A New Beginning

Okay, as a lot of you already know, I'm a diabetic. This is type II diabetes, also called "late onset diabetes", and can -- results vary -- be controlled by diet, exercise and oral medication. And that's where I've been for the past seven or so years; using oral meds and watching my diet.

And, for the most part, the results have not been unsatisfactory ... but they've also not been entirely satisfactory.

If you've been reading my blog entries, you'd already know that I had a serious low blood sugar episode several months ago and that this was my primary reason for Reba joining us for training as a medic alert service dog (which she is working at very nicely ... but still in training.)

Still, for all this time, I've been depending on regular blood sugar tests (normally once daily when I get up in the morning) and oral medications. At the right, you can see the lancet pen (cap removed) which I use to puncture a finger tip and squeeze out a generous drop of blood. The lancet itself (dark object at the right end) is both disposable and, using a very fine needle, doesn't produce much sensation. Not entirely comfortable, no, but not a serious pain either.

Lower right shows the AccuChek glucose meter, a tube of test strips (left) and a single test strip (top). These strips use capillary action to siphon up a small sample of blood for testing and, after a brief interval, the meter displays a digital result. The test strips, of course, are one-time, disposable with no possibility of reuse since they depend on a chemical reaction to calculate sugar levels.

The AccuChek also keeps a record of my sugar levels and, once a day, reports these to TeleHeath where a nurse gets daily reports along with my blood pressure, pulse, weight and oxygen saturation. Alternately, I could also dump these records to my own computer but I rely primarily on the TeleHeath nurse to spot anything significant.

In a month or so, I get to switch to a newer meter ... which requires a smaller sample which can be taken from anywhere on the arm, etc. Results, even less discomfort. The only delay is that TeleHealth doesn't have the equipment yet to interface with the newer meters .. but soon.

In any case, relying on these measurements, I've also been taking oral meds (glypizide, most recently; tobutamide previously) in the morning and at dinner. And, for the past seven years, I wasn't doing too badly. My A1C's (a measure of long-term blood sugar levels) were running under seven (6.5-6.8) which I'm told is really outstanding ... for a diabetic, anyway. (For the rest of you, 6.5 or less -- preferably less -- is the target.)

First was the extreme low episode which had me crawling (literally) across the floor to reach a phone.

Second -- but also annoying -- was finding myself getting very sleepy after some meals ... at which time, checks were reporting blood sugars in the high 200's or low 300's. (Between 80 and 120 is ideal; anything below 180 is generally okay and comfortable.) Granted, an hour's nap was generally enough to bring my BS down to reasonable levels but (Lazy bones, sleepin' in the sun; How you gonna get yer day's work done? Sleepin' in the noon day sun.) it's also not a habit I wish to cultivate.

So, with the agreement of my doctor, for two weeks, I kept a record of my sugar levels roughly every two hours ... including one in the middle of my sleep cycle.

The result was not in line with what my once-daily checks had been showing. In the middle of the night, I'd be reporting sugars in the 70-90's (which is generally enough to wake me up to get something to eat) and then the low 100's when I got up in the morning.

But, during the day, I was showing levels in the 200's ... and sometimes higher.

This is not a good thing! (Saml. Johnson -- "Dictionary" Johnson -- noted that: "By 40, a man is either a fool or his own physician." I haven't been 40 in quite a while but I've always tried to fit in the latter category.)

When I went back to the doctor with my two week record, I'd also done a lot of research -- as had Mary -- and we were loaded with data.

The medications which I'd been using previously were all sulfonaureas; there's another medication -- metformin -- which is a glucophage and which seems to give very good results to a great many people ... much better results than I was having. Unfortunately, metformin also seems to be contraindicated for anyone with a heart problem (or my heart problem anyway ... which makes it a moot point).

I've already been though a long process of trying different levels of medication, varying what time of day I took how much, etc. None of it seemed to help much, some if it had very bad results.

Now, this does not mean that I have to inject myself at regular intervals. Instead, I need to check my sugar levels roughly four times a day (before meals preferred) and, if my sugars are too high before eating, I give myself an injection ... and then eat. Right away, no delay ... until the food's on the table, no insulin ... otherwise, I might send my sugars too low. (It's something of a balancing act, yes, but still a big improvement.)

At right (middle) is an insulin pen with the cap below. Above, the three objects from left to right are the needle package, the gray needle guard and, last, the needle itself.

To use an insulin pen, I tear open the needle package (paper seal), insert the pen and thread it down on the needle. Then I remove the needle and guard from the package, discard the guard and, once I've injected myself, I use the needle package to remove the needle from the pen and dispose of it in "sharps" container. (I know I'm not contagious ... but others don't know -- therefore, using a sharps container is simply a courtesy to everyone.)

The needle itself is a double-ended needle such that one end penetrates a seal in the pen and the other end is used to penetrate my skin. Since a fresh unit is used each time, I'm always using a sharp, clean needle. The needle itself is 31 gauge (very small) and only 8 mm (5/16th inch) in length ... just enough to penetrate the skin and reach the fatty layer below and the injection is quite painless. The amount of the injection (units) is selected by a dial on the top of the injector.

So, it's a minor inconvenience, yes ... but I feel better. Both physically -- since this lets me adjust when and as needed -- and mentally -- because the diabetes now back under my control, rather than being a hit or miss, one-size fits all situations.

And I guess I should say that there's a plus-side as well. After talking with my DAV Service Officer (that's Disabled American Veterans; I'm a life member), I'm told that the change from oral to insulin moves me into a totally new category for benefits (yes, the diabetes is service connected, chemical exposure and that's all I plan to say about that.) Granted, we haven't been missing any meals but we have been watching our budget very carefully ... so ... more money is not unwelcome.

And there are some other bonuses but the most important is having better control and feeling better.

Always remember, it doesn't matter who you are, where you are, what you own, etc -- health is always your greatest wealth!

As most (if not all) of my friends, family and acquaintances are aware, I am a very shy, retiring sort and not given much to experimentation or questioning authority ... Okay, okay, you can stop smirking now ... yes, I mean you. So, to get back to my point, during my first two weeks on insulin, I was injecting 2-3 times a day (before meals) for an average of 6 units per day. And things were certainly working better -- i.e., I was feeling better; no emotional jags, no naps after a meal because I simply couldn't stay awake, etc. -- but it still didn't seem to be optimized.

Therefore, after doing a bit of research -- or, more accurately, reviewing research we'd already done before even trying insulin or consulting with my doctor -- I made one more change: 5 mg of glipizide daily and insulin as required. (Previous, I had been taking as much as 20 mg of glipizide daily but had not been happy with the results.)

Results? Very satisfactory! Over the past several weeks, my blood sugar has been very much more stable even though my insulin requirements have dropped from 6 units daily (average) to 1.8 units daily (average, some days with none). Most important, I've never needed more than 2 units once daily, I've had no extreme highs and no extreme lows and, on average, my blood sugar readings have been almost as good as if I weren't a diabetic at all. Almost, that is -- this is a treatment, not a cure ... but it sure is better.