Monday, September 9, 2019

My Early Years With Type 1, Part 2

Prior to the discovery of insulin there were several treatments for diabetes. Those treatments included bleeding, opium, starvation, exercise and diets. A diet low in carbs and high in fat and protein was sometimes used. Without the availability of insulin these treatments extended the lives of diabetics by approximately one year. I was diagnosed in 1945, and newly diagnosed children were not expected to live beyond their teens. My doctor did not tell us that, and I did not know it until I researched diabetes history on my computer in the early years of this century. I'm glad I did not know my life expectancy back then. Ignorance was bliss, and I had a good life while growing up.
Insulin was discovered in 1921, and became available to the general public in 1923. The first insulin was taken from pigs and cows by a Canadian team. Thank God for Dr. Banting and his team!!! The insulin was impure and large doses were necessary. They frequently caused an abscess at the injection site. At first the beef/pork insulin was short acting and multiple doses were needed each day. In the 1930's, the first longer acting insulin, Protamine Zinc, was introduced. In the 1940's the first standardized insulin syringe was introduced. It was made of glass.
I was supposed to inject the insulin into muscle. Insulin acts faster when injected into muscle. There was no fast acting insulin back then, so muscle injections was very helpful. My abdomen was never used in my childhood. I found injections on my arms more painful, so we usually used the tops of my upper legs. I started giving myself my own injections when I was 10. A picture below shows a girl injecting into her leg muscle. That picture was taken in 1930, fifteen years before my diagnosis.
During my early years with diabetes things were shaping up very nicely on our ten acre farm. My Father built a small barn all by himself, and there were stalls for our cows and a horse. The doors were left open so the livestock could use the shelter during bad weather and at night. Two calves were born each year, and after they were fattened we took them to the stockyard and sold them. The extra cash was much needed. My Father hitched the horse to a plow and plowed the 2.5 acre garden space every spring. There was one time that I approached our horse and tried to pet him. The horse reached down and grabbed a chunk of my abdomen, and I made a motion and screamed. The horse let go and ran away. That horse could have pulled part of my abdomen off my body. I was lucky to have only a few heavy teeth marks, not much bleeding. I would rather have injections any day!! Another time Daddy had the horse hitched for some very light plowing. The horse keeled over in the middle of the garden and died. Daddy dug a very large pit beside the horse, and rolled the horse into the pit. We never had a horse after that. Later on that year Daddy bought a used tractor. We had a mowing machine and a hay rake that we hooked to the tractor. I drove the tractor and Daddy controlled the machines while riding them behind me. We mowed the fields and made hay for the livestock. We raked the hay and stacked it ready for feeding the cows during the winter. Our farm had only ten acres, but it was still a farm. We had chickens, pigs, cows and a horse. We had our own eggs, milk and butter. The hogs were butchered in the Fall. We had a huge garden and an orchard. We had so much good, healthy food.
I was not a very good student during my first few years of elementary school. I made a lot of C's, but I never failed a grade. I studied hard and my Mother was a great help. She was a good tutor. She was the valedictorian when she graduated from her high school. Impressed? I guess I should tell you that there were only four students in the senior class that year. She attended a very small country school house in the area where she was raised. When she started school it was a one room schoolhouse, and one teacher taught grades 1-12.
We did not know anything about carbs while I was young, and we did not have information about foods I should avoid. Our one and only rule was to avoid sugar. There was no device for testing my blood sugar, and urine testing was unreliable. My blood sugar was so difficult to control. There was no fast acting insulin. The insulin I used was a 24 hour insulin, only one injection each day, and there were times that it was too much for me at night. A snack before bedtime helped, but there were nights that my blood sugar dropped a lot. There were nights that I had hypos, and there were occasional seizures.
During a seizure my teeth would be tightly clenched, my body muscles would be drawn, and I would be almost unconscious, not knowing anything that was happening. Mother poured small amounts of the sugar water on my lips, until I had enough in my mouth to partially awaken me. Then I would drink the liquid more freely. I was always drenched with sweat, and very weak after a seizure. My body was sore the next day. The sugar water caused my urine test to show high the next morning. I continued to have seizures for many years, but they occurred less frequently when I was older. There was never any effort made to call an ambulance. I don't know why. Perhaps it was because the nearest hospital was at least 10-15 miles from our house, and I doubt that the paramedics in the ambulance had glucagon injections available back then. Home care was probably the best solution. I think my mother saved my life many times during the years I lived at home.
Mother was afraid I would have a hypo while at school. She approached the teacher at the beginning of each year, and explained my condition, and why I should not exercise like the other kids. She convinced Dr. Davis to write an excuse before school started each fall. I never participated in play period or gymnastics of any kind. I sat and watched the other kids. Mother would not have it any other way. My classmates knew I was different and they ignored me, but never made fun of me. I tried to make friends, but I was never very successful. I became very withdrawn and terribly shy. I hated my diabetes because I knew it was responsible for my misery in school. I never blamed my Mother because I also feared having a hypo in school. Mother always brought me out of my hypos at night by feeding me water containing a lot of sugar. I knew there would not be anyone to do that for me at school so I sat and watched the kids play. I felt comfort in knowing I would not have a hypo. I would have been so embarrassed if I had had a hypo at school.
By the time I reached fourth grade I started making better grades. In the sixth and seventh grades I made several A 's and B's, not many C's. I was always the best in my class at spelling. I took great pride in my ability to spell complicated words. When I reached high school my Mother still wanted me be excused from gym classes. I was rather good at basketball, at home. Daddy nailed a basketball hoop to the side of the corn crib and I became very good at making baskets. I played and worked hard at home, but always under Mother's watchful eyes. I still had that fear of having hypos in high school, so I agreed to not participate in gym classes. I wish now that I had rebelled and taken gym. I was still withdrawn and shy in high school. I made a few friends though, and my grades were very good. I graduated number 13 in high school in June, 1957. My math teacher in my senior year found that I was not intending to go to college. She begged me to go. I considered it, but I knew my parents would not approve.
(The first picture below shows my family in 1945, the year I was diagnosed; the second picture shows a girl injecting into her leg muscle in 1930.)

Wednesday, September 4, 2019

Do you overcorrect high blood sugar?

An interesting report from dLife.com.

Do you use too much insulin to correct highs, resulting in frequent hypos?

My blood sugar was much too high in the 1940s until the 1980s when I finally had my first glucose meter, A1C testing and knowledge of carbs. I did not have a truly fast acting insulin until the mid 1990s, but my management greatly improved in the 1980s. Prior to the 1980s I did not know my actual glucose numbers, so there was no treatment of highs. The urine testing showed high most of the time, but there were no actual numbers until glucose meters were available. Treating highs began when Humalog insulin was introduced in the mid 1990s. The research done by the Mayo Clinic shows that millions of T1D's use too much insulin to lower their highs. I will admit that I am guilty of doing that, much too often. I have numbers in the 70s, and lower, frequently. Here is the report from the Mayo Clinic.

Note: The research was done with ADULTS. No children were involved. I am guessing that the results would be much the same with children

"New research from Mayo Clinic finds that more than 2.3 million adult patients in the U.S. are likely being treated too intensively for their diabetes.

The researchers find this has caused thousands of potentially preventable emergency department visits and hospitalizations for hypoglycemia (low blood sugar).

The study team, led by Dr. Rozalina McCoy, an endocrinologist and primary care physician at Mayo Clinic, sought to identify the real-world implications of intensive glucose-lowering therapy across the U.S.

Her team found that overly intensive glucose-lowering therapy — when patients receive more medication than is required based on their hemoglobin A1C level — was not only common across the U.S., but also directly contributed to 4,774 hospitalizations and 4,804 emergency department visits in a two-year period."

Monday, August 26, 2019

My Early Year With Type 1....In The Beginning

I have many new friends who have not read my story. I am starting from the beginning with this post.
I don't remember some of the content, but discussions with my Mother many years after my diagnosis helped me fill in the gaps. I remember those conversations very well.
My diabetes, in the beginning…
In 1945 I started school in the first grade, the next day after Labor Day. I did not feel like going, but my parents wanted me to go even though I was only five years old. I was six years old during the second week of my school year. I felt sick in my classroom, and I was not paying much attention to the teacher. I just wanted to go home, and stay there. The steps on the school bus were steep, and it was hard to climb them because I was feeling weak.
Several months previously, I had chickenpox. Then I had mumps. While I was recovering, I stopped wanting to eat, and I started losing weight. Mother and Daddy took me to our family doctor, but he did not know what was wrong with me. He had us get a tall bottle of brown stuff, and I was supposed to have some of it a few times each day. It was supposed to give me an appetite, and make me want to eat, but it did not help. Not at all. We saw two other doctors, and they did not know what was wrong, either. My Mother made an appointment with a fourth doctor. We hoped so much that he could help me.
My sixth birthday was on September 10. I did not want to eat any cake, or anything else. I was feeling very sick, and I didn’t have an appetite. Mother kept giving me things to eat, but I refused to eat them. I was very weak, and I was having a hard time walking. I had lost a lot of weight. I drank so much water, but I was still thirsty. Peeing so much!!
A few days after my birthday, we went to see the fourth doctor, Dr. Williams. His office was upstairs in an old building in Salem, Va. It was a very long flight of stairs. I was so weak that it was difficult to climb the stairs. Daddy carried Shirley, my little sister, up the steps. She was two years old. Mother walked beside me, and tried to help me up the steps. I had to stop and rest some, my heart was beating so fast. We reached the top of the stairs, and walked down a long hall. The doctor was in his office, and Mother and I sat down in chairs. It felt so good to sit down. Daddy stood in the doorway behind us, still holding Shirley.
We had my blood tested several days before seeing the doctor, and he had the results. He gave us some bad news. He said I had diabetes. I looked at Mother, and she was very pale. I could tell she was very scared about what the doctor was saying. What is diabetes? Is it serious? I was scared too!! The doctor said a lot more, but I don’t remember any of that. Mother’s face scared me, and I just wanted to go home. I do remember the doctor saying I had to go to the hospital. It was late in the day then, and we waited until the next morning to go to the hospital. Another doctor was supposed to meet us there. We hoped he would help make me feel better.
I had been to a hospital twice before. The first time was to have a hernia removed from my right side. I was four years old then. Later that year I had my tonsils removed. I had a terrible sore throat for a long time. I was so glad when my throat was better, and I could eat again. When I went to the hospital for diabetes, I knew I would not have surgery. I was so glad about that! I was also glad that I would not be going to school for awhile. Maybe I should not have started school that year.
I was taken to a room in the hospital, and put in a bed in one of the rooms. Dr. Davis came to the room and talked to us about diabetes. I was given something called insulin, and the doctor said it would make me feel much better. I liked hearing that, but the very long needles they used hurt me so much! I had lost so much weight, and my arms were so skinny. The shots were given in those arms. After a few days in the hospital, I had an appetite again. I ate some food in my hospital room, and before I went home, I was gaining some weight. I felt stronger, and walking was much easier. Dr. Davis told us that I could eat anything I wanted, and as much as I wanted, if it did not contain sugar. There were no other restrictions. I loved Dr. Davis!!!
The first few days at home were difficult for me, and my parents. When I got up each morning I had to pee in a cup. Daddy had a big test tube containing some blue liquid called Benedict’s solution. He put a few drops of my urine in the test tube, and then put it in a tin can on the stove. There was some water in the tin can, and we waited until the water boiled for awhile. When the test tube was removed, we could see the color of the solution. If it was still blue, I did not have any urine sugar. If it was green I did have sugar in my urine. The other colors that showed even more sugar were yellow, orange, and red. The red color meant that I had very high sugar level. I hated red, and felt much better when I had blue or green.
I used insulin that was taken from the bodies of pigs and cows. The amount of urine sugar determined the amount of insulin I needed each day. Daddy put the insulin into a big glass syringe, and then he twisted a needle onto the tip of the syringe. The needle was about three quarters of an inch in length. Dr. Davis wanted Daddy to inject the insulin into the muscle on my very skinny arms and legs. The insulin was not fast acting, and injecting it into muscle made it work faster. The injections really hurt a lot!! The needles were very thick, and long. The insulin was a 24 hour insulin, and I did not have another injection until the next morning.
The syringe and needles were placed in a jar of alcohol, until the next morning. After a week had passed, the syringe and needles were placed in a pan on the stove, and boiled, to make them sterile. We had a well on our property that supplied our water, and there was some lime in the water. The lime left a white coating on the syringe and needles. Sometimes the lime deposit clogged the needles, and Daddy had to take a very fine wire and push it through the needle to unclog it, before loading the syringe with insulin. The needles were wide enough for the wire to be pushed through. There were also times that a deposit appeared on the outside of the needle, near the tip. Daddy had to remove the deposit by using a whetting stone. If we did not notice a deposit on the needle, and it was pushed into my skin, it made a popping sound, and that hurt so much!
After a few days at home, I returned to school. I was feeling much better, and I was strong enough to easily climb onto the bus. I could pay attention to the teacher, without any problem. I had missed several days of school, and catching up was not easy. Mother went to the school and had a discussion with the teacher. The teacher had never heard of diabetes. Mother told her that I should not play with the other kids in the gym, or on the playground. The activity could cause my sugar to drop too low, and I could have an insulin reaction. Mother tutored me at home. The teacher told her what lessons had been covered while I was in the hospital. Mother was a very good tutor!
That is the way it was, for many years. We did not know about diabetes complications. Test my urine before breakfast, take my morning insulin, avoid sugar and don’t play too hard. That seemed simple enough. No worries. Everything was good. I wonder how things would have been if we knew about the potential complications, and the true nature of diabetes.

Monday, August 19, 2019

Using An Infusion Set More Than 3 Days?

"The FDA approved on Friday a proposed trial of an insulin infusion set that can be worn for 7 days, according to a press release from Medtronic."

That would cause so much trouble for me. If I use an infusion set more than three days, the insulin absorption is not as good. Scar tissue can begin to form. If I used the set for seven days, I would probably get very little absorption. Scar tissue can remain in the area for a long time, and there might be poor absorption after applying a set at the same location later on. Doesn't Medtronic and the FDA know about scar tissue?

What are your thoughts on this topic?

https://www.healio.com/endocrinology/diabetes/news/online/%7B77bb9a97-4cd2-4f11-bf32-ab3de8343223%7D/medtronic-receives-fda-investigational-approval-for-testing-of-longer-use-insulin-infusion-set?M_BT=4563255241780

Tuesday, August 6, 2019

Lilly, The Insulin Doll

LILLY - the insulin doll. Created in celebration of the 77th
anniversary of the discovery of insulin. Eli Lilly and Company was the first to make insulin commercially available. In the early 1920s, the company supplied insulin free of charge to a group of children being cared for by Dr Elliot Joslin at the New England Deaconess Hospital.
In response at Christmas time, the children sent Mr J K Lilly Sr a personal letter thanking him for his gift. Mr Lilly was so touched that he sent each child a new doll and new insulin kit. Without exception, each doll was named "Lilly" by its recipient.
https://asweetlife.org/breakthrough-the-dramatic-story-of-the-discovery-of-insulin-at-the-new-york-historical-society/

Sunday, July 28, 2019

Nasal Glucagon

A new form of Glucagon is now available, through the nose, and not by injection.
"On July 24, the FDA approved Baqsimi, the first non-injectable emergency treatment for severe episodes of hypoglycemia. Submitted for approval by Eli Lilly and Company, this powder form of glucagon is administered into the nose, and comes in a single-use dispenser.
Once administered, Baqsimi works to rapidly increase blood glucose levels by stimulating the liver to release accumulated glucose into the bloodstream.
Glucagon is the standard treatment in situations of severe hypoglycemia, but until now, all approved treatments have come in the form of an injection. Injectable glucagon has been available for several decades, but is not shelf-stable at room temperature and therefore requires mixing a powder and liquid with a syringe, which can be intimidating and prone to user error in emergency situations.
'People who are living with diabetes are at risk of their blood sugar levels falling below the normal range. There are many products on the market for those who need insulin, but until now, people suffering from a severe hypoglycemic episode had to be treated with a glucagon injection that first had to be mixed in a several-step process,' said Janet Woodcock, M.D., Director of the FDA’s Center for Drug Evaluation and Research.
Baqsimi was evaluated in two studies of 83 and 70 adults with diabetes respectively, during which a single dose of the nasal powder was compared to a single dose of glucagon injection. The FDA reported that Baqsimi was satisfactory in increasing blood glucose levels. A pediatric study of 48 patients with Type 1 diabetes also saw similar results.
Notably, Baqsimi does not need to be inhaled and therefore can be administered to an unconscious person suffering from severe hypoglycemia.
'This new way to administer glucagon may simplify the process, which can be critical during an episode, especially since the patient may have lost consciousness or may be having a seizure. In those situations, we want the process to treat the suffering person to be as simple as possible,' added Woodcock, M.D.
Representatives from Eli Lilly have indicated that Baqsimi should be available in U.S. pharmacies within a month. The U.S. list price for a Baqsimi one-pack will be $280.80, which is the same price as injectable glucagon. Beyond Type 1 is hopeful the new drug will be widely covered by all insurance plans that currently cover injectable glucagon.
'Severe hypoglycemia is an unpredictable event for people with diabetes that can happen anytime, anywhere. It’s an experience that can be very stressful and difficult for those helping a person in a low blood sugar emergency,' said Dr. Sherry Martin, Vice President of Lilly Medical Affairs. 'The FDA’s approval of Baqsimi may help people prepare for these moments with an innovative product that has the simplicity of nasal administration.'
According to a press release, Lilly is in discussions with insurance providers to make the nasal glucagon available to as many people as possible. Additionally, the company is offering a savings card through the end of 2020 for patients with commercial insurance to obtain 2 devices for as little as $25.
Patients and healthcare professionals with questions about Baqsimi can visit www.baqsimi.com or call The Lilly Answers Center at 1-800-LillyRx (1-800-545-5979)."
Read the full press release from the FDA by clicking on the link below.

https://www.baqsimi.com/?fbclid=IwAR2NLvlgRSbpFJgm0ycjJwFwxJdYbYx80f47-ohElcx44C-Uc3tJhIODgao