Profiles in Type 1: Kent David
Diabetes was a graduation present from high school when I was 17. I was getting ready to go on a cross-country trip with a friend. In retrospect, I realize that I was symptomatic before we left, but I didn't recognize it at the time. I lost a good 20 pounds on the six-week trip, and I was spending all my time peeing and having my tongue stick to the roof of my mouth. It was pretty miserable. At a certain point on the way home, I called my parents and said "You might want to make an appointment for me at the doctor because something is not quite right."
I got home, saw the doctor, and spent the next week in the hospital, putting on five pounds a day in fluids. My blood sugar when I got into the hospital was around 400. I was certainly ketoacidotic. I don't know how far away I was from coma, but I clearly looked like what I was, which was an undiagnosed, untreated diabetic.
As soon as I got out of the hospital, I went off to college. I didn't have any choice but to deal with diabetes on my own-I wasn't living at home with my parents looking over my shoulder. In a way it might have really helped focus me not just on my health, but also on my studies and life at the big college. I wasn't pleased about it, but what are you going to do? At that point, maybe I was young enough that I just felt "This is a challenge that I'm going to have to deal with."
There was no time to wallow in self pity. I just had to move forward. Anyway, I was really happy that I could sleep through the night and that I wasn't peeing all the time, and I loved college. So I was actually a pretty happy guy, just with the unfortunate side effect that I had something extra to be responsible for.
I didn't hide my diabetes, but it was a little awkward-I would go to the bathroom to take my shots at a restaurant, for instance. I certainly was more concerned about how other people would react to me taking a shot than I am now. At some point as an adult, I realized, "I'm not going to the bathroom to give myself a shot," and that was really liberating.
I don't think that I ever ended up in the emergency room when I was at school. I was in fairly tight control and I certainly had bad lows, but nothing too dramatic. I've awakened in the ambulance a couple of times, but that was back in the NPH days. When I am awake, I've always been fairly aware of my lows or impending lows. I'm a fairly deep sleeper, however, so all of the problems I've had have been when I've been asleep.
I started on porcine insulin-NPH and regular. I switched over to Humulin shortly after it became available. Really, the biggest change for me that was a huge positive was probably the change from NPH to Lantus. I've certainly appreciated improvements in testing, but in terms of mitigating the number of lows and being able to go on long bike rides without plummeting, Lantus was a huge step forward.
When I became diabetic, I started with the strips that turned from blue to green to brownish. They were pretty good, but there was still a lot of technique involved in taking your blood sugar by reading a test strip. The first meters that came out had a little light in them and would judge your blood sugar based on the color of the strip; it was a photoelectric means of assessing the darkness of the test strip. There was a fair amount of technique involved in using those devices. You had to put the blood on the strip and then blot it off, and depending on how hard you blotted it off, you could affect the reading fairly significantly. There was a lot of recalibration. It was great to have something that was perhaps a little more accurate than the read-it-yourself strip, but they weren't great.
Then came meters that operated on an electrochemical basis instead of an optical basis. Reagents in the strip would react with the blood sugar in your sample, so the meter would give you a number based not on optical properties of the test strip, but on the chemical properties. So it was a little bit more reliable, a little bit less dependent on testing procedure and how well you blotted the strip.
Of course, the strips require much smaller samples now, and the technology has certainly gotten better. But in terms of being able to treat one's diabetes, those have been incremental steps. It's nice to have smaller meters, it's nice that they're quicker, it's nice that they need smaller drops of blood, but at the end of the day, they're still giving you the same information. It's important, but not nearly as important as the step to continuous glucose monitoring (CGM), which for me has certainly been an eye-opening experience.
I've had the Dexcom Seven Plus CGM for about a year and a half, and it's really a quantum change in my treatment. I've learned a great many things. I learned that my nighttime Lantus dose was too high because I was decreasing every night in a constant downward slope. You don't get that information with testing blood sugar. You test your blood sugar and say "Okay, I'm at 100, I'm perfect, I'm going to bed." You don't realize that you're at 100 and jumping off the cliff and about to be at 60 in five minutes. Or that you're at 100 and on your way to being awakened at 3:00 AM with your blood sugars at 200.
The CGM allows you to know, before you go high or low, that you're heading in that direction. Before I got the CGM, I was over-correcting when my blood sugar was high. My calculation was off by a fairly significant factor because I was correcting for the peak and not for the total duration or impact of a shot. I'd take a shot and it would work-within an hour I was where I wanted to be-but I didn't realize that within another hour I'd be too low, because I just didn't have that data.
Using a standard meter is like driving with your eyes closed and then opening them every hour, or like looking backward, versus seeing a movie of where you're going. It's a change in paradigm, really, and I've found it very powerful.
Despite the fact that I have a CGM, I use multiple daily injections. I haven't gotten the pump yet partially because the idea of having a catheter or Sof-set under my skin all the time was a little abhorrent to me for a long time (although having a CGM certainly has gotten me over that hump). Also, having young kids who climb all over me made me a little bit less willing to have the tubes snaking around.
I've also resisted because MDI has worked fine for me. My control's been good, and my numbers are fine. My last A1C was 6.4%, so there hasn't been any impetus to go that route. Still, I'm probably headed in the direction of getting a pump as a result of my experience with the CGM. I'm beginning to realize, "Well jeez, I'd actually like to be able to use different sites that I can't really use at work, and I'd like to have the ability to give myself smaller doses conveniently." If I take a unit at 70 mg/dL per unit, that's probably more correction than I need all the time.
The flip side to that is, I don't want to walk around with a utility belt worth of stuff. I'm probably looking more toward the patch pump because I'd prefer not to have those snaking tubes, but I'm kind of just dancing around the edges of investigating that right now. What I'm really looking forward to, and I know it's not that far off, is the integration of the CGM that I like with the pump that I like. I think that both things will come together sometime in the next two years or so, maybe sooner.
The one frustration that I've had due to my CGM is the new knowledge of just how long it takes sometimes for my shots to work. I used to think, "Okay, I take my Humalog, and 30 minutes later I'm good." But now I realize, "I take my Humalog, and depending on how active I've been and where I gave myself the shot and how lucky or unlucky I am, in a half hour it might just start working." Now I know just how slow it is. That's new knowledge, so it's good, but it's certainly been a source of frustration.
Another thing that I've learned from the CGM is that perhaps the most important thing that I do to control my blood sugar is be active. I've remained fairly active during my 30 years of having diabetes, and I think that's probably what's really saved me from having any complications. It's not that I'm a great diabetic-it's just that I've stayed active.Click Here To View Or Post Comments