Sunday, February 7, 2016

My Life With T1, Part 13

My Life With Type 1
........Part 13........
After retiring and teaching part time for a few years I was having good blood sugar control with A1c's below 6.0. Doctor B. would walk into his office with a big smile on his face and say, with his heavy Thailand accent, "nondibeetic". He would go over every line of my extensive lab report, and discuss anything that needed discussing. He had much blood work done every three months ever since I first became his patient in 1977. Almost everything in the report was good except for a few occasions. My cholesterol was 280+ one visit. I took several meds, and finally settled on Zocor. In Nov. 2007 my cholesterol had dropped to 128. I had bad reactions to Mevacor and Questran, but Zocor was much better for me. At the present time (2016) I am using Crestor. In the 1990's my kidneys showed some sign of hyperfiltration. I started taking Altace, which is primarily intended for lowering blood pressure, but it has a side effect of stabilizing the hyperfiltration in the kidneys. My kidneys have been great ever since. In early 2007 my blood pressure was 145. Dr. B. gave me a Rx for water pills, and prescribed Altace. I started experiencing dizziness with the Altace, and there were times I fell down. I started taking Lisinopril, and I reduced my dosage from 10 to 5 mg, without asking my doctor. My doctor approved when I had my next appointment. My blood pressure has been somewhat higher ever since. I test my blood pressure at home too, and it stays between 115 and 135. Dr. B. is the only doctor I have had who had extensive testing like this done.
All other blood tests had been great, with one exception. In August of 2002 my PSA count was 4.2. The previous year it was 3.0. This test is to determine the size of the prostate gland. Now 4.2 is a very low number, and would not normally be anything to cause concern. Dr. B., however, is very cautious on all matters. He sent me to a urologist who told me I was probably fine, but he had twsting done, just in case. The test did not indicate anything was wrong. The urologist still wanted to do a biopsy. His concern was not the number itself, it was that 4.2 was a 40% increase over the 3.0 from the preceding year. A 40% increase is significant. The biopsy showed I had cancer. After an MRI and other tests, it was determined that the cancer was totally contained in the gland. The little cancerous tumors were so small that they did not show up on the X-ray. They were microscopic in size. Dr. B's cautious nature resulted in such an early diagnosis that I did not have to have surgery to remove the gland. That is considered to be major surgery, when it is done. I had radiation treatment done in Jan. and Feb. of 2003. On each of 41 visits to radiology I received 6 jolts of high intensity X-rays into my lower abdomen to destroy my cancer. That is a lot of radiation. It worked perfectly, but there were very unpleasant side effects that continued for about two years. I developed anemia. Iron tablets helped. Damage was done to my intestines, but it was kept under control, and when the bleeding in my bowels stopped two years later I was in good shape. I was told that there was an 80% chance that the cancer would never return. I saw my radiologist doctor each year with good reports. After ten years (2013), he told me that he would not need to see me again. I learned that males used to be checked for prostate cancer in their early 60's. In the present day men should be checked by the time they are 40 because prostate cancer has been found in men who are in their 40's.
I still had a significant amount of overweight in the early 2000's. I bought a treadmill, and started strengthening my leg muscles. After several months I could walk a mile in 20 minutes using a 7.0 incline on the machine. By reducing my daily carb intake to 150 carbs and using the treadmill I managed to lose 26 pounds. I still needed to lose more weight, but I felt great, and I had to buy new trousers since my waist size was 4 inches smaller. I leveled off and stayed at that weight for several years. I was pleased I was not gaining more weight.
In 2006 I watched a dLife TV broadcast and heard them advertise the dLife website. I joined the support group on dLife on July 4 of that year. I really loved it. I made friends there. Janis Roszler was a moderator for dLife. She is a CDE, a RD, and has written three books for diabetics. I enjoyed her comments on dLife, and the help she gave the members there. I spent several hours each day posting on that site. I was giving much support and advice. Janis encouraged me to become an ambassador for dLife. There were four of us ambassadors then. We were not moderators but we were the ones most likely to welcome, advise and support the members as needed. By Dec. of that year the other three ambassadors were working hard at their jobs and, since I was retired and had more time, I did almost all the work the four of us had been doing previously. I did too much though. I was burned out, and I sent Janis an email. I was through posting there. I went back there occasionally to visit friends.
I wanted to join a new and larger site so I typed "diabetes support forums" on a search engine. The first site listed was dLife and the second wasdiabetesdaily.com. That was late Jan. of 2007. I had never heard of that second site, and I immediately joined. I was so impressed. It had so many wonderful features that I had not seen on other sites. I was really hooked. What a wonderful job David Edelman had done in creating this superb site!!! I felt so fortunate to be a part of such a wonderful group!
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In the early 1980's I was teaching a class in basic Statistics at the community college. All students in the nursing program at the college were required to take the Statistics course. I was the only teacher there with a degree in Statistics, so I taught most of the Statistics classes at that time. I taught many nurses through the years. In the summer of 198? I had about 10 nurses in a Statistics class. It was an evening class. I left my office and started my walk to reach my class, I had blurred vision, and I was very dizzy. It seemed to hit me so suddenly. I reached for my container of sugar in my pocket. It was not there. I recognized one of my students in the hall, and asked him to go to the classroom to tell them I would be late. I fumbled in my pocket for change to use the candy machine. No change. I had no one dollar bills to use in the machine. I should have gone to my class and asked for help but I was not thinking clearly. I went outside to my car. The parking lot was rather dark and my vision was so bad that I had great difficulty finding my car. I finally found and unlocked the car door. I knew I had a roll of quarters I used for tolls. I grabbed the roll and headed back to the candy machine. It was not in the same building as my class. My hands were shaking, and I dropped several coins. My vision was so bad that I had to feel for the coin slot. I managed to get several coins in the slot. I could not read the letters and numbers so I just pushed buttons and pulled knobs until something dropped. I felt something, but did not know what it was. I wanted candy but I had a big cookie with some sticky stuff between layers. I gobbled it down, and headed to the other building to meet my class. I was about 15 minutes late. I explained what had happened. The nurses were all over me for not asking them to help. A couple of them were perhaps in their late 30's, and had been nurses in a local hospital for years. They were at my desk, feeling my pulse and asking me questions. The class started late, but I have always bounced back from these hypos wery well. The class was about 2 1/2 hours long but it was Ok that evening.
Two days later I had a terrible hypo during the night, and my wife could not get me to eat anything. I was convulsing, and she called an ambulance. They were there promptly, and gave me a much needed injection. I was hospitalized for two days. One of the nurses from my class waited on me there. Another nurse from my class kept dropping in even though she was on duty in another part of the hospital. That was a weekend, and I was back in class Mon. evening. Everyone knew what had happened by the time I got to class. Those nurses took good care of me both in class, and at the hospital. That was the only time in my first 34 years of teaching that I had such help, or need of help, from my students.

Friday, February 5, 2016

Diabetes is the Leading Cause of...??

"QUESTION: How many of you believe that diabetes is the leading cause of blindness, kidney failure, and amputations?
FACT: Diabetes is NOT the leading cause!!!
POORLY CONTROLLED DIABETES is the leading cause.
If your initial answer was "Yes", this might lift a weight from your shoulders. If you have good control, you would be no more likely to have those complications than a non diabetic."
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The above message was given by Riva Greenberg during her interview ontudiabetes.org. She talked to us and answered questions on Friday, Feb 1, 2015. Riva is a dynamic speaker, and she was well received by the group listening that day.
I think this implies that complications are caused by the diabetics who do not take good care of themselves, rather than being caused by the disease. I have some disagreement with the message. The message certainly says that taking good care of ourselves is very important, and it is true that reduces the likelihood of the complications mentioned.
I have participated in the Joslin Medalist Study in Boston. The purpose of the study is to determine the factors that have enabled many type 1 diabetics in the US to live for 50 years, or more, and usually avoid the more serious diabetes related complications. 1000 long term type 1 diabetics have participated thus far.
In Dec, 2009, when I participated, the lady in charge of the examination given to me gave me some interesting information. She said some participants had not taken good care of themselves, but are healthy and complication free. Others have done their very best to have good control, but do have complications. These smaller groups of diabetics are the exceptions to the rule. The great majority of the participants, like me, have worked hard to have good control, and do not have any serious complications. So Riva's statements are not always valid, but they are valid for most of the type 1 diabetics in the US today.
What are your thoughts?

Tuesday, February 2, 2016

My Life With T1, Part 12

My Life With Type 1
........Part 12.......
This chapter is dedicated to my sons, David and Gary.
David was born in Monroe, NC on Sept. 21, 1966. He was a perfectly normal baby, and he had a perfectly normal childhood. Things were a bit different with Gary. We were living in Richmond, VA west of the city, in Tuckahoe Village. The village was a housing development that built in swampy region. Tons of soil had been used to build up the area so houses could be constructed there. Days before Gary was due to be born we had a lot of rain. The roads leading into the village were at a lower level than the village itself. Some of those roads were covered with water a few feet deep. The village had become an island. We could not get off our island. We found that there was a doctor in the village who agreed to deliver Gary if it was necessary. We were lucky though, the rains stopped the day before Gary was born, and the water was not so deep. We made it to the hospital, and Gary was born on Sept.9,1969 No problems after that. We had a few anxious hours before the rain stopped though.
I have been diabetic since age 6, and never thought anything about taking my insulin when the boys were present. It has been so long now that I cannot remember if they were curious about me injecting. They grew up with it, and it was just a part of our everyday routine. I tested my urine in the bathroom, and there was no glucometer for my testing my blood sugar until they were in their late teens. So there was very little evidence of me even being diabetic. I was running highs almost all the time, and there were rarely any hypos. I must have seemed like a normal daddy with no health problems. In later years I discovered I had been running blood sugar that was much too high, so I was not so healthy as I had thought.
When we moved to New York David was 3 and Gary was 11 months old. My birthday is Sept. 10, Gary's is Sept. 9 and David's is Sept. 21. Gary was 3 weeks premature, and was almost born on my birthday.
When Gary was preschool age we noticed that he was very bright but, there was something wrong and we could not identify it. He was having trouble in school. We took him to a center in Kingston where he was tested. He could not respond well to written questions, but showed very high intelligence when he responded to questions given orally. We were referred to an expert in learning disabilities. Mrs. R. said that Gary had learning disabilities, and she told us she could work with him. She would enable him to correct those problems. She worked with Gary for two years. He began making better grades in school. When he was in high school he was such a great student that they kept yanking him out of classes, and putting him in accelerated classes. He was extremely bright! Mrs. R. really knew what she was doing with Gary. We were so lucky to have the help of such an expert way back in 1976.
When David was very young he wanted to grow up, and drive a fire truck. Later on he wanted to be a magician. He put on magic shows for us, and his grandparents. He did very well in school, and he was also placed in advanced math and science classes. He attended the community college where I taught, and thought he wanted to enter the business field, then he wanted to be a doctor. He made B's in both introductory business and biology courses, and was discouraged. He then decided that he would major in computers. Finally, that was what I wanted him to do in the first place. Does this sound familiar to anyone? He was an excellent computer student, straight A's all the way. He received his BS in computer science at Marist College in 1987, and then was awarded a research assistantship at Georgia Tech in Atlanta.
Gary was much more into math and science than David. He majored in engineering, and took several computer courses too. He was the only person during his two years at the community college to make A's in general and organic chemistry, and physics. He graduated from the community college with a 4.00. We were so proud of both of them. Gary joined David at Georgia Tech in 1989, and he majored in computer engineering. They both earned their MS degrees there.
David worked one year at the Center of Disease Control in Atlanta, in their computer center. Near the end of his first year there he was interviewed by a representative of a new group that eventually became known as webmd.com. He was put in charge of designing and implementing the basic vehicle that we know as webmd.com. He had nine other computer people working under him.
Gary became an expert in information technology, and worked for a pharmaceutical research facility in the research triangle in Morrisville, NC. He love his work.
David married a beautiful Chinese girl and they have a daughter Vanessa now 12 years old, and a son Jason, now 8 years old. They live in Atlanta. They are a very happy family. Thank God that none of my children and grandchildren are diabetic. David is now 49 and Gary is 46. They have beautiful homes, and happy lives. Gary is still single.
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When my sons were quite young I wanted to take them out west to see Yellowstone, the Grand Canyon, the canyon lands and many other interesting sites. We had a family meeting and I gave my sons a choice of the big vacation that I had explained in detail, or they could choose a computer instead. That was the first PC released by Apple, before IBM had released its PC's. My sons had no difficulty deciding. They wanted a computer. We were very short of spare cash, and we could not afford both a vacation and a computer. If they had not chosen a computer I wonder if that would have affected their futures. We were saving every bit of money that we could for their college education. Their majors in college were in computers, and their lives have revolved around computers ever since. I am happy that I gave them that choice. Rats! I really wanted to go on that vacation.
Pictures: 
David and his bride-to-be in 1999; Uncle Gary holding Vanessa in 2003; Anita holding Jason in 2007.









Sunday, January 31, 2016

Advice for Parents of T1D's

A wonderful interview with Barbara Anderson about parenting type 1 children. Barbara is a clinical psychologist, and a teacher of pediatrics. I wish all parents of T1D's would read this. She gives excellent advice.

Saturday, January 30, 2016

My Life With T1, Part 11

My Life With Type 1
.......Part 11.......
It was August of 1970 Anita and I were in Kingston, NY, far from familiar surroundings in Virginia. People talked so differently! We walked into a little shop and the young woman at the counter asked "Can I help yous?" What did she say? I thought "yous" might be like a plural for "you". I had never heard that word before. I talked with a southern drawl, and people told me I sounded like Andy Griffith, and Jimmy Stewart. After 45 years of living in NY I still have a little of that southern accent. You can take an ole' boy out of the south, but you cannot take the south out of the boy.
I was nervous about teaching in a NY college. The students had a much better high school background than most of my students in the southern colleges. High schools in the north are typically given much higher ratings than those in southern states. My fringe benefits package in NY was vastly superior to what I had in the south. In all the colleges in which I taught in the south the fringe benefits were very poor and almost nonexistent. During the beginning weeks of my first year teaching there there was a strike by the teaching staff at my college. I could not believe it! The best salary and fringe benefits I had ever imagined, and the faculty wanted more, along with higher salaries. I could not relate to any of that. I explained my feelings, and my fellow faculty members seemed to understand, but classes were not held while faculty picketed in front of the college. I did not participate in the picket lines. I just watched. Some of the faculty members were arrested and jailed for one night. The community college is a state college, and striking by faculty is illegal in NY State. I was happy that I was not arrested, but I was sorry for my friends who spent the night in jail. After a week or so the bargaining between the faculty and the county ended. Fringe benefits were even better, and there were faculty wage increases of 20% retroactive for the preceding year, and another 20% for the year in progress. The faculty won at the bargaining table, big time! I got the benefit of the raise for the current year, and that was a big bonus that I felt I did not deserve. I did not participate in the strike in any way. If a faculty in a southern college even talked about striking, heads would roll and it would never take place. Things were sure different in New York.
My years of teaching at Ulster County Community College were very enjoyable. My diabetes gave me very little problem. Dr. B. became my doctor in the late 1970's, and my diabetes control routine changed drastically. I started carb counting in the late 1980's, but was not keeping any logs until a few years later. I had much lower test results with the use of a glucose monitor. I eventually adjusted to lower blood sugar, and my diabetes health was improving. I had more frequent hypos though, and that was a major concern. My A1c's were taken in the mid 1980's, and they gradually improved. Dr. B. knew that I had frequent hypos, and in the late 1990's he had me use an NPH/Humalog mix. I had many highs and lows, but better A1c's because the high and low readings gave a good average blood sugar level and good A1c's. I think I may have had A1c's in the 7's at that time. I eventually convinced Dr. B. to let me use separate vials of NPH and Humalog. That way I could take meal boluses with my Humalog, and my carb counting could really help me. Dr. B. had hesitated to do this because he thought that my taking separate doses of Humalog would give me even more hypos. He was right. I had some very serious hypos, and there were 3 or 4 visits to my home by the paramedics. On one occasion I spent a couple of days in the hospital. Dr. B. knew about the hospital episode, but I did not tell him about the other hypos. I did not want him to take my Humalog away from me. My A1c's were in the 6's and still improving.
In the mid 1990's I had a new problem. I had been gaining weight with these new modern day insulins. That had actually started in the early part of that decade. By the mid 1990's I had gained 57 pounds. I worked so hard to keep my weight under control, but I kept on gaining. I had been running a lot of high blood sugar, and I had increased my dosage by 40%. My next A1c was much higher. In 1998 Dr. B. had new blood tests done which showed I was experiencing insulin resistance. That is a Type 2 symptom. At that time I was a Type 1 with a Type 2 symptom. A type 1 with insulin resistance is a "double diabetic". That does not mean I was both Type 1 and Type 2. I was autoimmune, and my pancreas did not produce insulin. That clearly made me Type 1, and not Type 2. Many Type 1 people have insulin resistance.
My performance on campus was not so good in the mid 1990's because of these new developments. I felt so run down, and I became tired so easily. My energy was zapped after my morning classes. I still had afternoon classes, and on some days, evening classes to teach. It was just not possible for me to have any enthusiasm when I met those later classes. I had nothing left in me. My last good year was 1993. After that year everything went steadily downhill. I was 54 and I had intended to retire when I was 62 so I could start drawing social security. We were heavily in debt. We had put both of our sons through six years of college. I taught lots of overload and summer school in order to finance their education, but my earnings were not enough. We took out a second mortgage on our home, and we borrowed money until we were not permitted to borrow any more. Our sons had their MS degrees and good jobs. That was very important to us. I struggled with my teaching until 1997. Then something wonderful happened. The county offered retirement incentives to retiring faculty members. I announced my retirement, and I received 70% of my annual salary as an incentive. That enabled us to pay off all our remaining debts. I retired in June of that year and we were out of debt. A miracle just when I needed it. I still had higher than usual A1c's and a roller coaster type of control. I continued part time teaching. We needed that extra money until I qualified for social security. I desperately needed to lose weight, and get better control.
In the very late 1990's Dr. B. told me there was a new med called Avandia being used in Europe. It was not yet introduced in this country because there was a chance it caused liver damage. By 1999 it was considered safe, and I started taking Avandia tablets twice per day. In just a few days I started improving. My insulin dosages returned to normal. A few weeks later I had regained my energy. My part time teaching was fun, and my teaching improved. I almost wanted to become full time again, but that was impossible. My full time position had been filled, and I would also have to give up my retirement income if I was full time again. I was happy, I felt great, and I was really enjoying my retirement. My weight was my only big problem at that time.
In the early 1980's we decided we needed mortgage insurance on our home. I went to a local insurance company, and they told me it would require a physical examination. A very old semi-retired doctor had me fill out a form. He asked me for a urine sample. He tested the urine with the special tape used for that purpose, and it turned a dark green. That indicated high urine sugar. He said he could not recommend me for mortgage insurance based on that urine test. He walked outside with me, and we stood by my car. At that time I had a been diabetic for about 35 years. He told me that I was very lucky to have lived so long without complications. He went on to say he had known another male diabetic like me who was doing very well, but had high urine sugar almost all the time. Less than one year after he had seen the man he developed kidney failure, and was going blind because of his diabetes. The doctor told me I should not expect to live much longer than I had at that time. He wanted me to prepare for dying. This reminded me of the doctor visit in Richmond, VA when I was told I should not expect to live beyond my 40's. I paid very little attention to this doctor with his antiquated ideas. The next day I went to the local Metropolitan Life building. They called Dr. B. on the phone, and they learned that I was doing very well after 35 years of diabetes without complications. They offered me a mortgage insurance policy. We also got one for my wife. I wish I had gone to Metropolitan in the first place. The insurance policies gave us peace of mind. We never had to use them. Our house was fully paid for in August of 1995.

Wednesday, January 27, 2016

Injections and a CGM

As healthcare providers we should be helping patients find what will help them be most successful in managing their diabetes. Technology has a place, but not for everyone.