I recently learned of a famous diabetologist, Dr. Lawrence in England, who made all the endocrinologists he trained take a shot of insulin to experience an insulin shock. He felt this was necessary for them to become good doctors.
Then I met the father of a little girl with diabetes who told me something interesting. Out of concern for their young daughter, his wife wanted to know what hypoglycemia felt like. She found the non-diabetic counselors at her daughter's diabetes camp had already tackled this question. They told her if she took 15 units of Regular insulin, she could have a good "low." It worked. She described hunger that was stronger than anything she had ever thought humanly possible. (Please don't try this on your own.)
These are the same parents who set the alarm and get up every night at 2 a.m. to test their daughter's BGs. Now the mom knew first hand what her daughter's hypos were like. But did she really?
Taking insulin and knowing you're going to get a hypoglycemic reaction is quite different than getting a completely unexpected hypo - such as when you're conducting a meeting, or even worse, while you're sleeping.
On the flipside is the worry of another diabetic friend. He tests 6+ times each day and takes insulin almost as often. His active three- year-old son hovers around him each time trying to get in the act. "I want to test like you daddy," he says. He has walked into the room and seen his son with the cap off one of his insulin syringes. "Sharp," the boy says with respect.
This Dad's nightmare is walking into a room and seeing his son using the syringe like daddy does - taking an injection of insulin. He works at keeping his diabetic supplies up high and out of the way - which is difficult when he needs his sugar and supplies so many times each day.
Luckily, my own kids don't care about the needles so much, but they do go for the glucose tablets. "Daddy's medicine" we call it.
Recently, I was at an international diabetes meeting and had the chance to talk with a diabetologist from Germany. She runs the C-Peptide test on every one of her patients. She claims that she can't prescribe the correct treatment until she knows exactly how much insulin the body is still producing - which can vary significantly from patient to patient. (The C-Peptide test can tell you if your body is still making any insulin on its own.) I liked this woman's ideas so much I asked her to join our advisory board. Please welcome Elke Austenat, MD, who is preparing an article for us about the need to use the C-peptide test. Keep an eye out for her article in a future issue.
In July I attended a lecture by the International Diabetes Federation President and endocrinologist, Jak Jervell, MD, who spoke on the topic of type 2 diabetes. He pointed out that our ancestors used to forage for food six hours each day. This burned a lot of calories. My own grandmother chopped wood every morning to get the stove going before she could make breakfast for a dozen farm hands. After she was done in the kitchen, she worked in the garden swinging a grub hoe.
These days many of us have desk jobs. But unfortunately, we still have the genetic programming to gorge ourselves when food is readily available. I think the real answer to the approaching epidemic of type 2 diabetes is to go back to our roots and get more activity in our everyday routine. I wish that doctors could write prescriptions for six hours of foraging a day.
This leads to a controversy on type 2 diabetes currently being discussed in professional circles. One side believes that type 2 diabetes is the result of sloth and overeating. They say "if the patient would just lose weight, the type 2 diabetes would go away."
The other side believes that type 2 diabetes is a genetic disease with the patient being the victim. "You don't blame a patient for something they inherited - they can't help it." This camp looks to science to right this situation with pills.
Much headway is being made here. I had dinner with an endocrinologist who told me some of his type 2s take 12 medications a day. With several new pills on the market, and new ways to combine them, type 2s might take two, three or four pills to lower blood sugar, more to lower blood pressure and something to lower lipids.
Now that the FDA has cleared prescription drugs for television advertising, we are going to see even more diabetics getting educated and requesting new drug treatments.
Last night I talked with a gentleman who wasn't happy with his therapy. His doctor had him on an older class sulfonylurea drug and wouldn't let him try one of the new insulin sensitizers now available for type 2s.
I pointed out that it may be his health care plan which is pressuring his doctor to keep him on an older and cheaper drug.
I suggested he look his doctor straight in the eye and say, "If you can't give me a good reason why I shouldn't try GlucophageÂ¨, RezulinÂª or PrecoseÂ¨, then I want your to prescribe it for me."
On that note, I got a call from Carol, a long time reader who lives in Florida. She told me a interesting story. Her insurance plan decided all those insured would now have to use the same meter. They told her she could not get her usual strips which fit in her small meter. The meter they wanted her to use came with a carrying bag the size of a man's shaving kit. She told the company the new machine would never fit in her purse and would therefore limit her ability to test away from home.
The company replied that she did not need to test more than three times a day. Carol protested that her frequent testing (8 times per day) kept her A1c in a good range. The company representative told her the A1c was not an important gauge.
At this point Carol got angry! She told the representative with quiet restraint that "I am the mother of three young children and I pray to see them grow to adulthood. This is why I work so hard on control. If I don't get what I need my A1c numbers could skyrocket. I would be delighted to sue the insurance company in advance for my expected premature death and would see that part of that pre-death claim would involve the insurance carrier paying all bills for my children through graduate school." She added that this case would make national headlines and set a wonderful precedent. The next day Carol's full order was delivered, including sufficient strips to test frequently with her current monitor.
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