Think Like a Pancreas (Continued)
I was also given a bottle of test strips and taught about blood sugar testing. No meter, mind you. Just test strips. These strips had a big square box at the tip that had to be covered with blood, blotted, and then timed before matching the color on the strip to the color chart on the bottle. Pale blue meant you were 40–70 mg/dl (a bit low). Light blue, 70–100 (low-normal). Ocean blue, 100–125 (normal). Aqua-blue, 125–150 (slightly above normal). Just plain aqua, 150–200 (a bit too high). Aqua-green, 200–250 (high). Sea green, 250–350 (very high). Green, 350–450 (very, very high). Brownish green, look out. In other words, determining your blood sugar required an extremely sensitive eye for subtle differences in pastels. Hey… when I grew up, there were only eight crayons in my box of Crayolas. And none of them were "sea green".
The bottle of test strips came with a medieval torture device called an "Auto-Let." The Auto-Let had a small disposable platform with a hole, where you placed the victim . . . er . . . I mean, your finger. A disposable 25-gauge lancet was placed in the firing mechanism, which swung around at a high speed like a pendulum to stab your finger and make it bleed. I called it "The Guillotine."
Then I met with a dietitian—a tiny, middle-aged woman who taught me the fine art of the "exchange" diet.
"You really don't have to change what you eat that much," she told me. "You just have to be careful not to eat too many concentrated sweets, fats, or very large portions of anything." Apparently, she had no idea who she was talking to.
I can still remember my "generous" 2,500 calorie exchange diet—chock-full of fruits, vegetables, meats, milks, fats and starches. Oh, how I hated that diet sheet. I was hungry constantly. The exchange system meant that everything I ate had to be placed in a category, and that I could only eat so many things from each category at each meal and snack. Talk about sucking all the fun out of eating!
My first "exchange diet" meal looked so puny on the plate. A sandwich, a piece of fruit, a cup of milk, and a handful of chips. And there were no seconds, thirds or fourths like I was used to having. I was hungry all the time.
The first couple of weeks were really rough. Even after starving myself and doing everything I was asked to do, the stupid test strips kept turning aqua-blue instead of sea green (or maybe it was the other way around). I cried a lot those first couple of weeks. My mom told me that my dad, normally an unemotional guy (a chemical engineer by trade), was crying, too, and that he wished that it was him, and not me, who got diabetes.
A few weeks after my diagnosis, I purchased my first blood glucose meter—a Glucometer, to be exact. It weighed about a pound and was the size of a sandwich (but without the onion smell). The testing procedure is still etched in my brain: Guillotine, then squeeze out a big "hanging" drop of blood, dab the big box on the strip, start the counter, wait 1 minute, blot the strip and insert it in the meter, press the button again, and wait 90 seconds for that 58 or 314 to appear. (Just once, wouldn't you like to see a meter advertisement where the reading on the screen wasn't so darned perfect?)
That meter lasted about a year. Then Lifescan came out with its first One Touch meter, and I jumped to get one. Imagine—no blotting, a round test area (it's not easy covering a square box with a round drop!), and only 45 seconds from stick to finish. I was in hyperglycemic heaven. It didn't do much for my control, but I did have an extra five minutes a day to spend doing things other than waiting for my test results.
My early insulin program presented another challenge: NPH and Regular, at breakfast and dinner. The Regular would peak in about 2 hours and last about 6; the NPH would peak in 6 hours and last about 12. Everyone at the endocrinologist's office kept telling me the same thing: "You can live a n o r m a l life, as long as you do things according to your insulin." Basically, that meant that I would have to eat certain things at certain times of day; exercise (with caution) at certain times of day; sleep only at certain times because of the need to take shots at specific times; and test my blood sugar at certain times. What could be more normal than that?
Back in 1985, two shots a day was the norm. So was making your life conform to your insulin program. But things did improve over time. I was given a "sliding scale" for my insulin, which was a good thing, because I began sneaking in lots of extra "exchanges" and was rarely "ocean blue." With all the exercise I did, I probably had as many lows as I had highs, so my glycosylated hemoglobin levels showed a decent overall average. But the low blood sugars were becoming more frequent and more severe, especially during the night.
When I returned to college in the fall, my doctor suggested that I move my dinnertime NPH to bedtime. While that helped cut down on the nighttime lows, I started having more lows before lunch. Oy vey.
My One Touch meter got a lot of use through college (I went to Washington University in St. Louis, home of the Cardinals and the world's best frozen custard). Before dinner, my friends in the dorm would gather to wager on my blood sugar level. Everyone threw a dollar on the table; closest guess took the loot. Some of them became pretty adept at the whole diabetes thing: they would ask questions like "What did you eat for lunch?" and "Did you work out this afternoon?" Talk about getting by with a little help from my friends! It was lighthearted stuff like that that kept me from getting down about my diabetes.
Despite the technological improvements, I was still plagued by frequent high and low readings. Anyone with diabetes knows how those blood sugar swings make you feel—fatigued and frustrated. Besides the support of my friends, exercise was a key to helping me keep a positive attitude. I had always been into sports, but after being diagnosed with diabetes, my passion for staying in shape soared to a whole new level. Every day, I managed to find time for some form of exercise. If there wasn't anybody to play basketball or racquetball with, I would go to the gym to work out, ride my bike around the park, or jump rope in the lounge to the beat of Motown music. Exercising made me feel like I was still strong, fit, and in control of my own health, despite having diabetes.
Unfortunately, the emotional "high" I got from exercise was often followed by a serious low blood sugar. One month after starting my first post-college job, I showed up for work in a complete daze. Some days, I couldn't even remember getting dressed or driving to work. It's amazing that I never crashed buck-naked into a tree. To make matters worse, I was no longer getting symptoms that a low blood sugar was coming. Gone were the "good old days" of shakes and cold sweats. Now, mental confusion was the first noticeable sign that my blood sugar was dropping. And sometimes, it was too late for me to handle it on my own.
Thank God for my wife, Debbie. She's very good at knowing when to let me do my own thing and when to get involved. I met her in college and knew I would marry her after our first Valentine's Day together. She learned a few things about diabetes and went out of her way to prepare a huge heart-shaped box filled with popcorn and pistachios. You know what they say . . . The way to a man's heart is through his pancreas.
Sopa Seca Red Lentil Soup with Lemon Yogurt Salad with Citrus Juice and Sweet Pecans Grilled Cinnamon Peaches and Papaya Garlic-Sage-Marinated Beef Pot Roast Sugar-Free Chocolate Chip and Sour Cream Muffins Cranberry-Quinoa Salad (Gluten Free) Orange-Marmalade Sirloin Chops Chicken with Tomatoes and Olives Oriental Pork Skillet
Well maybe not so much a furor as a controversy. The question, bluntly put, is whether or not a single HbA1c reading should be sufficient and adequate to diagnose diabetes — and whether the conditions under which the test was conducted should have any bearing on the diagnostic or non-diagnostic value of the test. The lede from