Split-Level

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I am writing this post to get into how the liver and pancreas work together to regulate blood sugar but also to ruminate on something that’s been a big mystery in my life for close to 15 years. Let’s dive right in:

 

I was 15. Only a couple years into largely managing my diabetes on my own and maybe a year or so into using insulin pens rather than syringes. My family and I lived in a split-level home with a kitchen, dining room, and two bedrooms upstairs and two more bedrooms plus a TV room downstairs.

 

On this night, I fell asleep on the couch downstairs. I woke up on the kitchen floor upstairs. Well, it was more like I woke up splayed out in the doorway connecting the kitchen and dining room. Pissed pants on the dining room carpet. Pounding head on the cool linoleum next to the dog’s food dish.

 

My grandmother woke me up: “Ryan, what are you doing on the floor?”

 

I rolled over. Mumbled something about not knowing how I ended up here.

 

“I think you got really sick.”

 

“Yeah. My head hurts. I think I peed my pants.”

 

“The refrigerator door was open. The clock is on the floor.”

 

“I’m sorry. I don’t know what happened.”

 

“I think you got really sick. Do you feel low? Let’s check your blood sugar.”

 

135 mg/dl. Oddly normal. But it had to be diabetes. To my knowledge, I’d never sleepwalked before. Plus, I had the kind of searing headache I only got immediately following an episode of particularly low blood sugar. Or, you know, the kind of headache you get after cracking your noggin on linoleum.

 

I didn’t go to the hospital like I maybe should have. I guess the thinking was the emergency had already passed, and I was ok now. Grandma and I went back downstairs. I went to sleep on the couch again. She slept on the chair on the other side of the room just in case anything else happened that night.

 

We’re still not completely sure what happened, but here’s what I do know:

 

To put things simply: your pancreas and liver work in tandem to keep your blood glucose levels steady throughout the day. When you eat a meal, your pancreas sends out insulin to break down carbohydrates into glucose for energy. The liver hangs on to any extra glucose and stores it for when you need it between meals or during sleep.  The liver knows when to disperse its stored sugar because when glucose levels start to drop off, the pancreas will secrete a hormone called glucagon. When that glucagon is secreted, the liver knows to send some of its stored glucose into the blood stream to keep blood glucose levels and energy levels steady.

 

If you or someone you know has diabetes, you may have recognized the term glucagon. That’s because all diabetics are (or at least should be) armed with a glucagon kit. It is usually kept in a bright red case and works something like an EpiPen with the additional step of mixing the actual glucagon with the diluting solution contained in the syringe. When someone’s blood sugar is low to the point that they are unconscious or unable to safely eat or drink something, a glucagon shot is administered to kickstart the process of getting the liver to release more glucose into the bloodstream.

 

Let’s assume the reason I stumbled upstairs to the kitchen, knocked a clock off the wall, opened a refrigerator door, and passed out on the floor was extremely low blood sugar. No glucagon shot was administered. Yet, when I came to, my blood sugar was damn near perfect. So that leaves me with two ideas as to what may have happened. One: my liver began kicking out glucose at the very last minute. That doesn’t quite make sense, though. Any extra sugar my liver had would have been spent in trying to slow what was apparently a very rapid descent. From everything I’ve read, I just don’t think it’s possible that my liver just held out until the last second like that. But I am certainly no doctor. Maybe someone reading this can tell me if that’s a thing?

 

The second, and I think more likely option, is that I managed to eat or drink something right out of the fridge moments before collapsing. This is a scary thought, because I don’t remember doing that at all; I don’t remember any of it. And if my blood sugar was low enough to knock me out, it was low enough for me to forget how to chew and swallow. I could have easily choked on anything I managed to get into my mouth. By choking or by abysmally low blood sugar, the chances of my brain losing its supply of oxygen and/or glucose for a catastrophic amount of time that night were incredibly high. If things happened the way I think they did, I am incredibly lucky to still be alive with a functioning brain.

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What is This A1C You Speak Of??

 In this blog, I bring up hemoglobin A1C a lot. I realized recently that if you are not diabetic or have never been tested for diabetes, you most likely have no idea what that means. And if you’re recently diagnosed or have pre-diabetes, it may be a new and confusing term for you. I’ve been diabetic for 22 years, and I only recently really understood it on a level beyond “High is bad, low is good.” So, to help remedy that and hopefully clear up any confusion, today I will try to answer the question: just what the hell is A1C??

 

The short answer: an IQ test for blood glucose management.

 

The long answer: Hemoglobin is a protein found in red blood cells. This is where glucose that has not been broken down by your body for energy can be found. The A1C test measures what percentage of your hemoglobin is coated with sugar (the term for being coated with sugar is “glycated,” which is why the test is sometimes called a glycated hemoglobin test).

It is used as a diagnostic tool and as a way of measuring how well someone with diabetes has been controlling their blood sugar. It’s good for these purposes because it gives your doctor a good idea of your average blood sugar for the previous 3 months. The higher percentage of glycated hemoglobin, the higher your 3-month average blood sugar. An A1C score for a healthy individual without diabetes should be between 5 and 6 percent. Here’s how the numbers break down, courtesy of Mayo Clinic:

 

A1C level Estimated average blood sugar level
5 percent 97 mg/dL (5.4 mmol/L)
6 percent 126 mg/dL (7 mmol/L)
7 percent 154 mg/dL (8.5 mmol/L)
8 percent 183 mg/dL (10.2 mmol/L)
9 percent 212 mg/dL (11.8 mmol/L)
10 percent 240 mg/dL (13.3 mmol/L)
11 percent 269 mg/dL (14.9 mmol/L)
12 percent 298 mg/dL (16.5 mmol/L)
13 percent 326 mg/dL (18.1 mmol/L)
14 percent 355 mg/dL (19.7 mmol/L)

 

I hope this post was helpful in clearing up any confusion you may have had as to what exactly an A1C test was! Mayo Clinic’s website is a good source of information on this and any other health issues if you are looking for more!

I’m Waiting for the Man

 

I’m waiting for my man.

26 dollars in my hand.

 

Nervously walk up and down the aisles. Some of these health and beauty products would be nice if I had the money. It is a Wednesday, and I have 14 dollars in my checking account. It is just about 4PM, though. If I write a check for 255 dollars to pay for the insulin, it won’t get to the bank until Thursday. Hopefully the bank won’t get it processed until Friday when my convenience store paycheck of 475 dollars is deposited.

 

He’s never early. He’s always late.

First thing you learn is that you always got to wait.

 

It is just about 4PM, though, and the pharmacist had to fax my doctor to authorize a refill. There is a chance this might not get filled until tomorrow. If that’s the case, I’ll be headed to the emergency room tonight. I’ll have to hang my head and tell them I ran out again. Beg for any Novolog samples they might have lying around. I’ll get a bill for 600 dollars from the hospital later, but I’ve heard you can get away with not paying those kinds of bills for a while. Should have come in yesterday when I knew my supply was getting low, but then the check would have bounced for sure. Shouldn’t have spent those nervous 2 hours swearing and chain smoking in the parking lot, but what is one supposed to do before walking into hell. Don’t know why a lifelong-need prescription must constantly be reauthorized. Can’t live without it. Can’t really sell rapid-acting insulin on a street corner. Unless there are others in my predicament. Of course there are, but I need this.

 

Up to a brownstone, up three flights of stairs.

Everybody body’s pinned you, but nobody cares

 

This Hy-Vee grocery store is my nightmare. An anxiety-ridden and easily overstimulated brain leaves me averse to supermarket crowds as it is. Throw in money woes, constant fears that I got here too late, and a pharmacist who rolls her eyes and sighs every time she sees me, and it is enough to crush me right into the slick concrete floors. They all know. Look at me in my Goodwill clothes, my flannel jacket reeking of smoke, my ignored hair greasy and standing on end. Look at my nervous shuffle, head down. They know I don’t take care of myself. They know as well as I do that I should be ashamed. They know I can’t even scrape together the cash to pay for what I need to live but have no problem shelling out 8 bucks a pack for cigarettes. They know I’m too afraid or too lazy to do the necessary work to get health insurance. Hell, they probably think I’m here to rob the place. I’d be lying if I said it never crossed my mind. I probably wouldn’t succeed, but a quick death from a cop’s bullet is a fabulous dream when you’re eternally hopelessly mired. Give me cash or give me death. Just stop looking at me.

 

He’s got the works, gives you sweet taste.

Ah then you gotta split because you got no time to waste.

 

“Albertson? Your prescription’s ready. Still no insurance?”

“Thanks,” I shout as I write out the check too quickly to be legible. Ignore the insurance question. They know the answer. I just need to get the fuck out of here before a mob of pharmacy technicians, endocrinologists, and 77-year-old women pricing out hams banishes me to the uninsurable wilderness where I belong. They all know this check is rubber until payday.

 

“Thank you! Have a nice day,” the eye-rolling pharmacist says unconvincingly.

 

If I stick around long enough to respond, the conversation will go:

 

“You too! I’m actually planning on drinking myself to death tonight!”

 

“I don’t give a fuck, asshole. Get out of the line. The people behind you have the cards with the pretty Blue Crosses.”

 

—But I don’t stick around to respond.

 

I’m feeling good. I feel oh so fine

until tomorrow, but that’s just some other time.

 

I fill my insulin pump with the sweet stinking anti-nectar as soon as I get back into my car. Light another cigarette for good measure. Nearly cause four separate accidents speeding out of the parking lot. I talk to myself out loud over the dumb angry music playing through my car stereo. A sad little monologue on how this will be the moment I start to turn things around. This is the time I finally learn my lesson. Bright and early tomorrow morning, I’m making an appointment with my doctor that I simply must show up for. Tomorrow, I’m calling up the county to see if they can help me out. No more paying out of pocket for this ridiculous shit. No more shame-filled hours in the emergency room or in grocery store parking lots. Yes, tomorrow I will take my first big steps to a healthier and happier me.

 

But I went through a lot today. Tonight will be about relieving some stress. Tonight will be about laughing and singing and drinking with the roomies. Drinking. Yes, it must happen. Drinking to forget about today and most likely tomorrow.

The Cost of Innovation: 30 Million Lives

I know what life without health insurance looks like for a diabetic. It is a cranky and penniless existence manifested nervously in lines at the pharmacy and in vinyl chairs in the emergency room. It involves more bare-knuckle mathematics, sweaty rationing, and talking angrily to an empty room than the daily grind of a junkie on his last 26 dollars.

$250 for one goddamned vial of Novolog insulin.

Two-Fifty. One vial — about three weeks worth of life-sustaining insulin for me. For 250 bucks. For some diabetics who use other types of insulin, the price tag is even higher and the vial may not go as far. For some, dropping upwards of 600/month on insulin is a part of life. $600 per month just to not die the grizzly death that diabetic ketoacidosis provides.

And here’s the big kick to the kidneys: Even for many with insurance, the out-of-pocket expenses needed before reaching their deductible can be high enough to put them on the street, in the emergency room, or in the morgue before that deductible is reached.

Yes, we’ve got a problem. However, it wasn’t always like this, and it doesn’t need to be like this now.

Frederick Banting discovered insulin in 1923. A patent was placed on it and sold to the University of Toronto for one dollar with the names of his colleagues– Charles Best and James Collip– but without his own. The idea that anyone would attempt to make a profit off of something necessary to keep people alive violated Banting’s own personal code of ethics. What a hunk, am I right?

Ah, it would be great to return to the days when people had personal codes of ethics and only paid one dollar for things. I think we would all love to see the pharmaceutical industry adopt Mr. Banting’s way of thinking. But that was 94 years ago. Banting is long dead, and the last century has brought great progress. Progress no doubt gained by streamlining the economics of medicine by removing pesky morals from it’s design.

So instead of just pointing at Banting’s grave and screaming, let’s take a look at where we are now and some potentially more effective ways forward.

Numbers are a little hard to report efficiently simply because there are so many different types of insulin used, so we’ll take a look at two of the most popular forms of rapid-acting insulin (taken with meals and to treat high blood sugar) for a small sample of what we’re dealing with. (Graph from Business Insider)

insulin-prices-humalog-novolog-v2

 

It should be noted that Humalog and Novolog are made by two entirely different pharmaceutical companies: Eli Lily and Novo Nordisk, respectively. So you may be looking at the graph again and thinking, “I mean, yeah, that is an absolutely ridiculous price increase over just 20 years, but what a strange coincidence that two ENTIRELY SEPARATE drug makers’ prices would stay exactly the same for so long!”

You aren’t the only one to notice that, and it is probably not a coincidence. Earlier this year, Senator Bernie Sanders called on the federal government to investigate these pharmaceutical companies for price collusion.

Now, why on earth would 3 apparently competing pharmaceutical companies (Eli Lily, Novo Nordisk, and Sanofi) want to work together to make sure their prices match? Shouldn’t businesses in any industry want more reasonable prices than their competitors? Shouldn’t the competitive nature of the business drive prices down?

Haha. You would sure think so.

Unfortunately, when real progress and longstanding notions of how the economy should work stand in the way of maximizing profits, industry enemies may turn to each other for help in turning on us. If they all raise their prices together, they all get more money. Everyone wins. Except for the millions of diabetics who handed over that money

And what about that dirt cheap patent? Hasn’t it expired yet? Where are the generics?

The original patent actually expired 75 years ago. However, drug companies have been able to make enough changes and improvements over the years to keep the patent perpetually renewed. And that is largely these companies’ answers when you ask them about rising insulin costs. They will say that this is the cost of innovation. “You want your insulin to be as effective as possible, right? We need this ludicrous pile of cash for research and development.”

They’re not wrong, but it is a completely bullshit answer to the question. Researching more effective types of insulin costs a lot of money. Producing insulin in a lab isn’t cheap either. But raising prices at a rate 450 percent the rate of inflation? That simply does not match up with the kind of results their research and development has brought. Meanwhile, profit margins remain incredibly high

So what is the answer?

The calls for investigations into price collusion are a good start. That patent that turned from a symbol of goodwill to one of all-encompassing greed should probably die so that more generics can be introduced.

In the long term, though, we need to push for a single-payer healthcare system in the US. In the UK, the government sets the price it is willing to pay for drugs and other medical necessities. Manufacturers are forced to compete to provide the lowest possible price or else risk losing the entire nation as a market. Here in the United States, Medicare, our government-funded health insurance program isn’t even allowed to negotiate with the pharmaceutical industry the way private insurers are. Let’s bug the ever-loving shit out of our elected officials to change that. Let’s make Medicare for all a reality, and force open that spot at the negotiating table. Let’s give diabetics (along with every other human in the US who needs a prescription at some point in their life) the leverage in a discussion on what the cost of staying alive should be.

 

 

Quick Update

Humalog List Price

The graph above tells a story that is all too familiar to diabetics. It mentions Humalog specifically, but the same story is true for Novolog, Lantus, etc.

There will be more full-lengths posts coming this week. One of which will cover the reasons why the price of insulin (along with so many other life-saving medications) has increased so dramatically in recent years and what we can do to bring them down–or at least stop their climb.

Keep your head up, and stay healthy!

Vicious Sleep Cycle: Hashimoto’s Disease, Depression, and Diabetes

It is hard telling what came first: giving up on managing my diabetes, severe depression, or a form of hypothyroidism called Hashimoto’s Disease.

Type-1 diabetes is an autoimmune disorder, and having one autoimmune disorder often means developing a second one at some point in your life. Like a bad low-level employee, if your immune system fucks you over once, you can almost count on it happening again. One of the more common secondary autoimmune disorder for people with type-1 diabetes (and one of the most common causes of hypothyroidism in the US) is a thyroid condition called Hashimoto’s disease. And it makes sense that these two chronic conditions would be pals when you look at the very similar way they operate.

In type-1 diabetes, the immune system sees the pancreas as a foreign object in the body and attacks its insulin-producing cells until there is little or no insulin production at all. In Hashimoto’s, it’s very much the same story, except this time your dumbass immune system thinks your thyroid gland is a foreign object and attacks until production of the thyroid hormone free thyroxine is greatly impaired. The symptoms of hypothyroidism, brought on by Hashimoto’s disease or any other condition, are: fatigue, weight gain, sensitivity to cold, constipation, reduced exercise tolerance, irregular or heavy menstruation, and depression.

Depression. The big D. The slow-moving, all-encompassing landslide that has made it incredibly difficult to even get across the street at different points in my life. I was first diagnosed with major depression and general anxiety disorder when I was 13. I tried a couple different anti-depressants at the time. They worked pretty well, but I became uncomfortable with the idea of taking them. So I stopped suddenly (can’t recommend the suddenly part.) Long story short, I stumbled through the last few years of adolescence and the first few years of adulthood. Never in a deep dark depression, never in a suicidal state. I was just kind of there. Terrified of new people, having oddball mood swings, and never quite able to finish anything I started.

At some point in college, I began to slip. I would miss classes for long streaks. I would stay in bed all day, not really sleeping that much but not really doing anything either. I eventually dropped out, and in the years that followed, the mood swings, lack of energy, and social phobias only got worse. There was a week-long stay in a psych ward in 2015 followed by a couple different prescriptions for antidepressants. After that, my mood seemed to be mostly stable, and my anxiety levels were manageable. But I was still fucking exhausted all the time.

I pinned this incredible laziness on high blood sugar. All of the above happened at the same time I was losing control of my diabetes. High blood sugar for an hour will make you sleepy. Can you imagine what high blood sugar for the better part of a decade will do?

Well, I wasn’t wrong, but there was more going on. Early this year, I was referred to an endocrinologist by my regular internal medicine doctor. He immediately noticed my inflamed thyroid, ran some tests, and determined I had Hashimoto’s disease. I probably had for quite some time. He prescribed a hormone treatment (just one small pill a day), and wouldn’t you know it, my energy levels almost immediately bounced back to levels I hadn’t known since childhood. Not only that, but I was thinking more clearly than ever, and my mood improved even further. And, as I’ve slowly reigned in my blood sugar, all of this has only gotten better.

It has, of course, been fantastic feeling both my physical and mental state improve so much this year. But, this has also lead me to a chicken-egg scenario. Did my hypothyroidism lead me to laziness and depression, which lead to me not taking care of my diabetes? Or did the depression come first, leading to me not taking care of myself, putting my body and mind under more stress, damaging my thyroid through constant battery of adrenaline and cortisol? How exactly did I become such a lazy diabetic?

I suppose that doesn’t much matter at this point. I’m spinning on a good cycle now. Treating my thyroid levels has given me more energy to take care of my diabetes. Better control over my diabetes gives me even more energy to take care of myself. This year has felt like a new beginning for me. Largely because of a literal pain in the neck. Depression and extreme lethargy are so 2016.

 

Here are some sites with good information on hypothyroidism and it’s effects on the body and brain:

Thyroid.org

Everyday Health

Piss and Vinegar: Your Body on Ketoacidosis

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As I’ve mentioned in previous posts, for several years I did not check my blood sugar because I had no health insurance and could not afford both insulin and test strips. Such is the heartless nature of capitalism and my own unending trail of bad decisions. But hey! I had an insulin pump! I could still dial in the carbs, skip over the pesky “ENTER YOUR BG” screen, and more or less get the insulin I needed! Modern technology wins again! Right?!

Haha. Wrong.

Don’t get me wrong, modern technology has been great for diabetics like me. The standard Medtronic insulin pump has made life so much easier! I have much more freedom to eat what I want, when I want, and still maintain much better control over my blood sugar.

That is, if I use it correctly. The one big thing missing from modern tech in diabetes management is an ability to reign in free-will, laziness, and missed insurance premiums. You see, in the spring of 2014 (on my birthday, in fact), my insulin pump screwed up–and so did I. It wasn’t delivering the steady basal rate needed to keep my blood sugar at healthy levels between meals. This actually happens on a regular basis; the tube the insulin travels through gets clogged or kinked somewhere. Then the insulin pump will start beeping at you with increasing volume and frequency (if you ignore the warnings, you also start peeing with increasing volume and frequency.) The screen will read NO DELIVERY and won’t let you do anything else until you change your tubing and/or infusion site and fix the problem. Then insulin can flow freely from your pump to your bloodstream again, and you’re golden.

Well, on this spring day in 2014 (my 24th birthday, in fact!) my pump decided, “Hey, this guy hasn’t entered a blood glucose reading in 2 years! He apparently doesn’t give a fuck if he lives or dies! Why waste precious battery life letting him know he’s not getting any insulin!”

The previous evening I had gone out for pizza with a woman I was dating to celebrate my birthday (did I mention this all happened on my birthday?) It was good shit. Fancy Greek pizza with gyro meat and tzatziki sauce. I ate a lot of it. Lots of delicious carbs right down the ol’ gullet. Dialed a rough approximation of how many carbs I’d eaten into my pump and went home. After a couple hours, I started feeling very sleepy, so I just went to bed.

I awoke on the morning of my birthday throwing up like I had never thrown up before. It was AWFUL. I thought maybe I had food poisoning. Or, there were chest pains, so maybe this was a heart attack? My joints ached and were too weak to stand upright any longer than it took to get from my bed to the toilet. Maybe a nasty stomach bug?

When it ceased, I was very hungry, so I decided to try eating. I inhaled a couple bowls of cereal. I managed to dial in the carbs and press ACT on my pump (still not actually getting any insulin, still not getting any warning) before I was back porcelain-side, sending my Cinnamon Toast Crunch down the drain. The day went on like this: Sleep for an hour or two, throw up for twenty minutes, repeat.

It finally got to the point where almost nothing was coming up. Just dry heaves accompanied by small amounts of stomach acid. My lips were a dehydrated white, and my mouth tasted like fire. That’s when I made my way to the emergency room.

When the ER doc got word I was a type-1 diabetic, she of course asked what my blood sugar was the last time I checked. I sheepishly told her I hadn’t actually checked in awhile.

“How long ago?”

“It’s uh… it’s been awhile–hey! I’m really thirsty! Can I get some ice chips?”

They checked my blood sugar, and it was of course insanely high. I can’t remember exactly what the reading was, but it was apparent that I had gone into diabetic ketoacidosis. DKA happens when your body is unable to break down glucose for energy (this happens when there is no insulin in your system) and begins to break down the fats and proteins in your body for energy instead. The acids from this broken-down fat and protein ends up in your bloodstream and wreaks havoc on everything in sight. I was pretty far along in this process by the time I made it to the hospital. Again, I can’t remember any of the exact numbers, but I remember very clearly the ER doctor using the phrase “extremely acidotic” several times. Left untreated, my organs would have eventually begun to shut down. I probably would have gone into a coma before dying a desiccated husk of a man. On my birthday, no less!

Luckily, I was able to make it out, not only alive, but without so much as slight kidney damage! Many people who experience this are not so lucky. I hope none of you reading this ever have to go through an experience like my own. But the truth is, many do. There are right around 200,000 cases of DKA in the US every year. Unfortunately, an experience like this is how many people come to find out they have type-1 diabetes.

But that wasn’t the case for me. I knew better. I just thought I couldn’t afford to do better. If I’d had insurance and been able to afford test strips, I probably never would have stopped checking my blood sugar altogether. And if I was checking my blood sugar regularly (or, you know, at all), I could have seen my numbers continuing to rise even as I attempted to give myself more insulin. I could have seen something wasn’t right and made the necessary changes before this became an emergency situation.

But I didn’t. Because I couldn’t. Also because I didn’t feel like putting in the effort to get some goddamned insurance. I guess the moral of this post is, if you have diabetes, either type of diabetes, take care of yourself. I know a lot of things have been in limbo as far as health insurance goes lately, and diabetics have always been considered “uninsurable.” But you’ve got to do everything you can to fight for access to the supplies you need to take care of yourself. Once you’ve got that, you have to use those supplies effectively to monitor and control your diabetes before it completely controls you.

Your life depends on it.

What is Type-1 Diabetes? How does it differ from Type-2?

I think for many people there is a bit of confusion as to what the difference is between the two main types of diabetes, how they operate, what kind of care they require, what causes them, and what their respective effects can be. So, I’d like to briefly go through some of the main differences and similarities right away in this early post!
Type-1 diabetes is what I was diagnosed with when I was 4 years old. It is also the primary subject of this blog. Type-1 is caused when a body’s immune system sees the pancreas as a foreign object and begins attacking and destroying it’s insulin-producing cells. This greatly inhibits, and in many cases, completely destroys the body’s ability to produce its own insulin. This is a serious problem because insulin is key in the digestion of food. Insulin takes the glucose you consume in food and drink and converts it into energy. Without insulin, the glucose builds up in your blood stream, making you weak, irritable, and all kinds of thirsty. A high enough build-up of glucose in the blood stream  puts a lot of stress on all of your internal organs (especially the kidneys.) And in the extreme cases, your body begins to break down fat and proteins for energy, sending acids called ketones into the blood stream. Diabetic ketoacidosis (something I will get into in a later post) can eventually lead to coma and ultimately organ failure and death.

Fun stuff!

Luckily, it doesn’t have to come to that these days. Type-1 diabetes can usually be managed pretty well with close glucose monitoring and insulin injections. There have recently been some big breakthroughs in technology for managing type-1 diabetes that has and will continue to make life easier for people living with this chronic illness. Insulin pump and continuous glucose monitoring technology has come so far in recent years that the term “artificial pancreas” has even been thrown around. And while no cure has been found yet, there seem to be multiple reports coming out every year from researchers who appear to be getting awfully close!

Doctors still aren’t sure what initially causes the body’s immune system to attack the pancreas in patients with type-1, but there are some ideas that have gained traction.

Type-2 operates under different mechanics but can lead to many of the same complications and has many of the same symptoms. Type 2 diabetes happens when the body becomes resistant to insulin or does not produce enough insulin. It is most often associated with obesity, poor diet, and lack of exercise. But it can also just come on in old age if it is in your genetic cards. Most people with type-2 are not insulin dependent. They may need few insulin injections if any at all. Many type-2 diabetics are able to manage the disease with pills. Type-2 can often (but not always!) be reversible with changes in diet and significant weight loss. This is not the case for type-1 diabetics.

I have simplified a lot of this information, and there are many more details and defining characteristics in both types of diabetes. Hopefully this was at least enough to give you a solid idea of the differences between the two. I will certainly be going into more detail about each (especially type-1) in posts to come!

Future of the blog!

I started this blog to document my progress in getting my diabetes under control and to educate readers on type-1 diabetes. So, for these first few posts, I am going to be focusing mostly on straight information. Definitions for some of the terms I’ll be using in later posts and some information on the finer points of the disease itself. Once I get to posting more frequent updates on my own personal journey, I will move these informative posts to an FAQ-type page and link off to them when necessary!

The Early Days

In January of 1995, I became a very thirsty, very sleepy, and very cranky little boy. I was a few months from my 5th birthday, so I don’t remember many details. I do remember my mother taking me in to urgent care. I remember the first finger prick. My first blood glucose reading was 365. Blood sugar levels in a healthy person should be between 80 and 100. Diabetes mellitus, or “type-1” diabetes was the diagnosis.

Immediately after my initial diagnosis, I spent some time in the hospital while doctors figured out correct insulin dosages and gave my parents and grandparents what had to be an overwhelming deluge of information including what my diet should look like and how best to administer insulin shots.

My family did a great job taking care of me. Particularly my parents, for on whom most of the burden was placed. Sure, I had a few scary incidents with particularly high or low blood sugar, but I survived and came out of childhood a pretty healthy person.

The teenage years were a little bumpy, as the responsibilities shifted from my parents to myself. A whole set of high-stakes chores for a moody, hormonal, and severely depressed and anxious (more about that later) teen meant more than a few scary incidents. But my family was still always there to fall back on when I had any problems, and by the time I was 18, I had this shit down.

This was when I got started on an insulin pump. This made life so much easier. I had much more freedom in what and when I could eat. As long as I kept checking my blood sugar regularly and entering in how many carbohydrates I was consuming, I was golden. I did great with this at first. I was checking my blood glucose 6-8 times a day. My hemoglobin a1c was well within the healthy range for a type-1 diabetic, hanging around 6-7.

A couple years later, I was living on my own and going to college about 150 miles from my parents. I kept up with everything pretty well until I missed paying a few premiums on my health insurance and lost it. Insurance is essential for a diabetic, particularly in the United States. Insulin is incredibly expensive, with prices ranging right around $250. And test strip prices can vary considerably depending on the type of meter you use. So without insurance, diabetes becomes much more dangerous than it already is. Especially when you’re living on a college student’s budget.

So I stopped checking my blood sugar. Completely.

The thinking was this: Without insurance, I could only afford either insulin or test strips (the thought of purchasing a meter that used cheaper supplies apparently never dawned on me). I could survive without checking. Not well, but it was doable. I could still bolus for what I ate, just without the adjustments based on my glucose levels — and that, I thought, could be eyeballed based on feeling.

This was a fucking terrible idea.

I should have sought out other forms of assistance. But I didn’t. Laziness and ignorance got the best of me. Years (YEARS) went by, and I kept stumbling along like this, somehow survivng. There was a lot of money borrowed from roommates and girlfriends just to pay for one vial of insulin. There were a few trips to the ER. There was one run-in with the dreaded diabetic ketoacidosis. I always managed to miss deadlines to sign up for insurance policies. Getting myself to doctor appointments was always a problem. My a1c was, at one point, right around 11.

And that brings us to about two years ago, when I finally got on a good state insurance plan (Minnesota really has it’s shit together with things like this.) The pendulum should have started swinging back to healthy, right? Well, old habits die hard.

I had gotten so out of the habit of doing things right that despite my several near-death experiences, it has been incredibly difficult for me to get back on track. Difficult to even check my blood sugar more than once or twice a day.

I have gotten slightly better recently. In the last year, my a1c has gone down to 9.2. A big improvement, for sure, but I’ve got a long way to go. And that is why I am starting this blog. I want to chronicle my progress and my mishaps on the way to taking better care of myself. I hope that in the process, I can educate anyone who finds this blog on what life with type-1 diabetes is like. And I hope I can make anyone else out there who has fallen by the wayside feel a little better. Like you’re not alone. That, if you are currently struggling with your diabetes (or any other chronic illness), you don’t need to stay stuck in despair. Things can and will turn around with a little effort.

If my lazy ass can do it, so can yours.