Thursday, February 28, 2019

Low Carb for Type 1? Not Me!!

I have read that many type 1 people eat very healthy, low carb meals. That certainly helps with the control of blood sugar levels, but I do not find that to be necessary. For so many years, starting in 1945 when I was diagnosed, I ate anything I wanted as long as it did not contain sugar. My portions could be as large as I wanted. Not eating sugar was the only limitation made by my doctor. My typical day saw me eat hundreds of carbs, many of which were very fast acting. That was poor diabetes management, but my parents and I did not know any better. I lived on a farm, and there was a lot of exercise. My doctors knew very little about diabetes back then. I was very fortunate that my diet did not cause any diabetes complications.
In 1988 I read an article in a magazine that mentioned carbohydrates. I saw that carbs were very much involved with blood sugar management.That was the first time I had that knowledge. I was still using injections with animal insulin, so knowing about carbs did not help me very much. I did, however, start eating smaller portions of food that had fast acting carbs.
In the mid 1990s Humalog was introduced. That was my first fast acting insulin. I started carb counting. Trial and error showed that I needed one unit of insulin for every 10 carbs I ate. Before breakfast my carb sensitivity was greater, and I needed 1 unit of insulin for every 7 carbs, but only for that meal. Carb counting, and eating only small portions of carbs with fast acting foods greatly improved my blood sugar control. My A1c's began dropping, as you can see in the graph below.
I began using a pump in 2007. Programming my insulin:carb ratios, and my variable basal rates at different times of the day on the pump gave me so much improvement in my control. Fluctuations did occur because of scar tissue, and occasionally forgetting to bolus at the right time, but my management was very good. I started using a Dexcom CGM in 2015. I have set my CGM to alarm when my BG reaches a high of 170, or a low of 70. That has resulted in my staying in my 70-170 range 90% of the time.
At the present time I eat an average of 130-140 carbs per day, and my A1c's have been in the 5.4-6.4 range for more than 20 years. Here is a typical day in my current schedule:
8:30 AM....A slice of toasted bread (9 carbs), a slice of ham, berries (16), one egg, and coffee.....total....25 carbs
12:00 noon....A medium size baked potato (30), a pork chop....total....30 carbs
2:00 PM....Before going to the gym for a one hour workout....one half cup of ice cream with sugar...(25)...only a 1.5 unit bolus since I was going to get a lot of exercise
5:00 PM....Five corn chips with salsa, and coffee (10)
7:00 PM....Pastrami sandwich with mayonnaise, slice of cheese, and slice of tomato... only one slice of bread, 9 carbs per slice...(12)....cottage cheese (6)....strawberries (10).....total....28 carbs
10:00 PM....My BG was 79 so I needed a small snack....peanut butter and crackers (12)
TOTAL for the day....130 carbs
I never eat anything with sugar (table sugar) unless I am going to get exercise afterwards, or I have a low. I carry a small ziplock bag of skittles with me when I am away from home.
Note: My meals vary a lot, but the carb counts and the times that I eat are very stable. I do like a lot in my food choices so no two days are the same. As long as my diabetes management is stable, I see nothing wrong with that. My A1c is good, and I am not overweight. My BMI is 23.6.
I like variety in food, TV programs, movies, activities,
exercises, and most all things......but not women. My wife is
wonderful and I do not need variety there. ;)

Tuesday, February 26, 2019

My Early Years, and Blood Sugar Management

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

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

Friday, February 22, 2019

My Diabetes Life In One Post

I have previously posted my diabetes story in a long series of chapters. Time consuming to read, and perhaps somewhat boring, too. I am now telling my life story with a single post. A lot of details missing, but I have hit the high points. 
1945-1970...I led a 'normal' life, with no fear. I tested my urine in the morning, took my shot of animal insulin, and I did not have any more insulin or testing until the next morning. I did not have any real problems, and I did not know there were potential complications. Ignorance of the true nature of type 1 diabetes was bliss!
1970-1990...I learned about the possible complications, and saw terribly high numbers on my first meter in the mid 1980's. I was very scared!! I did not know what to do about that. In 1988 I did learn that carbohydrates had something to do with blood sugar, but I did not have the complete explanation. My doctors were not very helpful.
1995-2006...I completed my first 60 years of Type 1, and had no diabetes related complications, except for some neuropathy. That, and my joining my first online support groups, gave me confidence. My fears were gone.
2006-2017...I started using a pump and CGM, and my A1c's were very good, in the 5.4-6.4 range for more than 15 years. My wife has been my beacon for 54 years of marriage. I could not have done it so well without her.
2017-2019...In 2017 my neuropathy spread into my legs. There is numbness, but no actual pain. My balance is affected, and I have fallen down a few times. Physical therapy has helped, but I have to be careful when I am on my feet.
I am not disillusioned by my present condition, not a all. Like someone else said, it is a lot more work, but it is good to know what I am doing, and seeing good results. I do not mind the extra work with the devices we have now. Good diabetes management, and no serious complications after 73 years of type 1 is wonderful!!
There now, this is my life in one single post. What do you think?

Thursday, February 21, 2019

Commitment

Commitment
In the 1945-1988 years I had only one rule to follow. Don't eat foods
containing sugar. My doctors never mentioned carbs. I was very
committed to following that rule. I became so used to using artificial
sweeteners, that a teensy taste of something containing a lot of sugar
was too sweet, and I did not like it. Having only one rule to follow
made it easier.
In 1988 I read an article in a magazine saying that diabetics should
restrict the number of carbs they ate to help keep their blood tests
lower, and more stable. Why didn't my doctors tell me that? That was
my first exposure to carbs. Then I found that some carbs acted faster,
and others more slowly. I started eating smaller portions of the foods
with faster acting carbs, and I stopped eating some foods. There were
more rules to follow, and things became more complicated. Then there was using my first meter in the 1980s, basal and bolus insulins with carb counting in the 1990s, and my insulin pump in 2007. Things were very complicated then. It was so much simpler in my early years to just avoid sugar. It was hard to be committed to having tight control
with all these newer rules, and devices to follow. I sometimes wanted
to just drop everything, and go back to the old ways. I had no
complications despite all the high blood sugar I must have had during
my first 40+ years, so convincing myself to follow all the new rules
and use the new devices was difficult.
I did not know any other diabetics until I joined some diabetes
websites in 2006-2007. That was 61 years after my diagnosis. That
turned things around for me. I met so many diabetics like me, and saw they were struggling with the same problems I was having, or had previously experienced. There were so many not taking good care of themselves, and having diabetes related complications. I could feel myself becoming more and more committed to having really great control. I had always worked hard to have good control, but my online experience made me more committed than ever before.
My commitment has led to my having 71 years of type 1 with no
complications except some neuropathy, and other minor nerve damage. I do not need any medication for that, and I am very fortunate that having only the "no sugar" rule for so many years has not caused me any major problems.
I am definitely committed to being committed. Perhaps diabetics who
are not committed should be committed to online diabetes support
groups! 
What does commitment mean to you?

Wednesday, February 13, 2019

Early Retirement and Diabetes

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

Friday, February 8, 2019

The Joslin Medals, and Medalist Study

The Joslin Medalists are people who have completed 50 years with type 1 diabetes, and who have been awarded a medal for that accomplishment. There are more than 5000 individuals who have this medal. The picture below shows medalists who attended a meeting in Boston in 2011. I am the taller fellow in the center of the back row. There are also 75 and 80 year medals. If you know any long term type 1 diabetics in any part of the world, and they do not have the medal, be sure to tell them to apply. The medals shown are, from top to bottom, for living 50, 75 and 80 years with type 1.
The Joslin Medalist Study in Boston examined 1000 medalists during the period 2005-2015. It was funded by JDRF, NIH, and private donations. I participated in 2009 and again in 2017. The examination was very thorough, and my past history was required, in detail. Many tests were performed while I was at the Joslin Center.
Many very interesting things were found during the study, including the fact that many of us still produce some of our own insulin. Dr. George L. King is the head of the Joslin Medalist Study in Boston. His area of expertise involves researching the causes of, and preventions for, diabetes complications. Here is an article, about three years old, about the research. The quotes are Dr. King's own words.
"The major fears of the diabetic patient are blindness, renal failure, or hypoglycemia—all of which are complications of type one diabetes. Focus groups have shown that, if not for the complications, diabetic patients could tolerate the disease quite well." King is one of the world’s leading researchers into diabetes complications. He is Director of Research and Head of the Section on Vascular Cell Biology at Joslin, as well as a Professor of Medicine at Harvard Medical School, and he has been at both Joslin and Harvard since 1981. “My area of expertise is how insulin interacts with the blood vessels,” King says. Specifically, King is examining the effects of insulin resistance and hyperglycemia, or high blood sugar, on the molecular mechanisms that could lead to degeneration of vascular systems in the body. In 1989, Dr. King spearheaded breakthrough research postulating that activation of protein kinase C is the primary pathway in which hyperglycemia causes loss of function, and other complications, in the retina, kidney and cardiovascular systems. Following this, King showed in a series of studies using vascular cells from the retina, kidneys, and arteries specifically how hyperglycemia contributed to causing various diabetes complications. King’s research into understanding the causes of diabetes complications, so he can help to find ways of preventing them through treatments and lifestyle changes, extends far beyond the confines of a lab or a petri dish. He is working with more than 800 people in the Joslin Diabetes Medalist program —people who have been awarded medals for living with type 1 diabetes for 50, even 75 years —to uncover how they have managed to avoid many diabetic complications through the decades.“They are very interesting people,” King says about his study group. “Some of them built their own glucose meters in the 1960s and 70s, before they were widely available to the public. ”Aside from being avid do it yourselfers, King found other shared traits of those who have minimized the complications from diabetes, despite living with the condition for many years. After discounting genetic factors, King’s research so far reveals that most of the Medalists exercise regularly. They are also very careful with their diets. But, more than this, King noted another shared trait that, although fairly abstract, is very important. “They are very good advocates for themselves,” King says of his subjects. “The are always on the lookout for new treatments. They are definitely a proactive group. They’re not sitting on the sidelines waiting for something to be done for them. They’ll do it for themselves first, if they have to.” King, and other researchers, also discovered that hdl levels, the so-called “good cholesterol,” is high in Medalists without complications.“We are looking into that,” King says about the implications of the hdl levels. By examining the Medalists King hopes to uncover the specific, if not the actual molecular ways in which they are protected from complications. Is it lifestyle? Genetics? Life choices? Or, is it something else? “The hope is we look at humans who are protected, then see why they’re protected, and come up with answers about lifestyle,” King says. “Then, by looking at their tissue and biochemistry (after death) we can perhaps develop medications to simulate the biochemistry that protected them. ”On that front, King says they have discovered a way that naturally produced human insulin prevents arteriosclerosis. “Can we design an insulin to prevent arteriosclerosis?” King says. “I think this may be possible in the next five years." Because up to 30 percent of people with type 2 diabetes use insulin, such a breakthrough would be good news for more than just for type 1 diabetics, he points out. Meanwhile, as researchers like King work to understand the factors that protect some people from the complications caused by diabetes, and until the development, and testing of medications as a result of those findings come to market, there are things diabetics can do to help themselves avoid retinopathy, neuropathy, kidney disease and cardiovascular disease.“Don’t smoke, watch your diet, and exercise,” King advises. “Also, advocate for yourself. Be proactive. That’s the main trait of the Medalists—they stick up for themselves.”






Wednesday, February 6, 2019

Do You Complain About Weather?

This is me today! :(










Have You Used A Glucagon Kit?

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

Friday, February 1, 2019

Diabetes 1922

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

Pat McAlister...71 Years With Type 1

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

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

Complications With and Without Today's Tech

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