Monday, December 17, 2012

The Pancreas Is Multifunctional

A type 1 diabetic may sometimes think their pancreas is useless, since it no longer produces insulin, but the pancreas has other important functions. It produces enzymes that help the body to digest fats, carbohydrates, and proteins. A type 1 diabetic's pancreas may not produce insulin, but it can still produce those enzymes. That is why I do not consider my pancreas to be useless. 

My father-in-law was diagnosed with pancreatic cancer, and his pancreas was removed. He had to inject insulin for the rest of his life. He was also given pills that served the purpose of the missing enzymes.

http://pancreasmd.org/education_home.html

Tuesday, November 27, 2012

Type 1 Child and Teen Deaths Are Decreasing

An encouraging article from the Diabetes Health magazine.

"There was a 78 percent reduction in deaths associated with diabetes among children under 10

There was a 52 percent reduction in deaths associated with diabetes among children ages 10 to 19"

http://www.diabeteshealth.com/read/2012/11/23/7717/child-and-teen-deaths-from-diabetes-plummet-over-41-year-period/

Monday, November 19, 2012

Diabetes Health Is Improving In The US


In 2009, the 10 leading causes of death in the US were, in rank
order:

  • Heart disease: 599,413
  • Cancer: 567,628
  • Chronic lower respiratory diseases: 137,353
  • Stroke (cerebrovascular diseases): 128,842
  • Accidents (unintentional injuries): 118,021
  • Alzheimer's disease: 79,003
  • Diabetes: 68,705
  • Influenza and Pneumonia: 53,692
  • Nephritis, nephrotic syndrome, and nephrosis: 48,935
  • Intentional self-harm (suicide):
 So Diabetes ranked number 7 that year.   

http://www.cdc.gov/nchs/fastats/lcod.htm

I recently saw an old article online that said diabetes was the third leading cause of death in the US, after heart disease and cancer. I don't know what year that was, but since it is the seventh leading cause now, we have certainly come a long way.

The link below says that the life expectancy of type 1 diabetics is almost as good as that of non diabetics:

http://usatoday30.usatoday.com/news/health/medical/health/medical/diabetes/story/2011/06/Life-expectancy-improves-for-type-1-diabetics/48851072/1

Thursday, November 8, 2012

My Subdural Hematoma

Oct. 15:  Dizziness caused me to fall backwards at my home, and the back of my head hit the asphalt on my driveway. I went to my local ER, and they said I would probably not have a concussion. They sent me home. I seemed to be ok. About a week later I started feeling very weak in my legs, and had to start using a walker at home. My condition did not seem to get any worse for the next couple of weeks.

Nov. 1: My wife insisted that we see my doctor. He sent me to the ER, and a cat scan showed bleeding in the vicinity of my head injury. I was diagnosed with a subdural hematoma. They sent me to the Albany Medical Center about one hour north of my home. Further testing showed the bleeding had spread. Walking was impossible at that time, and I could not turn over in bed. My legs were partially paralyzed. I had to stop using aspirin, which I use as a blood thinner. When my blood was no longer too thin, a procedure was to be scheduled to remove the old blood.

Nov. 3: The procedure was performed. After shaving a patch on both sides of my head, they drilled holes and used a device that let the blood drain out. A lot of blood drained during the next two days. I was able to turn over in bed, and I had a wonderful sleep!!! The next morning I noticed a lot of renewed strength in my hips and legs. I was allowed to get up and walk, with help. Physical therapy was to be prescribed, and I know a great PT guy in my home town (Kingston, NY). I was anxious to get back to workouts at the gym. My trainer there is excellent, and she is able guide me through appropriate exercises, and the machines to use to get me back in shape.

My wife will take very good care of me at home. We have been married 48 years, and we want to have a golden anniversary, so I must stay in good shape! LOL!!

As you can see, I have very good people to take good care of me. Old man Richard will survive and continue his quest for the 75 year Joslin medal in the year 2020.

Nov. 5: The tubing was removed from my head today, and staples placed there, to hold everything in place. I don't want any brains to spill out! LOL! I am walking again with a walker, and strength is coming back into my legs. They are sending me home tomorrow. They cannot wait to get rid of me! lol

Nov. 6: I arrived at my home after dark today, and am doing very well. While my cab was headed south the car in front of us swerved and ran onto the edge of the interstate highway. The cab driver managed to avoid hitting the car as we ran over a big bump. Then we realized that the other car had hit a deer. We ran over that deer without any problems. I could have ended up having to go back to the hospital!!The taxi driver was very good. When we arrived at my house, my wife and I gave him a big tip!!

Nov. 8: I have put my walker in the closet. Almost all my strength and coordination have returned. I feel so lucky that my recovery has been so fast. I am 73 years old, and I have been a type 1 diabetic for 67 years. Neither diabetes nor brain surgery are going to keep me from having a long, healthy life!! 

Sunday, October 21, 2012

Diabetes Alert Dogs, A Survey

Jeff Hitchcock, creator of the children with diabetes website, has posted a survey involving diabetes alert dogs. I know some of my friends have them, and maybe you want to take the survey.

https://www.surveymonkey.com/s/3WKM5D3

Saturday, October 13, 2012

Is There A Conspiracy Preventing A Diabetes Cure?



I have seen so many discussions suggesting that a conspiracy may exist. This is a very good article addressing this topic. It is written by Allison Blass on the Diabetes Mine website.

http://www.diabetesmine.com/2012/10/is-there-a-conspiracy-preventing-a-diabetes-cure.html

Thursday, October 4, 2012

Trying To Avoid Diabetes Complications

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, and 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 160. The average is 100, but there are numbers that indicate unhealthy highs and lows.

 Patient B has test results 72, 80, 94, 100, 106, 120 and 128. The average is again 100, but the data is more closely packed, and none of the numbers are undesirable.

Patient B is experiencing much better control, and is much 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 100. Patient B had smaller deviations, so the SD was much better. I try to keep my SD close to 20, but it is difficult to do. My A1c's have been in the 5.4-6.1 range for almost 10 years, but when I have too many highs and lows, my SD is higher and I can feel the neuropathy symptoms in my left foot. I sometimes have some spots of retinopathy in both eyes if this situation persists for too long.

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 avoiding the highs and lows.

I had A1c's no higher than 6.1 for almost 10 years, but had the beginning stages of neuropathy and retinopathy. My control had been tight, but it was necessary to make it even tighter. I stopped having so many highs and lows and after a few months had passed, the retinopathy disappeared. The neuropathy is still present in one foot, but I rarely experience any pain. If I have high blood sugar for several hours there is sometimes mild pain during the night. I have been a diabetic for 67 years, and have not had any serious complications. I want to keep it that way!!

Monday, September 17, 2012

My 67'th Diaversary

September 15, 2012, was my 67'th diaversary. I was diagnosed in 1945. I have lived this long with type 1 diabetes, and I do not have any diabetes related complications, except some very mild nerve damage. 

I don't have any "secret". I do the same things that many type 1 friends have done, but my routine seems to have worked better for me than it has for so many others. The research in Boston is attempting to find why us long term, healthy type 1 diabetics have been so successful. I participated in that research in 2009. The research is ongoing, and began in 2005. There have been almost 800 participants thus far. All of the participants are Joslin medalists who have had type 1 for 50 years, or more. 

They have found several interesting things. Many of the medalists are producing small amounts of their own insulin. They have found that we have an inner protection of some sort that keeps us from having problems with our eyes, kidneys and other types of nerve based damage. Our hearts, however, are not protected. Many of the medalists have had heart attacks, bypass surgeries, etc. The Joslin doctors have advised us to be especially careful with our heart health. 

Thursday, August 30, 2012

Poor Grandma

I found this in my email:

POOR GRANDMA!!

The computer swallowed Grandma,
Yes, honestly its true!
She pressed 'control' and 'enter'
And disappeared from view.

It devoured her completely,
The thought just makes me squirm.
She must have caught a virus
Or been eaten by a worm.

I've searched through the recycle bin
And files of every kind;
I've even used the Internet,
But nothing did I find.

In desperation, I asked Mr. Google
My searches to refine.
The reply from him was negative,
Not a thing was found 'online.'

So, if inside your 'Inbox,'
My Grandma you should see,
Please 'Copy', 'Scan' and 'Paste' her,
And send her back to me.

Factors Influencing Insulin Dosages

Here is a great article by Riva Greenberg. Riva is a type 1 diabetic, and she writes articles for the Huffington Post. Her article concerns glucose meter accuracy, and other factors that influence our glucose control. The meter accuracy is important but accuracy in carb counting, and the levels of absorption of the insulin are also very important. Here is a quote from Riva's article:

" .....if a meter meets the ISO standard (95 percent of the time it's within plus or minus 20 percent of a standard lab test at glucose concentrations equal to or above 75 mg/dl, and within 15 mg/dl at values less than 75 mg/dl). Comparatively, the average error in carb counting is about 20 percent and in insulin absorption about 25 percent. Hence, a lot of inaccuracy to base my dosing on. Yet, notice meter accuracy is much less impactful to my dosing accuracy. The solution, for now, is to make each of these three factors more accurate. So if we increase meter accuracy to within plus/minus 15 percent -- the new reference standard now pending FDA approval -- and I brush up on my carbohydrate counting and get a little better at calculating my insulin dose, I'll increase my chances of getting my insulin dose more accurate more of the time."

In my case the insulin absorption is a major factor. After almost 62 years of injections, and 5 years of pumping, my body is riddled with spots of scar tissue. The level of absorption is very variable because of the scar tissue. I have to change programming on my pump every time I change infusion sets. When I change sets every 3 days I never know whether my absorption will be great, mediocre or poor. It was the same with injections. Some of my scar tissue is permanent. Be sure to rotate sites to avoid scar tissue. Here is Riva's article:

Blood Pressure Meds, and Dizziness

A recent study suggests that many doctors are prescribing BP meds unnecessarily. I started taking a BP med many years ago, even though my BP and kidneys were good. My doctor wanted to protect my kidneys, just in case there might be a problem. Diabetics are more prone to have kidney problems. I had only mild side effects with the BP med. In 2007 I started having higher BP
 numbers, like 135/75, so my BP dosages were doubled. I started having dizziness as a side effect. For 5 years I have had dizziness, and recently it is much worse. Sometimes I fall down or stagger with dizziness. I stopped my BP med for two weeks last year and my dizziness was so much better, I could walk normally. What a relief, but my BP increased into the 140's. While using a full dosage of the BP med my BP is like 120/58. Why is that second number so low? Is that dangerous? My doctor says it is not dangerous. If I use a half dosage my BP is like 135/65. Is it better to have a 135/65 and very little dizziness, or is it better to have a 120/58 and lots of dizziness? I have never had any kidney problems, so I do not need a BP med for my kidneys. The recent research makes me skeptical about my higher BP dosage. Here is the link:

http://www.peoplespharmacy.com/2012/08/15/hypertension-heresy-are-we-overtreating-high-blood-pressure/

Tuesday, August 7, 2012

Insulin Vial, 1923


This picture shows a vial of insulin produced in 1923, two years after insulin was discovered. It shows a 5cc glass bottle. The insulin is from Lab. No. 257-4, dated November 5 1923. The label on the front of the bottle reads: 'Insulin 10 units - 5 c.c. vial. 10 units per c.c. Connaught Laboratories. University of Toronto'. According to the Connaught anti-toxin laboratories filling records for insulin this bottle was filled November 1, 1923.

The dark color of the insulin may be doe to the insulin not being purified during the early years. Insulin was taken from pigs and cows, but not purified and made safe for injection purposes until the Lilly company took over and made the insulin safe by removing the impurities. 

Friday, August 3, 2012

Do You Hide Your Diabetes?

Do you hide your diabetes?

For many years after my diagnosis in 1945, I did not know another diabetic. I mentioned my disease to a couple of friends when I was a teen, but they looked so puzzled. They did not know what I was talking about, and I doubted they even believed me. So I hid my diabetes for many years, but I did try telling a few teachers in high school and college. They did not seem to understand, and maybe they did not believe me. When I was a college sophomore I had a very bad hypo while taking my first calculus test. When I approached the teacher and explained that my vision was blurred, and I could not read the test paper, he would not help me in any way. That was the only test I ever failed. There seemed to be almost no knowledge about diabetes in my early years. 

I dated and told my girlfriends. It did not seem to make a difference to them that I was a diabetic. That was probably because they did not know enough about it to be concerned. The first person I knew who really was concerned was my wife, but only after we were married. She was not concerned before we were married because she never saw me have a hypo. I was high much of the time on animal insulin. I did not tell my students after starting my teaching in 1962. There did not seem to be any reason for doing so. I was alone as a diabetic, except for my family, until I was married. My wife and I have been married for 48 years, and she has been so wonderful in so many ways with helping me with my diabetes. But there was still something missing!

In July, 2006, I found diabetes on the internet. That essentially changed my life, in a very important way. There were so many people online who were diabetics, or they had family members with diabetes. We talked with each other, and we learned so many new things. I believe that at least 80% of what I know about diabetes was learned on the internet. I was helped in so many ways, and my control and my life improved. I became a diabetes advocate to many online people who needed to know the things I had learned. So many parents of diabetic children have found me to be an inspiration because I was diagnosed when I was 6, and am very healthy now that I am 72. 

After 66 years as a type 1 diabetic, I am very comfortable telling people about my diabetes, and about diabetes in general. It is very comforting and rewarding to give and receive help online. I will never again hide my diabetes. I hope my online friends feel the same way!

Wednesday, August 1, 2012

Stress? Who ME? Yes, but only after 50 years of Diabetes.

I have seen several posts about whether it is best to be diagnosed at a young, or at an older age. I was diagnosed when I was barely 6, and cannot remember very much of my life before that. There were no "types" back then, all of us were given animal insulin, told to not eat sugar, and that was it. There were no other rules to follow. I w
as so young that it seems now like my life was just beginning then. I feel that was an advantage for me since I was very healthy back then, without any complications. I tested my urine and took one injection before breakfast. I ate anything I wanted all day long, as long as it did not contain sugar. There was no more urine testing or injections until the next morning. Sounds simple, doesn't it? It WAS simple, and so much less trouble than today's management routine. I was never stressed about my D in the old days, because there were no complications.

I became stressed in the 1990s, 50 years after my dx. I was forced to stop animal insulin and started using synthetic insulins. There was carb counting, basal/bolus control, testing many times each day, and MDI. What a BIG change! I adjusted to that, but I was also diagnosed with neuropathy, retinopathy, frozen shoulders, carpal tunnel, cataracts, arthritis, and a few other things. I was extremely stressed! I thought things were supposed to be better with the modern day devices, insulins, and knowledge about how we should control our D. I felt everything had backfired, and I was going downhill fast. I feared for my life!! Then I joined online D sites and found others like me. My new friends convinced me to use a pump. That is what turned things around. My complications no longer bother me because my numbers were much more stable. I had gained weight during the years I was so stressed, and insulin resistance entered the picture. I am now using Metformin along with my insulin, I am not overweight, my health is great, and I will live forever!!! <wink>

Sunday, July 29, 2012

I Want To Be A Motivational Speaker

I would love to meet with groups and become a motivational speaker, but I don't know how to get started. After 66 years with type 1, and much experience with online diabetes groups, I have learned so much. I have much to share. I have asked some online people who have spoken to groups, but I have not been given any direction for getting into this kind of thing.

 I want to meet people face to face who have diabetes in their lives, and to meet parents of diabetic children. I think I have something to offer to these people, but how do I set this up? What is the first step? I watched Scott Johnson's recent video, and heard his talk. I met Scott in Oct, 2011, in Minneapolis. I loved his video speech. I want to do what Scott does. Any suggestions?

Tuesday, July 10, 2012

A Facebook Friend Interviewed Me

Katrina Huckaby is a Facebook friend. She has a child who is a type 1 diabetic. She is doing a series of interviews with people who have diabetes and are more than 60 years old. She interviewed me several days ago. Here is the interview, Katrina Huckaby is the interviewer:

"So over the past week I hit on what it is like to be the mother of a type 1 diabetic, the father of a type 1 diabetic, and today we have some interviews from 2 amazing men who have lived with type 1 diabetes for 30+ years.

 These men have seen all the changes that have come about in diabetes treatment and management, they have seen the DOC come into fruition with the help of the internet, and they drive others to know that you/your child CAN live a long healthy life despite the diagnosis of type 1 diabetes.

Richard is the author of Beating The Odds: 64 Years Of Diabetes Health in which he tells the story of how he was first diagnosed with type 1 diabetes in the 1940s, and the steps he needed to take to overcome the problems which this caused. You can purchase his book online through Amazon

Here is his interview with me ...

Q: Your first name
A: Richard

Q: How old are you?
A: 72

Q: For the management of your Type 1 Diabetes are you on an insulin pump (If on pump which one) or multiple daily injections?
A: I use the Medtronic Revel pump, model #523

Q: What made you choose this method for management?
A: I chose to pump in 2007 because I was having too many highs and lows with my blood sugar tests. My A1c was very good, but the trauma to my body caused by those highs and lows resulted in retinopathy and neuropathy. These complications, although mild, were helped by pumping since there were far fewer highs and lows. My retinopathy disappeared. The neuropathy is still present, but the pain is no longer there.

Q: How comfortable are you with managing your diabetes?
A: I have been a type 1 diabetic for 66 years, and do not remember much of my life before being diagnosed. My diabetes is an integral part of my life, and I am very comfortable with my diabetes management.

Q: What has changed the most in regards to diabetes management since you were diagnosed?
A: My diagnosis occurred in 1945, and EVERYTHING has changed since that time. Going from animal insulins to modern day synthetic insulins, from testing urine to testing blood sugar, and from one injection per day without paying any attention to carbs, to carb counting and using basal/bolus control. Maybe the biggest change has been going from not knowing other diabetics and having very little information to help me, to now having wonderful online communities and so much knowledge at my fingertips.

Q: What does a typical day look like in your household in regards to diabetes management?
A: A typical day? Careful record keeping with 12-15 glucose checks, carefully counting carbs and insulin dosing while keeping exercise and other activities in mind. My days are comfortable and enjoyable, except when the occasional highs and lows occur, but I know how to handle those.

Q: What does a typical day’s diet look like?
A: My diet usually has 30-35 carbs for breakfast' lunch and dinner. I also have two or three snacks with 15-20 carbs each. I usually avoid cereals, grains with fast acting carbs, rice, and other foods that are known to raise my blood sugar very fast. I eat whole grains, and small portions of pasta, and other foods that are known to give me a fast rise in my blood sugar.

Q: What tips or advice would you give to a newly diagnosed Type 1 Diabetic children/teen/adult?
A: I advise the parents of newly diagnosed diabetic children to choose an endocrinologist who works well with them and the children. It is so important to have a doctor who knows diabetes well, and who gives good advice. Parents should read books and join online parents support groups. Working with experienced parents of diabetic children can be a tremendous asset. All newly diagnosed diabetics should get to know other diabetics who are experiencing the same problems. Support groups in their local communities, and online, are very helpful. There are many very good books written that can also be a great help.

Q: Besides a cure what 1 thing would you like to see researchers working towards and why?
A: All type 1 diabetics, their loved ones, and the parents of diabetic children are hoping for a cure. So much research has been done that suggests that a cure might be possible, but time after time the research has not produced what we are all looking for. There are many discoveries like the insulin pump, the continuous glucose monitor, and the soon to be automatic pancreas that help so much, but none of them are cures. I hope an actual cure will be seen in the not too distant future.

I hope that researchers will determine why some of us long term type 1 diabetics have lived so long and are so healthy, without serious complications. The Joslin Medalist Study has examined more than 700 type 1 diabetics, all of whom were diagnosed at least 50 years ago. It is hoped that the factors that have enabled these individuals to live long, healthy lives, will be found. If the factors are found, then maybe a treatment can be devised that will help younger type 1 diabetics to also have longer and healthier lives.

Q: What would you like to see more of out of the Diabetes Online Community?
A: The diabetes online community (DOC) is wonderful, and so much can be learned there. The thing that bothers me most about the DOC is the occasional arguments between individuals. There was a bitter debate between type 1 and type 2 diabetics on one of the biggest online communities. It was called the Civil War among diabetics, and written up in some major newspapers. The website that sponsored that debate lost some members, and I do not post there very often now. It left very bitter feelings for me, even though it had been my favorite diabetes website at one time. This kind of thing is unnecessary, and should always be avoided. There have been some debates like this in Facebook groups too, but things seem to have improved in that respect during the past year.

Q: What is your favorite thing about the Diabetes Online Community and why?
A: My favorite thing about the DOC is that there are many very experienced diabetics, and parents of diabetic children, who take the time to reach out to help their fellow diabetics and parents in so many ways. These individuals are an important part of the foundation of the DOC.

Q: What is your least favorite thing about the Diabetes Online Community and why?
A: My least favorite things about the DOC include the harsh comments made by some people, the occasional offering of advise that is so incorrect, and the people who are advertising so called cures and other inappropriate spam.

Q: What 1 thing would you like to see discussed in the Diabetes Online Community that is not discussed enough?
A: In my opinion, the things that we 30 million diabetics in the US need most is more support from the government, and a widespread recognition of our plight, along with much educating of the general public, so there would not be so many myths, and so much misunderstanding about diabetes in general. The DOC has done much to help in this respect, but only a small portion of the 30 million diabetcs in our country visit the DOC. We need to reach out and make the vast majority of the diabetics out there be aware of our existence, so they too can benefit from the online experience.

You can read more about Richard and his life with type 1 diabetes by reading his book Beating The Odds: 64 Years Of Diabetes Health

I appreciate the time he took to help me with this multi-segment blog and I hope you all are liking the posts so far .. Plenty more to come.
 Posted by Insulin Princess"

Thursday, June 14, 2012

Many T1 Diabetics Have Eye Protection


Many of the Joslin medalists, with type 1 diabetes for at least 50 years, have been found to have protection from diabetic retinopathy. I may be one of them since my ophthalmologist has been saying for many years that I do not have any diabetes related eye damage after 66 years of T1D. It is hoped that further study of a small subgroup of the medalists will "lead to a means to prevent or slow the progression of diabetic eye disease".

http://www.eurekalert.org/pub_releases/2012-06/jdrf-jrs061112.php

Friday, June 8, 2012

Diabetes Dos & How Tos

My friend, Riva Greenberg, is preparing her third book. She has been type 1 for 40 years and is a wonderful author. Did you read her other books? Her book on diabetes myths is fantastic!! It is called "50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It". Type her name: Riva Greenberg: in the search bar on amazon.com and look at her books.

Riva is collecting diabetes stories for her third book, and she needs your help:

"I'm writing my third book - “Diabetes Dos & How Tos" and need your help. I'd like to feature a dozen people with just a line or two about something you do that helps you stay healthy living with diabetes.
The book has a number of Dos (steps) to take care of your diabetes, and several recommended ways (How Tos) how to do that.

There are 4 sections: Food Dos, Medical Dos, Fitness Dos and Attitude Dos and at the end of each section I’d like to feature a "How To" from a few people - what you do to manage one of these aspects.

Can you share in just a sentence or two with some detail what you do:

1. To manage to eat healthy? e.g. "I always bring my own food to the airport because that way I can ensure I'm going to eat something healthy."

2. To take care of your diabetes – it can be anything from how you organize your medicines, to reading up on new advances, to preventing or treating hypoglycemia - anything you do that is at all medical related to caring for your diabetes. e.g. "I keep glucose tabs in all my purses and pockets so if I have a low I'm ready for it"

3. To manage to stay fit, or get exercise? e.g., "I work out at Curves three times a week. Being around other people and the inspiring music keeps me going."

4. To keep your stress under control e.g., "I go to a yoga class in my neighborhood once a week, and twice if I can find the time."

You can answer all or any of the 4 questions above. Can you also let me know:
Your name?
What type of diabetes you have?
How long you have had diabetes?
How old you are?

Thank you so much,

riva"

Saturday, June 2, 2012

My Type 1, and Metformin

I was type 1 for about 50 years when I changed from animal insulins to modern day insulin. That led to my gaining weight and becoming insulin resistant (IR). I had to use a type 2 med to handle the IR. Avandia was the med my doctor chose, and I used it successfully for 12 years, starting in 1999. Avandia was found to cause many users to have heart problems, so my endo would not renew my prescription, and he prescribed Metformin in early 2011.

I have mixed emotions about Metformin. It has enabled me to lose 22 pounds, and I am now only one pound above my ideal weight (185 pounds). That is great, although I have had to buy new clothes and belts. Lol! My insulin resistance has been decreased, and my insulin sensitivity has increased. That is also good.

Metformin was initially introduced as a med to help with weight loss. Later on, it was found to help with with IR. It has caused me to lose some of my appetite, and I don't want to eat as much now. At one time I was losing an average of two pounds per week. To keep from dropping below my ideal weight, I had to increase my carb intake from 130 to 150 carbs per day. My weight has now stabilized. I don't want to eat that many carbs, and sometimes I have to eat when I am not hungry. That is annoying! If I lower my carb intake, then my weight drops too. I have tried lowering my Met dosages, but then my IR increases, and my BG numbers rise a lot. I am taking 1000 mg of Met in the morning and evening.

While using Avandia my BG's were very good, and I stayed in the interval 70-130 about 90% of the time. I have used Met for 15 months, and I have a lot more highs and lows than before. My BG's are now in the 70-130 range only 66% of the time. BG's as low as the high 30s, and as high as the 170s are happening. I did not have those kinds of numbers while on Avandia. I am now on the roller coaster with my BG's, like I was before pumping.

During the first few years of the new century, I was diagnosed with some spots of neuropathy in both eyes, and neuropathy in my feet. That was caused by the unstable control, and the roller coaster I was experiencing. Complications can occur for that reason, even when the A1c is good. My A1c was below 6.0 for several years when those complications were diagnosed. After using a pump for a few months my BG's stabilized a lot, and my retinopathy disappeared. My neuropathy was still there, but the symptoms rarely appeared. The pain was gone. Pumping is great!

Now, while using Met, my roller coaster control has returned, and I am concerned that my retinopathy, and neuropathy pain may return too. My doctor says he has no other med to offer to help me with my IR. Avandia and Actos have both caused damage to many diabetics, so Met seems to be my only choice. I have tweaked the heck out of my pump, trying to get more stable control. It was easy with Avandia, but seemingly impossible with Metformin. I am apparently stuck with Met, and with the more unstable control. I am expecting those complications to return at any time now. Call me a pessimist, but this happened in the past, and it may happen again.

Any suggestions?

Tuesday, May 22, 2012

Good Control Is Usually The Key To Success

When I participated in the Joslin Medalist Study in 2009, the director was there making sure everything was done properly. She gave me some interesting info. The medalists are type 1 diabetics who have lived with diabetes for 50 years, or more. I was told that some participants had never taken very good care of themselves, and they still eat almost anything they want. They do take insulin, but they have no serious complications. There are also other participants who have some rather serious complications, but they have taken very good care of themselves. So I asked if these two groups were a significant part of the 500+ medalists who had participated at that time. She said that the two groups were rather small. The great majority of the participants who had practiced good diabetes management were in good health, with no serious complications. It seems that the members of the small groups mentioned above are exceptions to the rule. I am one who has always done everything possible to have stable control, and it has paid off.

At the present time there have been approximately 750 participants in the Medalist Study, and they plan to continue until there have been 1000 medalists participating. The JDRF, the NIH, and private sources are funding the study. Some very interesting things have been discovered.

I have mild nerve damage after 66 years of type 1,but there is no other diabetes related problem. I hate to think what might have happened if had been in denial during my early years. I want to be the first type 1 diabetic who lives 100 years with diabetes. That would happen on September 15, 1945, and I would be 106 years old. Does anyone want to attend my celebration on that date? :)

Sunday, May 20, 2012

My Diabetes Hero

This is the last day of the Blogger's Week participation. The topic for today is "Diabetes Hero". I have encountered many heroes during my diabetic life. I could easily choose my mother, who took good care of me from my diagnosis in 1945 until I left home for my first full time job in 1963. There is one other person, however, who has watched over me for almost 48 years. My wife, Anita. She is definitely deserving of being my diabetes hero.

Anita and I were married in May,1964. She knew nothing about diabetes before we met, but she learned so much, so fast. She brought me out of so many hypos and seizures during our marriage. There was no way to test my blood sugar during our first 21 years, so low blood sugar episodes did occur without warning. Anita was a pro, and helped me through so many difficult times. There were no guidelines concerning a proper diet except to avoid sugar. She watched closely and soon realized that certain foods caused high blood sugar, and she began preparing meals that were more appropriate. In 1988 I learned about the effect carbs had on my BG. My daily carb intake was reduced a lot, and only small portions of some foods were allowed. My control improved, and Anita found it easier to cook for me. With basal and bolus insulin in the 1990s, things improved even more. In June, 2007 I started using an insulin pump. Since July of that year I have not needed any assistance with low blood sugar episodes. Anita is very happy with my pumping experience, it is like she is having a long vacation. She does not have to watch me so closely now, but during the night she still has concerns. If I make a noise in my sleep, or am unusually restless, she awakens me and has me test my blood sugar. On some of those occasions my BG was dropping, so I don't argue with her. I test whenever she thinks I should.

I will be forever grateful to Anita for her wonderful care taking. I love Anita so much!! We will celebrate our 48'th anniversary on May 31, this year.

Saturday, May 19, 2012

Picture, Joslin Medalists

For the sixth day of the Blogger's Week participation, we are to show some picture that is special to us. The picture below shows a group of long term type 1 diabetics. They have all been type 1 for 50 years, or more. The Joslin diabetes Center in Boston awards medals to these diabetics. The older people in the picture are the medalists, the younger ones are doctors and staff members at the center. I am the taller fellow in the middle of the back row. The Joslin Medalist Study is examining medalists to see what makes us different. I participated in the study in 2009. The doctor presiding over the meeting said that he had never seen such a healthy looking group of "sick people" Lol!



Friday, May 18, 2012

What Non Diabetics Should Know

All diabetics have to put up with the widespread ignorance that exists among nondiabetics. We diabetics hear statements like "You got your diabetes because you ate too much sugar"; "If you get fat you are going to be a diabetic"; "You cannot eat that, it has sugar in it";....and there are so many other myths we hear.

My friend, Riva Greenberg wrote a wonderful book called "50 Diabetes Myths that Can Ruin Your Life and the 50 Diabetes Truths that Can Save It". Riva did a wonderful job debunking the 50 myths mentioned in her book.

If every nondiabetic was forced to read Riva's book then the myths would no longer exist. There would be so little ignorance about diabetes.  Would this possibly lead to the population taking diabetes seriously, and would all the newly aquired knowledge lead to a cure? Hmmm, there is one stumbling block here. How do we gen the many millions of non diabetics to read Riva's book?

Any ideas?  Lol!!!

Thursday, May 17, 2012

Fantasy Diabetes Devices

I used a Medtronics CGM for a week in 2008. It was a loaner of a sensor from my endo's office. It did nothing for me, it just kept me awake with false alarms, so I put it in vibrate mode and ignored it. In 2010 my insurance allowed me to use a Dexcom. It was much better, I liked it! Then in October of that year I was informed my group insurance was changing. I lost my coverage and would have to pay for everything myself. I stopped using a CGM. In October, 2011, I went to Minneapolis to meet online friends, and attend their diabetes Expo. One friend let me use his Navigator CGM, made by Abbott. I couldn't believe my eyes. It had a short warmup period, and the accuracy was incredible. I used it three days and the agreement with my FreeStyle meter was amazing. It was so much more accurate than Medtronics or Dexcom. So why is the Navigator no longer sold in the US??? It is sold in Europe, but not here. My fantasy for quite some time has been an accurate CGM. Apparently we cannot buy a Navigator from Europe if we want our insurance to cover it. Medicare will not cover any CGM whatsoever. My fantasy is to see this wonderful CGM sold in the US again. I have a Facebook friend who participated in an artificial pancreas trial in Boston last year. The Navigator was used in detecting the BG numbers that ran the whole trial. They made a good choice.

Wednesday, May 16, 2012

One Thing To Improve

I was a type 1 diabetic from 1945 until the 1990s while using animal insulins. Then synthetic insulins entered the picture. I was counting carbs and getting plenty of exercise, but I started gaining weight, and did not know why. I was having to use much more insulin than before. My teaching at the community college was not good anymore, I had lost my ability to be a good teacher. I retired at the age of 57 in 1997. My doctor diagnosed insulin resistance, and in 1999, I started using a type 2 med, Avandia. My resistance decreased, and so did my insulin dosages. I felt much better and taught part time for several years. Avandia was found to cause heart complications for many users and was banned in many countries. My endo then prescribed Metformin. I had been reading more and more about type 1 diabetics who were using Metformin for isnulin resistance, and was anxious to give it a try. I had no complications with Metformin ER and took 1000 mg both AM and PM. I started losing weight, and during the first 14 months of using that med, I have lost 22 pounds. Now I am only one pound above my ideal weight.

Metformin has helped me very much, but my control is not as good. My weight has stabilized, but the range of my BG's has increased. I am having more lows and highs that before. Adjusting many things, especially basals and ratios on my pump, has not helped very much. I have an average of two lows in the 35-55 range each day, and they can occur randomly and show no consistent pattern. I have adjusted to these lows, and never need any help with them, but I really need to find some way of avoiding them. I really need to improve this situation, and stop having so many lows. My spring and summer schedule is going to be hectic with working on my house and doing a lot of sanding and painting. I insist on taking a lot of long walks and working out at the  local gym. Staying in good physical shape is an obsession of mine. I am very active, but that is part of the reason I have these lows. I must try and have my schedule become more consistent and find a way of keeping my BG above 60. It won't be easy, but that is my challenge for the rest of this year.

Tuesday, May 15, 2012

One Great Thing

I was diagnosed in 1945 when very little was known about diabetes. There were no "types" back then, All diabetics were told to avoid sugar, but there was very little other advice given. In the 1980s I bought my first glucometer and in 1988 I learned about the effect of carbs on my BG levels. in the early 1990s I started keeping charts so I could keep track of my BGs, insulin dosages, carbs eaten, and daily totals. In more recent years I have added exercise, infusion set changes, daily notes on taking medicines, etc. I have been very very good about this and it has helped so much to develop good diabetes management. I realize that I could do this on a computer, but I started keeping these records before the PC's existed. Old habits are hard to break, and I am sticking to my charts that are hand written. Just call me old-fashioned. I take a chart to my endo and she makes a copy for all of my visits. We discuss it in detail, and she has always given me high praise for having very good control. My record keeping and the good control I have is the "one great thing" I am mentioning today.

Find A Friend

I am getting a late start on diabetes blogger's week. I did not know about it until today. I have not done much blogging, even though I started in 2010. I will make posts today for the Monday and Tuesday topics.

I have recently found a wonderful blogsite called Dia-Beat This, located at http://diabeatthis.blogspot.com/. The young lady posting there is named Lesley. She recently participated in an automatic pancreas trial at the University Of Virginia. She has written a series of blogs about her participation, with many sidelights. Her blogs are very well written, and I really enjoyed reading them.

I have not joined many blogsites yet, so the one I have mentioned is my contribution for today's topic.

Monday, May 14, 2012

I'm A Prisoner In My Own Home

Anita and I have been married for 46 years. I was a diabetic for 19 years before we were married in 1964. She was only 20 then, and knew nothing about diabetes. I rarely had insulin reactions back then since my blood sugar was undoubtedly high so much of the time. There was very little known about diabetes care. The monitors for measuring blood sugar levels were not available until the mid 1980s, and there was almost no useful advise given by my doctors. When I became more educated about diabetes, and had a doctor who knew more about diabetes, I started using tight control. Along with that control came many insulin reactions (hypos). When the hypos started in the early 1970s Anita was very good about it. She did a great job!!! I praised her every time she brought me out of a hypo.

Anita devoted most of her time to our two sons. Many years later the boys were in high school, and they demanded very little of her time. She was a stay-at-home mom, and had a lot of time on her hands. Later on, the boys went off to college, and I was the center of her attention. She became a chronic worrier about so many things, including my hypos, which were not so frequent at that time. She would feed me glucose tablets when hypos occurred at night.

Fast forward to the new century. Anita is an extremely nervous person, especially concerning my diabetes, even though I am using an insulin pump, and have very good control now. She wants me to test every 2 hours while I am awake,  every 3 hours  during the night, and once every hour when we are out traveling, shopping, etc. She rarely drives our car because of her nervousness. Every time I turn over at night she wakes me up and wants to know if I'm OK. I love her to pieces but she drives me crazy!!! She worries needlessly about my diabetes, even during the daytime.

Anita started to become overprotective after the kids left home. They have been gone for 23 years now. They live in NC and GA and we are in NY. We usually see them only once per year. My wife heaps all her mothering on me. I have realized that for some time now, but there is nothing we can do about it. Our marriage is wonderful, and I understand she cannot help being this way. Is it possible to be loved too much? HA!

I started training on my insulin pump in May of 2007. Anita attended all the training sessions with me. She actually said that she thought that I would do much better, and she would not have to worry so much. It was a dream come true to hear her say that! The very next night after she said those words, I had a rather bad hypo. It was the first one since Jan. 5 of that year. She still seemed rather optimistic though. I was encouraged about pumping, and her optimism. I have not had any hypos that required her help since July, 2007. So why is she still worrying as much as ever??? I still have to test every two hours, and nothing has changed, despite the fact that my control is very good with no hypos that require her help. Her worrisome ways will never end. I am convinced of that.

After retiring I wanted to travel and see more of our country and Canada. The UK and other European countries were places that really interested me. Anita hates travel and loves staying at home. She even hates flying to Atlanta to see our kids and grandkids but she loves the visit once we get there. I want to travel alone, and am very confident that I would be perfectly safe in doing so. Anita says she will not allow this! If I go, she will go with me, even though she does not want to do so. Enjoying a vacation with her tagging along would be impossible. She would not enjoy it, and we would both be miserable. Staying at home seems to be the only option. This situation is so very frustrating!

I can tolerate Anita mothering me, and worrying about me, but I want to travel. I worked hard for many years and we have a savings that would permit the travel. The only feasible solution seems to be my running away from home. I would stay away for a few weeks and call her three or four times per day. She would probably, eventually, forgive me. She would be at home with her three cats, where she wants to be. She would be very angry but she would understand, or would she? This escape has occupied my mind for several years. So why don't I do it? My love for Anita is so strong that I cannot do this to her. She would worry so much, and lose sleep at night.

We planned a trip to England in 2011. When I made out our scedule, we bought our passports, and I was about to purchase our plane tickets, she came unglued. She could not make that trip, she was so frightened. What if I had a terrible hypo while we were in another country, so far from home? What would she do?  I had to put all the plans away. We have planned trips like this before, but they never happened. We went to Minneapolis in October, 2011, and I had a great time at a diabetes expo. We met so many of my online friends there. It was wonderful!! Anita had a "grin and bear it" time. She did it for me. Now I am more hungry for vacations like this than ever before. Anita says we took a nice trip, and I should be satisfied. She thinks we should save our money for the future when we are in a nursing home. I would be sitting there in the nursing home and regretting I had never taken the trips I so very much wanted.

What would you do if you had this problem? It is not fair to me if I stay at home to make her happy, and it is not fair to her for me to take her along, or run away on these dream vacations. We are getting older, and something has to be done about this, but what? <sigh>

Wednesday, May 9, 2012

Living With Type 1 For More Than 60 Years

In October, 2008, the Diabetes Forecast magazine interviewed eleven long term diabetics who had lived with type 1 diabetes for 60 years, or more. That month was the 60'th anniversary of the magazine.

I was one of the diabetics chosen for the article, and they sent a professional photographer to my home. It was August and the issue was not going to be released until October, so the photographer told me I would have to look Octoberish. Lol! I wore long sleeves and pants with long legs. It was a day when the temperature was in the 90s F. That was difficult, but I was pleased to be part of this group. 

The gentleman on the cover of the magazine is William Rounds. He was diagnosed in 1923 when he was 11 months old. In 2008 he had been a type 1 diabetic for 85 years. In the side bars below William's story you will find the stories of the other participants. I hope he alive and well. He attended the Joslin Medalists meeting in Boston, in 2009. I was not at the meeting that year. It would have been great to have met him.

The link below shows the article. My story is on the left hand side about half way down. 

http://forecast.diabetes.org/magazine/features/long-lives-lived-well

Thursday, May 3, 2012

Hi Sugar, Honey, Sweetie....

I frequently call my wife sugar, honey or sweetie. Don't all of us call our loved ones by those names? Our spouses, children, close friends, dates, etc. Even our pets may share those titles, when they behave themselves. Our youngest cat is named Sweetie!

It seems that all humans are obsessed with sweet tasting things. Foods and drinks sweetened with sugar, candy, ice cream, soda pop,....the list is endless. Since we like things that have a sweet taste, it seems natural that we would use names like sugar, honey and sweetie to describe the feelings we have for our loved ones. I used to tell my wife that if I kissed her several times in the same day I would have high blood sugar and need extra insulin.

It seems a shame that sugar is one of the things we diabetics have to avoid, or exclude from most meals and snacks. I totally avoided sugar every day for many years. The only rule my parents were given when I was diagnosed in 1945, was to not give me any sugar, or foods sweetened with sugar. I stuck with that rule for many years. I ate raw sugar when I dropped too low, but avoided candy, cookies, cake, and ice cream unless they contained artificial sweeteners. Eating things containing sugar might have become addictive and I might have cheated and eaten my way into DKA. The artificially sweetened foods and drinks tasted very good to me while I was younger because I was not familiar with the taste of foods sweetened with sugar, so I could not make a comparison. The number of carbs in the artificially sweetened foods is sometimes as great as those sweetened with sugar, but sugar causes a faster spike.

In more recent years I have found that eating things containing sugar will not hurt me under certain circumstances. I cannot have sugar at breakfast or in the evening because I am not getting enough exercise to compensate. My exercise during my gym workouts or on my long walks always occurs in the afternoons. I can have an ice cream cone (24 carbs), a Hershey bar (26 carbs), a Payday bar (25 carbs), or other treats before exercising. I have learned that 24-28 carbs is just right before exercising. It is perfect for gym workouts, but I need one unit of insulin before taking a walk. The walks are less exerting. If I exercise longer than usual I need a few jelly beans to compensate. This has worked very well for me for a few years now, but for my first 60 years I was still avoiding sugar sweetened foods.

I still avoid sugar unless I know it is not going to hurt me. If I want a candy bar, or ice cream, then I know I am going to need at least an hour of exercise. My desire for sugar is an incentive for exercising. Since exercise is very good for us, I suppose this is a good thing. Do you agree, sugar?

Do you allow sugar in your diet? If so, how do you compensate for it? If you eat sugar sweetened foods or drinks, and do not exercise, how do they affect your control?

Tuesday, May 1, 2012

My A1c's 1980-2011

My A1c's 1980-2011

 I thought it might be encouraging to some of you to see my A1c's starting in 1980. A1c testing was not available until 1976. My doc started A1c's with his patients in 1980. I was diagnosed in 1945 when I was 6 and I must have had very high blood sugar until about 1988. That is when my A1c's began improving.  I am alive after 66 years of Type 1, and I have no complications except for mild nerve damage. If you have a lot of high blood sugar after diagnosis, that does not necessarily mean that you will suffer diabetes complications. I am living proof of that. Do the very best you can and keep this in mind.

 As part of my preparation for my taking part in the Joslin Medalist Study in 2009 I was supposed to have a listing of all my A1c's that have ever been done. My doctor was very cooperative, but there are several gaps in the list. The years 1990-1994 were not available.

 Below are the A1c's that my doc was able to retrieve from his files. I have updated for 2010-2011.

 1980...10.6, 9.6, 9.0
 1981...11.8
 1983...9.2
 1984...9.2, 9.7, 8.9
 1986...11.1
 1987...8.0, 9.8, 10.3
 1988...10.5, 7.7, 7.7
 1989...7.3

 1995...6.8
 1997...6.0, 5.4
 1998...6.5
 1999...6.8, 6.7, 6.5
 2000...6.3, 6.1, 5.5
 2001...5.8, 6.0, 5.6, 6.0
 2002...6.0, 6.4, 6.2, 6.0
 2003...5.6, 5.4, 5.9
 2004...5.9, 5.7, 5.8, 5.6
 2005...5.6, 5.8
 2006...5.6, 5.7
 2007...5.5, 5.6, 5.7, 6.1
 2008...5.7, 5.9, 5.7, 5.6
 2009...5.6, 5.8, 5.8
 2010...5.7, 5.6, 5.6, 5.4
 2011...5.7, 5.7, 5.8, 5.5

Notice the drop from the 10's to the 7's in early 1988. That is when I read an article in a magazine that said diabetics should watch all their carbs, and not just sugar. My doctors never told me that. Then about the start of the new century I was permitted to use basal/bolus control. In 2007 I started pumping. My A1c's have been very good during the new century because I finally knew what to do to get good control.

I took only one injection of beef/pork insulin per day during my first 40+ years. Can you imagine what my A1c's would have been during those years? Those were the years before my doctor started having my A1c's done.

I feel so lucky to be alive and healthy, without complications. Is it good genes? Maybe the Joslin Medalist Study will help answer that questions.

Friday, April 27, 2012

The Joslin Medalist Study, 2005-2012

The Joslin Medalists are individuals who have received medals for having lived with type 1 diabetes for 50 or more years. These medalists have not only survived, but have avoided most of the more serious diabetes related complications. This group is a natural for a study that would seek the factors that explain the longevity and good health of so many type 1 diabetics in the US. If these factors can be determined then there might be a treatment devised that could help younger diabetics to also have long healthy lives. So the study began in 2005, and is headed by doctors George King and Hilary Keenan at the Joslin Diabetes Center in Boston.

A different Joslin study in 1981 found that, among people diagnosed with  type 1 between 1939 and 1959, only 48 percent of women and 34 percent of men were expected to live to age 55. Many of these individuals, however, lived on and were free of many of the complications that so often occur among people with diabetes.

An examination of the first 351 participants showed that 43% were free from any serious diabetic eye complications, 87% from kidney disease, 39% from nerve disease, and 52% from cardiovascular disease.

I participated in the study in December, 2010, at which time there had been approximately 500 participants.  I received many pages in the mail requesting information about my past. I supplied information about genetic, environmental, psychological and physiological factors of my first 64 years of living with type 1 diabetes. I was also asked to provide a listing of all my A1c's that had been determined. My doctor provided a list that began in early 1980 and concluded in late 2010. Some of the A1c's were missing from my doctor's files, but the list was accepted, with no problem. When I arrived at Joslin on the morning of my participation, I submitted my list and then went to a room where many blood samples were taken. A glucose tolerance test showed an increasing BG level for two hours. The fact that my BG steadily increased from the 90s to the 300s showed there was no insulin in my body that would lower my BG. Some participants had a decreasing BG during the second hour after the test. This suggested they were producing some of their own insulin. I was then examined for neuropathy, and taken to the eye center where a thorough examination of my eyes was given. Pictures were taken of the backs of my eyes. I received the results of my study several days later. There was mild neuropathy present, but no other complications were found.

For the first 500-600 medalists examined  "...about 40% did not have serious eye disease even after 50-80 years of type 1 diabetes and less than 10% of the Medalists have any kidney problems. From a complications point of view, these findings are very exciting since they showed that 40% of the Medalists have factors or genes, which are protecting the Medalists from developing diabetic eye disease." It was also shown that over 66 % of the medalists who had participated appeared to still produce some of their own insulin, even after 50 or more years of diabetes. Several participants had volunteered their bodies for study after death. Post-mortem studies confirmed that these individuals had been producing some insulin. It seems that many type 1 diabetes patients have protection from beta-cell destruction.  Cells containing insulin were found in all of the 19 pancreases willed to the Joslin study.

There was a meeting of more than 100 medalists at the Joslin Diabetes Center in June, 2011. My wife and I attended and we met many wonderful people. Doctors King and Keenan were the speakers that day.

“We are on the cusp of identifying protective factors for eye and kidney complications,” Dr. King declared. “We’ve made huge progress in the past year.”
It was announced that the number of cases of type 1 diabetes among children less than 6 years old was rising rather rapidly. This was very alarming to all of us. Let's hope that the Joslin Medalist Study will produce some significant findings that will help these children to live long, healthy and happy lives, without serious complications.

The study is funded by the Juvenile Diabetes Research Foundation, the National Institutes Of Health, and private donations.

My wife and I will attend the next medalist meeting in 2013. I am very anxious for that occasion.

****************************************************************
The following links are the references for this blog:

http://news.harvard.edu/gazette/story/2011/06/what-makes-them-special/

http://www.joslin.org/medalist/6268.html

http://www.joslin.org/medalist/Joslin_Medalist_Updates.html

Sunday, April 22, 2012

C-Peptide

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.

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 such as peripheral and autonomic neuropathy. I have experienced both kinds of neuropathies, but neither type has proved to be particularly problematic after 66 years of type 1.

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.

"Several physiological effects have been observed in several Phase 1 and exploratory Phase 2 studies in almost 300 type 1 diabetes patients, who lacked endogenous C-peptide. Improvements were seen on diabetic peripheral neuropathy, nephropathy and other decrements associated with long-term complications of type I diabetes. So far, dosing with C-peptide has shown to be safe and there were no effects of C-peptide demonstrated in healthy subjects (who make their own C-peptide)."

"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)

The 725+ participants in the Joslin Medalist Study 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 do still produce some of their own insulin. My C-Peptide level was less than 0.1, showing that my good health after 66 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.
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.

Low levels of both C-peptide and blood glucose are found in liver disease, a severe infection, Addison’s disease, or insulin therapy."

I have believed for several 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 all the Joslin Medalists. Today's synthetic insulins do not contain any C-Peptide. I have experienced several minor complications since starting synthetic insulins, but none of them have been particularly problematic. 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 the medalists. Maybe he will have changed his mind when the study concludes.

The link below is my reference. It discusses C-Peptide in much more detail.

http://healthesolutions.com/c-peptide-what-it-is-what-it-does-why-you-test-for-it-what-it-means/

There is a company that has produced an injectable form of C-Peptide. Stage 2 trials have been held, and human subjects have been helped by these injections.

http://www.cebix.com/

Monday, April 16, 2012

The Joslin Medalist Program


Dr. Eliott P.Joslin  "....most often referred to as 'EPJ' is considered the pioneer in diabetes. He was the first doctor in the U.S. to specialize in the disease, and this distinction is the one of many 'firsts' associated with him. Everyone who works in the diabetes field at some point learns about EPJ. What makes him unique is both his early interest in a little known disease and his vision as to how to treat it." The link below gives his story.

http://www.joslin.org/about/elliot_p_joslin_md.html

Dr. Joslin once stated, "If a diabetic with his disease can live longer than his neighbor of the same age without it, I consider that he has attained a distinction, and should be recognized as outstanding." The Joslin Diabetes Center in Boston awards medals to type 1 diabetics when they have completed 50 and 75 years with their diabetes. The first medal was for 25 years, and was awarded in 1948. Other 25 year medals were awarded, but it eventually became commonplace for people to live 25 years with type 1, so now there is a certificate awarded, but no medal. There are both certificates and medals awarded for 50 and 75 years. These medals are presented to type 1 diabetics all over the world. An 80-year medal is currently being designed, and the first recipient is expected to receive that medal in June, 2012.

Since 1970, several thousand 50-year medals have been awarded. There have  been 50 distinctive 75-year medals awarded for the  years 1996-2012. Medals have also been presented to type 1 diabetics in Australia, Brazil, Canada, England, Hungary, Japan, the Netherlands, Pakistan, the Philippines, Russia, South America, Spain, Sweden and Switzerland.

I was diagnosed in 1945 and was eligible for the 50 years medal in 1995, but I had never heard of the medalist program at that time. It was not until 2006 that I first heard of the program. I found information on my computer and thought I could not apply since proof of my date of diagnosis was required. My parents and the doctors from my early years had died, and the hospital does not keep patient information for more than 10 years. Then a medalist read my message online and sent me an email. She explained that I could have people who knew me from my very early years write letters, and that would be accepted as proof. The letters told things they remembered about my diabetes during those years. My sister and a first cousin sent letters to me, and I included the letters with my application. I received my medal in 2009, and will be eligible for the 75 year medal in 2020. My 50 year medal is shown below.



One of the most rewarding benefits of having the medal is getting to attend meetings with other medalists in Boston. It is so wonderful to be with other long term diabetics who have lived through the same experiences that I have had. The most recent meeting was in June, 2011. There were more than 100 medalists there that day. The picture shows the medalists at that meeting. I am the taller fellow in the middle of the back row. The younger people in the picture are doctors and others associated with Joslin.



I have met many long term type 1 diabetics in the online support groups, and on Facebook. I am pleased that I was able to make many people aware of the medalist program, and was able to help them with the application procedure. So many people have not heard of the Joslin medalist program. More should be done to advertise these medals, the application procedure, and the wonderful meetings that are held in Boston every two years.

Another benefit of being a medalist is that it makes them eligible to participate in the Joslin Medalist Study. The purpose of the study is to determine what factors make the medalists different. What has enabled these long term diabetics to live so many years with type 1 diabetes, and remain healthy with no serious complications? I will be blogging about the study in the near future.

Monday, April 9, 2012

My Diabetes Today vs The 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  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 many 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 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.

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.

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, cataracts, and some mild spots of neuropathy occurred during that time. Several years later I was diagnosed with neuropathy in my feet. All of these things occurred after I stopped the animal insulins, and started using the synthetic insulins that are still used at the present time. How can this be? We know so much more about diabetes now, and we have devices, 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?

There are doctors who have told their diabetes patients that if they can avoid complications during their first 20 years with diabetes, then they are not likely to have complications later on. My complications began about 50 years after my diagnosis, so am I an exception to the rule? I really cannot fully agree with that 20 years rule.

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. Some of them have been diabetics for 10 or more years longer than me, and they do not have any serious problems that are diabetes related.

There is a study taking place at the Joslin Diabetes Center, in Boston. It began in 2005, and is ongoing at the present time. 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 2012, I have no symptoms of any complications that really bother me. Some mild arthritis, some dizziness in the mornings, and occasional symptoms of neuropathy are all that are present now. I am so fortunate to be doing so well, but I will always be curious about how it has all evolved.

Thursday, April 5, 2012

Urine Sugar Testing, 1940s 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 was placed in a test tube and 8 drops of urine were added. The tube was placed into a tin can containing about two 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 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 f 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 blood 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 the blood at any time of day. 

Later on there was a 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 shows the apparatus used in performing the CliniTest procedure. 



No doctor ever told me about CliniTest, so I continued using the Benedicts solution and boiling the mixture on a stove. It was not until the mid 1980s that I bought my first glucose meter to test my blood. My diabetes management became so much easier, and more accurate, with the actual blood sugar levels being revealed several times each day.

Sunday, April 1, 2012

Falling Asleep While Driving

I worked at a supermarket to earn enough to pay for my tuition and college expenses. During my first year of employment there, on a Saturday night, it was my turn to stay after hours to help with the mopping detail. Every aisle had to be clean and bright before we went home. Being so tired from the day's work made the mopping very difficult for me. On my way home that evening I thought my strange feelings were due to my fatigue, but while making a right hand turn at the first intersection, I collapsed at the wheel. The next thing I knew my parents were standing over me and a crowd of men were behind them. Several cops were there too. My wheels were not straightened during that right hand turn due to my hypo and my car went off the road and down a steep embankment into a creek bed.
My car had passed between two vertical posts that were supporting a huge bill board. Some people were measuring the distance between the posts and the width of my car, and they said the opening was about two inches more than the width of the car. My car had passed between the posts, but did not touch either one of them. I was not hurt and the car did not have a scratch on it. The guys standing in back were from a bar across the road. They had seen my car leave the road and they found my parent's phone number in my wallet.

Everyone but my parents thought I was drunk. There had never been any alcohol in my life at any time. My parents told the cops about my diabetes. I don't think anyone there believed their explanation. There was no ticket though and a big wrecker pulled my car up the embankment later that night, or on Sunday. It was like the whole thing was just a bad dream. There were many hypos during my early years during my sleep or after a lot of exertion. There was no way for me to test my blood sugar before starting home that night.

Glucose monitors were not available until many years after that. My feelings and urine testing were my only clues to possible oncoming hypos. My parents thought that God had protected me and that was why I was not hurt. It was wonderful that my car was in good shape. I was 18 and in my freshman year at the college. I felt very lucky to be able to attend classes Monday morning.