Sunday, May 29, 2016

Scar Tissue, Insulin Absorption

Scar Tissue and Insulin Absorption

When I was diagnosed in 1945, 70 years ago, I do not think my doctor knew that I should rotate sites when injecting insulin. My parents were so good about listening to my doctor, and we followed his advice without fail. We injected into the muscle on my upper legs for many years, and there were always very high blood sugar reports from the doctor's lab every six months. I think that was because we were not using different body parts and rotating sites. Scar tissue had probably formed on my very small legs, even though the animal insulin I was using required only one injection per day. By the time I was in mytwenties I was using my upper abdomen, and my blood sugar reports improved. There was no meter for measuring my blood sugar at home until the mid 1980's, so the biannual reports from the doctor's lab was the only thing I had to determine how I was doing. A1c's were not available until 1980.

In the 1990s I had a meter and much better insulin. Several injections were required each day, and I was still using my upper abdomen. Eventually it became very difficult to push the needle into my skin. I actually had some needles bend, and had to get a different disposable syringe, reload and try a different spot. I had not been told that this might be scar tissue, no doctor had ever mentioned that. No doctor had suggested alternating sites. Maybe my doctors in the 1990s assumed I knew about this since I had been type 1 for 50 years at that time. In the new century I was using basal and bolus insulins, and doing as many as 8 injections every day. The toughness of my skin in my upper abdomen made it necessary for me to start using my lower abdomen and upper legs. It was common sense on my part that caused me to make that change. My blood sugar tests improved significantly, but I still did not know it was because I had moved away from the toughness in my upper abdomen.

In 2007 I started using a pump, and things were going very well until I tried my upper abdomen. I got a 'No Delivery' alarm on my pump and did not know what that meant, so I called the Medtronics help line. After a long discussion it was decided I had scar tissue. That was the first time I had heard those words. A very young sounding lady at Medtronics made that diagnosis, but my very experienced doctors had never mentioned it. This made me very angry, and it has taken me a long time to stop feeling bitter about it. At least one doctor should have told me about site rotation. I have permanent scar tissue in my upper abdomen and can never use it again. The skin will always be tough, and the insulin absorption almost nonexistent. I tried using my upper ab earlier this year, and saw very high blood sugar in the next few hours. I am presently using my lower ab and upper legs, rotating infusion set locations. If I don't change sets after three days I start seeing high blood sugar. That is because scar tissue is beginning to form there. I keep the sites about one and a half inches apart, and change every three days. I have now had A1c's in the 5.5-6.4 range for almost ten years. Finding someone who told me about scar tissue has greatly improved my control. I will never know why I managed to avoid diabetes complications for the many years that I was not rotating sites, and having so much high blood sugar. I have some mild nerve damage, but my overall diabetes health is very good. That almost seems like a miracle to me.

I have frequently advised pumpers to rotate sites, and not use a site longer than three days. Most of my friends who pump are doing that, but I have met online pumpers who say they are using an infusion set for more than three days. One pumper says he uses sets for as much as a week, without having problems. I did not think that was possible. To keep scar tissue problems from occurring, and poor absorption giving very high sugar results, I strongly advise all pumpers to rotate sites, and avoid using a site more than three days.

I feel so lucky to have avoided serious complications after experiencing scar tissue and high blood sugar for so many years. I wish I could meet the young lady at Medtronics, and give her a big hug! lol

Friday, May 27, 2016

FDA, DOC, Artificial Pancreas

There will be a webinar on June 2 involving the artificial pancreas. The FDA and the DOC (Diabetes Online Community) will participate. Looks like an interesting webinar!

Wednesday, May 25, 2016

Smart Insulin

"Smart Insulin" is a very interesting product The 'first generation' of this insulin is now being developed. When perfected, we would need one injection per day, no carb counting necessary,..... This insulin would increase to correct highs, and decrease to correct lows. Sounds great!

Monday, May 23, 2016

Times Have Changed

Many years ago Type 1's were warned about the terrible complications that might develop. Times have changed. Now these complications are much less likely, and there are ways of dealing with them, so they will not become a big problem.
The old school and the new school:

Thursday, May 19, 2016

FFL Conference, 2016

Several of my Facebook friends were going to attend my talk at the Friends For Life conference this year in Orlando. My session was scheduled on Wed, July 6. It has been cancelled because of my son's diagnosis with cancer. He will be be needing us. I hope that those of you who will be attending FFL will enjoy the conference. Maybe my wife and I will attend in 2017.
Here is the link to this year's FFL conference. You will see several links to other pages in the box at the bottom of the page. If you click on "Adults and Parents" you will see the Tuesday-Sunday schedule July 5-10.

Sunday, May 15, 2016

Is Type 2 Autoimmune?

I have read a few articles on this subject. Very interesting! Maybe both T1 ad T2 are autoimmune diseases. The following paragraph is the conclusion made in the article.

"The possibility is certain! I am sure people will be relieved to see new proves that will show that they didn’t bring this disease on themselves by being over-weight or obese. Also people might also suspect that their diabetes might have been contributed to by toxins and chemical, which are associated with autoimmunity. Now that autoimmunity seems to be involved in both type 1 and type 2 diabetes, we cannot say for sure if the rancour between the two groups of condition will still continue but as Engleman said that even as the result of their research 'strongly suggest that immune modulation should be considered as a potential human therapy', 'diet and exercise are still the best ways to prevent type-2 diabetes in humans' until these effects can be successfully proven in humans."

Thursday, May 12, 2016

To All The D-MOMS!

Mother's Day Poem to all you Wonderful D-MOMS!
A poem in memory of the author, Gary Hempleman, for all children with diabetes.
She walks down the hallway in silence so deep,
Keep watch over him, as her little one sleeps.
With meter in hand, she opens his door,
Making sure not to wake him as she crosses the floor,
She sits on his bedside and brushes his hair,
As he dreams of shooting baskets, without a "D" care.
She holds his hand softly; his fingers so small,
As she watches and wonders why "D" came to call.
While she watches him sleeping, so peaceful and warm,
The forces inside him fight a constant "D" storm.
Will he ever be free of shots and blood testing?
She sits and she wonders as she watches him resting.
The beep of the meter breaks the silence of the night;
A small drop of blood tells if everything's right.
The seconds count down to the final display,
I hate this damn meter; i want to throw it away.
The number is fine, one down, a lifetime to go,
As he turns in his sleep, will he ever know?
Why does this "D" happen to someone so small?
My son is my hero, but my baby most of all.
She turns at his doorway, looking back one more time,
It's a nightly routine of the very worst kind.
She walks down the hallway and time passes by,
As she sits in dark silence and quietly cries.
I have to stay strong, and for him i will fight,
We'll battle this "D" with all of our might.
I'll teach him to master and conquer this foe,
This "D" will not stop him, i promised him so.

Tuesday, May 10, 2016

Dosing With A Dexcom

Should a CGM be used for dosing insulin? Would you use a Dexcom output, instead of your glucometer, to dose for a meal.or to correct for a high blood sugar? I know a few Dexcom users who do this, but I cannot do that. Scar tissue can cause inaccuracies on my Dexcom, so I test before meals, and when correcting highs.

Type 2 Pills for Type 1

Type 1 trials with several different pills are being held. the pills can reduce blood sugar, and "often cause weight loss, reductions in blood pressure, and come with less risk of hypoglycemia than insulin."

Saturday, May 7, 2016

Syringes, 1940's- 1960's

Needles and Syringes,

My father started giving me shots of insulin in 1945, when I was 6. When the needles were dull, he sharpened them with a "whet rock". We had our own well, and there were lime deposits from the rocks underground. The needles would be coated with these deposits after they were boiled, and they would occasionally become clogged. The opening in the needles was wide enough that we could push a very small wire through and unclog them. When the needles and glass syringe were being sterilized in boiling water on top of our kitchen stove, we would sometimes forget about them, and all the water would evaporate. Then there was a loud pop and pieces of glass would fly all over the kitchen. I don't think we ever got hurt by these flying pieces of glass, but it was a potential danger. Fortunately, we always kept a spare syringe on hand.

The picture shows a comparison of a 3/4 inch long 26 gauge needle attached to a glass insulin syringe, and a 5mm 32 gauge (5/32 inch) pen needle attached to a Lilly Luxura pen. What a contrast when we compare the 1940's and the present day! I used the 3/4 inch needle during my early years. My doctor had my father inject into my leg or arm muscles at a 90 degree angle. I was skin and bones when diagnosed, so the injections were very painful. It was not necessary to push the entire 3/4 inch needle into my muscle, but most of the needle was necessary to get the needed absorption. Injecting into the muscle caused the animal insulin to be absorbed more quickly. The insulin from pigs and cows was not as fast as the fast acting insulins we have today, so having a faster absorption was helpful. In my early years I had only one injection per day, before breakfast. The animal insulin was a 24 hour insulin.

In 1955 there was concern about the infection caused by the use of glass syringes, and the first plastic disposable syringe called the Monoject, was introduced. Unfortunately, doctors thought it was safer to reuse glass syringes after sterilizing them. In 1956 the plastic disposable syringe we use today was designed. Becton Dickinson did "extensive development trials and tests and in 1961 introduced its first plastic disposable syringe, the BD Plastipak."

I was still using glass syringes and long needles from 1945 until the 1960's when disposable needles and plastic syringes became available. There are so many things about my diabetes past that I took for granted back then. I tell recently diagnosed diabetics about my past, and some of them look at me in horror and disbelief.

I remember these things like they were in a movie, and then it dawns on me that I actually experienced all this long ago.

Thursday, May 5, 2016

UHC and Medtronic

United Healthcare is going to require the use of Medtronic pumps for all of its pump users, starting July 1. This is so unfair! We should be able to use any pump we want.
Here is a petition that would have United Healthcare cover ALL pumps. There are already many signatures, but more are needed.