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Re: [IP] Brittle Diabetics
Kathy Bruckmeyer wrote:
>... I was wondering if there are any brittle diabetics out there who are
>pumping and has being on the pump helped give you better control?
I've had IDDM (Type 1) for almost 30 years. I certainly consider myself to
be brittle. My basal doses and boluses can vary considerably from day to
day. At constant activity and diet, the basal can vary from 0.5-1.3
units/hr. At constant exchange values, my dinnertime bolus can vary from
8-14 units. Insulin requirements generally persist for a few days and then
change again. I can recognize changes to the basal requirement much faster
than those to the bolus. If I'm taking too much basal, I'll have repeated
low blood sugar episodes at unexpected times. If the basal dose is too low,
I'll have a very particular sluggish feeling and blood sugars that climb
slowly and steadily when I'm not eating.
The pump has certainly helped. When any basal change occurs, I can react
instantly. When I was on MDI, I had to wait for the long-acting insulin to
complete its activity first. (This eliminates over 12 hours of needless
wait with Ultralente, my last long-acting insulin.)
My control is no better statistically now than it was prior to the pump,
considering the distribution of blood glucose values, the generated
statistics, and my A1C values (which, surprisingly, have continued to be in
the middle of the normal range). I feel better about the treatment I'm
providing myself with the pump, though, since I know that I'm reacting as
fast as modern technology allows to the whims of my body concerning its
insulin requirement. Only closed loop control could be better.
Slowly, I learn to recognize new influences. It took me years to conclude
that low-level sinus infections were at work. It then took several more
years to find an effective treatment. After the sinusitis subsided, the
amplitude of the changes decreased dramatically, but there were still other
changes that persisted. Years later, I discovered that I'm sensitive to
certain milk products, especially ice cream and whipped cream. Eating a
couple of scoops of ice cream will elevate my basal for about two days.
Whipped cream in any quantity has an even more pronounced effect.
Lately, I've noticed that I'm seeing either accelerated insulin absorption
or delayed release of my meal from my gut -- I'll eat and administer my
bolus, start a reaction as I finish dessert, treat the reaction, and
observe elevated blood sugar about 5 hours later. The bolus I'll need to
administer is *exactly* what's needed to compensate for the sugar used to
treat the reaction. I'm using square wave boluses to contend with this.
Over the years, I've had short periods of up to several months when my
insulin requirement stays stable. Diabetes is truly simple to manage at
such times and, for me, such periods are like a vacation from diabetes.
Those periods end as quickly as they begin and for no discernible reason.
None of my endocrinologists has been able to do more than skeptically shrug
their shoulders at all this. After all, my A1C tests are good, as is my
overall health -- I have no overt diabetic complications. So any discovery
I make is due to my own persistence. It's slow, since I'm my only subject
-- few diabetics ever complain about changes to insulin requirements,
except when talking about their kids and the effects of "growth hormone".
It appears, then, that the incidence of brittle diabetes is very low.
To summarize, the pump helps me respond more quickly when my insulin
requirement changes, but it hasn't diminished the frequency or intensity
of those changes.
Hope that helps.
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