Eye on the ball – by Oliver Double

It’s summer so the patio doors are open. I’m pottering away in the kitchen when I hear a weird splashing noise from the back garden.

Tom recently got back from staying the night with a friend. As he slouched through the front door he looked thoroughly knackered and complained that he wasn’t feeling very well. I put it down to him being 17 and told him it was probably because he’d gone to bed eye-wateringly late. He grunted something about having had high blood sugars, and I said, ‘Well that won’t be helping then.’ He ambled out to the back garden, and I didn’t think much more about it.

But now there’s a weird splashing noise, so I rush out to see what’s going on, and I see Tom violently throwing up all over the brick patio. It splashes onto his feet and trousers as he vomits again and again. As soon as it subsides, we go through the usual rigmarole.

‘When did you last check your blood sugars?’
‘A bit ago.’
‘Better check them now, then.’

Somebody brings him his blood glucose meter, he tests himself, and we find out he’s raging high. His blood sugars are up in the twenties. A quick conversation reveals that he’s been high all day. Jacqui – the fount of all diabetes knowledge – always knows what to do. She gets him to check for ketones with his blood ketone monitor. The monitor tells him his ketones are on 2.6mmol/L, and the official advice is telling us to contact a healthcare professional.

Ketones of 2.6? That’s insane! I can’t remember a time since they were diagnosed when Tom or Joe have had ketones that high. I’m thinking we might be spending the rest of the weekend in hospital, but Jacqui’s taking charge of the situation and she’s not being as hasty as me. She always keeps a cool head in a crisis, and it’s time like this that her fount-of-all-knowledge status really comes into its own. ‘Let’s just try and get his blood sugars down and check again in half an hour.’ And, of course, again in another half hour, and another and another.

He gives himself a pen injection – something he has barely ever had to do since he went onto the insulin pump several years ago. Then he changes the infusion set and insulin in his pump, to make sure that’s all working as it should do. We begin a tense wait. His blood sugars start to come down, not without a struggle, and gradually the ketones start to drop too. Tom feels horrific. He’s tired and he hurts and we don’t resent having to do everything for him while he’s feeling like this.

It turns out that he has a nasty virus which takes him a good week and a half to shake. He feels lousy and enervated and his limbs ache so much that it’s painful even to walk up the stairs. The questions he keeps asking us suggest that he’s worrying that he might have something dreadfully wrong with him. Unfortunately for him, hypochondria runs in both sides of the family, and he’s got it badly. We keep calmly reassuring him that it’s just a virus.

The illness keeps his blood sugars constantly on the up. He puts a temporary basal rate into his insulin pump, but we have to keep watching him. It’s like going back in time to when he was younger and we had to do much more of his diabetes care rather than leaving him to look after himself. I go back to the habit of checking his blood sugars last thing before going to bed and first thing in the morning, with the added fun of checking his ketones as well. We get them down to minimal levels pretty quickly, but they won’t go away completely, bubbling under at 0.1 or 0.2 mmol/L.

Jacqui gets the short straw though – she’s the one who’s setting the alarm for 2am so she can make sure his blood sugars aren’t rocketing or plummeting in the middle of the night, to try and keep him safe until morning.

Most mornings I find his blood sugars higher than they should be, perhaps 8 or 10 mmol/L, and he’s so groggy and ill that I get his pump and set the correction bolus for him. He’s only had this pump for a few months, and this is the first time I’ve actually had my hands on it. I have to work out how the use the controls.

This is when it hits me. Tom’s become so self-reliant in managing his own condition that I’ve become utterly de-skilled. Besides carb counting when I cook, I don’t really do any diabetes stuff any more. Jacqui and I gave up regularly testing blood sugars in the night several years ago, and the technology that we have now is so good that both Tom’s and Joe’s blood sugars tend to be pretty much under control for pretty much all of the time.

I expect that Joe and Tom still find diabetes a bit of an unwanted annoyance in their lives, but I’m at one removed from it all and it’s tempting to think that it’s all just kind of gone away. It only takes a virus and some wonky blood sugars to remind me that until somebody finds a cure, diabetes is still the crappy unwanted gift that just keeps on giving, even when you think it’s given all it has to give. The ketones in Tom’s blood and the puke on the patio are a reminder that you can never afford to take your eyes off the ball.

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