I wish to add here two pieces of information that are not included in the book. That is because they had not occurred to me until very recently.

(1) Firstly I have been thinking very hard about the very significant differences, then and now, between my food intake and my use of insulin. Before my use of the Dexcom I have now realised that my insulin regime was tied to the instructions instructed by the original consultant endocrinologist who switched me to using insulin  the late 1990s this is NOT a criticism of that doctor He was simply applying the accumulated experience that was available to him at the time. The regime was to be Novo rapid [fast acting] 10 units three time a day at mealtimes plus 10-20 units at bedtime of Levemir; a slow acting insulin designed as a ‘back up’ cover that would remain in the system for 24 hours. I was also warned that I might gain weight now that I was using insulin but that it was the stronger ‘tool’ for the control of blood glucose compared to the tablets I had been using. I now realise with a gathering understanding of how these things work, that it was virtually inevitable that I would gain weight under that regime. I still find myself being asked the question by medical staff; What is your insulin regime ? Or words to that effect. I just cannot answer the question in the way that the questioner expects.

It was only recently that I realised that my glucose monitor had helped me to completely switch the balance between the two regimes. I now use far less insulin and I now use it specifically to counter/control actual levels of blood glucose as they develop and change in my body. On the previous regime I was in reality, eating to control the insulin that I had injected, as per plan, without having the very deep understanding, that my monitor now gives me,  of how my body is reacting to the interaction between insulin and my food intake. It used to happen like this; I eat my meal and the amount of food is not enough to counter the insulin that I have recently injected at the beginning of the meal. I begin to enter the danger period as the body heads towards a hypo. I am either lucky and have a body that feels this or I take ‘prick and stick’ measurements as a precaution. Either way I need to intake more food in order to avoid the inevitable hypo which will become more and more dangerous until it kills me.  Thereby I gain weight.  With the glucose monitor this doesn’t happen because the observation range of the monitor is literally continuous. It is akin to having bio-feedback. Prior to eating I look at the face of my monitor and I see there, an up-to-date notification of my blood glucose level. It also gives me, by the direction of a pointer, the direction in which the glucose level is moving behind the scenes, as it were. All this information, together with my accrued experience and in light of aspects such as my recent activity level, all guide me as to the amount of insulin I need at that moment.  This is as close as I can get to the normal function of the body. It is very much closer than the previous regime. Just as an example: this morning at breakfast I took 3units of Novo Rapid and 5.5 units of Levemir. I may or I may not take any more during the day as indicated by circumstances. Under this regime a prospective hypo is very much easier and quicker to deal with because the levels of insulin are so low and so much closer to what was required by the food intake anyway.

It is now 11.40 AM and my level of glucose is 7.6 mmol/L and descending gently.  It has not  risen above 10 mmol/L at all this morning. I do not allow it to go below 3.9 mmol/L because lunch will intervene; if not a couple of dextrose tablets will remedy the situation. I usually begin my lunch at a blood glucose level in the low 40s. in fact. In this way I have regained just a very tiny element of the levels of personal autonomy lost to Diabetes T2 over the years. Tiny yes, but important to me.

(2)

In fact I wish to list here the conditions that have affected me over the years by this very invasive condition Diabetes T2.

a) Erectile Dysfunction, the first and the worst.

b) Neuropathy, in the form of stabbing pain in my feet.

c)  Retinopathy, more severe in my right eye.

d) Gout, extreme pain in my knees in particular.

e)  Prostate Cancer.

f) Chronic Kidney disease.

g) Right foot ulcer leading to below the knee amputation of my right leg.

h) Heart block leading to the insertion of a pacemaker.

i) Atrial fibrillation. Very recent.

It is, of course, possible for a non-diabetic person to fall foul of one or more of these conditions. In each case, however, research indicates that a person with Diabetes is more vulnerable. I rest my case, therefore, that Diabetes is a condition that is much better AVOIDED!!

There are other conditions to which Diabetics are vulnerable. So far the Gods have spared me those. Fingers well crossed!!

                                                                                             Tony Kreit d.o.b. 08-03-1939