Who’s it for?
I would unreservedly recommend this book to anyone living with type 1 diabetes. It might be a little intense for family and friends who are interested, but it doesn’t presuppose much understanding of T1D, and explains everything in an incredibly succinct way. However, I would say that I have a pretty good (said in a Larry David voice) understanding of T1D, and I still learnt a lot, and, more importantly, I didn’t feel patronised. It focuses on using insulin to manage diabetes, so some type 2s who are using insulin or have been told that they are reaching that stage, would also find it beneficial. I would go as far to say that I think that all type 1 diabetics should be given this book for free – I found it that useful!
Why should I read it?
Not only does the author have T1D (automatic expert), he also works in diabetes care, and even runs an online T1D university with expert-level courses on managing your diabetes. He covers a variety of topics in a sufficient level of detail. He also lists extensive resources for further research into specific topics should you want to learn more. The only criticism I have is the number of American sports analogies, but that’s not much of a criticism! He helpfully lists BG in both mmol/l and dl – I know I could have used a conversion table, but I find it much easier to grasp mmol/l, and I would have found it a bit of drag to be continually converting numbers. There are a few times when he forgets to list a conversion, but perhaps this will be addressed in a future edition. Essentially, it is useful for all diabetics, regardless of how they measure their BG.
How can I get hold of it?
It is not currently available new in the UK, but you can easily find a second-hand copy. (https://www.abebooks.co.uk/servlet/SearchResults?sts=t&an=&tn=&kn=&isbn=9780738215143)
What didn’t I like? Oh wait, it turns into something I did like!
I found the frequent references to the insulin NPH a little irrelevant, as it isn’t commonly prescribed at least in the UK. However, there are mentions of several medicines that can be taken alongside insulin that have significant benefits, of which I wasn’t aware. As I was reading, I made a list of things to ask my GP about. One such thing is the C-peptide test, which measures how much insulin your pancreas is producing on its own (p. 128). This would only be useful for relatively newly-diagnosed T1Ds who are unsure if they’re honeymooning. Personally, I’m really interested to see if I am, as its often given to me as a reason why I can’t have access to certain diabetic things, such as DAFNE and a pump!
The top ten things I learnt:
- Why you might end up treating a nighttime hypo with extra insulin: This might be explained by the Somogyi phenomenon. This is when a nighttime hypo causes the liver to secrete extra glucose, causing an elevated BG reading upon waking. Without knowing what has caused this, you would likely increase your nighttime long-acting insulin, whereas you actually need to decrease it. By testing at 3am, you should be able to determine whether Somogyi is responsible (p. 133). Symptoms of overnight hypos that you haven’t woken up from: sweaty bed and pyjamas; cool body temperature; restlessness; feeling hungover; rapid waking heartbeat; strange dreams; and not feeling rested upon waking (p. 194).
- Why you might be carb-counting incorrectly: When carb-counting, you must subtract fibre grams from carbohydrate grams, as fibre is resistant to digestion and therefore does not raise your BG (p. 91).
- Why low-carb does not always mean low BG: Protein usually has no effect on BG, unless it is consumed without carbohydrate, in which case the liver will turn some protein into glucose in order to get its energy. So a carb-free meal may still raise your BG (p. 51).
- How to calculate your accurate correction dose: In order to calculate your insulin sensitivity factor (how much one unit of insulin will lower your BG): 94 (if using mmol/l or 1700 if using dl) / total insulin units (add up how much rapid- and long-acting insulin you use in an average day) = sensitivity factor (p. 162).
- How to quickly lower your BG: To lower your BG very quickly, inject insulin directly into a muscle (p. 176).
- When to bolus for different foods: When consuming high-GI foods such as white potatoes, bolus 20-30 mins before eating. He also suggests how to bolus for moderate- and low-GI foods, and provides a helpful GI level chart (p. 180).
- Why illness is a triple whammy for T1Ds: White blood cells (the ones that fight infection) are less effective when your BG is high AND that extra glucose swimming around your blood actually nourishes viruses and bacteria AND to come full (shitty) circle, the infection is what causes your BG to rise in the first place, by releasing stress hormones (p. 192).
- Why shopping can give you a hypo: Simply being in a mentally stimulating environment can cause a hypo. (p. 200)
- Why you don’t need a hotel room with a fridge: Insulin still works for up a month if kept at room temperature (but not above 32 degrees celsius/ 90 degrees fahrenhiet), so there is no need to refrigerate insulin when travelling (but aeroplane holds will freeze insulin and render it useless) (p. 207). However, you should dispose of any opened, unused insulin after a month anyway as it loses its potency.
- How to determine your perfect dose of nighttime long-acting insulin: Long-acting nighttime insulin should not raise or lower your BG by more than 1.7 mmol/l, assuming that you haven’t taken any rapid-acting insulin or performed heavy exercise before bed (p. 131).