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.

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. ;)