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

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.