It’s Something You’ll Never Perfect
Another year, another adventure. I was living in Melbourne, Australia, having returned to this beautiful country after some time spent at home recovering from the torture of compulsory regional farm work for my second-year, working-holiday visa. Darwin had been my first stop this time around, and boy was it everything the Australian dream had promised and then some: sweltering heat, saltwater and fresh water crocodiles lurking in lagoons and waterways, Mindil Beach tropical sunsets, the enchanting whisper of indigenous songs in the air, and what can only be described as a mass of Steve Irwins.
This bubble, as it undoubtedly always does, soon popped. And I headed for Melbourne for some “proper” job hunting. For the last two years the city had enticed me. I felt like it was my destiny to become a Melbournian (or an adopted one at least). When I arrived and stumbled upon a street named “Batman Hill” (later I would commute through here daily) my fate was sealed, and Gotham, I mean Melbourne, became home for the next 10 months.
Back to the point at hand. In February 2017, after a few months of excessive water drinking, irritatingly frequent urination and severe fatigue I was diagnosed with type 1 diabetes.
My first feeling was, well, relief. I hadn’t actually become a hypochondriac since my return to Australia as I’d feared. I wasn’t going mad either. I had been ill. Definitively ill in fact for the last three months. This was confirmed through HbA1c blood tests.
The speed and professionalism of my wonderful Acland Street GP detected what another doctor had overlooked a few months earlier and blamed on an iron deficiency. I was soon engrossed in new medical terminology. Diabetic ketoacidosis (DKA); hypoglycemia; chronic illness; cardiovascular disease; retinopathy; nephropathy; and, scariest of all, “insulin to carbohydrate ratio.”
Before I knew it, I was sitting in a hospital waiting room surrounded by people of all ages waiting for my first ever appointment with an “endocrinologist.” Then those fateful first words were spoken: “So, Shannon, you’ve joined the club that nobody wants to join.”
Looking back, he could have been a bit more sensitive, but doctors can be like this, straight to the point, a trait I quickly grew to admire tremendously. I think my first thought was, “Okay, this is intense.” Then he struck the knockout blow to my little bubble of denial.
“It’s not a disease for a perfectionist,” he said. “It’s something you’ll never perfect.”
What? I’ll never perfect this? Surely, he’s mistaken. Anything can be perfected if you concentrate hard enough, work hard enough. Or can it? It’s funny how one seed of doubt can motivate you. And so began the challenge to achieve diabetic perfection.
What is perfection for someone with type 1 diabetes? In basic terms, it’s achieving blood glucose levels (BGLs) of approximately 72-144 mg/dl4-8 mmol/L. That balancing act was it really. Well that and avoiding hypos at all costs. It couldn’t be that hard, could it?
First, I had to re-educate myself around food. I say this was the first thing to learn, but I say it loosely as it came after learning the basics, including how to put a needle on an insulin pen; where to inject the insulin; and that, yes, I could eat a Skittle again without dying.
My BGL had dropped dramatically in the first week of insulin treatment from a dangerous 504 mg/dl28 mmol/L to the mid-teens 270 mg/dl15 mmol/L. This was completely thanks to the “long-acting,” once-a-day insulin I was using. To bring my BGL down even more, I was prescribed a second insulin treatment—the “short-acting,” before-each-meal insulin.
“So how do you think you’re doing?” my endo asked at my next appointment. I pointed out the numerous hypoglycemic events (BGLs below 72 mg/dl4 mmol/L) that I’d had over the previous few weeks and the occasional and unexplained 9s and rare 10s. He looked at me like I was crazy. He was shocked by my speedy management and general grasp of this daily tightrope walk and commended my efforts. If he had put ten gold star stickers beside my name on a large board entitled “diabetic of the month,” I wouldn’t have flinched.
I walked out feeling a little shocked myself. I’ve got this, I thought. Then life, as it so often does, took over. Work, stress, socialising and a few five-dollar Sauvignon Blancs later, 4s, 5s, 6s, 7s and even 8s became less frequent in my daily readings. Why? Infrequent BGL testing was the major culprit. Or as it’s more commonly known: finger-pricking. Life had gotten in the way of routine.
I had discovered that taking out a glucometer, however discretely packaged, and pricking your finger until you had enough blood to put on a testing strip was more than just a challenge against feeling like a social outcast, it was a psychological battle. The pure physical discomfort of pricking your fingertips at least eight times a day was starting to leave me dreaming of having more fingers. In addition, the practicality of even remembering to do this while maintaining a “normal” lifestyle—hectic work schedule, physical activity, driving, sleeping—was becoming a source of great frustration, undercutting my initial successful diabetes management.
The idea of perfection was a distant memory. In fact it seemed like an impossible dream. Management was the new struggle.
In the last year, flash glucose monitoring has changed my life. The Freestyle Libre is revolutionary. This is not an exaggeration. I used it for the first time in June. For two whole weeks I didn’t once prick my fingertips, even though I was monitoring my blood glucose levels more than ever before. Sure I’d only been pricking my fingers for a few months, but I genuinely felt like this device had given me a ray of hope in the dark landscape of diabetes management. While it only lasts for two weeks (until you must replace the sensor) and doesn’t have the same accuracy level of scheduled finger-pricking, this clever device, a sensor inserted into your arm, can simply be swiped to deliver blood glucose readings. It’s quick. It’s painless. It continually measures even while you sleep. It banishes the social stigma of finger-pricking.
Of course, this isn’t the cure—after all, I hear imperfect is the new perfect, and those developments are still to come—but it’s a start. As a wise man (my grandpa) once said: “you can never get rid of this, but by managing it every day you are fighting it. You are beating diabetes by living with it.”
