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underthecity
07-29-2011, 07:48 PM
Way back when I was developing this story, I posted a question about teen diabetes in this forum (http://www.absolutewrite.com/forums/showthread.php?t=201884&highlight=teenage+diabetes). And I received a lot of very helpful posts. As a result, the MC did in fact find out she had diabetes at sixteen and has to give herself insulin three times a day, as well as adjust her way of life.

No problems so far. At least two months pass between her diagnosis until the climax, which is where I am right now. It was always my intention that during the climax the diabetes would be problematic, but I'm not sure exactly how.

In the scenario, it's eight p.m. and the MC has been kidnapped and tied up by her tormentor. She manages to escape and is now about to chase the antagonist.

She realizes that she has not eaten and/or she hasn't taken her insulin. I recall from speaking to a former coworker about his diabetes is that he had to eat every two hours or so, low carb, low sugar food.

How does this affect her in this present moment, and what does she need to do? Is she weak? Does she have to eat a candy bar? What happens if she misses her insulin?

PinkAmy
07-29-2011, 10:33 PM
She could go into a diabetic coma, she's not going to be in any condition to be chasing criminals.

Hbooks
07-29-2011, 11:17 PM
Would she really be up to chasing someone? Is there something wrong with the antagonist where they can't easily get away from someone who's severely compromised? If she's low, she's going to need to eat something and get her sugar up, pronto. Keep in mind that once you start feeling symptoms of being low, you may only have minutes before you could black out. It's very serious. While I can imagine her getting into this scenario and being lucky enough to escape and have access to her glucose tablets if her purse wasn't taken, I don't understand why she would then turn around and chase the antagonist instead of just making her way to the nearest place to call for help as soon as she could walk.

kuwisdelu
07-30-2011, 12:51 AM
In the scenario, it's eight p.m. and the MC has been kidnapped and tied up by her tormentor. She manages to escape and is now about to chase the antagonist.

Are you sure? I think her vision's going dark and she's about to pass out.

underthecity
07-30-2011, 01:10 AM
Thanks hbooks and kuwisdelu, I wasn't sure exactly how she would feel in the situation.

So, I've incorporated it into the rewritten scene. She feels herself growing lethargic, is able to free herself, her tormentor runs off (making a longer story short here), feels almost ready to pass out, checks her phone and finds out her sister is on her way and has called 911, makes he way up to the kitchen to grab a quick snack, then runs outside to find the tormentor before she gets away/disappears/kills self--I don't know I haven't written that part yet.

The diabetes part adds to the moment's tension.

And PinkAmy, she could go into a diabetic coma and knows it.

Hbooks
07-30-2011, 01:44 AM
She feels herself growing lethargic, is able to free herself, her tormentor runs off (making a longer story short here), feels almost ready to pass out, checks her phone and finds out her sister is on her way and has called 911, makes he way up to the kitchen to grab a quick snack, then runs outside to find the tormentor before she gets away/disappears/kills self--I don't know I haven't written that part yet.

It's your story to write as you wish, but I feel compelled to share my honest reaction that I would have trouble accepting this as plausible. If she's low enough to feel the effects of it, that she's almost ready to pass out, as you say, she's going to be lucky to get to the kitchen and her snack in that state. After that point, it's going to take some time for her body to get back to normal where she can even begin to think about following the person (which I still would rethink.) It's not an instant eat a snack and you're good to go sort of thing. Unless the tormentor has two broken legs, I don't understand how they wouldn't be able to get far away in the time it would take your MC to get over being incapacitated.

GeorgeK
07-30-2011, 05:30 AM
There are different types of diabetes and different degrees of those types. Some have reasonable glucose control when they fast, but you have to eat sometime and then their sugars skyrocket requiring insulin. Others are in a constant battle with their sugars regardless of what they do or don't eat. If someone is going hypoglycemic and recognizes what is going on, that, "quick snack," is going to be something that does not require preparation. When they crash, there is little warning.

tedi.s
07-30-2011, 06:40 AM
If she has not eaten, then she will get dizzy, disoriented. If she has eaten and not taken insulin she will get sluggish and grumpy! Either one could make her pass out.
My sister didn't take her insulin once and drank cranberry juice and went to bed attempting suicide. She was unconscious and barely breathing when they found her the next morning. She coded twice on the way to the hospital.
If you need more specifics, I might be able to ask her questions. She is in a much better place in her life now, although she still has issues maintaining her blood sugar levels. I can ask my father as well. he is also diabetic. I know that if they don't eat, there is no way they are chasing anyone. Normally we have to run and make them food and get them glucose tablets (they carry them in their pockets) or juice. A candy bar but we usually try a miniature size to minimize the sugar low. Then feed them something good for them.

blackrose602
07-30-2011, 09:40 AM
I'm going to go against the grain here and say write it however you need it. My dad's diabetic, and just as prone to hypoglycemic episodes as anyone else. But stress does different things to different people. When Dad's stressed, his sugar goes high--not dangerously so, but enough to keep him going long beyond when he "should" have eaten. I could easily see him in that situation, running on adrenaline, sugar high because of it, going directly after the bad guy.

The same thing happened on season 17 of The Amazing Race. Nat was a doctor, half of the winning team, and she had diabetes. It was mentioned on the show and in post-show interviews that her sugar frequently went high during the race, even though she was sometimes going as much as 16 hours without food. So it's definitely something that happens to some people.

Now, when the stress wears off, your girl's going to be in a world of hurt. Better have some glucose tablets in her pocket or *immediate* access to candy or juice or sugared soda, or she's probably going to pass out. Need to follow that up with a balanced meal ASAP. But in the heat of the moment? I'd buy tearing off after the attacker way before I'd buy "goes to the kitchen and makes a snack." Just my opinion though.

blackrose602
07-30-2011, 09:44 AM
Also wanted to say: If she does have glucose tablets or something in her pocket, I'd buy her popping a few (Dad usually takes three) on her way out....better safe than sorry sort of thing.

alegory
07-30-2011, 02:07 PM
Diabetes is one of those things that can have very different effects on people. Of course there are the textbook symptoms, reactions...etc but I wouldn't necessarily get hung up on them because they can change from one person to the next (as can the point at which a person gets warning symptoms for highs and lows...). Whilst I would agree with what people have said about the time it takes to correct a low, the feelings associated...etc, I would also say it's variable enough that you might be able to twist various things to your advantage...

I'm a teenage girl with 16 years of personal experience of diabetes and happy to help if you need it :)

I quite like the idea though, from what you've outlined- I get bored of diabetes being used as a bit of light entertainment on TV shows :P

PinkAmy
07-30-2011, 04:35 PM
It's your story to write as you wish, but I feel compelled to share my honest reaction that I would have trouble accepting this as plausible.

This.

I don't read poorly researched books or books that manipulate real conditions for plot line.

underthecity
07-30-2011, 05:56 PM
Thanks for the comments. I think what could work best for this scene is that once she's free, she takes some glucose tablets which should get her into the upcoming chase. BUT she shouldn't be at 100% yet. And this will affect what happens next.



This.

I don't read poorly researched books or books that manipulate real conditions for plot line.
From what I know about diabetes and from what I'm reading in this thread, the condition affects each person differently, especially given the circumstances. Believabilty here should be consistent with what we know about the character and her treatment of diabetes.

If this character has had diabetes up to this climax, then IMO the diabetes should be a part of the climax in some way, either as a hindrance or some kind of advantage.

Bracken
07-30-2011, 06:07 PM
I'm not real clear on why the teen is "chasing" her kidnapper at all, diabetes or no.
It doesn't seem like a very realistic idea. In fact, it rather defies credulity, i'm afraid, especially once you add diabetes into the equation.

Uncarved
07-30-2011, 06:10 PM
As someone who takes care of a diabetic and has been in this situation countless times.... want to up the ante?

Have her feel herself fixing to just fade away and pass out and let her realize she has a glucagon shot (its a sugar shot to buy her some time and snap her up about 30 to 50 points on a blood sugar monitor). Now she'd have to eat fairly soon after the shot. The shot releases the stored insulin in the liver and will need to be put back. But you can have her light dimming and give her a realization of boom turning that light back on for enough energy to crawl to a phone, call 911, etc. etc..

If you need diabetic advice, I've been in all kinds of situations and can tell you what would happen and how they'd feel.

Hbooks
07-30-2011, 06:39 PM
Thanks for the comments. I think what could work best for this scene is that once she's free, she takes some glucose tablets which should get her into the upcoming chase. BUT she shouldn't be at 100% yet. And this will affect what happens next.

Out of curiosity, have you ever been around someone having an insulin reaction? While I think it can be a lovely thing to include characters with serious issues in novels, it can be off-putting to those who really deal with them to have an issue treated lightly or misrepresented. This is true whether it's a medical condition, or assault used as a cheap plot device and then tossed aside by the next chapter without the character suffering any after-effects.

Tinasamuels had a good suggestion of how to include diabetes at the end, but in a realistic way, her struggling just to get to the phone and call for help rather than popping a few glucose tablets and then running good as new after her attacker.

underthecity
07-30-2011, 06:53 PM
See, this is exactly why I started this thread in the first place. All very helpful advice, tina, hbooks, etc.

The reason she is now chasing after her kidnapper is . . . complicated to explain here. It all has to do with the story and what led it to this point.

Hbooks
07-30-2011, 07:09 PM
See, this is exactly why I started this thread in the first place. All very helpful advice, tina, hbooks, etc.

The reason she is now chasing after her kidnapper is . . . complicated to explain here. It all has to do with the story and what led it to this point.

If she HAS to chase her kidnapper (which I would need a really compelling reason to justify--most girls who were kidnapped and escaped would be relieved to be free and call for help, not pursue the person), then maybe this is the wrong time for her diabetes to come into play. Or, maybe you change up the timeline so she doesn't miss her meal, she chases them, burns up too much energy doing so (you usually have to snack when exercising), after she chases them her sugar gets too low and the police arrive to save her, or whatever.

ULTRAGOTHA
07-30-2011, 07:17 PM
Whatever you decide to do in this climactic scene would probably work, PROVIDED you then make sure that your MC's particular type of Diabetes is consistent in the rest of the story. Need her to go haring off after her attacker? Then make sure she isn't a very fragile type I diabetic.

You could make her a Type II diabetic and not have to worry about insulin shots and still make her moggy at the climax.

Bracken
07-30-2011, 07:48 PM
Whatever you decide to do in this climactic scene would probably work, PROVIDED you then make sure that your MC's particular type of Diabetes is consistent in the rest of the story. Need her to go haring off after her attacker? Then make sure she isn't a very fragile type I diabetic.

You could make her a Type II diabetic and not have to worry about insulin shots and still make her moggy at the climax.


True; my dad's a type 2 diabetic, and he does all sorts of stuff, including near-constant international travel. Although he needed insulin shots when initially diagnosed, he now controls his condition with diet, exercise, and pills.
Type 1 diabetes, to my knowledge, is much more serious, however.
And, while I'm aware that type 2 diabetes is becoming more common in adolescents, I believe it's only common in a certain type of adolescents- ones who are morbidly obese.
So if you're going to make your MC a type 2 diabetic teen, you need to make her obese, in order for that to be realistic.

Al Stevens
07-30-2011, 07:49 PM
I'm a diabetic. My son-in-law and two of my grandsons are diabetic. We all react differently to high and low blood sugar.

Exertion, fasting and stress can and usually do lower blood sugar. Insulin shots are taken in anticipation of planned levels of food consumption and exercise. Your MC's situation would be unplanned, so her most recent shot would not have anticipated the stress and exercise that's coming. Having become diabetic at 16, she's probably a type I insulin dependent diabetic.

The old cliche is that diabetes is a three legged stool: diet, exercise and medication. If one leg is off, the stool topples.

She might or might not feel it coming on. She might be standing around not doing anything and then hit the floor, still conscious but needing a Coke or something to get her up. She might pass out immediately. She might act drunk. You get weak and shaky and lose physical stability. Low blood sugar wakes me up if it happens at night.

High blood sugar, which is caused by failing to take the shot or eating too much of the wrong food, typically takes longer to have effects. Hours for some, days for others. My grandson went into diabetic ketoacidosis (DKA) because he neglected to take his shot. A day later he looked jaundiced and couldn't stay awake, even though he was back on schedule with his insulin. It took a several-day hospital stay to get him under control.

If it helps, the ER doctor said he was a DKA poster child and was within hours of dying.

Then there's the so-called "brittle" diabetic, who, no matter what they do, their blood sugar is always out of whack, too high or too low. That's me. That was my two brothers who died in their 50s.

The problem with using all this as a plot factor is that the general population has different conceptions of diabetes based on their personal experiences with the disease. Whichever way you have her react, there are lots of people who think you got it wrong, because they have had different experiences with a family member, co-worker, etc.

Selcaby
07-31-2011, 08:19 PM
Just another data point for you.

Me: Type 1 diabetic, diagnosed aged 24, now aged 33. Taking insulin 4 times a day.

My hypos: occur every few days on average, sometimes more than once a day, but they're mild. I carry glucose tablets and other snacks, and I'm generally okay within a few minutes.

How do I know I'm hypo? It varies. Sometimes I feel tired or shaky. Sometimes I notice my brain isn't working at normal speed. Sometimes it's really subtle; the world around me starts to feel just a bit unreal, and lights start to seem brighter than usual, and I check my blood sugar and confirm that I'm hypo. If it happens when I'm out and about, I sometimes find myself wandering about aimlessly or getting lost, and I've learned to recognise that as a sign.

I avoid excessive alcohol and caffeine because they interfere with hypo symptoms. I am better at spotting hypos when I'm in familiar places and situations.

Walking long distances late at night can give me a hypo a couple of hours later. More strenuous activity can make the hypo happen sooner. I have found that the number one hypo-inducing activity, for me, is heavy lifting, including climbing. I once had a hypo up a tree. You'll understand why I don't do much sport, other than walking.

I tend to get very cranky when I'm separated from my medical kit and/or food for any length of time. Being kidnapped and tied up would be even more of a nightmare for me than for most people. The stress would tend to send my blood sugar high (but nowhere near the level where it would put me in a coma, at least not in the short term) but, because the adrenaline reaction would make me shaky, I'd also feel as though I might be hypo, and being unable to check would drive my stress level up further.

I have never had a hypo so bad that I needed anyone else's assistance. I have never had one that made me pass out, but I have sometimes needed to sit down for a while, fortunately only in situations where doing so wasn't a problem. I carry glucagon, but nobody has ever needed to use it on me. I have also never fallen into a coma from high blood glucose, and have been hospitalised only once, at diagnosis. (My GP told me to go to hospital, and I went there by myself on the bus. They put me on a saline drip and an insulin drip, and when I was stabilised, taught me to inject myself, gave me lots of advice about adapting my lifestyle, and sent me home.)

As I said, stress stimulates adrenaline reactions (the fight or flight response) increasing the blood glucose level. So hypos are less likely, but I think they're still more likely than being incapacitated by high blood glucose. If you want to give her a hypo, make sure it's a long time since she last ate, so the glucose stores in her liver are depleted. It would also help if she had already had a hypo that day. Once you've had one, another one is more likely, especially if you haven't eaten in between. Then when she needs to run, she'll weaken more easily.

I hope these somewhat disorganised thoughts make sense to you! Feel free to ask me if you have any questions.

PinkAmy
07-31-2011, 09:41 PM
If this character has had diabetes up to this climax, then IMO the diabetes should be a part of the climax in some way, either as a hindrance or some kind of advantage.

I definitely agree with you on this.

areteus
08-01-2011, 08:45 PM
Speaking as a Type I Diabetic and a former scientific researcher into the secondary complications of Diabetes, I would like to add some info to this...

First off, if she has been unable to take insulin for a while and not given any food then she will not, under any circumstance, suffer hypoglycaemia (low blood sugar). This is because type I diabetics (what used to be called insulin dependent or juvenile onset but not any more due to that being inaccurate) do not produce any insulin at all. This is opposed to type II (what used to be called non insulin dependent or maturity onset) which is caused by a condition known as 'insulin resistance' - in other words they have normal (or near normal) insulin production but their body cells cannot react to it normally.

So, insulin is needed to activate receptors in the body cells which allow glucose to move from the blood into the cells where it can be metabolised to make energy. Without insulin, those receptors remain 'locked' and any and all glucose which enters your body goes into the blood and remains there - leading to hyperglycaemia (high blood glucose). This has several effects including:

- lack of fuel for respiration in body cells leading to the body assuming it is under a 'fast' condition. This means it tries to get glucose from other sources including the glycogen stores in the liver and the fat stores in the adipose tissue. The glucose from these sources also ends up in the blood (how else is it going to travel?) and makes the blood glucose even higher without solving the issue so it becomes a catch 22 loop. This means that an untreated diabetic will lose weight phenomenally and the more they eat the more weight they lose (there are some horrifying images of pre-insulin diabetics looking like famine victims)
- The breakdown of fat tissue is done rapidly rather than slowly and this, biochemically, is not good. Rather than metabolising safely into water and carbon dioxide it leads to an inefficient breakdown releasing ketones into the blood. Ketones are toxic (specifically acidic) leading to a condition known as ketoacidosis. It will also lead to an obvious symptom - the smell of peardrops on the breath (which is the smell of acetone, one of the ketones). Paramedics, on finding an unconscious diabetic, will generally do nothing until they know for certain what caused the unconsciousness - hypo or hyper. One of the signs they look for is this smell of peardrops on the breath.
- In the long term, even small rises in blood glucose (above the 4mmol/L physiological norm) can lead to problems. These are largely caused by the reaction of glucose in the blood with proteins. For example, the proteins in nerve tissue, in the kidneys and the structure of the vascular system. These reactions (called glycation reactions) lead to permanent cross linking of proteins which can distort or damage the tissues leading to a greater risk of vascular diseases (leading to heart conditions or blindness if certain specialist vessels are damaged), nerve damage or kidney disease.

Now, out hero here is going to have been without food or insulin for a day at most. Her blood sugar cannot go down (no insulin to open the receptors) but everytime it goes up it stays up. From my experience of this same sort of situation (short term high blood sugar due to insulin that was past its use by date) she may not go into a diabetic coma (unless she eats something to put her blood glucose up massively) but she will not feel well at all. Symptoms vary from person to person but I get mood swings (I get irrationally angry and unreasonable), headaches and a sort of strange feeling that I can't really describe in words other than to call it 'the feeling I get when my blood sugar is high' :) She will also be incredibly thirsty (the osmotic effects of sugar in the blood mean that the kidneys release more fluid than they should - lots of very weak urine hence the name translated to 'Fountain of honey'). If she can get hold of insulin she'll be fine in a few hours.

alegory
08-01-2011, 09:25 PM
First off, if she has been unable to take insulin for a while and not given any food then she will not, under any circumstance, suffer hypoglycaemia (low blood sugar).


Not to be difficult but I have done exactly that :D I think it would be possible to suffer a hypo if her blood sugar was, say around 6 or 7mmol (UK readings, I don't know how to translate to the American version if that's what's being used) or lower when she was kidnapped, and she didn't eat. I know someone else said that stress raises blood sugar levels but, from my experience, it can also lower them so if the blood sugar wasn't too high to start with, she could potentially go low...

areteus has some good info there, though :) Always good to know what's going on when these things happen...

underthecity
08-01-2011, 09:52 PM
Thank you for all the great feedback. I was away from the computer for the most part this weekend, so I haven't been able to respond to any of these comments until now.

There's a lot here to sort out and figure out what will work for this character and in this situation.

A few bullet points:

She is Type I diabetic and is insulin dependent. She takes it three times a day. In this instance she is away from home and has forgotten to bring her insulin kit with her. (It's a rough draft. I don't know if that "kit" has a name.)

I don't know what "going hypo" means. I've googled it. Everyone talks about it without actually defining it. I also don't know if this would happen to this character.

After she sets herself free, she must find her captor. Two things here: 1. It wouldn't be very exciting if in this ending, she sits around and waits for the police to arrive. Emily saved. The End. 2. Her captor turns out to be a friend of hers named DeeDee who is carrying a very huge grudge against Emily. So, it's not a stranger, it's someone with serious problems who Emily has inadvertantly wronged in the past.

From the above posts, I'm still unsure how the lack of insulin and food would affect the circumstances. From what has been discussed, diabetes affects everyone in different ways. It appears there is no single way one can expect a person to react in some kind of tense situation.

So, when Al Stevens above says this:

The problem with using all this as a plot factor is that the general population has different conceptions of diabetes based on their personal experiences with the disease. Whichever way you have her react, there are lots of people who think you got it wrong, because they have had different experiences with a family member, co-worker, etc. But this very fact gives me more leeway in showing what will happen with this character. As long as the basic facts are correct, then different things could happen given the situation.


So, then, in the current first draft scene, Emily is tied up, is hit by a stun gun (yes, that happens, DeeDee is screwed up), must reveal on camera the secret she's been holding for two years, is able to free herself, DeeDee runs out.

(There's a whole lot more to it than this, that's the bare bones.)

Meanwhile, she is feeling weak and light headed, realizing she doesn't have insulin and hasn't eaten.

I can stick some glucose tablets in her pocket if need be.

She gets her cell phone. Message from her sister: "I'm on my way, police have been called." Help will be there in about twenty minutes. She must find DeeDee. DeeDee has found out the truth about what really happened two years ago, and is now in a state of panic. DeeDee might run away (this is in the country, a rural road), she might even kill herself, nobody knows. But she must be found right away.

So, she can now immediately go find DeeDee before anything happens or just sit around. No, she's going out there. It's cold and windy and she's weak.

So then, does she run up to the kitchen and grab a snack of some sort? Are the glucose tablets enough? Or does she just ignore all that and run out the door? She isn't thinking clearly.

The diabetes is a hindrance.

Can it also somehow be an advantage?

alegory
08-02-2011, 12:09 AM
She is Type I diabetic and is insulin dependent. She takes it three times a day. In this instance she is away from home and has forgotten to bring her insulin kit with her. (It's a rough draft. I don't know if that "kit" has a name.)
This is another thing that may vary from person to person but 'kit' seems perfectly logical.

I don't know what "going hypo" means. I've googled it. Everyone talks about it without actually defining it. I also don't know if this would happen to this character.
Hypo= hypoglycemia= low blood sugar.
It could happen to your character but, at present, you seem a little unsure about what will happen in the lead up to this moment where she is either high or low (you mentioned "she has not eaten and/or she hasn't taken her insulin")?
You could approach this in two ways: 1) decide she'll be high or low and then work out how she gets there or 2) if there's a reason some of the contributing factors can't happen (eg: not being able to take insulin because she's forgotten it/ or DeeDee refusing to give her food...) then choose that first and work out the consequences. If it's imperative that Emily goes chasing after DeeDee then she has to be able to run and therefore I would not suggest her being very low (or very high but high could be easier to work with).


I'd suggest going backwards through this and working out the contributing factors to suit the desired outcome.

You wrote this at one point (post 13):
"I think what could work best for this scene is that once she's free, she takes some glucose tablets which should get her into the upcoming chase. BUT she shouldn't be at 100% yet. And this will affect what happens next."
When you say it will affect what happens next, do you mean in terms of it making it difficult for her to run after DeeDee or do you mean in terms of making it difficult for her to think straight as you said in post 26? It might help to know so as to suggest whether a high or low would suit the situation better...

I really hope this hasn't utterly confused... I've been tracking back through the thread and might have been unintentionally mixing the info up and I hope that's not come through too much here...

Al Stevens
08-02-2011, 12:11 AM
She is Type I diabetic and is insulin dependent. She takes it three times a day. In this instance she is away from home and has forgotten to bring her insulin kit with her.
Believable if she uses conventional syringes. You keep the vials in the refrigerator. I'm always forgetting mine.



I don't know what "going hypo" means.
Hypoglycemia - http://en.wikipedia.org/wiki/Hypoglycemia



Everyone talks about it without actually defining it. I also don't know if this would happen to this character.
Yes it would. It's a routine part of Type I.



Meanwhile, she is feeling weak and light headed, realizing she doesn't have insulin and hasn't eaten.
In that case she doesn't need insulin. She needs food.



I can stick some glucose tablets in her pocket if need be.She probably wouldn't be without them. But if she's tied up, can she get to them?



So then, does she run up to the kitchen and grab a snack of some sort? Are the glucose tablets enough? Or does she just ignore all that and run out the door? She isn't thinking clearly.
Any of the above.



The diabetes is a hindrance.
Can it also somehow be an advantage?
If she were to die from hypogylcemia, her captor would be charged with felony murder. If he knows that, he might untie her not knowing what she needs. Then she hits him with a 10-lb salami from the frig. Or whatever.

Hbooks
08-02-2011, 12:15 AM
"Going hypo" refers to entering a state of hypoglycemia, or having your blood sugar become too low, like when you haven't eaten or have exercised too much.

Right now, I think you need to address two main issues: is what you're suggesting reasonably plausible for most readers and do the MC's actions make sense. Is there a clear cause/effect relationship in place and can we understand her motivations, or is she reacting in a nonsensical way in order to serve the story line, not because it's how someone in her position would really react?

Yes, I agree with you that the MC needs to be active. Having her sit around twiddling her thumbs is not an exciting ending. However, writing an implausible ending is not a good solution either. Both will turn off readers. I would gently suggest reworking this so that she can be active, but within her limitations. Perhaps that means that she does not become affected by her diabetes until after she's already run after DeeDee, so that DeeDee can redeem herself by saving Emily as well.

The problem with what you currently have is that if she's low enough to feel lightheaded, she needs to stop and eat right then. She can't go tearing off after DeeDee. Even after she eats, she'll need time to get her bearings and strength back. Yes, there is some variation in how each person reacts, but honestly, if you are choosing to give this character diabetes, please do it justice. What you're describing would come across to me as taking the cheap way out, that at the worst moment, when I would expect her to be most hindered, she just shrugs it off, takes a few glucose tabs and runs off like a track star. No biggie. It would belittle the actual struggle that many diabetics live with every day, rather than highlighting it, and I would hope in choosing to include this issue in your book, that this is the last thing you would want to do.

underthecity
08-02-2011, 12:22 AM
Thank you guys for all that.

We've been talking about eating versus insulin.

I had another thought. What if that instead of Emily forgetting her insulin kit, DeeDee runs off with it and Emily needs it right now? So she has to chase after her?

Plausible?

alegory
08-02-2011, 12:29 AM
Potentially but she'd need to be high first in order to need it. That would mean having eaten during her time as a captive...

Hbooks
08-02-2011, 12:45 AM
Thank you guys for all that.

We've been talking about eating versus insulin.

I had another thought. What if that instead of Emily forgetting her insulin kit, DeeDee runs off with it and Emily needs it right now? So she has to chase after her?

Plausible?

Why would DeeDee do that? Is she trying to kill Emily? I need to be able to understand DeeDee's motivations as well, and I can't figure out why she would run off with Emily's insulin kit unless she wanted to kill her.

If she needed her insulin kit, she would have to be high, not low. Additionally, I don't find this reaction plausible given that her sister has notified her the police are on the way and will be there in 20 minutes. They can just take her straight to the hospital where they can give her some more insulin. Being high is usually not as immediately urgent as low. You may only have minutes once you realize you're low. Typically you could be too high for a day or so before you're in real danger. Yes, reactions vary, but it's not as immediate a danger as being too low, so chasing after her doesn't make sense when the police are on the way.

underthecity
08-02-2011, 01:09 AM
Points taken. Why would DeeDee grab Emily's insulin kit?

I don't know yet.

Maybe she does want to kill her. Maybe at this point DeeDee feels she has nothing to lose? I have to think about it.

Al Stevens
08-02-2011, 01:23 AM
If DeeDee wants to kill her, and she is confined or tied up, an overdose of insulin is a way to drive her into hypoglycemia. She'll be unconscious in minutes. Then, without attention, she will die.

Look up Sonny and Claus Von Bülow.

underthecity
08-02-2011, 01:31 AM
Two thoughts on that:

1. If DeeDee overdoses her on insulin, wouldn't Emily be too messed up to escape? (All throughout her being captive, she's been working at a combination lock behind her back.)

2. On the converse, what if DeeDee runs out the door with Emily's insulin kit not knowing that without it, Emily could die? Then she wouldn't be intentionally trying to kill her. All DeeDee would know is that Emily really needs that insulin. ("I didn't know she needed it that bad.")

Hbooks
08-02-2011, 01:41 AM
Two thoughts on that:

1. If DeeDee overdoses her on insulin, wouldn't Emily be too messed up to escape? (All throughout her being captive, she's been working at a combination lock behind her back.)

2. On the converse, what if DeeDee runs out the door with Emily's insulin kit not knowing that without it, Emily could die? Then she wouldn't be intentionally trying to kill her. All DeeDee would know is that Emily really needs that insulin. ("I didn't know she needed it that bad.")

1. Yes, she'd likely be too messed up to escape. (I'm questioning the combo lock thing too, but I'll ignore for the moment.) If DeeDee does this, she's looking at an attempted murder charge. And, it could very quickly kill Emily.

2. In this scenario, I can't imagine that Emily wouldn't yell, "No, you can't take my kit! I'll die without it!" (which isn't really true, but if she wants it that badly...) And again, this still doesn't explain why Emily doesn't just wait for the police (who will be there in 20 minutes.) She doesn't need the insulin that badly. Being high isn't as immediately emergent as being low. Makes much more sense to wait for the police and a quick trip to the hospital rather than go chasing a psychopath out into the rain and cold in a rural area where you could die before anyone could find you.

Why does the diabetes have to come up before the chase scene? Why can't it become an issue after the chase?

underthecity
08-02-2011, 01:53 AM
1
Why does the diabetes have to come up before the chase scene? Why can't it become an issue after the chase?The intention is that the diabetes issue is part of the climax, versus something that happens afterwards.

And the combo lock thing. It's a lock with three separate dials, 0-9. She knows the combination is 0 0 0. The zeros are marked so you can dial in the dark. She can do it by feel. (I used to have a lock like this on a bike chain.)

areteus
08-02-2011, 01:59 AM
Not to be difficult but I have done exactly that :D I think it would be possible to suffer a hypo if her blood sugar was, say around 6 or 7mmol (UK readings, I don't know how to translate to the American version if that's what's being used) or lower when she was kidnapped, and she didn't eat. I know someone else said that stress raises blood sugar levels but, from my experience, it can also lower them so if the blood sugar wasn't too high to start with, she could potentially go low...

areteus has some good info there, though :) Always good to know what's going on when these things happen...

6 - 7 mmol/L is actually fine - slightly high but some normals can get to that level if they pig out (just as normals can get to less than 4 if they fast - usually as low as 3). I usually run somewhere between 4 and 10 with no symptoms. Thinking back on my rustier physiology knowledge, I do know that adrenaline has the effect of lowering blood glucose (it increases the amount taken in from the blood) so stress could, in theory, lower it. Would need to check the mechanism of how that works, though, because if it is a mechanism that requires the insulin receptors to work then it may not...

You mention a 3 injections a day regime. Is this based on a real world one you have seen? I ask because the main ones I have seen are based on either 2 injections (mixed shot and long acting) or 4. My current one is 4 a day and involves 3 of the short acting (work within a few minutes of injection unlike earlier fast actings which acted within 30 minutes of injection) and one which gives a low basal level which lasts 24 hours. This is supposed to act like the real situation where you have a low level of insulin all the time and this is boosted just before meals. Now, on this regime there is less risk of high blood glucose because you can happily skip an injection and not eat (say you don't fancy lunch) or have an injection later (say if lunch is going to be late) so long as you inject just before you next eat. Depending on when she usually does this 24 hour injection (some do it first thing in the morning, others just before bed) she will have until that time the next day to inject again.

Now, in the UK the NHS pay for this treatment so many are on this regime. I have been told by American doctors that some insurance companies will not cover it and insist on the older insulins which are less good.

IN case no one has defined these yet:

Hypoglycaemia is low blood glucose or a 'hypo'. Hypo means 'low', glyc refers to glucose and aemia is blood.

Hyperglycaemia is the opposite.

I can't remember what the US system is but in the UK it is measured in mmol/L (millimoles per litre, only really makes sense if you are a chemist and know what a mole is...) and it is generally considered that:

4mmol/L is normal healthy human physiological level
more than 4 - 10 high, at the upper ends you may feel symptoms
more than 10 you will definitely feel symptoms and as you approach 20 you are getting ketoacidosis
More than 20 is very serious and starting to risk ketoacidosis. I beleive more than 30 is critical and I once heard someone on a fictional hospital programme declare a blood glucose of 60 on a patient in coma... 10 seconds after that the patient was dead...

Less than 4 is officially hypoglycaemia. Here the margins are tighter and a small change in concentration makes a massive difference in symptoms. I've been as low as 1 before (and conscious... the nurse who measured it was surprised normally consciousness would be lost by then) and that was a trip to freak out city. Effects between 4 and 3 are milder and similar to what may be experienced by someone who fasted for a while (light headedness).

Hbooks
08-02-2011, 02:04 AM
The intention is that the diabetes issue is part of the climax, versus something that happens afterwards.

And the combo lock thing. It's a lock with three separate dials, 0-9. She knows the combination is 0 0 0. The zeros are marked so you can dial in the dark. She can do it by feel. (I used to have a lock like this on a bike chain.)

Ah, I understand now about the lock. We call something else a combination lock around here, and it would have thousands of permutations, so I didn't understand how she would figure that out so quickly :).

I think having the diabetes as a part of the climax makes for a good plot. I just think it's important to do so in a realistic way, or it kind of has the opposite effect (belittles what it means to deal with it every day if the realistic hindrances she would face disappear for the sake of making the plot work.) Good luck finding a workable solution.

ULTRAGOTHA
08-02-2011, 02:22 AM
Points taken. Why would DeeDee grab Emily's insulin kit?

I don't know yet.

Maybe she does want to kill her. Maybe at this point DeeDee feels she has nothing to lose? I have to think about it.

Her kit could be in her purse and DeeDee takes her purse for some reason. The kit is just along for the ride.

underthecity
08-02-2011, 02:38 AM
Thanks, ultragotha, that could work. I hadn't thought of that.

DeeDee's already taken the cell phone and set it aside.

underthecity
08-02-2011, 05:55 PM
Regarding the diabetes issue. The main character having diabetes isn't the only reason for this climax, the chase scene. Her diabetes must be a part of it somehow.

The main subplot of the story is Emily's cheerleading. She becomes a flyer--the topmost cheerleader on a pyramid. During a game, she's up on top when she passes out, falls down and lands on her head, twisting her ankle in the process. (DeeDee, btw, was one of the bases. Instead of trying to catch her, she let her fall.) At the hospital, she learns that along with a concussion and sprained ankle, she has diabetes--the reason for her blackout. She decides to tell no one that she has diabetes.

Weeks before, the school board had lifted its ban on cheer pyramids at games (a knee-jerk reaction to the inherent dangers of the sport). So, after Emily's accident they reinstate their ban on pyramids and flying.

Following the climax at the end, there is a school board meeting at which Emily was scheduled to speak with her fellow cheerleaders regarding the new ban. At this meeting, Emily reveals that she has diabetes, which caused her to fall. It was not any fault of her fellow cheerleaders (except for DeeDee, which may or may not be mentioned there) and that they should reconsider the ban. That plot line is left open ended, so the reader never learns if the ban was ever lifted, possibly hoping that it will be.





"Going hypo" refers to entering a state of hypoglycemia, or having your blood sugar become too low, like when you haven't eaten or have exercised too much. What happens to you then? What do you have to do?

I was diagnosed with hypoglycemia when I was in grade school. I do don't do anything in particular except cut out most sugar. I do know that when I don't eat for a while, I tend to get lightheaded and can't think straight. And if I eat a big meal, I get tired. Other than that, it's nothing.

Meanwhile, my father (73) has diabetes, but acts like he doesn't. He eats whatever, and I think now he has to monitor his blood sugar more often (than never) and has to take insulin.


Right now, I think you need to address two main issues: is what you're suggesting reasonably plausible for most readers and do the MC's actions make sense. Is there a clear cause/effect relationship in place and can we understand her motivations, or is she reacting in a nonsensical way in order to serve the story line, not because it's how someone in her position would really react? I don't believe my scenario is reasonably plausible yet. I do think Emily needs a stronger motivation to chase after DeeDee. Maybe D does have Emily's insulin. Or there could be something else. I haven't written that part yet.

But what does happen will be a function of the plot, but will also make sense that it happened.





You mention a 3 injections a day regime. Is this based on a real world one you have seen? I ask because the main ones I have seen are based on either 2 injections (mixed shot and long acting) or 4. My current one is 4 a day and involves 3 of the short acting (work within a few minutes of injection unlike earlier fast actings which acted within 30 minutes of injection) and one which gives a low basal level which lasts 24 hours. This is supposed to act like the real situation where you have a low level of insulin all the time and this is boosted just before meals. Most of Emily's diabetes symptoms and treatments came from a former coworker of mine who had diabetes. He did insulin three times a day, told me how he was diagnosed, what foods he ate and when, things like that.

Selcaby
08-02-2011, 06:41 PM
The main subplot of the story is Emily's cheerleading. She becomes a flyer--the topmost cheerleader on a pyramid. During a game, she's up on top when she passes out, falls down and lands on her head, twisting her ankle in the process. (DeeDee, btw, was one of the bases. Instead of trying to catch her, she let her fall.) At the hospital, she learns that along with a concussion and sprained ankle, she has diabetes--the reason for her blackout.

A sudden blackout doesn't sound realistic to me. I'm not saying it couldn't happen, but I think it would be unusual.

If she's got undiagnosed diabetes, her blood glucose is too high and has probably been that way for weeks. Her kidneys are working overtime to flush all this excess glucose out through her urine. That means she's peeing a lot, getting dehydrated, and drinking a lot. She won't be able to sleep through the night without going to the bathroom. She's also losing weight. (She might welcome this.) Her hair might start thinning because of her generally run-down condition. She might get muscle cramps (in my case, in my legs in the middle of the night, and very painful) or tingling in her fingertips. She might have trouble staying alert, the way people sometimes doze off after a heavy meal, only more so. If she loses consciousness because of high blood glucose directly, it's probably an extension of this, not a sudden blackout.

Then again, unusual things happen. When I was diagnosed, I had swollen ankles. It was obviously something to do with the diabetes, but nobody seemed sure exactly what. I had many of the other classic symptoms too (everything in the paragraph above apart from the last sentence) but they had come on slowly and I was in denial. The ankles were what made me go to the doctor. It was like I couldn't be convinced to go until I had something visible wrong with me.

Since the blackout looks very important to your plot, I don't want to tell you to get rid of it, but I think you should research it very carefully.


She decides to tell no one that she has diabetes.

I hear this is quite common. Personally I don't understand how people manage. I hope "no one" doesn't include her family, because I don't see how it would be possible for her to keep it from them at her age. Concerned parents would also want to inform her school, although she could probably intercept the letter or something, since your plot seems to hinge on the school not knowing.


Most of Emily's diabetes symptoms and treatments came from a former coworker of mine who had diabetes. He did insulin three times a day, told me how he was diagnosed, what foods he ate and when, things like that.

Be careful with this. Diabetes treatment styles have changed a lot over the last few decades. Look up the Diabetes Control & Complications Trial, a landmark study. In the last 15 years, new kinds of insulin have changed the way a lot of people manage their diabetes, as have easier and cheaper blood glucose testing, and new insulin delivery devices (I use a "pen" with an insulin cartridge, a plunger that controls the dose, and little screw-on needles). The dietary advice has also changed, and there are several competing schools of thought. There are smaller innovations too -- she might like to run a diabetes management app on her iPhone, for instance.

underthecity
08-02-2011, 07:35 PM
There were symptoms that arose before her diagnosis.

In the first chapter, she cut her foot. The cut just would not heal until the doctor found it after she went to the hospital following football game. Also, she was feeling lethargic and starting to lose interest in things she liked to do, i.e. cheerleading. Plus she was thirsty all the time and was using the bathroom all the time. On game day, she ate little and was moving around a lot. She blacked out on top of the pyramid.

When she is diagnosed, she "tells no one," meaning nobody at school or any of her friends. Her parents know, the principal and school nurse know, but that's it. She doesn't even tell her best friend; she figures it out later.

underthecity
08-02-2011, 08:11 PM
I'd suggest going backwards through this and working out the contributing factors to suit the desired outcome.

You wrote this at one point (post 13):
"I think what could work best for this scene is that once she's free, she takes some glucose tablets which should get her into the upcoming chase. BUT she shouldn't be at 100% yet. And this will affect what happens next."
When you say it will affect what happens next, do you mean in terms of it making it difficult for her to run after DeeDee or do you mean in terms of making it difficult for her to think straight as you said in post 26? It might help to know so as to suggest whether a high or low would suit the situation better...

I intended her to be physically exhausted when chasing after DeeDee. She should be thinking clearly at this point. Also, she's healing from a sprained ankle. In the ensuing chase, she's supposed to re-injure the ankle and get her leg put in a cast.



I would gently suggest reworking this so that she can be active, but within her limitations. Perhaps that means that she does not become affected by her diabetes until after she's already run after DeeDee, so that DeeDee can redeem herself by saving Emily as well.This is an option I hadn't thought of. How soon after eating something would she need insulin? And if DeeDee has that insulin, Emily would need it and runs after her. Would she "go hypo" at this point? Could she collapse? Could DeeDee be the only person at the scene who could help her? She has the stolen insulin bag.

alegory
08-02-2011, 08:20 PM
She won't be able to sleep through the night without going to the bathroom.

Maybe this could have brought on exhaustion which contributes to the blackout?

And with regards to the 3 injections a day thing, I wondered about that too... I actually do 4 injections a day but do my long acting, 24 hour dose alongside the one I do for breakfast so it might be that people would think of that as only one injection period... I imagine this method of using long and short acting insulins is the standard for new diabetics so it might be worth thinking about. I found this blog post which you might want to look at (especially the writer's January 12 post in the comments section) : http://blogs.diabetes.org.uk/?p=451

alegory
08-02-2011, 08:32 PM
I intended her to be physically exhausted when chasing after DeeDee. She should be thinking clearly at this point. Also, she's healing from a sprained ankle. In the ensuing chase, she's supposed to re-injure the ankle and get her leg put in a cast.


In that case, I'd think about making her high at the point she goes into the chase. Being low can be a bit like being drunk which may not be the best mindset for her to be trying to make decisions in. If she was high, she would probably be a bit ratty (I know I get like that :P ) but she would be better able to make rational decisions and may even think the chase is a good think for trying to get her blood sugar down... She wouldn't even have to be ridiculously high (it might be worth steering clear of extremes in either direction because both can be quite incapacitating), maybe in the mid to late teens or something, and if DeeDee's got her insulin too? Well...

How could she get high? I don't know what the situation is between DeeDee and Emily during Emily's kidnap but could DeeDee maybe give her something to eat? Like, if Emily said she needed to eat or she'd become really ill, would DeeDee be willing enough to keep her alive to give her something?

As I said, I don't know what your plans are but there's some things to think about... :)

ETA: sorry, your post hadn't come up when I submitted my last post.

underthecity
08-02-2011, 09:00 PM
Had a new thought, then. Before her capture, Emily's stomach growls, so she eats a Snickers bar with the intention of doing her last shot of insulin sometime soon. That candy bar was supposed to be for later, but she's having it now.

That would make her blood sugar go up. She would need insulin soon, shouldn't she? This is when she would "go hypo?"

Then she gets captured. Afterwards, DeeDee leaves with the insulin (but not on purpose), and Emily has to go find her right now, and cannot wait twenty minutes?

alegory
08-02-2011, 09:13 PM
That's not a bad idea.

But that would not make her hypo (=low). She would need her insulin because, without it, she would become high (hyperglcemic, I don't know why it's not shortened to 'hyper' but it isn't, as far as I'm aware, anyway). So yes, she would then start becoming ill if kidnapped and couldn't take her insulin but she would be able to wait 20 minutes because as someone else said, high's are not as pressing as lows. Does she have to have got the text? If not she might think that she has to go haring off after DeeDee...

underthecity
08-02-2011, 09:46 PM
One detail I've left out is that she's sharing this experience with her friend, who is also tied up and present at the scene. After Emily escapes, she unties her friend who tells Emily to "go get that b----" before she got away.

So, there are two cell phones at the scene, plus a house phone. I could go the cliche route and have DeeDee cut the phone lines (but they need it for the internet webshow, so they need the phone lines.)

DeeDee could smash both their phones, so communication would be cut off.

(And thereby silencing a potentially piece of damning evidence against DeeDee's brother. See other thread for details)

After DeeDee runs out the door, she could then cut the phone lines, thereby ending the live webshow. They will be unable to call out for help.

If Emily has no phone so she can't get a text, and has no internet, then she'd have no idea when help was arriving. All she knew was that her sister was coming "sometime." Maybe it'll be ten minutes, maybe it'll be two hours.

All she knows now is that help might not be on the way.

Therefore, she'll need that insulin.

And chases after DeeDee.

Does that work?

Selcaby
08-02-2011, 10:40 PM
Had a new thought, then. Before her capture, Emily's stomach growls, so she eats a Snickers bar with the intention of doing her last shot of insulin sometime soon. That candy bar was supposed to be for later, but she's having it now.

That would make her blood sugar go up. She would need insulin soon, shouldn't she? This is when she would "go hypo?"

Then she gets captured. Afterwards, DeeDee leaves with the insulin (but not on purpose), and Emily has to go find her right now, and cannot wait twenty minutes?

What alegory said. How about, instead, she takes the insulin that's supposed to cover her dinner, but doesn't have time to eat the food? Or eats something, but not enough? She reckons she'll eat the rest later, but she gets captured, so she can't.

It would probably take a couple of hours for her blood sugar to get dangerously low. Then it doesn't matter where her insulin is (she won't need it, unless it's time for her next routine injection) but she will need food. Even if she has some glucose tablets handy, they're not a substitute for a full meal. They'd only keep her going for a little while.

Selcaby
08-02-2011, 10:50 PM
There were symptoms that arose before her diagnosis.

In the first chapter, she cut her foot. The cut just would not heal until the doctor found it after she went to the hospital following football game. Also, she was feeling lethargic and starting to lose interest in things she liked to do, i.e. cheerleading. Plus she was thirsty all the time and was using the bathroom all the time.

OK, that sounds all right.


On game day, she ate little and was moving around a lot. She blacked out on top of the pyramid.

I don't understand how her diabetes makes her black out. Her blood glucose can't be low because she isn't taking insulin yet.

Perhaps she is just so tired, or desperate for a pee, that she loses concentration and falls?


When she is diagnosed, she "tells no one," meaning nobody at school or any of her friends. Her parents know, the principal and school nurse know, but that's it. She doesn't even tell her best friend; she figures it out later.

I thought your plot depended on the school staff not knowing? Perhaps I misunderstand the way cheerleading squads are organised.

rkr4cds
08-02-2011, 11:24 PM
If she can get hold of insulin she'll be fine in a few hours.
Everything was going great in this discussion - - - - until this response.
I had really hoped that we'd moved past the old dialog of past years and misinformation, in every type of media, when the first remarks were always "Quick, give them some insulin!"
The fact remains, in a Type 1 person, that they already have *enough insulin* in their/our systems and need food to balance it: a sugar/carb for a quick rise along with a protein or similar food to balance out the sustained effect and no sudden drop afterwards.

Out of curiosity, have you ever been around someone having an insulin reaction? While I think it can be a lovely thing to include characters with serious issues in novels, it can be off-putting to those who really deal with them to have an issue treated lightly or misrepresented. This is true whether it's a medical condition, or assault used as a cheap plot device and then tossed aside by the next chapter without the character suffering any after-effects.

This is a very scary, most helpless feeling, especially when the person is your own child. This happened countless countless times to our son, between his 4th birthday until he turned 38 (and living on his own but we jumped when the phone rang and heard a breathless voice "..Mom..?" until his first kidney & pancreas transplant took it away. You just try to get the food into them.. and wait until it takes effect. It's more than popping-a-few-tablets, because sometimes the person is almost instantly unable or unaware of the circumstances to e able to treat themselves.

Is diabetes the only disease you can think of which will pack the same instant import in your manuscript?

Hbooks
08-03-2011, 01:20 AM
I intended her to be physically exhausted when chasing after DeeDee. She should be thinking clearly at this point. Also, she's healing from a sprained ankle. In the ensuing chase, she's supposed to re-injure the ankle and get her leg put in a cast.

This is an option I hadn't thought of. How soon after eating something would she need insulin? And if DeeDee has that insulin, Emily would need it and runs after her. Would she "go hypo" at this point? Could she collapse? Could DeeDee be the only person at the scene who could help her? She has the stolen insulin bag.

My overarching worry with all of these scenarios, is that they're all quite a stretch. If you have the MC making a bad decision or two, eh, that's fine. But when your MC gets into one unlikely scenario after another, or proceeds to make a series of implausible choices, it hurts the credibility of the novel. I would gently suggest that it might be you're trying too hard to *force* diabetes to manipulate itself around your plot, rather than really looking at what it is to live with it and making the plot unfold naturally.

The school isn't going to just keep the diagnosis to the nurse and principals. That's useless. The nurse won't ever see Emily unless she comes to the nurse's office. Same with the principal. They're busy running the school. The teachers are the ones who have to know she's diabetic so they can pay attention for signs of hypoglycemia. Emily won't be allowed to leave the room to go to the nurse without another student with her. The teacher is forbidden by law to leave the class alone. So if Emily refuses to tell other students (which is her right by law), they'll have to page the nurse or an administrator to come down to the room to get her and escort her there each and every time she's low. This is the reality of schools today. They're very lawsuit conscious.

With the whole climax/chase thing, Emily's motivations have to be understandable. Since she's the MC and especially at the climax of her story, you want us to be able to identify with her and understand her choices. You generally want to build up a rapport and sympathy for your MC, especially at the end where she's hopefully gone through some character growth.

I would be surprised if DeeDee would know how to cut the phone lines and/or would take that step. That's not a typical teen skill and I don't understand why she wouldn't simply take the phones and toss them in a ditch along the way instead of going to the trouble of smashing them.

I wouldn't understand why Emily made the decision to chase DeeDee to get her insulin bag. Why? There's no motivation to do so. Having your blood sugar too high is not an immediate emergency in the same way being low is. You could go an entire day for many people before being in serious trouble. No, it's not healthy and you won't feel great, but that's all the more motivation that no way would she go tearing off after DeeDee in the rain and dangerous cold. Especially after the psychopath tied them up and cut the phone lines. She'd wait around for someone to come back and get her to some insulin. Add a sprained ankle? Even more motivation for why the heck would she choose to do that. If Emily collapses from being too low, then having the insulin bag is useless. She needs sugar, in that case.

alegory
08-03-2011, 01:31 AM
Perhaps she is just so tired, or desperate for a pee, that she loses concentration and falls?

This. Blacking out because of the diabetes seems a bit unlikely at this stage but the symptoms she will have been experiencing might cause her to lose concentration or be weakened enough to fall.



It's more than popping-a-few-tablets, because sometimes the person is almost instantly unable or unaware of the circumstances to e able to treat themselves.

Is diabetes the only disease you can think of which will pack the same instant import in your manuscript?

That top bit is definitely important, though I think you probably understand this already. It might also be worth noting that a person’s awareness of a low can be affected by how quickly it happens. For example, I tend to find I’m less aware (and more in need of help to correct it) if my blood sugar falls very quickly. Things like this might be especially important in the early days of diagnosis when she’s still trying figure things out.

I do think diabetes is working for the plot, though. You seem to be approaching it quite sensitively (I mean, you’ve actually bothered to research it!) and as long as you carry on thinking about what you’re doing, it should be okay... One thing I would suggest, though, is that you try and get a diabetic, or someone who has quite an intimate knowledge of the condition, to read your manuscript as a beta when you get to that stage, just to double check that everything in the novel is accurate and that you’ve not got minor misunderstandings bringing it down.

areteus
08-03-2011, 01:39 PM
Diabetic treatments have changed a lot in the past 20 - 30 years, not only the change from animal (porcine/bovine) insulins which were in use ever since the 1920's to human insulin (derived from genetically modified bacteria) but also the changing of attitudes to diet.

I read a book discussing the situation in WWII with diabetes. Even post insulin, doctors were still sticking to some of the bizarre 'no carbohydrate' diets which they'd used to prolong life before it was discovered (the thrice boiled cabbage being one). They added some carbs to the diets but they were still some wierd and wonderful ones. With the start of rationing, diabetics were basically left to it - the rationing system had no room for special diets, they ate the same as everyone else apart from permission to swap their sugar ration for something else. It was expected in the medical literature at the time for there to be many diabetes related deaths. There weren't. In fact, many diabetics prospered and got healthier. After the war they began to instigate diets which were more liberal than the pre war ones which, by the 1980s, led to the 'carbohydrate exchange system' which measured the carbohydrate content of a meal either in grams of carbohydrate (i.e. a portion of potatoes is assumed to contain 10g of carbohydrate, a portion of rice 5g) or in 'exchange units' where 10g = 1 unit. Patients were given a carbohydrate value for each meal based on their age and activity level and their insulin dose was set to take that level of carbohydrate into account. This was the system I was taught but soon after that (late 80s to 90s) they started to move away from it and reverse the technique. Instead of restricting diet, they now control insulin. So diabetics are allowed to eat however much they want (with concepts such as healthy eating in mind, of course...) and adjust the insulin to suit. The new regimes of insulin are designed for this flexibility and if it is the modern day I think any medical professional will consider this sort of regime for a young person who may have a very flexible life and a very active lifestyle - teenage girls rarely eat at regular times of day and the same amount every day.

So, I would do some research into these new regimes to see which one might suit your character best because the regime given to an older man may not be the one given to a young female (in fact, of all the diabetics I have known, none of us have the same treatment).

Selcaby
08-03-2011, 02:34 PM
I read a book discussing the situation in WWII with diabetes. Even post insulin, doctors were still sticking to some of the bizarre 'no carbohydrate' diets which they'd used to prolong life before it was discovered (the thrice boiled cabbage being one). They added some carbs to the diets but they were still some wierd and wonderful ones. With the start of rationing, diabetics were basically left to it - the rationing system had no room for special diets, they ate the same as everyone else apart from permission to swap their sugar ration for something else. It was expected in the medical literature at the time for there to be many diabetes related deaths. There weren't. In fact, many diabetics prospered and got healthier.

Very interesting. What's this book? I'd like to read it.


Instead of restricting diet, they now control insulin. So diabetics are allowed to eat however much they want (with concepts such as healthy eating in mind, of course...) and adjust the insulin to suit. The new regimes of insulin are designed for this flexibility and if it is the modern day I think any medical professional will consider this sort of regime for a young person who may have a very flexible life and a very active lifestyle - teenage girls rarely eat at regular times of day and the same amount every day.

This is what I was advised to do when I was diagnosed in 2002. It works well for me. I pay attention to nutrition information on food packaging, and I weigh out portions of things like breakfast cereal, pasta and rice. Cooking for one, and eating things that come in standard-sized portions, make my life easier. Actually portion size isn't everything, because different foods raise your blood glucose at different speeds, so the insulin doses I choose are based on past experience at least as much as on numbers.

At diagnosis I was told that if I felt 4 injections a day was too many, I could go on mixed insulin twice a day and have a stricter diet, but that they didn't think that was right for me as an active twentysomething woman. I agreed with them.

alegory
08-03-2011, 03:17 PM
Sound advice from areteus and that book does sound quite interesting.

I was diagnosed back in '94 and used a regime where I took a mixed dose twice a day (breakfast and evening meal) until around 2004 when I started the basal bolus regime. As said above, it really does enable a lot more flexibility. Thinking back on how I used to do things, I wonder why I didn't think of it as massively inconveient but then I guess it's one of those things where you don't really complain if you don't know any better...


Actually portion size isn't everything, because different foods raise your blood glucose at different speeds, so the insulin doses I choose are based on past experience at least as much as on numbers.


If you want more info on this, try looking into the Glycaemic Index (GI). It's probably not stuff you'd want to put much detail on in your novel but understanding more than you need will make your portrayal more solid (and will help you work out what to feed her if she's low, etc).

areteus
08-03-2011, 06:38 PM
If she can get hold of insulin she'll be fine in a few hours. Everything was going great in this discussion - - - - until this response.
I had really hoped that we'd moved past the old dialog of past years and misinformation, in every type of media, when the first remarks were always "Quick, give them some insulin!"
The fact remains, in a Type 1 person, that they already have *enough insulin* in their/our systems and need food to balance it: a sugar/carb for a quick rise along with a protein or similar food to balance out the sustained effect and no sudden drop afterwards.


This is a total misconception... Type I means no insulin at all, they lack the ability to create it due to the loss of pancreatic beta cells (usually due to some viral infection or other damage leading to an autoimmune response). Unless they inject insulin regularly, any carbohydrates they eat will end up in the blood and stay there - unable to be used by the body to create energy. This is hyperglycaemia or high blood glucose. Symptoms vary from person to person and can be the same as hypoglycaemia in many which is why paramedics rarely take action until they have tested the blood glucose to see which it is and then know if they should apply glucose/hypostop solution/glycogen injection to prevent low glucose or inject insulin to prevent a high blood glucose (well, to be fair, they might wait for a doctor to administer the insulin unless there was some of the patient's own there and they were conscious enough to give it themselves).

Now, in most cases of collapse of a treated type I, it is going to be hypoglycaemia - they have injected too much insulin or not eaten enough food or done more exercise than they were anticipating when planning their dose and so it dips too low and they have to eat something. The cause for collapse of an untreated diabetic (i.e. someone who didn't know they were until they collapsed) is going to be high blood glucose and, in fact, most diabetics are diagnosed after collapsing this way. In terms of first aid/paramedic response it is actually usually more critical to deal with low blood glucose quickly than it is to deal with a high blood glucose because the ill effects of the former are far worse in the short term and will keep getting worse whereas high blood glucose can keep getting higher with little change in condition.

In the situation the MC is in here, she has been denied both food and insulin for several hours (not stated exactly how long but up to a day). Because she has no insulin in her system (because she has not injected any) her blood glucose cannot go down at all but will continue to rise. How much and how quickly it rises depends on what and how much she eats but even if she eats nothing she will still get a small rise as her body starts to take glucose from other sources (glycogen stores and conversion of lipids in fat reserves) because the body thinks it is being starved because the glucose is not getting through.

areteus
08-03-2011, 06:39 PM
Very interesting. What's this book? I'd like to read it.



I can't remember the title, it was a very old book and one I found in a medical library being sold for pennies as out of date (medically, not historically :) ). I may still have it somewhere and so be able to post a reference.

underthecity
08-03-2011, 08:16 PM
I've been reading every post on this thread and now I have to admit my head is spinning. It turns out that I know absolutely nothing about diabetes, and sure hope I never get it--although it's possible since my father has it.

I'm still at a quandary about how this affects the main character.

For the purposes of story, I don't think I need to go into the minute details of her condition: food portions, insulin dosage amounts, that kind of thing. The diabetes should only be there as the story requires. It's part of her character, and how she is dealing with it is all subplot that occasionally spills into the main plot.

For instance, her blacking out on top of the pyramid--which sends her to the hospital early on--is supposed to have been caused by low blood sugar. For several chapters she had been exhibiting signs of diabetes, but didn't know it. Finally, due to exertion and not eating that day, she blacked out and fell off the pyramid. I had discussed this event with my former diabetic coworker who confirmed that such a thing could happen. If it's wrong, please explain how and I can make the necessary changes.

Regarding the character details after reading this thread, now I wonder:

Is she Type I or Type II? The amount of insulin she gets is arbitrary. But I put it at three shots a day based on what my coworker said.

Would eating a candy bar before being captured necessitate needing an insulin shot soon after? If not, then what would happen to her?


It seems my sequence of events during the climax is flawed.

Does she need to actually chase DeeDee for the insulin--even if she has no idea when help will arrive? From the looks of things, it seems she doesn't have to. Plotwise, Emily had to be active during the climax rather than sitting around waiting for help to arrive.

Then there must be some other vital reason for her to chase DeeDee.

One option is that DeeDee runs out (without the insulin) and Emily decides to wait for help to arrive. Minutes later, DeeDee starts terrorizing her in some other way and Emily must now act.

Regarding DeeDee and the phones.

I have another thread in the Research forum that explains DeeDee's motivations and what exactly is on Emily's cell phone. DeeDee smashes the cell phone so nobody will ever see the evidence on it. Then she smashes Emily's friend's phone because--well, it's all first draft stuff, so I guess she does it to be mean.

Then she "cuts the phone lines" in the house. In the first draft I wrote last night, after she smashes the phones the house phone starts ringing. Nobody knows who's calling. DeeDee looks around and sees a grey wire on the wall near the circuit breaker box that "looks like a phone line." She yanks it out and the phone stops ringing. And the internet connection goes down.

Now everyone is cut off from communication.


So, aside from all that is how Emily's diabetes figures into the climax. She might still give chase, but the circumstances of the chase might change.

Is she tired? Alert? Does she need insulin? Food?

areteus
08-03-2011, 08:53 PM
Untreated diabetics will not have hypos. What is likely to happen is a collapse from high blood glucose because she has been eating normally for a while without any insulin to deal with it. This is known as 'diabetic coma' and is a symptom of severe ketoacidosis which is the build up of toxins called ketones in the blood due to the body trying to break down fat stores really quickly because, due to the fact that none of the body cells are getting any glucose to turn into energy, the body assumes that the person is starving to death and takes steps to prevent that.

Incidentally, there were a number of cases of teenage diabetics, especially female, who deliberately stopped taking insulin just so that they would enter this state and so lose weight. A possible aspect for you to explore there...

It is HIGH blood glucose that causes the collapse in this case not LOW. A Type I diabetic can only get low blood glucose if they overdose on insulin or not eat enough/exercise too much. Before the collapse (maybe for several weeks) it is likely that she is also suffering several symptoms linked to high blood glucose. These include:

- A hell of a lot of urination. I mean a hell of a lot (when I was untreated I used to sit on the toilet pissing while drinking water...) and it will be very weak, watery urine. Because of this you also get:
- EXTREME thirst. As if you were in a desert and hadn't drunk in ages. And no matter what you drink you can't lose it. Some make the mistake of drinking sugary drinks which obviously makes it worse...
- Mood swings. Extreme shifts in mood which could be mistaken for typical puberty/PMT. Extreme anger being one.
- What is described as a 'general malaise' which means tiredness and lack of focus.
- Bad breath. Not at all coincidentally enough the same bad smell you get on the atkins diet (similar biochemical basis). This is the ketones. Sometimes referred to as a 'pear drops' smell.

Now in my case, my parents spotted these and had me off to the hospital before you could spit but most diabetics aren't spotted early enough and reach the stage of ketoacidosis where you collapse because you are not getting enough energy to live. At which point it is straight to the hospital and onto an insulin drip and, in my case, two weeks in the place stabilising the blood glucose and learning how to inject and balance food (which took longer).

Type I and Type II are very different syndromes and should not be confused. Cause and treatment are entirely different.

Type I, as discussed, is where the patient cannot produce insulin. Pancreatic beta cells are dead. They have to be treated by regular insulin or they die.

Type II is caused by something called 'insulin resistance'. This is where the insulin receptors do not work but insulin production is relatively normal. So, there is plenty of insulin (and injecting more makes little difference) but blood glucose remains high. Insulin resistance is an inherited thing and gets worse the older and fatter you get. This is why the first course of treatment is often diet (reduce weight, restore insulin absorption to normal) followed by tablets which create a passage for the insulin to enter the cells if that does not work. Some really bad Type IIs may end up on insulin and tablets because their pancreas beta cells give up and stop working...

Selcaby
08-03-2011, 09:19 PM
I've been reading every post on this thread and now I have to admit my head is spinning. It turns out that I know absolutely nothing about diabetes, and sure hope I never get it--although it's possible since my father has it.

My head spun too when I was diagnosed. Don't worry about it. The important thing is that you're learning.


For the purposes of story, I don't think I need to go into the minute details of her condition: food portions, insulin dosage amounts, that kind of thing. The diabetes should only be there as the story requires. It's part of her character, and how she is dealing with it is all subplot that occasionally spills into the main plot.True, readers don't need to know all those details. But if you know them, your portrayal will be more convincing.


For instance, her blacking out on top of the pyramid--which sends her to the hospital early on--is supposed to have been caused by low blood sugar. For several chapters she had been exhibiting signs of diabetes, but didn't know it. Finally, due to exertion and not eating that day, she blacked out and fell off the pyramid. I had discussed this event with my former diabetic coworker who confirmed that such a thing could happen. If it's wrong, please explain how and I can make the necessary changes.Let's recap some basics.


Food makes your blood glucose go up.
Insulin makes your blood glucose go down.
You need insulin all the time, but you need more after you eat.
If you're healthy, your body makes the right amount of insulin at the right time.
If you've got diabetes, your body can't make insulin any more, or can't make enough. Everything else about diabetes follows from this.
To treat diabetes, you inject insulin. (There are also drugs, but let's ignore those, because I don't think your character would be taking them. They are all for type 2 diabetes - see below.)
If you inject insulin, you have to work out day by day how much to inject. This is hard, because you don't know exactly what's going on inside your body.
If you inject too much insulin, that's when you have an attack of low blood sugar (a hypo).
The cure for a hypo is food, especially glucose tablets. Once you've eaten, you usually feel better within minutes.
If you inject too little insulin, your blood sugar gets too high. This is serious if it goes on for years (it can damage your eyesight, for instance) but it's not an emergency the way a hypo is. (Edit: I'm not talking about ketoacidosis here. That is more short-term and urgent, but it still probably takes days of missed injections to build up to it, not just an extra candy bar here and there.)
High blood sugar doesn't make you pass out unless it's extremely high for a long period, I don't know how long, probably days. It doesn't happen to people who have access to insulin and are sensible about taking it.

So no, your character cannot have a hypo until after she's started on insulin injections.

Someone was talking about being diagnosed with hypoglycaemia. That's the same word "hypo" is short for. I'm not an expert, but I expect what happens is that the hypoclycaemic person's body overreacts to rises in blood glucose by producing too much insulin, causing the same symptoms as a diabetic who's injected too much.




Is she Type I or Type II? The amount of insulin she gets is arbitrary. But I put it at three shots a day based on what my coworker said.As a teenager, she is far more likely to have Type 1. I'd stick with that. You already have her taking insulin, and you have the disease coming on suddenly. Those are hallmarks of Type 1. (People with Type 2 can go for years without realising they have it, and they are often treated with drugs or even "diet and exercise" instead of insulin.)

These days, four shots a day is more likely than three. You have one with each meal (you're not supposed to skip meals) and one shot per day of a different, long-acting insulin that sustains you through the night.

As a new patient, she's probably on Lantus or Levemir for her long-acting insulin, and Humalog, Novorapid or Apidra at mealtimes.


Would eating a candy bar before being captured necessitate needing an insulin shot soon after? If not, then what would happen to her?Ideally she should have an insulin shot, but the consequences if she doesn't won't be dramatic. Basically a milder version of the way she was in the days before her diagnosis.


Does she need to actually chase DeeDee for the insulin--even if she has no idea when help will arrive? From the looks of things, it seems she doesn't have to.I don't think she has to. If she can get away, then presumably she can go home where her spare kit should be stored (by the way, her spare insulin should be in the fridge, since it only lasts a few weeks at room temperature) or to a hospital if she needs a new prescription in a hurry. In the meantime the candy bar won't kill her.


Is she tired? Alert? Does she need insulin? Food?In the circumstances, she's going to be running on adrenaline, so she's going to be alert unless she is very sleep-deprived. Just like a healthy person.

If she had that candy bar earlier, then she probably does need insulin, but not that urgently. I don't think there is much plot tension to be found there.

If it's time for her next injection, the same applies. That should be her next mealtime (for her short-acting insulin) or bedtime or some fixed time in the evening (for her long-acting insulin).

If you want, you can give her a hypo. I'd foreshadow it by having her last meal interrupted (after she's taken her insulin). We've already said a lot about what happens with a hypo, so I won't go over it again.

alegory
08-03-2011, 10:40 PM
I'm in awe of Selcaby's response :D There's not a lot more to add to it so I'll just say 'I agree'.

underthecity
08-03-2011, 11:58 PM
Someone was talking about being diagnosed with hypoglycaemia. That's the same word "hypo" is short for.

Yeah, that was me. I was diagnosed in grade school as having it. Mostly, I avoid a lot of sugar, but don't feel any different.


So, I think I've come up with a solution. See if you think this works.



Emily's still tied up, etc. Dee breaks the phones. Emily frees herself. DeeDee's stun gun fails. She grabs Emily's insulin bag and runs out the door.

Her friend, who's still tied up, tells her to go get her insulin bag bag, she needs it. Emily stops and says, no, I'll be okay until help arrives. She unties her friend, go upstairs, Emily gets food, and they turn on the TV and wait.

Emily is exhibiting some kind of signs that she needs insulin. High blood sugar, maybe? Maye she was so worried she ate food she shouldn't have.

After a tense fifteen minutes, Emily notices a reflection in the TV. She turns around, it's DeeDee watching them through the window. Emily yells "hey," and just then the police and everyone arrive, lights flashing, etc.

DeeDee is gone.

Everyone is okay, Emily is taken in for observation, if need be, and life goes on (in summary).

DeeDee was never found; she disappeared. They wonder if she moved or changed names. Her parents have no idea. They think she ran away.

A month goes by. Emily and friend are doing their webshow. She gets a text. It says: Not funny Emily, not funny at all.

(Those are the same words from the very first harrassing text DeeDee (the mystery stalker) sent her.)

Emily is scared all over again. DeeDee must still be out there.

The end.



So, how about there is no chase? Instead, they do wait it out and are saved? But that's the false ending?

Or is Emily not being active enough in this version?

Selcaby
08-04-2011, 04:29 AM
Her friend, who's still tied up, tells her to go get her insulin bag bag, she needs it. Emily stops and says, no, I'll be okay until help arrives. She unties her friend, go upstairs, Emily gets food, and they turn on the TV and wait.

Emily is exhibiting some kind of signs that she needs insulin. High blood sugar, maybe? Maye she was so worried she ate food she shouldn't have.

I've got an idea. Where is Emily's blood testing kit? Mine's always in the same place as my insulin, so chances are DeeDee has taken it. That means Emily doesn't know for sure whether her blood sugar is high or low. She's tense and hyped up, so she's maybe a bit shaky from adrenaline, but this is also a symptom of a hypo, and it's likely she can't tell the difference, especially since she hasn't had diabetes for very long.

So she eats just in case it's a hypo, then worries that she shouldn't have done. It's not very dramatic on its own, but that could be a scene from my life.

Perhaps you need emotional drama instead of action. Those fifteen minutes could be when she comes out to her friend about her diabetes. That conversation changes her life, because from now on she can relax and feel like her old self again, knowing that her friend will be supportive.

In the early days after my diagnosis, I felt like I was fighting to stay the same person I had been and not change into "a diabetic". Gradually the feeling faded away, and now the diabetes is a part of me but not something I reject. I even celebrate it -- for instance, I've written about more than one science fictional device that looked just like a blood glucose meter.

I wouldn't be surprised if everyone who goes through a sudden life change experiences something similar. And for an adolescent, sense of identity is especially important. It could be why Emily's trying to hide, and in the end she could work out that she doesn't need to.

I can't comment on your final ending with the mysterious message except to say that if you think it suits the book, go for it.

alegory
08-04-2011, 03:29 PM
Perhaps you need emotional drama instead of action. Those fifteen minutes could be when she comes out to her friend about her diabetes. That conversation changes her life, because from now on she can relax and feel like her old self again, knowing that her friend will be supportive.


Emotional drama can pack just as much punch as action, more so if it's more plausible. Selcaby's right about teen identity and, especially after experiencing a traumatic event like being kidnapped, it's quite possible that Emily could end up reassessing her priorities and her reasons for wanting to hide the diabetes...

Oh, and just a thought... I can't remember if you'd decided on a reason for the bag (purse) being taken but if DeeDee is so determined to destroy the evidence on Emily's phone, would she be content to just leave it smashed and possibly open to recovery by the police? Maybe she wants to take it with her... If it's still in Emily's bag, would that give her a reason to take the bag and Emily's insulin with it if she leaves in a hurry?

As for your potential new ending- it has to be what you want to write. I read a bit of the other thread you made about the criminal justice system and you seemed quite keen to go down the route of court cases and those sort of things. Is this still something you want to cover because it seems you would lose all that if you went with this new idea... I think the new idea could work but is it the story you want to tell? Maybe it is, maybe it isn't... I guess it comes down to deciding which elements of your plot are most important to you and what sort of sacrifices you have to make to get to them. Worth thinking about, though.

areteus
08-04-2011, 03:45 PM
To answer a previous point: The book about Diabetes which I mentioned before was (I think, seems the most likely after a scan of the many medical books on my shelves) The Saccherine Disease by TL Cleave (who was actually an army surgeon according to the bio). The version I have was printed in 1974 but is an reprint of an older edition from 1966. I would not suggest this as a reference for the medical details of Diabetes (we've done some work since then in research terms as well as considerations on how to treat it :) ) but it was interesting in light of the history of the condition.

With reference to the above idea about her eating something she shouldn't without insulin... oh yes, can agree to that. I've done it myself - eaten when blood sugar was high because I mistook the symptoms and not bothered to test. Under stress and if she doesn't actually yet fully understand either the condition in general properly or how her body reacts (cos that takes time to learn) then she may well assume she is having a hypo and eat something and therefore make the problem slightly worse.

Given that when I was diagnosed it was stressed that hypos are bad, avoid at all costs because you could be driving or doing something dangerous when it happens and you may DIE!!! (to the point where I actually briefly developed a paranoia about hypos so I often ate more than I should to keep my blood glucose high to avoid the risk) I don't see a problem with this reaction. Usually, if you cannot test and have symptoms it is generally considered good sense to assume hypo and eat rather than assume hyper and inject - the former will make you only slightly worse in the short term if wrong whereas the latter could kill you.

There is a condition referred to as 'Hypoglycaemia' which has nothing to do with diabetes. This is a syndrome where the blood glucose is lower due to some other means than injection of insulin. I think one potential cause is a benign tumour of the pancreatic beta cells (which means you have more of them and they are pumping out insulin without any control mechanism so your blood glucose levels are not linked to insulin production).

Hbooks
08-04-2011, 03:55 PM
Perhaps you need emotional drama instead of action. Those fifteen minutes could be when she comes out to her friend about her diabetes. That conversation changes her life, because from now on she can relax and feel like her old self again, knowing that her friend will be supportive.

Excellent suggestion

underthecity
08-04-2011, 05:10 PM
It's an excellent idea, using those fifteen minutes for her to have a serious talk with her friend, but there's only one problem.

They have already had the talk.

A couple of weeks before her friend asks Emily why she hadn't told her about her having diabetes. By observation she noted the symptoms and figured it out.

So, in this climax scene, would it work just as well if they had a serious talk about something else? Emily has been keeping a nasty secret from her friend that was revealed during the earlier Big Reveal while they were tied up. Emily has some serious apologizing and explaining to do if she wants to keep that friendship alive.

OR, I could go back to that earlier scene and change it so Emily reveals the bad secret THEN, and save the diabetes secret for the climax. Not sure which is more critical.


Regarding the ending of DeeDee's story, what with her brother and the drug dealer murder and all that, it could still work since DeeDee gets away in the end.

The plot point I left out in the last post is that Emily's parents are pissed. On camera, DeeDee abducted Emily and her friend, stun-gunned them, then (either on purpose or not) took her insulin and ran out the door. They want to see DeeDee brought to justice, but she ran away. Not sure yet how this will all work out yet; I plan to start writing this revised ending today and see how it goes.

debirlfan
08-05-2011, 12:26 AM
I don't know if this will help you or not, but if you're looking for info on the latest state-of-the-art treatment/monitoring, one of the drivers in this year's Indy 500 race (Charlie Kimball) is type-1, and there was a considerable amount of coverage regarding it this past May - it should be easy to Google.

Fresie
08-09-2011, 01:06 AM
Hi,

another Type 1 here.

Actually, everything that can be covered seems to be covered by other people here, but I've just been reading long diabetes forum threads about Type 1 teens and, according to parents, it seems to be quite a problem that many teens tend to be in denial of their diabetes problem, to the point where they regularly skip insulin shots and don't do blood tests. Some type 1 teens (especially girls) develop a sort of eating disorder where they stop injecting short-acting insulin with their meals (and thus only inject fasting long-acting insulin once a day) in order to go into ketosis and lose weight (although you do realize, of course, that type 1s are generally skinny, not overweight, don't you?). I just thought that you might use these ideas to create some sort of inner conflict for your girl because apparently, at this age and with hormones wreaking havoc with their emotions, some type 1 teens attempt to rebel and reject their diabetes, which, of course, can in the long term cause grave bodily harm (blindness, leg amputations, kidney failure), much to their parents' desperation.

Another thing with type 1 teens is that they can be very manipulative as they quickly learn to use their diabetes as a handy excuse to get out of tasks they don't like, especially because people know so little about it, so your girl can blatantly lie in order to manipulate the criminals to her advantage, like saying she would die without a shot (which is never true, you can live with sky-high blood sugars for years before you develop any of the above complications -- a few weeks or even months off insulin won't kill you, unless you're really unlucky).

Just my two cents...