Well, January is nearly gone, and
this is my first new blog post of 2019. It’s been a busy time for me, and it
promises to be a busy year, not least in the world of diabetes which has become
such a big part of my life in retirement.
One of the things that has
occupied some of my time and attention this month has been starting my role
with the newly re-constituted @FIT4Diabetes Board, a group of
healthcare professionals who work under that banner, supported by Medical Technology Company Becton Dickinson, to promote best practice in
technique and safety for those receiving and administering insulin injections.
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| FIT Board Members |
I was pleased, but frankly
somewhat surprised and flattered, when I was asked late in 2018 to join the FIT Board as a patient representative. I am aware that I am one of the longstanding
members of the online diabetes patient community, known directly or online to
many fellow people living with the condition; I am also aware that I have been
something of a minority voice in that community as one of those happily managing
their condition by multiple daily injections rather than an insulin pump. The very nature and
demographic of the online world gives a false impression of the ubiquity of
pump and diabetes technology use.
Moreover, I am also very aware
that I am no expert in diabetes, despite my 21 years of living well with it.
Indeed, I have often said that I’m not really very interested in diabetes, nor
do I have any great enthusiasm for clever technological solutions. I am very
interested in people, and in doing my bit to support and contribute to the
greater good, and so my participation in #GBDoc is based very much on an
interest in the people with diabetes, rather than the condition per se.
However, having attended the
first meeting of the FIT Board, I have realised that I do have something to
contribute to this group and their work. At our meeting, we started with an
illustrated presentation about best practice in injection technique: not the
most comfortable viewing when sitting there as the only patient accompanied by
three DSNs, two pharmacists and a GP! I watched with a mixture of amusement and
embarrassment as one by one, my occasional or permanent bad habits in diabetes
management were exposed:
Wash hands? X.
Change needle every time? X.
Rotate injection sites? X.
Prime the pen? X.
Wait ten seconds before
withdrawing needle? X.
Dispose of used needle
immediately in a sharps container? X.
OK, so some of these I am better with
than others, but I doubt if many longstanding PWD could in all honesty tick
every single one, every single time. My excuse? Well, it’s that life gets in
the way! We’re often told that diabetes shouldn’t stop you leading a full and
normal life, and I have certainly lived as full and as normal a life since
diagnosis as before it.
However, “normal life” is often
very busy: I think back to my hectic working days as a teacher, often in work
from 7:30am until 6pm, with literally no break. Lunch was often snatched on the go,
and dressed in a suit, with formal shirt and tie, eating in a crowded school
canteen or grabbing a sandwich during a lunchtime meeting is not conducive to good injection technique. It’s hardly easy
carefully to choose the right site, prime the pen, leave it in for 10 seconds
etc. More likely grab the pen - untuck shirt under table - jab - pen back in
pocket with top on over needle. And all that was until very recently
(with the arrival of FreeStyle Libre) preceded by a messy finger prick test!
I am also very aware that
discreet and hurried injecting is, rightly or wrongly, rather easier for a man
than a woman: a dress and tights, still commonly a staple of formal dress for women in the workplace,
gives no opportunity for easy, dignified exposure of a suitable injection site,
and it is small wonder that many women with diabetes inject through tights –
far from ideal, but a pragmatic compromise.
But does it matter?
Well, since my watching that
awkward presentation at the FIT meeting, I have to say yes. Confession time: I
have become very aware that the flabby bits above my waistline are not just a
touch of middle-aged spread, but actually a textbook example of
Lipohypertrophy, lumps under the skin caused by accumulation of fat
cells at the site of insulin injections. Not life-threatening, far from the
worst of the secondary issues which can arise from living with diabetes, but
nevertheless a very real and creeping
threat to living well on insulin injections.
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| I wonder whose tum that is?? !! |
Lipos develop because of poor site
rotation over the years, and injecting into them significantly reduces the
effectiveness of insulin, caused by irregular and incomplete absorption rates.
Since that meeting two weeks ago, I have been carefully avoiding those
over-used sites, and guess what? My insulin requirement has fallen, quite
significantly!
I genuinely think that Lipohypertrophy is the Cinderella of diabetes issues. We PWD are all so bothered about avoiding hypos, dealing with the uncomfortable highs, pursuing elusive “flat lines”, over-reacting to the TMI that many of us now get from our Libres and CGMs, that we overlook the insidious damage that we are doing to our too-easy-to-reach tummies.
And judging by the responses to a
quick Twitter poll that we did after the meeting, checking our injection sites
and advising on injection technique are a frequently missing part of our
consultations with HCPs in clinic.
Perhaps it’s time we all started
to think rather more about injection technique, site rotation, size of needles
etc. I spent the first 20 of my 21 years with diabetes using the 8mm needles
that were the norm back in 1998, blissfully unaware that current thinking among
experts is that 4mm are best for everyone, regardless of their BMI. And whilst
my eyes are screened annually, my feet jabbed at every visit, questions asked
about my “control”, my highs and lows, my erectile functioning, etc., nobody
has ever asked about, let alone examined, my (frankly rather unattractive)
midriff.
So please look out for tweets and
posts from my wonderful colleagues on @FIT4Diabetes. They have been brilliant
in not making me feel guilty about my own shortcomings in technique, but I have
to say that, thanks to them, I’m going to try very hard to Do the Right Thing.
There you go, a title for this
post - from a song, as always: a classic from the heyday of Mick Hucknall’s
Simply Red. Click on the title and enjoy a bit of 90s nostalgia, then sing it to yourself while you inject.
