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