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....

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