Balance: Signpost to Success

Diabetes commonsense

Introduction: Enter Dr Lawrence
Balance: Signpost to Success
Juggling the Blue Carbohydrate and Red Insulin Balls
The Great Debate: Natural Animal or Artificial ‘Human’ Insulin?
Conclusion: Commonsense Rules


Diabetes Common Sense

Balance: Signpost to Success

Diabetes, to my surprise, forced me to become a juggler, learning to balance the blue carbohydrate balls against the red insulin balls. My aim is to keep the blood sugar steady, to throw the coloured balls so they will not fly too high nor fall too low. Either extreme leads to disaster. This balancing act is the secret which I have found to be the key to managing my diabetes and my life.

The message Dr. Lawrence passed on to me was, “Never let diabetes stop you doing anything you want to do. And remember you must control your diabetes: never let it control you.” Every diabetic, like every human being, is different and you are the only one who can listen to what your body is telling you. However caring and clever other people may be, they cannot overhear what your body is saying. No-one but you can decide which of many available treatments fits your lifestyle and suits you best. The job of the doctor, nurse and diabetic clinic should be to empower you to make an informed choice and help you put your choice into practice. The care team is there to provide a gentle accompaniment in the background: the melody is for you to play.

My focus on being a juggler and seeking balance is based on experience; it is not a will o’ the wisp, a passing fancy. It goes back a long way. “In 1932, for the first time in the history of any disease, a group of diabetics, aided by their interested doctors, began to form what became the British Diabetic Association to assist themselves and other diabetics. By 1934, an office was set up and a journal was established to link the members together.”(2) It is no accident that, to this day, their magazine is called BALANCE. This title sums up in one word what we diabetics must do to stay healthy.

Diabetes is not an illness any more than having red hair or flat feet is an illness. It is a permanent condition that has to be accepted and organised. If anyone from the diabetic establishment tries to persuade you that you have an illness, close your ears and go elsewhere for help and guidance. What did it mean, therefore, when I was told seventy years ago that I had diabetes? How was I different from those around me? First, it meant that while other people who are not diabetic produce enough insulin to digest the food they eat: I do not. My insulin shortage leaves energy-producing carbohydrates unprocessed and this causes blood sugar levels to rise. These undigested carbohydrates clog up the system like untreated sewage and, if not dealt with, the persistent poisoning is deadly. Second, it meant that other people have a natural system to control the level of their blood sugar: I do not. This is something I can do nothing to remedy and is less easy to cope with than the lack of insulin. Yet, strangely enough, it is a problem which has received little attention from diabetic specialists and has not attracted the curiosity of research scientists who seem unwilling or unable to notice how important its solution would be. Success here would be more valuable to ordinary diabetics like you and me than the money and ingenuity set aside to develop new insulin cocktails which only serve to complicate our juggling.

When, as good jugglers, we observe what is happening to us, we notice that doctors now push us towards low blood sugar. Imbalance has become woven into the pattern of modern treatment. Commonsense has been forgotten. Patients are warned that high blood sugar must be avoided at all costs because it will threaten their health and make them more vulnerable to long-term complications. This may well be true, but current medical advice leads patients into the unfriendly territory of low blood sugar and the dangers of more frequent hypos. The middle way is lost.

Why do some people fail to consider both the long and short-term complications that may be piling up in the aftermath of these repeated low blood sugar episodes? When a hypo hits us, the result is always distressing. The brain is starved of sugar, we sweat profusely and nothing works properly. This disrupts normal life, sometimes causes serious accidents and occasionally, especially after a sudden hypo at night, lands a diabetic in hospital in a coma. If one extreme is bad, would it not be prudent to expect the other extreme to be just as bad? Why is all the blame for long-term complications heaped on high blood sugar? Has any research been done to establish whether routine exposure to low blood sugar might also have to bear some of the guilt? This may sound like heresy, but doctors who are not themselves diabetic need to be constantly reminded that their diabetic patients can carry on when blood sugar rises but are flattened when it falls below normal. Whatever warnings the experts may issue to frighten us away from high blood sugar, I still prefer what happens to me when blood sugar rises to what happens when it falls too low. Prophesies of future complications seem a long way away, hidden in the shadows of Never-Never Land, while sudden hypos, felt in our blood and bones, crowd around us and demand immediate attention.

I have been a diabetic juggler for almost a lifetime and the balancing game has become second nature. This experience enables me to suggest that in modern treatment the scales should be weighted more evenly to help us keep the blood sugar steady. Our doctors will be able to help us better after they accept the truth, obvious to us diabetics, that abnormally low and abnormally high blood sugars are equally bad. Changes in treatment will not come about spontaneously, but it would be an advantage if all diabetic jugglers knew what they wanted and were determined to get it. Let us hope that a time will come when doctors will have the confidence to emerge from behind the protection of their white coats and listen to what we tell them. Together we may then clear the air and talk the same language.