Aggressive Treatment – by Olly Double
I’ve never been a brilliant sleeper. Chuck a bit of stress into my life and I’ll either not be able to get to sleep in the first place, or – much more commonly in recent years – I’ll wake up at stupid o’clock and not be able to get back to sleep. So I wasn’t too pleased yesterday morning when I was woken by the annoying miniature police siren of Joe’s continuous glucose monitoring system.
Everything sounds louder at night, and even though it’s a pathetically tinny little sound, there it was drifting out through Joe’s open bedroom door and in through my earhole. I think the sound invaded my confused dream state before I fully woke up and realised I’d need to lug myself through and check his blood with a finger prick test.
His pump told me the CGMS thought his blood sugar was low, but when I tested him he was on 4.3 mmol/L. I checked the time. 5am. Would it be OK to leave him be, or was there a chance he’d go hypo in the hour and a half between now and getting-up time? I decided to set his basal insulin rate to zero for half an hour, with the idea that this should stop his glucose falling any further. Given I was already awake, I thought I might as well also check Tom. His blood sugar was running high, so I gave him a correction bolus…
By the time I came back downstairs to the middle floor, Joe’s CGMS was already alarming again. I was now wide awake and lucid enough to consider going out to the shed, grabbing a lump hammer, and wreaking a smashy vengeance on Joe’s bleeping insulin pump. In the event, I controlled my rage and just went and cancelled the alarm instead. I really wish that when you update the pump with the level from the finger prick test, it could remember that it’s been informed that the blood sugar’s OK and therefore wouldn’t start its idiotically obnoxious alarming again.
I crawled back into bed, and although my body firmly intended to go back to sleep again, my brain had other ideas. It had decided to make me think about all the difficult, anxiety-provoking things that awaited me at work that day. I put the light on to see if it would help if I read for a bit, but it turned out I was too tired to concentrate on the words on the page. Too tired to read, too wide awake to sleep. Is that even possible?
At 6.35, my radio alarm went off as it does every weekday. It’s much less obnoxious than the CGMS alarm. It gently fades in with the sounds of Radio 4’s Today programme. I’m so used to it that I spring awake as soon as the fade-in starts, even when the volume is still infinitesimal. On this particular day, I was already all too bloody awake and the initial sound simply made my heart sink. The night was officially over. No more sleep for me.
Then the next story came onto the radio and James Naughtie was announcing ‘a huge fall in the increased mortality rates of people with diabetes’. Apparently, in the mid-1990s the mortality rate for people with diabetes was twice as high as for people without it, but now the rate is only one and a half times as high. I felt somewhat cheered. We still have a long way to go, but the fact is that people with diabetes are living longer than they used to, and when both of your children suffer from the condition, that’s the kind of news you really want to hear. It’s thought that one of the reasons is because diabetes is being treated more aggressively than it used to be, and we’re now really reaping the benefits.
I hauled myself out of bed and went and checked the boys’ blood sugars. Joe’s CGMS alarm was going off again. That bloody thing! Turns out that in spite of reducing Joe’s basal insulin rate, he’d still fallen to 3.9 mmol/L and had to start his day with a swig of Lucozade to bring him up from his hypo. Tom had come down but was still a bit high and needed another correction bolus.
Of course, I shouldn’t get annoyed by the CGMS alarm going off. It’s a bit like shooting the messenger. It was right when it woke me up at 5am. Joe’s blood sugars were starting to dip a bit low, and even though the action I took didn’t stop his hypo altogether, it probably avoided a more prolonged or severe one. And the correction boluses I gave to Tom probably gave him a much more stable start to the day than if I’d done nothing. In fact, since Joe and Tom went onto insulin pumps and started using CGMS, their blood sugars have been much more tightly controlled, and as a result their HbA1C results have been much better than they used to be. It might mean we have to work a bit harder, but the evidence suggests that this kind of aggressive treatment really pays off in the long run.
I only wish it didn’t leave me feeling so knackered.