Living With Diabetes Number One.

I am the partner of a type one Diabetic. We became aware of his disease in early January, 1994, when not only was he urinating every 45 minutes throughout the day and night, but his vision also grew blurry. We were living in Casablanca, Morocco at the time. There one could take oneself off to a Laboratoire and have tests done without the initial step of visiting a doctor. So, off he went, without breakfast and before going to work, to check out our fears. The results of both blood and urine tests were positive for high blood glucose and the presence of ketones, this latter marking the type of diabetes that had developed. The laboratory owner and head chemist, also the husband of the then Principal of the international high school where both my spouse and I worked, advised on an internist. An appointment was made and insulin treatment and diet instituted.
Initially, my spouse was put on animal insulin, but within a few months he was using a fast acting human insulin via an insulin pen for his mealtime doses and a 22-24 hour ultra long-acting human insulin via hypodermic at night for the 'housekeeping' dose. This regimen together with careful attention to diet, though not extending to the exclusion of wine, worked admirably. Little did we know then how much of a honeymoon phase those three years of diabetes in Morocco were. There were no hypoglycemic comas or near comas; boiled sweets satisfied his self-recognized low blood glucose episodes; his blood glucose seemed under control. We had, thankfully, no need of para-medical aid, or of glucose tablets or glucose jelly (anyway unobtainable in Casablanca at the time). (Glucose is something of a misnomer as the vital ingredient is dextrose.)
After six years of life in Morocco, we left in 1997 for Louisville, Kentucky. The first couple of months went smoothly enough, diabetically speaking, as my spouse had taken enough insulin with him to carry him through the initial period in a new place, with new doctors. When trouble arose it came from unanticipated quarters: the insulin and comas.
In the States, the overwhelming majority of insulin used comes from one company, Eli Lilly. Both insulins used by my spouse had been from the major European supplier, Novo-Nordisk. He was able to continue to use his regular fast-acting mealtime insulin by NN without any difficulty, as that was readily available; but the NN ultra long-acting, housekeeping insulin was not. To replace that, his endocrinologist prescribed the longest acting insulin then in Eli Lilly's formulary. None of us, including his doctor, knew that the Novo Nordisk ultra long- acting and the Eli Lilly long-acting did not act similarly, at least in my spouse. While the former achieved a steady state action within 30-60 minutes after injection and stayed in that state for 22-23 hours, the latter peaked and fell over a period of twelve hours. Thus, unbeknownst to us, there was little long-acting housekeeping insulin activity going on during the daytime. The consequence of this was high blood glucose readings from mid morning onwards. His doctor prescribed a medium acting insulin to replace the long acting - with disastrous results: his second coma.
Back in 1994, just two days after we had learnt of his diabetes, I flew off to England to see my father (for the last time as it turned out) who had suffered two heart attacks in as many weeks. The day before I flew back to Casablanca I spent a few hours in Leeds, visiting book shops and generally wandering around soaking up home ground vibrations. At one of the book stores I found and bought an excellent guide for diabetics, written by an endocrinologist. The book was wonderfully explanatory and did not treat its readers as if they were barely literate children. It became our 'bible' on matters diabetic. Among its many important sections was a diagram which illustrated the peaking time and duration of each and every insulin available at the time. From this more detailed diagram, I drew up my own illustrating the working of the insulins that my spouse was using in the States and that did not seem to be controlling his blood glucose levels satisfactorily. This diagram made apparent the shortfall of the available long-acting insulin. To rectify the problem caused by the insulin's shorter working time, he would have to take two smaller doses, each about twelve hours apart. It worked.
Our first coma occurred when we were staying with friends over our first Thanksgiving. We had driven over to Missouri, spending a night in a hotel on the way to reduce the physical strain on him (I can't drive). At two o'clock that first night in Columbia, however, we all got a shock. When my partner's jerking around in bed became obviously more than restlessness and he didn't respond to my questions, I turned on the bedside light and promptly went into panic mode, as I had never seen anyone in a hypoglycemic coma before, with its convulsions, heavy, heavy sweats and autonomic urination. And this was all happening to the man I loved. But at least I remembered enough from my student nurse training (four months before I dropped out) in another lifetime, to make sure that his airway was clear and that he was on his side. Then, I ran out of the bedroom screaming for help, for an ambulance. Our friends called EMS and the minutes waiting for it to arrive seemed like years. Our friends were pure gold and we were so thankful to have their support that first time; without them I do not know what would have happened. There have been many comas and near comas since then, all of them still scary but some scarier than others.
Since that night in 1997, we have tried not to be without a Glucagon kit or glucose jelly. That jelly has saved him from many full-blown comas and when that has been too dangerous to give, then the Glucagon kit has often been the life-saver.
The availability and price of glucose, in jelly or tablet form, is anything but uniform across countries and continents. In the US, glucose tablets are available at many pharmacies. But I have only found glucose jelly, in packs of three at $12 a pack, in one pharmacy chain. In the UK, glucose tablets are readily available in a variety of stores; glucose jelly, also in packs of three but at the staggering price of 11 pounds sterling/pack (!), has to be bought at chemists (equivalent of pharmacies). But there you could on occasion find dextrose energy tubes for 99p each and small tubs of dextrose (used in making certain types of icing for cakes) at a similar price. The drawback to the confectioner's dextrose is its consistency: very stiff and so difficult for the hypo diabetic to swallow. In Germany, the glucose jelly comes in re-sealable tubes, at 1 Euro 76 cents per tube. The glucose tablets are 49 cents a tube in drugstores (two are equivalent to one US glucose tablet) and other dextrose tablets are available in most grocery stores. The US and UK glucose jelly prices are iniquitous; and doubly so given that the tubes in both countries are not re-sealable. Nor are their tubes easy to open for the low blood glucose diabetic, whose hands are likely to be somewhat uncoordinated and greasy with sweat.
But where we now live, glucose jelly is unavailable; and glucose tablets cannot be bought with any regularity or certainty. They were non-existent during our first year here; then they appeared on the shelves of the nearest hypermarket for about six months but have since disappeared again.
This constitutes the first blog on living with diabetes.