Tag Archives: Blood sugar

When Giving Advice

I’ve been reading post on twitter for a while now. A lot currently are on political issues. I kind of take these on a side note. They are people opinions of the facts they are presented and most of all believe and trust. The election and subsequent statements in speeches and on twitter are a good point. Some believe the president’s points and other do not. I’m not here to chat about those problems though. My issue is the diabetic on diabetic degradation and giving advice and the seeming hurt feeling when someone doesn’t accept it. This may seem a little blunt but get over it. I’ve both given and taken advice from more people than I can possibly remember. There are two things one needs to keep in mind when either giving are receiving this advice.

First, you must remember that everyone is not created equal. Therefore, what works for one does not necessarily work for all. It may work but not as well. Take the advice and decide if you want to try it or not. Does it seem to fit your lifestyle? Does the science seem sound? OK science is the same for everyone but do the facts seem to agree with what you know? Can a diet cure a genetic issue? What I know of, it does not. Are you willing to try it and experiment with it to see if it is a fit for you? I have heard so much on cutting back carbs to prevent needing more insulin instead of rationing your supplies or to stabilize your sugar levels. If you cut back on carbs can you sustain your lifestyle? I work hard and on an average day will consume about 3400 calories. That is more than twice the amount most people I talk either do or will admit to eating. I used to eat about 4100 when I was younger and more active. I looked at a few sites for average calorie intake and was very surprised. One stated men could eat about 2200 a day and maintain their weight. Almost all the ones after adding the words diabetic to calories intake said from 1200 to 1800 calories a day. 50% of those calories should be from carbs. The math came out to 195 grams a day. I eat about 280 grams a day and have not lost or gained much in about 20 years. SO I consider myself maintaining my weight at 3400 calories a day and 280 grams of carbs each day. Low carb? What I can see tells me it just is not a sustainable issue for me. Will I loose weight? Oh without a doubt. Problem is what happens when your body gets a point where you have little to no fat left? Most people call it starvation. Your body will start to consume its own muscle to power itself. My point is that I could loose weight by going on one of these diet but I will need to come back off of it when I reach my goal. It is not a lifetime permanent diet for me. A metabolic endocrinologist told me during a consultation that a ketogenic diet was not a good fit for me since I was so active. It was more for office people than factory floor workers.

And most of all, if you are the one giving any advice, don’t get upset if the person says they aren’t going to try it or posts a different opinion on the subject. God gave us all free will to decide our own fate and it just seems wrong for man to try and take that power from us. Even if you firmly believe the person is wrong and will do damage to themselves, all you can do is try and give reasons to support your point of view. PLEASE do not stoop to name calling or other bullying tactics. It shows a grand display of insecurity about your own point of view. When I get it, I really take a good look at what was posted because I am immediately suspicious. I get a big kick out of someone who says “you should read this article it says (blank) and proves my point”. I read the mentioned article and low and behold it does say what they say it does. It also goes on to mention other issues that need to be looked at for it to work as well. One of the biggest offenders of this are articles on cures for diabetes. One if I have to change your lifestyle to prevent needing insulin I can’t call it a cure since the cause is still there. I am simply treating the symptom with a diet change or exercise change. If I stop, I go right back to where I was. As for the article itself, quite a few times somewhere in the article it actually says not tested on type 1 or not recommended for type 1 diabetes. IF your type 2 then by all means I do hope it works for you but I am not type 2 so it is not likely to give me the same results. I tolerate people who do not agree with me on a variety of subjects nor do I try to force them to adopt my views. Someone telling me I’m wrong and should be doing things their ways to live better is not going to earn them any points in my book. Will I listen? Of course. From my point in life I have this to say. A wise man is quiet and listens to everything said, a fool keeps talking to make his point heard. Listen to what the other person is saying, don’t just ignore them all together. On the other side of that is that you do not have to follow their advice. Take or leave it is commonly said in these situations. It fits perfectly.

And the Costs Go Up

Its been a while since I posted a blog. I don’t write until something hits me as needing to be said. Found one. The rising cost of medical care. Congress and the president have talked about taking it to task to fix these issues for us. Still waiting. Why has the cost gone up so far so fast? I’ve been reading lots of posts on both Twitter and Facebook talking about rising cost and some not being able to afford the medication they need to live.  Why? I can’t afford to spend the $2,000  to $3,000 for a couple months supply of insulin and I’m just starting to make good money.

It’s not like these drug companies are not making a profit. Novo Nordisc made several billion dollars in 2015. I think that was the year I looked at a while ago. Sadly they made about a few million less from us than the rest of the world all together. I think profit has a lot to do with the price increases. A chart I read in a Wall Street Journal article says med prices went up 69% since 2000. The drug pricing process is so confusing and oblique, finding a source for the increase is very hard. Many states have started enacting laws that while not controlling the prices but open the doors to see why the increases are happening.

A few months ago there was a news blip about companies freezing prices instead of increasing them like normal. An article I read claimed the freeze was only for low market use drugs (more popular drugs still got the increases) and there was no indication it would last. In other words it sounded like to placate the people and get us off their case, they postponed the increase until we calmed down again.

Insulin is my drug of choice so I use it often to show the increases and the effects of them on my life. I started on NPH back in 1977 when I first became a diabetic. According to research I’ve done it was about $35 a bottle (10ml). Currently I’m taking Novolin N which is the same basic biosimilar formulation but different company. There has ben little to no improvement in over 40 years to this insulin. Even the regular Novolog I take now has not been extravagantly advanced in many years. Newer insulins are faster but the older ones don’t really change much. Its why I’m on them, they should be cheaper. So one would think. Reality is they are not much different. Last time I asked about it at pharmacy here was a difference of about $20 between older insulin and newer one I had been on.

I asked to switch years ago due to money issues to a cheaper fast acting insulin. My cost dropped from about $115 a bottle down to $60- $70 per bottle. Biosimilar (means the same formula really) products now-a-day are about $294 a bottle. How did it go up without a significant change? Still kicks in in about 30 to 90 minutes and last around 4 hours. Newer insulins kick in about 15 minutes and only last 3 hours. That is not a huge change but I’d give that a thumbs up for a price bump at least.

The long term insulins? Those are even worse in my book. Lantus is a long acting (24 hour) insulin that has been around for years. An article I read claimed that its patents was set to run out a year or two ago. I’ve never really checked into that. I got put on Toujeo a few years ago shortly after it came out. “It will be so much better for you.” I was told by my doctor. Well it was not. I read the information the company put out on it since it was supposed to be so new, only out for a few months when I was put on it. Come to find out Toujeo is actually a new formulation of Lantus. It will last in your body 36 hours according to the literature on it. 36 hours? Why? I still have to take it every 24 hours so I’m not gaining anything by switching other than a more costly insulin. The best part was I also read that since it was similar to Lantus the patent on Lantus was extended. No generic insulin then. It sure sounds like a profit boosting measure to me.

Another area that seems to be boosting prices is the lack of competition. Lack of competition? This is America were we can innovate out of anything. The corporations are really good at it. When people here started realizing that the same meds here are only a fraction the cost in other countries they began ordering them through the mail. A law was put on the books to stop that once it impacted the drug makers profits. Instead of opening up competition they capped the market to prevent having to compete and lower the prices here in the USA. The same insulin people get for $150 a bottle here are only about $9 in the UK and $2 in India. WTH? Same drugs made by the same company are so much cheaper there. Why? Those countries have a universal system that has the government as the health insurance provider. If you want to sell your drug there you have to negotiate a reasonable price for it or you don’t sell it at all. They would rather have a smaller profit than no profit. And yes they still show a profit in those countries even with such low prices. Huh.

The USA has an average price tag of over $8,000 per person in medical costs. The next one down the list was about $5,000. lol Even better that country had a longer life expectancy than we do. Less money and better care than we have. We should be paying more attention and less money.

Are We Being Forced to Use New and Improved?

I responded to a tweet earlier that me think about my answer and a need to talk farther about it. A woman asked what was going to happen when diabetics started using the older  less improved insulins? It’s a solid question and I can give an answer at this point because of this exact thing happening to me.

As followers might know, I was asked to try a 670G pump and it did not work out as was hoped. When it was over, I wanted to go back to injecting insulin and my endocrinologist at the time stopped pushing to stay on it and accepted my decision to get off the pump. That’s were our worlds separated.

She talked about me going on to using a newer insulin, Tresiba, as my basal insulin. Now to those who do not know about it, Tresiba is a long acting insulin that by the makers information can last in the body for about 42 hours, about 1 3/4 days. My question is why does it need to last that long if you take it every day? Wouldn’t you slowly build it up, or stack it being the term for this, over time?

My biggest issue was not to be asked, but being placed on it again after its lack of benefit the LAST time I was on it. She had said try a new insulin but we had tried this one before I been placed on the pump to see if it could improve my A1C numbers. I had been given a sample to use to see if it made a change.

I had been on Toujeo for a while and since starting at 24 unit a day was down to 4 units a day as which was still making my levels drop while at work still. Yes I was taking 20 units less in the end as it was dropping my blood sugars too low while at work overnight. My morning levels however where very high. Some of that has to do with me eating to stop the lows and over compensating. The doctor did not understand why I was still dropping with such a small amount in my system. This was not supposed to happen.

When she brought up going to this “new” insulin she wanted to start at 22 units a day. If she had actually looked at my charts, it was in there that I had been down to 4 units of Toujeo and I’m hoping there was some note of using the Tresiba as well. Regardless, I pointed out we had already tried this and did not want to try another 24 hour insulin as it “locked” you into one dose all day. NPH seemed to be a better fit as it was only 12 hours and would let us switch from  lower dose at night to a higher dose in the morning when I needed more help. This made sense to me but apparently not to her.

All kinds of excuses were given, forgetting and going into ketoacidosis being the most pushed fear of hers. I could not help but feel a little uneasy as it seemed she was fighting too hard to stop me from using a much older and most likely less pharma pushed insulin. NPH has been out there for decades as Toujeo and Tresiba are very new, about one year at this point. Back hen I think Toujeo had only been out for a few months and Tresiba was not even through the FDA trials yet.

I found it very hard to ignore the voice in my mind telling me there was something not right with this. After arguing for over a week about it, I grabbed a 4 year old bottle of NPH I had in the fridge from a past prescription and started using it. She was so mad I had done that but immediately got on board and we started making changes to doses and working out how this was going to work.

My point is, why was it so hard for her to get on this new train that would let me follow the pump rates closer? The only thing my mind came up with was kickbacks from big pharma. Give out our insulin and we’ll give you something. Maybe there was nothing to fuel her determination to keep on the pump when it obviously was not working for me and then fight to go back to same insulin that I had such poor performance from that led her to press me for trying the pump, again. But that idea is hard to ignore with all the posts about on Twitter and in the news.

The rising cost of the newer insulins and people going back to older insulins because of this only lead me think this will end in one of two fashions. Either they will raise prices for these older insulins or they will stop producing them altogether to force people to buy the more expensive ones.

The first reason is actually already happening. The cost of the NPH was only about $200 when I started back then. I was forced to switch to Novolin N which is a biosimilar made by Novo Nordisk by my insurance company. It was only a $40 copay at first but became a $65 copay by the time I switched insurance by switching employers. Let’s do the math on that 20% copay. A $40 copay means a price of $200. A $65 copay means a price of about $320. A $120 jump in price in a little over a year. I heard of people on twitter and Facebook switching to keep cost down and look what is already happening to the pricing. There has been no improvement in this insulin in over 30 years. I used NPH in the late 1970s when I first became a diabetic.

Are there kickbacks for doctors to keep people on the newer meds and technology to control diabetes? I don’t know. I’m not a doctor. We will die without these meds and the technology will help us keep tighter controls to avoid later costly complications. I can only tell you what my opinion is, which comes from what I see, hear, and experience. The prices of even much older insulins is going higher fast. Research can’t be used as an excuse since it is so old the research cost has to have been recovered by now. Again, I don’t know but I have think it must have after that length of time. How could it not? It would be a poor business plan to run that cost out too far and risk loosing it due to newer meds that will replace it.

A co-worker once gave me a great piece of advice, the doctor works for you not you for them. If they give a treatment that does not work for you or you know you can’t afford it tell them and work with them to get to a more affordable treatment. I do pay them and quite well I must add. I will listen but they must listen as well. Another doctor once told me that would have to stay off my foot after an injury for about 2 weeks. I simply told him that I did not have any vacation to cover that and would loose my job and insurance if I had to be off that long. He did not look happy but agreed to let me go back to work as long as after work I wore a boot on the foot. I did and work went great. I had already been working on that foot at work for 3 weeks so its not going to make anything worse. lol

The Same Yet Different

I just read a post from a woman who lives in the UK. She is also a diabetic as are many of the people I follow on twitter. Facebook is great for friends and such but twitter lets me find people who are like minded as far as my disease. Well I don’t go looking for them, Twitter finds them for me. I have some here in the States (one is on TWO of the new Dexcom G6 commercials) but quite a few are in the UK as well. I have learned as much from them as fellow diabetics here in the USDA.

The post I read was from a woman who yesterday ran a half marathon (10k) and finished it. Way to go!! Now some not familiar with diabetes may think so what. It’s only a half marathon and she didn’t finish first. Oh my good people, to me it is great that she even tried let alone did finish no matter what place it was.

Why? A diabetic knows the answer to that already, someone not so in touch with the problems of this disease may not. Let’s start with the basics. Diabetes is a disease where your body does not produce insulin to control your sugar levels in the blood. So a diabetic must double as their own pancreas since the one they were born with no longer works like it should. Normal people don’t get this as their body regulates it’s own insulin level. A diabetic has to do this the entire 24 hours of each day. It is a true 24 hour 7 day a week jobs and there are no vacation from this job. Now here is the first in lessons some don’t know. There are actually 2 types of diabetes and although they are both called diabetes they are very different creatures. Type 1 is insulin dependent and type 2 can still make it although not enough or sometimes the wrong chemical makeup, it doesn’t work right. There about 22 million diabetics here in the USA alone and out of those only a 10% section are type 1. That means I am one of about 2.2 million people here in the USA who depend on insulin to live. We do not make it on our own and so must take it several times each day. It is not a pill and though there has been some headway to make it easier, the only way to get it is to inject it through the skin.

“I’ve read that you can also inhale insulin.” There is only one and I do not know what complications it can cause or how effective it is. Most people, I do not know of any on this inhalable insulin, use injection. You can use pumps instead of needles but as some of my former coworkers can attest to, it is not a perfect solution. It also still goes through the skin. I was told years ago (decades really, I’m polishing my cane later) being a hormone insulin would not survive the human digestive tract hence it must be injected. As far as inhaling, I’d be more scared of an infection from that kind of delivery than an injection. In the 40+ plus years the only infection from insulin I’ve had is with a pump cannulas but it was on its 6th day instead of the 3 days recommended by the maker. I had to, sweated the first one off early so to make up I had to reuse the next one or I would have run out.

OK back to task, Type 2 diabetics are people whose body still makes insulin but it either makes not enough or the chemical makeup is not right and it does work as needed. Insulin does not actually control blood sugar but it unlocks the walls of cells so the sugar can get in and let the cell use it for energy. Think of it as a key for the lock on your cell wall door. If there is no key you don’t get in, if you don’t get in there is no power to run the cell and it will die. Type 2 can be controlled by pills or diet or both without needing insulin. Sadly, it can regress to the point where insulin may be needed anyway. My mom and both aunts where like after years with type 2.

Emma uses a pump and just to make things easier I will just say that if you have a hard time programming your universal remote a pump is not any easier and your remote won’t kill you if you screw it up. I don’t know her that well but I can guess from her post she does not run marathons on a daily basis. Here is another issue with diabetes, changing your routine is scary. I am far from a perfect diabetic but I try to eat at the same times and even the same foods on a rotating basis so I know how I react to each food and how many carbs are in each meal. Carbs are how diabetics count and calculate how much insulin they need for the food they eat. Each food has a certain amount of carbs that enter your body at different speeds and as a diabetic you need to be able to know how many are in each food and add them together and then calculate how many units of insulin you need. A pump can do this on its own but you still need to tell it how many carbs you are eating.

Since she was running a marathon her activity level was going to be so much higher than normal for her so she had to try and compensate for this. With a pump you can lower the background insulin you get on a temporary basis so she made the changes.

This where I noticed the biggest difference. She dropped her rate 2 units. Wow! My basal rate (background insulin) was at times only 0.250 units per hour! That equals 1 unit every 4 hours. There was no way I could have dropped it 2 units. Even as low as it was set, it still crashed my sugar level without extra work (running a marathon being as low as it can get on that list) and although it would shut off automatically,  I still needed to eat to bring it back up as it was low for hours after going low.

The other issue I noticed was when she described making corrections for a highs the morning of the race. Every diabetic has a rate to add extra units to prevent a high once it is started. Mine is 1 unit for every 50 points over 200. It used to be 2 unit back then when I was on the pump. She was correcting a 1/2 unit for less than 200. Amazing!

Reading about how she ran her diabetes compared to my treatment brought to mind what I frequently tell other diabetics. Everyone is different and has a different treatment routine. I have been telling people that for years now but I never had actually applied it to myself until reading that post. I had always thought I must have done or been doing something wrong to create this difference. I am me. I am not Molly, I am not Emma, I am not Amy, I am not any of the other diabetics I know.

I am not doing anything wrong I am merely doing things the way that works for me. MY correction rate works for me. My basal rates, well now doses, works for me. My diet works for me. It will not work for anyone else nor should it. I can try a technique I hear from someone but I will also need to test it to see if it will really work for me.

I can stop thinking “Why does this not work for me like others?” We, the other 2.2 million type 1 diabetics, have the same disease and share common problems and issues. Our solutions though are not and should be the same. They are unique to that person. Everyone is different and should follow their won path to control.

Damned If You Do Damned If You Don’t

I wrote a post a little while ago on Facebook and got a few comments back that showed me a need to explain diabetes and what causes it. I’m not dissing or throwing shade on anyone (modern young person terms) because I looked online and was horrified by what I found. The 2 type of diabetes are thrown together and made to seem like they one disease of which type one was the worse than the other. From my view point they are in reality 2 different but related diseases. Type 1 is caused by a bad gene called SIRT1 gene and it causes an autoimmune response in which the body’s immune system kills off the beta cells that create insulin. Type 2 is more of an environmentally caused disease. Being overweight, not eating good balanced diets, not exercising, and yes genetics also are all noted for causing this disease. The biggest difference between them is using insulin to control it. Type 2 diabetics can control it without insulin for quite a while. I have an aunt who has had for longer than I have but was able to control it with diet and pills only for decades before it progressed into needing insulin to control her sugar level.

I was never that lucky. I was 8 when I was diagnosed with type1 diabetes. I ate my veggies (not so much now lol) and was very, very active back then so diet and exercise get thrown out the window right off the bat. Nor was I fat back then. I spent too much time riding my bike all over town to eat all the time and sit in front of the TV. My body’s immune system killed off the beta cells that made my insulin. I had a test run last year (after the last pump failure) to see if I was actually type 1. I am. My body does not make any of its own insulin nor do I have any binding antibodies in my blood. Those are another possible causes of the issues I had been experiencing.

Now on to the “cures” for diabetes. The plain and simple fact is there is no cure for diabetes, type 1 or type 2. Yes type 2 and even type 1 can be controlled BETTER by taking certain herbs and medicines. The oldest one I heard of is garlic. It actually contains the vitamins that help insulin act more efficiently. The only issue to me is that if you need to take garlic additives or add more of it to your diet you weren’t eating enough in the first place.

Now as far as curing type 1 diabetes, there is no cure and I do not have much hope I will see one in my lifetime. The true cause of diabetes is the reason for my lack of hopeful thinking. Since it is caused by a bad gene even if you used stem cell research to make new beta cells what will stop your body from once again destroying them? The only true fix is to fix the bad gene. We are no where near that kind of medical technology, unless you watch too many movies.

I had a previous experience with this issue, the difference between treating a symptom or fixing the cause. My shoulder when it is was messed up was hard to get diagnosed let alone treated well. They kept trying to use physical therapy to fix it. Several CAT scans and MRIs later they could not find a decent answer to the pain I was having. It went on for nearly 3 1/2 years, I’d go to therapy and then the pain was back. Finally I did my own research and found that scope surgery had a 90+% chance of ending the pain. So I asked and was told if it was what I wanted they would do it. The only other option brought up was a steroid shot which for a diabetic is a true nightmare. It will send your sugar level into orbit for the better part of a week. When even the doctor is reluctant to do it you know there is a high risk factor.

Well, the surgeon told me after the surgery he found the problem as soon as he got the scope in there. I had apparently dislocated my shoulder and ripped 1/3 of the cartilage (cartilage does not show up on any CAT or MRI scans, only scopes can see it) off the front of the joint. It had been getting pulled into the joint and that had in turn torn up my bursa sack (lubricates the bone to bone joint). For 3 1/2 years they had been treating the symptom instead of the real problem. In that 3 1/2 years it had probably caused even more damage. One can never really be sure but you have to wonder about it. So if they had gone in and looked when it first started would my shoulder still have a bursa sack?

Back to diabetes, so the death of the beta cells is not the true disease simply a symptom of a bad gene and run away immune system. So to really fix (cure) diabetes you will need to fix this bad gene. The holy grail of medical science is to be able to fix bad genes. Downs, diabetes, heart issues, and many other diseases are greatly or solely influenced by genes, mainly bad ones. Its a two edged sword as well though. Where do you stop once you start? Do you give people animal hearing? Better sight? Fur to be able to handle colder temperatures? Where do you stop at this level of engineering? Damned if you do damned if you don’t.

The Fears of Being Diabetic

Why the fears of being diabetic? Why not? I didn’t call them phobias, they are not debilitating. A good diabetic will acknowledge the risks and prepare for them. Risks in my opinion are simply controlled fears. Will I run out of insulin today or drop the bottle and break it? Past incidents have led me to be very careful of where I set it when it is out of the case, aka been there done that. There are so many of them I can’t possibly bring up and talk about them all. The whole point to this post is letting people know that there are many risks to being a diabetic and not everyone knows them or wants to talk about them.

By knowing the risks you can either avoid them or minimize the chances of them happening. My big fear is having a low. Its not as bad with the CGM (that leads to another fear all diabetics have) since it lets me know where I’m at with my blood sugar and most of all which direction it is going. I can avoid the lows by knowing they are coming before they get too bad. I carry Skittles in my pocket so when I know I’m going somewhere I will not have easy access to snacks. Cutting back on exercise is never an option for me. I was not raised that way and can’t get past wanting to give 100% at whatever I do, at home or at work.

My 40+ years of dealing with diabetic issues have led me with a few near phobias with the lows being at the top of that list. I have been told what I am like when my sugar gets low and that scares the hell out of me more than anything else. I become a very combative, aggressive person. People who know me can tell you how calm and passive I am normally but lower my blood sugar and I become a different person. When I was 12 I threw a nurse across our living room, I’ve knocked orange juice out my mom’s hand so many times I lost count, and I woke up with 8 EMT/firefighters holding me down on my bed to get an IV started. At work I have told them to never try to force me to eat or drink anything. Just call the EMTs and let them handle it. The fear is hurting someone I care about. My old doctor hated the fact I run my sugars so high to avoid it.

Another fear that I alluded to earlier is how I am going to pay for all the meds and supplies I need to stay alive. It is sad to say insulin is not the only med with this issue but it is the one I am most familiar with. The cost of the bottles of insulin have gone from $115 about 10 years ago to $295 currently. That is also with the insurance company discount. Buying it without insurance I’ve heard is more like $380 a bottle. The CGM is also a big cost. Each month with insurance I pay about $120 for the sensors. Without insurance they are about $450 each month. They are only meant to stay on for one week but to save money I will leave them on as long as I can, 3 weeks at times if the adhesive stays put. The transmitters are another thing. I pay about $250 for one transmitter that last only 3 months, $1,000 a year with insurance. Without insurance, I would ben  paying $1000 each for them, $4,000. What happens if I loose my insurance? It keeps me up during the day, I work nights so that is my sleep time.

Up comes another fear/risk, loosing my job. I hate to break it to those who feel the ADA protects them but I have been in situations where employers have been, lets just say creative, in forcing me to leave. I don’t think I’m a bad employee. I show up for work on time 99% of the time, I don’t call in sick very often, I do what I am asked to do whether it is a part of my “job” or not, I get along with coworkers well, and am willing to work overtime when needed. I’m not going to get into the politics of it but “right to work” states also allow an employers to let you go without a reason. They will not use the word diabetic in any letter or phone call since that involves the ADA. They can just give any excuse and let you go, if they respond in the first place. As far as getting hired, that is another nightmare all together. The easiest form letter to use is “we have gone with another more qualified applicant” one. Have they? I have wondered how many times they hear about previous situations of low issues and decide to not hire over it. I’ve read the fine print at the tale end of the applications. You give permission for the company to run background checks on you which includes credit, criminal, and employment. You give them access to your employee files from former employers.

An everyday fear/risk is not calculating insulin does correctly. Did I count the carbs right? Did I get the right ratio? Did I do the math right? I’m not perfect. I’ve screwed this up more than just once in 40 years. Don’t panic and make the correction. Eat more if you go low. Take a bolus if you go high. This one is really easy to manage. Its more annoying than anything else.

Fear is a constant companion for a diabetic. One you need to become friends with instead of being paralyzed by it. I could  die by walking out of my house and down the street today, but I’m still going to do it. I could screw up any of the diabetic things I’ll do today but I’m still going to do them. As I said it in past blogs, I’m 9 years past my expiration date so in my mind I’m not loosing anything if I died today. I can hear the gasps from here. It’s life. I’m going to die, everyone will die. Its just when will I bite the big one. I realize the issues of being a diabetic each day and I work with those obstacles. I control them and move on. Enough said.

Wow! Already?

I read a post a little while ago from another fellow type 1 diabetic on accepting her “broken” body. I have to agree with her, our bodies are broken. Our immune system attacked and killed the beta cells in our pancreas that made insulin. Yes I said made because they are gone and have been for decades. We make no insulin on our own like type 2 diabetic so to live we must inject it everyday several times a day. To me although they are both considered diabetes type 1 an type 2 are separate diseases, different causes and different treatments.

Reading the post brought back memories of my life years ago when I was resolved to live with the knowledge that I was going to die much sooner than most if not all my friends. I would have to make sacrifices each day just to stay alive. The last few years of high school and the years shortly after I had given myself an expected life span of 40 years. Why you ask? I had been hearing for the last 10 to 20 years that I was more likely to have a heart attack, stroke, loose a kidney or an eye, loose a foot or leg, or one of many other possible bad things that are more likely for diabetics.

Well I am happy to report that my supposed end date was wrong. I have turned 49 so I’ve gone past my expiration date by 9 years already. I’ve had issues such as bad infections that apparently, according to my family doctor, was not expected to survive it was so bad. I also have had retinopathy in one eye but it is controlled and no further problems have been found. Just had them checked last week.

Now to the nitty gritty of why I’m writing this post. As much as diabetes has impacted my life, it has molded me into who I am today, a driven, resourceful, proud person. Some who know me might question that last description.

Proud? Yes, very proud. I don’t ask for help unless I’ve already proved I can’t do it alone. I don’t rely on others others to do things for me as I am completely capable of doing them myself. Maybe at times more headstrong than smart as I tend to push things to the limit to find where it is.

When I first became a diabetic, age 8 (1977), I had tried to hide it from others around me. I was different now. I had to pee in a cup to check for sugar in my urine. I had to get shots twice a day to stay alive. I had to get blood drawn once or twice a week to make sure the dosages were right. I had to watch what I ate at meals and in between. That was the worst as I had to get up in the middle of class to get a snack out of my launch box with everyone in the class watching. How was I supposed to hide that?

Diabetes is invisible. I don’t have a missing arm or massive scar on my face to mark me as a diabetic. Its why we all are expected to carry something like a med-alert bracelet/necklace. Even EMTs can not tell unless they are told. Makes it easy to hide.

I no longer hide the fact that I am a diabetic.  I do not go around spouting out to everyone I pass about it but readily will anyone who asks or inform coworkers to make them aware. One of the reasons is the growth in diabetic awareness. Not to mention the fact back then there were estimated to be 6 million of us. There are now 22 million of us with only 10% of them are type 1 like me.

As much as it has changed my life and made it harder, diabetes has also made me who I am today. I am driven to manage more than defeat this problem. I watch what I eat and try to control my sugar level but also live like a normal person. I don’t avoid sugar. I also don’t hide from work. I’m not going to call myself a workaholic but it would be close. My job is a material handler at a factory. Yes I do drive a fork truck but most of what I do is by hand. I can honestly say that depending on the night I lift and move maybe 1 to 2 tons of steel. 2,000 to 4,000 pounds of steel. I use an air grinder to remove burs and slag off parts. Try it for at least 4 hours before you call it easy, you do flip the parts you are grinding and some of them weigh close to if not over 100 pounds. Its hard work and I love it. My problem at work it I do so many different jobs that I don’t know from one moment to the next what I will be doing. Friday I started out unlading a torch table then moved to grinding parts and then sat on a fork truck for 4 hours. Even then I couldn’t take it. I kept the radio with me but jumped off to finish grinding the parts I had started earlier. I also jumped back off at the end of the night to help load the plasma table to get it done faster. I’m such a pain in the buttocks.

I guess it has given me a chip on my shoulder. Because I have diabetes I feel the need to proof myself more than others. I need to prove I can work with the big dogs instead hide under the porch. I have never and will never use my diabetes as a crutch. I can do anything normal people can with some special conditions. Foremost among them is being able to eat when my sugar level drops too low.

I guess to wrap this up, I’m done hiding (have been for years). I don’t broadcast being a diabetic but I don’t hide in bathrooms to do my shots or check blood sugars anymore. You can’t stand the sight of blood or needles? I’m sorry, turn your head then. I’m not going to apologize for being a diabetic. I didn’t go looking for this and am sure as he11 (don’t want to sware here but………..) not going to feel less than human for having it. I guess my feeling anymore has gone to the point of if I have to live with this then you are just going to have to cope with the ways I have to use to deal with it. You don’t have to do anything other than leave me to deal with the shots, sugar tests, and food intake. Its all I ask of you

What does a low sugar “feel” like?

There are questions I get asked from time to time, usually after a hypoglycemic reaction.  Can’t you feel it? Why didn’t you stop it? Oh and my favorite didn’t you eat? I’ve heard them all at one time or other. Actually I’ve heard all of these more than once. To a diabetic they are “duh” questions, the simple answer of duh is the appropriate response. To those who do not have to fight or control these incidents it can be a mystery as to how or even why we feel what we do when the sugar level goes rooting around in the basement. I hope to help some of you understand that we don’t want such drama in our lives. There is plenty there already.

First, can’t you feel it? Simple answer is yes. I can feel the tired, confused mental state coming before I go into zombie mode. I don’t know what else to call it. I can hear but my mind does function well with a low blood sugar. I did some checking and 15% of your blood flow goes to your brain and about 20% of your bodies resources get hogged by it. So stop and think about that for a second. Your brain is like any other muscle in your body except it used much more of, well, everything. You use it or loose it (if you even had one in the first place mine is questionable in that case) and if you don’t eat well your muscles get weak, as does your brain.

Confusion is my main go to signal of a low. I can normally understand things with little problem. Once in a while someone will try and explain something to me and because I think about things differently, it may take me a while to get it into terms I can understand. If I run into something I know I should be able to do easily but I end up having to think about it a while or over and over before I solve it, I have a problem.

I also mentioned tired. This gets kind of tricky. Is it from having a low or only getting 3 hours of sleep yesterday? Got a coin to flip? I work nights so sleep is a luxury I don’t get enough of most days. Sometimes there are just too many things going on and I have to cut it short and sweet. Other times noisy neighbors and “normal” daytime sounds get in the way of a good sleep. A low sugar causes a tired feeling because it cuts your bodies power supply at its source. That annoying sugar level in your blood is also responsible for energizing your muscles and brain as already stated. No sugar, no energy.

Second question on the list why can’t didn’t you stop it. This one is also a multi-layered question. If I do feel it getting low I will try and fix it. A question to answer the question is what am I doing? Can I stop right now or do I need to get to a stopping point first? How fast the sugar drops is a big decision maker. Is it slowly dropping or is it making like a skydiver without a shoot? I have had my sugar drop 130 points in 1 hour. Hypoglycemia is listed as below 60 so doing the math on this I would have gone from “normal” to low in only 30 minutes. It takes about 15 – 20 to get sugar into the blood stream. Just the fact that it drops that fast can add to the confusion and quick onset of problems. I’ve felt confused at 110 because just 2 hours earlier it was 478. So take roughly 368 divide by 2 hours and we get 184. An hour! This happened just the other night at work. I did not wait for the engraved invitation to come in the mail, I got a pack of peanuts butter cups and was fine until lunch. It was still down to 78 but since the fall slowed down I was fine mentally.

Anyone confused now? Yeah it sucks doesn’t it. That low sugar slowing the brain down also means I don’t think rationally. I once had 4 people at a previous job trying to tell me I should eat something and the only thing on my mind was that they were just trying to pull my leg and get me to do something stupid. Well the EMTs knew me by name back then and were able to get me to down some nasty sugar paste in a tube. By the way anyone who has never tried it should and you will understand why hypoglycemic diabetics don’t eat it willingly.

The last question on the list is truly the most ridicules. If you could see my fat frame you would understand I don’t miss many meals in life. The lows actually are a part of why I am so heavy. I have to eat to bring my sugar level up and since the doctors want to keep it as  low as possible, I eat a lot to stay above water each day. I am fine to let it sit at 250 but it is a cardinal sin for a diabetic to let it get that high. It is a constant tension point between my doctor and I.

I have a phobia of having lows. It genuinely terrifies me. I keep a cool head and low profile as much as I can in life but when my sugar gets low I get combative. Just ask my sister and a close friend who both have tried to get me to eat somethings and I ended up hurting them. I tear up just writing it down.  When I was 12 I threw a nurse across our living room after she jabbed a needle in my arm to get me out of a low. My mom said she flew about 5 feet. I am much bigger and stronger now. Would she have gone through a window now?

On more than one occasion I have woken up from a low while sleeping with the help of EMTs. I believe the most I counted was 8. They said I was fine until they tried to start the IV and then my demons came calling with a vengeance. 8 strong strapping young fire fighters had to hold me down as another started the IV to get my sugar up. That is why they knew me by name back then. If they got the call to my house they brought back up.

I fear hurting someone without being able to control myself during one of these incidents. I have in the past and regret it deeply. That is not who I am or want to be known as . I have no control over my mind when they happen so they scare the crap out of me. I can’t speak for every diabetic but I will do whatever I can to keep this from happening. If I shorten my life a few years by keeping it high but everyone is safe, I am fine with that.

So that is how it “feels” to have a low. Confused, tired and most of all terrifying.  Can I feel and stop it? Yes I can under most circumstances but there are always curves that God puts in our way to both challenge us and humble us. We just have to deal with them as best we can and maybe get a little help from our friends. The loss of control is scary and humiliating at the very least. I am not a social butterfly so the extra attention garnered by such events is never welcomed. I would much rather be the wall flower in the back of the room who tells the guys about it the next day. Oh to dream.

Looking forward to CGMing it

A conversation with an advisor for Medtronics got me thinking. Now that I will have a really good insurance through my new employer, I will need to take advantage of the CGM technology that is a side bar with the pump. In plain language, the CGM, continuous glucose monitoring, allows you and your doctor to keep a 24 hour a day 7 day a week record of what your blood sugar is doing. The best part is it does this every 5 minutes so although not meant to replace a separate meter, it will give a better indication of any rhythms with your blood sugar. They had me on one before I started using the pump to get a good picture of my daily peaks and valleys. Exact words were something like “you have a very clear and distinctive pattern. Highs come in about 6 or 7 in the morning and then plummets around 2 or 3 in the afternoon. There are some other reasons I am looking forward to the CGM system. The most important is getting a CDL. Without the monitor I the doctor can not sign off on a medical card for a CDL. I don’t blame her. Do the length of time I have spent as diabetic, brittle diabetic no less (I hate that term “brittle” feels like I’m made of glass), I have a problem with sensitivity to lows now. With the sensors, it will see a low coming from a mile away and alert me like a phone ringer. If you set it higher say 80-85, I can check it long before it gets anywhere near 70. I’ve had lows in the low 20s more than once in my life and hope to never see them again. I hate the highs too but I tolerate them better since it is not a oh crap he in another low and won’t eat for us. It’s not for everyone though. The cost of the system is not necessary if you can feel the lows coming and they are not a major problem for you. It’s something you should talk to your doctor about. My last insurance wouldn’t even cover the cost of a glucagon kit for low blood sugars. Even the doctor couldn’t believe they wouldn’t cover it. As far as the CGM, they wouldn’t bite on that one. Think about it and discuss it with your doctor on your next visit.