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.






Thursday, March 21, 2019

How Do People Feel About Type 1?

I love this video. Brittany Gilleland has a wonderful diabetes support site called The Diabetic Journey. I highly recommend it. Visit the site to see more wonderful posts on the journey page. 
https://www.facebook.com/thediabeticjourneyorg/videos/1204232036341967/?t=0https://www.facebook.com/thediabeticjourneyorg/videos/1204232036341967/?t=0https://www.facebook.com/thediabeticjourneyorg/videos/1204232036341967/?t=0https://www.facebook.com/thediabeticjourneyorg/videos/1204232036341967/?t=0

Friday, March 15, 2019

Type 1 With Insulin Resistance

I was diagnosed with diabetes in 1945, when I was 6. I used animal insulin. My doctor told my parents I could eat anything I wanted, and as much as I wanted, as long as it did not contain sugar. I lived on a small farm, and I ate large amounts of food, but I avoided all sugar (sucrose). I was very skinny, and I got a lot of exercise on the farm. In the mid 1990's I started using a rapid acting insulin (Humalog). I began gaining weight, and I was overweight for the very first time. In 1998 a doctor diagnosed me with insulin resistance (IR). I had gradually reduced my daily carb intake from hundreds of grams to only 130 grams. I still had a lot of exercise, but I continued gaining weight. By the year 2000 I had gained 57 pounds! I had four relatives with type 2 diabetes. I think my IR was caused by genes passed down from those relatives. The weight gain triggered the IR. I was a double diabetic. That does not mean I had both types of diabetes. I had been tested, and found to be autoimmune. A C-peptide test showed I produced almost no insulin. I was a type 1 diabetic with a type 2 characteristic, but I was not also type 2. Many type 1 diabetics have been found to have IR.
My doctor was an internal medicine doctor, and he did not believe a type 1 diabetic should use Metformin. He prescribed Avandia, which slowed my weight gain, and I gradually lost about 27 pounds during the next few years. I continued using Avandia for many years. My weight stabilized, but I needed to lose another 30 pounds. I started seeing an endocrinologist, and she prescribed Metformin. In a little more than one year I lost 38 pounds. My weight before all the gain was 185 ( I am 6 ft, 2 in with a large frame). The doctor said my weight should be in the 170-200 range. I considered a weight of 185 pounds to be a good healthy weight. I continued using Metformin for seven years. After the weight loss I weighed 177 pounds. My IR seemed to have disappeared, and I stopped using Metformin in mid 2018. Recently, I have started gaining again. I currently weigh 186. My average daily carb intake is still 130 grams. I do not want to follow a Keto diet, I am happy with 130 carbs per day. I may start using Metformin again.
I have been type 1 for 73 years. My heart, kidneys and eyes are in great shape, but I have some neuropathy in my feet and legs. There is some numbness, but no pain. I feel that I have very good diabetes health.

Wednesday, March 6, 2019

Avoiding Diabetes Complications

Avoiding Diabetes Complications

Several years ago the Diabetes Health magazine published an article stating that diabetics should maintain a good BG average and A1c, and avoid a roller coaster type of control. The roller coaster control involves having many highs and lows. That would involve data widely scattered above and below the average. Blood sugars that rise and fall on the path of a roller coaster are traumatic to the body. Experiencing this trauma over and over again for a long period of time can lead to diabetes related complications, even if the A1c is good. I will demonstrate with two examples.
Patient A has test results 40, 55, 65, 100, 135, 145, and 200. The average is 106, but there are numbers that indicate unhealthy highs and lows.
Patient B has test results 72, 80, 94, 100, 106, 120 and 148. The average is 103, but the data is more closely packed, and none of the numbers are undesirable.
Patient B is experiencing better control, and is less likely to have diabetes complications. The "standard deviation" (SD) is a measure indicating how closely the data is distributed above and below the blood sugar average. Patient A had much larger deviations from the average of 106. Patient B had smaller deviations from the average of 103, so the SD was much better. I try to keep my SD as small as possible, but it is difficult to do. My A1c's have been in the 5.4-6.4 range for almost 20 years (The graph below shows my A1c's for the years 1980-2015). When I have too many highs and lows, my SD is higher and I can feel neuropathy symptoms. I used to have some spots of retinopathy in both eyes when I had a roller coaster control, even though my A1c was good. My using an insulin pump helped reduce the number of highs and lows.
The purpose of this discussion is to demonstrate the fact that a very good blood sugar average can still involve diabetes complications if there is a significant number of highs and lows over a long period of time. Don't rely solely on a blood sugar average and A1c. Try your best to avoid so many highs and lows. A good average accompanied by a stable control is the best way to avoid complications. Proper dieting and well chosen exercise routines can help very much in reducing the highs and lows.
I have had A1c's no higher than 6.4 for almost 20 years, but I had the beginning stages of neuropathy and retinopathy about 15 years ago. My control had been tight, but it was necessary to make it even tighter. I stopped having so many highs and lows. After a few months had passed, the retinopathy disappeared. The neuropathy is still present in my feet and legs, but I rarely experience any pain. If I have high blood sugar for many hours there is sometimes mild pain during the night. I have been a type 1 diabetic for 73 years, and have not had any serious complications. I want to keep it that way!!



Friday, March 1, 2019

Type 1 Endo Earns 80 Year Medal

I have been type 1 for 73 years, but there are people who have been type 1 much longer than me. Here is an endocrinologist with type 1 for 80 years. A wonderful story!! Thanks to Petronella Peach for finding this article. This article was published in 2015.
"Last month, Joslin awarded Dr. C Kenneth Gorman the Lifetime Achievement Award for living for 80 years with type 1. Dr. Gorman is one of five recipients of the 80-year medal and the only Canadian recipient thus far. In 1935, at the age of two, Dr. Gorman was diagnosed with T1D. He went on to become an endocrinologist and worked as a research fellow under Dr. Charles Best, one of the co-discovers of insulin. During his time with Dr. Best, Dr. Gorman began corresponding with Dr. Elliott Joslin and accepted a position as an N.I.H. Trainee Fellow in Diabetes at the Joslin Clinic from 1962 to 1964. Dr. Gorman’s next goal is to celebrate the 100th anniversary of the discovery of Insulin in 2021. Congratulations, Dr. Gorman!"
For more information on Joslin’s medalist program or to apply, click here:
https://www.joslin.org/medalist/apply_now.html


Thursday, February 28, 2019

Low Carb for Type 1? Not Me!!

I have read that many type 1 people eat very healthy, low carb meals. That certainly helps with the control of blood sugar levels, but I do not find that to be necessary. For so many years, starting in 1945 when I was diagnosed, I ate anything I wanted as long as it did not contain sugar. My portions could be as large as I wanted. Not eating sugar was the only limitation made by my doctor. My typical day saw me eat hundreds of carbs, many of which were very fast acting. That was poor diabetes management, but my parents and I did not know any better. I lived on a farm, and there was a lot of exercise. My doctors knew very little about diabetes back then. I was very fortunate that my diet did not cause any diabetes complications.
In 1988 I read an article in a magazine that mentioned carbohydrates. I saw that carbs were very much involved with blood sugar management.That was the first time I had that knowledge. I was still using injections with animal insulin, so knowing about carbs did not help me very much. I did, however, start eating smaller portions of food that had fast acting carbs.
In the mid 1990s Humalog was introduced. That was my first fast acting insulin. I started carb counting. Trial and error showed that I needed one unit of insulin for every 10 carbs I ate. Before breakfast my carb sensitivity was greater, and I needed 1 unit of insulin for every 7 carbs, but only for that meal. Carb counting, and eating only small portions of carbs with fast acting foods greatly improved my blood sugar control. My A1c's began dropping, as you can see in the graph below.
I began using a pump in 2007. Programming my insulin:carb ratios, and my variable basal rates at different times of the day on the pump gave me so much improvement in my control. Fluctuations did occur because of scar tissue, and occasionally forgetting to bolus at the right time, but my management was very good. I started using a Dexcom CGM in 2015. I have set my CGM to alarm when my BG reaches a high of 170, or a low of 70. That has resulted in my staying in my 70-170 range 90% of the time.
At the present time I eat an average of 130-140 carbs per day, and my A1c's have been in the 5.4-6.4 range for more than 20 years. Here is a typical day in my current schedule:
8:30 AM....A slice of toasted bread (9 carbs), a slice of ham, berries (16), one egg, and coffee.....total....25 carbs
12:00 noon....A medium size baked potato (30), a pork chop....total....30 carbs
2:00 PM....Before going to the gym for a one hour workout....one half cup of ice cream with sugar...(25)...only a 1.5 unit bolus since I was going to get a lot of exercise
5:00 PM....Five corn chips with salsa, and coffee (10)
7:00 PM....Pastrami sandwich with mayonnaise, slice of cheese, and slice of tomato... only one slice of bread, 9 carbs per slice...(12)....cottage cheese (6)....strawberries (10).....total....28 carbs
10:00 PM....My BG was 79 so I needed a small snack....peanut butter and crackers (12)
TOTAL for the day....130 carbs
I never eat anything with sugar (table sugar) unless I am going to get exercise afterwards, or I have a low. I carry a small ziplock bag of skittles with me when I am away from home.
Note: My meals vary a lot, but the carb counts and the times that I eat are very stable. I do like a lot in my food choices so no two days are the same. As long as my diabetes management is stable, I see nothing wrong with that. My A1c is good, and I am not overweight. My BMI is 23.6.
I like variety in food, TV programs, movies, activities,
exercises, and most all things......but not women. My wife is
wonderful and I do not need variety there. ;)

Tuesday, February 26, 2019

My Early Years, and Blood Sugar Management

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 every 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 the 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 the sugar water into my mouth. That 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 hypos, not remembering any part of what had happened. Mother gave me all the details many years later. I was always so grateful that they took such good care of me at those times. I have no idea how many of those seizures I had before I was an adult, but I know there were many of them. If we had meters for testing, basal and bolus insulin, and carb counting, things would have been very different. There may have been less serious hypos, without the terrible lows that caused seizures. The animal insulin I used for my first 50 years was neither bolus nor basal. It worked at the same level all day, and all night. I think that level was too much at night, and that was probably the reason I had low blood sugar so many times while I was sleeping. That insulin was a 24 hour insulin, with only one injection each day. There was no way of having different dosages with different levels at different times of the day.

To prevent hypos at school, I was not permitted to play with the other kids during play periods or gym. It was that way in grades 1-12. I played at home with a neighborhood friend, but Mother kept a close watch on me. I was usually able to feel my lows before they were so bad. I would tell Mother, and she would give me some sugar. I carried a small container of sugar with me while in school. I was never given candy. I think my parents did not want me to know the taste of candy, and other sugar sweetened things. There was never any ice cream in the house, and I assumed there was never any candy, but several years ago my sister told me an interesting story. When we shopped at our grocery store, no candy was purchased. Daddy stopped on his way home from work in the late evening, and bought candy. It was stored very high in a kitchen cabinet. I never saw it. My sister was given a candy bar, and she would eat it in the kitchen. If I entered the kitchen while she was eating candy, she would hide the candy behind her back, with her back against a wall. I never became suspicious. She waited more than 50 years to tell me that. I'm glad she got to have candy, and I am glad I never tasted it. There was artificially sweetened candy that we bought back then. I think the companies selling the candy were Diamel, Loeb and Estee. It wasn't so bad, I still remember the taste. Sweet story, sweet sister, sweet candy. HA!