The Chicken or the Egg – by Helen May


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Helen MayYesterday, I woke … no, start again. Yesterday, I struggled to wake. Finally, it was not my alarm or my boyfriend prodding me in the ribs that made me get out of bed. It was ache from all my war wounds, a dull pain between my eyes and a desire for a wee. I was up but not really awake. So it took me some time to work out the reason for my malaise: I had a high blood sugar.

I often read about people’s worries and problems due to low blood sugars. I also read about the long-term effects of high blood sugars and the need to reduce our Hb1AC. However, I rarely read about feeling rubbish due to short-term high blood sugars. If I was asked to rate my day after waking at different blood sugar levels, I would probably rate less than 3mmol/l at the same as more than 8mmol/l. Both have an impact on the rest of my day.

As with low blood sugars, once I have made a correction, I start trying to work out why I got there in the first place. Yesterday, between taking another reading and having more insulin, I was thinking:

  • Did I forget to take my basal insulin? Nope.
  • Did I go to bed with a high blood sugar? Nope.
  • Am I stressed? It’s coming up for Christmas and I have no idea what to buy my brother – but I don’t think I am that stressed about it.
  • Am I about to get ill? I hope not.

The last question is a double-edged sword. In some ways it is good to have an indicator that I have a cold coming. I can dose up on lots of fruit and vegetables and wrap up especially warm to keep the germs at bay. On the other hand, I’d rather not have the high blood sugar.

The final question I ask myself is whether I feel ill. The problem with this question is a high blood sugar makes me feel ill. I ache, I feel the cold more than usual and I lack energy. So do I have a high blood sugar because I am ill or do I feel ill because I have a high blood sugar?

Yesterday, I concluded it was just “one of those inexplicable diabetes things.” So carried on with my usual insulin regime. Unfortunately, the same happened today. And I didn’t sleep very well (another side effect of a high blood sugar for me). So I went through all the questions again and added one more: if I am feeling rubbish is my insulin working properly?

I have discovered that my basal insulin often loses potency over time. This is worst over the summer where, I assume, the increased temperatures affect the longevity outside a fridge. I try to keep it cool keeping my insulin out of direct sunlight and using Frio pouches when it gets particularly hot. My basal insulin seems to be more resistant to temperature: perhaps it’s because I use up to 50% more basal than bolus so it spends less time out of the fridge?

So there I am trying to work out whether I am the one not working properly or whether my insulin is not working properly. In other words is it the chicken or the egg?

Not wanting diabetes to impact my life, I am determined to go climbing tonight. After I go climbing, I usually need to reduce my basal dose by a third. If I have a good night on the walls, I will convince myself it is not the chicken (me) that is wrong. But does that mean I have got over whatever was causing the problem? Climbing can be a great stress reliever. Or does it mean there is something wrong with the insulin? So do I take the usual post-climbing basal dose or get another vial out of the fridge or … Diabetes seems to be a constant trial and error. Sometimes, I learn something new for next time (which, sometimes, I forget) and, sometimes, the root cause remains a mystery.

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