Numbers falling down

Halfway through February I went onto a low-carb diet to improve my numbers to a level whereby they could almost be considered to be normalised.

So far it's working well. I look at my blood glucose meter and it gives the following averages:

Last 30 days: 6.1
Last 14 days: 5.8
Last 7 days: 5.6

Averages aren't the best way to show control as I have a tendency to test more when too high or too low so it can distort the results a bit, however it still gives a general idea.

To find my averages under 6.0 since going on the low-carb diet is really encouraging. I'm giving myself a congratulatory pat on the back because to get to this from the woeful results only two months ago is really great.

I feel a lot better than I did in those 'dark ages' when I didn't really know quite where my levels were at throughout each day. My head certainly feels a good deal less stressed.

Here are the full figures

	0	2	4	6	8	10	12	14	16	18	20	22
01		15.6							6.7
02	4.2
03			4.4							7	3.4
04	7.4							7.2				8.6
05					7		7.9		8.6
06	9.6				6.8	9				4.6
07	6.8					2.8
08		7.6					5.4				3
09	6.6										2.8
10	5.8									7.4	4.1	6.2
11					4.8	7.9	4.7	5.2		7		8.5
12					4.7		8.4	4.3		5.5	3.2
13	9.8		4.1	5.3			8.3	5.3	10.8			6.6
14							11.6	6.9	6.6		9.1	8.9
15		6.9			3.4		5.8	3.5	3.7		4.6
16	4.1						7.3			8.9	7	9.1
17	9.4	8.1			3.8		3.7			6.6		4
18	2.7				7.4		8.4	5.7
19	4.7				6.2		4.6			5.8
20	4.6				2.8		6.2				6.1
21	4.6					2.9				8.3		9.1
22		10.2					5.1	5.6		6.1		12.2
23					3.2		7.7	3	6.4
24					3.1		5.1			5.1
25	4.3				3		4.6	2.6		6.1
26	7.5				8.9		5.4			6.4
27	5.9				2.7		6.8			6.6
28								3.7				13.9

new year's day

this weekend brought with it a revelation, one that had me walking into a completely different world. a world better than the one i'd been in (whether i was fully aware of it or not) since the early 90s. no love found, and no, no love lost.

the revelation was that my type 1 diabetes could be brought under a tight level of control.
the revelation that i may actually be able to reverse some of the damage my illness has inflicted upon me.

the solution is one which, by some irony, is blindingly obvious to anyone without diabetes.

tell someone you have diabetes and likely they'll think: "you poor thing, you won't be able to have any sugars now"

and that's what i thought when i was told, at the age of 11 that i had type 1 diabetes.

lead down the wrong path
however, what i was then taught was that i could, and should, eat like a normal person, just so long as i did my injections.

my type 1 as a child was relatively simple but as i grew into adulthood things got steadily more difficult, to the point where i was firing off shots of insulin that could hit any target in a very random fashion. in short, my levels were all over the shop.

where's the right path?
and then this weekend, i read in full Dr Bernstein's Diabetes Solution which said the complete opposite of what i'd been taught. he put it to the reader that all one needs to do to get their control to manageable levels is to stop so eating such a ridiculous amount of carbohydrates.

with insulin you're trying to hit a target level. the more carbs you eat the more insulin you need. it's like trying to hit a target with a rifle. for small ranges you're going to have a much better chance of hitting the target than if you're a long way back from it.

similarly with hitting your target sugar levels, you've got a far better chance of hitting the target levels if your carbs and insulin are small amounts.

busting out of vegas
so with this in mind i can get out of the losing lottery i was playing for all these years. damage has been done and i owe a large debt to my body, but i've now got a chance to halt and possibly even recoup some of those losses.

all i've got to is make sure i don't overdo the carbs. avoid eating the sugars, just like i thought i should be doing all those years ago as an 11 year old.

it feels like i've climbed a mountain for nothing but now i've at least got the chance to run back down it, to a place of safety.

Analyse this

This is venturing into geeky territory but it's good stuff for knowing what's happening in me when I eat.

The idea is that when I eat and take my insulin shot the insulin tries to get the energy into the cells (or liver or somewhere) and out of the blood stream at the same rate as the sugar is entering your blood during digestion.

It works something like this

1. I inject insulin
2. I eat more or less straight after
3. The sugar starts to be broken down and begins to be absorbed into the blood
4. The insulin starts to be absorbed into the bloodstream
5. The insulin works to get the sugar from my blood into my cells

In an ideal world the insulin would be acting on the sugar in my blood at the same rate as the sugar is entering my blood, but this is rare.

Typically with meals involving a fair amount of carbohydrate, the sugar will get to your blood at a faster rate than the insulin can get the sugar into your cells.

If the digestion rate is faster than the insulin absorption rate, like this, my blood sugar will start to rise. The further my sugar levels rise, the less ideal the balance.

Of course, different foods have different sugar absorption rates. High GI foods get absorbed quickly, low GI foods are absorbed more slowly. GI means glycaemic index which essenially means how quickly the sugar in different foods are absorbed into the blood.

So how can you measure the balance?
To measure whether your insulin is reacting fast enough to cope with the sugar absorption, you can test yourself after meals. Two hours after meals is thought to be the point at which your blood sugar levels are likely to be at their highest after eating.

So it makes sense to take a sugar reading just before eating and a reading or two 1 to 3 hours after eating.

So how did I do?
Here's my sugar level readings from the last few days

	0	2	4	6	8	10	12	14	16	18	20	22
10	5.8									7.4	4.1	6.2
11					4.8	7.9	4.7	5.2		7		8.5
12					4.7		8.4	4.3		5.5	3.2

Evening meal analysis
On the 10th I had pasta for evening meal with half a glass of orange juice.

7.4 at 18:11 just before eating
4.1 at 20:10
2.4 at 21:16 (I ate sweets to get levels back up to a normal level)
6.2 at 23:37

This shows two things.

I probably took too much insulin for my evening meal (as my levels went significantly below 4.0)
The pasta at this time of day isn't causing my sugar levels to jump up - a very healthy situation

Breakfast analysis
On the 11th I had mini-shredded wheats for breakfast with skimmed milk

4.8 at 09:13 just before eating
7.9 at 10:33
4.7 at 12:45

This shows I'm taking the right insulin for breakfast.
It also shows that my breakfast is being absorbed a bit quicker than my insulin can keep up with.

Why are the levels going up between meals?
My shredded wheats are probably not too dissimilar in GI to the pasta I have at tea time. I would expect the sugar in the shredded wheats to be absorbed about as quickly as the pasta.

However, I think there is another reason that is causing the raised sugar levels. It's a phenomen which I've seen referred to as 'the dawn phenomenon' in Dr Bernstein's 'Diabetes Solution' book. The idea is that in the morning hours, just after one wakes up and for about 2 to 3 hours after, the insulin is less effective at lowering blood sugar levels. The insulin is slightly impaired.

This would offer a good explanation for why my sugar levels are raising a few points up to a couple of hours after eating breakfast.

What can you do?
As far as I can think tonight, there are two main options available

• try to eat less carbohydrate (sugar) by choosing a lower-carb breakfast
• try to eat a lower GI breakfast

I don't really want to change my breakfast as it is already fairly low GI, quick and easy to make, and a cheap option too.

However, I may be able to lower the GI of the breakfast if I switch to using full fat milk instead of skimmed milk.

I am told that having fat with a meal can slow down the absorption of the sugar, so it's worth a go. I'll give it a go next week and see if it helps at all.

Where from here?
I'll spare the lunch analysis but it is along similar lines.

So now I've got an idea of how good these particular meals get absorbed and how well the insulin works against them.

If I were to analyse each relatively regular meal I have I would be in a very good position to control my levels really well. That's the ultimate goal.

As a bonus, the results I've been getting this week have been really good.

that's what you get

So what would've happened if I stayed getting the numbers I was getting in December?

If I'd carried on how I was, I would be really risking some seriously horrible stuff happening to my health and well being. One thing that happens when you have consistently high readings over a number of years is that you start to get haemorrhaging of the blood vessels in your retina - a condition called retinopathy. As more vessels burst, you start developing black spots on your vision that you can't shift. You'd need some serious-ass surgery to sort it out which is beyond the means of most - if it exists at all?! If several of them bood vessels start to burst, you're on a one way ticket to blindness.

Ouch.

...and it gets worse
High blood sugars don't just hurt your eyes, they will really fuck around with your kidneys, your heart and, scarily, your nerves.

Keep the blood sugars too high and I'll be asking for big trouble. Your nerves are really important. They're a big factor in controlling digestion for instance. When the nerves have been degraded by consistently high sugar levels, they cause a constant alternation between constipation and diarrhoea. This condition is called neuropathy.

When you read about some of the sufferers in their 20s and 30s it's hard to accept. The stories are beyond heartbreaking, they're heart stamping. I don't mean to venture into hyperbole but if you read what some people are going through, you'll understand what I'm trying to describe.

The sad thing is that there are loads of people, often teenagers who are struggling so bad to keep themselves controlled that they're heading straight down the railroad to this real-life hell.

I was riding this very track until this January and it's only will power that'll keep me away.

blood sugar part III

Here are the results since the last time I updated this

	0	2	4	6	8	10	12	14	16	18	20	22
09		7.7	2.8							5.9		5.2
10							4.9
11	7.8						3.8					8.9
12									5.9
13									3.3
14							5.9				4.5
15					3.8						6.1
16					8.1	5.1					3.5	3.6
17	9.7						4.9

I couldn't have predicted how much better the results would be.

It goes to show what a difference a bit of focus can make.

Knowing that I didn't want to post set of shabby results, I started to do the things I should have been doing for ages:
putting insulin injections in either just before or just after eating - previously I'd sometimes put them in an hour or so after eating, which causes trouble later
thinking about how much carbohydrate is in things - I've had success with this before but it's always been short lived
doing regular blood tests - this used to be a strong point when I was younger but I became more erratic more recently, sometimes going days without a test during times I was perhaps in most need of a test

All I've got to do now is keep doing this and watch I don't slip. Not always the easiest thing to do but I'll see how I get on at the end of the month.

the best I've ever had

One of the things that inevitably has had an effect on who I am is the diabetes I was diagnosed with aged 11.

Upon being told I headbutted the bathroom door hoping I'd die. Through school though I found it really easy to cope with. Nowadays, though, it's become something I've had to wrestle with. Like trying to hold a fishing boat on a steady course within a storm.

Emotionally it didn't affect me too much at school as it never really got in the way very much. More recently though it has got in the way and I've felt the illness becoming more of a weight to bear.

the dreams in which I'm dying
I remember one of the most memorable emotional moments from when I was much younger (maybe 7 or so), was after watching a tv show and one episode had the main character (a boy no older than 10 - I think) in hospital.

It made me really want to be in hospital. Several years later, during secondary school, I had another moment like that when I woke from a dream in which I was in hospital with cancer.

I'm not quite sure why but I love the idea of being in a state whereby I'm ready to die. As a result I really like the line in Tears for Fears' Mad World which goes

"the dreams in which I'm dying are the best I've ever had"

It doesn't escape me that life itself is essentially a state whereby you're dying. Therefore, I should really enjoy being alive if I apply a bit of linear logic. Living like you only have a short period of life left is generally looked upon with high regard.

back to the diabetes
The diabetes gives me different glimpses of dying both short term and long term. Chances are that if I live long enough the illness will start to degenerate me earlier than if I didn't have it. This bothers me but I'm comforted to some extent by the fact that I have no wish to live to old age anyway.

In the short term I've had the chance to be closer to death than most people. I've passed out numerous times with low blood sugar and have been taken to hospital with high blood sugar (a condition called ketoacidosis).

I've often really enjoyed being low on sugar. It's done some funny things to my thinking. The one time I was really high on sugar has inspired day dreams too.