Saturday, April 22, 2017

The Artificial Pancreas Scares Me

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

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

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

Wednesday, April 12, 2017

Diabetic Seizures

Throughout my early years as a diabetic I had no major health problems, and I coasted along rather easily. I was always very skinny, maybe slightly underweight, until many years later. I had high urine sugar during the day, and usually at night. There were, however, some nights that I had very bad hypos. My bedroom door was always left open at night, and my room was immediately across the hall from my parent's room. Mother was keyed in to my thrashing about, and the moans I would make when having a hypo. She would jump out of bed, and grab a glass containing several tablespoons of sugar. She stopped at the bathroom, partially filled the glass with water, stirred the mixture with a spoon, and entered my room. Daddy raised my body, sat on the bed behind me, and held me while Mother slowly poured bits of the sugar water into my mouth. This usually worked very well, but occasionally my mouth was shut so tightly that she could not get any of the liquid into my mouth. Some of these hypos were very bad, and they became seizures. It took a long time to get me to the stage that they could get me to drink some of the sugar water. She would rub some of the liquid on my lips, and I would lick my lips. This gave me just enough sugar so I would start to relax, and then she could get me to swallow some of the sugar water. I would come out of these seizures not remembering any part of what had happened. I would clinch my muscles while having a seizure, and there was much soreness for days afterwards. I ground my teeth together, and there was damage to those teeth that is still present today. I have read that some people have bitten off parts of their tongues during a seizure. I am glad that never happened to me. I was always so grateful that my parents took such good care of me at those times. Our family home back then was north of the city of Roanoke, Va. The nearest hospital was far away. An ambulance would have taken a very long time to reach us. That is why my parents needed to handle my seizures without additional help.
I have no idea how many of these seizures I had before I was an adult, but I know there were many of them. I attended local colleges, and lived at home during those years. I did not leave home until I was 23. My first full time job was teaching math at a college three hours from my home. I met a young lady named Anita there. She was a sophomore. Teachers were permitted to date students at that college back then. We dated during my first year of teaching. We were married in 1964 after only seven months of dating. Maybe that was too hasty, but it has worked perfectly. We have had a wonderful marriage for 52 years now. I had a few seizures after we were married. Maybe two per year. They were not as frequent as they were when I was still living at home. Mother had instructed Anita on how to care for me during a seizure. Anita handled my seizures perfectly. She remained calm, and used the sugar water treatment just like mother had done. I think it was in the mid 1980's that I had my last seizure. There was one that was very bad, and I was hospitalized. Anita had not been able to bring me out if that one. That was the only time that I was hospitalized with low blood sugar.
In 1980 I had my first A1c testing, and in the middle of that decade I had my first meter, Finally, I could measure my blood sugar at home. I learned about carbs and there effect on blood sugar, and my diabetes management improved. My seizures occurred during my first 40 years after diagnosis, before all this new knowledge, and having a meter. If we had a meter for testing, basal and bolus insulins, and carb counting during my earlier years, things would have been very different. There would have been less serious hypos, without the terrible lows that caused seizures.
I know that some of my Facebook friends have had seizures soon after diagnosis, while learning how to care for themselves. I have read about children having seizures, and their parents giving them the needed care. This results in trips to the ER on many occasions. I have joined several parents groups, and have read about the problems that occur with child care, with diabetes. I have been welcomed to those groups since I was diagnosed when I was 6, and have lived with type 1 for 71 years without any serious diabetes complications. When parents hear about my past, they realize how much better things are now. That gives them some calm, and peace of mind. It is still very difficult to manage a child's diabetes, especially soon after diagnosis. I am glad there is so much knowledge today, knowledge that was not available in the past. That knowledge, and the devices that are now available, makes diabetes management so much better.
There has been some speculation that seizures can cause brain damage. I have not had that problem. I had a college education, and became a math professor at the college level. I do not think seizures would cause brain damage, unless they were very severe. A seizure that resulted in a coma might cause brain damage.
Glucagon injections can be given at home in modern times. That is the best way to handle a seizure. You can get a prescription from your doctor for glucagon. This assumes that the seizures are due to diabetes, and very low blood sugar levels. Seizures can also be caused by other conditions such as epilepsy.
The following links give very good information about seizures. There are replies from some people at the end of the first link describing seizures that they have had. Interesting discussions.

Monday, April 10, 2017

My Diabetes Now vs My Early Years

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

Friday, April 7, 2017

William Rounds, Type 1 for 87 years

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


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

Wednesday, April 5, 2017

My First 64 Years With Type 1

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

Thursday, March 30, 2017

Special Video, Boy With Type 1

This is a terrific video about a boy named Luke, who was diagnosed with type 1 diabetes. I hope that you will watch the video.

Monday, March 27, 2017

Isolated With Type 1?

Did you ever feel isolated as a type 1 diabetic? I did for more than 60 years until I discovered the diabetes online community (DOC). Most of what I know about type 1 was learned online. It is wonderful to be able to communicate with other diabetics. The picture below depicts my place in the world of diabetes before I discovered the DOC.


Thursday, March 23, 2017

Diabetes Mine, My 70 Years With T1

Here is the introduction on the Diabetes Mine page. It is one of the very best sources on diabetes reporting.
"We offer a unique mix of news, views, reviews, guest posts, interviews, videos, cartoons, Q&A and any other type of quality content useful for people touched by diabetes.
We provide a strong voice of patient/consumer advocacy for the diabetes community.
We aim to improve life with diabetes by acting as a catalyst for innovation."
Amy Tenderich, Michael Hoskins and William Lee Dubois are the hosts on Diabetes Mine. They write wonderful blogs.
In July, 2015 Michael asked me to write a blog about my diabetes history. Michael did a wonderful job editing and presenting that blog. Here is the result:



Thursday, March 16, 2017

Tuesday, March 14, 2017

Four Brothers, Three are Type 1


Meri Schuhmacher-Jackson has four sons, and three of them are type 1. She has a super blog site called "Our Diabetic Life". Here is a sample of her writing. Great stuff!!
http://www.ourdiabeticlife.com/2017/03/the-avalanche.html

Monday, March 13, 2017

Feeling Guilty About Feeling Guilty

I was a member of the diabetes support group at diabetesforums.com (not on Facebook) a few years ago. Here is a blog I presented there in 2013. The link below shows the discussion with 19 replies made that year. (I'm not sure you can tap into that link if you are not a member there. Let me know if you can.)
For many years now I have been thinking about the past and the fact I knew so little about my T1 diabetes. My doctors did not know much either. There were no T1Ds that I knew back then, in fact there were no types when I was diagnosed in 1945. Types were identified years later. I lived in a rural area in south central Virginia for my first 23 years. Given those circumstances, maybe I should not feel guilty about my ignorance, however, I now realize that there were parts of the country where many newly diagnosed diabetics had very good doctors who knew so much about diabetes. I have seen many fellow medalists post that they were patients of Dr Joslin in the Boston area. Dr Joslin specialized in T1, and he even wrote a book about T1 in the years 1900-1950. That book can still be read online...very interesting. If I had read that book in my younger years, I would have had much more stable control. Some medalists have written about knowing about carbs, and weighing their food. I never heard about carbs and their effect on T1 control until the late 1980s.
Many days I feel guilty that I knew so little for so many years. Why? Well, I was in college 1957-63 and there were libraries where I could have researched T1D. Maybe Dr Joslin's book was there? I might have visited larger cities in Virginia and searched for a doctor who was more knowledgeable about my diabetes. I did visit a doctor in Richmond in 1970. He was the one who told me my life expectancy would have me die before I was 40. I was 31 at the time. HA! I hate doctors who use scare tactics!!!
My management in the 1945-1995 years left a lot to be desired, and I cannot help but feel guilty about that. There were things I could have done to learn more, but ignorance prevailed, and I did nothing. Well, I avoided sugar, and that was the only advice my doctors gave me during my early years. I ate tons of food, all kinds, but avoided sugar. I thought I was doing everything appropriate to avoid complications.
I joined online diabetes support groups starting in 2006. There were some T1Ds who had been on diabetes message boards as far back as the mid 1990s. Why didn't I know about them? More guilt. Some of my long term online friends have known about carbs and carb counting many years before I did. Their diabetes management was so much better than mine until the current century. More guilt. I felt so grateful to find so much wonderful information online and I have had much better control.
More recently I have forgiven myself for these feelings. I have been a T1D for 71 (edited) years, and the only diabetes related complication I have is some mild nerve damage. Even if I knew all the things I know now during my early years, I might not be any healthier. It is time I stop feeling guilty. Sometimes I feel guilty for having felt guilty in the past, but that is a forgivable kind of guilt. :)

Thursday, March 9, 2017

Avoiding Diabetes Complications

A few years ago 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. 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 200. The average is 106, but there are numbers that indicate unhealthy highs and lows.
Patient B has test results 72, 80, 94, 100, 106, 120 and 148. The average is 103, but the data is more closely packed, and none of the numbers are undesirable.
Patient B is experiencing better control, and is 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 106. Patient B had smaller deviations from the average of 103, so the SD was much better. I try to keep my SD as small as possible, but it is difficult to do. My A1c's have been in the 5.4-6.4 range for almost 15 years (The graph below shows my A1c's for the years 1980-2015). When I have too many highs and lows, my SD is higher and I can feel neuropathy symptoms. I used to have some spots of retinopathy in both eyes when I had a roller coaster control, even though my A1c was good. My using an insulin pump helped reduce the number of highs and lows.
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 reducing the highs and lows.
I have had A1c's no higher than 6.4 for almost 15 years, but I had the beginning stages of neuropathy and retinopathy about 12 years ago. My control had been tight, but it was necessary to make it even tighter. I stopped having so many highs and lows. After a few months had passed, the retinopathy disappeared. The neuropathy is still present in my feet and legs, but I rarely experience any pain. If I have high blood sugar for many hours there is sometimes mild pain during the night. I have been a type 1 diabetic for 71 years, and have not had any serious complications. I want to keep it that way!!

History of Insulin

The following link gives an updated version of the History Of Insulin from dLife.com. When you have finished the first part (video), click on additional parts in the right hand margin. There are many great videos here on insulin and diabetes. WARNING: There are some graphic scenes in these videos

Staying Between The Lines

"Staying Between The Lines", by Riva Greenberg​

Riva is one of my favorite authors for her articles, blogs, and books on type 1 diabetes. The article/blog below is one of the best I have seen on day-to-day care of adult type 1 diabetes. You can learn a lot from Riva. She and I had a long phone conversation a few years ago. You might want to look at her books, they are excellent. Click on the link below, to see one of her excellent articles.

Friday, February 24, 2017

My Diet

I know so many type 1 people who eat very healthy, low carb meals. That certainly helps with the control of blood sugar levels, but I do not find that to be necessary. For so many years, starting in 1945 when I was diagnosed, I ate anything I wanted as long as it did not contain sugar. My portions could be as large as I wanted. Not eating sugar was my only limitation. My typical day saw me eat hundreds of carbs, many of which were very fast acting. That was poor diabetes management, but my parents and I did not know any better. My doctors knew very little about diabetes back then. I am very fortunate that my diet back then has not caused any serious complications.
At the present time I eat an average of 150-160 carbs per day, and my A1c's have been in the 5.4-6.4 range for fifteen years. Here is a typical day in my schedule:
8:30 AM....A slice of bread (9 carbs) toasted with sugar free jelly (5), a slice of ham, mixed berries (16), a half cup of coffee (2).....total....32 carbs
12:00 noon....A medium size baked potato (30), a pork chop, a small amount of gravy (5)....total....35 carbs
2:00 PM....Before going to the gym for a one hour workout....an ice cream cone (chocolate) with sugar...(25)...only a one unit bolus since I was going to get a lot of exercise
5:00 PM....Five corn chips with salsa (13)
7:00 PM....Pastrami sandwich with mayonnaise, slice of cheese, and slice of tomato... the bread has 9 carbs per slice...(20)....cottage cheese (6)....strawberries (10)...half cup of coffee (2).....total....38 carbs
10:00 PM....My BG was 77 so I needed a small snack....peanut butter and crackers (12)
TOTAL for the day....155 carbs
I never eat anything with sugar (table sugar) unless I am going to get exercise afterwards, or I have a low. I carry a small zip lock bag of jellybeans or skittles with me when I am away from home.
Note: There is really no typical day for my meals, I like a lot of variety so no two days are the same. As long as my diabetes management is stable, I see nothing wrong with that. My A1c is good, and I am not overweight. I like variety in food, TV programs, movies, activities, exercises, and most all things......but not women. My wife is wonderful and I do not need variety there. LOL!!!

Tuesday, February 21, 2017

Commitment

Commitment

In the 1945-1988 years I had only one rule to follow. Don't eat foods containing sugar. My doctors never mentioned carbs. I was very committed to following that rule. I became so used to using artificial sweeteners, that a teensy taste of something containing a lot of sugar was too sweet, and I did not like it. Having only one rule to follow made it easier.

In 1988 I read an article in a magazine saying that diabetics should restrict the number of carbs they ate to help keep their blood tests lower, and more stable. Why didn't my doctors tell me that? That was my first exposure to carbs. Then I found that some carbs acted faster, and others more slowly. I started eating smaller portions of the foods
with faster acting carbs, and I stopped eating some foods. There were more rules to follow, and things became more complicated. Then there was using my first meter in the 1980s, basal and bolus insulins with carb counting in the 1990s, and my insulin pump in 2007. Things were very complicated then. It was so much simpler in my early years to just avoid sugar. It was hard to be committed to having tight control with all these newer rules, and devices to follow. I sometimes wanted to just drop everything, and go back to the old ways. I had no complications despite all the high blood sugar I must have had during my first 40+ years, so convincing myself to follow all the new rules and use the new devices was difficult.
I did not know any other diabetics until I joined some diabetes websites in 2006-2007. That was 61 years after my diagnosis. That turned things around for me. I met so many diabetics like me, and saw they were struggling with the same problems I was having, or had previously experienced. There were so many not taking good care of themselves, and having diabetes related complications. I could feel myself becoming more and more committed to having really great control. I had always worked hard to have good control, but my online experience made me more committed than ever before.

My commitment has led to my having 71 years of type 1 with no complications except some neuropathy, and other minor nerve damage. I do not need any medication for that, and I am very fortunate that having only the "no sugar" rule for so many years has not caused me any major problems.
I am definitely committed to being committed. Perhaps diabetics who are not committed should be committed to online diabetes support groups! :wink:

What does commitment mean to you?

Monday, February 20, 2017

Only In America

Only in America ......do drugstores make the sick walk all the way to

the back of the store to get their prescriptions while healthy people
can buy cigarettes at the front.
Only in America ......do people order double cheeseburgers, large
fries, and a diet coke..
Only in America .....do banks leave vault doors open and then chain
the pens to the counters.
Only in America ......do we leave cars worth thousands of dollars in
the driveway and put our useless junk in the garage.
Only in America ..........do we buy hot dogs in packages of ten and
buns in packages of eight..
Only in America .....do they have drive-up ATM machines with Braille lettering.
EVER WONDER ...
Why the sun lightens our hair, but darkens our skin?
Why can't women put on mascara with their mouth closed?
Why don't you ever see the headline 'Psychic Wins Lottery'?
Why is 'abbreviated' such a long word?
Why is it that doctors call what they do 'practice'?
Why is lemon juice made with artificial flavor, and dishwashing liquid
made with real lemons?
Why is the man who invests all your money called a broker?
Why is the time of day with the slowest traffic called rush hour?
Why isn't there mouse-flavored cat food?
Why didn't Noah swat those two mosquitoes?
Why do they sterilize the needle for lethal injections?
You know that indestructible black box that is used on airplanes? Why
don't they make the whole plane out of that stuff?!
Why don't sheep shrink when it rains?
Why are they called apartments when they are all stuck together?
I like this one!!!
If con is the opposite of pro, is Congress the opposite of progress?
If flying is so safe, why do they call the airport the terminal?

Thursday, February 16, 2017

Type 1 Diabetes, Bone Density

Long Term Type 1, Bone Health Protection
The Joslin Medalist Study has examined more than 1000 people with 50 or more years of Type 1 diabetes. The purpose of the study is to find what makes the medalists different from so many other type 1 individuals who have had diabetes related complications. The study began in 2005, and is ongoing. I participated in the study in 2009. In 2011, I attended a medalist meeting at the Joslin Medical Center. Dr King, head of the project, announced that a large group of the participants in the study have some kind of "inner protection" that has prevented them from having any serious complications with their eyes, kidneys, and nervous systems. He also said that the inner protection does not protect our hearts, and that we should do our best to have good heart health. Many medalists have had heart by-passes. I have been type 1 for 71 years, and except for some very minor nerve damage, including neuropathy , I do not have any of these complications. My heart is also in good shape.
A study of a subgroup of these participants was done at the Bone Density Center of the Mass General Hospital. It was determined that the long term diabetics examined have a protective factor preventing bone health deterioration. The following abstract shows the details of the subgroup study:
Protection from Fracture Risk in Long Term Type 1 Diabetes: 50- Year Medalist Study
HILLARY KEENAN, SARA TUREK, STEPHANIE HASTINGS, GEORGE KING, Boston, MA.
Abstract:
Individuals with type 1 diabetes (T1D) have demonstrated a 12-fold increased risk of fragility fractures over their age-matched peers. As hospitalization for fracture is highly associated with decreased quality of life, morbidity and mortality this is an important, yet little studied diabetic complication particularly amongst those with extreme duration T1D. The 50-Year Medalist Study has extensively characterized over 800 individuals with a mean age of 69 y and duration of 55 y of T1D. Early examination of self-reported rates of hip, vertebral, and wrist fractures show extraordinarily low rates (0.33%, 0%, and 1.7%, respectively) in stark contrast to the 12-fold increase expected. To further examine these findings, 55 participants received DXA scans, 29 females, 26 males with a mean ±SD HbA1c of 7.2±0.8% and 7.0±1.2%, age 62.1±6.5 y and 66.7±6.8 y, and duration of 52.9±2.7 y and 55.8±5.1 y, respectively. BMI for this age group was low with 25.0±5.2 kg/m^2 for females and 27.3±4.4 kg/m^2 for males. T-scores, indicative of risk for fracture, for female 1/3 radius (1/3R) was -1.1±1.3, lumbar spine (LS) 0.1±1.2 and for the femoral neck (FN) -1.3±0.8. For males the 1/3R, T-score was -1.1±1.3, the LS was -0.1±1.9, and at the FN -1.3±0.8, none in the osteoporotic range. Total vitamin D, D2, D3 and calcium did not correlate with T scores among female or male, except for D3 among male and the LS T-score (R=0.5, p=0.03). There was no association of T scores with HbA1c, BMI, age or duration in either gender, p>0.05. As BMIs were low in male and female, the lower than expected risk T scores are likely not due to increase weight bearing as seen in T2D patients. These pilot data demonstrate protection from fracture, and low risk in this group with long term T1DM suggestive of a protective factor preventing bone health deterioration.

Tuesday, February 14, 2017

Diabetic Cheiroarthropathy

I read about a new complication today..."diabetic cheiroarthropathy".

"Diabetic stiff hand syndrome, also known as diabetic cheiroarthropathy, is a disorder in which finger movement becomes limited as the hands become waxy and thickened."

I had carpal tunnel and ulnar nerve surgeries more than twenty years ago, but this stiff hand problem is a little different. I am having carpal tunnel trouble again, in both hands. I may need more surgery, soon.

I have seen discussions abut trigger finger problems. It is very common, and a simple surgery corrects that. I have occasional trigger finger problems. It occasionally occurs when I have very low blood sugar, but it is corrected when my blood sugar is corrected.

"A typical technique for diagnosing diabetic stiff hand syndrome is to hold your hands together, both palms touching.
If the skin and joints of each hand cannot touch each other, or if there is a gap between the fingers and palms, then you should consult your doctor."

More discussion of diabetic cheiroarthropathy appears in the link below.

http://www.diabetes.co.uk/diabetes-complications/stiff-hand-syndrome.html

Saturday, February 11, 2017

Beautiful Writing, Type 1 Blog

The following blog was written by Jess Drexler, a 22 year old type 1 diabetic, diagnosed at age 6. It is a masterpiece, such beautiful writing, I wish I could write like that. I have her Mom's permission to share it here.
"Cold hard truth. In the palm of one hand I am holding
one bottle. It is a bottle of Novolog fast-acting insulin. In the other, I am holding one 50u syringe, drawn back to the fourth marker with no breach, because I have become an expert in transporting air bubbles back into the air[a]. But, for a diabetic, it is not just about the medicine. It is the intricacy and the intimacy we develop with the illness, finding ourselves reasoning with her, or begging for her to stop. It’s in the fridge, cupboards, and cabinets, and it is the clear liquid that my life teeters on. Diabetes poses a very humbling reminder every time we get up in the morning. The one thing that can kill us is also the one thing that keeps us from dying, and I’m holding it in my hand.
I still remember the last night I spent alone, before this world of vials and syringes.. It was dark outside, so the lights inside created a little reflection on the window of my small, 28 pound, 6 year old body. The street lights were illuminating a visible shape from the shadows to the pavement. I saw the bugs dancing around the streetlights in their own crazed rhythm. They’d enter the shadows and go unseen, but then the light would sweep them up again, flying in intricate circles and bumping into each other, fighting for the light. I always wondered why those bugs wanted the light so badly, but only came out at night[b].
I didn’t know that would truly be my last moment I remember, being alone.
Now, we are always together, I am always with her; we share the same body, the same home. 17 years. That’s 204 months, 886 weeks; that’s 150,000 consecutive hours we’ve spent, body-to-body, sharing the air around us.
When people ask me how I can do it, I lie.
I don’t say that I still hate every shot as much as I hated the first one when I was 5 in a white room in the pediatric unit[c]. They would grab my arms by my wrists, and pin them above my head on the white pillows, and next my ankles, until I couldn't wiggle my way free. Then the nurse would enter, with that seem[d]ingly sinister smile, holding the syringe, she’d creep up to me. I knew I couldn't escape the fear, all I could do was try to understand it. After a couple days, I understood. I understood that arguing, fighting, and running away wasn’t going to set me free, I understood that kicking and screaming wasn’t going to change anything. But,when people say “I could never do that,” or “that looks like it hurts,” I tell them “well, you do what you have to do.” But this isn’t the truth, none of it is. It does hurt, the needles and the pokes and sticks don’t get more pleasant as the days go by.
But you begin to understand, you begin to see what it is truly like, to not have a choice.
So, when people ask me about my diabetes, without having a clue about it, I lie. Because maybe, the truth isn’t what they want to hear.
Maybe it is because I can’t say it’s inconvenient having to make sure I have my phone and keys, wallet, monitor, test strips, short-acting insulin, long-acting insulin, syringes, lancets, and glucose tablets every time I leave to go somewhere.
I can’t say I almost died last weekend because I ran out of glucose tabs at my apartment[e].
I can’t say how shitty it is that I have to make the walk into bleach-greased bathroom stall and put one leg up onto the toilet to give an injection because I’m embarrassed to do it where people can see, where people can stare.
I don’t tell what it is like to have a needle fall out of your pocket in a gas station, and hit the floor like steel on a mirror[f]. I don’t tell them about getting pulled over, searched, and detained, for a needle, my lifeline, sitting on the passenger seat.
When people ask me how diabetes impacts me, I lie.
20,000 injections, 31,000 finger pokes, millions in medical bills, and a slew of misconceptions, and she shows no sign of stopping[g]. She doesn’t stop reminding me that she has control, that she watches my every move, my every moment, she is there, waiting for a mistake so she can slip inside[h]. She reminds me that I have to understand her better. She tells me I have to test more, I have to change my basal rates, or change my ratios, I have to study her and study myself, and never forget that I’m not alone. She keeps me up at night, aching for a drop of blood, or a half-filled syringe. Everyday, every hour, every second, since that night the bugs were dancing in the street lights, she is with me.
I have diabetes[i].
This is the truth[j].
Jess Drexler"

Wednesday, February 8, 2017

Joslin Medalist Study

The Joslin Medalists are people who have completed 50 years with type 1 diabetes, and who have been awarded a medal for that accomplishment. There are more than 5000 individuals who have this medal. The picture below shows medalists who attended a meeting in Boston in 2011. I am the taller fellow in the center of the back row. There are also 75 and 80 year medals. If you know any long term type 1 diabetics, and they do not have the medal, be sure to tell them to apply.
The Joslin Medalist Study in Boston examined 1000 medalists during the period 2005-2015. It was funded by JDRF, NIH, and private donations. I participated in 2009. The examination was very thorough, and my past history was required, in detail. Many tests were performed while I was at the Joslin Center.
Many very interesting things were found during the study, including the fact that many of us still produce some of our own insulin. Dr. George L. King is the head of the Joslin Medalist Study in Boston. His area of expertise involves researching the causes of, and preventions for, diabetes complications. Here is an article, about three years old, about the research. The quotes are Dr. King's own words.
"The major fears of the diabetic patient are blindness, renal failure, or hypoglycemia—all of which are complications of type one diabetes. Focus groups have shown that, if not for the complications, diabetic patients could tolerate the disease quite well." King is one of the world’s leading researchers into diabetes complications. He is Director of Research and Head of the Section on Vascular Cell Biology at Joslin, as well as a Professor of Medicine at Harvard Medical School, and he has been at both Joslin and Harvard since 1981. “My area of expertise is how insulin interacts with the blood vessels,” King says. Specifically, King is examining the effects of insulin resistance and hyperglycemia, or high blood sugar, on the molecular mechanisms that could lead to degeneration of vascular systems in the body. In 1989, Dr. King spearheaded breakthrough research postulating that activation of protein kinase C is the primary pathway in which hyperglycemia causes loss of function, and other complications, in the retina, kidney and cardiovascular systems. Following this, King showed in a series of studies using vascular cells from the retina, kidneys, and arteries specifically how hyperglycemia contributed to causing various diabetes complications.King’s research into understanding the causes of diabetes complications, so he can help to find ways of preventing them through treatments and lifestyle changes, extends far beyond the confines of a lab or a petri dish. He is working with more than 800 people in the Joslin Diabetes Medalist program —people who have been awarded medals for living with type 1 diabetes for 50, even 75 years —to uncover how they have managed to avoid many diabetic complications through the decades.“They are very interesting people,” King says about his study group. “Some of them built their own glucose meters in the 1960s and 70s, before they were widely available to the public. ”Aside from being avid do it yourselfers, King found other shared traits of those who have minimized the complications from diabetes, despite living with the condition for many years. After discounting genetic factors, King’s research so far reveals that most of the Medalists exercise regularly. They are also very careful with their diets. But, more than this, King noted another shared trait that, although fairly abstract, is very important. “They are very good advocates for themselves,” King says of his subjects. “The are always on the lookout for new treatments. They are definitely a proactive group. They’re not sitting on the sidelines waiting for something to be done for them. They’ll do it for themselves first, if they have to.” King, and other researchers, also discovered that hdl levels, the so-called “good cholesterol,” is high in Medalists without complications.“We are looking into that,” King says about the implications of the hdl levels. By examining the Medalists King hopes to uncover the specific, if not the actual molecular ways in which they are protected from complications. Is it lifestyle? Genetics? Life choices? Or, is it something else? “The hope is we look at humans who are protected, then see why they’re protected, and come up with answers about lifestyle,” King says. “Then, by looking at their tissue and biochemistry (after death) we can perhaps develop medications to simulate the biochemistry that protected them. ”On that front, King says they have discovered a way that naturally produced human insulin prevents arteriosclerosis. “Can we design an insulin to prevent arteriosclerosis?” King says. “I think this may be possible in the next five years. ”Because up to 30 percent of people with type 2 diabetes use insulin, such a breakthrough would be good news for more than just for type 1 diabetics, he points out. Meanwhile, as researchers like King work to understand the factors that protect some people from the complications caused by diabetes, and until the development, and testing of medications as a result of those findings come to market, there are things diabetics can do to help themselves avoid retinopathy, neuropathy, kidney disease and cardiovascular disease.“Don’t smoke, watch your diet, and exercise,” King advises. “Also, advocate for yourself. Be proactive. That’s the main trait of the Medalists—they stick up for themselves.”


Sunday, February 5, 2017

Wolfram Syndrome, Type 1 Diabetes

Wolfram syndrome is a rare form of type 1 diabetes. It can cause eye and hearing damage, and other complications. This article comes from the beyondtype1.org website. There are about 30,000 people in the world with this form of diabetes.

Wednesday, February 1, 2017

Type 1 Diabetes, Then and Now

A fellow Joslin Medalist recently made a post in  'The Joslin Medalist' group page. He wanted to know how we felt about the differences from when we were diagnosed so long ago compared to the present day, and how fortunate we feel that we are in the 21'st century.

I started writing a very long blog to answer his request. The blog kept getting longer, and longer. The other replies were not so long as mine, so I deleted the blog and gave the following summary.  

1945-1970...I led a normal life, with no fear, even though I took one shot each day, and tested my urine. No complications, no problem!
Ignorance of the true nature of type 1 diabetes was bliss!

1970-1990...I learned about the possible complications, and saw terribly high numbers on my first meter. I was very scared!! I did not know what to do about that. My doctors were very little help.

1995-2006...I completed my first 60 years of Type 1, and had no diabetes related complications, except for some neuropathy. That, and my joining my first online support groups, gave me confidence, and my fears were gone.

2006-2017...I am using a pump and CGM, and my A1c's are very good, in the 5.4-6.4 range for about 15 years now. Like someone else said, it is a lot more work, but it is good to know what I am doing, and seeing good results. I don't mind the extra work with the devices we have now. Good diabetes management, and no serious complications after 71 years of type 1 is wonderful!!

Tuesday, January 31, 2017

Medicare Coverage of CGMs

"Dexcom will now work with CMS over “the coming months” to implement coverage, enabling those on Medicare to finally get CGM reimbursed. Dexcom previously expected coverage in 2018, but given the early ruling, diaTribe wonders if G5 reimbursement through Medicare could even come as early as later in 2017."

Tuesday, January 24, 2017

Dry Skin, Dry Eyes with Type 1

For more than ten years I have had very dry skin, especially on my lower legs, and ankles. Dry skin loves sugar, and diabetes can cause that dryness. I use Lubriderm on my skin to keep the itching and dryness down to a minimum. I used to scratch my legs in my sleep, and dried blood was there in the morning. One link below from WebMd gives a quiz and information about diabetes and dry skin.
I also have very dry eyes, and have used eye drops (artificial tears), several times day and night for several years. My ophthalmologist prescribed a medication (Restasis) that is supposed to help my eyes to start producing their own tears again. It has helped a little, but not much. Here is a link about diabetes and dry eyes.
http://www.dlife.com/diabetes/complications/eye-care/chous_sept2006
http://www.webmd.com/diabetes/diabetes-skin-15/rm-quiz-diabetes-affects-skin?ecd=wnl_dia_012117&ctr=wnl-dia-012117_nsl-promo-v_2&mb=UMJ%40CFgbw6kMs2%2fs8NsB%2feHnVev1imbCtuIN8LuideU%3d

Thursday, January 19, 2017

Enlite 530G vs Dexcom G4 Sensors

Gary Scheiner, author of "Think Like A Pancreas", wore both an Enlite sensor and a Dexcom G4 sensor for eight weeks so he could make a comparison. The results may surprise you.

Type 1 Cure? A New Approach

A new approach to finding a cure for type 1 diabetes. It involves finding "...a way to offer individualized and personalized therapies for people with diabetes much in the same way cancer treatment does today." It is hoped that a cure may found within the next six years.

https://asweetlife.org/city-of-hope-new-approch-to-cure-type-1-diabetes-in-six-years/

Wednesday, January 18, 2017

Increasing Cost Of Insulin

Here is a very good article on the increasing cost of insulin.

http://thediabeticjourney.com/drug-companies-are-profiting-huge-off-of-insulin/

Monday, January 16, 2017

Medicare Covering SOME CGMs

Medicare will cover SOME CGMs now!!
The following article on Diabetesmine answers a lot of questions concerning Medicare coverage of CGMs. If you have Medicare coverage, you should read this!!

Saturday, January 14, 2017

Diabetic's Guide To Coffee

I have posted about caffeine raising my blood sugar level. Many of my friends have said caffeine affects them in that way. Here is a more thorough guide to coffee and how it may affect your diabetes.

http://www.diabeticconnect.com/diabetes-slideshows/520-a-diabetic-s-guide-to-coffee?utm_source=Newsletter&utm_medium=Email&utm_campaign=DC_20170114_B&utm_term=1button#1

Friday, January 13, 2017

8 fitness myths debunked

Interesting article. This may change your way of exercising.

http://www.mnn.com/health/fitness-well-being/stories/8-fitness-myths-debunked

Saturday, January 7, 2017

Type 1 and DKA, Education

There is too much misdiagnosing of diabetes in the US. Type 1 diagnosed as type 2, and people with diabetes not being told that they have diabetes. Both type 1 and type 2 diabetes can occur in people of all ages. In some cases DKA occurs in some of these misdiagnosed individuals. That has been known lead to death in some instances. There is a new program that is attempting to help this situation. The program has been introduced in Ohio, and several other states are joining the project.The educational program described below should help.

"Along with two national parent advocates, Michelle Berman and Debbie Healy, and Malissa Sarver, Beyond Type 1 will raise awareness about T1D and DKA by deploying print materials to every pediatrician office in the state of Ohio, altogether, that’s over 250 pediatricians. The materials include multiple print posters with T1D warning signs in English and Spanish, a parent handout, and a survey."

http://portsmouth-dailytimes.com/news/12831/beyond-type-1-offers-education-on-type-1-diabetesdka

Thursday, January 5, 2017

Five Facts About Type 1 Diabetes

Five facts involving type 1 diabetes. Some are rather surprising. See the link for more detail.
1. The Number of Children Diagnosed T1 in the United States is Virtually the Same Number as the Number of Adults.
2. A Majority of People with Diabetes Don’t Make Use of Technology That Can Help.
3. Hypos Happen, Even in Hospitals.
4. Pumps or Pens? According to Diabetes.co.uk, just one in 1,000 people – or about 6 percent – use a pump to administer insulin.
5. Our Survival Rates Are Still Climbing.

https://timesulin.com/5-surprising-type-1-diabetes-statistics/


Sunday, January 1, 2017

Slow Dance....A Poem

Slow Dance
This is a poem written by a teenager with cancer.
She wants to see how many
people get her poem.
The poem made me think of my son who died on Dec 19 with terminal cancer. It really hit home with me!
It is quite a poem, please pass it on.
This poem was written by a terminally ill young girl in a
New York Hospital.
SLOW DANCE
Have you ever watched kids on a merry-go-round?
Or listened to the rain slapping on the ground?
Ever followed a butterfly's erratic flight?
Or gazed at the sun into the fading night?
You better slow down.
Don't dance so fast.
Time is short.
The music won't last.
Do you run through each day on the fly?
When you ask, “How are you?”
Do you hear the reply?
When the day is done, do you lie in your bed,
with the next hundred chores running through your head?
You'd better slow down
Don't dance so fast.
Time is short
The music won't last.
Ever told your child,
We'll do it tomorrow?
And in your haste,
Not see his sorrow?
Ever lost touch, let a good friendship die
Cause you never had time
To call and say,'Hi'
You'd better slow down.
Don't dance so fast.
Time is short.
The music won't last..
When you run so fast to get somewhere,
You miss half the fun of getting there.
When you worry and hurry through your day,
It is like an unopened gift....
Thrown away.
Life is not a race.
Do take it slower
Hear the music
Before the song is over.
This young girl has 6 months left to live, and as her dying wish, she wanted to send a letter telling everyone to
live their life to the fullest, since she never will.
She'll never make it to prom, graduate from high school,
or get married and have a family of her own.