Saturday, May 18, 2019

Dr. Ponder, Endo, Joslin Medalist


Dr. Stephen Ponder is a pediatric endocrinologist in Texas. He is the author of the very popular book "Sugar Surfing". He is a type 1 diabetic, and he is a Joslin medalist. He will be a speaker in the Friends For Life type 1 diabetes conference in July. He has two sessions scheduled for the morning of Wednesday, July 17. My session is scheduled that afternoon at 3:15 PM.
Here is the link for the conference scheduled July 17-21:
Stephen is also a very inspirational blogger. Here is one of his blogs. I really like this one.
The Wall (revisited)
June 7, 2018
Stephen W. Ponder MD, FAAP, CDE
27 years ago I learned an invaluable lesson about living well with my diabetes. It happened in a most unusual way. It has remained with me ever since.
I was working as Medical Director at the Texas Lions Camp for Children with Diabetes. One afternoon I was covering camper activities at the high element ropes course. There was a new 75-foot climbing wall that the campers would attempt to scale. When they reached the top they would ring a small victory bell.
After all the campers had their turn to climb up the adult staff were offered a chance to participate. I was very eager to do it.
But each attempt I made to scale the wall seemed futile. I'd get no more than 10 to 20 feet up and fall off. Time and time again I failed. Quickly, I became frustrated. Excuses began to flow from my mouth. I said there was no way I can do this. I was heavier than the kids. Too old. Weak. Just about any other lame reason or excuse I could conjure up was said. It was a major whine.
The young man who oversaw the activity witnessed my frustration (His name was Todd). He said to me "Dr. Steve, let me show you how to do it".
Todd had only one arm. He lost his left arm above the elbow to bone cancer when he was very young. I watched dumbfounded as Todd scaled the entire wall in a matter of seconds: using both legs and ONE arm. With a feeling of combined awe, embarrassment and deep humility, a warm feeling suddenly came over me. A true epiphany.
I learned a life lesson which has carried me forward to this very day: that while I can always find something to complain about, make excuses for, rationalize away, or simply dislike, the only thing that truly limits me is myself...my attitude and belief in my own abilities. You see, Todd was different…but hardly abnormal. In fact, he accepted no limitations and placed none on himself. I thought to myself that I wanted to be like that guy, not limited by my differences.
Such an incredible lesson I learned one sunny afternoon at diabetes camp in 1991. Type 1 diabetes may make me and many other people 'different', but we should never look at ourselves as abnormal. And most of all, never use our differences as excuses for the things we wish to do or accomplish for ourselves or others. Many of the barriers we place before us are of our own creation. Ironically, I tore down a wall as I scaled another one.
After watching Todd scale the wall, I made the trek to the top and rang the bell. He not only showed me the proper technique, but most importantly, the proper attitude. I often reflect on that day.
I respect everyone’s right to be unhappy, complain, or just simply be mad about whatever angers them. There is absolutely nothing wrong with that. But as I’ve said so many times, life with diabetes is all about choices, and I CHOOSE to look at my condition differently. Todd made a similar choice about his life and I learned from his example.
In the natural world, I should have died after March 1, 1966, the date of my diabetes diagnosis. I am kept alive and relatively healthy each day by artificial means (injected insulin, meters, sensor, etc.…) and my wits. That’s a gift I choose to not complain about. Every day of my “second life” has been a gift. I consider each day I awaken on this Earth with equal thanks and gratitude.
Some of you may wonder why most of my FB posts about diabetes are usually positive and empowering. Now you know why. I have shared this story before with campers. Many could relate, and some just listened politely. We can learn valuable lessons about living well with diabetes or any other life challenge in some of the most unlikely of places or situations. This is one example.

Saturday, April 27, 2019

Keeping My Diabetes A Secret....

When I was diagnosed in 1945, I was not actually ashamed of my diabetes. I did not realize what was happening. I was six years old, and my family was in charge. Later on it was obvious that people we knew were totally oblivious, they had not heard of the disease. Our relatives, neighbors, my teachers, and my classmates in school could not understand what was involved. People would stare in disbelief when I tried to explain my diabetes. Of course, explaining was very difficult since neither I, my family, nor my doctors knew much about it. I could not explain the highs and lows, DKA, carbs, and the possible complications since I knew nothing about them for so many years. My doctors gave no information except that I should take a shot of insulin each morning, and not eat sugar. It seemed like a simple disease back then. I got tired of seeing the doubtful looks on people's faces, and I kept my diabetes a secret for a very long time. My mother went to my school on the first day of classes for seven years, and had private talks with my teachers. Those teachers had not heard of diabetes, but I think they believed her. To prevent low blood sugar, I was not permitted to participate in gym or on the playground. I felt like an outcast, and I was ignored by my classmates because I was so different. I became shy and withdrawn. That was the most complicated part of my diabetes during my early years.
In high school I was more mature, and I had less trouble with it, so I opened up with a few friends. I did not talk to my teachers, but I did not have lows during school hours. My blood sugar was high almost all the time, but I did not have any DKA, or did I? I don't think there was a way of measuring ketones at home, and there was no glucose meter for my first 40 years. In college I talked to some of my teachers, and they actually listened, somewhat. I had friends who were concerned, but they did not understand this mysterious disease very well. I didn't either, at that time.
When dating I did not tell my girlfriends about my diabetes. It was not necessary, and I was afraid that they would not want to date me if they knew. I did not have lows, so that was okay. My lows occurred during the night, at home, or when I had too much exercise. After college I told my dates about diabetes, and they were interested. They listened, and wanted to help! I married one of those young ladies, and she has been a tremendous help to me for almost 55 years!!! Anita has helped me through many lows, including several seizures. I think she has saved my life several times.There were glucose meters in the mid 1980s, and I finally knew my blood sugar numbers. I learned about carbs in the late 1980s, and started basal/bolus management in the mid 1990s. My A1c's dropped from a high of 12 into the high 5's over a period of several years. How I have managed to avoid serious diabetes related complications is a mystery to me. I was not taking good care of myself for 50 years, because I did not know what 'good care' was. Now I am taking very good care of myself. My using an insulin pump in 2007 has eliminated my needing any assistance with lows. I am also using a Dexcom CGM, which is very helpful.
I am not at all shy and withdrawn about my diabetes now. Maybe I am too open? I do not hold back because many online people tell me that I offer inspiration and hope for themselves, or their type 1 children. That is why I chose to be a speaker at the Friends For Life type 1 conference in 2015, in Orlando. I am scheduled to do that again this year on Wednesday, July 17.
My life with diabetes is an open book. I actually did write a book about my life with diabetes. It was published in 2010, and it describes my first 64 years with type 1. Here is the link:
https://www.amazon.com/Beating-Odds-Years-Diabetes-Health/dp/1450515967/ref=sr_1_1?ie=UTF8&s=books&qid=1268873383&sr=1-1

Friday, April 12, 2019

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 54 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 the 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 73 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 link from the Mayo Clinic gives very good information about seizures.
https://www.mayoclinic.org/diseases-conditions/diabetic-hypoglycemia/symptoms-causes/syc-20371525

The next link gives a good presentation on diabetic seizures, and concludes with replies made by people who have seizures. You can add your own  case, or reply to the people who have posted there.

https://www.thediabetescouncil.com/diabetes-and-seizures-what-are-they-what-are-the-symptoms/

Tuesday, April 9, 2019

October, 2008....60+ Years Of Type 1 Diabetes

The American Diabetes Association was created in 1940, five years before my diagnosis. The ADA magazine, the Diabetes Forecast, began in 1948. In October, 2008 the magazine celebrated its 60'th anniversary. There was a search that year for people who had lived with type 1 diabetes for 60 years, or more. Eleven people were chosen, and I was one of them. The October issue had an article with stories and pictures for those individuals. A photographer came to my house in NY in August of that year. The pictures he took appear in the magazine. (See below.)
The most impressive individual in the article was William Rounds (1922-2010). William was diagnosed with diabetes in 1923, less than a year after he was born, and only 2 years after insulin was discovered. He was T1 for 87 years the year he died. He attended the Joslin Medalist meeting in Boston in 2009. I did not attend that year, but I wish I had. My first time attending the Medalist meetings was 2011, the year after William died. William's picture appeared on the cover of the Diabetes Forecast in the October, 2008 issue. (See below).
The link below shows the article with pictures and stories about the eleven individuals chosen for that issue. The stories appear in a jumbled arrangement, and mine appears on the left side of the page, starting with "Just don't eat sugar...".

For The Love Of Hypos



This is the Truth!!



Monday, April 1, 2019

Sunday, March 24, 2019

Urine Testing in the 1940's and Beyond

I was diagnosed in 1945, when I was 6. There was no blood testing device for home use at that time, so my father tested my urine every morning. That was the only test done each day. Benedict's solution (1) was placed in a test tube, and several drops of urine were added. The tube was placed into a tin can containing a few inches of water. The can was placed on a burner on the stove, and the water was boiled. The tube was then removed from the can, and the color was observed. The picture below (2) shows the possible colors that might have been seen. The original color of the Benedict's solution was blue. If the color was still blue after the boiling, then there was 0% sugar in the urine. If the urine contained sugar then there was a progression of colors that could appear. Blue-green showed a trace of sugar. The higher sugar levels showed green, yellow, orange, and red. Red was the color I always hated to see because it represented very high urine sugar.
Urine testing was a very poor indication of the amount of sugar in the blood. I usually had a lot of urine sugar before breakfast. My doctor did not suggest testing urine sugar at any other time of day. We should have been given instructions to test my urine before each meal, but more frequent testing could have been misleading. If I did not pass any urine between breakfast and lunch, there would still be sugar in my urine if the morning test showed a significant amount of sugar. The urine test would have shown high sugar, but the blood sugar might have been low due to the effect of the insulin taken that morning. There was usually very poor correlation between the amounts of sugar in the urine and in the blood at any time of day.
In 1941, four years before my diagnosis, there was a somewhat better way of testing urine, called CliniTest. It involved placing a tablet in a test tube containing water and urine. The mixture would fizzle and become very hot. Then the mixture would show some color. Comparison of the color with a chart provided the estimated amount of sugar in the urine. The picture below (3) shows the apparatus used in performing the CliniTest procedure. No doctor ever told me about CliniTest, so I continued using the Benedict's solution, and boiling the mixture on a stove.
I was married in 1964, and the same urine testing routine was continued until I purchased my first roll of Testape (4). Eli Lilly introduced Testape in 1954, but it was many years later, after my marriage, that I discovered that product. I was able to dip a piece of the tape into my urine, and then see the color that was produced. The natural color of the tape was yellow. If the yellow color was present after dipping into urine, there was no sugar present. When sugar was in the urine, there was a green color on the tape. The darker the green color, the more sugar was present. I carried a roll of Testape in my pocket, and tested before each meal, even when away from home. That was a much improved way of testing my urine sugar.
I used urine testing for approximately 40 years. It was not until the mid 1980s that I bought my first glucose meter to test my blood. My first meter was the Accu Check II (5). My diabetes management became so much easier, and more accurate, with the actual blood sugar levels being revealed several times each day. There were finally numbers instead of colors. I needed to study those numbers to improve my control. My blood testing showed very high numbers, sometimes in the 300s. Numbers in the mid to high 200s occurred frequently, especially after meals. There was no fast acting insulin to prevent those post meal highs. Accu Chek called me each year, and asked me questions about the my use of the meter. When they introduced new models, they sent me a new meter. That happened at least twice during the 1990s. The newer models were smaller, and they gave me numbers much faster. My diabetes management was much better. 

I learned about carbohydrates, and their effect on blood sugar, in 1988. That knowledge, and the improved meters, enabled me to have better blood sugar control. My A1c's started in 1980. I had A1c's in 
the 10-13 range at first. After 1988 my A1c's improved a lot. That was the beginning of a significant improvement in my diabetes management. I will never know how I survived all those year with very high urine and blood sugar. I feel that I may have had DKA at times, but I did not have any diabetes related complications during those early years (1945-1995). I started using a faster acting insulin (Humalog) in the mid 1990s. That is when my A1c's were greatly improved. For almost 20 years, I have had A1c's in the 5.4-6.4 range.






Thursday, March 21, 2019

How Do People Feel About Type 1?

I love this video. Brittany Gilleland has a wonderful diabetes support site called The Diabetic Journey. I highly recommend it. Visit the site to see more wonderful posts on the journey page. 
https://www.facebook.com/thediabeticjourneyorg/videos/1204232036341967/?t=0https://www.facebook.com/thediabeticjourneyorg/videos/1204232036341967/?t=0https://www.facebook.com/thediabeticjourneyorg/videos/1204232036341967/?t=0https://www.facebook.com/thediabeticjourneyorg/videos/1204232036341967/?t=0

Friday, March 15, 2019

Type 1 With Insulin Resistance

I was diagnosed with diabetes in 1945, when I was 6. I used animal insulin. My doctor told my parents I could eat anything I wanted, and as much as I wanted, as long as it did not contain sugar. I lived on a small farm, and I ate large amounts of food, but I avoided all sugar (sucrose). I was very skinny, and I got a lot of exercise on the farm. In the mid 1990's I started using a rapid acting insulin (Humalog). I began gaining weight, and I was overweight for the very first time. In 1998 a doctor diagnosed me with insulin resistance (IR). I had gradually reduced my daily carb intake from hundreds of grams to only 130 grams. I still had a lot of exercise, but I continued gaining weight. By the year 2000 I had gained 57 pounds! I had four relatives with type 2 diabetes. I think my IR was caused by genes passed down from those relatives. The weight gain triggered the IR. I was a double diabetic. That does not mean I had both types of diabetes. I had been tested, and found to be autoimmune. A C-peptide test showed I produced almost no insulin. I was a type 1 diabetic with a type 2 characteristic, but I was not also type 2. Many type 1 diabetics have been found to have IR.
My doctor was an internal medicine doctor, and he did not believe a type 1 diabetic should use Metformin. He prescribed Avandia, which slowed my weight gain, and I gradually lost about 27 pounds during the next few years. I continued using Avandia for many years. My weight stabilized, but I needed to lose another 30 pounds. I started seeing an endocrinologist, and she prescribed Metformin. In a little more than one year I lost 38 pounds. My weight before all the gain was 185 ( I am 6 ft, 2 in with a large frame). The doctor said my weight should be in the 170-200 range. I considered a weight of 185 pounds to be a good healthy weight. I continued using Metformin for seven years. After the weight loss I weighed 177 pounds. My IR seemed to have disappeared, and I stopped using Metformin in mid 2018. Recently, I have started gaining again. I currently weigh 186. My average daily carb intake is still 130 grams. I do not want to follow a Keto diet, I am happy with 130 carbs per day. I may start using Metformin again.
I have been type 1 for 73 years. My heart, kidneys and eyes are in great shape, but I have some neuropathy in my feet and legs. There is some numbness, but no pain. I feel that I have very good diabetes health.

Wednesday, March 6, 2019

Avoiding Diabetes Complications

Avoiding Diabetes Complications

Several 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 20 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 20 years, but I had the beginning stages of neuropathy and retinopathy about 15 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 73 years, and have not had any serious complications. I want to keep it that way!!



Friday, March 1, 2019

Type 1 Endo Earns 80 Year Medal

I have been type 1 for 73 years, but there are people who have been type 1 much longer than me. Here is an endocrinologist with type 1 for 80 years. A wonderful story!! Thanks to Petronella Peach for finding this article. This article was published in 2015.
"Last month, Joslin awarded Dr. C Kenneth Gorman the Lifetime Achievement Award for living for 80 years with type 1. Dr. Gorman is one of five recipients of the 80-year medal and the only Canadian recipient thus far. In 1935, at the age of two, Dr. Gorman was diagnosed with T1D. He went on to become an endocrinologist and worked as a research fellow under Dr. Charles Best, one of the co-discovers of insulin. During his time with Dr. Best, Dr. Gorman began corresponding with Dr. Elliott Joslin and accepted a position as an N.I.H. Trainee Fellow in Diabetes at the Joslin Clinic from 1962 to 1964. Dr. Gorman’s next goal is to celebrate the 100th anniversary of the discovery of Insulin in 2021. Congratulations, Dr. Gorman!"
For more information on Joslin’s medalist program or to apply, click here:
https://www.joslin.org/medalist/apply_now.html


Thursday, February 28, 2019

Low Carb for Type 1? Not Me!!

I have read that many type 1 people 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 the only limitation made by my doctor. 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. I lived on a farm, and there was a lot of exercise. My doctors knew very little about diabetes back then. I was very fortunate that my diet did not cause any diabetes complications.
In 1988 I read an article in a magazine that mentioned carbohydrates. I saw that carbs were very much involved with blood sugar management.That was the first time I had that knowledge. I was still using injections with animal insulin, so knowing about carbs did not help me very much. I did, however, start eating smaller portions of food that had fast acting carbs.
In the mid 1990s Humalog was introduced. That was my first fast acting insulin. I started carb counting. Trial and error showed that I needed one unit of insulin for every 10 carbs I ate. Before breakfast my carb sensitivity was greater, and I needed 1 unit of insulin for every 7 carbs, but only for that meal. Carb counting, and eating only small portions of carbs with fast acting foods greatly improved my blood sugar control. My A1c's began dropping, as you can see in the graph below.
I began using a pump in 2007. Programming my insulin:carb ratios, and my variable basal rates at different times of the day on the pump gave me so much improvement in my control. Fluctuations did occur because of scar tissue, and occasionally forgetting to bolus at the right time, but my management was very good. I started using a Dexcom CGM in 2015. I have set my CGM to alarm when my BG reaches a high of 170, or a low of 70. That has resulted in my staying in my 70-170 range 90% of the time.
At the present time I eat an average of 130-140 carbs per day, and my A1c's have been in the 5.4-6.4 range for more than 20 years. Here is a typical day in my current schedule:
8:30 AM....A slice of toasted bread (9 carbs), a slice of ham, berries (16), one egg, and coffee.....total....25 carbs
12:00 noon....A medium size baked potato (30), a pork chop....total....30 carbs
2:00 PM....Before going to the gym for a one hour workout....one half cup of ice cream with sugar...(25)...only a 1.5 unit bolus since I was going to get a lot of exercise
5:00 PM....Five corn chips with salsa, and coffee (10)
7:00 PM....Pastrami sandwich with mayonnaise, slice of cheese, and slice of tomato... only one slice of bread, 9 carbs per slice...(12)....cottage cheese (6)....strawberries (10).....total....28 carbs
10:00 PM....My BG was 79 so I needed a small snack....peanut butter and crackers (12)
TOTAL for the day....130 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 ziplock bag of skittles with me when I am away from home.
Note: My meals vary a lot, but the carb counts and the times that I eat are very stable. I do like a lot in my food choices 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. My BMI is 23.6.
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. ;)

Tuesday, February 26, 2019

My Early Years, and Blood Sugar Management

Throughout my early years as a diabetic I had no major health problems, and I coasted along rather easily. I was always very skinny, maybe slightly underweight, until many years later. I had high urine sugar every day, and usually at night. There were, however, some nights that I had very bad hypos. My bedroom door was always left open at night, and my room was immediately across the hall from my parent's room. Mother was keyed in to my thrashing about, and the moans I would make when having a hypo. She would jump out of bed, and grab the glass containing several tablespoons of sugar. She stopped at the bathroom, partially filled the glass with water, stirred the mixture with a spoon, and entered my room. Daddy raised my body, sat on the bed behind me, and held me while Mother slowly poured the sugar water into my mouth. That usually worked very well, but occasionally my mouth was shut so tightly that she could not get any of the liquid into my mouth. Some of these hypos were very bad, and they became seizures. It took a long time to get me to the stage that they could get me to drink some of the sugar water. She would rub some of the liquid on my lips, and I would lick my lips. This gave me just enough sugar so I would start to relax, and then she could get me to swallow some of the sugar water. I would come out of these hypos, not remembering any part of what had happened. Mother gave me all the details many years later. I was always so grateful that they took such good care of me at those times. I have no idea how many of those seizures I had before I was an adult, but I know there were many of them. If we had meters for testing, basal and bolus insulin, and carb counting, things would have been very different. There may have been less serious hypos, without the terrible lows that caused seizures. The animal insulin I used for my first 50 years was neither bolus nor basal. It worked at the same level all day, and all night. I think that level was too much at night, and that was probably the reason I had low blood sugar so many times while I was sleeping. That insulin was a 24 hour insulin, with only one injection each day. There was no way of having different dosages with different levels at different times of the day.

To prevent hypos at school, I was not permitted to play with the other kids during play periods or gym. It was that way in grades 1-12. I played at home with a neighborhood friend, but Mother kept a close watch on me. I was usually able to feel my lows before they were so bad. I would tell Mother, and she would give me some sugar. I carried a small container of sugar with me while in school. I was never given candy. I think my parents did not want me to know the taste of candy, and other sugar sweetened things. There was never any ice cream in the house, and I assumed there was never any candy, but several years ago my sister told me an interesting story. When we shopped at our grocery store, no candy was purchased. Daddy stopped on his way home from work in the late evening, and bought candy. It was stored very high in a kitchen cabinet. I never saw it. My sister was given a candy bar, and she would eat it in the kitchen. If I entered the kitchen while she was eating candy, she would hide the candy behind her back, with her back against a wall. I never became suspicious. She waited more than 50 years to tell me that. I'm glad she got to have candy, and I am glad I never tasted it. There was artificially sweetened candy that we bought back then. I think the companies selling the candy were Diamel, Loeb and Estee. It wasn't so bad, I still remember the taste. Sweet story, sweet sister, sweet candy. HA!

Friday, February 22, 2019

My Diabetes Life In One Post

I have previously posted my diabetes story in a long series of chapters. Time consuming to read, and perhaps somewhat boring, too. I am now telling my life story with a single post. A lot of details missing, but I have hit the high points. 
1945-1970...I led a 'normal' life, with no fear. I tested my urine in the morning, took my shot of animal insulin, and I did not have any more insulin or testing until the next morning. I did not have any real problems, and I did not know there were potential complications. 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 in the mid 1980's. I was very scared!! I did not know what to do about that. In 1988 I did learn that carbohydrates had something to do with blood sugar, but I did not have the complete explanation. My doctors were not very helpful.
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. My fears were gone.
2006-2017...I started using a pump and CGM, and my A1c's were very good, in the 5.4-6.4 range for more than 15 years. My wife has been my beacon for 54 years of marriage. I could not have done it so well without her.
2017-2019...In 2017 my neuropathy spread into my legs. There is numbness, but no actual pain. My balance is affected, and I have fallen down a few times. Physical therapy has helped, but I have to be careful when I am on my feet.
I am not disillusioned by my present condition, not a all. 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 do not mind the extra work with the devices we have now. Good diabetes management, and no serious complications after 73 years of type 1 is wonderful!!
There now, this is my life in one single post. What do you think?

Thursday, February 21, 2019

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! 
What does commitment mean to you?

Wednesday, February 13, 2019

Early Retirement and Diabetes

Early Retirement in 1997
In the 1990's I changed from animal insulin to synthetic insulin. I started gaining weight. Additional exercising and reducing my carb intake helped, but I was still gaining. I was a math teacher at a local community college, and my performance in the classroom was not good. I no longer enjoyed teaching, and I dreaded driving to campus each day. That made me feel very guilty. I had enjoyed teaching for many years, but with all the weight gain, and other symptoms, I was teaching only for earning a salary. My students deserved better, so I retired from my job in 1997. I was only 56 at that time. I had intended to teach until I was at least 62, so I would be receiving social security. It was difficult for Anita and me to face our financial obligations for several years. We had taken out loans while putting our two sons through college until they had their MS degrees. We also needed a new car, and we put that off for a long time.
In 1998 I weighed 242 pounds. That was a 57 pound gain from my initial 185 pounds in the early 1990's. I was averaging 130 carbs per day, and getting a lot of exercise. My internal medicine doctor diagnosed insulin resistance (IR) later that year. I had not heard of T1D's being diagnosed with IR, but online research let me know that it was not unheard of at that time.There was no other change in my lifestyle back then. My doctor prescribed Avandia, an oral med for helping with IR. My weight gain stabilized. My pants size had increased from 36 to 42 inches, and I felt miserable. With Avandia I lost 15 pounds.
A T1 with IR is called a Double Diabetic. You can research that term. That does not mean that I was both T1 and T2. I have taken both the Autoimmunity and C-peptide tests. I was found to be autoimmune, and I was producing almost zero insulin. That is very much to be expected with long term T1 diabetes. T2's are not autoimmune, and they produce a significant amount of their own insulin. So I was T1 with a T2 characteristic, but I was not T2.
I had four T2 older relatives. I think I must have inherited a gene that triggered my IR after my weight gain. Having that gene may explain my weight gain after beginning the use of Humalog insulin in the mid 1990's. I have two cousins near my age who became T2, but other cousins did not, even with weight gain. I think that those with T2 also inherited the gene which caused the IR to develop. At one time my sister gained weight, but she was never diagnosed with diabetes. She probably did not inherit the gene. None of my relatives are/were T1. I am the only T1.
I taught part time at the college after retiring. Teaching only a couple of hours each day was not a problem, and it helped our financial situation. I started using an insulin pump in 2007. Friends in the diabetesdaily.com support group convinced me to use a pump. I saw an endo that year for the first time. She approved my using a pump. I had been T1 for 61 years at that time, and she said I deserved the opportunity to experience what a pump could provide. Pumping did greatly improve my diabetes management. My A1c was 5.6 before pumping, and 5.7 the first time after pumping. That was not an improvement, but it was so much easier to manage my diabetes. I had fewer highs and lows, and no extreme highs or lows like I occasionally had while injecting. Time in range greatly improved.
In 2010 an endo prescribed Metformin. That was a relief since the Avandia I had been using was suspected to be the cause of heart problems with some users. After two years on Metformin I had lost the rest of the weight I had gained. My waist was a size 37, and I felt so much better. I started with 2000 mg of Metformin, and gradually reduced the dosage to 1000 mg. Several months ago I stopped Metformin, and I am not gaining weight. It seems that my IR is not much of a problem now.
I feel guilty for stopping teaching when I was only 56. I never worked full time after that, and my last part time teaching was in 2004. We are doing ok now, physically and financially. We are in our 70's, and I will be 80 in September. I am so lucky to be T1 for 73 years, without any serious complications. I have neuropathy in my feet and legs, with numbness and a problem with my balance. That is my only diabetes complication at this time.
We plan to attend the Friends For Life type 1 conference in Orlando, in July this year. Maybe I will see some of you there. 

Friday, February 8, 2019

The Joslin Medals, and 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 in any part of the world, and they do not have the medal, be sure to tell them to apply. The medals shown are, from top to bottom, for living 50, 75 and 80 years with type 1.
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 and again in 2017. 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.”






Wednesday, February 6, 2019

Do You Complain About Weather?

This is me today! :(










Have You Used A Glucagon Kit?

Have you ever used a glucagon kit to treat a low blood sugar emergency. I admit that I have never owned one, but there were times in the past when I could have used one. I feel that I will not need one now because I am warned about low sugar by my CGM. My CGM, however, is sometimes as much as 20 points higher or lower than my glucose meter. I may fail to get the alarm from my GGM under those circumstances. I think I should have a kit on hand.
Daniele Hargenrader has a video in which she demonstrates the use of a glucagon kit. She uses an expired kit to show the demonstration. Here is the video:
Daniele has an excellent program and I am a subscriber. The email I received today shows the video.
Daniele also mentions Beyond Type 2, a new community support system for people living with Type 2 diabetes! Here is the link to that community:
Daniele is the founder of the Diabetes Dominator Coaching & the Diabetes Empowerment Summit.
She is also the author of two books : "Unleash Your Inner Diabetes Dominator" and "Love, Forgive, Never Give Up!"
Here is the link for one of the books on Amazon. It is a best seller. You can read it for free while on that page.
You might want to subscribe to Daniele's program and receive emails. Look up Daniele Hargenrader on Facebook. 

Friday, February 1, 2019

Diabetes 1922

An amazing article published in The Toronto Daily Star newspaper in 1922. January 11, 1922 was the first day insulin was used to treat diabetes.
Click on the link and read the article.

Pat McAlister...71 Years With Type 1

Pat McAlister is a Joslin Medalist who has been Type 1 for 71 years. Here is her story:

https://www.childrensdiabetesfoundation.org/71-years-with-type-1-diabetes/?fbclid=IwAR3222yqIZcE9kKRx2PRw-MjqwnXwIG49ggxikm1xWlJZMJB3gH2CtQwADk

Complications With and Without Today's Tech

Complications With and Without Today's Technology
I was diagnosed in 1945, and for my first 40 years I did not have a glucose meter. I had no idea what my blood sugar level was in those years, and I had to go by my feelings. I used insulin taken from animals for my first 50 years. That caused many problems. There were no basal and bolus insulins then. I had some seizures at night, and many episodes of very dangerous low blood sugar until I started Humalog in 1996. I am very lucky that I did not have serious complications during those early years.
Now I have used a pump for 11 years, and a CGM for 3 years. It was after I started using the pump and CGM that I developed neuropathy in my feet and legs. I have much numbness and poor balance caused by the neuropathy. That makes it seem like the modern technology did not help me, but I know that is not true. After many years with Type 1, complications are more likely to develop, even though these wonderful devices are being used. I know that my glucometer, basal and bolus insulins, insulin pump and CGM are helping me. I might not be alive now if I did not have them.
Many people who were diagnosed in more recent years had modern day technology available when they were diagnosed, or soon after diagnosis. That makes it very likely that they are less likely to have the problems and complications us long timers have had. Take good care of yourselves, and you may never have serious complications.