Saturday, April 22, 2017

The Artificial Pancreas Scares Me

After 40 years of testing urine, and not really knowing my blood sugar levels, it was wonderful to have my first glucometer in the mid 1980's. My control was really bad those first 40 years. After using a meter it was obvious that my BG had been much too high during those years. I was seeing numbers in the 200's very frequently, and numbers in the low 300's, too. I felt comfortable at those levels, but I felt uncomfortable below 150, and hypo below 120. It took a lot of adjustments with my diet and insulin dosages to feel good while having numbers in the low 100's. Control was better, but still not so good, until synthetic insulin was available in the 1990's. By the end of the 1990's I was able to use carb counting, and a fast acting insulin. Then my numbers  were so much better, and my A1c's were in the high 5's. I do not know how I survived for 50 years on animal insulin, and type 1, without having any serious diabetes complications. 

Improvements in the 21'st century are happening so fast, perhaps too fast. There are several artificial pancreas devices being developed, and tested on human subjects. They depend on a CGM for measuring the blood glucose levels. I am using a Dexcom G4, and it is very accurate about 80% of the time, but there are times it is as much as 30 or 40 points different from my meter. If I was using an artificial pancreas device, and I had a false high, I could be given insulin that I did not need. That would give me a hypo, maybe one that would put me in the hospital! There are devices being developed that would give us insulin when we are too high, and glucagon when we are too low. We would not be making the decisions. The device would be making the decisions for us. I feel very uncomfortable with that. The almighty CGM is not accurate enough to have the device do the decision making. I know that the Dexcom G6 is being developed, and it will be more accurate, but I cannot believe that the accuracy will be good enough that we would never have occasional false highs and lows with that CGM. For that reason I will not use an artificial pancreas, even if one was given to me as a gift.

The "Guardian® sensor 3 continuous glucose monitoring sensor Introducing the most accurate sensor from Medtronic, now with up to 7 day wear and easy insertion. It is the FIRST and ONLY continuous glucose monitoring sensor FDA approved and trusted to control insulin dosing." That one is being sold now, but I will not use it. I am chicken! I am eligible for a new pump in May, but I will be getting the Medtronic 630g. That one can be used without the CGM supplement. I will be wearing my Dexcom G4 CGM, and I will be making all of my own decisions!! I have made my own decisions for 71 years, and I have done very well. I want it to stay that way for the rest of my life. :)

Wednesday, April 12, 2017

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 52 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 there 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 71 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 links give very good information about seizures. There are replies from some people at the end of the first link describing seizures that they have had. Interesting discussions.

Monday, April 10, 2017

My Diabetes Now vs My Early Years

From the year of my diagnosis in 1945, until the mid 1990s, I did not need any medications, and there were no diabetes related complications. That was approximately 50 years with no problems. How was that possible? Beef and pork insulins did very well for me, although common sense suggests my blood sugar must have been very high most of the time. The urine tests every morning showed very high urine sugar on most days. There was only one urine test each day until Tes-tape for easier urine testing was introduced a few decades after my diagnosis. There was no basal and bolus control, and no involvement of carbs in my daily routine. My meals consisted of hundreds of carbs, and there was no information about my needing to limit my intake of any foods, except those containing sugar. My doctors had very little advice for me. Despite all these factors, there were no diabetes problems. There may have been DKA on some occasions, but I did not know about DKA until the present century. So how did I avoid complications for such a long time? I think it may have had something to do with the beef and pork insulins I used for all those years. Several online long term friends agree that the insulin we were using did seem to offer us protection from the complications to our eyes, kidneys and our nervous systems. Maybe it was the C-peptide in the animal insulin. C-peptide is known to offer protection against diabetes complications. The synthetic insulin we use now does not contain C-peptide.
When I started using synthetic insulins in the mid 1990s, things were so different. I was aware of the involvement of carbs at that time, so my eating habits had changed. My carb intake was greatly reduced, and foods with fast acting carbs were restricted to smaller portions. I counted carbs and determined appropriate insulin:carb ratios. That, along with my basal and bolus insulins, resulted in my having A1c's below 6.0 soon after the start of the new century. My A1c's before the mid 1990s were much much higher. I think my highest many years ago was 13.
In the late 1990s I needed medications for cholesterol, blood pressure, and water retention. I was also diagnosed with carpal tunnel, and ulnar nerve problems. Frozen shoulders, and cataracts occurred during that time. I was also diagnosed with neuropathy in my feet, and spots of neuropathy in my eyes. All of those things occurred after I stopped the animal insulin, and started using synthetic insulin. How can this be? We know so much more about diabetes now, and we have devices, basal and bolus insulins, and medications that can improve our control so much. Indeed, my control did improve very much, but those complications and the need for medications did occur. Don't you think it would have made more sense for me to have complications in my early years, when I had so much high blood sugar, and almost none of the present day knowledge? I am certainly not unique. There are a few thousand type 1 diabetics in the US who have lived with diabetes for at least 50 years, and without any serious complications. More than 6000 have received the Joslin 50 year medal. Some of them have been type 1 diabetics for 10 or more years longer than me.
There is a study taking place at the Joslin Diabetes Center, in Boston. It began in 2005, and was to have been a ten year study, but it is ongoing at the present time, in its thirteenth year. I participated in the study in 2009. The purpose of the study is to determine the factors that have enabled so many long term type 1 diabetics to live so long, and be so healthy. Maybe the reason so many of us had no complications during our early years will be revealed.
My having some mild complications in the 1990s, and not earlier, is still a mystery to me. Now, in the year 2017, I have more neuropathy problems, but the retinopathy is gone due to better control with my insulin pump. My neurologist gave me an EMG test in January, 2016. He says I have severe polyneuropathy in my legs. There is no bad pain, just numbness, and I do not need medication, so I'm not sure it is severe. Some mild arthritis, some dizziness in the mornings, and the neuropathy are all that are present now. The dizziness and neuropathy make me wobble a bit when I walk, somewhat like a duck. Maybe I can get a job working on TV for Affleck? lol
I am so fortunate to be doing so well, but I will always be curious about how it has all evolved.

Friday, April 7, 2017

William Rounds, Type 1 for 87 years

William Rounds (1922-2010) was diagnosed with diabetes in 1923, only 2 years after insulin was discovered. He was T1 for 87 years the year he died. In 2008 William was one of eleven interviewed who had lived for 60+ years with T1D. I was one of the eleven. The stories were published in Oct, 2008 in the Diabetes Forecast, the American Diabetes Association's magazine. That was the month that the Diabetes Forecast celebrated its 60'th anniversary.


http://www.diabetesforecast.org/2008/oct/long-lives-lived-well.html

Wednesday, April 5, 2017

My First 64 Years With Type 1

My book was published in March, 2010. It is an autobiography of my first 64 years with type 1 diabetes. It begins in September, 1945, the month I was diagnosed. The book is available on Amazon.