Diabetes Self-Management Blog

It was 2:30 AM last Friday, and I was being bombarded with alarms. No, I wasn’t dreaming. My insulin pump was telling me it was low and my continuous glucose monitor (CGMS) was telling me I was low.

Sometimes, technology can be too much of a good thing.

I was, of course, glad to know that I was sliding into hypoglycemia before I got to the fuzzy-headed, shaky sweats stage, but I do have glucose tablets and gel on my nightstand and could have stayed in bed. However, I did have to crawl out of my nice, warm bed to put insulin in my pump.

Note to self: Check level of insulin in pump before going to bed.

Back to the CGMS, however. That was the second time I’d been awakened in the early hours by an alarm telling me my blood glucose had slipped below the range I had set. Seems it’s time (again) to change my basal rates.

I needed to lower my basal rate and could not, for the life of me, remember how to do it on my relatively new pump. So I e-mailed Abby the trainer, who immediately called me back.

“Change your diet?” she asked.

“Yeah,” I acknowledged. “That, plus the seasons are changing, it’s the fortieth anniversary of the Age of Aquarius, and the moon is in the sky.”

Herself a pumper, Abby commiserated, saying she’s constantly having to change her basals for some odd reason or another.

There’s a saying that the only thing consistent about diabetes is its inconsistency.

Go ahead. Prove me wrong. Do the same thing and eat the same foods at the same times for two days in a row. Tell me your blood glucose is the same both days. Betcha it isn’t.

I remember weeks when I couldn’t get my blood glucose down. I ran high and giving myself insulin in an attempt to bring my blood glucose down was like dumping the stuff into a black hole: Nothing happened. Then, as if by magic, the insulin miraculously began to work—and I couldn’t keep my blood glucose up. The latter happens, of course, overnight. It doesn’t make for a good night’s sleep.

It wasn’t until I starting pumping nine-plus years ago that I realized how sensitive our bodies are to changes. Changes in diet; changes in the weather; changes in stress levels; changes in other things that are happening in our lives…I’m not sure all health-care providers realize that.

People with Type 2 diabetes have other changes. I wish I had been told early on that it would likely require medication and then additional medications and, finally, insulin (and then additional insulin) to keep my blood glucose levels in a decent range. While the word is that Type 2 diabetes is progressive, it’s more like beta cell failure is progressive.

For that reason, diet and exercise may work—for a while. And one pill may work—for a while. Combinations of pills may work—for a while. This much insulin may work for now, but may not later. Over the years, my body has required more insulin to help me metabolize the same amounts of food. A sandwich that used to take two units of insulin now takes four times that much.

An article published in the Southern Medical Journal in 2004 points out that “It is the inability of the endocrine pancreas to compensate for peripheral insulin resistance that leads to hyperglycemia and the onset of clinical diabetes. It is increasingly believed that this ß-cell failure is at least partly genetically preprogrammed, rather than driven by or a consequence of insulin resistance.”

What that means in “English” is that Type 2 diabetes occurs when your pancreas is unable to manufacture enough insulin to overcome your body’s resistance to it, and that the failure is partly genetic rather than “it’s all your fault because you got fat and lazy.” Although it does help to remain active and eat more healthily than most Americans do. Whether they have diabetes or not.

Had I been told that beta-cell deterioration was inevitable (as were the resulting changes), I might not have felt (been made to feel?) like a failure because I kept needing more…well, crutches, as it were.

In 1998, the results of the 20-year-long, 5,000-subject United Kingdom Prospective Diabetes Study (UKPDS), which followed people with Type 2 diabetes, was released. You may have heard that the study proved that intensive management reduced the risk of complications in people with Type 2 diabetes (just as the Diabetes Control and Complications Trial—or DCCT—proved with Type 1 diabetes). Which is great.

But another fact that emerged was not as well publicized: “There is an increase in blood glucose levels with increasing duration of Type 2 diabetes—an upward trend noted in both the conventional and intensive treatment groups of the UKPDS,” said an article in a 1998 issue of Diabetes Care.

Intensive treatment included increasing the treatment dosing or adding treatments if a person’s blood glucose rose above target.

So, as time elapsed, even people with good control, who were being closely monitored, required more and/or multiple drugs (including insulin) to maintain blood glucose control. Apparently, there’s nothing those of us with Type 2 diabetes can do about it: Even with good control, it’s likely to take more and/or different drugs to maintain good blood glucose control. It’s just those crazy beta cells continuing to poop out.

Perhaps, one of these years, science will discover a way to change that.

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Insulin & Other Injected Drugs
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FDA Approves Inhalable Insulin (07/03/14)

 

 

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