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Debbie and I left St. Louis and moved to Chicago after we both graduated. While in Chicago, I met with a few more endocrinologists and other specialists about my diabetes. By this time, I was growing more and more frustrated with the constant swings between highs and lows. Nobody had any answers – just the dame old rhetoric about “This is what your insulin is doing; you just need to adjust to it.”
Then I had the most severe low blood sugar of my life. It came in the middle of the night after I had been playing full-court basketball earlier in the evening. According to Debbie, I was pale and completely unresponsive. My limbs jerked uncontrollably. She called for paramedics, according to the reports, I fought them off pretty well while they tried to put an IV in my arm. When I finally regained consciousness, Debbie was standing next to me with an exhausted , worried look on her face. I also saw blood. My blood. On the pillow. On the sheets. On the floor. Everywhere.
That experience really shook me up. I found a guy at a nearby diabetes clinic who specialized in exercise. He gave me some suggestions about self-adjusting my long-acting insulin and eating extra food to prevent the nighttime lows after exercise, but he emphasized that my doctor would have to approve any such changes. It was the first time anyone had introduced the concept of self-adjusting my own doses. Why hadn’t my doctor told me about this? And why in the world would I need his approval to make these kinds of changes?
That exercise physiologist opened my eyes to more than just a few minor dosage changes. He set me on an entirely new career path. I liked his approach so much that I decided to become an exercise physiologist for people with diabetes. So what if there were no full-time jobs for exercise physiologists at diabetes centers? I loved exercise. I had diabetes. And I was on a mission to put the two together and help as many people as possible. So I went back to school, earned my master’s degree in exercise physiology, and landed a position with the Joslin Diabetes Center’s affiliate office in Philadelphia.
Being a New York/New Jersey native, Philadelphia seemed close enough to home – and it had it’s own NBA and NFL franchises (I don’t think I could live in a city that did not have them). So we packed up and moved to Philly, where I became the Joslin Center’s full-time exercise physiologist. I have to admit – my office was really cool. It had weights, treadmills, bikes, video equipment, and a great view of the sports complex in south Philly. The only thing better than my office was the team I worked with. The doctors, nurses, and dieticians were heavily into the concept of flexible insulin dosing and self-adjustment. I cross-trained with them at every opportunity and absorbed as much as I could about the many facets and components of diabetes care.
Perhaps the biggest breakthrough in terms of my own self-care was my decision in 1994 to try the insulin pump. Nobody at our center had used one, but there was mounting interest on the part of the patients to have an insulin pump program. So I decided to be the guinea pig.
I’ll never forget how nervous I was the day I got hooked up to that little gray box. There were about twenty doctors, nurses, and administrators watching my every move. Luckily, I had a super-nice trainer named Bob who coached me through the whole programming and infusion set change process. My first infusion set was a bent needle (the needle actually stayed in all the time). Soon, a flexible tube infusion set became available , followed by a set that could be disconnected and reconnected easily. Before that, you had to stay connected to the pump all the time – during showers, sports, even sex.
The pump’s adjustable basal insulin patterns and mealtime blousing feature really helped to stabilize my blood sugar levels. For the first time in almost 10 years, I could sleep past 8 a.m. without having my blood sugar skyrocket. I could delay my lunch without bottoming out. And best of all, I could work out to my heart’s content without going low in the middle of the night. In fact, I haven’t had a single severe low blood sugar since I started on the pump 10 years ago.
Along with the pump therapy came a whole new approach to dietary management: carb counting. By counting the grams of carbohydrate in my meals and snacks, I can now eat what I choose as long as I match it with the correct dose of fast-acting insulin.
Speaking of insulin, the introduction of insulin analogs (lispro and aspart) in the late 1990s has had a tremendous impact on my diabetes management. Unlike Regular insulin, which takes 30 minutes to start working, 2 to 3 hours to peak and 5 to 6 hours to fade, the rapid-acting analogs peak in about an hour and only last 3 to 4 hours. They do the job and then get out of the way. Gone are my readings of over 300 right after eating. I can also be more spontaneous and flexible in terms of what I eat and when.
Of course, there have been a few other improvements along the way. My blood glucose meter now takes less than 1 microliter of blood and performs the test in 5 seconds. The old ‘Guillotine” has been replaced by an adjustable lancing pen with lancets that are micro-thin. I can barely feel the finger pricks anymore. If I choose, I can even take a reading from my arm or leg. I can do a Hemoglobin A1c in 4 minutes with a machine that I have in my office, and everything – from my pump to my meters to my carb counting book – is downloadable. Heck, my latest insulin pump can practically do my taxes for me!
Technology aside, the thing that has made the greatest difference in my life with diabetes is learning how to match my insulin to my needs. No more molding my life to fit my insulin program. Now, I shape the insulin program to fit my life.
As proud as I am of what we have accomplished in diabetes management, I can’t help but recall how proud my original endocrinologist was with the state of things back in 1985. twenty years from now, I’ll probably look back to today and think, “Man, that was really archaic.”
God, I hope so.
Why Manage?
Diabetes can be a dangerous and deadly illness – if you let it. Millions of people have had their lives shortened and seen the quality of their lives suffer, due to poorly managed diabetes.
There are countless examples of people with diabetes who have excelled in all aspects of life: professional athletes such as Jonathan Hayes (football), Catfish Hunter (baseball), Bobby Clarke (hockey), Chris Dudley (basketball), Bill Talbert (tennis), Michelle McGann (golf), Kris Freeman (skiing), and Gary Hall (swimming); entertainers such as Mary Tyler Moore (The Dick Van Dyke and Mary Tyler Moore shows), Jean Smart (Designing Women), and Zippora Karz (the New York City Ballet). Pioneers Bill Davidson (co-founder of Harley Davidson), Thomas Edison (inventor), Ernest Hemingway (author), and even Miss America 1999, Nicole Johnson.
Unfortunately, this group represents the minority of people with diabetes. More typical is my wife’s grandmother, who lost her legs, her eyesight, and eventually her life to poor control of her diabetes.