More musings about hypoglycaemia.

I have a confession to make. I used to try to reduce my blood sugar as much as I possibly could before going to sleep in order to make it vaguely possible for me to even sleep. Ever sat up for hours at night with a feeling like your mouth is filled with vomit and the skin around your lips has become encrusted shit? That is basically the feeling I get when I lie in bed at night with a blood sugar even slightly to the North of 10.0 mmol/l.

Given that the range at which one does not experience symptoms directly relating to their blood glucose is between 5.0 and 10.0 mmol/l, perfectly balancing one’s blood glucose should probably be considered impossible. A good analogy is the expanding and contracting cycle of economies. Blood sugar basically rises and falls in accordance with other events in the subject’s biology, such as hormonal changes, drug consumption, emotions, and even physical activity. But what a lot of people seem to fail to internalise with the case of diabetes is that managing one’s blood glucose in order to reduce symptoms and the likelihood of complications is basically a counter-cyclical effort, much like the manner in which governments add money to or subtract money from economies. In essence, it is an effort to smooth out bumps.

As I have said before, hypoglycemia and drunkenness bear a suspicious resemblance to one another. This is because although the mechanisms differ a great deal, the biochemical and neurochemical result is basically the same. The brain depends on fuels in order to function, and whilst one is a depression in the level of fuel reaching the brain in itself, the other an overload of chemicals that depress the cognitive functions of the brain. One is chemically-induced, often in a social context, and often on purpose. The other is something that happens generally by accident, and those susceptible to it will expend much time and resources in order to avoid. A small but substantial portion of the revenue generated by confectionery manufacturers of all stripes is, ironically, from diabetes patients or carers thereof who wish to stop episodes of hypoglycemia before they become too severe.

This probably applies just as much to the soft drink product known as Coca-Cola. Which, for my money, remains the single most effective way to stop a hypoglycaemic episode dead in its tracks. Not only is the per-volume content of sugar in Coca-Cola greater than almost any other product I have encountered in my lifetime, it tends to hit the bloodstream faster than is the case with any other product I can remember consuming.

Problem is, hypoglycemia has its opposite, too. As is said during one film, everything in nature comes in pairs. When the blood glucose level has surpassed 10.0 mmol/l and is rapidly rising to 20.0 mmol/l or worse, the feeling this produces can be like death. This, of course, is why I always react as if I have been told that black is white when an emergency officer tells me they would rather keep it a little high than run the risk of being low. Clearly, I feel compelled to tell them, you have never known anyone that lives with diabetes. Because although there are variables involved, the feeling of being 11.0 mmol/l is most emphatically not preferable to the feeling of being 2.0 mmol/l. The latter is not exactly what I would call a good way to spend a few minutes, but it is far easier to reverse, and safely at that, than the former. Especially when the patient is a heavyweight like myself. Contrary to what diabetes “specialists” in Queensland seem to think, having a bodyweight in excess of a hundred kilograms (that is 220 pounds to you Americans out there) does have a measurable and real effect upon the efficacy of synthetic insulin. Given all the crap people waffle on with about “insulin resistance” and the like, it puzzles me that it never occurs to anyone that weight does have such an effect. I mean, seriously, they go on and on about how alcohol’s effect varies according to overall bodyweight, so why it never occurs that the same might happen with insulin has me beat.

Which is one of the reasons I am finding myself so infuriated with the kind of medical staff I have encountered in Queensland. Without fail, whenever my diabetes has been focused upon by medical practitioners in Queensland, especially ones from the hospitals, their idea of what should be done in response to un unwanted outcome has often been a polar opposite of mine. And on every single occasion, the results after their opinion has been followed have proven them to be dead wrong. This is a marked contrast to Professor Steven Boyages, whose advice to change both the kind of insulin I use and the manner in which I use it has made my diabetes exponentially easier to live with after a fashion. Yes, Queenslanders, Professor Boyages is from Sydney. Like you were not expecting that.

The Christian Bible has a lot of text concerning people thinking themselves wise thus making themselves into fools and such. Whilst this is anti-intellectualism at its most pernicious, it is also the authorities in Queensland to a T. You see, I tend to subscribe to the Socrates theory of wisdom. Socrates proclaimed himself to be the wisest of philosophers, stating that he knew this to be the case because he knew he was not wise. He was, however, a lot wiser than the people who expect their knowledge to be taken as the final word in all matters, and that is how I apply it in my life. You see, whilst I know that I know a lot about certain things such as how to put together a good home theatre or what to try and avoid in terms of home video, I do like to remind myself when I can that there are limits to my knowledge, and I should not try to exceed them in terms of presentation without a good reason.

This is a polar opposite to Queenslander medical professionals, who seem to think that their few years of medical school and residency in a backwater hospital where public lavatories need to have signs warning customers to not eat the “big white mint” somehow overrides more than two decades of living as a Human guinea pig with the illness. Professor Boyages‘ way of phrasing advice was to say “we have this device or medicine that is the result of years of research that you might benefit from, here are some preliminary guidelines for use that you ought to follow until you are used to it”. Occasionally, he would even supplement that with “this is the benefit I expect you to receive from this suggestion, and why”. This is a marked contrast to the Queensland way, which seems to primarily consist of “do this because I say so” and “if it fails to benefit you in a manner you can verify, I do not care”. I am struggling to remember a single occasion of having left a Queensland hospital without a heightened blood glucose level.

This, I suspect, is what people like my maternal grandmother were talking about when they said that often the best way to learn to appreciate something is to have to do without it for a while. I will be very plain about this. I had no love of the medical staff I encountered during my life in Sydney. Often, when I was speaking to them, I felt a certain air of contempt or being looked down on from them. But the big difference is that there was a certain cell within the medical profession in Sydney that was aware of the fact that far more flies have been caught with honey than vinegar. And when the patient has a history of being led to grief by medical professionals, one that is voluminous and easily looked up without their knowledge, it is easy to discern that trying to order that patient around is not the wisest course of action.

I have said in the past, to multiple people, that a wristband display that measures the blood glucose in real-time and displays a reading on demand would improve diabetes care no end. I stand by that statement, although obviously making such a device practical is going to be a challenge exceeded only by such things as actually curing diabetes. But that is the whole character of science: the scientists see a problem, pore over it at length, and work on a solution. It does not matter to them whether they take ten years or a hundred years, but a key fact that conspiracy theorists never seem to be able to get their heads around is that no scientist in the world has a real reason to suppress a cure for diabetes. Quite the opposite, in fact. There is a Nobel prize for science, a place in history, and the love of billions of people from that point to the end of Humanity awaiting the team of scientists who develop a working cure for diabetes. (I am not going to go into how big a contrast this is to the people working against the autistic, just mention it here as a jab.)

This also brings me to a critical point from this article about the nature of science. I will quote point seven in its entirety here because it bears thinking about:

Repeating a false notion does not make it true. Many people are convinced that sugar causes hyperactivity in children—not because they have examined studies to this effect but because they have heard that it is so. In fact, a slate of studies has demonstrated that, if anything, sugar has a calming effect on children.

Ladies and gentlemen, if you are not convinced by studies, then let me share with you the proof I live on a daily fukking basis. When my blood glucose is below 5.0 mmol/l, I feel such strong sadness and upset that I often find myself believing that the Fluoxetine I have lately been forgetting to take is ineffective. When my blood glucose descends below 4.0 mmol/l or 3.0 mmol/l, I feel like I want to punch people. When I am not ready to throw myself in front of a car, anyway. And if you repeat the “sugar makes ya hypah!” line around me when my blood glucose is hovering around 3.0 mmol/l, best look the fukk out. Because the manner in which my brain is affected by insufficient glucose supply makes it exceedingly fukking obvious to me that some people should just be taken away to schools where the bullshit is washed out of their brains.

Unfortunately, as has been implied by my comparison between hypoglycaemia and drunkenness, there are a host of things that can be easily mistaken for hypoglycemia. If I had a dollar for the each PSI in the amount I wanted to hit one man with when he asked me if I had had my insulin when I nearly fell asleep on my feet whilst trying to purchase a ticket on the bus he was driving, I could be very rich. Apart from the fact that the question is based in ignorance (I was going to tell him, in fact, that considering how little sleep I had had during the previous day, he had best pray that I had not), the words “none of your fukking business” apply, too.

If you have someone important in your life who suffers (and in this case, it is the correct word) from diabetes, please take the following from this rambling mess. I know it is hard for you to respond appropriately, or cope, when things go badly wrong. But try to remember that from their perspective, the difficulty imposed by things going badly wrong is much, much worse.

As an example of what I mean, try to imagine finding yourself bent backwards around a toilet and not having much memory of how you got there. When you are all of seventeen or so years old. Unless you have experienced something like that, when you wish to complain about what another person is doing because they are experiencing difficulty in their own survival, kindly keep it to yourself.