all a massive and sincere thank you to Dr D and his excellent team at the hospital in Bristol. For a number of years I stopped going to the hospital and was seen by the Diabetes Specialist Nurse at my GP surgery. However I've recently been asking all sorts of pointy questions about changing my treatment and they have referred me back to the Consultants clinic.

I went up today for a sort of annual-review lite. Having been reviewed earlier this year it was more a bit of a check-over and chance to catch up on changes over the last few years. Since February's trip to casualty I've been taking far more blood glucose readings, making far more notes and generally paying a lot more attention to my day-to-day diabetes goings-on. So I went armed with plenty of results to discuss and lots of questions.

I also went wanting to change my insulin. Well not in fact that, but I wanted to try the Memoir pen which doesn't fit NovoRapid cartridges and though it's a weird way round I wanted to try a pen that records my doses and timings more than I felt the need to stay on NovoRapid.

I was expecting a little reluctance to this tail-wagging-dog request. The pen is, after all only the device. It's what's in it that counts.

However I was massively impressed and very thankful for the way I was treated. They listened carefully to everything I had to say, gave thoughtful insights and suggestions, but at no point did I get the feeling that they had any kind of agenda. They were, in short, wholly on my side. In true NICE guidelines style I was included as an important partner in my Diabetes care.

So from this evening I'm on Humalog and the Memoir pen.

I'll let you know how I get on.

Primary Driver

When you have kids, life becomes more precious. Their lives of course are precious, precious beyond belief; but also your own lives, as parents. You have a responsibility that must be upheld at all cost, I know that's how I felt, I'm sure that's how most parents feel.

Before we had children, Mike and I shared the driving fairly equally. When I was pregnant I felt nauseous as a passenger, which combined with the fact that I wasn't drinking alcohol and Mike was, changed the balance. I have remained primary driver ever since, largely because of my own anxieties about Mike's diabetes.

There have been times in the past when Mike has had to stop the car and test, and I've had to take over the driving because his blood sugar is low, or at risk of going low. With children in the car it's never a risk worth taking. Mike does drive, and drive the kids, and he tests regularly, runs his sugars slightly higher, takes all the necessary precautions, to know that he is totally in control. As I say, it's my own worries and anxieties that make that a rare occurrance.

This post has been written because of a conversation Mike and I had yesterday, which followed an email conversation Mike had with Matt Jones, who has commented on the first blog on this site.

It is not, I repeat, not, just me being a control freak. It is a genuine worry. Control, having said that, does come into it. There are times when Mike is not in control, it's not predictable as to when that will be, so I suppose I am always on alert, I do feel I always have to be in control. And there are those times when you are somewhere you know longer want to be, a visit that has come to an end shall we say. (Particularly relevant if you need to get toddlers out of sombody's house before they break something, or begin to play up out of boredom or exhaustion.) The last thing you want to do is find you need to stay an extra half an hour while the driver sorts his levels out. I like to be ready to take over just in case, so if wine is offered, I say no, which means that Mike might as well say yes. Lets call this a diabetic bonus. You have to make the most of them when they come along.

Jane

I do apologise for going rather quiet for a while. My life is divided, when the kids are at home, I'm full time Mum. That, sadly, did not mean that the kids were willing to share their Easter Eggs with me. Back at school, for Beth, the youngest, the last term ever at primary school, and I now need to make the most of the next three months before I stop for the summer. Back to work, and time for a quick blog.

I have noticed since I turned forty, that my picture of old age has changed. I always quite fancied myself as a roly poly Grandma with soft, downy cheeks. Now I see a tough old bird who can bite the tops off beer bottles and then spit them a good distance across a room. I think Mike prefered the first vision, but I suppose I feel the need to be strong and prepared, because ageing might not be the easy ride I'd once imagined.

We are lucky. We are healthy (diabetes apart). We are not genetically disposed to develop anything nasty (diabetes apart). We should be heading towards a fun retirement; but it is all a bit scary, and much like the time when we were first expecting Ellen, we need to know everything there is to know so that we are as prepared as we can be.

There is a nagging thought at the back of my mind, which I've been ignoring for a while. It's not just Mike. I'm going to have to be fit too. It's actually not enough encouraging him to go to the gym, telling him how important it is to look after himself. I need to be strong too. Damn. I hate excercise. Hmmm.

Jane