Think Like a Pancreas (Continued)
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 that time, I was growing more and more frustrated with the constant swings between highs and lows. Nobody had any answers—just the same 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, and according to the reports, I fought them off pretty well while they tried to put an IV into my arm. When I finally regained consciousness, Debbie was standing next to me with an exhausted, worried look on her face. I looked to the side and saw tubes coming out of my arm. I also saw blood. My blood. On the pillow. On the sheets. On the floor. Everywhere.
That experience really shook me up. Then I met an exercise physiologist who worked part-time at a nearby diabetes clinic. He had diabetes himself and gave me some suggestions about eating extra food at bedtime and self-adjusting my long-acting insulin to prevent the nighttime lows after exercise. It was the first time anyone had introduced the concept of self-adjusting my insulin doses. Why hadn't my doctor told me about this?
That exercise physiologist opened my eyes to more than just how to adjust insulin by a few units. (His recommendations worked very nicely, but the way.) 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 to 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 in Philadelphia.
Being a New York/New Jersey native, Philadelphia seemed close enough to home—and it had its own NBA, NFL and Major League Baseball 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 guru. 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 clinical team I worked with. The doctors, nurses, dietitians and psychologists 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 nuances of diabetes care.
Perhaps the greatest breakthrough in my own self-care was my decision in 1994 to try an insulin pump. Nobody at our diabetes center had used one, but there was mounting interest on the part of 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. My first infusion set was a bent needle (the needle actually stayed in all the time). Soon, a flexible plastic 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 was very basic compared to today's models. Nevertheless, just having the ability to adjust basal insulin levels and mealtime boluses 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 more than 15 years ago.
With 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 rapid-acting insulin. "Grazing" is still a problem; blood sugars tend to stay elevated if meals and snacks are consumed too often. So I try to spread my "feedings" several hours apart.
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This past weekend was a whole lot of diabetes weird. I've finally gotten into a good rhythm with my Lantus rate - settling in with a 70-30 nighttime-morning split of the total dose. My bolus dosing seems to be pretty much on the money too. I'm avoiding huge swings... Though lows are creeping up more often, I think because summer traditionally is a lower basal rate time, owing to warmer weather, increased activity and sweat, as we get closer to the warmer days I just need less insulin in the...