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Insulin Issues.

What to do about cheesecake??"Now I thought you couldn't eat that?  Or can you just dose for it and it's okay?"

She wasn't being the dreaded "diabetes police," but she was just asking a question.  Type 2 diabetes is a familiar disease for some of Chris's relatives, so I can understand his aunt's confusion about how my type 1 diabetes is handled.  Wasn't I supposed to just avoid sugar?

"I can eat this," I gestured to the slice of cheesecake on my plate, "So long as I check my blood sugar beforehand, take the appropriate amount of insulin from my insulin pump, and I avoid a high blood sugar spike afterwards."

"So you can eat anything you want with that insulin pump?"

And this is where I get a bit confused.  Being a type 1 diabetic since I was a kid, I've always taken insulin.  Always.  I don't know anything about type 2 oral medications and I have no concept of managing diabetes solely through diet and exercise.  It's either been multiple injections or the insulin pump. 

Insulin is cool stuff.  It keeps me steady and solid on days when I'm following "the rules," but for things like holidays (where there is a whole dessert table and all kinds of sugary treats), I do have the option to up the bolus ante.  But a cure?  Nope.  Using insulin requires a lot of work.

The thing is, I think that insulin makes it seem like I can eat anything I want.  While I indulged in that piece of cheesecake after Christmas dinner, it was a risk I took.  I took more insulin, and I've read all these obtuse reports about how taking more insulin is tougher on our bodies. (Is that true - does anyone have a study they can point us to that states how insulin ages us or something?  I'm so curious.)  I risked the immediate spike and the latent spike in my blood sugar after eating the cake.  I wanted to indulge and I weighed the risk of this indulgence.  It's a split-second decision that my brain is programmed to make by this point.  Diabetes is all about coloring in the lines, i.e. keeping blood sugars well-controlled to minimize the impact on my body.

But I wonder what people think sometimes when they watch me eat.  How does it look from their eyes?  They know I have diabetes, and from their less-familiar vantage point, they view it as "serious" because I take insulin.  I use Equal in my coffee and I never drink the eggnog or have regular soda.  I almost always avoid the mashed potatoes and sweet potato casserole, and at family gatherings, there is usually a "sugar-free" dessert.  They hear me talk about blood sugar control and they know I work in diabetes advocacy.  They understand as much as they can, not actually living with the disease themselves.

But what to they think when I reach for a piece of cheesecake?  Do they think I'm "off the wagon?"  Do they think I'm being irresponsible because I'm eating a sweet?  Responsible because I'm testing and shooting accordingly?  Does it confuse them to see me clamor for a glass of grape juice when my blood sugar is low?  Do they wonder why every time they see me, there appear to be new "rules" for managing my type 1 diabetes? 

Diabetes is a constantly shifting platform that we're trying to balance on.  Every day is different, every diabetic is different, and the rules do seem to change every day.  On Christmas, I ate cheesecake and never sported a spike.  Last night, a cup of tea tossed me towards 200 mg/dl.   

"A pump isn't a cure, though, right?  I mean, you still have to prick your finger and tell the pump what to do, don't you?"

She's learning, petal by petal.  And despite all these years, so am I.   


please let us know if you find anything wrt: "does anyone have a study they can point us to that states how insulin ages us or something?"
i've heard that as well, but have never seen any studies to reference. i always figured it was the blood sugar flucuations commonly associated with insulin use that caused wear and tear on the body - not the insulin itself. but i'm curious as well.

It confuses me and I'm a Type 1... I mean, I had a muffin for breakfast. Way more carbs than I should have. But I always drink the diet pepsi. How do we explain to people that diabetes is different for different people? That having a cookie isn't going to kill us? But that it's better to drink diet?

I definitely think that subject is difficult to navigate. You tell people that yes, you can have a sweet, that you just have to take insulin and monitor your blood sugar afterwards. The next obvious question is well, then can't you eat eat and do anything you want if you take the right amount of insulin? Of course not! But then they get that confused look on their face.

I usually say well, if you don't have diabetes, does that mean you can eat whatever you want? Sure, but you will pay the consequences with weight gain, clogged arteries and generally poor health. Same for diabetics and we have one added consequence. There is no way to predict exactly what our blood sugar will do any given day with any given food. We can eat carb-laden treats but then need to be on the lookout for spikes. And just because we CAN doesn't mean we don't have extra work on our plates afterwards to make sure our bloodsugar does climb out of control. It's a risk and a balance act that we can choose to do if we deem it a worthy occasion (aka the holidays) but wouldn't be wise to make a lifestyle choice to live that way.

i love the example of petal by petal. i weighed the indulgences this holiday season, and not always in my favor. but i do try!

Thank you so much for posting this - it is one of my biggest pet peeves. I'm recently married and definitely don't expect my husband's family to know everything about diabetes, but I hate feeling them watch me eat after I explain that I can have a cookie. I also hate when they ask when we're having kids. Not only is it an annoying question, but I don't think they grasp how hard pregnancy can be while managing diabetes! Glad to know I'm not the only one who experiences in-laws with lack of diabetes knowledge frustration. I guess we just need to keep working hard to politely educate them!

This morning a co-worker came to me to let me know her A1c came back at 6.6% and she now has to take Metformin. She is in her late 60's....after a night of chasing numbers for both Maddison and I, this was the last thing I wanted to hear as I started my day.

She went on and on about how her diet and excersize will change. She told me that she doesn't need a meter "yet" and that she hopes this will not turn into Type 1 because her fear of needles. She asked me questions about our eating habits at our house, and generally, YES...she is very confused. VERY uneducated with every aspect of Diabetes.

You just don't know until you live the life. You really don't. My advice to her, was to read everything, even still....a Type 2 will probably not understand us Type 1's just as we can't relate as well to their management. Crazy how we are all the same, yet so entirely different.

First off, I think most people will think you're human when watching you eat. Truth is, we should all be on the same healthy diet. Does that mean you can't indulge every now and then? Of course not! Life is about living it to it's fullest, but we all (diabetes or not) have to be aware of the foods we put into our bodies. We just have to do a little bit more leg work. I read a someone's explanation on Diabetes Mine that said something to the effect of "we are a stick shift, and you are an automatic (non diabetic)."
I think that's pretty appropriate.

About the insulin causing harm, I have read that excessive insulin can be hard on your heart, but I think it's geared to those who are insulin resistant and are exposed to large amounts. Even if your pancreas worked, you would still be producing more insulin for the cake, so don't feel bad about taking more insulin, just be wary of the highs and lows. The most important thing is that you enjoyed the cake!

When it comes to using insulin, it seems to have made me feel like my own science experiment. Never quite sure, and awaiting an outcome that will probably never be repeated. But I guess that's life.

It is the life of a type 1 to educate the ignorant about the disease and then know that they still don't get it. We try not to deny Casey any goodies, he just gets them in smaller amount. In the six years since dx, I haven't caught him stealing candy, cookies etc...
I do worry about the effects of insulin on a kid dxd @ 7, then going through the battles of puberty and adolescence where the insulin demands are higher and then...Sigh. What's a mother to do?

Try and I may I never can avoid the spike. I try bolusing long before I consume and yet I spike. I get so frustrated about it all sometimes but that also seems to be the norm with diabetes.

I find it hard to answer lots of questions that get thrown my way about T2 since I am in the dark about it.

Oh wow! Excellent post. I can totally relate to every word of it. I hesitate to explain Insulin and the pump to people because they seem to think I'm in "control" then and therefore "cured." And it never ceases to amaze me how I get "Are you supposed to eat that?" when it's something I choose to eat but never hear it when it's something others are trying to entice me to eat!

You are still my hero!!! We learn step by step, day by day, all of us, together!!!

We may avoid the bgs spikes but like non-diabetics we don't avoid what the high fat and refined sugars are doing to our bodies. After 42 years of diabetes I am developing many many skin issues even though my A1C's are holding steady. I like you, even with the visible signs of long term diabetes all over my body, still indulge on a daily basis, because like you I had a freaking 200 bgs today for no apparent reason besides, things that are out of my control, stress and I believe many bubbles in my reserviors lately.

Great blog again . I dont know how you come up with the material that you do but it is always thought provoking great job keep up the good work .

oh, i fight with my sister all the time. she says "should she eat that?" and i say "should your kids?" the advances in insulin and attitude are great. i tell every newly diagnosed to read Sweet Kids. We moms can't be the food nazis! Happy New Year Chris and Kerry! a baby in 2009!

We are a complicated bunch!

When I went to the dietician the first time after diagnosis I got mad because she was telling me I could eat whatever I wanted as long as I took insulin for it. That didn't seem right.

I don't like cheesecake so I would pass on that, but I do love my potatoes. :)

However, I would never drink diet soda. How much sense does that make.

I think a lot of it has to do with when we were diagnosed. As much as 'things change' the things we were told at first diagnosis tend to stick.

As a Type 2, when I was on oral meds, I had about as much flexibility (or lack thereof) in diet as someone using only basal insulin (one of the 12-hour or 24-hour formulations). In short, diet has to be fairly strict because there's no good short-term method of reacting to a spike. This is the source of the "you're diabetic -- should you be eating that?" reaction.

That being said, within the bounds of "what works for us", all of us make individual decisions of where to expend our calorie allotment, our carb allotment, our anything-that-needs-to-be-restricted allotment. These choices don't always make sense to others, and are sometimes inconsistent enough to generate questions.

As I read it, you chose a single indulgence, and did what you could to mitigate its effects and minimize the risk of indulging. Those of us T2s who are "on the wagon" often have to be so A-R about controlling even thought of indulging -- to give in to the possibility we could might send us tailspinning into binge-eating. There are, of course, many more of us T2s who have "fallen off the wagon", or who don't realize there even is a wagon, or who are led to believe that their oral medications are chauffeured limousines that never need refueling...

I can so relate to this! This Christmas my niece told me she could relate to my diabetes now because she has been diagnosed with many food allergies, with sugar being one of them. This was as we were going through the family buffet line, and so I was feeling guilty about what I was putting on my plate! I think that my being quiet about it only furthers the misconceptions. I do my best to explain that it is not sugar my body has troubles with, but rather insulin, but sometimes it gets tiring.

Interesting - i was just at an endocrinologist's office a few weeks ago because i was referred by a diabetes educator - who told me that I wasn't type 2, but that I was "MODY." The Dr. confirmed but said I was maintaining good control with an A1C of 6.3 on glucophage and most recently - adding in 2000 iu's a day of vitamin D (lot of new research on vit. D and diabetes) ...anyway, I had major surgery Christmas eve, and fortunately, the new dr. had wrote me a prescription for a finger stick post surgery and my blood sugar was 273. I was there for five days and tested 3x a day and whenever I was over 150, I received insulin. I'm back on the glucophage now and usual carb restricted diet (100 or less/day) and maintaining...but the whole "am I a type 2 or do i have MODY and whoa - what's with the insulin...has got me feeling a bit out of control:)" I've been reading your blog since August, when I was first told about MODY. it has really helped me to understand type one and insulin...in case I end up going in that direction. Thanks!

I think one of the biggest problems with diabetes is that the destructive process called glycation can be accelerated, that is sugars react with the bodies proteins, resulting in the formation of non-functioning glycation end products, which may lead to common diabetic complications. Protein degradation is a significant contributor to aging and disease, destruction of the proteins can be caused by oxidation and protein – sugar reactions i.e. glycation. It is well known that diabetics may suffer a host of disorders associated with blood glucose imbalances, and of course excess blood glucose creates more glycation reactions in the body. I would think the most important thing we can do is to try to achieve a good HbA1C and reduced BG fluctuations, taking whatever amount of insulin is necessary to achieve that, something most if not all diabetics endeavor to do.

Reference Good Calories Bad Calories by Gary Taubes regarding the effects of insulin. There is a famous study done on dogs where they inserted an insulin drip into one of the femoral arteries of the dog. The femoral artery where they dripped the insulin developed atherosclorosis. The other side without the insuline drip had none.

You're great! Check out the blog I started for my daughter. I've read a couple of your entries--I have to show it to Betsey. Yo udon't need to post this on your site, I just wanted to "land" you!! Great stuff!

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