Ask the Diabetic (possible TMI)

Miscellaneous and Personal Stuff I Must Share
21

What’s it feel like to get an insulin shot?

I don’t mean the needle stick - getting allergy shots for 40 years and donating blood for 30 has given me some idea there.

But does it feel good, bad, odd, or nothing as the insulin takes effect?

I have a diabetic cat whom I give shots twice a day, and he knows approximately when they are due and will come get me or float around the table where we do it. He seems to want the shots. I wondered if he liked the feeling. Of course, he might just like the attention.

A friend says her diabetic sister dislikes the way the shots make her feel afterward.

22

That’s a really interesting question, and not something I’d thought about before. It’s just been part of me for so long I don’t remember what not getting injections feels like. The closest I come is when I’m too sick to eat and what’s the fun in that?

As I think about it, I’d have to say that it depends on what my control’s been like. If I have a high blood sugar and I give myself extra Humalog to lower it, then eventually it starts feeling good. My headache goes away, I’m not thirsty anymore, my body temp returns to normal – I return to normal. (Or as normal as I get. I’m a dill of a pickle to begin with. :stuck_out_tongue: )

If my control’s been good, then I don’t really notice anything. Things just stay where they should be, and that’s a wonderful thing. So, having good control is good. I feel almost like someone who doesn’t have to worry about diabetes all the time. It’s just part of the regular flow of my day then and doesn’t stick out at all.

The one thing that does suck about injections is that sometimes I’ll hit a patch of scar tissue on my arms or thighs (my fault for not rotating the sites properly), and then it will sting/burn. Then I’ll have a bruise for a couple days and people will think I’m a battered girlfriend or something like that. One of the drawbacks of having really pale skin.

23

Is exercise a regular part of your disease management? How does it affect your blood readings, if at all? Is it best to rehydrate with plain water when you’re diabetic, or can diet drinks be used?

24

This is a cool thread. Thanks for starting it.

I’m technically not diabetic right now, although I am officially “pre-diabetic” aka “impaired glucose tolerant.” However, I was an insulin-dependent diabetic during each of my pregnancies. I started taking insulin before even attempting conception for my second child, and in my third month of pregnancy, I got an insulin pump on the recommendation of my medical team.

I can tell you unreservedly that the insulin pump is totally awesome. No more carrying needles around in my sunglasses case for eating at restaurants. No more having to get up at a particular time to inject and eat. It was very freeing, and I would recommend it to any insulin user.

As far as pregnancy goes, the risk to the fetus is minimized to almost that of a normal woman’s fetus if you can maintain normal numbers starting from three months prior to conception, throughout the pregnancy. (Especially during the first trimester when the organs are forming.) My OB/GYN, who is a perinatologist specializing in treatment of pregnant diabetic women, considers this to be an A1C of 6.0 or lower.

Hell, maybe I should start an “Ask the (formerly) pregnant diabetic” thread. Nah, I’ll just lurk in this one. :wink:

Oh, and I often injected in restaurants before meals. I’d lift up my shirt a little bit under the table, and as far as I know, nobody except my dining companions ever saw me. It was truly not a big deal.

25

The only persons I know who are on the pump were those with juvenile diabetes.

26

  1. “Juvenile diabetes” is an outdated term, because the onset of Type 1 diabetes (formerly “juvenile” or “insulin-dependent” diabetes) can occur well into a person’s late 20s.

  2. There’s no reason that any diabetic, type 1 or type 2, who uses insulin, can’t use an insulin pump. I mean, no medical reason; price, convenience, and so forth can all be factors, of course.

27

I was diagnosed Type 2 diabetic 2 years ago tomorrow. My worst struggle has been with my mind. Due to depression, it is not always on the side of my body.

I was 36 years old, weighed close to 200 lbs at 5’10", had high cholesterol, and my liver was so fat it was borderline pâté. All of which were the result of a depressive-aggressive binge of eating and physical inactivity, brought on by a miserable experience getting off 13 pounds a few years earlier. One of my great joys in life was eating what I shouldn’t, in plentiful quantities.

The first year for new diabetics is usually the time they turn it around. By exercising moderately but consistently, eating low-carb and sugar-free, and oral glucose inhibitors (metformin or Glucophage), in one year I was down nearly 30 lbs and running a “functionally non-diabetic” A[sub]1C[/sub] of 6. I didn’t feel all that deprived of food and was, overall, pretty happy.

Then…somewhere around Christmastime…I got sick of doing the right thing. This is the very common, second-year syndrome.

My family never failed to remind me of what I already knew about food. It rankled. Sweets and starches tasted better and better. It felt so calming and reassuring to ignore all the damn rules. Never mind that I packed on 5 lbs that haven’t left to this day, and started my A[sub]1C[/sub] slowly climbing towards 7. Never mind that I might be frying beta cells by the gazillions and ever so slowly turning my fingers and toes into Tootsie Rolls. It just felt like such a relief to be off the treadmill I hadn’t even realized I was on.

Now I am addressing the situation again. My medication has been upped. The eating is way more sensible. But this time, I don’t have the luxury of positive motivation. Moderate exercise is quite pleasant, but do it 3 or 4 days in a row and the routine starts making me cringe. There might be one night in ten I manage to go to sleep without a bedtime snack, which invariably makes my morning blood glucose reading soar. I don’t have to stuff myself to get the rise, either; all I need do is go to bed satisfied. Not eating much between meals doesn’t make up for addressing that one single craving.

Lucky though we may be (or so I’m told by Type 1s), we Type 2s don’t get the option of adjusting insulin to make up for the occasional lapse. We have to sweat out the cravings and either exercise more strenuously (which, for me, provokes a raging need for a reward in bad food) or live with days of self-reinforcing high BGs, self-loathing and guilt. Obviously, I need to get back to the place where I am glad to do what is needed for the reward of less worry about blood numbers and a general feeling of physical well-being.

I remember not missing junky food much. I missed it, just not terribly. But here’s the thing. Once I fell off my healthy routine, I didn’t miss that at all.

28

Mr. brown works at a pharmaceutical company which looks like it may have the first inhalable human insulin product. It’s in the final stages, which is promising, and awaits approval by the FDA. Here’s a chart of the company’s drug pipeline, and the insulin product is listed near the top, in the “filed/approved” area:

Nektar Drug Pipeline

29

I’m wondering if my dosage is normal. I’m taking 50 units of Humulin 70/30 twice a day, and there is a sliding scale for R insulin if my glucose is higher than 180. Is this a large dose, or is it relatively small?

30

I have some questions for you! Did you have any diabetic symptoms prior to discovering you had gestational diabetes? At what point in your pregnancy was the diagnosis made? How did that affect the rest of the pregnancy? Did you have appointments with a dietician? Was insulin necessary immediately? Was the baby really big?

Just curious. I know that traditionally, babies of women with gestational diabetes are bigger than usual, and I just read that they are also more likely to have immature lungs so premature delivery can be even more worrisome than usual.

A diabetic (Type 1) friend just had her first child, and she told me that other than having more frequent OB visits and ultrasounds, her pregnancy was pretty standard. I had always thought Diabetes = Huge Baby, but it certainly didn’t hold true in her case. Curious whether she’s a fluke, or if big babies specifically relate to the gestational version of diabetes.

31

Well, I’m not MsWhatsit, but I too had gestational diabetes. I was doing fine pregnacywise, but they do a standard screening at 26 or so weeks especially for those with a family history of diabetes or other predisposing factors. I was watching my weight and diet carefully and gaining pretty exactly what I was supposed to (and no more) despite morning sickness.

The initial screening is just drinking a high glucose drink and then taking a blood test. That showed there was some reason for concern. I had another test three days later. I was told to eat 300 grams of carbs each day for the next three days. This was way more than I had been eating. It made me feel sick. I felt out of control mentally and emotionally. The test was worse. They first took my fasting blood sugar. I then drank a very sweet drink and they measured my blood sugar a few more times over the next three hours. Psychotic is an apt descriptor of how I felt. Even my resting blood sugar was quite elevated. I was sent to an endochrinologist who prescribed my insulin.

I also found a dietician. I did not use the one at the hospital because the dietician’s office staff at Lutheran General are a pack of bitches, as became apparent when trying to schedule an appointment. They seemed to view me being sent to a dietician as a punitive measure. I found a dietician through my insurance. She was the best. She was very helpful in setting up my diet, in dealing with emotional issues around this and in helping find foods to eat. She was very concerned by the amount of ketones I was spilling and increased my calories until I stopped spilling them. She explained about exchanges and what food were best. I was on a 2300 calorie per day diet. I followed it precisely. I took my insulin five times a day and checked my blood sugar 4 times a day. I kept precise records of what I ate and when I ate it and what my blood sugar was when. I still have the spreadsheets. My daughter weighed just what she ought to and was born on her due date. She showed no complications from having a diabetic mother and ate well and slept well too. The test they give to check long term blood sugar control results were mid normal range near the end of my pregnancy and six week after showed results in the normal range for a non-diabetic.

One of the reasons I was able to monitor my diet so carefully was that I was on bed rest for the last two months. After I was diagnosed but before I could see my dietician, I had half an apple turnover for breakfast and left the other half wrapped in plastic at my desk. A co-worker saw it on my desk and chose to berate me for my irresponsible eating. I tried to put her off, tried to get rid of her, but she continued. I was crying, sobbing loudly and still she continued. I left the building and fortunately she did not follow me all the way out. I finally calmed down and latter that day she approached me, and again she started. I left the building, called KellyM to come get me and started to go into labor. KellyM took me to the hospital at the advice of my doctor and they were able to halt my labor. A few weeks later I had another false labor and was put on bed rest for the remainder of my pregnancy.

The main reason the babies of diabetics are so big is that diabetics eat more carbohydrates than they have insulin to digest. Since their babies do have insulin and can digest it, they get fat.

Some doctors prefer to try to control the mother’s blood sugar by diet alone. The thought seemed to be that the women were just eating too many carbs for their insulin supply and if they were careful all would work out. I have read many distressed accounts of women swearing they are not eating the wrong things but their blood sugar stayed high and in some cases they were losing weight. I saw formulas for calculating diets for pregnant women with gestational diabetes that would have left me with 1700 or 1800 calories rather than the 2300 my dietician prescribed. Using insulin to treat gestational diabetes is fairly new, but it seems to work well if properly monitored.

32

Beware of Doug in some sense reminds me of myself - now and previously.

I highly appreciate the input of type-2 diabetics. It’s very enlightening to see how their experience is.

Frankly, the only time I go into “good diabetic” mode is when I got scared of the consequences of not taking care of myself (once, that I was going to die; another time, that I would loose my eyesight) and when being hyperglycemic so often became a bother.

After a while, it gets very, very tiresome having to worry all the time about drinking water and going to the bathroom so often. More than that, after some time a certain dis-ease sets in: lethargy, feeling sick in the stomach, weakness. That annoys me, so I drive it away with better control of diabetes.

But it’s so hard! It’s so very, very, very hard.

I sometimes envy people who were diagnosed with diabetes very early on, so they hardly remember not having it. I clearly remember what it was like not to have diabetes, and part of my mind still is quite irate that I got it. (I used to absolutely hate needles when I was younger. Imagine my surprise when I got diabetes and learned I’ll have to poke myself - for testing and injecting - several times a day for the rest of my life.) The attention, scrutiny, detail, and energy needed to control diabetes is not little. Diabetes very tangibly takes over one’s life. I think about diabetes almost all the time, factoring in my diabetes with what’s going on and what’s going to happen, making sure I am prepared and ready to make necessary arrangements. I carry my supplies everywhere I go, in case I need them.

What fascinates me is that I have a love-hate relationship with diabetes. If someone came to me tomorrow with a cure for diabetes, I would likely refuse it. I think I feel diabetes is a very needy, clingy, demanding, obnoxious friend, but a friend nonetheless.

WRS - in good diabetic mode because . . . it feels good to see consistently good levels!

33

Basically, if you can maintain good blood sugar control throughout the pregnancy, you have an excellent chance of having an outcome similar to that of a normal, non-diabetic woman. The days of “diabetic = huge baby” are mostly gone now, due to the advent of glucose screening, home meters, and tight control. You do still see it in women whose diabetes wasn’t screened for, or who were unable to maintain good control for whatever reason, though.

Prior to diagnosis, I had zero symptoms. I felt as healthy as I ever had. At the 26th week of pregnancy during my first pregnancy, I took the glucose screening test mentioned by lee, and failed spectacularly. The cutoff for getting sent back for the 3-hour test was 140 mg/dL. My blood sugar was 198 mg/dL. My OB was of the opinion that I didn’t even need to go to the three-hour test, because my result was so decisive.

For a week and a half, I tried to control my blood sugar using only diet and exercise. After meeting with a dietician – and here I should point out that apparently I got fabulously lucky, because my dietician was great and actually gave me good advice, unlike the dieticians seen by the great majority of other diabetics I’ve talked to – I started monitoring my carbohydrate intake. My dietary plan was 30g of carbs for breakfast, 45g for lunch, 45g for dinner, a 15g snack before bedtime, and also 15g snacks between breakfast/lunch and lunch/dinner. My fat/protein intake was not restricted, and neither was my overall caloric intake.

That was the only appointment I had with a dietician, because after that I managed well on my own. However, after a week and a half of following the diet precisely and getting a crapload of exercise, my numbers, particularly my fasting number, were still out of target range, so I started an insulin regime. My doctors were careful to make sure that I knew this wasn’t because I was a “bad diabetic”, it’s just that some people have more problems with blood glucose regulation than others, and unfortunately I am/was one of those people.

My insulin intake increased until my baby was born. He weighed 8 lb exactly, and was slightly hypoglycemic at birth (this is something that can happen with babies of diabetic mothers) but giving him a tube full of formula solved the problem quickly and he had no further problems.

With my second baby, I knew that my blood sugar numbers were already higher than target before I even tried to conceive. It’s weird because the target range for pregnancy is actually lower than the diagnostic cutoff for diabetes in non-pregnant people, so you can be running numbers that are higher than acceptable for pregnancy, but your GP will still say, “Nope, you’re not diabetic, you’re just glucose intolerant.” Anyway, I knew the real deal, so I went to the UW diabetes/pregnancy clinic for preconception counseling. They placed me on insulin immediately, to get my numbers into the target range. I conceived two months later and was followed closely throughout my pregnancy. My numbers stayed mostly in the target range, which is the best you can really hope for, and my second baby was 8lb 9oz, and had no hypoglycemia.

So really, insulin is not the big fat hairy deal a lot of people make it out to be. I had the good fortune of having medical teams during both pregnancies that are well-versed in the latest research and really knew what they were doing. I’ve heard horror stories from people who were put on calorie-restricted diets, or told they never had to check their blood sugar at home, or whatever.

Anyway, this post is already practically novel-length, so I’ll wrap up, but I’d be happy to answer any more questions about diabetes and pregnancy if anyone has questions. My first pregnancy, I had what is considered “gestational diabetes” only, but my second pregnancy was handled as though I were a true diabetic going in. I believe this is why my baby was born at full term, healthy, and at a normal weight.

34

During labor I received both insulin and dextrose IVs. The insulin was stopped in the middle when my blood sugar started to fall. This is not how delivery is always managed. Some give insulin and no dextrose and some give neither. Eating during delivery is often disallowed. It is quite easy to choke on food during a contraction, and often the appetite is not there anyway. Not getting nutrients during labor when you need them, and the homones crashing suddenly relieving the insulin resistance contribute to many babies of gestational diabetic mothers having hypoglycemia.

BUT, my daughter nursed 45 minutes for the first hour of her life, thanks largely to my delivery nurse. The nursery was pestering the delivery nurse to get them my baby so they could stick a big ol’ bottle of formula in her. The dilevery nurse called someone else to talk about it and then seemed to come to a decision and called the nursery to tell them that she was busy and would get them the baby when she got time. They tested Loren’s blood sugar after she finished nursing and it was fine. The nurse and I both thought that nursing was better if we could manage it.

35

I feel a little silly asking this, but can one of you give me a sort of general description/definition of both Type I and Type II diabetes? I mean, I was told what it was when I was a kid, and I’ve learned more since then, but I kind of feel like my idea of diabetes is like a house that has had lots of rooms added on to it haphazardly, and now it looks all funny. I’d like to make sure I have a good idea of what the disease is.

Thanks!

36

Type I diabetes is caused by the non-functioning of the islet cells in the pancreas. People with type I diabetes do not produce insulin. Insulin is needed to digest carbohydrates. People with type I diabetes need to take insulin. Insulin cannot be taken orally, it must be introduced in a more direct manner, so it is typically injected.

Type II diabetes is the result of growing insulin resistance and the body not producing enough insulin to digest all the carbohydrates eaten. It is usually controlled by a combination of drugs, most of which can be take orally, and diet.

Uncontrolled diabetes ravages the small blood vessels and causes other problems.

37

lee and MsWhatsit, thank you for all your information. My glucose tolerance test is in a couple of weeks, and I’d like to be armed with a bit of information just in case the results are not what I’ve hoped for. Thanks again!

38

In addition, there is a dramatic increase of Type-2 (formerly called “adult-onset”; also accurately called “non-insulin dependent”) diabetes among kids. Or so I have heard.

WRS

39

You want information? If you throw up the disgusting syrupy drink they give you, then you just have to drink ANOTHER bottle of it. Yuck. Oh, and I always found the LemonDex soda to be slightly less nauseating than the GluCola kind, but that’s just me.

40

WeRSauron, you are correct, sir. Cyros, I’m glad I could help a little! Good luck with the test.

To elaborate and expand on lee’s explanation of Type 1 vs. Type 2 diabetes: type 1 diabetes is an auto-immune disease. The beta cells in the pancreas cease function because the body’s own immune system attacks them. The subsequent lack of insulin in the body leads to rapid illness, and then death, if insulin is not administered.

Type 2 diabetes is a disease of insulin resistance. The pancreas manufactures insulin just fine (at least at first). But the body’s cells become resistant to insulin, and so the pancreas starts churning out more and more and more insulin to try to counteract this resistance. Eventually the pancreas just can’t make enough insulin to combat the resistance in the cells, and this is when blood glucose starts to rise. If type 2 diabetes goes uncontrolled for long enough, the beta cells in the pancreas can suffer and start to “burn out” (I know this isn’t scientific terminology, but I’m not a doctor), at which time the type 2 diabetic may also require injected insulin. Some type 2 diabetics are on insulin as part of their treatment regime anyway, just because they or their doctors feel it’s helpful. I’ve heard that there’s some research indicating that early administration of insulin in type 2 diabetics can actually preserve beta cell function for a longer period of time. I don’t have a cite for this, though.

I’ll share the metaphor that has always worked best for me: think of the cells in your body as little houses. Insulin is the key that will open the door to the house to allow glucose inside. If the body stops producing insulin, you don’t have a key, and all of the doors stay locked; the glucose stays in the bloodstream instead of in the cells where it is needed. If the cells become resistant to insulin, the keys stop working in the locks, and again the glucose stays in the bloodstream instead of entering the cells. (Not a perfect metaphor, because with insulin resistance, using LOTS AND LOTS of keys/insulin will “open the door” and let insulin into the cells, which is not a very realistic real-life scenario, but I hope you grok the gist.)

Anyway. Sorry to hijack the thread!