THE DAFNE DIARIES
I felt embarrassed going back on Wednesday, but as I sat waiting to have my ‘big’ blood test, I found myself sat with a couple of other people on the course who made me feel so much better. We were all diabetics after all and had some idea of the impact of a hypo, even if their control was much better than mine. I actually couldn’t thank them enough as generally ‘my nerves will be the death of me, I know’ (thanks Dallas Green) and even though I had some skinny nurse who smelled vaguely of glue sticks push a needle into my arm, I was generally feeling much calmer than the day before.
That day we had a doctor come in to explain about the usefulness of the diabetic Review and the impact diabetes had on each part of your body. In some ways it was incredibly scary, but at the same time added to my motivation to actually want to sort my sugars out. I had seen already that it was possible and was learning the skills on how to deal with them and now the doctor’s explanation of the long-term effects gave a clearer explanation of why good control is important. Of course this was mostly stuff that I had heard before, but learning about it in a group and getting to ask questions was a satisfying way of exploring all the ways diabetes affects your body.
Today we also talked about healthy eating which I suppose was a generic thing they had to add in. I was surprised with how interesting the discussion was actually, I had totally braced myself for an onslaught of boredom. For example, we discussed how sweeteners were developed in labs and had been given a bad review by the general media with regards to reports that they gave you cancer. In actual facts they had been tested on rats who then developed cancer, but the point was that if you feed a tiny mammal chemicals in quantities suitable for a human, the end result was never going to be good. We did however discuss how sweeteners have not been around for long enough to actually see long-term effects, so they may very well give you cancer, but we have no way of knowing that yet. Similarly I commented that they might also make you invincible, but I suppose we’ll just have to wait and see.
The discussion about fats was also pretty interesting. There are certain fats which occur naturally, such as saturated fats. During WWII however when animal fats and such were not readily available, other fats were created in laboratories which at the time were considered marvellous- these were hydrogenated and trans fats. The issue with these however is that they are made of such a tight/secure chemical composition that your body literally has no natural means of breaking these down– we are genetically designed to break down natural fats of course, but not the ones created in labs. This is why these kinds of fats tend to sit around your body. There are a lot of fats that are good, but these are definitely ones to try and avoid. I’ve never been one for eating particularly healthy, but at the same time this was rather fascinating information.
Oh! And did you know that carbohydrates have less calories per gram than other food groups, like protein? The only thing is we store a great deal of carbohydrates and not so much protein (we wee away about 85% of the protein we consume as it is only used for growth and repair, and if you are not a body builder or a child you don‘t have so much use for it), and so carbohydrates are generally thought to be worse to eat if you’re trying to diet. But this isn’t the case, so long as you use up the amount of carbohydrate you consume by being active.
The more you know!
Today we also ate out and ended up going to the Westfield Centre, where we got a few funny looks from passers-by, what with drawing blood from our fingers and generally stabbing at our stomachs with needles. I probably should have mentioned that there were eight of us all together, so we were a little bit of an obvious group of ruffians, who were also evidently drug addicts. We continued to use the 1:1 insulin:CP ratio and also made a note of our blood tests as we had been encouraged to do every week, to write them on acetate and show to the whole group when we returned to the hospital.
‘Modern finger-pricking devices help you to obtain a drop of blood. Blood glucose meters can provide you with the accuracy essential for determining blood glucose level and for working out how much insulin you need.’
The first class on Thursday covered what to do when you experience illness. It is a general rule that when you are sick your sugars will be higher as your body becomes more resistant to insulin. We were told about mild and severe illness, if you have a mild illness like a cold or a headache then you need to check your sugars and also check for ketones (mentioned in my first DAFNE post). If you do not have any ketones, then you must continue to check your sugars and urine every four hours, but generally you should proceed as normal except you might need to make more corrections.
For severe illness you are more likely to develop ketones and this can be resolved depending on the amount present in your urine (your Ketostix will tell you). For +++ to ++++ ketones present, then every two hours you will need to test and then also take 20% of ALL total insulin taken the day before. Every two hours, I know right?! Hopefully this will begin to bring them down, and as soon as you have + to ++ present then you can begin to take 10% of the previous day’s, until they have all disappeared or you only have a trace (remembering to check every two hours until they have gone). If you still have ketones by the time night rolls around you should just go to the hospital, as taking insulin every two hours during the night at home might, well, frankly, be a bit of a ball-ache. Plus it’s for your safety- you probably don‘t want to die. But mostly for the ball-ache thing.
‘When you are ill your body becomes more resistant to the insulin you produce or take by injection… It is likely that you will need to increase your insulin dose. Although you may not feel like it, it is very important to monitor your diabetes closely to prevent [DKA] developing.’
For lunch that day we went to the pub, and then went for a walk afterwards to determine the effect exercise has on your blood sugars. Generally it varies from person to person, but it also depends on the exercise you do. For example, high-adrenaline exercise may cause your sugars to go high before they drop, or low-level exercise might not need anything at all depending on your sugars. We were encouraged to experiment with different exercises to monitor the affect on our sugars. The same goes for alcohol, really- some drinks have more CPs than others, most will raise your blood sugar and then a huge drop will occur a few hours later. This is all down to the liver not being able to do two things at once, it’s either dealing with the ‘poison’ you’ve put in your body, or it’s doing it’s glucose-whatnot. So there is a bit of a delay with the sugar impact when drinking alcohol- this is something the DAFNE programme doesn’t have quite so much data on however, as apparently getting people drunk for the purposes of science isn’t quite morally ethical. Lol whut.
When I got home later that afternoon and I tested, my sugars had actually gone up even following the exercise we did after lunch (I didn’t have any alcohol myself). Thus, I then had to work out what had gone wrong and why, using DAFNE’s ‘Stepwise Approach’ to resolving blood glucoses which are out of target.
Thus, I could have underestimated the CPs I had for lunch or I could have mis-dialled my insulin pen. Moreover, my background insulin in the morning could have been too low, or my lunchtime ratio was not enough. There could be other causes too, such as heat and lumpy injection sites. The DAFNE approach states that you must wait for a pattern to emerge over two days before making this decision; the whole process is so intricate and requires much thought, and this is why it is so important to make a note of all my blood sugar results. I decided to leave the decision until Friday; other people had already needed to change their ratios (e.g. 2:1 instead of 1:1), and they had taken this decision after two days of evidence. However, as this was the first time my sugars had risen after lunch I needed to wait first.
Largely things had begun to fall into place, and I was really looking forward to seeing a pattern and though further testing on Friday found it to be an anomaly, it was a tiny bit exciting, almost as exciting as playing with the plastic food on the first day.