Monday, September 9, 2019

My Early Years With Type 1, Part 2

Prior to the discovery of insulin there were several treatments for diabetes. Those treatments included bleeding, opium, starvation, exercise and diets. A diet low in carbs and high in fat and protein was sometimes used. Without the availability of insulin these treatments extended the lives of diabetics by approximately one year. I was diagnosed in 1945, and newly diagnosed children were not expected to live beyond their teens. My doctor did not tell us that, and I did not know it until I researched diabetes history on my computer in the early years of this century. I'm glad I did not know my life expectancy back then. Ignorance was bliss, and I had a good life while growing up.
Insulin was discovered in 1921, and became available to the general public in 1923. The first insulin was taken from pigs and cows by a Canadian team. Thank God for Dr. Banting and his team!!! The insulin was impure and large doses were necessary. They frequently caused an abscess at the injection site. At first the beef/pork insulin was short acting and multiple doses were needed each day. In the 1930's, the first longer acting insulin, Protamine Zinc, was introduced. In the 1940's the first standardized insulin syringe was introduced. It was made of glass.
I was supposed to inject the insulin into muscle. Insulin acts faster when injected into muscle. There was no fast acting insulin back then, so muscle injections was very helpful. My abdomen was never used in my childhood. I found injections on my arms more painful, so we usually used the tops of my upper legs. I started giving myself my own injections when I was 10. A picture below shows a girl injecting into her leg muscle. That picture was taken in 1930, fifteen years before my diagnosis.
During my early years with diabetes things were shaping up very nicely on our ten acre farm. My Father built a small barn all by himself, and there were stalls for our cows and a horse. The doors were left open so the livestock could use the shelter during bad weather and at night. Two calves were born each year, and after they were fattened we took them to the stockyard and sold them. The extra cash was much needed. My Father hitched the horse to a plow and plowed the 2.5 acre garden space every spring. There was one time that I approached our horse and tried to pet him. The horse reached down and grabbed a chunk of my abdomen, and I made a motion and screamed. The horse let go and ran away. That horse could have pulled part of my abdomen off my body. I was lucky to have only a few heavy teeth marks, not much bleeding. I would rather have injections any day!! Another time Daddy had the horse hitched for some very light plowing. The horse keeled over in the middle of the garden and died. Daddy dug a very large pit beside the horse, and rolled the horse into the pit. We never had a horse after that. Later on that year Daddy bought a used tractor. We had a mowing machine and a hay rake that we hooked to the tractor. I drove the tractor and Daddy controlled the machines while riding them behind me. We mowed the fields and made hay for the livestock. We raked the hay and stacked it ready for feeding the cows during the winter. Our farm had only ten acres, but it was still a farm. We had chickens, pigs, cows and a horse. We had our own eggs, milk and butter. The hogs were butchered in the Fall. We had a huge garden and an orchard. We had so much good, healthy food.
I was not a very good student during my first few years of elementary school. I made a lot of C's, but I never failed a grade. I studied hard and my Mother was a great help. She was a good tutor. She was the valedictorian when she graduated from her high school. Impressed? I guess I should tell you that there were only four students in the senior class that year. She attended a very small country school house in the area where she was raised. When she started school it was a one room schoolhouse, and one teacher taught grades 1-12.
We did not know anything about carbs while I was young, and we did not have information about foods I should avoid. Our one and only rule was to avoid sugar. There was no device for testing my blood sugar, and urine testing was unreliable. My blood sugar was so difficult to control. There was no fast acting insulin. The insulin I used was a 24 hour insulin, only one injection each day, and there were times that it was too much for me at night. A snack before bedtime helped, but there were nights that my blood sugar dropped a lot. There were nights that I had hypos, and there were occasional seizures.
During a seizure my teeth would be tightly clenched, my body muscles would be drawn, and I would be almost unconscious, not knowing anything that was happening. Mother poured small amounts of the sugar water on my lips, until I had enough in my mouth to partially awaken me. Then I would drink the liquid more freely. I was always drenched with sweat, and very weak after a seizure. My body was sore the next day. The sugar water caused my urine test to show high the next morning. I continued to have seizures for many years, but they occurred less frequently when I was older. There was never any effort made to call an ambulance. I don't know why. Perhaps it was because the nearest hospital was at least 10-15 miles from our house, and I doubt that the paramedics in the ambulance had glucagon injections available back then. Home care was probably the best solution. I think my mother saved my life many times during the years I lived at home.
Mother was afraid I would have a hypo while at school. She approached the teacher at the beginning of each year, and explained my condition, and why I should not exercise like the other kids. She convinced Dr. Davis to write an excuse before school started each fall. I never participated in play period or gymnastics of any kind. I sat and watched the other kids. Mother would not have it any other way. My classmates knew I was different and they ignored me, but never made fun of me. I tried to make friends, but I was never very successful. I became very withdrawn and terribly shy. I hated my diabetes because I knew it was responsible for my misery in school. I never blamed my Mother because I also feared having a hypo in school. Mother always brought me out of my hypos at night by feeding me water containing a lot of sugar. I knew there would not be anyone to do that for me at school so I sat and watched the kids play. I felt comfort in knowing I would not have a hypo. I would have been so embarrassed if I had had a hypo at school.
By the time I reached fourth grade I started making better grades. In the sixth and seventh grades I made several A 's and B's, not many C's. I was always the best in my class at spelling. I took great pride in my ability to spell complicated words. When I reached high school my Mother still wanted me be excused from gym classes. I was rather good at basketball, at home. Daddy nailed a basketball hoop to the side of the corn crib and I became very good at making baskets. I played and worked hard at home, but always under Mother's watchful eyes. I still had that fear of having hypos in high school, so I agreed to not participate in gym classes. I wish now that I had rebelled and taken gym. I was still withdrawn and shy in high school. I made a few friends though, and my grades were very good. I graduated number 13 in high school in June, 1957. My math teacher in my senior year found that I was not intending to go to college. She begged me to go. I considered it, but I knew my parents would not approve.
(The first picture below shows my family in 1945, the year I was diagnosed; the second picture shows a girl injecting into her leg muscle in 1930.)

Wednesday, September 4, 2019

Do you overcorrect high blood sugar?

An interesting report from dLife.com.

Do you use too much insulin to correct highs, resulting in frequent hypos?

My blood sugar was much too high in the 1940s until the 1980s when I finally had my first glucose meter, A1C testing and knowledge of carbs. I did not have a truly fast acting insulin until the mid 1990s, but my management greatly improved in the 1980s. Prior to the 1980s I did not know my actual glucose numbers, so there was no treatment of highs. The urine testing showed high most of the time, but there were no actual numbers until glucose meters were available. Treating highs began when Humalog insulin was introduced in the mid 1990s. The research done by the Mayo Clinic shows that millions of T1D's use too much insulin to lower their highs. I will admit that I am guilty of doing that, much too often. I have numbers in the 70s, and lower, frequently. Here is the report from the Mayo Clinic.

Note: The research was done with ADULTS. No children were involved. I am guessing that the results would be much the same with children

"New research from Mayo Clinic finds that more than 2.3 million adult patients in the U.S. are likely being treated too intensively for their diabetes.

The researchers find this has caused thousands of potentially preventable emergency department visits and hospitalizations for hypoglycemia (low blood sugar).

The study team, led by Dr. Rozalina McCoy, an endocrinologist and primary care physician at Mayo Clinic, sought to identify the real-world implications of intensive glucose-lowering therapy across the U.S.

Her team found that overly intensive glucose-lowering therapy — when patients receive more medication than is required based on their hemoglobin A1C level — was not only common across the U.S., but also directly contributed to 4,774 hospitalizations and 4,804 emergency department visits in a two-year period."

Monday, August 26, 2019

My Early Year With Type 1....In The Beginning

I have many new friends who have not read my story. I am starting from the beginning with this post.
I don't remember some of the content, but discussions with my Mother many years after my diagnosis helped me fill in the gaps. I remember those conversations very well.
My diabetes, in the beginning…
In 1945 I started school in the first grade, the next day after Labor Day. I did not feel like going, but my parents wanted me to go even though I was only five years old. I was six years old during the second week of my school year. I felt sick in my classroom, and I was not paying much attention to the teacher. I just wanted to go home, and stay there. The steps on the school bus were steep, and it was hard to climb them because I was feeling weak.
Several months previously, I had chickenpox. Then I had mumps. While I was recovering, I stopped wanting to eat, and I started losing weight. Mother and Daddy took me to our family doctor, but he did not know what was wrong with me. He had us get a tall bottle of brown stuff, and I was supposed to have some of it a few times each day. It was supposed to give me an appetite, and make me want to eat, but it did not help. Not at all. We saw two other doctors, and they did not know what was wrong, either. My Mother made an appointment with a fourth doctor. We hoped so much that he could help me.
My sixth birthday was on September 10. I did not want to eat any cake, or anything else. I was feeling very sick, and I didn’t have an appetite. Mother kept giving me things to eat, but I refused to eat them. I was very weak, and I was having a hard time walking. I had lost a lot of weight. I drank so much water, but I was still thirsty. Peeing so much!!
A few days after my birthday, we went to see the fourth doctor, Dr. Williams. His office was upstairs in an old building in Salem, Va. It was a very long flight of stairs. I was so weak that it was difficult to climb the stairs. Daddy carried Shirley, my little sister, up the steps. She was two years old. Mother walked beside me, and tried to help me up the steps. I had to stop and rest some, my heart was beating so fast. We reached the top of the stairs, and walked down a long hall. The doctor was in his office, and Mother and I sat down in chairs. It felt so good to sit down. Daddy stood in the doorway behind us, still holding Shirley.
We had my blood tested several days before seeing the doctor, and he had the results. He gave us some bad news. He said I had diabetes. I looked at Mother, and she was very pale. I could tell she was very scared about what the doctor was saying. What is diabetes? Is it serious? I was scared too!! The doctor said a lot more, but I don’t remember any of that. Mother’s face scared me, and I just wanted to go home. I do remember the doctor saying I had to go to the hospital. It was late in the day then, and we waited until the next morning to go to the hospital. Another doctor was supposed to meet us there. We hoped he would help make me feel better.
I had been to a hospital twice before. The first time was to have a hernia removed from my right side. I was four years old then. Later that year I had my tonsils removed. I had a terrible sore throat for a long time. I was so glad when my throat was better, and I could eat again. When I went to the hospital for diabetes, I knew I would not have surgery. I was so glad about that! I was also glad that I would not be going to school for awhile. Maybe I should not have started school that year.
I was taken to a room in the hospital, and put in a bed in one of the rooms. Dr. Davis came to the room and talked to us about diabetes. I was given something called insulin, and the doctor said it would make me feel much better. I liked hearing that, but the very long needles they used hurt me so much! I had lost so much weight, and my arms were so skinny. The shots were given in those arms. After a few days in the hospital, I had an appetite again. I ate some food in my hospital room, and before I went home, I was gaining some weight. I felt stronger, and walking was much easier. Dr. Davis told us that I could eat anything I wanted, and as much as I wanted, if it did not contain sugar. There were no other restrictions. I loved Dr. Davis!!!
The first few days at home were difficult for me, and my parents. When I got up each morning I had to pee in a cup. Daddy had a big test tube containing some blue liquid called Benedict’s solution. He put a few drops of my urine in the test tube, and then put it in a tin can on the stove. There was some water in the tin can, and we waited until the water boiled for awhile. When the test tube was removed, we could see the color of the solution. If it was still blue, I did not have any urine sugar. If it was green I did have sugar in my urine. The other colors that showed even more sugar were yellow, orange, and red. The red color meant that I had very high sugar level. I hated red, and felt much better when I had blue or green.
I used insulin that was taken from the bodies of pigs and cows. The amount of urine sugar determined the amount of insulin I needed each day. Daddy put the insulin into a big glass syringe, and then he twisted a needle onto the tip of the syringe. The needle was about three quarters of an inch in length. Dr. Davis wanted Daddy to inject the insulin into the muscle on my very skinny arms and legs. The insulin was not fast acting, and injecting it into muscle made it work faster. The injections really hurt a lot!! The needles were very thick, and long. The insulin was a 24 hour insulin, and I did not have another injection until the next morning.
The syringe and needles were placed in a jar of alcohol, until the next morning. After a week had passed, the syringe and needles were placed in a pan on the stove, and boiled, to make them sterile. We had a well on our property that supplied our water, and there was some lime in the water. The lime left a white coating on the syringe and needles. Sometimes the lime deposit clogged the needles, and Daddy had to take a very fine wire and push it through the needle to unclog it, before loading the syringe with insulin. The needles were wide enough for the wire to be pushed through. There were also times that a deposit appeared on the outside of the needle, near the tip. Daddy had to remove the deposit by using a whetting stone. If we did not notice a deposit on the needle, and it was pushed into my skin, it made a popping sound, and that hurt so much!
After a few days at home, I returned to school. I was feeling much better, and I was strong enough to easily climb onto the bus. I could pay attention to the teacher, without any problem. I had missed several days of school, and catching up was not easy. Mother went to the school and had a discussion with the teacher. The teacher had never heard of diabetes. Mother told her that I should not play with the other kids in the gym, or on the playground. The activity could cause my sugar to drop too low, and I could have an insulin reaction. Mother tutored me at home. The teacher told her what lessons had been covered while I was in the hospital. Mother was a very good tutor!
That is the way it was, for many years. We did not know about diabetes complications. Test my urine before breakfast, take my morning insulin, avoid sugar and don’t play too hard. That seemed simple enough. No worries. Everything was good. I wonder how things would have been if we knew about the potential complications, and the true nature of diabetes.

Monday, August 19, 2019

Using An Infusion Set More Than 3 Days?

"The FDA approved on Friday a proposed trial of an insulin infusion set that can be worn for 7 days, according to a press release from Medtronic."

That would cause so much trouble for me. If I use an infusion set more than three days, the insulin absorption is not as good. Scar tissue can begin to form. If I used the set for seven days, I would probably get very little absorption. Scar tissue can remain in the area for a long time, and there might be poor absorption after applying a set at the same location later on. Doesn't Medtronic and the FDA know about scar tissue?

What are your thoughts on this topic?

https://www.healio.com/endocrinology/diabetes/news/online/%7B77bb9a97-4cd2-4f11-bf32-ab3de8343223%7D/medtronic-receives-fda-investigational-approval-for-testing-of-longer-use-insulin-infusion-set?M_BT=4563255241780

Tuesday, August 6, 2019

Lilly, The Insulin Doll

LILLY - the insulin doll. Created in celebration of the 77th
anniversary of the discovery of insulin. Eli Lilly and Company was the first to make insulin commercially available. In the early 1920s, the company supplied insulin free of charge to a group of children being cared for by Dr Elliot Joslin at the New England Deaconess Hospital.
In response at Christmas time, the children sent Mr J K Lilly Sr a personal letter thanking him for his gift. Mr Lilly was so touched that he sent each child a new doll and new insulin kit. Without exception, each doll was named "Lilly" by its recipient.
https://asweetlife.org/breakthrough-the-dramatic-story-of-the-discovery-of-insulin-at-the-new-york-historical-society/

Sunday, July 28, 2019

Nasal Glucagon

A new form of Glucagon is now available, through the nose, and not by injection.
"On July 24, the FDA approved Baqsimi, the first non-injectable emergency treatment for severe episodes of hypoglycemia. Submitted for approval by Eli Lilly and Company, this powder form of glucagon is administered into the nose, and comes in a single-use dispenser.
Once administered, Baqsimi works to rapidly increase blood glucose levels by stimulating the liver to release accumulated glucose into the bloodstream.
Glucagon is the standard treatment in situations of severe hypoglycemia, but until now, all approved treatments have come in the form of an injection. Injectable glucagon has been available for several decades, but is not shelf-stable at room temperature and therefore requires mixing a powder and liquid with a syringe, which can be intimidating and prone to user error in emergency situations.
'People who are living with diabetes are at risk of their blood sugar levels falling below the normal range. There are many products on the market for those who need insulin, but until now, people suffering from a severe hypoglycemic episode had to be treated with a glucagon injection that first had to be mixed in a several-step process,' said Janet Woodcock, M.D., Director of the FDA’s Center for Drug Evaluation and Research.
Baqsimi was evaluated in two studies of 83 and 70 adults with diabetes respectively, during which a single dose of the nasal powder was compared to a single dose of glucagon injection. The FDA reported that Baqsimi was satisfactory in increasing blood glucose levels. A pediatric study of 48 patients with Type 1 diabetes also saw similar results.
Notably, Baqsimi does not need to be inhaled and therefore can be administered to an unconscious person suffering from severe hypoglycemia.
'This new way to administer glucagon may simplify the process, which can be critical during an episode, especially since the patient may have lost consciousness or may be having a seizure. In those situations, we want the process to treat the suffering person to be as simple as possible,' added Woodcock, M.D.
Representatives from Eli Lilly have indicated that Baqsimi should be available in U.S. pharmacies within a month. The U.S. list price for a Baqsimi one-pack will be $280.80, which is the same price as injectable glucagon. Beyond Type 1 is hopeful the new drug will be widely covered by all insurance plans that currently cover injectable glucagon.
'Severe hypoglycemia is an unpredictable event for people with diabetes that can happen anytime, anywhere. It’s an experience that can be very stressful and difficult for those helping a person in a low blood sugar emergency,' said Dr. Sherry Martin, Vice President of Lilly Medical Affairs. 'The FDA’s approval of Baqsimi may help people prepare for these moments with an innovative product that has the simplicity of nasal administration.'
According to a press release, Lilly is in discussions with insurance providers to make the nasal glucagon available to as many people as possible. Additionally, the company is offering a savings card through the end of 2020 for patients with commercial insurance to obtain 2 devices for as little as $25.
Patients and healthcare professionals with questions about Baqsimi can visit www.baqsimi.com or call The Lilly Answers Center at 1-800-LillyRx (1-800-545-5979)."
Read the full press release from the FDA by clicking on the link below.

https://www.baqsimi.com/?fbclid=IwAR2NLvlgRSbpFJgm0ycjJwFwxJdYbYx80f47-ohElcx44C-Uc3tJhIODgao

Thursday, July 25, 2019

Joslin Medalists, 2019



The photo shows approximately 150 Joslin Medalists in Boston in May, 2019. There is a medalist meeting in Boston in odd numbered years. Each person in the photo has been a type 1 diabetic for at least 50 years. Some of the medalists shown have been type 1 for 75 years, and a couple of them for 80 years.


Friday, July 12, 2019

Double Diabetes

There were no diabetes "types" when I was diagnosed in 1945. All people diagnosed with diabetes were treated with insulin taken from pigs and cows. That crude form of insulin gave me back my health. In the years 1936-1939 it was discovered that there were two types of diabetes, but it was not until 1959 that the labels Type 1 and Type 2 were attached. Oral drugs for Type 2 diabetics were introduced in the years 1955-1956.
Now, in current times, we are seeing more and more people with
characteristics of both type 1 and type 2 diabetes. These individuals have "double diabetes". This occurs when:
1. A person with type 1 diabetes becomes overweight and develops the basic feature of type 2 diabetes – insulin resistance (IR). Typically, the type 1 diabetic would then use a type 2 medication to help control the IR. Insulin would still be necessary as well.
2. A person with type 2 diabetes has one of the key features of type1– the presence of antibodies in the blood against the insulin producing beta cells of the pancreas causing a decrease in the body's ability to produce insulin. The decreased insulin production can then lead to the type 2 diabetic becoming insulin dependent. These individuals still use their type 2 medication for their IR.
"The term ‘double diabetes’ was first coined in 1991 based on the observation that patients with type 1 diabetes who had a family history of type 2 diabetes were more likely to be overweight and rarely achieved adequate glycaemic control even with higher insulin doses. The more extensive, or stronger, the family history, the higher the dose the patient received."
Double diabetics may have initially been either type 1, or type 2. Once they have become double diabetics they have IR, they are using insulin, and they are using a medicine (usually metformin) for their IR. I have several type 1 friends, and type 2 friends, who are double diabetics. Some of my type 2 friends are using a pump and a CGM.
In the 1990s I stopped using animal insulins, and began using synthetic insulins. I began gaining weight, even though I was following a much healthier diet, and eating fewer carbs. The only thing that had changed was my insulin. I have read many reports that say the synthetic insulins cause our cells to store fat. Maybe that was the reason for my weight gain, but I did not know that information until much later. I had never been more than five pounds above my ideal weight (185) until the 1990s. By the year 1997 I weighed 242 pounds. That was a net gain of 57 pounds. A lower carb intake and plenty of exercise did not seem to help at that time.
Finally, in 1998, I was diagnosed with insulin resistance. I had several relatives with Type 2 diabetes, and it seems likely I was predisposed to become type 2. The predisposition and the weight gain are likely the explanation for my insulin resistance. In the early 2000s I reduced my daily carb intake, increased my amount of exercise, and lost 34 pounds. I initially used avandia for my IR, but started using metformin in early 2011. Using metformin for one year was very good for me. That medication has helped many diabetics lose weight. I lost an additional nineteen pounds, and was only four pounds above my ideal weight. Despite the weight loss, I still had IR. Metformin, eating an average of 140-150 carbs per day, and getting lots of exercise kept me in good health. My A1c's were typically below 6.0, and except for some neuropathy, I do not have any diabetes complications. Double diabetes can be controlled, and my health is just as good now as it was before I became a double diabetic.
A type 1 diabetic with IR has double diabetes, but is NOT both type 1 and type 2. That person is type 1 with a type 2 characteristic. That is not the same as having both types of diabetes.
If you are type 1, you gain a substantial amount of weight, and you have type 2 relatives, you might want to discuss your situation with your doctor. You may have insulin resistance. You may have double diabetes.

Tuesday, July 9, 2019

My Story on Diabetes Mine

In the year 2015, Mike Hoskins published a blog on Diabetes Mine about my life with type 1 diabetes. I sent the article to Mike, and he edited it, including pictures, and a reference to my book. Here is my story on DiabetesMine.com

Wednesday, July 3, 2019

Finding The Right Lady, Our Marriage


I was teaching at Bridgewater College in 1963, in Va. I had a little black book with names of coeds that I had picked from the 1962 yearbook. I showed the list to my dorm mother friend. She looked very carefully at my list and said date this one, her name is Anita, she is wonderful, and forget about the others. That was not my plan, but I agreed to give Anita a call. After a few dates with Anita I was not so interested in calling any more girls, so I just stuck with Anita and Wanda. I dated Wanda on Friday, and Anita on Saturday, Sunday, Monday,..... I guess the dorm mother had hit the nail on the head. Anita was different in a very positive way. Beautiful, so sweet, and I felt very comfortable with her, like I had with Mary Louise. I looked for that little black book one day, and it was gone. I have wondered if the dorm mother had cleaned my room one day. saw my list, and threw it away??? She really did like Anita. I DID TOO!!! I stopped dating Wanda, and Anita and I were going steady. Anita eventually told me that the girls at her dorm had helped her fix her hair, pick out the dress she wore, etc before our first date. I think the whole campus knew we were dating. At that stage I was even dating her on Fridays. Dating every day of the week. I wonder if any other couple ever did that.
I took Anita home with me for the Thanksgiving weekend. Mother loved Anita! Daddy did too! Hey, this is getting serious here!!! Anita and I had already admitted our love for each other. When the semester was over I went home for Christmas, and Anita went to Falls Church, Va to be with her family. It was agreed that I would go to Anita's house the day after Christmas so I could meet her family. Late on Christmas Day a terrific snow storm hit Roanoke. The roads were plowed late the next morning, but the driveway at our house had about 18 inches of snow. My parents insisted that I stay home, and wait to see my sweetie when the spring semester began. They were out of their minds!!! I shoveled the driveway, and packed my car while Mother was screaming at me. I started up the hill on our driveway. Too much ice, it was bitter cold. My tires were spinning, and Daddy helped me put chains on the rear wheels. I still could not make it up that hill. I was about to give up when I saw daddy coming with his tractor. He pulled my car up the hill to the road, and off I went. The roads between Roanoke and Falls Church, Va. were slick and dangerous, but nothing was going to stop me. It took me about six hours, normally it would have been four hours. I found her house, and I met her parents and her brother. Nice people!
That evening we went downstairs to the rec room where there was a fireplace, all warm and cozy. I proposed marriage that evening, and she said yes!!! HURRAY! Months later her Mother said she knew that we were engaged, she could tell by Anita's grin as we walked up the steps. We were going to keep it secret for awhile because we had been dating for less than two months. We planned our wedding for May 31, 1964. We were married after 7 months of courting. We celebrated our 55'th anniversary on May 31, 2019. We have had a wonderful marriage, still going strong!!!
*******************************************
Anita read this chapter after I finished writing it in 2010.. She proofread all my chapters. She said it was to find misspelled words and grammatical errors, but I know she had other reasons as well. She was an English major in college.
She laughed all the way through this chapter.
The first picture below shows Anita when she graduated from high school in 1962. The second shows us with our firstborn, David, 1966.


Friday, June 21, 2019

Wednesday, June 19, 2019

Diabetes and College, 1957-59

Diabetes and College, 1957-59

My parents told me I could not go to college. They thought I would not be successful because of my diabetes. None of my relatives had ever gone to college. Many of them had good jobs and good salaries They lived in fine homes. My parents did not understand my being so obsessed with going to college. What they did not understand was that I was deeply hurt by their telling me I would not make it through college because of my diabetes. I wanted to show them I could do that, and do it well! I had a good mind, and I wanted to use it in a meaningful way.

They begged me to apply for a job at the post office where my father worked. I could become a post office clerk, and he could watch over me. So I had to choose between standing at a counter selling stamps and weighing packages, or going to college. The only coed college available was Roanoke College, just 20 minutes away. If there had not been a college nearby I would never have gone to college. My parents were disappointed in me, and Mother cried. They were so dead set against my doing this.They refused to pay for any part of my tuition or my college expenses. They were kind though, and they gave me free room and board. Daddy let me drive his older Chevy instead of trading it in when he bought a new car. He kept the car in good shape, and paid for the gas. I had no money of my own, so I had to get a job. I started working at a supermarket the very month I graduated from high school. I worked about 30 hours per week during the summer, and started off at 75 cents per hour. Every few months I would get a raise of 5 or 10 cents per hour. I saved enough to pay for half of my tuition for the fall semester. I was supposed to pay the other half later during that semester. College expenses were so much more reasonable back then. If someone was working at a grocery store to pay for tuition in the 21'st century, it would be impossible. My being able to live at home, and make enough money to pay tuitions, made it possible for me to go to college. I reduced my hours at the grocery store when college was in session.

I wanted to become an architect. There was a pre-engineering program at Roanoke College, and I chose courses that would enable me to transfer after two years to Va. Tech, to become an architect. I made all A's and B's (mostly A's) during my freshman year, except for chemistry. I was not ready for college chemistry. I talked to the chemistry teacher and she understood my problem, but she could not do anything for me. I received C's in both semesters of chemistry, but I knew almost nothing about chemistry when the spring semester ended. Not having had the high school prerequisite chem course made it almost impossible for me. I felt the C grades were a gift. I was very grateful, but I felt guilty about it. I made new friends while in college, and we visited each other's homes. We played golf and went bowling many times. Good friends. I had a crush on several girls while in high school, and during my freshman year of college, but I was too shy to ask them for dates. I had my first date during my sophomore year of college. My shyness and lack of confidence kept me from dating until then.

While in college, I continued with one shot of animal insulin each day. I had Test Tape for testing my urine. That was so much better than the test tube and boiling on a stove. There were no glucose tablets for a long time to come. Sugar worked very well. I remember having lows during tests, and my teachers never let me take a make-up test. I took my test with my class, or not at all. I had a low during a calculus test that was so bad that my vision was blurred, and I could not read my test paper. My teacher would not believe me. That was the only math test I failed in college. There were only three tests and a comprehensive final exam in each math course I took. My failing grade on that test resulted in a B grade for first semester calculus. I made A's on all of my other Calculus tests.

When I returned to campus for my Sophomore year the pre-engineering program had been cancelled. I had engineering drawing, engineering orientation, and a class in slide rule during my Freshman year. (Can you believe that? There were no computers back then, and slide rules were very popular. I carried it strapped to my belt for my Freshman year. I still have my slide rule in a closet today.)

Since the pre-engineering program was cancelled, I could not continue my preparation to become an architect. It was too expensive for me to commute to Va.Tech, even though the campus was only one hour away. I needed to stay in Roanoke and work at the grocery store so I could continue paying my tuitions at Roanoke College. I had to change my major, and give up the idea of becoming an architect. I had always loved math in high school, and during my first year in college. The head of the math department convinced me to change my major to mathematics. I was disappointed that I could not continue to prepare for becoming an architect, but it all turned out well. The wonderful things that happened in the years ahead would not have happened if I had continued my original major on another campus. My mother was pleased that I would continue for four years at Roanoke College, while living at home.

I dated a very nice girl named Linda during my Sophomore year. We dated many times, and I really liked her. I will continue with that in my next chapter.


Saturday, June 15, 2019

School and Type 1....1945-1957


One shot per day, one urine test, large portions of food, and no worries. We did not know there was any potential problem, and I led a rather normal day to day existence. Ignorance was bliss!! There were no health problems with my diabetes throughout my childhood, despite my very irregular blood sugars. I have often wondered why I did not have DKA back then. Was something protecting me? All the fast acting carbs I ate each day, without correction boluses like I take now, must have kept my blood sugar very high. The only times I had lows and hypos were when I got too much exercise, and sometimes during the night. My insulin was working during the night just like it did during the day, but without food. That would sometimes give me lows and seizures while I was sleeping, if I did not eat enough before bedtime.
My parents did the best they could for me during my childhood. Dr. Davis gave no instructions that helped. My parents raised me in much the same way that they were raised in their mountain homes. They did not drink, smoke or swear. They were good Christians, and kept to themselves. They bought land outside the Roanoke, Va. city limits so they could have a farm. They were raised on farms, and they loved that kind of living. That had a lot to do with the way I grew up, the development of my shyness, and my overall personality.
My mother wrote her own story when she was in her 80's. She only briefly mentioned my diabetes diagnosis. She did not say anything about the months leading up to my diagnosis, or the trauma in the months that followed. My parents were devastated by my diabetes, and not knowing how to care for me. The memories were probably too painful for her, and she chose not to include those details in her story. It is impossible for me to remember all that happened back then, but my parents told me all the details years later.
I was not a very good student during my first few years of elementary school. I made a lot of C's but I never failed a grade. I studied hard,and my Mother was a great help. She was a good tutor. I had hypos during the night about once per week, and then ran high blood sugar during the day. All those carbs caused the highs. Mother was afraid I would have a hypo while at school. She approached the teacher at the beginning of each year and explained my condition. She said I should not exercise like the other kids. She convinced Dr. Davis to write an excuse before school started each fall. I never participated in play period or gymnastics of any kind. I sat and watched the other kids. Mother would not have it any other way. My classmates knew I was different, and they ignored me but never made fun of me. I tried to make friends, but I was never very successful. I became very withdrawn, and terribly shy. I hated my diabetes, and blamed it for my misery in school. I never blamed my Mother because I also feared having a hypo in school. Mother always brought me out of my hypos at night by feeding me water containing a lot of sugar. I knew there would not be anyone to do that for me at school, so I sat and watched the kids play, and felt comfort in knowing I would not have a hypo. I would have been so embarrassed if I had had a hypo at school. I never did have a hypo in grades 1-12.
By the time I reached fourth grade I started making better grades. In the sixth and seventh grades I made several A 's and B's, not many C's. I was always the best in my class at spelling. I took great pride in my ability to spell complicated words. When I reached high school my Mother still wanted me be excused from gym classes. I was rather good at basketball, at home. Daddy nailed a barrel hoop to the side of the corn crib, and I became very good at making baskets. I played and worked hard at home, but always under Mother's watchful eyes. I still had that fear of having hypos in high school, so I agreed to not participate in gym classes. I wish now that I had rebelled and taken gym. I was still withdrawn and shy in high school. I made a few friends though and my grades were very good. I graduated number 13 in high school in June, 1957. My math teacher in my senior year found that I was not intending to go to college. She begged me to go. I considered it but I knew my parents would not approve.
My parents told me I could not go to college. They thought I would not be successful because of my diabetes. None of my relatives had ever gone to college. Many of them had good jobs and good salaries They lived in nice homes. My parents did not understand my being so obsessed with going to college. What they did not understand was that I was deeply hurt by their telling me I would not make it through college because of my diabetes. I had to show them I could do that, and do it well!
The picture below is my senior year picture in high school.

Sunday, June 9, 2019

Misdiagnosis of Adult Diabetics

I have read so many times about adults being diagnosed with T2D when they are actually have T1D. Here is a quote from a very good article on this topic.

"People with adult-onset Type 1 diabetes/LADA who are misdiagnosed as having Type 2 diabetes are wrongly treated as though they have Type 2 diabetes.  Consistent evidence shows the importance, in terms of clinical outcome, of early initiation of insulin therapy in Type 1/LADA.  Thus, the early clinical recognition of people with adult-onset Type 1 diabetes, as distinct from Type 2 diabetes, is extremely important to guarantee the most suitable treatment in order to preserve beta-cell function, gain optimal metabolic control, and improve long-term outcomes.  A correct diabetes diagnosis is the cornerstone of correct therapy and a wrong diagnosis delays achievement of optimal metabolic control, frustrates patents, and increases the risk of life-changing or fatal complications."

The link for the complete article appears below:

http://adultt1diabetes.blogspot.com/2019/06/getting-it-right-for-people-with-adult.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+AdultOnsetType1Diabetes+%28Adult+Onset+Type+1+Diabetes%29

Saturday, June 8, 2019

Friday, June 7, 2019

A1C Testing

A1c testing was not available until 1976. My doctor 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 was when I learned that carbs had an effect on blood sugar levels. My A1c's began improving. Now I am alive after 73 years of type 1, and I have no complications except for some mild nerve damage.
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. 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 2013-2016.
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...5.6, 5.7, 5.8, 5.6
2012...6.1, 6.1, 6.0
2013...5.8, 6.1
2014...5.7, 5.6, 5.8
2015...5.8
2016...5.9, 6.0, 6.1
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 follow a low carb diet. My doctors never told me that. Then in the late 1990s 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 was very successful for several years before pumping too, but using an insulin pump has made good control so much easier.
I took only one injection of beef/pork insulin per day during my first 35+ 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 serious complications. Is it good genes? The Joslin Study of long term type 1's in the US has reported that many of the participants are still producing some insulin. Those individuals are insulin dependant, but any amount of insulin produced in our bodies is very beneficial in helping to prevent complications. My C-peptide is less than 0.1, so I am producing almost zero insulin. There has to be some other explanation for those of us living so many years with type 1, and not having any serious complications.

Tuesday, June 4, 2019

Joslin Medals

The Joslin Diabetes Center offers medals to people with type 1 diabetes who have completed 50, 75 and 80 years. There is also a certificate for 25 years.
The Joslin medals are available all over the world. People in many countries have the 50 year Joslin medal.
It is necessary to prove that you have been T1 for 50 years when you apply for the Joslin medal. Verification from a hospital or a doctor is ideal, but some people do not have that information. I was told by a medalist that you can have 2 or 3 people who knew you the year you were diagnosed to write letters about what they remember from that year. Those letters are usually accepted as sufficient proof. My sister and a cousin wrote letters for me, and i received my 50 year medal with their help.
Here is the link for applying for these medals. A printable form of the application appears on the link page.




Monday, June 3, 2019

Needles and Syringes, 1940's-1960's

Needles and Syringes,1940's-1960's
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.
One of the pictures below shows a comparison of an approximately 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. Since I was so skinny, the long needle might have struck bone. Most of the needle was needed in the flesh to get the necessary absorption. Injecting into the muscle caused the animal insulin to be absorbed more quickly. The insulin from pigs and cows was not as fast acting 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 infections caused by the use of animal insulin in 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. I did not have any diabetes related complications from the time of my diagnosis in 1945 until the mid 1990's when I stopped using animal insulin, and started using synthetic insulin....Humalog. Soon after starting Humalog I started having complications. But that is another story, for another day. None of my complications are serious, and I am very lucky to have good diabetes health after 73 years of Type 1 diabetes.
If you have not seen a history of insulin, here is an article giving the highlights.


Friday, May 24, 2019

My Early Life, Without Sugar

When I was diagnosed in 1945, the doctor told my parents that I should not eat anything containing sugar. I don't remember my reaction to being denied sugar at that time. My diagnosis was only a few days after my sixth birthday. I do remember missing sweet things to drink. For some time I drank milk from our own cows. That was not a good choice, but we did not know that. It did not contain sugar, so we thought it was ok. When we went grocery shopping my family did not buy candy, cookies or ice cream. I don't know what my sister thought about that, she was three years younger, and she probably wanted sugary treats.
A year or so later, we discovered saccharin at a drugstore. My mother learned to prepare desserts sweetened with saccharin. I had pies, cookies, and a birthday cake sweetened with that wonderful stuff. Saccharin was great! Mother made desserts sweetened with sugar for the rest of the family. I was happy with my own desserts, and I never wanted to taste of theirs. My father prepared homemade ice cream, and a portion sweetened with saccharin was set aside for me. I always looked forward to that. It was a summer treat.
One day in our grocery store we saw a display of little bottles containing colored liquids. It was called Kool Aid. It was invented in the 1920s and initially sold in concentrated liquid form. Later on it was sold as a powder in little packets. The Kool Aid we bought in the 1940s was in a concentrated liquid form, so we added water and saccharin. It made a delicious drink. I was very happy.
I had low blood sugar at times for many years, and my mother gave me a glass with some water mixed with sugar. That was the only sugar I had for very many years. I had some awful seizures at night several times each year, and the sugar water was ready for those occasions. If I could not drink the liquid, my father would sit behind me on my bed and prop me up while my mother rubbed the sugar water on my lips and gums until I had enough to bring me around, so I could drink some of the liquid. I think I may have associated the sugar with my seizures, and that may have made sugar even more undesirable.
There were no meters for measuring blood sugar for my first 40 years after diagnosis, so my urine was tested for sugar each morning to determine my insulin dosage, and then I had to depend on my own feelings to detect low blood sugar the rest of the day. While sleeping at night my parents would listen for me to be thrashing around in bed to determine that I had low blood sugar. Their bed was close to mine for many years, so that worked out well.
Now I will fast forward to the current century, and tell you about a discussion that my sister and I had a few years ago. Our father worked at a post office, and he had an afternoon and evening shift. He got home at 11:30 PM. She told me that he would stop at a store on the way home from work and buy candy bars. They were hidden high in a cabinet in the kitchen. I can remember entering the kitchen several times and my sister was standing with her back against a wall, with her hands behind her. I guess I was not curious about that. She was hiding a candy bar she had been eating. I never saw a candy bar, and she waited more than sixty years to tell me about that. We laugh a lot about her candy bars. I am glad she had them, and I am glad I did not see them.