Dealing with Diabetes

The instructions really come down to four simple steps.

  1. Inject the liquid already in the syringe into the little glass bottle with the white pill.
  2. Shake until the pill dissolves and mixes with the liquid.
  3. Draw the new mixture back into the syringe
  4. Inject the mixture into my unresponsive husband.

I’m learning to administer a drug named Glucogone, though, if all goes as planned, I’ll never have to do it. Glucogone is a treatment of last resort for diabetics. It’s to be used only if the blood sugar drops to where the person is unresponsive.

“You would basically use this when Steve is so far into a low that he can’t swallow,” explains diabetes nurse educator Joy Geiger. “If he’s conscious and able to swallow, you still try to use juice or something like that.”

While I may never have to administer the shot, I worry that in six months – or six years – this unlikeliest of emergencies will arise and I won’t remember exactly how. Geiger assures me that’s a common concern and has me go through the steps with a practice kit.

This was our third visit to the diabetes education centre at Grand River Hospital since my husband, Steve MacPhee, was diagnosed with diabetes last fall. Not Type 2, as you’d expect of someone who’d just turned 54. But Type 1, more commonly known as juvenile diabetes.

He’s 5’3” and usually has a 29-inch waist. In less than four months, he lost close to 30 pounds, dropping from just over 130 to 103. He’d also grown increasingly tired; we took a climbing class last year and he stopped barely 15 feet off the ground, joking that he must be showing his age. Diabetes wasn’t really one of our worries until his trips to the bathroom increased.

“I was driving home from Barrie one night in September and I had to stop four times,” he explains. “So the next Tuesday, I went in to see Sean (family physician Dr, Gartner), they checked my blood and it was 17.6. That’s high; it’s supposed to be between five and seven. If it had been 20 or higher, I would have been sent to emergency immediately.”

Instead, Steve was sent to see Dr. Luciana Parlea, the endocrinologist next door. “I took my first shot of insulin that night,” says MacPhee, who now takes four injections daily. “Took me a while to screw up my courage, but then I barely even felt it.”

The next few months followed a similar pattern: high anxiety due to worst-case scenarios – often involving blindness or amputation – followed by a growing realization: this can be managed as no more than a daily annoyance, a new factor in planning our day-to-day lives.

But that came later. Initially, the diagnosis kicked off a series of tests, from simple blood work to ultrasounds and CT scans. Some helped confirm that we were dealing with Type 1, since that usually manifests by age 40. Others ruled out early damage that might have developed before the diagnosis.

One of the first appointments is with our optometrist. Within days of starting on insulin, MacPhee found he could no longer watch television or decode road signs –without his reading glasses. Reading a book or computer screen was near impossible.

“You’re going to be a little more volatile, because of the diabetes,” explains Dr. Carol Cressman. And for the next four weeks, MacPhee walks around with three pairs of disposable glasses – one pair sitting on his nose, one atop his head and a third hanging from his shirt collar – before his distance vision returned to 20/20.

“If the diabetes gets worse and your numbers start running high, then your vision will be worse,” warns Cressman. “And if you jump around a lot, if there’s a great variation in your blood sugars, that’s when you’ll have more trouble with your vision, long term. Things like cataracts develop faster. Or retinopathy, leaky blood vessels of the retina, which we do not want to see.”

Managing the diabetes is the best way to avoid complications. While the doctors ordered tests, MacPhee and I focused on the lifestyle factors we could control.

Our first priority was to reduce blood sugars from the dangerously high levels of the recent weeks – or worse still months – to an ideal 6.0. An acceptable range is between 5.0 and 7.O. Lower numbers can quickly lead to coma or death, while higher ones eventually lead to the dreaded complications. Stress is a factor, so we temporarily withdraw from our usual extracurricular activities.

Hitting the ideal target involves balancing insulin, carbohydrates and activity. We spend the first month focused on identifying MacPhee’s ideal ratio, the point where the three factors combine in the right amounts to produce the desired number. Doing so requires rigid discipline, but we were motivated.

“When you hear stories about spending the next few years eating and drinking as you always did,” said MacPhee, “and feeling fine, but you risk waking up and all of a sudden you’re blind, or you can’t move your legs and hear that they have to amputate your feet, all because you didn’t take it seriously and get the ratios right – it becomes your focus.”

Everything entering his body, whether insulin or food, was carefully measured to ensure consistent amounts. He initially tested his blood at least seven times a day, before each meal and bedtime, and at intervals in between; more if he felt something odd. All data was recorded and considered against levels of activity, as the impact of an hour’s hike versus an hour of reading is markedly different. We needed to establish baseline levels before we learned to adjust the factors.

MacPhee’s initial efforts are frustrated by the simplest of questions: What constitutes a serving?

“What I consider a serving is very different from what someone twice my size puts on their plate. I knew I had to get this right, but couldn’t find anything that helped. Then the nutritionist at Grand River Hospital handed me a chart that says one serving equals a half-cup of cereal, two plain cookies or 10 French fries. It was the simplest thing, but it made all the difference.”

We also happened to have tickets for a whisky tasting in Toronto and my first thought is that we should not go. But MacPhee suggests I look on the bright side: I now have a designated driver and twice the tickets for samples. We had a nice enough time, but left early, giving away half our tickets.

“Very frustrating, of course,” he later admitted. “It was a month without alcohol, no chocolate or any of the sweets I normally would have inhaled.”

But it produced the desired result. By the end of that first month, we determined that he needs to consume, on average, 60 grams of carbohydrates and four units of insulin per meal. All other factors being equal, that ratio consistently produced a blood-sugar level near 6.0.

But all other factors are seldom equal.

Store-bought meals may offer detailed information per serving, but cooking from scratch requires a guesstimate. Regular pop is occasionally served instead of diet in restaurants. Sometimes people are simply too sick to eat. Sometimes they just want the extra helping of turkey at Thanks Giving.

“Diabetes has got enough restrictions without you’re feeling like you’re in a box all the time, so vary your food from time to time,” Geiger advises. “You need to now experiment with different things and see what they do to your blood sugars.”

Among the discoveries was the impact of crockpot chili. Most tend to drive MacPhee’s sugars higher than expected, based on the ingredients, a fact he discovered with a most unusual sensation.

“I have to be pretty high to feel anything,” he explains. “So far the only tell for me is a tingling in my big toes. And I have to be above 10 to feel that.”

Work stress and surprisingly moderate activity (MacPhee lists housework, but I remain dubious) appear to lower blood sugar more than expected. But the symptoms are common: sweating, shaking hands and confusion. Dealing with a low immediately is crucial, but also easy, involving nothing more than a sip of juice. Better still is the best-named of all candies – the lifesaver.

“Doesn’t matter about the flavor; they all have the same sugar count – one lifesaver raises my blood sugar half a unit,” says MacPhee. “It’s a fast acting sugar and more convenient than juice. That’s why I like using them the best for dealing with a low. I now always carry a handful, and I pop one every half hour or so, if I’m mowing the lawn or we’re hiking.”

The best surprise involved his favorite beer.

“Guinness doesn’t seem to behave like beer,” he says. “When I have most beer, I get the alcohol low that everybody told me was going to happen. But when I have a Guinness and a little something with it, to just counteract the low, I get a high. I’ve tried it five times now and I don’t get the low.”

That’s five Guinness and three other brands in just over eight months, well within allowable limits and not something MacPhee considers much of a hardship.

Rare was the night in recent years when either of us had more than two drinks. We’ve long offset a love of cheeseburgers and chocolate with a daily breakfast of oatmeal or cereal with fruit. And we hike a lot from spring to fall, though we do hibernate through the winter. So the lifestyle changes were more evolution than revolution.

“Where as before I might have had a snack bar that’s covered in chocolate, now I have a snack bar that has two or three chocolate chips in it,” explains MacPhee. “And the carbohydrate and sugar levels in that bar will be considerably lower than before.”

The moderate approach paid off. Within months, the ratio is on target.

“These numbers are excellent,” Dr. Parlea declares during our last visit. “In the beginning, there was quite a bit of up and down, but I think you’re doing very well with the numbers so far.”

The progress has allowed us to relax. MacPhee has dropped the daily tests from seven or more to just four. He has grown comfortable enough with the ratio to increase his insulin for an extra helping of turkey, though only on rare occasions. And I no longer worry if he feels a low coming on while we are hiking hours from civilization.

All of that is as it should be.

“From now on,” says Dr. Parlea, “the trick becomes finding the balance between becoming very obsessive compulsive about these numbers and still enjoying what you do.”

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