Monday, January 25, 2010

Fluctuating insulin needs

One of the most difficult things I find with having type 1 diabetes is unexpected changes in my insulin needs.

I've been dealing with this recently. Just a couple of months ago, my sugars were running high quite frequently, especially in the evenings. My doctor was recommending more and more insulin to compensate at dinner.

Then, suddenly, my insulin needs suddenly reversed course. I started crashing all the time and had to back off my once-a-day Lantus dose by several units.

Now I'm taking one unit less of my daily Lantus than I used to, but I'm no longer having the same problem with the highs. In fact, my sugars have been under great control, so why am I complaining?

The hardest part of this kind of thing is trying to figure out something that often has no rhyme or reason to it. I have a guess at what could have caused part of the change, but not all of it. I went through a 2- or 3-week period where I wasn't riding my horse, and it was shortly after I started riding again that I started crashing all the time. However, this doesn't explain why I'd been struggling with highs for a month or longer, as I was riding regularly during part of that period.

Whether or not you can find an explanation for abrupt changes in your insulin needs, one thing is for sure — having diabetes requires a lot of vigilance.

Tuesday, January 5, 2010

Dan Hurley and 'Diabetes Rising' on NPR

I haven't posted to this blog in quite a while, I guess partially because I have barely had time to check my sugars, let alone think about diabetes for long enough to write a blog post about it. Between the holidays, a sick cat, and a few other contributors, I have been quite busy.

But today I saw a story on NPR that made me want to come over here and blog again: Despite Advances, 'Diabetes Rising'

It's a promotional story for a new book about the increase in diabetes, written by a type 1 diabetic and an investigative journalist. The radio story lasts for about 30 minutes, but I took notes, so I'll highlight what I thought was noteworthy:

A few of Hurley's quotes:

Diabetes is a "disease of modern culture."

"The world we're living in is a diabetes machine," referring to aspects of the American lifestyle, which seem to contribute to a higher incidence of both type 1 and type 2 diabetes: lack of activity and exposure to sunshine, pollutants, etc.

Apparently diabetes (both types) is increasing faster than obesity itself, indicating that obesity isn't necessarily the only cause. According to Hurley, in children born in 2000, a third of the boys and 39 percent of the girls will be diabetic.

He talks about the difference between type 1 and type 2:
- Type 1 is an autoimmune disease that results in a dead pancreas and no insulin production: "There's no diet that will save you."
- Type 2, although it has been seen as a condition that results from age, inactivity, and poor diet, is now being seen in younger people, even children, and in people who are not actually overweight.

A brief mention is given to what Hurley calls "diabulemia," which he says occurs in about a third of young women who are insulin dependent: They actually stop taking their insulin in order to lose weight. Scary!

He is also very clear that there is NO SUCH THING AS PERFECT CONTROL. "We need to accept that we are human beings, and we were not put here to control our blood sugar, and we do the best we can." Doctors need to understand that "we've got more important things to do with our life than stare at our blood sugar all day."

He also talks about the artificial pancreas — basically a combination of insulin pump and continuous glucose monitor — and the frustrations in the medical industry as to why the FDA won't approve such a device. "It's entirely doable, all the products exist, all we need is some final testing and get the FDA to wake up."

Finally, a listener sent in an email about how the medical industry seems to have backed off of the idea of finding a cure, and questions whether that's because they benefit more from treating diabetes than from curing it. While Hurley doesn't think they are intentionally keeping people sick in order to make money off of them, he does say "they want to make money. They need to make money — that's their job. But it's the job of people with diabetes to demand harder work and the kinds of research that will get us to a cure."

Hurley doesn't seem to think that cure is likely to be biological just yet, by the way — he thinks a "computer cure" (i.e., the artificial pancreas) is much more attainable.

Finally, he also commented on how much we as diabetics have to spend on health care — it's "just obscene," he says, stating that he doesn't think it has to cost this much.


Although the radio spot talked about diabetes in a more general sense, the book itself sounds like it is tackling the question of why diabetes is becoming so much more common. I've put a hold on it with my library (it's on order), so as soon as I read it I'll be back with a little more on the subject.