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

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."