Back seats

So, as you can probably guess, diabetes and I are once again strangers. I've decided to let it take a back seat in my life again. As you wonderfully astute readers will have observed, I am a student nurse. This means I spend a bit of my time on placement. Well, a fair bit of my time. Diabetes often takes a back seat when I'm working, unless I am hypo or in urgent need of a set change. My job comes first and I love it. I often experiment with temporary basal rates. Usually what seems to work is a a temporary basal of approximately fifty five percent. When I eat I tend to have a large meal and give a slow bolus over an hour and a half or so. That does work in the short term. In the long term however, it means that I delay a hypo until later in the shift or for when I get home. I'm currently working out how much I can reasonably reduce the bolus so I can get the correct balance simply because diabetes is a life of compromise.
Like I said, I do love my job and frankly I relish every day, well most days that is. On this placement which is a private surgical ward I am less busy than I am within the NHS which I have now fallen even deeper in love with I still get on my feet and make things to do because I cannot abide being idle and sitting on my arse end. Therefore I make work for myself. I can also take my time doing things which I might not necessarily have had in the NHS. That said, please, please send me back to the NHS.
So diabetes has taken a back seat. Yes I am struggling a little bit with it at the moment thanks to being back on shift work and season related changes but it's nothing too dramatic. I'll stand by for a bollocking from my consultant but hey, she's a decent old bird so she will understand. I think I might also see the shrink that is attached to my team as well, I think it's about time because I am getting more than a little tired and apathetic towards my diabetes. I suppose that this is just an occupational hazard at the end of the day. I reckon all diabetics go through ups and downs in relation to their mental health. Statistics would have me believe that diabetics have a raised chance of acquiring depression, one in four diabetics also have depression if memory serves. Ah well. Let's see how this goes.
Interestingly, I have yet to meet my new DSN, despite being under this team for about a year. I know, I'm a terrible slacker but I think I'd best get on with it sooner or later. I suppose I'd better get my arse in gear and actually touch base with this lady.
Before my wonderful dementia (I hasten to add I am self diagnosing therefore to be taken with a pinch of salt, well bucket of salt) one of my modules at university takes you through the journey and experiences of a patient. It takes into account the anatomy and physiology, pathophysiology and the current evidence based treatments for it. The next module I believe may well cover diabetes so I have offered my services to the leader of the current module to do the patient based part of it as we have had some wonderful people with the conditions being lectured upon come to share their experiences. Most notable was an HIV positive woman who was wonderful. We all loved her and felt humbled by her. Maybe I'll be able to do the same. Who knows.

Until the next time dear proletariat!

Up date!

So my module leader got back to me and my email. He said they'd be greatful for my experiences. I'm more than happy to share. 

Rememberance

As it's now November the nation's minds begin to turn towards those who gave their lives in service of their country. Many British servicemen have made the ultimate sacrifice for my country over the years. Please bear with me, I do have a point. 
In nineteen seventeen Frederick Banting graduated from his medical school in Toronto. As many will know, the First World War was raging at this time. Banting was immediately called up to serve his country, Canada, who made a massive contribution as part of the Commonwealth Forces.
As a young medical officer Banting saw and dealt with the horrific realities of war. Something that my generation will not have to deal with on a similar scale. For heroic actions despite being wounded himself Captain Frederick Banting was awarded the Military Cross for his bravery. Here's the citation which gives the details of his heroism:

Military Cross - Deed of Action

 

Captain Frederick Grant Banting

13^th Field Ambulance, Canadian Army Medical Corps.

 

Near Haynecourt on September 28^th, 1918, when the medical officer of the 46^th Canadian Battalion was wounded, he immediately proceeded forward through intense shell fire to reach the battalion. Several of his men were wounded and he, neglecting his own safety, stopped to attend to them. While doing this he was wounded himself and was sent out notwithstanding his plea to be left at the front. His energy and pluck were of a very high order.

 

Canada Gazette, Vol. 53, Part I, 1919: July-September. Supplement, p. 13

 

Now to many people who live with type one diabetes such as myself, Frederick Banting is a hero for his life saving discoveries. Please remember that there is always another side to a person. Here is Banting's relatively unknown heroism.

 Lest we forget.

 

 

In Flanders fields the poppies blow
      Between the crosses, row on row,
   That mark our place; and in the sky
   The larks, still bravely singing, fly
Scarce heard amid the guns below.

We are the Dead. Short days ago
We lived, felt dawn, saw sunset glow,
   Loved and were loved, and now we lie
         In Flanders fields.

Take up our quarrel with the foe:
To you from failing hands we throw
   The torch; be yours to hold it high.
   If ye break faith with us who die
We shall not sleep, though poppies grow
         In Flanders fields.

 John McCrae 1872 - 1918  

 

I'll be home for the summer...

So I'm back at my Mum's for the summer. This means many things. No I am not going to be slobbing around and simply sunning myself. Funds do not allow this despite due to the economic circumstances this country finds itself in meaning that there's bugger all work going. So instead I am making myself useful at home. My project for the moment is sorting out the garden which is a bit of a tall order but I'll get there.

Due to summer temperatures and such like I am having to alter my basals quite dramatically. My total basal dose is no 28.85 units in twenty four hours. This is because I have been hypoing massively and constantly due to heat and working hard in the back garden (back yard for your septics that may read this). I've worked out the temporary basal that I need and that's about 10% for the duration of the gardening and a bit of time after it. I also leave a little off the meal bolus I have before and I give that over a half hour to an hour so that it isn't all in my system at once and that means I don't drop like bat out of hell. I have been doing through enough glucose to keep the manufacturers in business singlehanded.

Other than that it's chill out, try not to let the diabetes kill me and enjoy life. At the last look in July my HbA1c was a wonderful 6.5%, however this is due to a few too many little hypos but still, given my line of work that is inevitable to be honest with you. On a work note, I saw and participated in my first cardiac arrest. That half hour or so will stick with me forever.

Until the next time, well, whenever I next remember the password to this place!

Injections

I had a bit of a struggle remembering my password to get onto this place. Time to blow the dust off the damn thing.

So as you all may gather, I am a student nurse. This means that I get to give injections. Yes, lots of injections. The usual poison of choice being deltaparin, a heparin based anti coagulant used in DVT prophylaxis.
Despite having been injecting myself in a bid to stay alive for the past fifteen years it feels rather bizarre to be harpooning people on a regular basis. Be that a sub cutaneous injection or an intramuscular one. For those of you that don't know what those are, go and look them up.

It is a rather strange and taboo feeling that I've had to over come since starting my nursing degree because it is quite normal to me to give myself an injection but to give someone else an injection? This isn't what I am used to. Then again, many people are not used to the reverse of that situation. Strange eh? IM injections though aren't bad at all. I quite enjoy them. I have two to my name. That's due to many medications that used to be given as an IM medication being now given intravenously.

Not really the priority at the moment I must say.

Well yes, congratulations for working out quite how I feel about diabetes at this moment in time. As I say, it's not what I'd call my priority. I've got bigger things to worry about. There's far too much going on outside of diabetes for me to really give a damn about it. Yes I am keeping an eye on it but not too closely. Things are working well with the pump and all that. I've had my blood results back from the clinic I attended a few months ago and all is well on that front. I'm quite happy with it. My albumin was a little on the higher end of normal but none the less it was in range so I'm not worried at all.
So why am I not exactly giving diabetes my full attentiong you might ask? Simple really. I have exams to prepare for and assignments to do for my university. These take priority. Thankfully there is nothing to do with diabetes in these things that I have to do. Also I don't want to give diabetes my full and undivided attention. If I do that, it has won. It'd have me by the short and curlies. I suppose this is me exercising a greater degree of contol other than ensuring that my BMs are spot on and such like. I'm quite happy to bumble around at the moment safe in the knowledge that I don't have to be a slave to diabetes. I don't want to burn out is the simple thing.
At the end of the day, the diabetes is behaving itself and I am getting on with my life surprisingly enough. I suppose it's just to show that unlike some schools of thought would suggest, diabetes does not have to become your life. Frankly I couldn't think of anything worse.

Update time of the month.

What's new pussy cat? No, I won't impersonate Tom Jones. I cannot sink that low, oh wait, I have. Balls.

So, in theory I am on holiday from university at the moment, however, I've stayed on a little to crack on with an assignment. I love it as it's on cardiology. I'd hate to have to do another on diabetes again. Something that really gets me and bugs me every time I have to deal with it in a professional capacity. Thankfully this essay is one I'm really getting my teeth into and fascinates me. What's more is it doesn't have the same impact upon me in terms of emotion and such like.

In terms of diabetes I've had a little of a rough patch for reasons that I can't fathom. A few entertainingly high BMs and multiple cannula changes combined with correcting by a syringe. Things are now back on track thankfully. I'm sure my time on placement and the raised number of hypos, albeit minor ones has helped balance out the highs. Essentially I'm just plodding on and making the odd minor change to my basals. I think a little weightloss that has happened over the past few months has helped render me a little more sensitive to insulin and caused the need for a reduction in the amount of basal insulin that I require. Quite nice that.

Summer. Well, it is only April but we've had a fair old bit of sunshine. This brings with it the joys of making seasonal adjustments to my insulin regime. If memory serves, the logic behind becoming more sensitive to insulin when it's warm is that the heat causes vasodilation (expansion of the blood vessels) to bring blood nearer the surface to disperse heat by evaporating sweat. This also seems to increase the rate at which insulin is absorbed and used by the body resulting in a few more hypos. Something easily ironed out with my pump. Thank God for technology.

Overall it's going nicely here. I can't whinge. Too much.

Bugger!

So the first set that I put in my arm about an hour ago went tits up. Yeah, not quite planned. It turned into an intramuscular infusion as opposed to a sub cutaneous one that it needs to be. I have another one in now. This time in my right arm. I was kindly aided in the insertion of the set by my trusty Spencer Wells artery clamps which are very good at helping you reach the flab on the back of your arms that you just can't get to with fingers. Who said bingo wings aren't useful? Let's see how this bastard thing does.

A link to a little about my trusty Spencer Wells :

http://www.sciencemuseum.org.uk/broughttolife/objects/display.aspx?id=5515

Infusion sets and boldness.

I have just put in a new set. I put it in my arm. I've heard of people doing this before but I've never quite worked up the courage to do it myself until now that is.

Anatomically speaking it's in the flab around the deltoid/tricep muscles. I don't think the layer of flab is quite as deep as I thought it was as it's little uncomfy but nothing too bad. I need to give my belly a break which I've been using non stop for nearly two years now.

I shall post when I take the thing out of my arm.

Putting the damn thing in was a bit tricky. I am quite used to doing these things with two hands. One hand was quite something else. I think you really need three arms or another person to do it if you want it done quickly and effectively rather than the fifteen minute battle I had to get the thing just where I wanted it. At least it is now in and well, it's a case of watch and see what happens. More when I see it.

The set is a Medtronic Sure T with a six millimetre cannula with an eighty centimetre tube. Not bad at all really.

A cause for celebration?

Given that I use a message board for diabetics I seem to read a lot of things, if I don't post much on there as well, I have very little worth reading.

One that sort of got me a little irritated was the thread about the Joslin medal schemes and such like awards for "long service". Link at the end of this.

I can't quite put my finger on why having a medal for fifty years of diabetes irritates me. I suppose it's effectively rewarding something that has taken a fair chunk from me. I can understand the fact that through the past years I've had to deal with something that I didn't get any say in other than take the medication or die. What I don't need is a reminder to say how long I've dealt with that crap. The less it intrudes into my life the better I say.

I deal with it enough on my own, my diabetes but anything other than dealing with my own diabetes is a little bit on the side of hard. Given that I am a student nurse, I see a lot of diabetes and it's consequences, both good and bad. I don't want to celebrate something that has come close to killing me and endangering my life. It's as if I were ceding ground to an enemy, taunting it, red rag to a bull sort of thing, tempting fate. Coming away complication free and healthy is reward enough. I don't seek praise for living with this. I don't want it either frankly. Having someone bestow a medal upon me is, the way that I see it, effectively a pat on the head and saying "who's a brave boy." Praise will be due on the day a cure is found for everyone that has made it that far. I doubt that I'll be around when a cure comes along. The standard excuse is "in ten years there'll be a cure." My arse.
At the end of the day I didn't get the choice of whether or not diabetes came into my life. I don't want to celebrate that I've had something forced upon me that has made me change my life, has take so much and will continue to take from me for the rest of my life. I will cling to whatever vestiges of control that I can. Diabetes take and will take more than enough from me. I don't want to stop and stare. I want to move on with life and enjoy it with minimal intrusion from diabetes. I won't give anything to it. I won't let it win. I acknowledge that I have this and I must control this to stay in decent shape. However, if I stop and celebrate it I let it win a little victory. It's like being burgled and then when Her Majesty's Constables have nicked the scrote who turned you over you invite them over to tea and give them the run of your house with you sat blindfolded on the sofa.

In the fell clutch of circumstance

I have not winced nor cried aloud.

Under the bludgeonings of chance

My head is bloodied yet unbow'd.

Link:

http://www.diabetessupport.co.uk/boards/showthread.php?t=4170