A snapshot of diabetes care in the UK

I watched the History of Everything last night. It was a brilliant film, and another reminder that there are plenty of things in life worse than having type 1 diabetes.

I watched the Theory of Everything last night. It was a brilliant film, and another reminder that there are plenty of things in life worse than having type 1 diabetes.

I had my annual eye scan last week. After missing my first appointment due to diarising it for the wrong day (cue pangs of guilt), I turned up at Homerton hospital on a damp Thursday morning to have my eyes photographed.

Retinopathy is a common problem for diabetics. High levels of sugar in the blood vessels damage the eyes over time, eventually leading to blindness. A 2002 study showed that almost all American adults with type 1 diabetes for 20 years and 60% of adults with type 2, had retinopathy. It is the leading cause of blindness in the under 65s. What horrific statistics!

Diabetes Management

Does training help the body burn fuel more efficiently?

An important part of getting fitter, and improving both speed and endurance is training the body to burn fat at higher levels of intensity. This is really important for athletes who do the things I like doing – running (because they can go faster and further) and mountaineering (because mountaineers don’t have very good access to food to top up their limited carbohydrate stores).

One of the advantages of having diabetes is that I can observe how much carbohydrate I need to eat to keep my blood sugar stable. Does this mean that I have an insight into how well my body is adapting to burning fat? Can this help anyone else?

Data Training

Does doing A LOT of running help blood sugar control?

This is where it all started - running in Chamonix in September made me want to do an ultra marathon in Chamonix. I found out yesterday that I have a place in the CCC - a 100km race from Courmayeur in Italy to Chamonix. It includes 7500m of vertical height difference.

This is where it all started – running in Chamonix in September made me want to do an ultra marathon in Chamonix. I found out yesterday that I have a place in the CCC – a 100km race from Courmayeur in Italy to Chamonix. It includes 7500m of vertical height difference.

Waking glucose – it was perfect for a few weeks round the start of December

I’m still in the honeymoon phase. That means my body produces a small amount of its own insulin and is therefore capable of controlling my blood sugar to some extent. In theory, if I was sensitive enough to this insulin, could my body control its sugar levels like a healthy person? Who knows!

For a few weeks before Christmas, I was consistently waking up with blood glucose readings of between 5 and 6 mmol/litre. That is basically PERFECT. It’s what a healthy person would wake up with. I started noticing that, and I also noticed that it was often 5.7 regardless of what level it was when I went to bed.

Over the past month it’s been between 6 and 7 when I wake up. That’s still good, but not PERFECT. I’ve noticed the change in trend and want to know why.

(Click on charts to enlarge.)

Wake up glucose

The blue line in the chart above shows my average waking up glucose. You can see a golden period before Christmas, where average waking up glucose was about five despite average glucose when I went to bed (red line) being higher. For the rest of the time, glucose on waking is pretty well correlated to glucose when I went to sleep. This suggests that my long acting insulin (Lantus – I take it before bed and it acts like “background” insulin, staying in my system for 24 hours or more) dose is about right.

What explains the really good waking glucose levels, and what explains them not being quite as good now? Please forgive the very busy chart below – it shows average waking and bed time glucose, how many minutes of running I did a day on average and average grams of carbs I eat before bed.

Factors affecting wakeup glucose

It’s not lantus

My Lantus dose has been steadily dropping as I seem to become more sensitive to insulin over time. (You can see I took it down to just four units while I was skiing, but it’s back up to 5 now.) There’s no obvious correlation between Lantus dose and waking blood sugar.

It’s not what food I eat at bedtime

If my blood sugar is a bit low when I go to bed, I normally eat something so that I don’t get a hypo. Am I eating more before bed now than I was? You can see from the chart that the opposite is actually true – I was eating slightly more before bed at the same time as my waking blood sugar was best controlled.

Could it be the running?

The other line on the chart is the number of minutes I’ve run a day, on average. In the lead up to my ultra, I was doing a lot of running (between 50 and 70 miles a week, or over 40 minutes a day on average). I wonder if doing all this running makes my body sensitive enough to insulin to enable my own insulin production to control my blood glucose to the optimal level? I’m going to ask my doctor.

The chart below shows my waking blood glucose, with periods where I’ve done over 35 minutes a day of running on average. You can see that there’s a rough correlation between waking with blood sugar of between 5 and 6 and me doing lots of running.

Running vs waking BG

I’m ramping up my running training again ahead of the London Marathon. I managed ten miles yesterday, 14 today and hopefully will do eight tomorrow. I’ll continue to monitor my waking glucose (of course!) and will be interested to see whether it starts coming in between 5 and 6 again.

I feel great to be running a lot again, and if it helps control my blood sugar better then that’s a nice bonus!

Data

Will I go blind? HbA1c can help measure the risk

THIS IS NOT TO SCALE! Illustrative chart to show how average blood sugar (HbA1c) is linked to the risk of developing complications.

THIS IS NOT TO SCALE! Illustrative chart to show how average blood sugar (HbA1c) is linked to the risk of developing complications.

Before I start, I’d like to remind you that I’m not a doctor and all my knowledge about diabetes comes from conversations with my doctor (which I may misremember) and Wikipedia. Oh, and personal experience!

When one is diagnosed with diabetes, it’s not long before the word “complications” is encountered. Diabetics are more likely to develop heart problems, eye problems (including blindness), kidney failure and ulcers in the feet. It is my understanding that consistently high blood sugar is a causal factor in all of these. So an important reason to measure blood sugar is that it allows a diabetic to assess how successful their blood sugar control is and whether they need to change anything.

An important test for this is the HbA1c test, first used in the Seventies. When the glucose content of blood is high (this can occur in a healthy person immediately after a glass of coke for example), glucose molecules attach to hemoglobin in the red blood cells. Red blood cells live for up to three months, so it is possible to find out how much glucose has stuck to the hemoglobin and therefore find a measure of average blood glucose levels over the past couple of months.

HbA1c can be expressed in different ways, but many people use a percentage. A healthy person will have an HbA1c of between 4% and 5.9%.

According to my doctor, the risks of developing complications rises exponentially as HbA1c rises. To understand what this means, just look at the graph on the top of this post. You can see that as HbA1c goes from 7 to 5.9, the risk of complications goes down by the amount in the lower shaded area on the left hand side. So the risk decreases but not by very much! If a diabetic has higher average blood sugar though, and their HbA1c goes from 11 to 10, then the risk of complications goes down by the higher shaded area on the left hand side of the graph.

What this means, is that if blood sugar is high, there are really big gains in terms of long-term health by controlling it better. If blood sugar is low (say HbA1c is 6.5%) then whilst risk does decrease by bringing blood sugar down, it doesn’t decrease by much. At these levels, other lifestyle factors such as smoking are much more important. (Another reason why diabetics have to eat a super healthy diet. Keeping cholesterol low, for example, is important in reducing the risk of heart disease.) So at low levels of HbA1c the costs of getting average blood sugar down further (increased risk of more hypos) probably outweigh the benefits. I will be advised by my medical team what balance to aim for, and other diabetics will be too – it depends on personal circumstances, sensitivity to hypos etc.

My doctor and I discussed all this in the context of heart problems, so I’m not 100% sure that the graph is the same for other complication such as eye problems.

I can’t remember what my HbA1c levels are. They are still too high. When I was diagnosed they were through the roof, and on my most recent visit last week they were much lower. (Dr Powrie was very complimentary saying how impressed he was with how much it had come down!) Anyway, I’m not going to worry about them yet. I’m sure (I hope) that a few months of high blood sugar around my diagnosis won’t make much difference to my risk of complications, and as I get things under control, my HbA1c should come down by itself.

Data What is type 1?