It’s been a
while since I posted anything about diabetes; there’s been a veritable pandemic
of words and opinions throughout the Coronavirus emergency, and I have many
times in recent months turned off the TV, closed or muted a person or a conversation
on Twitter or just cut short a real life conversation because I am so exasperated by a
surfeit of half-baked opinion. I am,
therefore, cautious to write and post anything, let alone anything medical, but
if you’ll bear with me on this one, it will get to diabetes and has no direct
relevance to COVID-19.
The train of
thought leading to this post started with one of the many really bad flare-ups
of hay fever which I have experienced this year. Apparently, like nearly
everything, the exceptionally bad hay fever experienced by many of us in 2020
can be traced back to COVID-19, in that the (very welcome) lowering of
pollution, caused by the lack of road traffic, caused by the lockdown, caused
by the COVID-19 pandemic, has allowed the pollen to run riot in the less
polluted atmosphere. Such is the chaos theory in practice that we have all
experienced this year.
 |
| Sodium Cromoglicate eye drops |
This made me
take to Dr Google: do eye drops enter the bloodstream and therefore act on
symptoms other than the eyes themselves? I was aware, from all the COVID-19 “don’t
touch your face” talk, that the eyes are a potential entry route for infections,
so perhaps I shouldn’t have been surprised to find, quite readily, that the
eyes are indeed a route into the bloodstream:
“When you put drops in your eye, the drops can become
“pumped” into the tear system if you blink. Once in contact with the vascular
nasal mucosa, relatively rapid absorption of drugs into the bloodstream can
occur. The drops can act as a systemic “bolus”
- an infusion of the drug into the bloodstream.”[1]
There you are
- I said I’d get to diabetes! The word “bolus” jumped out of that sentence from
a medical website, and - perhaps like many not medically qualified people - I was
surprised to see it, apparently in a new context. “Bolus” is a word all too familiar
to those of us whose lives are sustained by insulin, so familiar that I had
never really thought much about any wider use of the word. However, look up the
word and you’ll find a definition such as this:
“a single, relatively large, quantity of a substance,
usually one intended for therapeutic use, such as a bolus dose of a drug
injected intravenously.”
So it’s not
just we people with diabetes who bolus! I hope that other non-HCP readers will react in
the same way, otherwise this blog post is an embarrassing confession of ignorance.
Being a linguist
by trade, my reaction to having a word brought to my attention is to think about
and research its etymology. So again, I turned to the internet to discover that
the word bolus is, as expected, of Greek via Latin origin and originally meant a clod or lump of earth. Some sources
suggest a connection to the English word ball,
but that is far from clear.
So there you
have it: that familiar word bolus is so called because we are injecting
or pumping a “lump” of insulin into our bodies. It gets even better if you
know the etymology of the word “dose”, because that word actually comes from
the Greek word for “gift”. I love the idea - especially as it was gifted, not
monetised, by Banting et al - that we inject a gifted clod of insulin!
So what about
bolusing? Well for me, it is one of the arts of diabetes management at which I
have become increasingly skilled, but at which I am still a long way from being
proficient, and never will be. I, along with the vast majority of people with Type One diabetes, rely
on injection pens for the administration of insulin (I am miles away from
fulfilling any criteria for a pump), so bolusing remains for me a relatively
unsophisticated - dare I say hit and miss - process of trying to whack the mole,
ideally before the mole pops up. (...now where did that “whack-a-mole" analogy
come from??)
I make no
claim to being an expert in diabetes; quite the reverse, in fact, compared to
many whom I have come to know through the online diabetes community, but I have
certainly become more confident in the art of effective bolusing in recent years.
For me, two aspects
of bolusing stand out.
Firstly, the timing of bolus injections of fast-acting insulin prior to
eating: I was taught at diagnosis, nearly 23 years ago, that the injection of
fast-acting should be just before eating (“wait until the food is on the table”)
and for years I feared some kind of humiliating loss of sense and dignity if my food was
delayed for more than a few minutes. However, in recent years, I have realised that
for me, a bolus dose is most effective if taken well in advance - sometimes up
to an hour, especially at breakfast time.
Secondly, correction doses: I used to be very
cautious about injecting between meals, but these days, I willingly inject in
response to a rising level, or ahead of a snack-attack. The result of this is
that I almost always have more than the theoretical three doses of fast-acting
a day.
I will add
two very important caveats to this. Firstly that freedom to bolus with such relative recklessness is dependent on always wearing some form of
CGM, which for me is the NHS funded Freestyle Libre. I have said it many times, but the ability to know more than just a snapshot BG value, but rather a clear indication of direction of travel, is life-changing. Secondly, that I am
fortunate enough to be retired and therefore more in control of my time and
activities than someone in a busy working life. When I was working, there wasn’t
time to pre-bolus or correct, nor was the timing or nature of my midday meal in
any way predictable.
I am well
aware that my mastery of bolusing will never be perfect, and indeed that it
could be far better with the help of an insulin pump and associated looping
technology, but I am nevertheless grateful to the incremental improvement of
knowledge gained through the online diabetes community, a
better-late-than-never DAFNE course and of course the advice of HCPs.
And having
discovered the etymology of bolus, I am most grateful that I am able to indulge
in bit of constructive mud-slinging – throwing
a little bit more insulin into my body. There’s the customary song title for my post, a memory
for those old enough to remember it, from that long, hot summer of 1976.
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