Proud Diabetic

Symptoms of high versus low

2011-10-24T12:34:00.000-06:00

I remember when I was first diagnosed as diabetic, about nine and a half years ago, someone (a nurse at the hospital when I was there, I think) telling me that high and low symptoms can be very similar — enough so that you may not know the difference.

Obviously she wasn't diabetic, because while there are some similarities, I've never thought it difficult at all to tell which I am.

Crashing, to me, is perfectly obvious. I get tunnel vision. I get shaky. I can't concentrate. In short, I feel like shit.

Going high can feel like shit too, but in a different way. I often get heartburn, a stomach ache, and/or a headache. Sometimes I feel dizzy (hence the minor similarity to crashing) but it's in a different way than when I'm low. And if I'm high for a long time, of course, I get dehydrated. My hands and even my eyes start feeling dry, which is a perfectly miserable experience.

One other symptom of going high that I've noticed is irritability. It's not like the second my blood sugar goes up, I get grouchy. It's more like if I'm high over an extended period of time — for instance, if I'm struggling with highs for several days in a row — I start feeling illogically angry about everything. I've gotten irritable when I've crashed before, but it's rare. Usually I know I'm crashing right away, whereas I don't always realize I'm high unless I check my blood sugar, so I think that makes a difference. If I know I'm cranky because I'm crashing, for instance, it's much easier to stop being cranky once I realize the cause. When I'm high that's a much more difficult attitude adjustment to make.

In fact, that was one of my unknown symptoms in the months leading up to my diagnosis: I was much more easily provoked to anger. I worked at a preschool at the time, and I had noticed that I was getting angry at the kids more easily when they didn't listen or misbehaved. I didn't know why it was happening at the time, but I definitely noticed that I was having to work harder to control my temper.

What about you? What symptoms do you have when you're crashing, and what are your symptoms when your blood sugar is high?

Medical studies: What's in it for me?

2011-08-19T12:58:00.000-06:00

I was telling a friend of mine recently that I was going to be participating in another medical study, and I was rather surprised when her response was, "How does this benefit you?" I've been participating in studies for several years, and I can tell you, that's the first time I've ever received that particular response.

I won't lie. There are plenty of ways in which it does benefit me to participate in these studies, and that's part of why I do. I get paid — more for some studies than others — but because I don't get that money until the study is over (sometimes 4 or 6 months), that's not a major deciding factor. Many of the studies provide my insulin, needles, and test strips for duration of the study, which is a huge incentive for me, especially since my co-pays have gone up. Sometimes they provide gas cards (usually $20) for every visit you have to make to the doctor's office, which is nice considering the price of gas lately. Some study participants have to drive a long distance to get to the clinic, but I don't (and my car gets decent gas mileage), so those gas cards generally help to keep me in gas throughout the duration of the study.

I'd be lying if I said these weren't influential reasons why I do the studies, but they aren't the only reasons. I like being part of the process of new medications and devices coming out. I've gotten to experience continuous glucose monitors and new insulins this way. Usually these studies are a ways into the testing, too, so I don't have many concerns for my health and safety, and I can always back out of the study if that changes. And of course, there is always the satisfaction of knowing that I'm helping these new medications and devices become available to everyone. It's hardly my biggest reason for doing the studies, but it's still a good feeling.

So I'd say there's quite bit in it for me — but really, do I have to prove that in order for this to be considered a good thing?

Diabetes isn't a death sentence

2011-07-05T15:35:00.000-06:00

There was an article on USA Today the other day that I really appreciated. Not only did it specify that it was talking about type 1 diabetes, it also was attempting to dispel one of the fear-inducing myths surrounding diabetes: that as a type 1 diabetic, you are going to die young.

Life expectancy improves for type 1 diabetics

See? Isn't that beautiful? "Type 1" clearly specified, even in the title!

The article looks at life expectancies for type 1 diabetics in 2 groups: diagnosed between 1950 and 1964, and diagnosed between 1965 and 1980. Life expectancy for the first group was 53.4 years, versus 68.8 years for the second group. Compare that to an average of 72.4 years for the general population.

Of course, the article doesn't address people diagnosed after 1980, probably because none of us are old enough to start dying yet. (Ha, ha.) But I can only imagine that our life expectancy has gone up even more, and might even be about equal to the life expectancy of everyone else. In fact, because having type 1 diabetes makes you so health-conscious, I wouldn't be surprised if our life expectancy is even longer than the general population — we certainly pay more attention to diet and exercise than the average person does!

This just goes to show how much of a difference modern medicine can make. With modern insulins and glucose meters, pumps, and continuous glucose monitors, we are given such precise control over our blood sugars that we can actually mimic the insulin production of a normal body fairly closely. And if you keep your blood sugars within normal range most of the time, then theoretically you shouldn't have any of the complication of diabetes that come from having high blood sugar for extended periods of time. It may take a lot of work, but it's essentially like not having diabetes at all!

Progress on preventative vaccines for type 1 diabetes

2011-06-30T12:12:00.001-06:00

One of the top headlines on USA Today the other day reported mixed results on type 1 diabetes vaccine trials. One of the trials seems very promising — I don't understand all of this, and by the way the article is written I'm not sure the journalist did either, but it sounds like the vaccine essentially turns the patient's T cells into cells that protect beta (insulin-producing cells) instead of attacking them. The drug is in phase 2 trials, and so far so good — although it doesn't prevent diabetes, it looks like it can at least delay the failure of insulin-producing cells.

The article also reports on another trial, one that didn't work. The second trial was also looking for an antigen that would preserve insulin production in diabetics who were just diagnosed. The article says that the antigen works in mice, but not in humans.

What I find curious is that they are only testing these drugs on people who have already been diagnosed. Why? Modern medicine does enable us to identify people who will become diabetic, but aren't yet. For instance, the children of type 1 diabetics are often tested for signs of an autoimmune response, such as elevated T cells. I think it would be much more interesting to test these drugs on people who are destined to be diabetic, and see how long the vaccines would hold off their diagnosis.

Say which type of diabetes you mean!

2011-06-28T15:12:00.000-06:00

If you have read my earlier posts, you know that one of my pet peeves is people — especially journalists and scientists — not specifying which type of diabetes they mean.

Take, for instance, this article on the rapid increase in diabetes cases. Anyone who knows about diabetes can figure out that the article is talking about type 2, but they don't say it anywhere it in the article — not once.

Now, I don't have anything against type 2 diabetes, and I agree that the rapid increase is alarming. However, I think it's important to note which type of diabetes you are talking about. A rapid increase in type 1 cases would mean something very, very different than a rapid increase in type 2 cases.

Splitting your Lantus dose

2011-05-25T16:55:00.000-06:00

I recently decided to start splitting my Lantus dose. I tried this a few years ago, before I started doing so many studies, and didn't find it helpful. Recently, however, I became convinced that I really needed to. If I took Lantus in the evening, with dinner or shortly before bed, my sugars were consistently very high around dinner and bedtime, and I was at risk of crashing in the wee hours of the morning. If I took Lantus with breakfast, my sugars were always very high when I woke up — and I'm talking in the upper 200s. High.

The reason for this is that Lantus isn't perfectly even across the entire 24-hour period. It has a peak around 2-3 hours after you take it, and tapers off over the last few hours of the 24.

So I started splitting my dose. I take half with breakfast, and half with dinner. It works out great because it's not as important that I take it at the same exact time every night, and I'm not having as many problems with highs OR lows. If you have problems with dramatic swings in blood sugar that you think may be caused by Lantus's peaks and valleys, I highly recommend talking to your doctor about splitting your dose.

Medical studies: Should you participate?

2011-04-22T12:21:00.000-06:00

I don't often blog about it, but I participate in medical studies fairly frequently. I've done one study on continuous glucose monitors, two on new kinds of insulin, and one on a new kind of glucose monitor.

No matter what the study is, I generally enjoy participating very much. I wish I could say that I do it to help out the study of diabetes and to benefit other diabetics, but I'm afraid I'm not that noble. Some of the biggest reasons I do it are because I get to try out cool new medicines and gadgets for free, because the studies generally pay for all of my supplies, and because on top of all that, I get paid for it too. It's not a ton of money, but it's a nice little bonus, especially at the end of a long study.

How much they pay varies from study to study. I recently did one that paid $100 for just one day. That made getting up at 5:30am in order to get to my doctor's office by 6am totally worth it! Other studies may just pay $30 or $40 per office visit, but when you're in a study that lasts for months, that can really add up (and they pay it all at the end). I was in another study where I got a gas card every time I came in, which was highly appreciated considering gas prices lately, and the fact that I live across town from my doctor's office.

It also varies whether the medicine you get to try out really has any benefit to you. I didn't get to try out the new glucose meter, for instance, just had to give some blood for testing purposes. For one of the insulin studies I was in, I was actually randomly put into the control group, so I didn't get to try out the new insulin at all. (I didn't mind much, though, since they still paid for all my supplies during the study.) Another study I did, however, introduced me to a fantastic new type of insulin that I will be switching to the instance the FDA approves it.

Finally, not everyone feels this way, but I find the studies to be very interesting. I like getting to see firsthand the process that companies have to go through in order to gather enough data to submit their medicine or device to the FDA. I like meeting other people in the studies, both the other participants and the research assistants. I haven't had the pleasure of knowing other diabetics, so it's always nice to talk to others with the same condition.

My point is, though, that there are a lot of good reasons for participating in medical studies, and not all of them are altruistic. In my opinion it's well worth asking your doctor's office if they have any opportunities for you to participate in studies, and if not, where else you can check. It seems like university hospitals have the most opportunities, but some studies will even be advertised on Craigslist!

Diabetes book review: Diabetes for Dummies, Mini Edition

2011-04-13T23:51:00.001-06:00

Recently I bought a Nook, so when I saw the ebook of Diabetes for Dummies Mini Ediiton on sale for only 99 cents, it seemed like a good one to get and review on Proud Diabetic.

First of all, when they say "Mini Edition," they really mean it — the book is only 40 pages long. It also could be called "Beginner's Edition" or "Intro Edition," because most of it is pretty basic information. It starts out by explaining what diabetes is — type 1 and type 2 — and then addresses medications, insulin, diet, and exercise for diabetics.

On the whole, I thought this was an excellent ebook for people who were just diagnosed, know someone who was just diagnosed, or just want to learn the basics about the disease. It's not for someone who knows a lot about diabetes already, and I think there's actually some incorrect information.

A few things I had a problem with:

- The book tries to differentiate between type 1 and type 2 symptoms. Realistically, high blood sugar is really the main symptom of both diseases (rather than the disease itself, since the body gets there two different ways). Since both types of diabetes are usually found out because of high blood sugar, the symptoms are more or less the same. For instance, the ebook lists blurry vision under the symptoms of type 2, when I can tell you for a fact that it happens with type 1 too. The only symptoms that I think were accurately placed in only the type 2 category are numbness in the extremities (which tends to be caused by long term high blood sugars, and therefore usually isn't present when type 1, which comes on very quickly, is diagnosed) and heart disease (which is I believe a complication because of the combination of long term high blood sugars, and the weight problems usually present in type 2 diabetics).

- The book doesn't seem to know some of the facts about type 1 diabetes. It claims type 2 is more of a genetic disease, which isn't true because autoimmune diseases are definitely genetic (and because we don't know whether it's type 2 diabetes, or the weight problems that lead to it, that are genetic). It also claims that there is no way to tell for sure if you're going to get type 1, which also isn't true, because someone with the autoimmune disease will have certain antibodies in their bloodstream. It also claims that 90 percent of type 1 diabetics became diabetic because of a fever as a trigger, an old theory that was debunked in Dan Hurley's book Diabetes Rising.

- The book sometimes seems rather outdated. In addition to the fever-as-trigger theory and the apparent lack of knowledge about antibodies and the genetic nature of autoimmune diseases, the book is also shockingly outdated on other things. For instance, it describes two types of test strips, one that changes color (which tells you your approximate blood sugar) and one that gives you a glucose reading. Since I have not heard of anyone using the color strips in probably 20 years, I think this is glaring evidence that the book needs to be updated or probably just rewritten altogether, using the newest information.

- The author recommends a diet that is only 40 percent from carbs. Most studies indicate that high-carb diets are much healthier for you, heart-wise and in other respects as well. Since modern insulin can do such a good job of managing your sugars, a low-carb diet seems to be rather old-fashioned. For instance, I eat a very high-carb diet, and my A1c is consistently around 7 (even lower in the last year, because I was doing a study and was on a new insulin, a replacement for Lantus, that is just starting the approval process with the FDA). I also don't agree with him that low-carb diets make it easier to control blood sugar — I find that hours later, when protein and fats are finally converted into glucose, I end up with a spike in blood sugar if I've eaten a low-carb meal.

In other words, the book is a great intro into the subject, especially for the price, but I wouldn't let it be the final word on anything.

Using technology to manage your diabetes

2011-02-25T10:39:00.000-07:00

Yesterday, USA Today ran this article, about how smartphone apps keep health at your fingertips. I've been using an app to track my blood sugar for at least 6 months now, probably longer, so I found the article especially interesting — even though it didn't mention anything about blood sugar or diabetics.

I use a pretty basic iPhone app, called Glucose Buddy, for tracking my blood sugar. It was a free app when I downloaded it, but since then they've added a lot of fancy (and, at least for me, unnecessary) features that you have to pay for. They've also added advertising, which wasn't there before. However, it is a decent little app and does what I need it to do. I can input my blood sugar, insulin doses, gram of carbs eaten, exercise, and even (a newer feature, but still free) my A1c. To review past logs, I have to scroll down a list on my phone. The graph only shows the high, low, and average values for each day, which is too bad — I'd rather see a graph of all my values for one day — but it's still useful.

Do you use any iPhone apps to keep track of your diabetes? If so, which one or ones do you recommend? Please don't forget to include the price of the app, and if it costs something, what makes the app worth getting instead of a free app.

Energy drinks and diabetes

2011-02-17T11:46:00.000-07:00

The other day, this article ran in USA Today: 'Pediatrics' study disputes energy-drink claims. Essentially, studies are now contesting the claims of energy drink manufacturers, that the drinks provide any benefits for physical and mental performance. In fact, the study claims that the drinks can cause some serious health problems in kids with other conditions... such as diabetes.

I am curious if other diabetics have had similar experiences with energy drinks as I have. Caffeine usually causes an increase in my blood sugar, and energy drinks seem to be particularly bad. Every time I've drank them to try to stay up late to work on a paper for school, or something of the sort, I've ended up with ridiculously high blood sugar. I suspect it has something to do with adrenaline causing the body to release extra sugar into the blood stream.

What about you? Have you found that you need to avoid energy drinks, or even that you have to watch your caffeine intake?

Reviews of diabetic cookbooks

2010-11-17T14:21:00.000-07:00

I'm not much of a fan of the low-carb diets that are promoted for diabetics, but I do realize that having type 1 is a bit different than having type 2. Whatever type you have, though, this article has a few suggestions for holiday meals, based on some of the top diabetic cookbooks:

Holiday dishes fit for a diabetic

The white bean and tomato soup sounds especially good right now, with colder weather setting in!

My husband is a vegetarian and I consider myself a flexitarian, so I don't really eat a lot of meat around the holidays, even when we celebrate with meat-eating family members. No big loss to me, as I never really did like turkey. What about you? What do you usually eat around the holidays?

How to prevent insulin injections from hurting

2010-11-05T12:03:00.000-06:00

The other day I wrote about an article in USA Today, dispelling some of the myths surrounding diabetes. In addition to the 5 myths debunked in the article, the article started with a 6-question quiz to test the reader's knowledge about diabetes. One of the questions was about whether insulin injections should hurt — the quiz said no.

I was amazed at how many people took exception to that in the comments. A whole lot of adults started whining about needles hurting them, as one commenter put it. The thing is, I agree with the author of the quiz — with the advancements in medical technology, injections don't hurt if you are doing them right. The needles are 30 gauge or smaller these days, and shorter than a centimeter. I take between 5 and 8 injections every single day, and I hardly even feel them unless I do something wrong.

The vehemence in the comments made me wonder how many people don't know how to properly give themselves an injection. Many of these people said they had been diabetic for many years, and that's how they know it hurts. But that just makes me wonder whether they have seen an diabetes educator since the early days of their diagnoses, to make sure they are injecting themselves properly and using the most modern technology available.

I am not a diabetes educator by any means, but I can offer some tips from my own experience. Here is what I would recommend:

1. Make sure you are using the smallest needles available. With an insulin pen delivery system, you should be able to get ultra fine short needles, which are 30 or 31 gauge, and about a centimeter long (if not shorter). These are the needles I use, and I can tell you, I hardly feel them.

2. Choose your injection sites carefully. There are certain, more sensitive spots you should avoid. I like to give myself injections in the backs (the fleshy part) of my upper arms, the sides of my stomach, and sometimes my inner upper thighs. However, I was once warned by another diabetic not to give myself an injection too close to my belly button, because it can hurt pretty bad there.

3. Rotate your injection sites every time. I have noticed that if I give myself an injection in a spot that has been used too much lately, it will burn like the dickens — but that doesn't mean that injections hurt. It means I made a bad call. Your educator should tell you to rotate your injections every time, and this is one of the reasons why. (The other reason is because that spot will develop scar tissue that prevents the insulin from absorbing in your system correctly.)

I typically rotate back and forth between both sides of my stomach and both upper arms. However, just that much rotation isn't enough. You have lots of room on your tummy for those tiny little shots — use it! When you rotate back to your stomach, move your shots around so that you aren't injecting on top of last night's or that morning's shot. I vary my shots up and down on my upper arm and tummy, and further in and out from my belly button. Every square inch is a different injection site. There are many more injection sites on your body when you think of it that way, and very little reason why you ought to be causing yourself pain by injecting in the same place twice in too short a time.

4. Inject large amounts of insulin slowly. If you have a larger shot to give yourself — i.e., 15-20 units or more — it tends to sting if you shove it all in too fast. That is because your cells are having to essentially stretch to make room for all the insulin. Again, this is completely avoidable.

If you use a vial and syringes, you will have an easy time adjusting the speed at which you inject the insulin. Instead of depressing the plunger all at once, just do it in increments, a few units at a time. If you are on insulin pens, not all the pens allow you to do this — with Lilly pens, you just press the button at the end of the pen all the way in to inject the insulin. With other brands, however, the inner workings of the pen turn unit by unit as you press the button, allowing you control over how fast the insulin is injected.

These are a few of the tricks I have found work well to keep my insulin injections painless. Like I said, I inject myself a minimum of 5 times a day, and rarely ever feel any pain — rarely ever feel anything at all, even! If you have anything to add, please feel free to add it in the comments. I don't think anyone in this day and age ought to walk around thinking that it should hurt to give yourself insulin!

Setting the record straight on diabetes

2010-11-03T16:15:00.003-06:00

USA Today ran a great article recently on diabetes: 5 myths about diabetes. I love these kinds of articles, because they dispel the myths that are often repeated even by the media, but unfortunately they are few and far between.

If you read the article online, it starts out with a 6-question quiz about diabetes. If you have the disease and have a good handle on it, most of the questions should be easy. For instance, we all know that eating right as a diabetic isn't expensive, and most of us know that you can get diabetes even if no one in your family has ever had it.

The article dispels some of the more critical myths, in my opinion. For instance, it completely debunks the idea that diabetics can't eat anything with sugar in it. In explanation:

"We know now that table sugar doesn't raise blood sugar any more than other starches, like a baked potato, rice or bread," says Elizabeth Kern, director of the diabetes program at National Jewish Health in Denver.

I think there is still evidence that certain carbs raise blood sugar faster than others, but if you are aware of that, take the right amount of insulin, and monitor your blood sugar a handful or so of times a day, it won't be a problem for you.

The article also talks about how having diabetes doesn't automatically mean you'll have other complications such as blindness and kidney failure. Those complications are associated with untreated diabetes, so the article stresses the importance of proper treatment.

The final myth the article debunks is the idea that having diabetes will limit your career choices. It shouldn't — we have the ADA for that, though apparently military colleges can still deny anyone with diabetes. (WTF?) You may have to fight for it — my last employer tried to cover less of my health insurance premium than my non-diabetic co-workers, so I had to contact a lawyer — but having diabetes shouldn't have an impact.

In regards to this last one, I think that sometimes the only impediment to someone's career is actually in their head. I have heard diabetics complain about how crashing wipes them out, rendering them unable to come to work on time, or stay at work if they are already there. Crashing happens, but it shouldn't frequently happen with enough seriousness to impact your work performance if you take good care of yourself.

Can you think of other negative myths about diabetes that you would like to set straight?

Prevalence of diabetes going up

2010-11-01T14:25:00.002-06:00

There was a scary article the other day about the rising prevalence of diabetes:

Diabetes may affect as many as 1 in 3 Americans by 2050

Really? A third of the population? That is INSANE. C'mon people — lay off the fast food and the soda, and get off the couch once in a while!

Of course, I know that not all type 2 diabetics (what the article is primarily talking about) are diabetic because of diet and lack of exercise. But those factors are responsible for many cases of type 2 diabetes, and certainly for much of the rise in diabetes. Our American lifestyle has got to change, and fast, if we don't want a third of our population to be diabetic in 40 years.

Service dogs for diabetes?

2010-10-29T12:11:00.001-06:00

Service dogs are used for a number of odd things. For instance, I've read about service dogs being used to detect a seizure coming on — I guess they can smell the difference in the person. Heaven knows how you train a dog to do that!

I've always wondered whether dogs (or other animals, for that matter) can smell the difference in a diabetic who is crashing. Do my dogs know that something isn't right with me, even if they haven't been trained to do something about it? Furthermore, does my horse know if I'm riding him and my blood sugar goes high or low?

I guess dogs at least can sense it, according to this article about service dogs used for diabetic patients:

Dogs alert diabetes patients when blood sugar is off

I think the idea of a service dog for this is fascinating. The only thing I don't like about the article is the big deal it makes about this little girl crashing. Seriously, she is crashing more than 6 times a day? And is "knocked out for an hour" every time? And her parents had to check on her to make sure she hadn't gone into a diabetic coma during the night?

I am coming to realize that the media likes to exaggerate the dramatic moments of diabetes, and is probably eager to use someone as an interview subject who embodies the drama they are looking for. Because really, most diabetics, if they are in good control, shouldn't crash that often or be at risk a diabetic coma every night. And hey, it's not like you should have to need the dog's detection skills 6 times every day in order to deserve a service dog.

But I am getting away from what I am most interested in, which is: Do any diabetics out there have pets that respond to your low blood sugars in some fashion? I'm talking about just regular pets here, not trained service dogs. Have your cats, dogs, or other animals ever indicated that they know when you are crashing?

Cholesterol medication time?

2010-10-27T12:11:00.000-06:00

When I went into the doctor last week, I discovered that my cholesterol has gone up again. My LDL is up around 130-140 again. I think this is probably because I stopped drinking grapefruit juice months ago — I think the grapefruit juice was responsible for bringing down my cholesterol over the past few years.

My doctor is taling about putting me back on Lipitor, but I told him I want to try drinking grapefruit juice every day again first. He wants to recheck my cholesterol again next time I'm in, in 3 months. Even if my LDL is still around 130, however, I plan to tell him I won't take Lipitor again. Like I've said before, I don't believe I am truly at risk for a heart attack — I am healthy, active, and eat pretty well — and if I weren't diabetic no one would care about my LDL being around 130. If it keeps going up, of course I will reconsider, but I just don't feel that an LDL of 130 is worth risking the long-term effects of being on Lipitor for the rest of my life.

A scary finding about exercise

2010-10-03T12:39:00.000-06:00

I am aware that as an active diabetic, I am not the norm. I ride my horse several times a week at the very least, and my husband and I take the dogs for a brisk walk nearly every Saturday and Sunday.

As it turns out, it sounds like I'm not the norm for the average American, any more than I am the norm for the average diabetic. A national telephone poll found that only about 5 percent of those called had exercised in the last 24 hours. The majority of people polled had done nothing more active than food and drink preparation.

Yikes! What kind of country do we live in, that the height of our daily activity is standing in the kitchen, making ourselves something to eat or drink? I don't expect everyone to ride a horse every day, or even to go to the gym (I hate gyms). But for heaven's sake, how hard is it to take the stairs at every opportunity or take a walk on your lunch?

What do you do to try to get some exercise throughout the day, and what could you do to improve your activity levels?

Would you trade your heart for normal blood sugars?

2010-09-23T11:54:00.001-06:00

The increased risk of heart attack is one of the biggest incentives for diabetics to closely monitor and control their blood sugars. So why would you want to take any medication that makes it more likely that you'll have a heart attack, even if it does do a good job of lowering your sugars?

That's what I don't understand about why the FDA has chosen to keep Avandia on the market. The increased risk of heart attack is documented, so why would they allow the company to continue selling the drug, even if it is on a more restricted basis?

I wouldn't be surprised if someone is pressuring the FDA to keep the drug on the market...

Being diabetic BEFORE Lantus

2010-09-20T15:21:00.000-06:00

I got an ugly look recently at what it used to be like to be type 1 diabetic.

On Friday, for a study I am participating in, I was put on an older 12-hour insulin called NPH. I've heard that when Lantus replaced these older long-acting insulins, they revolutionized the way a diabetic lives, but I had no idea how true this was until this weekend. I was diagnosed shortly after Lantus came out, and never had to use anything else.

Well, let me tell you, NPH sucks. This is why diabetics didn't used to be able to delay or skip meals! Good heavens. I fight crashing from lunchtime until well after dinner, but when I wake up in the morning, my blood sugar is sky high. I rarely ever have readings over 400, but I've woken up with my blood sugar that high two mornings in a row now.

It is destroying my life. I have to snack and purposely run my sugars high, so that I won't crash while I'm doing something like riding my horse. Then I feel like crap all the next morning while my blood sugar comes down from its ridiculous high.

Luckily, I'm only on NPH for a week, and let me tell you, I can't wait to get back on a real long-acting insulin! If you still take NPH — and I know there are type 1 diabetics out there who do — do yourself a favor and ask your doctor about switching to Lantus and a short-acting insulin such as Humalog. You'll be amazed at the freedom you get from more modern insulins.

Avoiding too much medication

2010-09-07T13:36:00.000-06:00

One of my big beefs is how much medication we, as Americans, take. It actually made top headlines the other day, too: Prescription drug spending doubled in less than a decade.

Now, obviously part of this has to do with out-of-control health care costs. The cost of prescription drugs is rising rapidly.

But part of it also has to do with how many more drugs we are taking now. For instance, the percentage of people who took five or more drugs in the past month doubled as well, from 6 percent to 11 percent in 10 years. (Increases in those who took one or two drugs in the last month are more modest, but when you think about what this means in terms of the big picture, I think it's still pretty alarming.)

Why are Americans taking so many more drugs now? The most commonly used drugs are what you might expect: statins, antidepressants, and for children and teens, medications for asthma and ADD/ADHD.

I personally feel that as a society, we are overmedicating ourselves. Now there is a fine line to draw between what is actually needed, and what is too much. For instance, I really do need insulin, because my body no longer makes it (or at least not enough to keep me alive). A cancer patient really does need chemo, and someone who has had an organ transplant really does need the medications that keep his body from rejecting the new organ.

(You'll have to forgive me if there is a medication you really need that I haven't mentioned. I don't pretend to know much about other diseases, even if I know a lot about my own, and I'm sure many people are the same way.)

But where to draw the line? Do we medicate little Johnny to keep him from acting out in class, or do we try harder to work with him? Do we give someone statins to keep their cholesterol low, or do we encourage them to improve their diet and their lifestyle? Isn't the route of less medication, if it's available, always the healthier choice?

How empowered are you?

2010-09-03T17:56:00.002-06:00

There was an article on USAToday.com that I found encouraging: More 'empowered patients question doctors' orders. Apparently it is becoming increasingly more common for patients to do their own research, and want to have some input in their treatment.

The article talks about how people's attitudes and involvement in their own health care have changed over the years, as out-of-pocket costs have gone up — and as information has become easier to come by. For instance, one source mentions longtime diabetics who don't know what an A1c is or why they need it.

Doctors seem to disagree as to whether this is a good thing. Some doctors don't like it, while others — such as the one who talked about diabetics not knowing about the A1c — think it's a good thing for people to be more interested in their own health care.

I've talked before about my decision to get off Lipitor, which was made independently of my doctor. I've also talked about my first doctor, whose overbearing and accusatory bedside manner convinced me to switch. Clearly I am one of those "empowered" patients. However, I also know many people who seem to accept their doctors' orders blindly.

Where do you fall on the scale?

Obesity surgery controversy

2010-07-21T12:21:00.003-06:00

I recently blogged about my thoughts on Dan Hurley's Diabetes Rising, a fantastic book about the history, present, and future of diabetes. The one thing I noticed was that he was somewhat noncommittal on whether he attributed type 2 diabetes to diet — he claims early on that it's not as simple as that, but later in the book, he does a great deal of talking about an area of the country with the highest incidence of the disease: the number of fast food restaurants there, the lack of health education, etc.

Anyway, one subject he talks about that I didn't mention in my last post about the book was obesity surgery as a cure for diabetes. There are two types of surgeries — one that makes the stomach smaller, and one that bypasses part of the intestines. He follows a guy who has both surgeries, and almost immediately the patient goes off his diabetes medications, which hadn't been working very well. It is a miracle cure for him.

Well, this obesity surgery has come into the news as a treatment for diabetes. Although Hurley writes about it very positively, I have mixed feelings. Sure, there are probably people who biologically need it in order to control their weight and their diabetes. But I also fear that type 2 diabetics who could be helped by diet and exercise, won't try to live healthier lifestyles, because it's so much easier just to get the surgery and be done with it. I also worry that people who haven't developed type 2 diabetes yet, but are perhaps prone to it, will not try as hard to watch their diet or stay active, because hey — what's the point? If their lifestyle starts to affect their health, they just have to get a quick surgery, and ta-da — all better!

What are your thoughts on the issue?

Diabetes Rising by Dan Hurley

2010-07-18T18:08:00.001-06:00

I recently read Diabetes Rising by Dan Hurley, a book that takes a harsh look at the rise in diabetes and what is (or isn't) being done about it. Most of us have heard that type 2 diabetes is on the rise, which we blame on the poor American diet. We also know that 9 out of 10 diabetics are type 2, which those of us with type 1 diabetes tend to think puts us in the clear. Ours is considered a genetic disease.

But Hurley turns that theory on its head in his book. First of all, he talks about how the incidence of type 1 diabetes is going up remarkably quickly. Some people would say that's because of medical advancements — e.g., we know what it is now, people can survive long enough to pass the genes on to their kids, etc. — but Hurley goes through a whole list of factors that have been shown in studies to increase the likelihood of someone developing type 1 diabetes.

For example, an increased chance of developing diabetes is linked to:

* Wealth - Statistics show that children from wealthier families are more likely to develop diabetes.

* Milk - Babies who are nursed for the first year are less likely to develop diabetes than babies who are fed formula. There is a theory that until a certain age (6 months? I can't remember what he said) our children's bodies are not made to digest any protein other than what is in our own breast milk, and feeding babies with formula — which is made from cow's milk — makes a child more likely to develop diabetes later on.

* Lack of sunlight/vitamin D - Diabetes rates are highest in the northeastern U.S. and northern countries where kids don't get a lot of exposure to the sun, and a study in Europe (Sweden? Finland? I can't remember where) showed that vitamin D supplements decreased the risk.

I think there were others, but these are the ones I remember offhand. Hurley also discussed one man's theory that type 1 and type 2 are not, in fact, different diseases — that type 2 is simply what people prone to diabetes develop when they don't get type 1. The chapter describes it better than I ever could, but basically, people who have type 2 also tend to have the antibodies that cause type 1 (autoimmune) diabetes, and people with type 1 also tend to have resistance to insulin. The thought is that, whatever the trigger is, if you develop diabetes early in life, it shows up as an autoimmune response, while later in life it shows up as insulin resistance.

Hurley also spends a great deal of time talking about scientific advancements for treating diabetes, versus advancements for curing diabetes. He points out that more of the effort is focused on treatments than cures, presumably because there is more money in treating it than in curing it. He also discusses non-biological cures, such as combining pump and CGM technology to create an artificial pancreas. The FDA won't approve such a device, because it claims that a human needs to be involved in making decisions about treatment, but Hurley has participated in studies on such software and says that it is far more accurate than any human could ever be.

The history of diabetes treatment is also pretty interesting. The "tight control" era is a fairly recent phenomenon, made possible by the small miracle we call a glucose monitor. Insulin, on the other hand, has been around for nearly a century — although not nearly as effective or as precise as it is now.

I highly recommend Diabetes Rising for any diabetic, anyone who has diabetes in the family, or — heck — anyone who knows a diabetic. It is fascinating stuff, written in a fairly brief but engaging format — an easy, interesting read for anyone who is invested in the subject.

More on Colorado's high-risk health insurance pool

2010-07-08T11:40:00.000-06:00

In my last post, on Colorado's new health insurance program, I mentioned that I didn't know how the new program differed from CoverColorado, a state program already in existence to provide health insurance for people with pre-existing conditions.

I have my answer now, thanks to this article:

Ritter details Colorado's new high-risk health-insurance pool

The difference is that people in the new program won't be paying any more than normal, healthy people would pay for health insurance. CoverColorado, on the other hand, charges people about 130 percent of what a healthy person would pay.

Another way the new program differs is that people have to have gone without health insurance for at least six months in order to qualify. That eliminates all of the people in the CoverColorado program. Essentially, what this new program does is target the people who couldn't afford to pay higher than market rates for health insurance — even CoverColorado rates.

Health reform starts to go into effect

2010-07-06T17:24:00.000-06:00

Today is a big day in Colorado. Today our state launches a website to help Colorado residents get health insurance until certain provisions in the health reform bill go into effect.

New Colorado health plan to cover those with pre-existing conditions

The program seems to be based on a state program that already existed: CoverColorado, which allowed people with pre-existing conditions to buy health insurance. I'm not sure how the new program differs.

The state program, a collaboration with Rocky Mountain Health Plans and the state's high-risk insurance pool, CoverColorado, will offer coverage to people who have been uninsured for at least six months and have been denied coverage because of a medical condition.

Colorado officials are keeping many details quiet until Tuesday, but the U.S. Department of Health and Human Services said monthly premiums for the Colorado program will cost from $120 to $551 with a $2,500 deductible.

Interestingly, when I looked into CoverColorado in early 2005, there was no requirements about how long you'd been uninsured. Also, I believe the monthly premium for me — with my type 1 diabetes — fell within that range. The only thing I seem to remember is that I would have received a discount, since I made under a certain amount. But it was still several hundred dollars a month.

The actual deadline for individual states to implement this type of program was last Thursday, but apparently Colorado is still ahead of many other states. I suspect that having a similar program already in place made it easier to meet the requirements.

The health care bill's regulations prohibiting companies from denying people with pre-existing conditions won't go into effect until 2014, so the state programs are supposed to help people out in the interim. Hopefully, for the sake of people with diabetes and other pre-existing conditions, the rest of the states will get their acts together soon.