Saturday, 23 April 2016

It's Four in the Morning

It's Four in the Morning, A guilty pleasure song if ever there was one. I've no idea why I like it, but I've loved it since it was a minor hit for Faron Young back in 1972. It comes into my head whenever I'm awake at four in the morning. And I'm awake at that time more often than I would ideally like to be.

If like me you have the dubious pleasure of living with Type One diabetes, it is likely that "a good night's sleep" is either a distant memory or something you've never properly experienced.  I don't think I have slept more than 3 or 4 hours non-stop since diagnosis at the age of 40, and in particular a "lie-in" just never happens.

Most nights, I fall asleep very readily (because I've been awake for so long), but I have to wake with an alarm at 1:30 am to check my blood glucose level, for fear of a night-time hypo. I then sleep until my in-built alarm tells me it's time to wake up. And that's normally between 4 am and 5 am. 

Now I know we are constantly told not to take our smartphones to bed, but I'm afraid I always sneak a look at my phone and if I glance at my Twitter timeline it is highly likely that I will see signs that my fellow diabetics are also awake. Sleep and diabetes don't mix well.

Early waking is indeed one of the many curses of Type One diabetes, and I often find myself awake at that infuriating moment when it's too late to go back to sleep but far too early to be awake. Welcome to our world. 

OK, so it's not the worst thing that could happen, but I think it's a complication often overlooked by those without diabetes, and one which causes difficulties and discomfort that we perhaps just "grin and bear" rather than telling our families, friends and colleagues what a burden it can be. Not to put too fine a point on it, we are more likely to be knackered during the working day, or too tired to enjoy our leisure hours in the evenings and at weekends. Early waking is not a medical "complication" but it's a significant and, I believe, widespread and very real issue for many Type Ones. Perhaps I'll find out just how widespread it is and how big an issue it is when I publish this post. Let me know, #gbdoc friends!

Early waking is no mystery. It's a well-known aspect of insulin dependent diabetes known as the Dawn Phenomenon and is caused when hormones cause the liver to release glucose towards the end of the night. More accurately, towards the end of sleep: a #gbdoc friend, a nurse who works nights, recently posted a picture of her FreestyleLibre trace showing a rise at the end of the afternoon. Dusk Phenomenon. It is notoriously difficult to control, and I personally find that most mornings I am awake by around 5. Not an ideal preparation for a busy working day, and especially annoying when it happens at weekends or when on holiday, when a sleep-in might be welcome.

We Type Ones have a complicated relationship with sleep. Come to think of it, we have a complicated relationship with lots of things, notably food, drink and exercise. But for me, sleep is the most difficult one: I am prone to low blood sugar, even hypos, at night if I don't snack at bedtime, but then I'm also very prone to the dawn phenomenon.  You literally can't win, in that low blood sugar wakes you up, high blood sugar wakes you up, and sudden changes in blood sugar wake you up. So the chances are that one or more of these wakes me in a typical night, but most commonly, it's a sudden rise, after an otherwise steady night, that wakes me. Here's a typical Libre trace showing what I mean:

Look how a pretty steady night ends so abruptly at around 6. This one wasn't too bad or too early, but you get the idea.

However, being me, I'll find a silver lining to this cloud. For a start, I rather enjoy early mornings, especially in summer. Sunrise, the dawn chorus, a silent house, the uniquely intimate companionship of early morning radio are all something of a consolation,  and I also enjoy the chance to catch up on the reading that I don't get done at bedtime because I've fallen asleep. And Godiva the cat is always more than happy to see me for an early breakfast and a cuddle.

But there's another consolation. Once again, the #gbdoc comes to the rescue. As I said at the start of this post, I very much get the impression from Twitter that I am not alone. When I started using the hashtag #GBDocBreakfastClub I found plenty of response, and any tweet at the crack of dawn is almost certain to be seen and responded to by my fellow diabetics. In fact, I'm going to publish this post at dawn, to see if I can prove my point. I'm willing to bet that I'll see a few #MugsofGBDoc as we share our early solitude.

And here's a nice selection of morning songs to listen to. Click on the words "Good Morning":-

                                                           Good Morning

Right now, I'm off to bed. Got an early start tomorrow....

Monday, 4 April 2016

Let's Taste the Spice of Life

As I approach the landmark age of sixty, I very much hope that I am NOT becoming a grumpy old man. Old, yes, but not grumpy. I happen to believe that for those of us fortunate enough to live in a liberal Western democracy, the world is a better place than it was when I was born. Indeed I believe our society is, by and large, a more tolerant, fairer, kinder one than it was, say, 50 or 100 years ago. Music was great in the 50's, 60's, 70's, 80's and 90's, but there's still some great stuff being written and performed. The worlds of theatre, cinema, sport, culture and business are more vibrant and innovative than at any time in my life and well before. And mainstream television, whose demise is often predicted, seems to me to be in rude health, not least in the area of drama, in which we have been treated in recent years to a string of productions of the highest quality in both lightweight escapism such as Downton Abbey, hard-hitting hyper-reality like Happy Valley, or Call the Midwife, which manages to be both escapist and hard-hitting at the same time.

So I don't believe in the "good old days", nor do I think that we are in an inexorable slide towards a new dark age. Of course the world can still be a frighteningly nasty place, and mankind's capacity for evil remains depressingly apparent. But that should not blind us to what virtue there is, nor to the fact that the younger generation gives me every reason to believe that the future is in safe hands. I don't think young people are feckless, lazy and degenerate; I find them to be engaging, hard-working, good-humoured and respectful of their elders. Yes, I know I am lucky enough to teach in a very good independent school, but I also know many wonderful young people from all sorts of schools and backgrounds (it would be remiss of me not to mention here my many young friends from the online diabetic community) So you won't, I hope, find me ranting and raving about falling standards, bad manners, popular culture and whatever else some older people seem to almost delight in moaning about as they grow older.

I do, however, have one overall regret about the world in which I must grow old: it's the way in which we seem to be losing variety and contrast from so many areas of life. So perhaps readers will permit me to be, well, just a little grumpy, about what can be termed the homogenisation of modern life.

"What on earth do you mean?", I hear you ask. "I thought homogenisation was a chemical process, most commonly applied to milk". Well yes, it is, but if homogenising means making everything more consistent, removing contrast, eliminating light and shade both literally and metaphorically, then our world is a lot more homogenous than it was even twenty or thirty years ago. And I feel it is somewhat diminished as a result.

I started thinking about this post earlier today - Sunday - when I was walking to church. I am lucky to live in a small market town with a flourishing Parish church, whose peel of bells can be heard throughout the town on a Sunday morning as it has been for generations. I posted a short clip of the peeling bells on Twitter which quickly attracted a few likes, some of which were from people whom I know to be atheists, which intrigued and heartened me. Perhaps I was on to something. At least until mid-morning here in Kirkham, it sounds and therefore feels like Sunday, and perhaps more people appreciate this than I had thought.

In many ways it is perhaps the seven days of our week which give the best example of what I mean by homogenisation. I am not a big fan of 24/7 and 7/7 living, in that I like day and night to feel different, Saturday to feel like Saturday and Sunday to feel like Sunday. Go into any town centre on a Sunday these days, and it looks and feels no different from any other day. I prefer my Sunday to feel like the proverbial day of rest. For me personally that means church, Sunday roast and a general chill-out. I know that not many people these days want to go to church, but even a secular Sunday should feel different - maybe a walk, some quality time with family or friends, catching up on reading or even TV. But not just another hectic day. Sunday needs church bells ringing out across an otherwise quiet town or it doesn't sound right. And for me it also needs the Songs of Praise or Antiques Roadshow theme music and the smell of a roast dinner. I dislike Sunday opening of shops, not for religious reasons, but because I belive we all deserve and indeed need a "day of rest", or in modern parlance, a chill-out day.

I feel the same about Saturdays. They too should feel like Saturday: leisure activities, hobbies, shopping, DIY, sports - watching or playing - with "Out of the Blue", the theme to Sports Report at the end of the afternoon and Match of the Day in the evening. I'd rather not have a hospital appointment on a Saturday, so I don't see why doctors should be bullied into doing non-emergency work at weekends in the name of a "Seven day NHS"

Days are like seasons. We appreciate them more if they feel different. We need the cold and darkness of winter to help us appreciate the warmth and light of summer. I would hate to live in a climate where there were no clearly defined seasons. I love contrast.

I suspect that many readers will agree with me so far, but I actually feel that homogenisation has pervaded all areas of how we live our lives in a rather more insidious way. I am saddened, for example, by the way we are forgetting that different activities and occasions require different styles of dressing, behaving and speaking. Taking dress as an example, I very much prefer to dress, and see others dressed, in a style which reflects who we are and what we are doing. I want politicians, doctors, solicitors, teachers and the like to be dressed formally so that they look professional and important, and I don't particularly want them to be informal, crack jokes and I certainly don't want them to feel the need to sound "down with the kids". It's perfectly possible to be approachable, sensitive and empathetic whilst smartly dressed and well spoken.

Likewise, I cringe when I go to a church that feels and sounds like a shopping centre and vicars feel compelled to be jokey and informal, beginning the service with "Good Morning Everyone" rather than "The Lord be with You", using dumbed down, modernised wording in hymns and prayers in an attempt to make them more relevant, and generally making the language and practice of religion indistinguishable from that of the secular world. For me, religion is a serious and solomn, but joyful, business which should feel different from the rest of our lives, albeit in a manner which makes us want to live it out in our everyday lives. That's why I love Choral Evensong. It's about contrast again: I want church to be different from day-to-day life, not just an extension of it.

Another example of homogenisation is in our use of language. As I said earlier, I don't agree with those who moan about "falling standards" of English, and who can't distinguish between change and decline, but I do think we are in danger of losing the ability to disntinguish between different registers of language. We write (or rather type) so much more than we used to, by texting, tweeting, facebooking, blogging and emailing, that we now write in the same way that we speak. I'm doing so right now in this blog post. Again, nothing wrong with that, but we still need to retain and cultivate a more formal, precise and correct form of spoken and written language in many situations. I worry when people think it's alright to start formal emails with "Hello" or even "Hi", where clearly a more formal "Dear...." is required. And again, I see nothing wrong with more sophisticated, even intimidating language in areas such as the law, medicine and business. Serious things need serious language.

So there it is. My fit of grumpiness, or as I prefer to call it, regret. I'd actually prefer to conclude on a more positive note. Rather than moaning about homogenisation, let's say that I appreciate contrast and variety. It's central to my view of life, my personality and tastes. I love punk rock as much as gregorian chant. I love rain lashing on my window as much as warm summer sunshine. I love serious conversation as well as slapstick comedy. I love baked beans on toast as well as fine cuisine. I am as much uplifted and exhilarated by being in a gothic cathedral as I am by being in a football crowd. I love being in crowded city streets as much as country lanes. You can't appreciate light without darkness, peace without noise, summer without winter. Let's cherish and celebrate difference and variety. Variety is the spice of life, so as Manhatten Transfer once said, Let's Taste the Spice of Life

Patience.....or patients?

It's an old joke, based like many on the rich supply of homophones in the English language: “You need patience to be a doctor” 😂😂...