Unexplained deaths in young diabetics and other poor treatment outcomes

Here is the text of a letter to the editor I had published recently in the online section of several newspapers:

Diabetes deaths

Yet another death of a young diabetic reported in The Canberra Times ("Woman may have lived if response had been quicker", August15, p3). A Canberra hospital staff member has told me there are many poor outcomes among a group of their patients with type 1 or juvenile onset diabetes. When is the Health Minister going to respond to the systemic issues relating to diabetes care, which have been notified to him?
Dr Nick Melhuish, Hughes

Read more: http://www.theage.com.au/it-pro/experiences-of-bullying-are-not-invalidated-by-turcs-issues-20150818-gj24wg.html#ixzz3mhXcLOXs

 I am also aware of a third young Canberra diabetic who also died in similar circumstances, soon after moving away.

The ACT Health Minister still refuses to comment of the issue of poor Type 1 diabetic outcomes. And while the complication rates of surgeons are subject to intense scrutiny, and made public if they are a few standard deviations from the norm, the outcomes of treatment provided by physicians are swept under the carpet. Despite the number of poor outcomes reported to me, I believe there has never even been any audit in Australia of outcomes in people with diabetes and Addison's disease.

I have read much of the original literature on the subject of "unexplained" deaths in young diabetics, and it certainly does not support the view that these deaths are unrelated to treatment methods or lifestyle variables.

My glucometer reading was 2.3 mmol/L (41mg/dl) so I decided to play chess

My glucometer reading, correctly done, was 2.3 mmol/l so I decided to play chess. I do not recommend that you try this yourself.

A Government health website states the following
"When BGL's fall below 2.8mmol/L, brain function slows down, causing reduced concentration and response time, confusion, poor coordination, blurred vision, and can lead to unconsciousness."

That certainly used to be something like what happened to me. (apart from the blurred vision and unconsciousness parts)
However, since I started ignoring medical advice and doing my own thing I am much better off.

Last weekend, my heart was a bit faster and pounding a bit stronger than normal. Usually I would just eat straight away, but I decided to check my blood and got a reading of 2.3 (or 41mg/dl).
Instead of eating, I decided to play a game of lightning chess against Fritz with a handicap setting of 1.
Rules: touch piece, if the game takes longer than 5 minutes, or I fail to notice a check, I lose. No taking back moves.
Here is the game

Total game time was 2 minutes and 37 seconds. A pretty scrappy game, but I am no grandmaster and that is about as well as I play when my blood sugar is normal and I am making each move in a bit over 2.5 seconds average.
I checked my glucometer reading again after the game with my usual impeccable technique, and it read 2.3 again, so I ate some food, but much less than that same Govt website says one should.

Conclusion: No evidence of cerebral impairment at a glucometer reading of 2.3. How low does my blood sugar have to fall before my ability to play lightning chess is noticeably impaired? Stay tuned.

If you have diabetes, you really should learn the science behind avoiding brain fatigue when your sugar is low.

Addison's disease

I was never much of a runner at school. I never represented the school in cross country and there was only one year where I just scraped in to the track team for one event.
Yet after 18 years of T1 diabetes I now run much faster than most of the people who outshone me at school.
In yesterday's Parkrun I posted the 4th best time for M55s since Ginninderra parkrun began.

http://www.parkrun.com.au/ginninderra/

I am still quite a few minutes behind the best ever time, but that gives me something to aim for.
A few reasons for my success.

1.I have been playing around with different steroid doses for sporty days.
My current favourite for races around an hour or two, which I used yesterday because Parkrun was not my only outing, is
Prednisolone 5mg
Hydrocortisone 15mg
Fludrocortisone 100 mcg
I had these at 4:30 am to make sure they were working before the start of the run, then no other steroids for the rest of the day. Of course doses like these are completely inadequate for a big ski day.

2. My diabetes management is completely contrary in most respects to what doctors recommend. Standards of medical research in this part of the world are appallingly low, both in general and with respect to diabetes. Look for yourselves at the original research that underpins your treatment and you will be horrified. Has anyone ever seen an article on T1DM in an Australian medical journal that has been even remotely helpful in their management? Many of the strategies that I use are described by Australian doctors as ineffective or deleterious. Yet I manage to do OK. Go figure.

3. I had the best ever earworm for the run. Mahalis's Just Like a Star. I was into the final kilometre before I had a chance to even think about how the run was going.

Skiing 6.9.15

After 10 years of skating track skating, I finally persuaded one of my kids to try backcountry skiing. A worthwhile trip up Twynam via Tate east ridge, despite the icy conditions for the first 200 vertical metres of the descent from Twynam. Strong cold winds meant we didn't stop for lunch until we got to Illawong.
Levimir 6U and Nrapid 4U in Jindabyne was good for the trip. Cold conditions and high winds meant testing BSLs was quite impractical for the middle few hours of the trip.

Intro

Everyone knows that young people with diabetes can do amazing things, even win an Olympic medal. But what happens to Type 1 diabetics after they reach legal retirement age and have had diabetes for many years? How do they manage? Here is my story.

Skiing 11/9/15

Backcountry ski trip to Leatherbarrel Creek from Dead Horse Gap.

Beautiful spring skiing. All up 1500 vertical metres of ascent and descent on mainly soft snow.
Levimir 8U and Novorapid 3U wtih breakfast and Novorapid 3U with lunch. I stuffed my face with carbs all day, but still had to eat more when I got back to the car at DHG to keep my readings up.
Mt Kosciuszko is near the horizon centre in the last pic.

Rod's Strava track from the day: