Sleigh Day – By Olly Double
I’m not a crazy fan of dealing with type 1 diabetes on an everyday basis, but it’s at its most annoying when you’re really busy. And this is always the busiest night of the year.
I know there’s going to be lots of physical activity, not the mention the stress and excitement, so I decide to set a temporary basal rate of 50% on my insulin pump. How long should I set it for? Well, it’s going to be hectic for pretty much the whole night, so I set the temp basal for 600 years – that should be just about long enough to get all the deliveries done.
I tuck my pump into my pocket, then wrap up really warm, pulling my cloak around me as tightly as I can and tugging my hat down over my ears. Just before I put my gloves on, I test my blood glucose. I’m on 6.8 mmol/L, so that’s a good place to start. I walk out of the house to my vehicle and climb aboard. The weather’s ridiculous. The wind howls around my face, and I have to blink to keep the snow from getting into my eyes. Why I’ve never upgraded to something that has a proper enclosed cabin after all these years is beyond me.
I get going. The icy air stings the exposed bits of my face, and I start to worry about the insulin in the tubing freezing up. Still, it should be all right underneath all those layers of jacket and cloak. As I get further south, the conditions get a bit less filthy and I start to mentally prepare for all the heavy lifting to come. I know there’ll be plenty of opportunities to stop and eat, but I have a snack nonetheless just to keep those blood sugars from falling.
The first delivery is always the most exciting. Of course, it used to start by having to shimmy down the chimney, but in many of the countries I visit nobody has chimneys any more, so I have to use other ways of getting in. There are three deliveries in this house, and when I’ve dropped the stuff off I go down to the kitchen to see what they’ve left for me. Of course, sherry and mince pies. Why can’t they show a bit of imagination? Be nice if they’d put something different out for a change, like, say, guacamole and crème de menthe, or doughnuts and amaretto.
Still, I like a nice mince pie. It’d be so much easier if they left a note with the carb count of the snacks they leave out for me, but of course they don’t, so I have to guess how much carbohydrate to enter into my pump, the bolus wizard calculates the amount of insulin, and I press the button that sends it down the tubing and into my body. I have one sip of the sherry and tip the rest down the sink – alcohol is so difficult to bolus for. Incidentally, the Bolus Wizard is a close personal friend of mine.
I hit trouble before I’ve even made my thousandth delivery. I must have carb guessed badly for several hundred of those mince pies, because I feel distinctly hyperglycaemic. I’m irritable and I need to pee. I look at the screen on my pump and my continuous glucose monitoring system thinks I’m over 15 mmol/L. My pump alarm must have gone off, but I didn’t notice it with all the kerfuffle. A finger prick test confirms it – I’m on 17.3. I turn off my temp basal and give myself a correction bolus. The problem is that a couple of thousand deliveries down the line, I start to feel sluggish. I ignore it at first, but then Rudolph’s nose starts to glow red. It’s so useful to have a hypo alert reindeer given the pressure I’m under. I swig down some Lucozade and stop to rest on the nearest rooftop until I come back up.
Further into the night the funniest thing happens. I’m in Whitstable in Kent, delivering to a little house on a terraced street. It starts badly. They actually have a chimney, and I relish the prospect of shimmying down it in the traditional fashion, but then it turns out it only leads down to a wood-burning stove which is latched shut. I have to climb back up and find another way in, so I’m already in a bad mood.
Two boys in this house, and both teenagers – so too old to believe in me any more. I’m putting gifts into the stocking of the older one when I hear my pump alarm go off. Hell’s jingle bells! I pull my pump out of my pocket and check the screen, but it thinks I’m fine – 5.3 mmol/L. Then I realise – it’s not MY pump that’s alarming. I check my list. Yes, of course. Joe Double, 17 years old – type 1 diabetes. I’m not sure I’m authorised to carry out medical procedures, but I can’t just leave him when his blood sugars are out of range. I find his pump by his pillow and hit the button to light up the screen.
It thinks he’s having a hypo. Now what do I do? OK, time for some of my magical powers. I transform myself into his dad and do a finger prick test, which confirms he’s on 3.5 mmol/L. There’s a bottle of Lucozade on the desk by his bed. ‘Joe, wake up, you’re low! Come on mate, you need to have some of this!’ He rouses himself groggily and drinks enough to bring him back up. He’s barely awake. I reckon I could have done this without transforming myself, and he wouldn’t even have noticed my red costume.
I’ll still need to retest him after 15 minutes to make sure he’s come back up, so I decide to fill some of the time by delivering to his brother up the stairs on the top floor. Here’s where it gets unbelievable. My pump alarm goes off – again! Maybe I read the screen wrongly when I looked at it in Joe’s room? Maybe it said 15.3 instead of 5.3? But no, I check it again, and sure enough it says 5.3. What the heck’s going on?
Then I realise – it’s not MY pump this time either. I check my list, and I check it twice. Tom Double, 14 years old – type 1 diabetes. Wow, two kids and they both have diabetes? That must make life pretty interesting in this family. Now I remember this house. A few years ago when Tom was still small, he left notes all around the place asking me for a cure for his diabetes. Of course, I couldn’t manage that – the only gifts I deliver are toys chocolate coins and tangerines and stuff. I remember feeling a lump in my throat as I read his notes, but there was nothing I could do. My magical abilities don’t stretch to medical cures, otherwise I’d have cured myself by now. So as soon as I got home I went online and made some big donations to organisations that fund diabetes research.
Now, I can’t just leave Tom’s pump alarming, so I check what it says – 12.7 mmol/L. Once again I transform myself into his dad to deal with the situation. A finger prick test confirms he’s hyperglycaemic – he’s actually on 13.1 – and I give him a correction bolus. Having done that, I look at my watch and realise I’ve still got a few minutes to wait before retesting Joe, so I go downstairs and check out the snack they’ve left out. Surprise sur-flipping-prise, mince pies and sherry! Hold on a minute though, that’s something else I remember about this house. The mince pies are always homemade, and the mum’s a brilliant baker. Not only that though, she’s left out a note with the carb count for them.
Ho ho ho!
By the time I’ve polished off the mince pies and gathered every last mouth-watering crumb from the plate with the tip of my finger, it’s time to retest Joe’s blood sugars. He’s come back up to 4.6, so my work here is done. I spring to my sleigh, give my team a whistle and we all fly away like the down of a thistle. But ere I drive out of sight, I exclaim, ‘Happy Christmas to all, and – in spite of diabetes – to all a good night!’