Think Like a Pancreas (Continued)
The introduction of rapid-acting insulin analogs (lispro, then aspart, then glulisine) starting 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. A few years ago, I added another injectable medication to my treatment program: pramlintide (Symlin). This hormone, produced by the beta cells of the pancreas (and lacking in those of us with type-1 diabetes) helps to slow down digestion so that blood sugars don't spike very high right after eating. The combination of rapid-acting insulin and Symlin has worked wonders. Gone are my 300+ blood sugars right after eating. The readings stay remarkably level between meals. I can also afford to be more spontaneous and flexible in terms of what I eat and when.
Of course, there have been a few other developments 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 The old "Guillotine" has been replaced by an adjustable lancing pen with lancets that are micro-thin. Using a sound lancing technique, 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 10 minutes with a machine that I have in my office, and virtually everything is downloadable. My latest insulin pump has so many advanced features, it can practically do my taxes for me!
And then there's my latest toy – the continuous glucose monitor (CGM). I began using CGM back in 2004, when the system was connected to your body by way of a cable, and the information was kept secret until you took the sensor out of your body and downloaded the receiver to a computer. Since then, the accuracy has improved, they have gone "wireless", they produce on-screen graphs and data for "real time" use, and sport a variety of customizable alerts to guard against high and low glucose levels.
Personally, I've found CGM to be the best thing since sliced sourdough bread. (you'll learn about the magical powers of sourdough bread later on in this book.) I love the fact that I don't have to prick my finger quite so often, and the alerts have saved me from many highs and lows. Perhaps the best thing about them is that they provide context to glucose values. It's one thing to know you're 100 (5.5 mmol); it's another to know that you're 100 and dropping quickly (or rising quickly). I was officially sold on CGM when I completed my first 10-mile run (the Broad Street Run in Philadelphia). I ran the entire course with my CGM receiver in my fist, checking as I approached each rest stop to see if I needed to grab water or Gatorade. My control was immaculate, and I finished the race without having to stop once.
But 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 to fit the life I want to live. And that's what I try to teach my clients to do… to think like a pancreas!
As proud as I am of what we have accomplished in diabetes care and treatment, I can't help but recall how proud my original endocrinologist was with the state of things back in 1985. Twenty five years from now, I'll probably look back to today and think, "Did we really do all that just to manage diabetes? That was totally archaic!"
At least I hope so.To read another topic excerpted from Think Like a Pancreas - A Practical Guide to Managing Diabetes with Insulin, visit here.
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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