Saturday, May 18, 2019

Dr. Ponder, Endo, Joslin Medalist


Dr. Stephen Ponder is a pediatric endocrinologist in Texas. He is the author of the very popular book "Sugar Surfing". He is a type 1 diabetic, and he is a Joslin medalist. He will be a speaker in the Friends For Life type 1 diabetes conference in July. He has two sessions scheduled for the morning of Wednesday, July 17. My session is scheduled that afternoon at 3:15 PM.
Here is the link for the conference scheduled July 17-21:
Stephen is also a very inspirational blogger. Here is one of his blogs. I really like this one.
The Wall (revisited)
June 7, 2018
Stephen W. Ponder MD, FAAP, CDE
27 years ago I learned an invaluable lesson about living well with my diabetes. It happened in a most unusual way. It has remained with me ever since.
I was working as Medical Director at the Texas Lions Camp for Children with Diabetes. One afternoon I was covering camper activities at the high element ropes course. There was a new 75-foot climbing wall that the campers would attempt to scale. When they reached the top they would ring a small victory bell.
After all the campers had their turn to climb up the adult staff were offered a chance to participate. I was very eager to do it.
But each attempt I made to scale the wall seemed futile. I'd get no more than 10 to 20 feet up and fall off. Time and time again I failed. Quickly, I became frustrated. Excuses began to flow from my mouth. I said there was no way I can do this. I was heavier than the kids. Too old. Weak. Just about any other lame reason or excuse I could conjure up was said. It was a major whine.
The young man who oversaw the activity witnessed my frustration (His name was Todd). He said to me "Dr. Steve, let me show you how to do it".
Todd had only one arm. He lost his left arm above the elbow to bone cancer when he was very young. I watched dumbfounded as Todd scaled the entire wall in a matter of seconds: using both legs and ONE arm. With a feeling of combined awe, embarrassment and deep humility, a warm feeling suddenly came over me. A true epiphany.
I learned a life lesson which has carried me forward to this very day: that while I can always find something to complain about, make excuses for, rationalize away, or simply dislike, the only thing that truly limits me is myself...my attitude and belief in my own abilities. You see, Todd was different…but hardly abnormal. In fact, he accepted no limitations and placed none on himself. I thought to myself that I wanted to be like that guy, not limited by my differences.
Such an incredible lesson I learned one sunny afternoon at diabetes camp in 1991. Type 1 diabetes may make me and many other people 'different', but we should never look at ourselves as abnormal. And most of all, never use our differences as excuses for the things we wish to do or accomplish for ourselves or others. Many of the barriers we place before us are of our own creation. Ironically, I tore down a wall as I scaled another one.
After watching Todd scale the wall, I made the trek to the top and rang the bell. He not only showed me the proper technique, but most importantly, the proper attitude. I often reflect on that day.
I respect everyone’s right to be unhappy, complain, or just simply be mad about whatever angers them. There is absolutely nothing wrong with that. But as I’ve said so many times, life with diabetes is all about choices, and I CHOOSE to look at my condition differently. Todd made a similar choice about his life and I learned from his example.
In the natural world, I should have died after March 1, 1966, the date of my diabetes diagnosis. I am kept alive and relatively healthy each day by artificial means (injected insulin, meters, sensor, etc.…) and my wits. That’s a gift I choose to not complain about. Every day of my “second life” has been a gift. I consider each day I awaken on this Earth with equal thanks and gratitude.
Some of you may wonder why most of my FB posts about diabetes are usually positive and empowering. Now you know why. I have shared this story before with campers. Many could relate, and some just listened politely. We can learn valuable lessons about living well with diabetes or any other life challenge in some of the most unlikely of places or situations. This is one example.

Saturday, April 27, 2019

Keeping My Diabetes A Secret....

When I was diagnosed in 1945, I was not actually ashamed of my diabetes. I did not realize what was happening. I was six years old, and my family was in charge. Later on it was obvious that people we knew were totally oblivious, they had not heard of the disease. Our relatives, neighbors, my teachers, and my classmates in school could not understand what was involved. People would stare in disbelief when I tried to explain my diabetes. Of course, explaining was very difficult since neither I, my family, nor my doctors knew much about it. I could not explain the highs and lows, DKA, carbs, and the possible complications since I knew nothing about them for so many years. My doctors gave no information except that I should take a shot of insulin each morning, and not eat sugar. It seemed like a simple disease back then. I got tired of seeing the doubtful looks on people's faces, and I kept my diabetes a secret for a very long time. My mother went to my school on the first day of classes for seven years, and had private talks with my teachers. Those teachers had not heard of diabetes, but I think they believed her. To prevent low blood sugar, I was not permitted to participate in gym or on the playground. I felt like an outcast, and I was ignored by my classmates because I was so different. I became shy and withdrawn. That was the most complicated part of my diabetes during my early years.
In high school I was more mature, and I had less trouble with it, so I opened up with a few friends. I did not talk to my teachers, but I did not have lows during school hours. My blood sugar was high almost all the time, but I did not have any DKA, or did I? I don't think there was a way of measuring ketones at home, and there was no glucose meter for my first 40 years. In college I talked to some of my teachers, and they actually listened, somewhat. I had friends who were concerned, but they did not understand this mysterious disease very well. I didn't either, at that time.
When dating I did not tell my girlfriends about my diabetes. It was not necessary, and I was afraid that they would not want to date me if they knew. I did not have lows, so that was okay. My lows occurred during the night, at home, or when I had too much exercise. After college I told my dates about diabetes, and they were interested. They listened, and wanted to help! I married one of those young ladies, and she has been a tremendous help to me for almost 55 years!!! Anita has helped me through many lows, including several seizures. I think she has saved my life several times.There were glucose meters in the mid 1980s, and I finally knew my blood sugar numbers. I learned about carbs in the late 1980s, and started basal/bolus management in the mid 1990s. My A1c's dropped from a high of 12 into the high 5's over a period of several years. How I have managed to avoid serious diabetes related complications is a mystery to me. I was not taking good care of myself for 50 years, because I did not know what 'good care' was. Now I am taking very good care of myself. My using an insulin pump in 2007 has eliminated my needing any assistance with lows. I am also using a Dexcom CGM, which is very helpful.
I am not at all shy and withdrawn about my diabetes now. Maybe I am too open? I do not hold back because many online people tell me that I offer inspiration and hope for themselves, or their type 1 children. That is why I chose to be a speaker at the Friends For Life type 1 conference in 2015, in Orlando. I am scheduled to do that again this year on Wednesday, July 17.
My life with diabetes is an open book. I actually did write a book about my life with diabetes. It was published in 2010, and it describes my first 64 years with type 1. Here is the link:
https://www.amazon.com/Beating-Odds-Years-Diabetes-Health/dp/1450515967/ref=sr_1_1?ie=UTF8&s=books&qid=1268873383&sr=1-1

Friday, April 12, 2019

Diabetic Seizures


Throughout my early years as a diabetic I had no major health problems, and I coasted along rather easily. I was always very skinny, maybe slightly underweight, until many years later. I had high urine sugar during the day, and usually at night. There were, however, some nights that I had very bad hypos. My bedroom door was always left open at night, and my room was immediately across the hall from my parent's room. Mother was keyed in to my thrashing about, and the moans I would make when having a hypo. She would jump out of bed, and grab a glass containing several tablespoons of sugar. She stopped at the bathroom, partially filled the glass with water, stirred the mixture with a spoon, and entered my room. Daddy raised my body, sat on the bed behind me, and held me while Mother slowly poured bits of the sugar water into my mouth. This usually worked very well, but occasionally my mouth was shut so tightly that she could not get any of the liquid into my mouth. Some of these hypos were very bad, and they became seizures. It took a long time to get me to the stage that they could get me to drink some of the sugar water. She would rub some of the liquid on my lips, and I would lick my lips. This gave me just enough sugar so I would start to relax, and then she could get me to swallow some of the sugar water. I would come out of these seizures, not remembering any part of what had happened. I would clinch my muscles while having a seizure, and there was much soreness for days afterwards. I ground my teeth together, and there was damage to those teeth that is still present today. I have read that some people have bitten off parts of their tongues during a seizure. I am glad that never happened to me. I was always so grateful that my parents took such good care of me at those times. Our family home back then was north of the city of Roanoke, Va. The nearest hospital was far away. An ambulance would have taken a very long time to reach us. That is why my parents needed to handle my seizures without additional help.

I have no idea how many of these seizures I had before I was an adult, but I know there were many of them. I attended local colleges, and lived at home during those years. I did not leave home until I was 23. My first full time job was teaching math at a college three hours from my home. I met a young lady named Anita there. She was a sophomore. Teachers were permitted to date students at that college back then. We dated during my first year of teaching. We were married in 1964 after only seven months of dating. Maybe that was too hasty, but it has worked perfectly. We have had a wonderful marriage for 54 years now. I had a few seizures after we were married. Maybe two per year. They were not as frequent as they were when I was still living at home. Mother had instructed Anita on how to care for me during a seizure. Anita handled my seizures perfectly. She remained calm, and used the sugar water treatment just like mother had done. I think it was in the mid 1980's that I had my last seizure. There was one that was very bad, and I was hospitalized. Anita had not been able to bring me out if that one. That was the only time that I was hospitalized with low blood sugar.

In 1980 I had my first A1c testing, and in the middle of that decade I had my first meter, Finally, I could measure my blood sugar at home. I learned about carbs and the effect on blood sugar, and my diabetes management improved. My seizures occurred during my first 40 years after diagnosis, before all this new knowledge, and having a meter. If we had a meter for testing, basal and bolus insulins, and carb counting during my earlier years, things would have been very different. There would have been less serious hypos, without the terrible lows that caused seizures.

I know that some of my Facebook friends have had seizures soon after diagnosis, while learning how to care for themselves. I have read about children having seizures, and their parents giving them the needed care. This results in trips to the ER on many occasions. I have joined several parents groups, and have read about the problems that occur with child care, with diabetes. I have been welcomed to those groups since I was diagnosed when I was 6, and have lived with type 1 for 73 years without any serious diabetes complications. When parents hear about my past, they realize how much better things are now. That gives them some calm, and peace of mind. It is still very difficult to manage a child's diabetes, especially soon after diagnosis. I am glad there is so much knowledge today, knowledge that was not available in the past. That knowledge, and the devices that are now available, makes diabetes management so much better.

There has been some speculation that seizures can cause brain damage. I have not had that problem. I had a college education, and became a math professor at the college level. I do not think seizures would cause brain damage, unless they were very severe. A seizure that resulted in a coma might cause brain damage.

Glucagon injections can be given at home in modern times. That is the best way to handle a seizure. You can get a prescription from your doctor for glucagon. This assumes that the seizures are due to diabetes, and very low blood sugar levels. Seizures can also be caused by other conditions such as epilepsy.

The following link from the Mayo Clinic gives very good information about seizures.
https://www.mayoclinic.org/diseases-conditions/diabetic-hypoglycemia/symptoms-causes/syc-20371525

The next link gives a good presentation on diabetic seizures, and concludes with replies made by people who have seizures. You can add your own  case, or reply to the people who have posted there.

https://www.thediabetescouncil.com/diabetes-and-seizures-what-are-they-what-are-the-symptoms/

Tuesday, April 9, 2019

October, 2008....60+ Years Of Type 1 Diabetes

The American Diabetes Association was created in 1940, five years before my diagnosis. The ADA magazine, the Diabetes Forecast, began in 1948. In October, 2008 the magazine celebrated its 60'th anniversary. There was a search that year for people who had lived with type 1 diabetes for 60 years, or more. Eleven people were chosen, and I was one of them. The October issue had an article with stories and pictures for those individuals. A photographer came to my house in NY in August of that year. The pictures he took appear in the magazine. (See below.)
The most impressive individual in the article was William Rounds (1922-2010). William was diagnosed with diabetes in 1923, less than a year after he was born, and only 2 years after insulin was discovered. He was T1 for 87 years the year he died. He attended the Joslin Medalist meeting in Boston in 2009. I did not attend that year, but I wish I had. My first time attending the Medalist meetings was 2011, the year after William died. William's picture appeared on the cover of the Diabetes Forecast in the October, 2008 issue. (See below).
The link below shows the article with pictures and stories about the eleven individuals chosen for that issue. The stories appear in a jumbled arrangement, and mine appears on the left side of the page, starting with "Just don't eat sugar...".

For The Love Of Hypos



This is the Truth!!



Monday, April 1, 2019

Sunday, March 24, 2019

Urine Testing in the 1940's and Beyond

I was diagnosed in 1945, when I was 6. There was no blood testing device for home use at that time, so my father tested my urine every morning. That was the only test done each day. Benedict's solution (1) was placed in a test tube, and several drops of urine were added. The tube was placed into a tin can containing a few inches of water. The can was placed on a burner on the stove, and the water was boiled. The tube was then removed from the can, and the color was observed. The picture below (2) shows the possible colors that might have been seen. The original color of the Benedict's solution was blue. If the color was still blue after the boiling, then there was 0% sugar in the urine. If the urine contained sugar then there was a progression of colors that could appear. Blue-green showed a trace of sugar. The higher sugar levels showed green, yellow, orange, and red. Red was the color I always hated to see because it represented very high urine sugar.
Urine testing was a very poor indication of the amount of sugar in the blood. I usually had a lot of urine sugar before breakfast. My doctor did not suggest testing urine sugar at any other time of day. We should have been given instructions to test my urine before each meal, but more frequent testing could have been misleading. If I did not pass any urine between breakfast and lunch, there would still be sugar in my urine if the morning test showed a significant amount of sugar. The urine test would have shown high sugar, but the blood sugar might have been low due to the effect of the insulin taken that morning. There was usually very poor correlation between the amounts of sugar in the urine and in the blood at any time of day.
In 1941, four years before my diagnosis, there was a somewhat better way of testing urine, called CliniTest. It involved placing a tablet in a test tube containing water and urine. The mixture would fizzle and become very hot. Then the mixture would show some color. Comparison of the color with a chart provided the estimated amount of sugar in the urine. The picture below (3) shows the apparatus used in performing the CliniTest procedure. No doctor ever told me about CliniTest, so I continued using the Benedict's solution, and boiling the mixture on a stove.
I was married in 1964, and the same urine testing routine was continued until I purchased my first roll of Testape (4). Eli Lilly introduced Testape in 1954, but it was many years later, after my marriage, that I discovered that product. I was able to dip a piece of the tape into my urine, and then see the color that was produced. The natural color of the tape was yellow. If the yellow color was present after dipping into urine, there was no sugar present. When sugar was in the urine, there was a green color on the tape. The darker the green color, the more sugar was present. I carried a roll of Testape in my pocket, and tested before each meal, even when away from home. That was a much improved way of testing my urine sugar.
I used urine testing for approximately 40 years. It was not until the mid 1980s that I bought my first glucose meter to test my blood. My first meter was the Accu Check II (5). My diabetes management became so much easier, and more accurate, with the actual blood sugar levels being revealed several times each day. There were finally numbers instead of colors. I needed to study those numbers to improve my control. My blood testing showed very high numbers, sometimes in the 300s. Numbers in the mid to high 200s occurred frequently, especially after meals. There was no fast acting insulin to prevent those post meal highs. Accu Chek called me each year, and asked me questions about the my use of the meter. When they introduced new models, they sent me a new meter. That happened at least twice during the 1990s. The newer models were smaller, and they gave me numbers much faster. My diabetes management was much better. 

I learned about carbohydrates, and their effect on blood sugar, in 1988. That knowledge, and the improved meters, enabled me to have better blood sugar control. My A1c's started in 1980. I had A1c's in 
the 10-13 range at first. After 1988 my A1c's improved a lot. That was the beginning of a significant improvement in my diabetes management. I will never know how I survived all those year with very high urine and blood sugar. I feel that I may have had DKA at times, but I did not have any diabetes related complications during those early years (1945-1995). I started using a faster acting insulin (Humalog) in the mid 1990s. That is when my A1c's were greatly improved. For almost 20 years, I have had A1c's in the 5.4-6.4 range.