Everybody Wants to be a Cat - or maybe not

Everybody wants to be a Cat - a Disney favourite from The Aristocats, loved by successive generations, and rightly so. A great song, a classic animated sequence, but is it true? Does everybody want to be a cat? Of course not, but it works well as a title for some thoughts on how those of us with a hidden medical condition portray it, both in the real world and online.

It is often said that cats are good - too good perhaps - at hiding their symptoms. It’s a survival strategy for a solitary species, as opposed to those who live in groups, herds, packs or other groupings. To show weakness is to encourage predators, such that the cat that walks alone prefers to keep its troubles, pains and discomforts private - a poorly cat will often be found hiding somewhere as if hoping nobody will notice. However, those species which live in groups may make more of a fuss, perhaps even looking for sympathy with the proverbial hangdog expression. We human beings, of course, have a choice, and according to our personality type, we may react to illness or disability by quietly withdrawing from interactions with others, or by making it something about which we are loud and proud, a dominant or even defining part of our persona.

So it is with diabetes, and with the growth of social media-based communities such as #GBDoc, a more visible divide has become apparent between those who portray their diabetes as a defining part of their identity, and in many cases a burden to be borne; and on the other side those who portray it as a nuisance alongside many other nuisances in life, but not something which they will allow to dominate their thoughts, words and deeds.

Social media has brought these contrasting attitudes into clearer focus. Some accounts of people living with diabetes flaunt their condition with pride and defiance, detailing their every success or failure, sometimes railing against the curse of T1D, and maybe raging against society's ignorance, or health care professionals' insensitive ignorance. On Twitter, these people are often those who choose a user name featuring a reference to diabetes and have a profile picture or bio that leaves nobody in any doubt that T1D is a big deal for them.

Other social media accounts of people living with diabetes carry little or no clue to their owner's medical condition. The giveaway is often just whom they follow or friend, or maybe just a passing reference in their bio. Their feed may well be about anything but diabetes, or just an occasional reference to it. Their Twitter name is less likely to reference diabetes.

To pursue the animal analogy, the former group are the diabetes pack animals, and are likely to talk frequently about their diabetes, both in real life and online, whereas the latter group are the solitary creatures, the cats if you like, who prefer to keep their condition private and who consequently seldom draw attention to it. Like most divisions, it’s not binary, and most of us have a nuanced attitude, sometimes wanting the world to know that we live with this damn thing and sometimes wanting nobody to know.  And above all, there are no rights and wrongs - just differences. However, my sense is that nearly all people living with diabetes of any type tend towards one type or the other. So which am I? A cat or a dog?

Well I am very much a cat. No surprise there, given my lifelong love of cats, so this post is about being a cat - hiding an already hidden condition.

Today is my diaversary. It was at 5pm on this day in 1997 that I went to see my GP, alarmed by a sudden recurrence of symptoms after I'd recovered from a week in bed with ‘flu. She had asked me to bring a urine sample and I can still picture her concerned and somewhat puzzled face as she told me that it revealed very high sugar levels, and probably diabetes.

I've told the story many times: it actually took several weeks for me to be diagnosed as Type One; back in 1997 it was still widely believed that Type One very rarely came on in adults: we now know very much otherwise.

Twenty Five years. A quarter century. One third of the average male lifetime. Most significantly for me, more than half of my adult life. So it's a day for much reflection, and indeed a blog post. There's much to think over, and whilst in many ways that dark and chilly December evening when I was told that life-changing news remains very clear in my mind, in other ways it seems like a very different life in a very different world.

Over those twenty five years, my attitude to diabetes has varied, and in particular the level of noise that I make about it, has varied due to circumstances as much as anything, but overall I have always tended towards saying less rather than more. As mentioned above, in diabetes as in all else, I want to be a cat.

Over the first 16 years or so, through very much the peak of my working career, diabetes was firmly in the background of my life, my concerns and my interactions with others. My diagnosis came at the end of a week off work confined to bed with ‘flu, but that was the last day off for sickness between then (1997) and my retirement 20 years later. (Other than routine appointments). So living with Type 1 had no impact whatsoever on my working life, indeed less than four months after diagnosis I was leading a group of 45 teenaged schoolchildren on a week-long school trip to France, as I had done for years before and continued to do for years afterwards. I remained the same busy person that I had been before T1D came to join me on my journey through life, and I often reacted with wry amusement rather than boiling anger as I watched others - notably work colleagues - moan about how busy and tired they were, or how much they were struggling with whatever short-lived ailment was troubling them. Very occasionally, I would drop the T1D bomb into a conversation or situation, as for example when a colleague was planning a day of interviews in which I was involved, and he said to me “It’s going to be a full-on day, with no time for eating” When I gently suggested that I would have an issue with that, he sheepishly remembered and re-jigged the schedule a little.

Outside work and home life, I also avoided diabetes and anything other than strictly necessary talking about it. I joined the British Diabetic Association on diagnosis (sounds so archaic now, but that’s what Diabetes UK was still called back then), and then ignored a series of letter invitations to local group meetings, not least because the subjects of their meetings were always about low-carb eating and getting more exercise, a clear sign that this was predominantly if not exclusively frequented by people living with Type 2.

However, the world of diabetes care and management was on the threshold of very significant change at the time of my diagnosis, and has come a long, long way in those years - as those whose lives with Type 1 predate mine will readily attest. Whilst by 1997 we had already reached the era of disposable pens and needles and electronic blood glucose meters, we were still two decades from the near universal availability of non-invasive glucose monitoring, and indeed the rapid advance in the availability and use of lightweight insulin pumps and closed loop technology. Yet the Rise of the Machines was already under way by the time I joined the ranks of the pancreatically challenged, and although I am not among those who are desperate to have the benefits of an insulin pump rather than MDI, I have from the very start been convinced that the quantum leap has been the ability to measure blood glucose levels without finger pricking: I was one of the earliest adopters of FreeStyle Libre back in 2015, and with Libre 2 now the norm, I am free from the fear of unforeseen hypos which was a genuine worry for me for the first 20 years or so. I was fortunate enough recently to be given a two week trial of Libre 3*, and whilst I remain unconvinced of whether I need or want a full CGM to remind me every minute of every day what my levels are, I can well see that this latest version is a state of the art which will be welcome by many and will sooner or later end up as the norm.

Equally striking when comparing 1997 and 2022 is the impact of the revolutionary advances in connectivity brought about by the internet. The birth of the World Wide Web is rightly quoted as 1992, but it was not until the late 90s that the internet started to reach ordinary homes on a large scale. We got our first internet connected PC in early 1998, but at first the internet was really just a giant online library. Emails were there from the start, but they were really just instant letters. The notion of real-time “conversations” with friends and family across the world would have seemed fanciful, and for me, any sense that ICT and the web would be of any significant connection to my new condition would have seemed very odd.

Yet for me, like many others, it was online connectivity that brought me out of my diabetes closet and connected me for the first time with fellow Type Ones. It’s a story that I have shared before, for example here and I have no hesitation in saying that connecting with others living with Type 1 was a life-changing move, which has brought me connection with 100s, friendship with dozens and a close and lasting bond with a few.

And yes, online diabetes connections and friendships are all about the sharing, and therefore only really of any value if those involved are prepared to talk about their condition, at least in some small way. From around 2013 onwards, I did indeed start talking about diabetes with others, and as a result became aware of the rapid advances in diabetes care and technology that were at that time starting to proliferate.

And yet……

I remain a cat. I remain a man of relatively few words in any setting, real world or online, and especially in the context of diabetes. My regular social media feeds only occasionally feature diabetes content, and my Facebook is a largely diabetes-free space. I sometimes think I should be more vocal, more of an “awareness raiser” or even a so-called advocate, but my heart just isn’t in it. Others clearly feel more strongly about it, and have more to say, whereas for me, the core of my relationship with this lifelong condition is that it is a nuisance, rather than a burden, that I will not allow to take over my life. To rant and rave about it seems to me to be a largely futile exercise, in which I would either be preaching to the converted or risk becoming a bore.

I am enormously grateful to and hugely respectful of those who define their persona so much by diabetes. In so doing, they are being generous and beneficial to others: we would not be nearly so far down the road to accessible diabetes technology for all according to their needs and wishes, nor would we have anything near the levels of camaraderie and peer support that we enjoy, without the efforts of those for whom diabetes is a big deal.

I certainly have no wish or intention to shy away from the diabetes community, indeed I interact with others living with Type 1 every day, and my best friend is a fellow Type 1. Yet outside the world of the diabetes community, I seldom if ever remind others of what I live with. Sometimes to my cost.

So when it comes to sharing my condition, I am a cat, whilst gladly accepting that not everybody wants to be a cat. I conclude this “Silver Diaversary” piece with a sincere thank you to all the individuals and organisations whom I have encountered as a result of that life-changing diagnosis twenty five years ago: healthcare professionals, diabetes charities, medical tech companies and above all diabuddies. I may be a cat, but as all cat lovers know, our feline friends do actually crave and appreciate company and attention. They're sometimes just too stubborn to admit it....

Illustrations? Well it had to be a throwback to the days when "#OfGBDoc" was a thing. This was a collage of cats belonging to GBDdoc folk which I made back in 2017/18. 

I am aware that some of those kitties are no longer with us, so I hope that the memories are warm and not too sad.

*  #ad #sponsored: I was given a FreeStyle Libre 3 sensor free of charge for evaluation purposes. The opinions in this post are my own and were not influenced or reviewed by Abbott.

Always on My Mind: the relentless reality of life with T1D

It’s coming up to my diaversary: December 19^th 1997 was the day on which I went to my GP for a hurriedly-arranged end-of-day appointment to investigate a urinary infection following a very bad dose of ‘flu, only to be told that I had very high blood sugar levels, indicative of diabetes. Within a few weeks, I was inducted into the world of injections, testing and, well, you know the rest…

It’s a story I’ve told more than once before on this blog and on social media, not least at previous diaversaries, so a simple recycling of my diagnosis story is neither appropriate nor necessary here.

However, diaversaries always stimulate reflection, and over the months of reduced activity and increased thinking time brought on by the pandemic, I am increasingly drawn towards the far-from-original narrative that the worst thing about Type One Diabetes is the sheer permanence and omnipresence of it. For me, that means towards a quarter century - over one third of my entire life and over half of my adult life - now lived with the seldom severe, yet ever-present burden of the condition. Just because we don’t look unwell, and just because (in most cases) we don’t constantly go on about it, doesn’t mean that we are fine with it. I still occasionally come across people who think I have “got better” from my unfortunate illness back in 1997.

My T1D Footprint from JDRF

My thoughts on this aspect have been brought on in part by a growing sense of disappointment with the latest portrayal of diabetes in the media. Six months ago a character in the TV soap Coronation Street, 17-year-old Summer Spellman, played by Harriet Bibby was diagnosed with Type One in a story which gained much attention on diabetes social media, and which seemed at the time to be commendably well-researched by the scriptwriters and producers of the long-running soap. Much was made of the fact that the writers and actors had spoken with diabetes charities, medical experts and most importantly people living with Type One to ensure that the diagnosis story was told in a realistic and relatable manner. So far, so good, and well done to Harriet for representing the condition so well - the picture below captures what will be a familiar memory for many readers.

Summer Spellman in hospital after her diagnosis,
June 2021

As a longstanding Corrie fan, I was pleased to see that the scriptwriters had chosen to use diabetes as a storyline. However, whenever diabetes rears its head in this way, I always sense that the reality of living with T1D, and therefore of portraying it in a TV drama, is actually not interesting or dramatic enough in the longer term. The result is that scriptwriters either forget the story altogether, or use it as the basis for something more exciting, but frankly unlikely. Such is TV drama.

Summer is not the first Corrie character to develop T1D, and a previous storyline illustrates the above point rather well: back in 2003, another young woman in the soap, Katy Harris, was also diagnosed with Type One, and like many TV scriptwriters, the then Corrie team saw in our lifelong and potentially fatal condition the potential for good dramatic material, rather than simply demonstrating what thousands of ordinary people live with. Soon after her diagnosis, Katy embarked on an affair with her neighbour Martin Platt, a nurse 20 years her senior who was helping her come to terms with the burden of her condition, but took this help rather too far. As inevitably happens in soaps (where conception seems remarkably easy) she immediately became pregnant and in the mess that ensued she ended up killing her own father and then herself. As you do.

Corrie's previous T1D character, Katy Harris,
with her ill-advised love-interest, nurse Martin Platt

At the time of writing, I am increasingly fearful that Summer’s story is heading for melodrama rather than a less dramatic portrayal of the reality of life with Type One which might be more helpful in raising awareness, but wouldn’t generate viewing figures. Summer’s onset and diagnosis were accurately portrayed, and credit should go to the scriptwriters and to the actors involved for keeping it pretty real. However, at the time of writing (early December 2021), Summer has become the centre of a story about an alleged inappropriate relationship with her neighbour and English teacher Daniel Osbourne, with diabetes reduced to a bit part in the story (Mr Osbourne’s giving her an “energy bar” when her blood sugar was low being used as part of the evidence against him). An unfortunate echo of the Katy storyline, and certainly a distraction from any awareness-raising about diabetes.

Summer with her alleged ill-advised love-interest,
teacher Daniel Osbourne

I shall be interested to see where this one goes: there have been passing hints that Summer is having some concerns over apparent (to her) weight gain, which leaves the door open for a diabulimia storyline, so that may yet be part of the story, and would be a good line to pursue in many ways, given that diabulimia is a hidden and overlooked aspect of the condition, very much known to me because of the battles faced by a good friend of mine who lives with it.

However, what has again been overlooked is the opportunity to portray the often dull omnipresence of diabetes in our lives. I am very much at peace with my diabetes, but if anything ever threatens to drag me down, it is this relentlessness. Most of us, most of the time are not visibly unwell, nor apparently burdened. Yet we are burdened, and if we don’t respond to and deal with that burden every single day, we would very quickly become unwell and, well, die. Diabetes is, as the song says, Always on My Mind (there you go, that’s the title sorted!), and that’s a very difficult reality to portray to others without becoming a bore. It’s not dramatic, it’s seldom tragic, but it’s always there. The first and last thing that I have done every single day since Christmas 1997 is to check my blood sugar level, and in between times, every action, every event, every plan, is made with reference to its potential impact upon my BG level. And as I so often point out, the irony is that it’s the miracle drug to which we owe our survival - insulin - that presents the day-to-day threat to our wellbeing. That’s a very odd thing to have to live with. We don’t monitor and react to the condition as such, we monitor and react to the effects of the drug used to treat the condition. And the administration and monitoring of that miracle drug is entirely in our own hands, day in day out.

If Summer Spellman’s diabetes in 2021 was being accurately portrayed, she would have at least one device visibly attached to her body, she would be seen frequently checking a phone or reader, and either fiddling with a pump or administering an injection in a potentially undignified manner before every meal. She would also quite often be mildly unwell, possibly a little confused, and would need to sit down somewhere and eat jelly babies or similar. To describe all this in writing makes it sound more intrusive than it actually is, but it is the truth. As the Diabetes UK campaign says, diabetes is relentless.

This post is perhaps untypically negative for me, and I am not given to self-pity, so I must conclude on a positive note. I am fortunate, very fortunate: I am fortunate that I live in 2021, not 1921 or any earlier; I am fortunate that I live in a prosperous western country with a publicly funded healthcare system; I am fortunate that I did not endure diabetes as a child or adolescent, when it would have impacted far more upon what I wanted to do; I am fortunate that I am male, and therefore not burdened with the additional impact of monthly hormonal variations on blood sugar, nor the body image issues faced more by women than men; I am fortunate that the relentless march of diabetes technology is reducing the burden, notably of finger prick testing; and above all I am fortunate that I enjoy the support and friendship of the many people from the diabetes community whom I have met and worked with in recent years, both fellow patients and healthcare professionals.

So I’m doing fine with it, and to continue to do so well into old age is my realistic and achievable aim. But yes, diabetes is Always on My Mind, whether it shows or not.

There's always a good song title for any post, and with this one there are two standout versions to share: either the peerless Elvis from 1973 or the wonderful electro-pop reworking by the Pet Shop Boys which famously prevented Fairy Tale of New York from getting the Christmas Number One spot back in 1987. A great song, with two very different interpretations. Click on those links to enjoy either or both versions on Spotify.

Happy Diaversary to me when it comes, and Happy Christmas to everyone.

High: 21st Diaversary Musings

21 years ago today, feeling exhausted and battered from all sides after an unprecedented week off work in my sick bed with real ‘flu, I made an emergency appointment with my GP, alarmed by what appeared to be a sudden recurrence of my first bout of “proper” illness since childhood.

It was a dark, wet and windy evening, and I was far from full of festive cheer on that last Friday before Christmas as I sat in a deserted waiting room at the end of the day. A urine sample test revealed sky high blood sugar and the startling revelation that I was displaying the classic symptoms of diabetes.

The full story has been told before, here.

So my diabetes is “21 today” 😊

My "diaversary" always gives me a cause for some reflection, and these days, with a little more time to spare in retirement, I hope that those who know me as part of the online diabetes community will forgive me for the indulgence of sharing them publicly.

Here I am, 21 years on, having lived a third of my life, or half of my adult life, with an incurable, 24/7 medical condition which requires constant treatment and monitoring combined with an awareness of the effects and risks of activities as basic as eating, drinking, sleeping, moving or not moving.

Sounds pretty grim, doesn’t it?

But I’m an incurable optimist, a believer in silver linings, and whilst I don’t seriously believe that “everything happens for a reason”, I do believe that we all have the power to turn negatives into positives.

So 21 years on, I can also reflect on the fact that I have in recent years acquired activities, contacts, acquaintances and friends from within the community of people with diabetes, their families, and the healthcare professionals and medical companies who help to care for them. My life has been greatly enriched by them and I find it very hard to imagine what my life would be like without the diabetes community.

And I recently came upon some proof of this: a recent printout from my GP of my HbA1c level over the past five years revealed that the two most striking improvements in my level had occurred as a result of my starting to use flash glucose monitoring in early 2015 (no surprise there) and my starting to interact with the world of diabetes online in 2013. 

My HbA1c, 2013 -2018

Coincidence? Possible, but unlikely.

I think it is highly credible that I became significantly “better” at walking the tightrope of life with diabetes once I started to associate with others who do so, or who help others to do so. The knowledge that there are others out there who “get it”, who understand the frustrations and the triumphs, is of immense benefit, and I very much hope that in receiving that benefit, I have also contributed to it in my own small way.

So thank you to all out there in the #GBDoc and well beyond it: I wish I’d known you were all out there back in December 1997, but then again, many of you didn’t even have diabetes then. Indeed one who has become one of my best friends from the community was celebrating her first birthday on that auspicious date, and was herself still eleven years from developing the condition. Such is the fickle nature of diabetes, yet it gives a strong and lasting bond, borne of a very difficult adversity which in a very strange way makes me feel blessed. Blessed, at least, to have acquired diabetes in the modern world, not that of less than 100 years ago, when it was, in effect, a death sentence. Thank you, Prof Banting!

Faces of GBDoc

Of course, all my posts require an appropriate song as their title, so for this one I've landed on a song that is exactly the age of my diabetes, and which for me evokes memories of some dark days in January 1998 as I adjusted to a life of injections, testing and clinic visits: High by the Lighthouse Family not only gives a nod to my blood sugar level in late 1997, but also has a wonderful sense of optimism, a sense that better days lie ahead. As they did for me on that dark Friday in 1997.

"When you're close to tears remember
Someday it'll all be over
One day we're gonna get so high

Though it's darker than December

What's ahead is a different colour

One day we're gonna get so high"

Listen to the whole song here:

My best wishes for Christmas, 2019 and well beyond, to all those whom I now know as an indirect result of that fateful GP visit back in 1997.

I'll be There for You

2017 has certainly been a significant year for me. Full retirement and a house move are pretty big events, so the year hasn’t exactly been quiet. Indeed I feel well and truly shaken out of any sense of drift or complacency, and grateful that I’ve been able to make these significant changes in my life at a time of my choosing, and with enough physical and mental energy to embrace them as new challenges rather than feeling “put out to grass”. I am certainly not daunted by having turned 60 - I have a nice sense of entering a new phase of life.

I never planned it this way, but I have to say that my relatively recent discovery of the online diabetes community has been a tremendous help in enabling me to feel re-invigorated and re-energised at this time of my life. I thought it appropriate to post some thoughts on this informal peer support community to mark a notable milestone in my life with Type One diabetes.

It’s twenty years on December 19th since I was diagnosed with the condition (an incorrect diagnosis of Type Two in the first instance - I've told that story here), shortly after the landmark birthday of 40 years. Of course that has to go down as a big negative in my life: developing an incurable, life-changing and potentially life-threatening medical condition at around the halfway point of a typical lifespan is not what anyone would choose for a happy and contented life.

Yet when I think about what I have done this past year alone, it is hard to avoid thinking that my life might now be rather dull without diabetes. I know that there are people out there who resent positivity about diabetes, so let me apologise to them, acknowledge how lucky I am to be able to live well with the condition, and ask that we accept that everyone has their own way of dealing with what happens to them. My own approach is, and always has been, to look for silver linings. And getting to know so many others who have, or live with people who have, diabetes has certainly been a silver lining for me. Some of the greetings I received from diabuddies via Twitter on my 60th birthday were wonderful, so thank you - you know who you are.

In 2017, diabetes has given me opportunities and experiences which have filled the potential void caused by retirement from a busy people-centred job: speaking engagements at #TADtalk2017, at the FreeStyle Libre factory, at the All-Party Parliamentary Group at Westminster and live on Breakfast TV would all have seemed like bizarre dreams a few years ago. And then there’s the real-world meet-ups: this year alone, I have spent lovely times in groups large or small in Oxford, Manchester, Amsterdam, Witney, Bakewell, London and Birmingham with friends from all over the UK and beyond, who were in all cases complete strangers until very recently. And most days I spend time on Twitter in conversation, sometimes serious, sometimes frivolous, with others all over world whose only connection with me is a shared medical condition. My horizons have expanded immeasurably thanks to an annoying and sometimes dangerous medical condition.

Yet it hasn’t been all sweetness and light. Wherever two or three gather together, they will disagree about something, and the diabetes community is no exception to that. It’s human nature, after all. The online community hasn’t been the happiest of places at times this year, and I have found myself the subject of some hostility, in particular over two issues:

Firstly, it became apparent in July that there was significant controversy and lack of confidence surrounding the so-called GBDOC and its founder and hitherto de facto leader. With trust in the brand and its weekly tweetchats severely eroded, I found myself as one of a well-meaning group of people who attempted to guide the community into a more collective and inclusive ownership, rather than being a mouthpiece for one individual. Although our moves were widely accepted, appreciated and recognised they nevertheless caused a degree of resentment in some quarters and unwarranted accusations of a “takeover”. 

Those who felt so threatened by this appeared not to acknowledge that nothing happens in a group large or small without someone taking the initiative, and that taking the initiative does not necessarily imply power grabbing or ego tripping. I hope that the continued existence of a warmly supportive GBDOC community and of weekly tweetchats under the community account @GBdocTChost led by volunteer hosts serves as powerful reassurance to those who feared a takeover. I would like publicly to thank in particular @Jules1315 @type1bri and  @Type1Adventures for their work in ensuring that this happened and continues to happen. Public-spirited, generous-minded and supportive individuals every one of them.

Then secondly came another source of controversy sparked by the decision in September by the NHS to add FreeStyle Libre sensors to the approved tariff for free availability on prescription. Although this development was the result of many months of hard work by groups and individuals, notably our very own NHS Sugar Doc @parthaskar, I was inevitably associated with the decision given my longstanding public endorsement of the Libre, my consequent attendance at events run by its manufacturers Abbott, my speaking to a parliamentary committee about it and my TV appearance on the day of the announcement. Understandably, I again felt the resentment of those unhappy with the decision, and even found myself and others accused, laughably, of “taking payment in little brown envelopes” from the manufacturers.

With some folks fearing that availability of the Libre on prescription would lead to reduced availability of CGM and other diabetes technology, or criticising the fact that Abbott have a monopoly on flash glucose monitoring, or unhappy that NHS availability was leading to delays in supplies for those still self-funding, and valid concerns arising with the use-by dates on sensors, it seemed for a while as if the funded availability of a new device which had been so very helpful to so many, including me, was the work of the Devil himself. And as so often in life, the quietly contented were drowned out by the noisily disgruntled, which must have been disheartening for those who had worked so hard to make it happen. The Libre, like insulin pumps, like CGM, is not for everyone, but at least we are moving towards a situation whereby it should be available to all, regardless of ability to pay. Had social media been around at the time, I am quite sure that some might have been equally angry about the first insulin pens, pumps and meters. Change of any kind is seldom universally welcomed.

Again, however, as time has passed and things settled down, more positive voices have come to the fore, and we reach the year’s end with the online diabetes community very much alive and well. My hope for 2018 and my next 20 years of living with diabetes is that people will come to accept that differences of opinion, factions and groupings are an inevitable part of any group of people. The wonderful thing about the GBDOC is that the very randomness of diabetes produces an online community which is by definition random (albeit including only those who use social media). So it would be a pretty odd, and frankly dull place if we all agreed about everything.

Other groups of which I am part consist of very differing people, some of whom I like a lot, some of whom I am indifferent to, and some of whom I disagree with. But that doesn’t mean I necessarily want or need to criticise those with whom I don't get on; indeed I have massive respect for those whose opinion differs from mine on all sorts of issues. In the real world, I just sit in a different part of the room from those with whom I differ significantly, and the GBDOC rightly consists of people who sit in different corners of the virtual room. I tend to “sit” with those who actually don't talk about diabetes that much. I just like having friends who “get it”, and I enjoy talking to them about other areas of mutual interest, with the comforting feeling that I am hanging out with folk who have such a big thing in common with me. It is a joy to me to share cat pictures or things like this year's #BaublesOfGBDoc with a group.

But we all use #gbdoc in different ways and rightly so: some talk enthusiastically on social media about pumps, ratios, doses, CGMs, closed loop systems etc, and I admire them for it and enjoy their enthusiasm and expertise.  But it’s not for me. Others use social media as an outlet for their woes and frustrations, and whilst I don't tend to do that, I do try to be a virtual shoulder to cry on and greatly value that opportunity. Some, including me, post images of their triumphs and I for one derive great pleasure from seeing other peoples' success. There's a word for it: confelicity. It saddens me when I read suggestions that to do this is selfish because it causes distress to others: nobody forces anyone to be on social media, and there’s always a mute button if others’ way of saying and doing things causes stress or offence.

When push comes to shove, we are all on the same side and it is a constant pleasure to me to see such a diverse group of people being a real source of company, friendship and support to others. It’s what friends do; as the theme song says I’ll be there for you. And I for one am glad that so many others are there for each other and for me. 

Here's to the next 20 years. 

Life is a Rollercoaster: Diaversary Reflections

This is an update and re-edit of a post previously published as My Diabetes Story. Today (19-12-2016) is my diaversary, a term used by people with diabetes to "celebrate" the anniversary of the day when they discovered they were to live the rest of their lives with an incurable but manageable condition. I was diagnosed on 19th December 1997, at the age of 40, and here's the story.

Until that age, I had lived a life with minimal contact with the health service. I had a couple of standard childhood illnesses, leading to a couple of spells off school before the age of 10; I then managed an entire secondary school career without a single day's absence. I fell off my bike at the age of 13 on the first day of the summer holidays and suffered a straightforward arm fracture, which mended in the standard six-week time frame. And that was about it. Prior to my diagnosis with diabetes in 1997, I had worked for 17 years as a teacher with a total of four days off sick (two lots of two).

Moreover, I was a slim, healthy and active person: as a child I cycled to school, played football competitively and spent holidays fell-walking with my family. As an adult I cycled to work, tended an extensive garden and walked from my home to the local shops rather than driving. And I still do.

Then, as 1997 came to a close, with Robbie Williams' enduring classic Angels dominating the airwaves and the Tellytubbies bagging the Christmas No 1, I had a very bad case of 'flu in the week running up to the Christmas break at school - a week's absence for the first time ever. No real cause for alarm: there was a big epidemic and a number of colleagues were off at the same time. Then, on the last day of term, after I had started to feel better again, my condition took a nosedive, and I went to my GP, alarmed at this apparent recurrence of an illness from which I had just recovered. I felt tired, thirsty and run-down, but just thought it was a hangover from my first real illness in years and a long, hard term's work. A routine urine test revealed very high blood sugar, and an alarmed GP (parent of three children whom I taught) informed me that she was pretty sure that it was diabetes, referring me to her colleague at the practice who was the specialist in diabetes. He told me to "cut out all sugary foods" and see if the sugar level fell. This puzzled me somewhat, as I have always had a famously "unsweet tooth"- there was little or nothing to cut down on. However, I agreed to do so, and came back a few days later - just before Christmas - to discover that my sugar level was higher than ever. "OK, said the doctor, we'll put you on medication" He was assuming, from my age, that I was Type Two. Looking back, I have to say this was a questionable diagnosis in the face of all evidence - I was slim, ate healthily and exercised plenty - but again, I went along with it and took the pills for a few days (including Christmas Day). 

It was only when I reported back with an even higher blood sugar level and no sign of feeling better that he finally wondered if it might be late-onset Type One. Off to hospital I went (only as an out-patient), where a consultant agreed it certainly must be Type One, and referred me to the clinic to learn the noble arts of injection and blood testing. I did all this without missing any days off work, despite feeling very tired. My school were very good to me, and as I live near to the school, I was able to come home for a rest at lunchtime and leave early when not teaching.

Two different insulins, two pens 
- my permanent companions.

Once the insulin started to have an effect (and that effect comes on almost instantly, as anyone with Type One will tell you), I was soon back to normal. By the Easter four months after diagnosis, I led my annual residential school trip to France with about forty pupils and five colleagues. I continued to do this every year whilst it remained part of my role at the school. By the June six months after diagnosis I was planning, setting up, organising and running the end-of-exams Ball for 200 Sixth Formers, a demanding job I undertake every year. In day-to-day terms over the 19 years since, I have continued to take on all that life and work throw at me, all with an unblemished attendance record in a very stressful job. I am certainly not a burden to anyone, and other than the cost of my insulin and test strips, the annual flu jab and my annual clinic review, I don't bother the NHS at all.

But let's not pretend it's easy. Living with Type One diabetes is a 24/7 challenge that we face on top of all as that we do in life, whatever that may be. You can never forget or overlook it for more than a few minutes. Every action, every piece of food or drink, every event needs to be thought through. Any departure from routine is potentially risky. And for me, the uniquely infuriating challenge is that insulin - the treatment that you self administer every day in order to preserve your life - is precisely what threatens to bring you down in day-to-day terms. I think is fair to say we have a love-hate relationship with it!

My Diabetes drawer - all the stuff we need to keep going

And yet it could be worse. Let us not forget that. It was a lot worse until the discovery of insulin therapy by Canadian Frederick Banting in 1922, when Type One was in effect a death sentence. It is a whole lot worse in many less fortunate countries where access to insulin is still limited or non-existent.

The 400 000 of us who live with the condition in the UK have good cause to be grateful to our doctors, nurses, designers and makers of insulin delivery methods and blood testing kits who enable us to live normal, active lives. I am particularly grateful that I discovered the FreeStyle Libre, a clever monitoring device which helps me to stay one step ahead of my blood sugar levels.

And then there's the silver lining to this cloud: my fellow diabetics. People with diabetes are remarkably supportive to each other and in recent years have used the internet to create a wonderful community, known as GBDoc in the UK.

What's the collective noun for diabetics?

In one of the best illustrations there is of the good side of social media, thousands of diabetic people of all ages, both genders and all backgrounds regularly support, help and encourage each other online in a spirit of togetherness and cheerful acceptance of a condition which can at times make its victims feel frustrated and lonely

It's no fun having Type One, although it is fun being part of a worldwide community of people who are very good at making the best of a cruel stroke of luck. I certainly feel that having diabetes has enriched my life and made me a different person with a more interesting life.

With diabetes, we are reminded every minute that Life is a Rollercoaster. We've just gotta ride it.