The lesser of two evils – by Jenny Foster

Is there a lesser of the two evils? By the two evils of course I am referring to what us slaves-to-diabetes call the hypos and the hypers or the lows and the highs; those times when blood sugar levels decide to slip out of their comfort zone and give their owners a little kick up the bum!

I was asked the question just the other day by a friend who was unfamiliar with the difference between the effects of high blood sugar readings to those of a low reading. I contemplated my answer and discussed it with Ewan, my 10 yr old son who has Type 1, insulin pumper!

When Ewan was diagnosed 2.5 yrs ago the word ‘hypo’ sent shivers down my spine, it sounded so serious, deadly serious! When I was told by a nurse that Ewan could have several of these a day while we were getting used to his insulin regime, I was horrified!

I imagined him passing out on the street, or slipping unconscious during classes at school but the reality of a hypo was one of our few pleasant surprises during those early weeks. Ewan would say he felt shakey, his legs a bit like jelly, a blood check would confirm his sugars were a bit low, we would treat with jelly babies or Lucozade and 15 minutes later all would be fine!

When I first heard the word ‘hyper’ I immediately thought of the abbreviation for hyperactive, I never related it to hyperglycaemic, why should I? I’d never heard that word before. So again my mind played tricks on me and I pictured Ewan running around the house screaming and waving his arms around or having an uncontrollable fit of giggles when he should have been concentrating in maths … but again, how wrong I was!

Whilst the hypo had been my pleasant surprise, the hyper came as a nasty shock. Words like ketones, ketoacidosis and coma (yes coma!!) we’re branded around in abundance and with unnerving normality.
Now, we’ve experienced many of these highs and lows over the past few years and as a mum I definitely find one much easier to deal with than the other, but as the person with diabetes, Ewan is at odds with my conclusion.

The hypo is quick, his awareness is exceptional so treating and recovering from them is quick too. The treatment feels like I’m giving him a treat and no sooner has he felt the shakes then he’s back to doing whatever it was he was doing! For Ewan though this is a pain, the shakes feel awful and stop him from doing what he was doing. The jelly babies and lucozade ‘treat’ as a treatment is becoming boring and a little bit sickly and because of hypos he has to carry a bag everywhere he goes with sugary supplies that he can’t just eat and drink whenever he chooses – torture!

The hyper is hidden. His symptoms of high blood sugars are almost none existent and often surprise us when we are doing routine checks. That’s when I have to start using my brain… calculating temporary basel increases, adjusting ratios and setting alarms for endless re-tests and ketone tests while his sugars slowly return to acceptable levels, all the while the words ketoacidosis and coma reverberate around my head and the long-term side effects of high blood sugars gnaw at my conscience.

Ewan on the other hand is pretty oblivious, aside from the extra testing and correction boluses through his pump he pretty much carries on as normal and feels no different.

You can see why our conclusions are at odds with each other!

For me – hypos are in the now, recognise them, deal with them quickly and all will be fine. Ewan is 10, he lives in the now, hypos are a pain.

For me – hypers are hidden and they signal something is really wrong, put it right or suffer the consequences of possible long-term side effects and hospitalisation. Ewan doesn’t look at the future, he is 10, he lives in the now.

The lesser of two evils? Ask me and I’d tell you hypo, ask Ewan and he’d say hyper. The real answer is in the question though, they are both evil!

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Thank you Sarah but my role was just to help raise the funds to open the Centre, which took 7 years from launch to completion. The people who now work in the Centre and the relatives who support the patients are the ones doing wonderful work. Coincidentally, students at the school I work at presented a cheque today, for around £2500, to a representative of JDRF. They raised it from putting on a Fashion Show. Lets all hope that the search for a cure will soon be rewarded, and your daughter and so many other young people will be able to live their lives without fear of complications from this pernicious disease.

Sue Marks, my heart goes out to you and your family. I also admire you for setting up the Diabetes centre in your daughters name. My 15 year old Hattie (diagnosed at 12) also has very limited signs of hypos and it is a constant concern although she is slowly recognising her particular signals. Diabetes is a term that so many people are aware of but until you are thrust into its orbit you do not appreciate what this terrible condition really means. I remember taking Hattie to the doctors the day she was diagnosed thinking “I wonder if it is diabetes” and thinking she might be poorly for a few weeks and then get better….. if only! Keep up the fabulous work you are doing in the name of your duaghter.

well I have been a diabetic for over 25 years now and I deal with having hypos and hypers at least every day my blood can range from 1.5 to 30 and this has always been Im on 4 times a day insulin injections after a time you get used to the highs and lows and deal with them the best way you can, I awake every day and say to myself is this going to be a low day or a high day, some times I do ride between the two reading and you just have to make the best of things as these things are here to stay there is no magic wand to get rid of them and I wish there was but for now until more research is done into diabetes and on a cure, we all have to make the best out of these things that diabetics has to offer us and overcome them.

There is no such thing as the lesser of two evils in diabetes; but Jenny’s blog and the comments that followed have demonstrated that you just can’t generalise or assume that every person’s experience will be identical. When my precious daughter Stephanie was diagnosed in 1996 (at the age of 11) we were told that long term control was the key aim (to avoid complications), and we were assured that the sudden and severe hypos which afflicted her from time to time, because of her lack of awareness of rapidly falling sugar levels, were not life-threatening. Stephanie had a hypo one night in June 2002 from which she did not wake up. She was 17. The Stephanie Marks Diabetes Centre in Surrey was built in her memory, and it is a comfort to know other diabetes patients benefit from the services provided in this wonderful unit, but I never stop regretting that we were not taught to give her hypos the respect they deserved.

My husband has been type 1 for 30+ years. I find I worry all the time about hypos. He has had many hypos over the years we have been together, sometimes totally out of the blue and have come on very suddenly, we believe insulin sometimes gets trapped and releases quickly. The worst was when he was driving, he managed to pull over in time but as you can imagine it was terrifying. His sugars seem to be more settled nowadays, but he has just been diagnosed with Neuropathy, we find it’s a constant battle between high and low.

Well, I’ve had diabetes for almost 43 years now. I’ve been on a pump for 25 years. I have good hypo awareness except for those brutal nocturnal hypos. I usually wake up though. But I have to say that hypers are worse – they do far more long term damage, if it gets very high for any amount of time, it makes me ill, headaches and sick to my stomach. A little hyper – say something in the teens (for UK) or in the low 200s (for US) isn’t a big deal. Change the infusion set and take a bit extra. But over 17 or 18 (or 300) for any amount of time and I’m good for nothing. And the damage that a bloodsugar that high causes to the eyes and the kidneys and the nerves. Scary.

I have to say, as type 1 diabetic diagnosed back on 1964 and now in my 63 year and thus having had just a little bit of experience,that Ewan is right the devil is Hypo, it can strike at the most inopportune moments and despite paying careful attention to diet and doses it can still bite back for sometimes inexplicable reasons.
Hypers are of course a problem long term but as they are easily detectable with todays blood glucose measurements, are not really an issue in my view (unless you choose to ignore them of course!).
The biggest advance that could be made in diabetes technology would be an implanted blood glucose meter with hypo alarm, they need to be reliable and above all cheap to use/buy/operate. I think that we are almost there with things like the Navigator BGM which i trialled earlier this year,but costs need to be brought down and the devices refined. For me that would remove the worry about the devil for good!!

My partner has had type 1 since he was young and, whilst he used to experience similar symptoms as your son, the older he gets the more the lines are blurred. He used to sense low bloods and correct it himself – or if it was night time a sudden rise in his temperature & a bit of twitching would alert me so I could wake him & get himself sorted out. Now the signs are weaker, he tests his bloods more as He becomes more unsure, and at night I frequently test his blood as now he twitches constantly in his sleep whether he’s low or not. He has the unfortunate side effect of fitting during a hypo, much like an epileptic, which leave him disoriented & sore afterwards. Of course in the long term hypers can lead to many complications but I find hypos terrifying

Jenny, that was really interesting. I was just thinking about that very question this morning while contemplating how my 12-year old daughter is doing. I completely agree with your last sentence. Thank you for not making me feel alone!

At the age of 27 I have to say I agree wholeheartedly with your son. I have severe hypo unawareness, I can go into a coma through low blood sugars without experiencing any of the symptoms your son has to alert him to test and treat his hypo. This leaves me in the position where it is much easier to test my blood sugars something like 2-3 times a day and correct high blood sugars than to test every 60 minutes in order to try to avoid a major hypo. It’s also a lot easier on the fingers. Many of the issues you highlight as the result of high blood glucose are long term issues, for me the risk of a severe hypo is much more immediate and equally as serious. I have previously known someone who went into a coma through low blood glucose and simply never came out of it. I guess it’s all a matter of perspective.

A well written blog & can well understand the sentiments, I was daiagnosed T1 in November 2010 & had many of the same concerns as knew absolutley nothing about diabetes at the time.
In one way I consider myself lucky that I had 36 years free of the worries, but then it has been hard adjusting life with diabetes, the constant testing, the mdi’s, making sure got my diabetic kit with me wherever I go & planning activity to try & avoid hypos while also trying not to send my blood sugar too high, which I really struggle with.
Hope 2013 is a good year for you & Ewan & all diabetics.