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.