I just finished reading an article in Diabetes Health written by, like myself, a 32-year insulin dependent diabetic veteran, Riva Greenberg. The article is entitled “Mind-Shifting: A Valuable Tool to Control Diabetes.”
Ms. Greenberg attended a a "Coping with Diabetes" workshop given by diabetes psychologist Dr. Bill Polonsky. Apparently, Ms. Greenberg and most of the 100 people attending the workshop were under the impression that diabetes is the leading cause of a variety of diaseases including eye, kidney and heart disease. Dr. Polonsky (a non-diabetic) explained that this is false. Further, he continued, that “poorly controlled diabetes” is the leading cause of these diseases.
My initial instincts caused me to think “derr.” Then I remembered how much of the last three years I’ve spent trying to explain exactly the same thing to other diabetics. I can never figure out whether I’m more frustrated with the diabetics who believe that the inate consequence of being diabetic is major and often life threatening complications or with the physicians, researchers, studies, etc. who lead them to believe this.
For years I read (frequently in Diabetes Forecast) that diabetics had 20% shorter life spans. During that time I figure that meant I’d have good quality of life until age 60 or 65. Perhaps that was true minus rapid acting insulin, frequent glucose testing and yo-yo blood sugar. However, we now have rapid acting insulin, self-management and do not have to live with daily yo-yo blood sugar. Those tools, combined with learning from physicians such Dr. Richard Bernstein, means we no longer are restricted to such thinking.
The 20% figure does not go through my mind regularly anymore. Glucose testing, normalized targets and appropriate corrections can and do prevail in my mind now. They can and do prevail in a successful, positive attitude. They can and do prevail as I set my daily, weekly and monthly diabetes-related goals. I know what’s possible. I have seen it, read about it and live it.
I do not take the somewhat laxadasicle attitude that Ms. Greenberg does, however. I do not believe that a blood sugar of 265 is “just a number.” In my mind, a 265 is a cause for immediate action and later, analysis.
A blood sugar of 265 is more than 3x normal. It means I am spilling sugar into my urine. It is a point that is going to cause possible damage to my body and I do not like leaving my body in that state any longer than necessary.
I also know that as icky as the 265 is making me feel, the swing back down to 85 is not going to feel so good either. In my case, a 265 means I am not eating carbs until I return to normal. (I have a rule – no carbs >110.) It also means I can’t necessarily count on my 70/75 point response to one unit of Humalog or Apidra, since a blood sugar greater thabn 170 tends to cause some insulin resistance.
So, I enact my previously defined project plan of taking the mathematically correct 2 ½ units of rapid acting insulin. That should get me a blood sugar of 90 in about 2 hours. I might also do two things: 1) Inject the 2 ½ units in a little bit in two different spots on my arm. Less volume means speeds. I do not inject in muscle, however. 2) Add an extra ½ unit for good measure. Again, sometimes a 265 is going to cause a bit of insulin resistance and I want down NOW.
The next part of my plan involves patience. Minimally, I test my blood sugar at 60 minutes and 120 minutes. Often, I test at 90 minutes, since at that point I’m almost at peak of either Apidra or Humalog. If my blood sugar has not dropped a proportionate amount (relative to injection amount, starting blood sugar and previously noted dcrops in blood sugar based on similar circumstances), I am likely to take another correection and continue testing.
I will have already attempted to assess the cause of the blood sugar – food (rapid or late digestion), dawn phenomenon, hormones, adrenalin release, etc. Normally, in my case, it is not a miscalculation relative to food. It is something more difficult to second guess.
I am known for requesting the next tool to not be a new and better CMGS or pump but for a “liverometer” since it is my biggest nemesis. I would also like an insulin sensitization-ometer. I want to know the following information: when is my liver going to release glucose, when will it bother to stop, is my insulin sensitivity level being affected and by how much.
One final tool would be very helpful – digestion-ometer. It is impossible to properly inject insulin or set a combo-bolus on an insulin pump without knowing at what rate food is planning to digest. Digestion rates vary by person, activity level, time of day, type of food etc. I use my log and experience to “guess” what my body might do but it is impossible to properly predict all the time. Weighing food certainly helps but it is not an infallible resource either. Even eating the same food, in the same quantity, at the same time, at the same blood sugar starting point doesn’t always work. So … scientists, please make me a digestion-ometer!
So, though it is vital for patients to understand that complications are not inevitable and that the mere act of being diagnosed with diabetes does not put you in complication territory, I do not believe a number “is just a number.” I believe in responding to and learning from blood sugar numbers and the circumstances surrounding them (thus my log books).
Though I do not believe any one high is life threatening, I do believe that the percentage of time we spend out of target each day does lead to long-term consequences, whether they are defined as complications or not. Therefore, I will never feel comfortable just shrugging my shoulders at a blood sugar of 265. I will not have an anxiety attack about one number but I will not shrug either.
Doris J. Dickson