Sunday, May 28, 2017

Scar Tissue & Insulin Absorption

When I was diagnosed in September,1945, 71 years ago, I do not think my doctor knew that I should rotate sites when injecting insulin. My parents were so good about listening to my doctor, and we followed his advice without fail. We injected into the muscle on my upper legs for many years, and there were always very high blood sugar reports from the doctor's lab every six months. I think that was because we were not using different body parts and rotating sites. Scar tissue had probably formed on my very skinny legs, even though the animal insulin I was using required only one injection per day. By the time I was in my twenties I was using my upper abdomen, and my blood sugar reports improved. There was no meter for measuring my blood sugar at home until the mid 1980's, so the biannual reports from the doctor's lab was the only thing I had to determine how I was doing. A1c's were not available until 1980.
In the mid1980s I had a meter and much better insulin. Several injections were required each day, and I was still using my upper abdomen. Eventually it became very difficult to push the needle into my skin. I actually had some needles bend, and had to get a different disposable syringe, reload and try a different spot. I had not been told that this might be scar tissue, no doctor had ever mentioned that. No doctor had suggested alternating sites. Maybe my doctors in the 1990s assumed I knew about this since I had been type 1 for 50 years at that time. In the new century I was using basal and bolus insulins, and doing as many as 8 injections every day. The toughness of my skin in my upper abdomen made it necessary for me to start using my lower abdomen and upper legs. It was common sense on my part that caused me to make that change. My blood sugar tests improved significantly, but I still did not know it was because I had moved away from the toughness in my upper abdomen.
In 2007 I started using a pump, and things were going very well until I tried my upper abdomen. I got a 'No Delivery' alarm on my pump and did not know what that meant, so I called the Medtronics help line. After a long discussion it was decided I had scar tissue. That was the first time I had heard those words. A very young sounding lady at Medtronics made that diagnosis, but my very experienced doctors had never mentioned it. This made me very angry, and it has taken me a long time to stop feeling bitter about it. At least one doctor should have told me about site rotation. I have permanent scar tissue in my upper abdomen and can never use it again. The skin will always be tough, and the insulin absorption almost nonexistent. I tried using my upper ab earlier this year, and saw very high blood sugar in the next few hours. I am presently using my lower ab and upper legs, rotating infusion set locations. If I don't change sets after three days I start seeing high blood sugar. That is because scar tissue is beginning to form there. I keep the sites about two inches apart, and change every three days. I have now had A1c's in the 5.5-6.4 range for about 15 years. Finding someone who told me about scar tissue has greatly improved my control. I will never know why I managed to avoid diabetes complications for the many years that I was not rotating sites, and having so much high blood sugar. I have some neuropathy , but my overall diabetes health is very good. That almost seems like a miracle to me.
I have frequently advised pumpers to rotate sites, and not use a site longer than three days. Most of my friends who pump are doing that, but I have met online pumpers who say they are using an infusion set for more than three days. One pumper says he uses sets for as much as a week, without having problems. I did not think that was possible. To keep scar tissue problems from occurring, and poor absorption giving very high sugar results, I strongly advise all pumpers to rotate sites, and avoid using a site more than three days. If the scar tissue is not so very old, then avoiding that body part will enable the area to eventually heal. If the accumulated scarring has occurred over a long period of time, then it may never go away. My upper ab is that way. Some people have lumps and sometimes larger amounts of it removed by surgery. Recently developed scarring can sometimes be helped by massaging.
I feel so lucky to have avoided serious complications after experiencing scar tissue and high blood sugar for so many years. I wish I could meet the young lady at Medtronics, and give her a big hug! lol

Wednesday, May 24, 2017

My Early Life, Without Sugar


When I was diagnosed in 1945, the doctor told my parents that I should not eat anything containing sugar. I don't remember my reaction to being denied sugar at that time. My diagnosis was only a few days after my sixth birthday. I do remember missing sweet things to drink. For some time I drank milk from our own cows. That was not a good choice, but we did not know that. It did not contain sugar, so we thought it was ok. When we went grocery shopping my family did not buy candy, cookies or ice cream. I don't know what my sister thought about that, she was three years younger, and she probably wanted sugary treats.
A year or so later, we discovered saccharin at a drugstore. My mother learned to prepare desserts sweetened with saccharin. I had pies, cookies, and a birthday cake sweetened with that wonderful stuff. Saccharin was great! Mother made desserts sweetened with sugar for the rest of the family. I was happy with my own desserts, and I never wanted to taste of theirs. My father prepared homemade ice cream, and a portion sweetened with saccharin was set aside for me. I always looked forward to that. It was a summer treat.
One day in our grocery store we saw a display of little bottles containing colored liquids. It was called Kool Aid. It was invented in the 1920s and initially sold in concentrated liquid form. Later on it was sold as a powder in little packets. The Kool Aid we bought in the 1940s was in a concentrated liquid form, so we added water and saccharin. It made a delicious drink. I was very happy.
I had low blood sugar at times for many years, and my mother gave me a glass with some water mixed with sugar. That was the only sugar I had for very many years. I had some awful seizures at night several times each year, and the sugar water was ready for those occasions. If I could not drink the liquid, my father would sit behind me on my bed and prop me up while my mother rubbed the sugar water on my lips and gums until I had enough to bring me around, so I could drink some of the liquid. I think I may have associated the sugar with my seizures, and that may have made sugar even more undesirable.
There were no meters for measuring blood sugar for my first 40 years after diagnosis, so my urine was tested for sugar each morning to determine my insulin dosage, and then I had to depend on my own feelings to detect low blood sugar the rest of the day. While sleeping at night my parents would listen for me to be thrashing around in bed to determine that I had low blood sugar. Their bed was close to mine for many years, so that worked out well.
Now I will fast forward to the current century, and tell you about a discussion that my sister and I had a few years ago. Our father worked at a post office, and he had an afternoon and evening shift. He got home at 11:30 PM. She told me that he would stop at a store on the way home from work and buy candy bars. They were hidden high in a cabinet in the kitchen. I can remember entering the kitchen several times and my sister was standing with her back against a wall, with her hands behind her. I guess I was not curious about that. She was hiding a candy bar she had been eating. I never saw a candy bar, and she waited more than sixty years to tell me about that. We laugh a lot about her candy bars. I am glad she had them, and I am glad I did not see them. 

Tuesday, May 23, 2017

Positive Effects Of Diabetes

Another wonderful and inspiring article from Brittany Gilleland and The Diabetic Journey. I love the article, and the picture. Thanks, Brittany!!



Thursday, May 11, 2017

C-peptide...Part 2

C-peptide .....Part 2

In the 1970s a study seemed to show that C-peptide was of no practical value in preventing diabetes complications, but "...the possibility that C-peptide may exert direct effects of its own was reevaluated in the early 1990s. A series of studies was undertaken involving administration of the peptide to patients with type 1 diabetes, who lack C-peptide. This approach gave positive results, and it became apparent that replacement of C-peptide in physiological concentrations results in significant improvements in several diabetes-induced functional abnormalities. These surprising findings prompted a renewed interest in C-peptide physiology, and during the following 15 years, a steadily increasing number of reports on new aspects of C-peptide physiology emerged. The information available included studies of the peptide’s interaction with cell membranes and its intracellular signaling properties. In vivo studies in animal models of type 1 diabetes have defined a beneficial influence of C-peptide on diabetes-induced functional and structural abnormalities of the kidney, peripheral nerves, and central nervous system. In addition, several studies in type 1 diabetic patients describing positive effects of C-peptide replacement therapy on nerve and kidney function have appeared. The wealth of information now available supports the notion that C-peptide administration, together with regular insulin therapy, may be beneficial in the prevention and treatment of microvascular complications."

Here is the link with a more thorough presentation of that research:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314360/

There have been many online discussions concerning C-peptide, and its being potentially helpful to people with type 1 diabetes.The following are examples of those discussions.

Here is a link giving a good discussion about C-peptide on diabetesdaily.com. I have been an active member there since 2007. (I don't know if you can view this discussion unless you are a member of Diabetes Daily.)

https://www.diabetesdaily.com/forum/diabetes-news-and-studies/79493-low-c-peptide-bad-type-1-a-2

There was an attempt by a company called Cebix to produce an injectable form of C-peptide. The project failed during human trials. Here is some of the background of that project.

http://www.xconomy.com/san-diego/2015/02/23/cebix-shuts-down-following-mid-stage-trial-of-c-peptide-drug/#

In another online diabetes support group, one person posted that Lilly had experimented in including C-peptide in the human insulin they had been producing. I do not have any details on this, and have not been able to find any information by researching online. If anyone finds any information about that, please let me know. Lilly aborted the experiment, so I am told.

Another discussion was made that suggested that having C-peptide in the synthetic insulin that we use today could cause major problems. People with type 2 still produce a significant amount of their own insulin. That insulin contains C-peptide. If type 2 individuals then injected insulin with C-peptide, there might be an overdose of it. Too much C-peptide is known to be harmful. Only type 1 people should use an insulin containing C-peptide. Some T1D's still produce some insulin for a period of time after diagnosis. That happens during the 'honeymoon' period with many individuals. Even some Joslin Medalists, T1 for 50+ years, have been found to still produce some insulin. So, there are both T1 and T2 individuals for whom insulin containing C-peptide could prove harmful. Maybe that is the reason any experimentation involving adding C-peptide to insulin was considered inappropriate. I am just guessing, but all of this does make sense to me.

There does not seem to be any present day attempts being made to add C-peptide to insulin, and the attempt to produce an injectable form of C-peptide has failed, for reasons stated. I am not aware that any other attempts are being made to provide us with C-peptide, but I have not given up hope. I am thinking that each individual could be tested and the appropriate amount of C-peptide needed could be determined. Then a prescription could be given that would enable that individual to inject that amount of C-peptide daily, weekly, or for an appropriate time schedule. That may seem far fetched, but I think there has to be a way for us to receive some of this potentially valuable substance.

What are your thoughts?

Tuesday, May 9, 2017

C-peptide...Part 1

C-peptide....Part 1
C-peptide was discovered in 1967. The first actual use of a C-peptide test was in 1972. In more recent times, C-peptide has been found to have an effect on microvascular blood flow and tissue health. Microvascular complications pertain to the smaller blood vessels and include retinopathy, neuropathy and kidney failure.Type I diabetics typically have very low levels of C-peptide because most of their beta cells have been destroyed. This has been seen in the development of long-term complications
I used animal insulin for 50 years, and it contained C-peptide, which helps protect us from many diabetes related complications. That may help explain why I, and so many other long term type 1 diabetics, did not have those complications back then. In the 1990s I started using synthetic insulins, which did not contain C-peptide. By the end of that decade I started having some complications. Was that a coincidence? I don't think so.
 I was diagnosed with spots of retinopathy in both eyes, and neuropathy in my feet. I started using a pump and my control was more stable. The retinopathy disappeared, and has not returned, but the peripheral neuropathy is now in my feet, legs, hands and arms. There is not enough pain to require medication at this stage. I also have autonomic neuropathy in the trunk of my body. None of my neuropathy is severe, but it is very annoying.
C-peptide has been shown to significantly improve nerve and kidney function. It has also been reported to have anti-inflammatory effects as well as aid repair of smooth muscle cells.
"Newly diagnosed diabetes patients often get their C-peptide levels measured as a means of distinguishing between type 1 diabetes, Maturity Onset Diabetes of the Young (MODY), Latent Autoimmune Diabetes of Adults (LADA) and type 2 diabetes.
The pancreas of a type 1 diabetic does not usually produce adequate insulin, so a decreased level of C-peptide is expected. Some secretion can still be present during the honeymoon stage for type 1 diabetics. C-peptide levels in type 2 diabetics are normal, or even higher than normal. Determining the amount of C-peptide in people who inject or pump synthetic insulin can help to determine how much of their own natural insulin these patients are still producing, or if they produce any at all.
The results of a C-peptide test can vary from lab to lab. So different labs may have different 'normal' ranges. Doctors will sometimes evaluate your results based on your health and other factors. A C-peptide value that falls outside the normal range may still be normal for you. The C-peptide and blood glucose levels are measured at the same time to give a better evaluation.
A normal C-peptide level may be indicated as – Fasting: 0.51-2.72 nanograms per milliliter (ng/mL) or 0.17-0.90 nanomoles per liter (nmol/L)"
In the early stages of the Joslin Medalist Study 725+ participants were tested for their C-peptide levels. That test along with a glucose tolerance test showed that more than 66% of these long term diabetics were still producing some of their own insulin. My C-peptide level was less than 0.1, showing that my good health after 71 years of diabetes has to be explained by factors other than insulin secretion.
"Persons with LADA typically have low, although sometimes moderate levels of C-peptide, as the disease progresses and high blood glucose levels appear.
The most common MODY syndrome may also have normal fasting C-peptide results because the flaw in this case is in the secretion of insulin in response to rising glucose and fasting secretion is still near normal. Their postprandial C-peptide however is below normal with elevated blood glucose."
I have believed for many years that C-peptide present in the animal insulins I used for 50 years may have protected me against certain complications. It may help explain the longevity and good health of so many of the Joslin Medalists. Today's synthetic insulins do not contain any C-peptide. I asked Dr. King, head of the Joslin Medalist Study, about this. He said he does not think that C-peptide is a factor in explaining the longevity and good health of so many of the medalists. Maybe he will have changed his mind when the study concludes.
The links below are my references. They discuss C-peptide in much more detail.
Note: In a few more days I will post Part 2 of this discussion: An online discussion in the Diabetes Daily group; An attempt to produce an injectable form of C-peptide; Adding C-peptide to synthetic insulin.