Thursday 1 May 2014

Explaining the diabetes beast: the breathing analogy

I pride myself on being a professional diabetic, in that when an opportunity to educate, advocate or raise awareness arises, I take it.  Most of the time I am able to explain the processes, practices and pitfalls of diabetes with ease; it has been part of my life for 27 years, after all. But every now and then a certain loaded question leaves me unusualy unable to explain myself.  

"If you take your insulin like the doctor tells you, why do your blood sugar levels still go up and down so much?"

As infuriating as that question may be to someone with diabetes - someone who understands the illness and that it just doesn't work that way - it's not all together a silly question.  Let's think about it in terms of what everyday people like you and I - those without a medical degree -  know about illness: If you have an infection and take antibiotics, the disease goes away; If you have high blood pressure and take lowering medications, your pressure drops; if you have a headache and take paracetomal, the ache subsides.  Why then if people take insulin, do their blood sugars not stabilise?

The list of answers to that question is almost endless, with much not yet known about why.  We know that getting 'the right' level of insuln is a minefield in the first place, and that the impact of foods, exercise, emotions, hormones and even weather can often not be anticipated. But when I try to explain why diabetes is so complicated, my usually eloquent and articulate self becomes a bumbling mess of technical words and medical jargon.  In fact, if you are as unfortunate as my niece, you may even have heard my "Once upon a time there was an islet of Langerhans named Jeff" story.  To this day, she has no idea what diabetes really is. And I don't blame her.

So I've been asking myself how I could make some of the mystery of diabetes a little more explainable, and I think I have it: it is all about breath.  

Breathing is an automatic process in the body.  We don't need to think about breathing because our body, in all its complex beauty, knows exactly when and how deeply to breathe in order to keep us functioning properly.  When we exert ourselves, our body knows to increase how hard and fast we breathe, because that oxygen is needed throughout our body. Our brains tell the body that when we sleep, it must continue to breathe; when we run, it must adapt; when we rest, it recovers.  We notice it, but we don't control it.  The body  does this second-to-second, minute-to-minute and hour-to-hour, very successfully.  In fact, if you had to try and breathe intentionally (and why not give this a go for 5 minutes - take each breath intentionally and try to make them as natural as possible, while not letting the body make the choice for you) you would not be able to do it nearly as well as the body does.  If you sit very still you may manage what you think is steady breathing, but there will be subtle differences between each breath you take; one will be longer than the last, the next will be deeper than the first.  Then, add in some complications such as exercise, and you now have a battle on your hands.  Try to do this while you are at work, at a party, in a supermarket or while reading a book, and it would be near on impossible.  Before you know it you would be gasping for breath because you didn't take in enough air, or would tired from the constant thinking about how much and how often you should breathe.

To me, this is the same as diabetes.  What has gone wrong in our bodies is that the automatic process of blood sugar management which in a healthy body - just as with oxygen - ensures that the correct amount of glucose gets around the body, is broken. Insulin is the intentional beathing we are trying to do to keep our breath (blood sugars) as stable as we can, but trying to mimic any process that the body does so well automatically, while external factors such as exercise, food, emotions and hormones pound our decision making and moving the proverbial goal-posts, means that blood sugars can never be controlled completely.  Our brains do not send the right messages. If we sat still in a room with no influences complicating things, we would possibly be able to keep those glucose levels as natural as possible, but somewhere in amongst all the focus on blood sugar levels, we have to live a life.  We need to go to work; to concentrate on that book; to go to sleep.  We cannot be consumed by the task of managing blood sugar levels. We can get close to stable blood sugars, but there will always be times when we are simply unable do as good a job as the body would have done, even with insulin.

So how do you tackle this topic when it comes up so that people aren't baffled by why insul does not simply equals stable blood sugars?  And if you are someone without diabetes, does this make a little bit of sense?


  1. So true Anna! Was at the cinema yesterday with a friend who is a mental health occupational therapist, is intelligent and very knowledgeable about food, diet and many other things BUT she was really judgemental when my Dex alarmed (low). She said that I should be doing this and that and it shouldn't happen. I was really upset and felt dumb because I could not convince her that life 'gets in the way' and even if you dose for exercise (as I'd done yesterday) things sometimes don't go exactly to plan. I shall cut and paste a bit of your blog for her, but won't hold my breath for too long (!!) as I know that she will come back and tell me I should have eaten more complex carbs (and I suspect you know how that makes me feel after years of struggling with food, weight and body image - esp when she eats about 4 times more than me and is skinny as a rake due to hyperactivity.....) Thanks for expressing one of the greatest frustrations I often feel following hypos.

  2. Hi Lis, thanks for posting. And well done for not come tell losing your cool with your friend; I can't say I would have had as much class. It always baffles me when people say 'that shouldn't happen'. Surely if we were having any highs of lows; we wouldn't be diabetic! Isn't that what defines diabetes!

    Diabetes is a constant effort to manage something the body would always do better if it worked. But it doesn't work, so we have to do it. We do it to the absolute best of our ability, but we have the added complication of having the rest of our lives to live. Easy to do if you aren't thinking hour-to-hour about your next blood sugar management strategy.

    Feel free to copy anything that may help explain it. There are a few things I want to add, so I hope it doesn't fall on deaf ears. But as a friend - and one who may know about the battles with food you have had - I would hope she would be open to hearing your side - the true side - of the story.

    Best wishes

    AP x