Wednesday, February 26, 2020

My Early Years and Blood Sugar Management

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 the next morning, and again when I was preparing to write my book. 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 schooI. 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!

When I had just started eighth grade I had intestinal flu. I stayed at home several days, and I could not keep anything in my stomach, not the medicine the doctor had prescribed, not even water. My parents thought that since I was not eating then they should not give me insulin. They were afraid I would have a hypo. They did not check this out with the doctor. After several days of no food, no water, no medicine and no insulin I was so weak I could not lift my arms, and I was barely able to move my head. I think I must have DKA at the time. The doctor came to our house, and called an ambulance. I stayed in the hospital almost two weeks. I recovered very well, and returned to school. I hope that those of you reading this know that you need your insulin even if you are not eating. You still need your "basal" insulin under these conditions, but you do not need your "bolus" insulin if you are not eating.

After Anita and I were married in 1964, I was still using the animal insulin. My control was better, with fewer lows, but there were some nights that I had bad hypos, and a few seizures. Anita learned how to handle those lows, and she did a wonderful job. In the 1980's she had to call the local paramedics. That happened three times, and I was given injections of glucagon. The first time I was taken to the hospital, but not the other two times. After the injections I was immediately able to stand up and walk around. It is amazing how fast glucagon can work. On the other two occasions the paramedics let me sign a form that gave me permission to stay home, and avoid going to the hospital.

In the 1990's I started using Humalog, and carb counting. I had a meter for testing my blood sugar at home. My control improved so much! In 2007 I started using an insulin pump, and my control improved even more. I stopped having very low blood sugar. The lows I was having then were not bad enough for me to need any assistance. Anita, however, has memories of how it used to be. She watches me like she did back then. She cannot sleep well unless I tell her my blood sugar level at 1, 4, and 7 AM. That disturbed my sleep a lot for many years, while having to do a finger stick three times during the night. It was difficult to fall back to sleep some of those times. It is so much easier now with my CGM. I can look at the CGM, give her the number, and then go back to sleep. No problem!

I have never been upset with Anita for having me do those night checks. She had to put up with so many hypos at night in the first four decades of our marriage, and she never complained. She never showed any signs of panic, or aggravation with my lows back then. She may have saved my life on some occasions. I love her so much for doing her job, and doing it well. She has painful memories of how it used to be, and my giving her my numbers during the night is the least I can do for her. I will never complain. Never!!



Saturday, February 22, 2020

The Way It Was in 1957

I graduated from high school in 1957. The following comments describe the time in which I lived back then. I hope you can enlarge the photo and read it. This makes me feel very old, but being old is not so bad. lol


Sunday, February 16, 2020

Allergic to Insulin

I want to introduce my good friend Linda Lee Corbett Mann. On Facebook she is known as Linda Lee. I first met Linda online in 2007 in the tudiabetes.org and diabetesdaily.com diabetes support groups. We have had many online discussions. Now we have discussions on Facebook messenger. My wife and I met Linda in November, 2009 in Boston. We had dinner together the evening before I participated in the Joslin Medalist Study.

Linda was diagnosed with diabetes in 1974, when she was 12. She was then diagnosed with an Anaphylaxis Allergy to insulin. The allergy has caused her to have many problems and complications during her 45 years with T1D. She has given me permission to post her story. Here is Linda's story.

"May I just say, Stress releases cortisol and causes much havoc with BS control no matter what your goals are. Then there are some people whose bodies reject insulin. I have lived 45 years with T1D and many complications are part of my life. I am not making excuses. Some of us try to use the right medical therapies for ourselves and follow the advice given by our Endo teams, but we have few positive results. Double Digit A1C’s has been my life. I know some of you may not believe how I survived for 45 years like this. I am alive and functioning well with my complications. If you look at me, I look like all of you who have a good A1C range.

Living a long life while having many complications is a blessing to say the least. Frame of mind and a positive mindset helps for sure. I have been in many diabetic studies thru the Joslin Clinic, Johns Hopkins and Harvard Medical School. I am even in a PDR -Physicians Drug Reference book.

By all rights living with a life threatening Anaphylaxis Allergy to insulin should have killed me in my teens. I have experienced several diabetes complications, including renal failure, and two heart attacks after my bypass CABG and 2-3 Sepsis. I am Legally blind with Proliferative Retinopathy.

Long story yes, but it must be told that YES, poor control can kill you earlier. It also has to do with who, how and where treatment is had. You must stay abreast of the studies and have a Positive Mind Set, with Excellent Doctors.

We all have a story to tell about our lives with Diabetes. As Richard knows I don’t take a 'No there is Nothing We Can Do for You' as an Answer to a Medical Problem. I have by far outlived what All the doctors have told me thus far!

I have grown to accept my story of T1D. The reason I wanted to stay private initially was that most people responded in disbelief to my having an anaphylaxis allergy to insulin and surviving. It hurt me because I LIVED through the testing and the studies and their method to help resolve my problem. Initially I was sensitive to negative criticism. It felt like some people thought I made it up. I hope that my story will help or encourage someone to be stronger and adapt to their situation in living with T1D. I wanted my story to be told.

Throughout the years one doesn’t need the perfect home or life and perfect numbers as a result to their diligent work. Just continue trying to gain control and working at it the best you can. It makes the setbacks real and gives you strength to continue the fight to stay as healthy as you can be."

Linda is legally blind, but she is able to tell her story. She presently lives in Maryland and she is the mother of two wonderful daughters. Her favorite hobby is boating on the rivers and the shore of eastern Maryland. She is currently active in training young dogs.

There are many links to insulin allergies. The link below gives a good summary of the different types.

https://www.iddt.org/about/gm-vs-animal-insulin/allergic-reactions-to-insulin?cn-reloaded=1

Saturday, February 15, 2020

Doctors' scales....Are they Accurate?

I see two different doctors several times each year. My endo and my GP. Their scales always show a weight that is 5 or 6 pounds more than my scales at home. This could mean that my scales show weights than are 5 pounds too low, but I have decided that their scales have purposely been set to show 5 pounds heavier than the patient's true weight. 😠That's my story, and I'm sticking to it! So there!! 😏

Tuesday, February 11, 2020

Autonomic Neuropathy

Autonomic Neuropathy (AN) is more common among diabetics, and is especially common after 25 years of diabetes. Here are the more common symptoms from the Mayo Clinic:
" Dizziness and fainting upon standing caused by a drop in blood pressure.
Urinary problems, including difficulty starting urination, urinary
incontinence and an inability to completely empty your bladder, which can lead to urinary tract infections.
Sexual difficulties, including problems achieving or maintaining an
erection (erectile dysfunction) or ejaculation problems in men, and
vaginal dryness and difficulties with arousal and orgasm in women.
Difficulty digesting food, due to abnormal digestive function and slow
emptying of the stomach (gastroparesis). This can cause a feeling of
fullness after eating little, loss of appetite, diarrhea,
constipation, abdominal bloating, nausea, vomiting, difficulty
swallowing and heartburn.
Sweating abnormalities, such as excessive or decreased sweating, which affects the ability to regulate body temperature.
Sluggish pupil reaction, making it difficult to adjust from light to
dark and causing problems with driving at night.
Exercise intolerance, which may occur if your heart rate remains
unchanged instead of appropriately increasing and decreasing in
response to your activity level."
My neurologist diagnosed my AN in 2010 after I had mentioned extreme dizziness in the AM, and my occasionally falling down. My BP was dropping as much as 40 points when standing up in the morning. Cutting my BP med to half doses has helped, but my BP is still irregular in the morning. I have four of the seven symptoms listed, and they are gradually becoming more pronounced. Gastroparesis is one of the symptoms, but I do not have that problem at the present time. I hope I never do.
http://www.mayoclinic.org/diseases-conditions/autonomic-neuropathy/basics/definition/con-20029053 3
Do you have AN, or do you think you do?

Wednesday, December 18, 2019

My T1D Management, and Using Fiasp Insulin


There have been many people asking me about my "diet" and my daily routine. People with T1, or their T1 kids, who are newly diagnosed seem to think my many years with T1D, and no serious complications makes my routine a good example to follow. I try to explain that is generally not true.
There is no set routine that will work for all type 1 people. We are all different. What works for me may not work well for you. Each type 1 diabetic needs to work out a routine by trial and error, until something is working well. Then keeping careful charts or records can help with making changes, as needed.
I eat an average of 140 carbs per day. I am usually using 36 units of fast acting insulin each day in a pump. My insulin:carb ratio is 1:10 (one unit per 10 carbs), but I am less sensitive to insulin in the early morning, so I use a 1:7 ratio for breakfast.
I avoid many foods that have fast acting carbs. I avoid rice, cereal, and most pasta. When I do have pasta or potatoes, I eat small portions.
I am using a 70-170 range on my Dexcom CGM, and I stay in that range more than 90% of the time. My A1C has been in the 5.4-6.4 range for almost 20 years.
There are other T1D’s who are using a 70-150 range, and doing very well with it. There are some who eat less than 50 carbs per day, I refuse to do that. As long as I can avoid serious complications, I do not intend to change my routine. I enjoy my life the way I am doing it now, and I do not intend to change.
This might not work so well for you. I hope you have developed your own routine, and I hope it is working well for you.
I want to also mention that I have started using Fiasp insulin, instead of Humalog. My endo did not approve of my using Fiasp, and I recently posted that on my page. A friend sent me a message saying Fiasp did not work well for her, and she returned to her Novolog. She sent me several vials of Fiasp. I started using it five days ago. It is working very well for me, but it might not work well for you. Fiasp is a faster acting insulin and the acting time for me is three hours, instead of the old four hours I used for Humalog. I do not do any early premeal bolusing now, and I am not having post meal highs. I had 150-190 post meal highs with Humalog, but now I am having 120-150 post meal numbers with Fiasp. My only problem with Fiasp is having some lows in the 50-70 range. I am adjusting my basal rates on my pump to try eliminating those lows. I would like to eventually have a a 70-150 range. Maybe Fiasp will make that possible.
My endo did not want me to use Fiasp, but my friend has enabled me to use it now. I use one vial per month, and I have enough for five months. I will be seeing my Endo on Jan 20. I hope she will be impressed with my better control, and she will finally prescribe Fiasp.


Saturday, December 14, 2019

Double Diabetes

DOUBLE DIABETES
There were no diabetes "types" when I was diagnosed in 1945. All people diagnosed with diabetes were treated with insulin taken from pigs and cows. That crude form of insulin gave me back my health. In the years 1936-1939 it was discovered that there were two types of diabetes, but it was not until 1959 that the labels Type 1 and Type 2 were attached. Oral drugs for Type 2 diabetics were introduced in the years 1955-1956.
Now, in current times, we are seeing more and more people with characteristics of both type 1 and type 2 diabetes. These individuals have "double diabetes". This occurs when:
1. A person with type 1 diabetes becomes overweight and develops the basic feature of type 2 diabetes – insulin resistance (IR). Typically, the type 1 diabetic would then use a type 2 medication to help control the IR. Insulin would still be necessary as well.
2. A person with type 2 diabetes has one of the key features of type 1 – the presence of antibodies in the blood against the insulin producing beta cells of the pancreas causing a decrease in the body's ability to produce insulin. The decreased insulin production can then lead to the type 2 diabetic becoming insulin dependent. These individuals still use their type 2 medication for their IR.
Note: The definitions above were found on a diabetes website.
So double diabetics may have initially been either type 1, or type 2. Once they have become double diabetics they have IR, they are using insulin, and they are using a medicine (usually metformin) for their IR. I have several type 1 friends, and type 2 friends, who are double diabetics. Some of my type 2 friends are using a pump and a CGM.
In the 1990s I stopped using animal insulins, and began using synthetic insulins. I began gaining weight, even though I was following a much healthier diet, and eating fewer carbs. The only thing that had changed was my insulin. I have read many reports that say the synthetic insulins cause our cells to store fat. Maybe that was the reason for my weight gain, but I did not know that information until much later. I had never been more than five pounds above my ideal weight (185) until the 1990s. By the year 1997 I weighed 242 pounds. That was a net gain of 57 pounds. A lower carb intake and plenty of exercise did not seem to help at that time.
Finally, in 1998, I was diagnosed with insulin resistance. I had several relatives with Type 2 diabetes, and it seems likely I had the Type 2 gene. The gene and the weight gain are likely the explanation for my insulin resistance. In the early 2000s I reduced my daily carb intake, increased my amount of exercise, and lost 24 pounds. I initially used avandia for my IR, but started using metformin starting in early 2011. Using metformin for one year was very good for me. That medication has helped many diabetics lose weight. I lost an additional 29 pounds, and was then only four pounds above my ideal weight. Despite the weight loss, I still had IR. Metformin, eating an average of 130-140 carbs per day, and getting lots of exercise is now keeping me in good health. My A1c's are typically in the 5.9-6.4 range, and except for some mild nerve damage, I do not have any diabetes complications. Double diabetes can be controlled, and my health is just as good now as it was before I became a double diabetic.
Do you think you may have double diabetes? If you are type 1 and have gained weight, and are using more insulin than usual, then you might want to speak to your doctor (preferably an endo) about this.