My unfortunate truth was that I could function reasonably normally running in hyperglycaemic range, I did for about a decade. I don’t believe I am alone in this truth. I was so terrified of the short-term vulnerability of hypoglycaemia, that I manipulated insulin to never put myself at risk of it. Here I analyse why this was the case.
Driving anxiety
In the UK, there are special conditions to your driving license as a diabetic. The guidance is known as ‘five to drive’.
- You must not drive if your blood sugar is below 5.
- You must take a break every 2 hours to recheck.
- If your blood sugar is below 5, prior to driving or during a break, you must treat it and get it above 5.
- Once above 5, you must wait 45 minutes before starting or resuming your journey.
I do have to tell you at this point and not to trigger further anxiety that:
- If you were involved in an accident due to a hypo, the law would treat you in the same legal category as a drink driver (although with mitigated punishments.)
- There would also be breaches of insurance policy in these circumstances.
The most oxymoronic factor of our driving conditions is that there is no maximum restriction. You are, apparently no danger to anyone if you blood sugar is 30mmol!
I avoided hypos whilst driving, for fear of crashing and fear of breaking the law.
Work anxiety
Whether you work with people, machinery or both, hypos can put you in vulnerable situations. Your employer does have to be understanding, diabetes is covered by the disability and discriminations act so you do need to have an assessment at work. If you work in the public sector, this would be in the form of an occupational health report. In the private sector it can vary. Large companies may have an occupational health department, in medium sized companies it may be an agreement with Human resources and in small companies, it may be just having a good relationship with your boss.
However, even if your assessment does say, lateness may occasionally occur, you will get in trouble if you are regularly late. If you are hypoing everyday, expect a call for a meeting!
Don’t kid yourself, if your T1D gets in the way of your job and forces your employer too much hassle and money, they will find a way to get rid of you in a way that you could never prove was in breach of the law.
I avoided hypos at work, for fear of losing that job.
Sleep anxiety
Sleeping is, technically, the only time when you are not in control and you potentially have to trust your insulin to work for 6-9 hours without the ability to correct.
Many diabetics suffer sleep anxiety, insomnia, avoiding going to sleep, for fear of not waking up, setting alarms for every other hour to check, light and therefore broken sleep. My unhealthy resolution to this anxiety was making sure I had high blood sugars before sleeping.
Death anxiety
The ultimate fear of all the above anxieties is death!
A hypo does leave you in immediate medical danger that needs to be acted upon there and then, that is a fact! Therefore, the ultimate anxiety related to all the specific examples above is death.
In my analysis, all these examples resulted in short termist decisions not to take, or to underdose my insulin.
Conclusion
If you wrote a list of the consequences of hypos and hypers and placed them side by side, what would you notice?
- The consequences of hypos are all short term vulnerability and death.
- The consequences of hypers are mostly long term consequences and medical debilitations.
It is not surprising therefore that many T1Ds fall into the trap of neglecting their control and subconsciously, or consciously, decide to test the probability of future complications in exchange for an uncomplicated life today. My experience says that you can live hyper and function reasonably well, however, the probability of complications is almost certain!