A fast blast from the past…why exercise is just the best

Having a good old tidy of files and documents on my computer, I came across this article which I wrote for the British Medical Association’s ‘Healthy Living’ Section in their weekly magazine a couple of years ago. It is slightly dated now and we’ve all come a long way since but there are some important points sprinkled in the text highlighting my personal experience of the significant benefits of EXERCISE for the management of type 1 diabetes. Feel free to have a read 🙂 In the meantime, I’m getting into the swing of reflecting for my final year of medical school so there will potentially be some more blogs cropping up from me in the next few months!cycling girls

Exercise, particularly running, has always been an integral part of my life and after being diagnosed with Type 1 Diabetes in December 2012, it has adopted an even more significant role. After experiencing all the textbook symptoms for a few weeks, it was the significant weight loss and simply unquenchable thirst that triggered a visit to my GP. An off-the-scale blood glucose and ketones in my urine prompted emergency admission to hospital with suspected DKA. Tests there revealed a blood glucose of 41.3mmol/l. No wonder I felt so rotten! This diagnosis has been life-changing and has had a profound impact on both me and my family. I am now on four injections of insulin daily.

Initially, I was worried that my diabetes would prevent me from doing regular exercise but in fact, as time goes on I realise more and more the importance of regular activity and the benefits it confers. When I exercise, I feel happier and healthier both in body and mind. Importantly, it helps keep my blood sugars more stable and reduces my insulin dose requirements. Soon after my diagnosis, I decided to sign up for the Great Manchester 10K Run which took place in May 2013 to raise money for DiabetesUK. I started training in January running outside and at the local gym. Fortunately I am a big fan of running and really enjoyed pushing myself and seeing my progress. I welcomed the presence of insulin in my body again and the difference in my energy levels and general well-being even after only a couple of days was remarkable! Crossing the finish line in May with a time of 45.23 was quite an emotional moment. It was a small victory for me in my battle with diabetes and proved that it would not stop me from doing what I enjoy. More importantly, I managed to raise £1578.14 for DiabetesUK. The race served as a great motivator to keep training but the realisation of the benefits to my diabetes management has made sport and exercise an essential part of my daily life. And it’s not just running! Since my diagnosis I have swam, cycled, hiked, played tennis, climbed mountains – anything to get my heart rate up! All I need to ensure is that I monitor my blood sugars before and after activity and have a source of fast-acting glucose available should a hypo occur.

This year has been a huge learning curve but as a medical student I feel it is important to reflect on and learn from experiences like this. I now have insight into how it feels to be a patient and realise how frightening hospitals can be. Diabetes is with you 24/7. There is no holiday. I now understand what it is like to have a chronic condition and feel I will be able to relate to patients on a whole new level. I have come to understand the importance of exercise and fitness both in prevention and management of diseases such as Heart Disease, stroke, diabetes (Type 1 & 2) and depression. I believe that the promotion of regular activity should be of top priority amongst patients and the general population. Human beings are not designed to sit around all day. We have muscles so should use them! I feel in a privileged position to have experience of working in the healthcare profession but also having a patient’s perspective. It is still early in my training and I am not sure what path of medicine I will pursue but what I am certain is that I will be the first to advocate the benefits of regular exercise, particularly in the management of Type 1 Diabetes.

All good things…

Today marks the end of DBlogWeek and the final topic is the deceptively difficult ‘My Favourite Things.’ Serendipitously, I have stumbled upon the blogging world after beginning to write about my own experiences a fortnight ago. Since then, I have been inspired by so many posts of other bloggers, captivated by the vast array of knowledge and experiences shared by fellow diabetics and feel like I have found something special in this world of blogging. I feel very lucky to have found so many diabetics all over the world who are so candid and forthcoming to share their experiences. I know I will (and already have) learnt a lot from my perusing this week. It is nigh on impossible to pick a favourite blog or comment from the week as there has been such a vast array of wonderful pieces written. I did particularly enjoy, however, the sheer creativity and thought behind all of the poems shared on Poetry Tuesday. 

I look forward to sharing more of my experiences with you all and hope they might be of interest and provide some enjoyment for some of you. Being open and honest myself has been very useful for me and a great release of some of the emotions and struggles i have encountered since my diagnosis. Thank you all and see you around!

Jabs, Stabs and Taxi Cabs

Saturday Snapshots is the topic of today for #DBlogWeek the aim of which is to show everyone what diabetes looks like! After some pondering, I decided I will share some snaps of some of the places where I have either had to test my blood sugar or dose myself up with an insulin shot. It’s only been a year and 5 months since my diagnosis but in that time I have injected myself an estimated 2060 times mostly in the thigh (very occasionally in my abdomen). But I feel more sorry for my finger tips which bear the brunt of the stabs and jabs diabetes requires in order to find out the sweetness of my blood.

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The first of many…

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Hiking in The Lake District….exposing thigh in freezing conditions.

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Hiking in California…other end of the temperature spectrum

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Hiking in Hong Kong on the Stanley Trail

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Injecting on the Metro in Barcelona

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In the taxi cab…

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Iconic Taxi cab of HK – crazy mad drivers + HK traffic = challenging glucose testing

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Having a hypo on The Peak Tram

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Life IS like a box of chocolates…and yes, diabetics CAN eat chocolate.

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BUPA Great Manchester Run, was a challenge to balance insulin with nerves and 10K to run!

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Sweaty at the gym – glucotabs to avoid those hypos!

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Our 21st – never a day off diabetes!

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At the casinos in Vegas – hypos aplenty amidst the heat!

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I get so unbelievably excited when this number appears. It’s the little things in life..

These snaps are just some of the weird and wonderful places I have had to fufil the duties of being a diabetic. For fear of boring you all with more pics, I will finish this post with two points I hope these snapshots have illustrated.

1) Diabetes follows you everywhere. There is no escape, no break, no day off. Even if it is your birthday, Christmas Day, wedding day, graduation…there is no respite. Every single day involves testing, calculating, administering insulin. It’s a full-time commitment. Nonetheless, as I have elucidated in previous posts, it quickly becomes a part of everyday life and something that you just get on with. C’est la vie.

2) You CAN still do incredible things, see amazing sights and lead a normal life. In the short time since my diagnosis, I have been extremely fortunate to have had the opportunities to travel and participate in a variety of exciting activities. Each different experience has presented new challenges in terms of managing my blood sugars within an optimum range and there have certainly been a few precarious highs and lows along the way. However, I’ve learnt much from my experiences and will not allow this diabetes to get in the way of living my life. When all is said and done, things could be a lot worse…

 

Close and Emotional Encounters of the Diabetic Kind…

#DBlogWeek coincides nicely with Mental Health Awareness Week (see link below) so fittingly, today’s blog topic is all about the emotional side of diabetes.

As medical students we are taught about chronic conditions, many of which have distinguishing physical manifestations and potential complications. Rheumatoid Arthritis for example, can cause destructive and painful changes to the joints in the hands and there are many images in textbooks demonstrating the negative aesthetics of disease. Diabetes itself has a plethora of potential physical problems all of which I have been reminded of more often than I would have liked.

What is of perhaps underestimated importance, and something not so well illustrated to us in medical textbooks, is the significant psychological impact chronic disease can inflict. Upon receiving my diagnosis, I hurriedly filtered through any of the medical information stored in my brain and tried to recall all I knew about Type 1 Diabetes. My knowledge extended to the very basics of signs, symptoms, causes and management as well as the quite frightening potential complications. My body was deficient in insulin so I would have to start injecting insulin four times daily to replace it, maybe one day I would get an insulin infusion pump. Threats of eye, heart, kidney and nerve problems (amongst others) sprang to mind and lingered there. These physical considerations of the disease were overwhelmingly terrifying to say the least. However, what has been most enlightening since that day (18/12/12), is learning about and indeed experiencing, the mental complexities that accompany the disease.

Now, being a reasonably reflective person I could ceaselessly jabber away about the emotional side of diabetes so I thought I would limit this blog to a few anecdotes that illustrate just some of the multitude of emotions I have experienced since diagnosis.

Despair on Christmas Day

Christmas Day 2012 was a week after my diagnosis. First gift from Santa – awaking in cold sweats and trembling. Happy hypo Phoebe! The rest of the day went quite pleasantly and after injecting my bolus I enjoyed a rather delicious Christmas Dinner. A short while later I began to feel those all too familiar feelings that suggested a hypo was on the horizon. Full to the brim, I reluctantly had to take on board more carbohydrate and this was when the stark reality hit me and tears did ensue. This affliction of diabetes was never going to leave me. There would never be a holiday. Unlike Father Christmas, diabetes doesn’t care if I’m sleeping or awake, naughty or nice. It will be a part of me all day every day, for the rest of my life.

Frustration

I was lucky enough to attend the Corpus Christi College 2014 Ball in Oxford a couple of weeks ago, and had an absolutely fantastic evening with some of my very best friends including my twin sister. The ‘getting ready with friends phase’ is one part of such evenings that is supposed to be enjoyed, but for reasons unbeknownst to me, my blood sugars were riding high. Perhaps it was excitement, perhaps it was stress but despite several correction doses those sugars just would not budge. When your blood glucose behaves with such stubborn resolve, it is easy to fall into a vicious cycle of frustration. The high readings are frustrating which dampens your mood. You get frustrated with your frustration and feel guilty to your friends that you are not in the party spirit. Fortunately, after some patience and a bit of my own stubborn resolve, the blood sugars came down to acceptable levels and the rest of the evening was full of fun and frolics with my chums.

 Anger

Diabetes can have the impressive ability to evoke powerful feelings of anger and resentment. There are days when I loathe and despise the disease and inevitably wonder why did it have to happen to me? But life is not renowned for being fair and you just have to get on with it. Sometimes I try to channel any negative thoughts and feelings I have towards diabetes and use it to my advantage when exercising. One particular time I attended a ‘boxercise’ class, which unsurprisingly involved punching and kicking manoeuvres (not of other people I might add). It might sound a little odd and maybe a bit sad, but each and every punch I would imagine I was beating diabetes. Focusing my anger in this way really does make me feel better and I will be the first to advocate exercise as an integral part of successful glycaemic control.

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Exercise exercise exercise. Just Do It.

 Anxiety

Every single diabetic day in my diabetic mind, there will exist at least one anxious thought. Where’s my blood sugar at this morning? Was that REALLY Diet Coke they served me at that restaurant? Where are my glucose tablets!!? Am I going to have a hypo in the supermarket/gym/lecture/exam/elevator…? How much insulin do I have left? Do my friends know what to do in case I have a hypo? No really…was it Diet Coke?

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Is it really diet coke they served me?

Now human beings are remarkably resilient creatures and have an extraordinary ability to adapt to new and different situations. And that’s what diabetes demonstrates. Testing your blood sugars every morning and evening, before and after meals and exercise, injecting four times a day, ensuring you have emergency fast-acting glucose supplies to hand at all times (I’ve got packets of jelly babies dispersed at readily accessible locations), checking your levels before driving, walking to the shops and during exams, ensuring insulin is kept cool in hot climates…it all becomes part of normal everyday life and tasks such as the relentless injecting and finger prick testing become routine. That’s not to say it stops you feeling anxious and for me, every single blood glucose test adds an element of stress to my everyday shenanigans. Sometimes however, it becomes so routine complacency can creep in….which I learnt last week on an excursion to Cadbury World (‘the world of chocolate delights’) by forgetting to take my insulin. Advice to fellow diabetics planning/hoping to visit Cadbury World one day: TAKE YOUR INSULIN.

Dealing with Diabetes

Dealing with diabetes has been an exponentially steep learning curve, arriving in my life in an unwelcome and disruptive fashion. It has changed my life. Taking the positives from the situation, I feel lucky in a way, as I have come to learn a lot about myself and gained an invaluable insight into the complexities that go hand-in-hand with chronic disease. All of these experiences will hopefully help me in later life, whether that be treating future patients or educating the general public about how there is certainly more than meets the eye when it comes to diabetes. I took a year out of my studies to come to terms with my diagnosis and learn more about how best to manage everything. This was a huge decision but a necessary one. Whilst I’m well aware there will be more trials and tribulations to face in the future, for now, I am in a much better place both physically and mentally. My friends and family have been absolute heroes and have had to deal with my mood swings, highs, lows and of course perpetual ramblings and reflections about diabetes. I would not be where I am today without you all and at the risk of sounding like one of those green aliens from Toy Story, I am indeed eternally grateful.

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Thank you friends.

For more information about Mental Health Week: http://www.mentalhealth.org.uk/our-work/mentalhealthawarenessweek/

Taking a stab at diabetic poetry… #DBlogWeek

By sheer serendipity, after starting my blog last week, I’ve discovered that May 12-18 2014 is the fifth annual Diabetes Blog Week! Although I missed the ‘Change The World’ post yesterday I hope that my two previous blogs (and hopefully future posts) illustrate some of the diabetic issues important to me.

And now it is Tuesday, which is none other than Poetry Tuesday. Here goes my attempt…please be kind…

There once was a time my blood got so sweet

Thirsty and tired, weight loss not discrete

Was so weak and so frail

Ketones wee did unveil

Alas, diabetes shall not defeat

 

From highs to hypos and a lot of sweat

Journey’s been long and it’s not over yet

Have learnt much in this time

Perhaps not how to rhyme

And there’s plenty more to come I will bet

 

So many needles and finger pricks too

Misunderstood, frustrated each review

Every day I will find

Affects body and mind

How complex it can be who ever knew?

Highs and Hypos in Hong Kong

This time a week ago I was coming to the end of what had been an amazing 10 day adventure exploring the incredible city of Hong Kong and its outlying islands. It is an extraordinary place which surpassed my expectations in terms of what it could offer as a vacation destination and potentially a place to live and work in the future.

And yet, scattered amongst some truly awesome experiences, there were reminders of the inevitable influence diabetes can have in my life. Now being in such an exciting country where dumplings (i.e. cooked balls of dough) form a staple of the local cuisine, a few blood sugar highs were unavoidable. But I could deal with highs this holiday. Particularly when reaching a substantial altitude meant an incredible view…

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Victoria Peak – incredible view!

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Chinese Dumplings – carbohydrate content…!!!   

It was in the airport before boarding our plane back to Heathrow where diabetes reared it’s (exceedingly) ugly head and decided it was time for the blood sugars to come plummeting down for the dreaded HYPO. For those of you who have experienced a low, I hope to do you justice and elucidate an accurate description of how utterly unpleasant it feels to have a hypoglycaemic episode. (I do appreciate however, that every hypo episode is different and symptoms can differ from one individual to another.)

One hell of a hypo at Hong Kong International

 In general, I manage to match my dose of insulin well enough with the amount of carbohydrate I’m eating to avoid too much of a fluctuation in my blood sugar levels. However, sometimes I get it wrong… and I mean horribly wrong. What had been a rather enjoyable brie, onion and rocket sandwich turned out to be much lower in carbohydrate than I had originally guesstimated (there’s a lot of guesstimating in diabetes). After a short while perusing the duty free before our flight departed, I began to feel a gradual haziness descending, clouding my thought and clarity of mind. It felt like I had had several vodka diet cokes too many. Then came the weakness. For me, it’s my arms that start to ache first and it sort of feels like I’m wearing armbands made of cement they feel that heavy. The energy is just sapped from you say as though you’ve just played a four hour game of squash or run a marathon.

 I somehow managed to make my way into the airport toilets and miraculously had enough mental strength left to test my blood sugars. Initial beep of the glucose monitor…the 5 second countdown… the second beep…2.2. Yikes. Thankfully my raspberry flavoured glucose tablets were at the top of my rucksack and I swiftly polished off half a tube before re-emerging from the bathrooms. Only to discover our flight was boarding and our gate was several escalators and a transit train away…

 Cue the hypo sweats. Now I know when I’m having a bad hypo when I start sweating and a blood sugar of 2.2 compounded with the Hong Kong humidity and a trek to our boarding gate meant these sweats were coming thick and fast. In a matter of seconds, beads were rolling down my face, neck, chest and abdomen. Even my legs start to sweat which is just a bit gross.

 With hypos like this, the dramatic reduction in blood sugars comes with a dramatic reduction in rational, reasonable thinking. In these circumstances, you get a seemingly insatiable hunger for sweets, biscuits, crisps, nuts…whatever you can get your hands on. So there I was in HKI, about to miss my plane, profusely sweating, dazed and confused and demolishing a pack of sour skittles followed by the other half of the sugar tablets. Because you feel so wretched, all consideration of carbohydrate amounts disappears in a frenzy of sugar consumption which leads to subsequent and infuriating highs. One of my best friends who had joined me on my travels had seen me struggling with a hypo before and she remained fantastically calm and collected, taking my bags and ensuring I was taking some sugar on board. I felt angry with myself for putting her in this position at the end of what had been a terrific holiday.

 Hypos like this remind you of the way that diabetes can infiltrate your life so invasively. The unwilling loss of control over both body and mind accompanied by the feeling of being a burden to those closest to you is an inexplicably frustrating feeling. Thankfully we managed to reach our boarding gate just as the final call was being announced. It took a good hour or so to finally come round and in that time I was close to tears as I had been reminded of the harsh role diabetes has the potential to play in my life. As anticipated, the first part of the 12 hour plane ride consisted of perpetually high glucose readings and consequent correction doses. It wasn’t until we were somewhere over mainland Russia when I finally reached an acceptable level of 5.3 and drifted off into sporadic sleep.

Every cloud…

Now my aim with this blog and with life in general is to maintain an optimistic attitude and I fully intend to identify all the silver linings of the diabetic clouds that may appear and perhaps linger every now and then. My time in Hong Kong illustrated that diabetes does not have the power to stop you from doing incredible things. It truly was a wonderful adventure and I feel very lucky to have had such amazing experiences. From hiking on Lantau Island to swimming in the South China Sea, sunbathing on stunning beaches to shopping in street markets, I did not let the fact that I had diabetes interfere with what I could happily call the holiday of a lifetime.

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Hiking on Lantau Island – keeping insulin cool in this humidity is a challenge in itself!

The Diabetic Responsibility

However, that’s not to say you can just go ahead doing whatever tickles your fancy and completely disregard ‘The Big D.’ With the diagnosis of diabetes, there comes a certain responsibility a diabetic has to accept. The management of this condition is a lifelong commitment and one in which has to be considered each and every single day. There’s no escaping this fact. But, I’ve come to realise that I myself have the power to control my diabetes rather than it control me (bar the occasional hypo as described above). This takes motivation, preparation and dedication and even with some background of medical education, it certainly isn’t plain sailing! I’ll finish with one of my favourite quotes which has become especially significant particularly in the past few years of my life from that well known Greek philosopher Epictetus. “It’s not what happens to you, but how you react to it that matters.” Wise bloke that Epictetus.

The Adventure Begins…

So it has been 502 days since the day that changed my life forever. My whirlwind tour from my local GP to the Emergency Department at Peterborough City Hospital, the resuscitation ward and finally the short stay ward culminated in a brutally frank diagnosis. “Phoebe…you have Type 1 Diabetes and will have to inject yourself four times a day for the rest of your life.”

Now with the symptoms I had experienced and my medical knowledge thus far (albeit limited), I had my suspicions there might be something awry with my pancreas but there was absolutely nothing that could have prepared me for the flood of emotions and tears that followed after hearing that sentence. Even at that stage lying in that hospital bed at a fragile 7 stone 11lbs (see image below), I had no idea of the impact this diagnosis would have on my life. Now anyone who knows me well, will be aware of my passionate enthusiasm for theme parks and high-speed high-thrill rollercoasters. So there was certain irony in this moment which signified the beginning of the most intense and emotionally challenging coaster I will ever ride along with my family and friends.

A year and 4 months on, and what a hell of a ride it has been so far. But here I now am, sat in my room at university, coming to the end of an intense third year of medicine at Birmingham Medical School. I’m still alive, I’m still kicking and perhaps feel the healthiest and fittest I’ve ever felt in my 21 years of life. Post the intensity of third year exams, I’ve had a bit more time and mental space to reflect and ponder on my experiences since that day in December 2012. It has been a remarkable journey and my diabetes continues to present new challenges and frustrations every single day. However, I feel a strange privilege in having been diagnosed. It has opened my eyes to the impact such a diagnosis can have both physically and psychologically not only on yourself but your friends and family and this insight will be invaluable as I progress throughout my medical studies and (hopefully!) career. So many lessons have been learnt in this time (too often the hard way!) and yet there is still so much more to learn and come to understand. I thought it would be wise to document my thoughts, reflections, experiences and anecdotes.  And so here it goes, the blog of a diabetic medic. In the words written above the entrance to Islands of Adventure in Orlando, one of my most favourite theme parks of all time, THE ADVENTURE BEGINS…

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Universal’s Islands of Adventure in Orlando, Florida. Just awesome.

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17/12/12. Emergency admission to the resuscitation ward. Blood sugar of 41.3, ketones in urine, 7 stone 11 lbs….yikesabee.