Type 1 Diabetics

Does your partner understand exactly how type 1 diabetes is managed?

The main goal in managing type 1 is to reduce the risk of complications by keeping blood glucose (BG) levels at or near the same as a non-diabetic.  The primary tool used to determine how effective your are at managing type 1 is the A1C test.

The A1C test result is a number that can be compared to that of a non-diabetic.  Getting the number to be closer to a non-diabetic requires you always avoid getting high BG levels.  This means that you must take enough insulin to cover all the carbohydrates that you consume.

The lower A1C number increases the risk of becoming hypoglycemic.   Your partner needs to be able to see when you have a very low BG level and how to effectively treat the condition.

The problem I have with my partner is that she wants me to never have a hypoglycemic event.  She thinks that giving me lots of food will reduce the chance of me becoming hypoglycemic.  Of course eating more food requires me to take more insulin which increases the probability that I will become hypoglycemic.

Obviously this is just a vicious circle that doesn’t work.  My only solution for this problem is to refuse to eat between meals or more than I need at meal time.  This is very frustrating for her and she always tells me “I told you so” after I become hypoglycemic.

My experience with a CGM (Continuous Glucose Monitor).

I had my first experience with a CGM from Medtronic in January 2010.  The sensor was difficult to insert into my body, only lasted 3 days and needed constant calibration finger sticks.  Also the readings were often so inaccurate, they could not be used for insulin doses.  I used it for about 3 months before deciding it was more trouble than it was worth.

A CGM WITHOUT finger sticks.

Now I have found a new device made by Abbott Labs that may actually work for me.  Its call the FreeStyle Libre sensor that automatically measures glucose readings day and night and is accurate for insulin dosing.  This device doesn’t require finger sticks for calibration.  They have been selling this device in Europe for about 2 years.  The only problem is that it’s not yet available in the USA.  If you go to the FreeStyle Libre website you can sign up to be notified when the device will be available.

If I do manage to get this device someday,  I will put it to the test and post my experience.  Also the Europeans are paying about $70 dollars for one sensor that lasts 14 days.  Cannot wait to see the price when it’s sold in the USA.

Johnson & Johnson fails type 1 diabetics.

I saw this article about Animas on the Insulinnation.com website.  Johnson & Johnson, a broadly based manufacturer of health care products, purchased the Animas corporation in 2006.  It looks like the insulin pump market was not profitable enough for J&J and they decided to sell Animas.  Unfortunately they have been unable to find a buyer.  Now they have decided to just sell their insulin pump customer list to Medtronic and discontinue manufacturing insulin pumps.

Big business is not always better.

I’m sure in 2006, J&J saw Animas as a perfect fit for their business model.  J&J is a huge corporation with loads of money that can be used to buy smaller companies.  Large corporations believe they create “economies of scale” that make better use of resources and lower costs.  They buy a smaller company and replace much of their overhead with services from the larger corporation.  The result is a more profitable company.  This works well when the smaller company has a mature product line.  Problems occur when the product lines involve new technologies that require constant updates and revisions.

Should type 1 diabetics be concerned?

In a word, YES.  J&J is helping Medtronic dominate the insulin pump market.  You cannot get better products and lower costs when only one or two companies provide the products.  This is especially true when it comes to a medical device like an insulin pump.  This summer, I started looking for a replacement insulin pump.  My Medtronic paradigm 722 insulin pump was having problems after 7 years of continuous use.  I was not completely satisfied with Medtronic and decided to look at other vendors.  I contacted Animas and received all their product information.  They told me their parent company was J&J but never said anything about J&J trying to sell Animas.  Fortunately I didn’t buy an Animas pump and will have to go with another Medtronic.

I just experienced my very first hurricane right here in Fort Myers.

Hurricane IRMA was a real in your face view of the power of mother nature.  My home is about 3 miles north of the Southwest Florida International Airport (RSW) in Fort Myers, FL.  The winds here were clocked at over 120 MPH.  My home was just built last year and didn’t suffer any wind damage.  But some of the landscape around my home didn’t fair as well.

The winds were coming from the east at 120 mph as the storm eye wall passed over us.  Next we were inside the eye and the winds completely stopped for about 20 minutes.  After that, the winds started coming from the west but with much less force than the winds in front of the eye.  About 30 minutes later we lost all electric power and it took FPL 2 and 1/2 days to turn it back on again.

Lessons learned.

1. Make sure you have at least 2 flashlights and extra batteries.
2. When the storm shudders are on all your outside windows, it will be pitch black inside your home at night.
3. You must buy an electric generator BEFORE you actually need one.
4. You can use the USB port in your car to charge a cell phone.
5. When a traffic light isn’t working, it becomes a stop sign for all directions.
6. Some people will not follow lesson 5 above so WATCH OUT for them.
7. Restaurants are not open when there is a power failure.  Same applies to gas stations.
8. After the storm passes by, all your family and friends will say “you should have left before the storm hit”.  Really?

Diabetes mellitus (the complete name for the disorder) is a condition where glucose is passed out in urine.

Diabetes mellitus and my history.

When I was diagnosed as diabetic in 1963, you either had juvenile diabetes or adult-onset diabetes.  A juvenile diabetic always needed insulin injections because their autoimmune system had destroyed the insulin producing beta cells in their pancreas.  On the other hand, adult-onset diabetes, occurred in older and/or overweight adults.   The experts believed that aging caused a reduction in the amount of insulin produced by the beta cells in some individuals.  In overweight adults, they believed the beta cells were not able to produce enough insulin to cover all the food ingested.

Before the discovery of insulin,  a juvenile diabetic would just die before reaching the age of an adult.  After insulin injections became widely available for treating juvenile diabetics, most lived well past the minimum age of an adult.  In addition experts were finding adults (i.e. actress Mary Tyler Moore at age 33) who had diabetes caused by the malfunction of the autoimmune system (aka juvenile diabetes).  Even adult-onset diabetes was being diagnosed in children as well as adults.  As a result, the two types of diabetes mellitus had to be renamed to mitigate the confusion.

Diabetes mellitus and type definitions.

Renaming the 2 types of diabetes mellitus should have been an easy task.  Just call them type 1 and type 2.  Right?  No, they went a step farther and decided to call them type 1, insulin-dependent diabetes mellitus (IDDM) and type 2, noninsulin-dependent diabetes mellitus (NIDDM).  The problem with this naming convention was that while all type 1 diabetics are insulin-dependent, some type 2 diabetics use insulin to treat the condition.  How could you say a type 2 was NIDDM when injecting insulin was the only effective treatment to manage their condition?

In my opinion, type 1 diabetes happens when the body cannot produce any insulin.  The cause of this condition is a malfunction of the autoimmune system.  The insulin C-peptide blood test results will show when no insulin is being produced in the pancreas.  The cause of type 2 diabetes is now defined as insulin resistance.  But I believe that type 2 diabetes also occurs when there is insufficient production of insulin in the pancreas.  Why is this divergence important?

Diabetes mellitus and buyer beware.

I often see articles about type 1 diabetes “cured” by changing diet.  They always report that after changing their diet they no longer need insulin injections.  A change in diet sometimes eliminates the need for insulin injections in a type 2 diabetic.  But in a true type 1 diabetic the best result will only be a reduction in the amount of insulin injected on a daily basis.  Please note, if your blood test shows your body doesn’t produce any insulin then iust ignore the hype about a diet that can “cure” type 1 diabetes.  Also understand that a true type 1 diabetic will die without insulin injections just like a non-diabetic will die without any food available to consume.

HAPPY BIRTHDAY TO ME!

In case you want to get me a little gift for my birthday, please see the links below:

For all type 1 diabetics, do yourself a favor.

Based on my experience, a type 1 diabetic MUST always have something that shows police and EMTs that you’re a diabetic.  You would think that having an insulin pump attached to your body would be all you need.  NOT TRUE.  You cannot communicate easily when you’re hypoglycemic.  The more ways you have to show that you’re a type 1 diabetic the better.

Diabetic ketoacidosis (DKA) can kill you.

I have experienced diabetic ketoacidosis only once in my life time. You can find many stories about type 1 diabetics who die from ketoacidosis. Fortunately I survived the experience and learned an important lesson.

I started taking insulin when I was 11 years old.  I remember being about 14 years old when I became ill and would throw up everything I tried to eat. At the time, both my parents were on a one week vacation.  They arranged for a sitter to take of me and my siblings at our home.  I thought that since I could not keep my food down, I should not take any insulin.  BIG mistake.

When my parents returned I was so sick they immediately took me to the hospital.  I spent about a week there recovering from diabetic ketoacidosis.

Lesson Learned.

The pancreas of a true type 1 diabetic doesn’t produce any insulin.  Even if you cannot eat any food, a type 1 still needs some insulin to prevent the occurrence of diabetic ketoacidosis.  It’s critical that all type 1 diabetics have a plan for when their primary source of insulin becomes unavailable.

Murphy’s Law.

I use an insulin pump to manage my type 1.  Keeping an extra pump on hand would cost me about $6000.  A waste of money since I’ve never had a pump go bad?  Have you ever dropped a bottle of insulin on a tile floor?  Was it the last one you had on hand?  Did it happen on a weekend?  Was the prescription out of refills?  Murphy’s law  says “anything that can go wrong will go wrong”.   You need a backup plan just it case you might need it someday.

My backup Plan.

I know from experience that I can turn off my pump for up to 4 hours without my BG level going sky high.  Beyond that period, I need a way get insulin into my body sooner rather than later.  A replacement pump could take 24 hours or more to arrive.  You could use Lantus insulin to manage your basal insulin levels but you need a prescription.  Hard to get one on a weekend.  The only option left is NPH insulin.  You can get NPH at most pharmacies without a prescription for about $25.  In most states you can also get diabetic syringes without a prescription.  Please make sure to speak with a qualified endocrinologist to find a backup plan that will work for you just in case what can go wrong DOES go wrong.