Wednesday, December 18, 2019

My T1D Management, and Using Fiasp Insulin


There have been many people asking me about my "diet" and my daily routine. People with T1, or their T1 kids, who are newly diagnosed seem to think my many years with T1D, and no serious complications makes my routine a good example to follow. I try to explain that is generally not true.
There is no set routine that will work for all type 1 people. We are all different. What works for me may not work well for you. Each type 1 diabetic needs to work out a routine by trial and error, until something is working well. Then keeping careful charts or records can help with making changes, as needed.
I eat an average of 140 carbs per day. I am usually using 36 units of fast acting insulin each day in a pump. My insulin:carb ratio is 1:10 (one unit per 10 carbs), but I am less sensitive to insulin in the early morning, so I use a 1:7 ratio for breakfast.
I avoid many foods that have fast acting carbs. I avoid rice, cereal, and most pasta. When I do have pasta or potatoes, I eat small portions.
I am using a 70-170 range on my Dexcom CGM, and I stay in that range more than 90% of the time. My A1C has been in the 5.4-6.4 range for almost 20 years.
There are other T1D’s who are using a 70-150 range, and doing very well with it. There are some who eat less than 50 carbs per day, I refuse to do that. As long as I can avoid serious complications, I do not intend to change my routine. I enjoy my life the way I am doing it now, and I do not intend to change.
This might not work so well for you. I hope you have developed your own routine, and I hope it is working well for you.
I want to also mention that I have started using Fiasp insulin, instead of Humalog. My endo did not approve of my using Fiasp, and I recently posted that on my page. A friend sent me a message saying Fiasp did not work well for her, and she returned to her Novolog. She sent me several vials of Fiasp. I started using it five days ago. It is working very well for me, but it might not work well for you. Fiasp is a faster acting insulin and the acting time for me is three hours, instead of the old four hours I used for Humalog. I do not do any early premeal bolusing now, and I am not having post meal highs. I had 150-190 post meal highs with Humalog, but now I am having 120-150 post meal numbers with Fiasp. My only problem with Fiasp is having some lows in the 50-70 range. I am adjusting my basal rates on my pump to try eliminating those lows. I would like to eventually have a a 70-150 range. Maybe Fiasp will make that possible.
My endo did not want me to use Fiasp, but my friend has enabled me to use it now. I use one vial per month, and I have enough for five months. I will be seeing my Endo on Jan 20. I hope she will be impressed with my better control, and she will finally prescribe Fiasp.


Saturday, December 14, 2019

Double Diabetes

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 type 1 – 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.
Note: The definitions above were found on a diabetes website.
So 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 had the Type 2 gene. The gene 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 24 pounds. I initially used avandia for my IR, but started using metformin starting 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 29 pounds, and was then only four pounds above my ideal weight. Despite the weight loss, I still had IR. Metformin, eating an average of 130-140 carbs per day, and getting lots of exercise is now keeping me in good health. My A1c's are typically in the 5.9-6.4 range, and except for some mild nerve damage, 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.
Do you think you may have double diabetes? If you are type 1 and have gained weight, and are using more insulin than usual, then you might want to speak to your doctor (preferably an endo) about this.

Tuesday, December 3, 2019

Type 1 Poem, The Way It Used To Be

I like this poem written by Alan Eastwood. Funny, but some of it is very close to the way it was when I was diagnosed in 1945;
"I won’t forget those wise old words my Daddy said to me
As he sat down in his chair one night and perched me on his knee.
He said, ‘Son, diabetes wasn’t always so much fun,
So let me tell you how it was in 1931!’
Twice a day we’d drive to town, down to the abattoir,
Pick out a bovine pancreas and stow it in the car,
And when we got home Mum and Dad would mash that organ up,
And strain it through a muslin bag into a paper cup…
Then Dad would get some chemicals and boil them in a pan.
Adding bits of this and that with flourish and élan!
And meanwhile I would drink and drink until I had to pee,
And Mum would take a jar away, as swiftly as could be!
She’d add it to the chemicals, and if it turned bright red
Then I would have no supper and be sent off straight to bed.
But if it just turned yellowish, I’d have something to eat
Like carrots mashed in gravy, with sweet pickles for a treat!
I didn’t like the needles though, at least six inches long!
So Mum would jig around the room, distracting me with song!
And when he’d scraped the rust off, Dad would stick it in my butt,
I’d bite down on a leather strap to keep my mouth tight shut!
So, should you whinge and moan about how finger pricking’s bad,
Then pause to contemplate about the progress we have had.
We’ve gone from times when prospects for our future might seem poor,
To looking forward to the day that they announce the cure!"

Sunday, December 1, 2019

74 Years With Type 1

Sept 15, was my 74'th diaversary. Still no complications except for some mild neuropathy in my feet and legs. I hope the research being done on long term T1D's in Boston will explain why some of us are so lucky to have lived so long, and be so healthy.

Saturday, November 23, 2019

Long Term Success With Type 1 Diabetes

I have been type 1 for 74 years, and I do not have any serious diabetes related complications. While participating in the Joslin medalist type 1 study in 2009 and 2017, I was told that several participants freely admitted that they have not taken good care of themselves. They eat a lot of food containing sugar, and other fast acting carbs. Despite their bad eating habits, they do not have any complications after many years of type 1. All of the 1000+ participants have been type 1 for at least 50 years, and are US citizens. I was also told by the lady in charge during my participation that several participants have used tight control, but have experienced some serious complications. These are the exceptions to the rule. The majority of the participants in this study have done at least reasonably well with their control, and they do not have any serious complications.
In 2011 at a Joslin Medalist meeting, Dr. George King, head of the Medalist Study, did discuss the "special inner protection" that so many medalists have. He said that this mysterious protection seems to protect us against serious problems with our eyes, kidneys, and our nervous systems,,,,but not our hearts. He wanted us to know that we should take every precaution to keep our hearts healthy. There is a secret group on Facebook called "The Joslin Medalists" where many members have posted about their stents, bypass surgeries, heart attacks, etc...but most of these same people have good eyesight and healthy kidneys. There are undoubtedly many younger type 1 people who also have this special inner protection.
After 60 years of type 1, I was diagnosed with spots of retinopathy, and some neuropathy. My A1C had been in the 5.4-6.4 range for many years, but I still had these complications. My control involved too many highs and lows, a roller coaster type of control. Those highs and lows can produce an average which is quite good, so the A1C will also be good. That can give us a sense of false security. The roller coaster control is traumatic to our bodies, and complications can result, even though the A1C is good. I started pumping insulin in 2007, and my control was much more stable, with not so many highs and lows. My time in range improved a lot. The retinopathy disappeared, and has never returned. The neuropathy is still present, but there is no significant pain, and no medication is needed. I do have some numbness in my feet and legs. It caused me to have poor balance. I fell down several times, but six weeks of physical therapy in late 2018 improved my balance. I have not fallen down this year. I am still able to take long walks and work out at a gym.
Avoiding complications seems to require a good A1C, and more stability with not so many highs and lows. If I had started pumping in the 1990's I may not have had any complications at all. I know people who started pumping in the early 1980's. I read about one lady who started in 1978.
I read an article a few years ago that said the life expectancy of young type 1 diabetics in the US is almost as good as for non diabetics. That is very encouraging news!!

Monday, November 11, 2019

My Life On The Farm With Type 1

My Life On The Farm With Type 1
I am delaying the early parts of my life with diabetes. My life on the farm while growing up was a very important, after my diagnosis. I will continue with my college education at a later time.
I loved and respected my parents, and I did not question their demands involving my diabetes care. I was NEVER to eat sugar or candy or other items containing sugar unless I was having very low blood sugar. I followed that rule to the letter. Mother was so good to make me wonderful desserts sweetened with saccharin. I loved her desserts so much that I was not tempted to eat their sugar sweetened desserts. Some of my favorites were banana cream pie, cherry vanilla custard pie, baked custard pie, chocolate pie, rhubarb pie, peach pie, and raisin pie. The pies had homemade crusts that were very thick, and they were divided into five pieces for my dinners, and suppers. Can you tell I liked pies??? There was also applesauce cake for my birthday and again for Christmas. The cake contained lots of nuts and raisins, and applesauce to make it stay moist. None of these desserts contained any sugar so they were OK for me, right? We thought they were. Can you imagine how many carbs were in these desserts? A typical breakfast had two kinds of meat, perhaps sausage cakes, and thick ham slices which I ate with my eggs. There were homemade biscuits with lots of butter, and I would dunk them in my saccharin sweetened homemade apple butter. That and a big glass of milk from our own cows completed my meal. Is it any wonder that I had terribly high blood sugar....er....urine sugar? The breakfast was so large because both of my parents were raised on a farm and they, and their families worked hard and needed that food for energy as they set out to do their farming chores. I do not think my parents knew any other way to live. We had three large meals every day, and I am certain I must have eaten more than 500 carbs per day. When the peaches were ripe in our orchard I would climb up on the lower branches, and reach up for a mellow, juicy peach. They were as big as a grown man's fist. I would eat one, and my tummy would hurt. I was covered with juice, so I would go home to wash up. Daddy always sprayed our fruit, and every time I ate our fruit I was eating dangerous chemicals. We did not know any better. It never hurt any of us so far as I know. We had plums, grapes , strawberries, raspberries, apples and pears. I ate too much fruit, but I loved doing that. I was in charge of the melon patch. I planted cantaloupes and watermelons each year. They required sandy soil and lots of water. The were left on the vine until they were fully ripe. They taste so much better that way than when they are picked green, and ripened afterwards. The same is true with all fruit and tomatoes. My mouth is watering as I write this.
Daddy milked the cows at daybreak, and cleaned their stalls. Then he ate breakfast, and went back out to hoe or plow the garden, water and prune trees and shrubs. He did so many other things. He would then go home for dinner, and sleep on the floor for an hour afterwards. He then reported to the post office where he worked from 2pm until 11pm with a one hour break for supper. The lunch pail Mother packed for him was unbelievable. He ate some of what we had at home for our supper. Daddy would get home late, and try to be in bed by midnight. I have never known a man to work so hard. On some days he made time to pick up a load of shrubbery at my uncle's nursery, and plant them at people's houses. We told people that Daddy had three jobs. The farm, the post office, and the nursery. Daddy had a lot of muscle, and was never much overweight. None of us were ever much overweight, even though we ate food like there was no tomorrow. I was always skinny until many years later when I started using modern day insulins. We worked hard, and we all loved each other so much. Good food, hard work, and lots of love. That is my recipe for a successful family, and growing up well.
My parents never smoked cigarettes, or drank alcoholic beverages. They were my guiding light, and I intended to follow in their footsteps. When I was 10 a young lad named Bobby, two years older than me, came to our house. He was in my homeroom when I was in fifth grade. He had failed two times, and had been held back. He had never ridden a horse, and he wanted to ride our old work horse. So Bobby, Larry and I climbed aboard, and we rode through the pasture. Bobby offered us cigarettes. Larry and I had never smoked, but we did not want to be called chicken, so we smoked a couple. After Bobby went home we decided we would continue smoking after school each day. Larry took a pack of Lucky Strikes out of his father's pickup truck, and we headed to his back property where no one would see us. We smoked our way through several packs in a few weeks time. Larry's Father eventually caught on. He was missing his packs of cigarettes, and his Mother had smelled the tobacco odor on Larry's clothes. One night after dark Larry and his parents came to visit. That was most unusual and I knew something was up. Larry would not look at me, and he hung his head down. The jig was up. My parents were shocked to hear what I had done, but they did not punish me. It was not necessary. I was so ashamed that I had disappointed my parents, whom I loved so much. I think they knew I would never do anything like that again, and I didn't. My urine sugar had been 4+ every morning all that time I had been smoking. Now we all knew why. I had not been eating well either during that time. Smoking was the only bad thing I ever did as a child. My parents were good examples to follow, and my sister and I were good followers.
After I was grown I found that my Mother and Dr Davis had been working together for my "benefit". Mother would phone him, and tell him things that she wanted him to tell me, before she drove me in for my appointments. "Now Richard, you can't drink or smoke. that will make your diabetes much worse." That was after my cigarette episode. "Now Richard, you can't participate in gym at school, that will make your sugar go too low, and you may have low blood sugar." I do not know exactly how Dr Davis expressed himself on these occasions, but I can still hear his voice, and his advice. I always trusted him without question. I was very disappointed in my Mother, and the doctor, for their plotting and scheming. He also questioned my going to college, but he did not sound so forceful as he had the other times. Mother admitted that she had called Dr Davis about college. I was onto their wicked ways! HA!! Never again! I never argued with Mother about this. I just told her I was disappointed in her and she apologized. Daddy did not know anything about this. Maybe he never did. I never told him.
When I had just started eighth grade I had intestinal flu. I stayed at home several days, and I could not keep anything in my stomach, not the medicine the doctor had prescribed, and not even water. My parents thought that since I was not eating then they should not give me insulin. They were afraid I would have a hypo. They did not check this out with the doctor. After several days of no food, no water, no medicine and no insulin I was so weak I could not lift my arms, and I was barely able to move my head. The doctor came to our house. He called an ambulance. I stayed in the hospital almost two weeks. I recovered very well, and returned to school. I hope that those of you reading this know that you need your insulin even if you are not eating. You still need your "basal" insulin under these conditions, but you do not need your "bolus" insulin if you are not eating. Of course I did not have basal and bolus insulins back then. I continued to use the animal insulin for many years.
Something has always bothered me about my past. I had so much very high sugar prior to the 1990s, but I was healthy, without diabetes related complications. I must have had DKA, don't you think? I never heard of DKA until I joined diabetes online support groups in 2006. I never tested my urine for ketones. My doctors never mentioned it. How did I avoid terrible sickness if I had DKA? Had my body adjusted to having high blood sugar, so that it became my normal state of being? I know that does not make any sense, but I have no other explanation.

Tuesday, November 5, 2019

My Early Years With Type 1....Part 3

My Early Years With Type 1, Part 3
I graduated from high school in June, 1957. I wanted to go to college, but my parents told me I could not do that. 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! I had a good mind, and I wanted to use it in a meaningful way.
My parents begged me to apply for a job at the post office where my father worked. I could become 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 that 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 grocery store the very month I graduated from high school. I worked about 30 hours per week and
started off at 75 cents per hour. Every few months I got 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 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 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 ever during my sophomore year of college. My shyness and lack of confidence kept me from dating until then.
One Saturday night I had to stay after hours at the grocery store to help with the mopping detail. Every aisle had to be clean and bright before we went home. I was so tired. I had not been on mop detail before. I got in my car and headed home. I thought my strange feelings were due to my fatigue. I turned a corner and collapsed at the wheel. I did not remember anything after that until I was awake, and my parents were standing over me with a crowd of men behind them. Several cops too. I had a hypo. I never straightened the wheel after the turn so my car went off the road and down a steep hill into a creek bed. The car went between two vertical posts that were supporting a huge billboard. The people were measuring the distance between the posts and the width of my car. They said the opening was about two inches more than the width of the car. How could my car have passed between the posts and not touch either one of them??? I was not hurt and the car did not have a scratch on it. The guys standing in back were from a bar across the road. They had seen my car leave the road, and they found my parent's phone number in my wallet. Everyone but my parents thought I was drunk. I had never been drunk in my life. I had never tasted alcohol. My parents told the cops about my diabetes. I really don't think anyone there believed their explanation. There was no ticket though, and a big wrecker pulled my car up the hill later that night, or on Sunday. I was back at college Monday morning. It was like the whole thing was just a bad dream. I had many hypos during my early years during my sleep, or after a lot of exertion. There was no way for me to test my blood sugar before starting home that night. Glucose monitors were not available until many years after that. I had to go by the way I felt. It was that way for about 40 years until glucose monitors became available in the 1980's. My parents thought that God had protected me, and that was why I was not hurt. I wasn't too sure about that, but I was certainly happy about having my car back, and going to classes Monday morning. I never missed a class during my four years of undergraduate work. I never had a bad hypo on campus, but I had many lows, and had to eat sugar from a small container in my pocket.
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 did not have a glucose monitor, so I could not test for sugar in my blood, or even in my urine when on campus. 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. My teachers in all my years of school did not understand diabetes. I don't think they had even heard of it.
The picture below shows the Roanoke College campus, 2019.

Monday, September 9, 2019

My Early Years With Type 1, Part 2

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

Wednesday, September 4, 2019

Do you overcorrect high blood sugar?

An interesting report from dLife.com.

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

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

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

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

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

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

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

Monday, August 26, 2019

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

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

Monday, August 19, 2019

Using An Infusion Set More Than 3 Days?

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

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

What are your thoughts on this topic?

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

Tuesday, August 6, 2019

Lilly, The Insulin Doll

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

Sunday, July 28, 2019

Nasal Glucagon

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

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

Thursday, July 25, 2019

Joslin Medalists, 2019



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


Friday, July 12, 2019

Double Diabetes

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

Tuesday, July 9, 2019

My Story on Diabetes Mine

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

Wednesday, July 3, 2019

Finding The Right Lady, Our Marriage


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