Money for jam.

The receptionist can set the tone of the practice she works for. 

Last Thursday, at the endocrinology centre I attend, there was an angular, grey, fifty-five plus supercilious tone, with a brusque Hawthorn - refined, possibly British-Australian - accent.  The eyes, peering down through half-cut reading glasses, remained fixed on the computer screen.

Having announced my arrival, took a seat and waited.

It's my third visit with this particular endocrinologist.  She's tall, slim and fair.  Today she's wearing a black, back-zipped, flared pant teamed with a sleeve-less bolero style top over a black camisole.  There's plenty of time to observe all this as she leads me into the room, indicates that I should take a seat, sits and smiles at me.  White, long, somewhat prominent, good teeth.

She continues to smile, like she's really happy to see me, or she's not sure what should happen next.  I've encountered this before here and I'd already determined that I was not going to 'lead' the discussion.  Nor blather on to fill a somewhat awkward, albeit congenial silence.  (Don't you love these little mind games?)

I smile back, shrug, look beyond her narrow shoulders at the moody sky and rain spattered window, wondering if I'll get caught in the rain on my way home.

I tell her I haven't brought in any blood glucose data because I couldn't find the appropriate dongle.  (What's with that word anyway?)  Instead, I hand over my blood glucose meter and she busies herself backtracking through a few recent readings. Uh-hmm.  Silence.  No feedback.

"Which pump would you recommend?'  I interject, knowing the four year warranty on my Animas 2020 will expire soon.

"Medtronic," she says unequivocally, smiling and nodding.

"Any reason?" 

"I find it's easier to access the patient's data."  Still smiling.

"So it's about you rather than me," I say.  Because after four years I'm quite adept at interpreting my own data and I'm the one who has to live with it day by day.

"Oh, I think you'll also find they have the best after-sales support."  Smile.  Teeth.  Medtronic have really nobbled the consultants, I think.  Must be superior marketing.

"But Animas has been amazing.  I couldn't possibly have had better support."  I'm thinking of helpline calls I've made that have been 'life-saving' when I'm melting down; long chats with the young girl in Sydney,. herself on a pump; loan pumps when I'm overseas and a brand new pump, no questions asked, when mine failed.  Being Type 1 D and on a pump is practically part of the job description at Animas.

"Well, of course, it's up to you."  Still radiant smiles and then silence, which I'm determined not to fill.  We look at each other.  I can't stand it any longer.

"So, what was my last A1c?"  Which is really the only reason I'm here.  I can get scripts written at my local bulk-billing - that is, no payment - clinic.

"7.7."

The previous result was 7.8.

"Oh well, I'm heading in the right direction."  Given the stress and sickness I've endured for the past three months I'm thinking that's not too bad.

Quiet again.  I wait.  Bit awkward.  White walls, desk, bench, cupboard, scales, sink.

"Do you want to test my blood pressure?" I ask.  I know the drill.  She wraps the cuff around my arm, presses a button, but doesn't tell me the result, and I don't ask.  "My weight's been pretty stable," I add, which prompts her to suggest I get on the scales.  We both peer down at my feet before she returns to her seat and writes a note.  I already knew what I weighed. Apart from a few extra grams for clothes, my weight hadn't changed since that morning.  What am I doing here?

"Do you need any scripts?" she asks.  Hurrah.  She hands them over along with a pathology form for my next visit.

"Could you write me a medical certificate?  Had to take a day off work today."  Despite only working three days a week, I had to take the day off because she only consults privately one morning a week.  Fair enough.

"Okay, see you next time."

"Thanks!"

Back out into the ice-cold reception area and I'm not talking about the aircon.  I've been with the endo for ten minutes, tops.

"That's a hundred dollars for today, thanks," says Mrs Personality, lifting her eyebrows in my general direction and reaching for my credit card.  "Cheque, credit or savings?"

Think it's time to review my diabetes management options.  Any suggestions?

Christmas Cheer.

For some unknown reason, we had our Xmas breakup at the local lawn bowling club - the last bastion of the White Anglo-Saxon Protestant and/or Catholic at leisure, maybe. No idea what to expect, apart from the stereotype of the elderly Aussie lawn bowlers' hangout.

Signed in - Fraudster, C/- The Windsor, Melbourne.  My nostrils were assailed by something foisty, faintly mothbally, and something else; essence of je ne sais quoi.

'Don't like the smell.' Fraudster curls lip, sneers a bit.  'Smells of old.' I'm sitting there at noon on Thursday before Christmas, kitted up to out-do a Christmas tree.
'Quite like it,' says Work Husband, guarding his pot of beer.  'Reminds me of my great-grandfather's house.'

The rest of the staff arrive.

'Don't forget to sign in.'

We sit in a bar around capacious ten-seater Formica topped round tables.  As people make their way across the enormous wooden dance floor, some of them trying out a few tap steps along the way, their faces, too, take on that look of searching for the source of the odour.

The brick bowling club dates from late 'fifties or early 'sixties.

'Perhaps someone could pop back to school to get some music,' a teacher suggests, given the echoey bleakness of this old people's place, bedecked with pennants from bowling comps past.  But that wasn't to be.

'We're here for a spit roast.  You can bowl later if you want to.'  That's our officious, put upon staff association leader, who'd organised the venue and catering..  (A coup was mooted by some of the young things last year, but ultimately no one either cared that much come the new year.  Or dared.)

I sipped my 100 ml of Chateau Cardboard wine and tried, unsuccessfully, to savour the ambience, like waiting for a game of bingo to commence.

We lined up like refugees for our 'meals'.  It was the usual spit roast fare, or what was left of it by the time I got up there, not being one to enjoy queuing for fifteen minutes in a pair of, for me, moderately high heels.  It was nutritious, I suppose.  The beef end was quite tender.  I don't eat much.

Then the floor show:

An aussie gent, sixty-something, Ted, in washed out striped polo shirt and shorts, unceremoniously held up a used Bandaid - sticking plaster.  'If any lady's lost the Bandaid off of her nipple, I've got it here.'  Embarrassed laughter ensued briefly.  Is that what the old 'ladies' do to prevent high-beams penetrating their bowling shirts?

Unabashed by lack of appreciation for his jest, Ted held up the wire stopper from a bottle of champagne.

'How long's this wire?' he shouted.

'What do you mean?' called one of my colleagues.

Ted frowned, a bit put out.  He spelled it out for the idiot.

'If you unravel this wire, how long is it?' Jeez, dumb teachers or what?

'Why?' called another temeritous soul.

Finally he explained that it wasn't a trick question, but a competition.  Ah!  The correct guess would win a bottle of wine.  Next question:

'How many hankies high is a horse?'  Huh?

'Men's or ladies'?' called a female teacher, getting into the spirit of it.  He reached behind the bar and produced an ironed, folded men's handkerchief.  Ostentatiously, he shook it out, grabbed it by two diagonally opposed corners and held it up for his captive audience.  Can't remember the answer.  I'd downed three 'cardies' by that stage.

I approached the bar.  Ted was the barman now, floorshow being over.

'Diet coke, please?'

'You don't look like you need a diet coke,' He narrowed his eyes; leered at me. Perhaps I only imagined him licking his already wet lips.  Wink.

'Ahahah!'  Hilarious. 'Thanks, but I'd like one anyway.'

'But you don't need it!'  He cast a raunchy eye over me, grinning lasciviously.

'Oh!  Ha ha ha, too kind.'  I tittered  'Can I have a diet coke, please?'

'You don't need one, love.'  Same deal.

'Look, I actually have diabetes.  Can I please have a diet coke?'

At that he changed tack; beckoned me along the bar, away from the others waiting for drinks.

Here we go, I thought.  Wants to share his own diabetic trials, or those of his dead grandmother.  Go with it.

Rictus smile on my face, I indulged him.  He waved me closer, the better to hear his confidence.  Okay.

With one elbow on the bar, grinning, catching me in an eye-lock, he recited some doggerel.  For about two and a half minutes.  A long time for me to smile and occasionally shrug politely, to feign interest.  Wasn't really focused, given 300 ml of chardy, that early in the day.  But the protagonist of the poem, a dog, was 'piddling' here, there and everywhere.  Meanwhile, a heavily made up, coiffed bowling club lady, ceased polishing the bar, to lend a delighted ear.

The rhyming punchline of his recitation, which he'd waited perhaps forty-five years to deliver?  'That dog's got diabetes!'

Unbe-fucking-lievable.

'Can I have my diet coke now?'

'No, you can't.  We've only got Pepsi Max,' he said, grinning like an imbecile, pleased as punch.

Merry Christmas.

That piece of doggerel?  The piddlin' pup.

Diabetes Pity Party Over

Bit hung over from the Diabetes Pity Party.  Should never have gone there.  Shouldn’t have indulged.  It’s too addictive.  Like alcohol - well, middle range chardonnay* - diabetes could control my whole life.

Used to regularly visit, and comment on, www.diabetesforums.com.  It was hugely supportive when I first started pumping insulin and needed some insight from other pumpers.  But it became repetitious; tedious.  Hundreds – probably thousands – of PWDs banging on about diabetes in its various forms. 

I’m sick of reading and thinking about diabetes.  It’s enough having to live with it.  But I’m caught in a bind.  On one hand, I’d like to ‘unfollow’ all those diabetes Tweets/Twitterers/bloggers (whatever!) because they make me focus more on all that stuff.  On the other hand, there are some brilliant people blogging/vlogging very effectively about diabetes.  The social media thing has allowed me to correspond with some of them.  Communicating with like-minded people is a massive part of why I write.

And another thing.  My brief dip into the Diabetes On-line Community seems to have revealed a strange correlation between PWDs and Christianity.  As a born again atheist, this really gets up my wick.  I won’t go into that one.  Enough there for a whole conference.

So I’m going to cull a few people on Twitter today.  I don’t need extra crap – albeit about diabetes – to read.  Get enough of that from my less able students of English.

Time to get the diabetes cart back behind the horse.

Can feel my hang-over lifting already.

*  Confession:  I'll drink cheap chardonnay.  In fact for want of something better, I've imbibed that awful 'Dalat White' when travelling in Vietnam.

Diabetes Makes Me Cry

 A former endocrinologist – the ‘brilliant young doctor’ who cared for the diabetic part of me for 25 years – wrote a letter to my GP explaining that he was giving up his small private practice.  In the letter he said that working with me had given him an insight into the ‘psychological burden of living with diabetes’.

It’s the emotional side of diabetes that’s so hard.  Because it just doesn’t go away.  And it gets worse.  (Hello, burgeoning retinopathy!) A relentless journey.

Here’s my tilt at Diabetes Awareness for the second Blue Friday.

Yesterday morning, I was sitting on a wooden ‘park bench’ in the foyer of the building where I’d just had my three monthly visit with my endocrinologist.  I needed to take a minute. to recover.

My bike pannier bag was beside me – I’d cycled the eight k into town.  I got my phone out and called my husband.  I told him my HbA1c was creeping up – 7.8 for those in the know.  I lost control of my chin, lips and voice at that stage and a few tears leaked out.  (The HbA1c ideally should be under 7 to avoid 'complications' - retinopathy - blindness, kidney and heart disease, neuropathy, and the rest.)

Trying to control this bastard condition is nigh on impossible, despite my best efforts.

A week prior to this appointment, I’d attended the local pathology centre for a fasting blood test.  ‘Small sting now,’ said the nurse, as usual, before digging into the vein on my left arm.  Easy to say.  Those injections inevitably hurt, but they’re usually quick.

I go through this process – the blood test followed by the endo appointment, where I find out whether I’ve been a ‘good enough’ PWD – person with diabetes - every three or four months.

Too easy.

But my blood result – my HbA1c - is too high.  My endo is sympathetic and we’ve worked out some sort of ‘action plan’ which I won’t bore you with.

This is the thing.  Diabetes is my ‘dark passenger’ – apologies to Jeff Lindsay of Dexter fame.  I try to hide it when I’m going about my daily business, trying to pretend I’m normal and as capable as the next person.  But it affects everything.  I rarely sleep for more than a couple of hours at a time for fear of  hypos – when my blood sugar drops to dangerously low levels.  Have to wake up and test my blood sugar to be sure.  Every morning begins with a finger prick test so I can feed the data into my pump – that little genius – and it can calculate my insulin needs so I can infuse the right amount into my body – through a cannula that’s inserted into some part of my ‘trunk’.  (Gets rotated/reinserted every three or four days.  Fun.)

Any carbohydrates eaten must be accounted for and balanced against the amount of insulin taken.  The pump calculates it all, with a bit of input from me.

If I’m cycling to work – 7 undulating kilometres – I have to factor that in, too.  Which in these happy insulin pumping days means reducing, for ninety minutes, the rate at which insulin is delivered.  I pedal hard up those hills, but I usually have to stop mid-ride, to check my blood sugar again.  I struggle to get those numbers right.  If it’s too low I have to stop; eat some glucose; drink some juice.  If it’s too high, well, I’m laughing because I can pedal flat out for the rest of the ride. 

You know, I’d really love to just take off on my bike and just enjoy the ride, without having to prepare for it and monitor it.

So, finger pricks.  About ten a day.  Fewer on my days off when I don’t teach.  Wouldn’t want to have a hypo when I’m in front of a class of 25 teenagers, most of whom are ready to pounce on any vulnerability.  And the pump?  It’s doing its stuff 24/7.

As a PWD – Type 1 – I can never be spontaneous without serious risk to my health.

A few of my stats:

I’ve been cycling for about 50 years.  I’ve been a secondary English teacher for 32 years.  I’ve been in a relationship with my husband for 32 years.  My son is 25 and my daughter is 23.  I’ve had Type 1 diabetes for nearly 31 years. 

Can’t seem to shake it off.

And BTW, I'll be glad when Diabetes Awareness Month is over.  Cos I'm sick of thinking even more about it.

Blue Fridays

Blue Fridays in November is about diabetes advocacy.

I’m supposed to wear blue every Friday in November and advocate about diabetes.  The thought doesn’t thrill me. 

There was no Diabetes On-line Community – DOC – when I was diagnosed in 1981.  There was no line to get on. 

Back then, I was admitted to a hospital in country Victoria, where I’d failed the glucose tolerance test, taken during a family holiday.  I slumped soon after that hit of glucose and was carried, by a doctor, to a hospital bed.  I raged for a bit; had a cry for a couple of hours.  But I responded well to a single shot of insulin.  By the time my family arrived that evening to hold a vigil at my bedside, I was cracking jokes about being able to eat as much powdered mustard as I liked because it was ‘free’, according to a pamphlet I’d been given.  Carb-free, for those not in the know about just one of the elements involved in managing diabetes.

Spent the following week in an eight bed very public ward at the Royal Melbourne Hospital.  Successfully injected myself on the first attempt.  Surprised by how easy and pain-free it was, despite my former horror of injections.  

Each morning, for the rest of my life, it was emphasised, I would require a single injection of a mix of long and short-acting insulin.  I’d inject myself, after I’d gauged my blood sugar level. 

Like this:  first thing in the morning.  Empty bladder.  Ten minutes later, catch the next bit of pee in a jug.  In a test tube, using a dropper, mix six drops of this urine with six drops of water.  Drop a tablet into it.  The cocktail fizzes.  Check cocktail’s colour against a chart.  Thus see how many ‘pluses’ of glucose are in one’s pee - how sugary it is.  Take more or less insulin accordingly.  (How primitive!)

Had to do the same thing in the evening, at six o’ clock.  Carried my little chemistry set around with me.  Often did this procedure in the ‘ladies’ at the local pub on a Friday after school.  What larks.

And the other thing was that I had to eat by certain times, because on only one injection a day I had to eat when my insulin ‘peaked’ in its action, otherwise I'd have a hypoglycaemic reaction.  Low blood sugar.  Bad.  (And they are!) This had all been explained to me during that steep learning curve week in hospital.  I’d also been given a crash course in carb counting by a dietician who drummed into me the nexus between carb counting and good blood sugar control.

Back then there was no nutritional information on foods.  The only sugar free soft drink was Tab Cola.  Gold Crest manufactured a ‘diabetic’ range of cordials.

I was discharged from hospital with a supply of syringes, insulin and testing gear.  It didn’t last long.  We didn’t have a National Diabetes Supply Scheme back then.  I tried to buy syringes in a pharmacy across the road from my school and I think the pharmacist called the police!  I found out from the local diabetes association that there was a 'diabetic friendly' pharmacy in the city where one could buy one’s supplies without suspicion.  Syringes weren’t cheap either.

There was a sort of ‘tourist excitement’ to all this which turned into ‘culture shock’ after about three weeks.  It was a hell that I endured for a year, at the end of which I was wraith thin and constantly sick with a variety of ailments that thrive on excess glucose in one’s system.

And then I found a brilliant young doctor who was into multiple daily injections and ‘home glucose monitoring’.  Lucky for me.

That was thirty years ago.

It’s my day off today.  I’m wearing a blue-grey tee-shirt and blue jeans.  Quite sure I won’t be telling people about diabetes today, other than through this blog, which perhaps five people will read.

We’re not supposed to talk about people ‘suffering’ from diabetes.  But you know what?  I have suffered.  And apart from battling with this condition on a daily basis, I’ve had to suffer people’s ignorance and insufferable, almost prurient curiosity about it.

Tip:  when you meet someone with Type 1 diabetes, don’t ask them if they should be eating whatever it is they’re about to eat.  And don’t tell them about your grandfather, or other close friend, who died of diabetes.  We don’t want to know.

Could go on, but no one likes a long blog.  If you’ve read this far, cheers.