In my first blog I have touched on my personal memories of the time shortly before and after the diagnosis with diabetes and on the the changes it brought about. In this second blog I will tell you a bit more about my memories of some of the periods in which my lifestyle changed as a result of having the disease.
Conservative therapy with mixed insulin requires discipline
Definitely according to modern therapies, I was conservatively established on a therapy with mix insulin, Novomix 30. One injection before breakfast and the second before supper. Three main meals and three ‘snacks’ in between. I am not sure whether or not I was already a disciplined person before my diagnosis, but I have never skipped a single injection or meal in all those 35 years. This implied that often I would decline food when, for instance, people would offer treat to celebrate, and often enough I would start eating when nobody else did, just because it was time for my snack or because my blood sugar was dropping.
I realized only much later that other therapies may have advantages, for instance using long acting insulin and injecting short acting insulin before eating.
More about this in blogs to follow.
My lifestyle, the first 35 years, was quite old-fashioned, as a diabetic, that is. Focus was for me to prevent high blood glucose levels, no consumption of sweet food and limited carbohydrates. I considered a low glucose level of e.g. 3 mmol/l (<60 mg/ml) a much better outcome than a relative high value of e.g. 12 (>200 mg/ml). Also, a low level was an opportunity to eat candy, like a mars, or have a sandwich with syrup.
At home, my mom was, and is, the queen of homemade apple-pie – really delicious, especially when right out of the oven! Until not so long ago, a whole pie would be baked just for me, without sugar, but with candarel sweetener (the powder is mostly used for warm meals, whereas the liquid sweetener is better in cold dishes). Still, the rest of the siblings claims to be upset when looking at the homemade apple pies and the largest one being mine, upon celebrations where we tend to meet each other at the family home. I am sure they are just kidding… or aren’t they?
In the early days of my diabetes it was recommended to have your blood glucose levels >3 and < 10 (>54 and <180 mg/ml), but my current doctor (in Germany) classifies every value below 4 mmol/l (72 mg/ml) a hypo. I tried to find the (Dutch) ‘>3 and <10 campaign’ on the internet. Nothing there. Although not a very frequent self-monitor of my blood glucose, I did stick to the 3-4 monthly analyses of my HbA1c by the laboratory. The value was almost all the time around the 6% (people without diabetes have a value of 4-6%; diabetics should aim for values below 7%), telling me that the mean blood glucose levels were in range for the last 2 to 3 months. That was comforting news, although it is possible that the relatively solid values were the result of many/long-lasting low values (“Sie unterzuckern” is what my current doctor says). To check that I should have made more day curves and monitor glucose levels every 2 hours – see next blog for more.
Sports and jojo-effects
At the time of my diagnosis I played some tennis; in my first blog I mentioned to have taken on fitness, when I was losing so much weight.
When starting the insulin therapy, I remained playing tennis, increased fitness frequency and intensity – I increased weight at high speed, from 59 kg towards 90. I also decided to start playing basketball and field hockey, bringing my average of sports activities to 4-5 times per week. Not just for fun, but also helping me to burn energy/sugar to retain low blood glucose levels.
I have ended up in some bad situations because of it. As a young man I could deal and function pretty well still with blood glucose levels of around 3 mmol/l (54 mg/ml); in case the low levels remained for longer periods I kind of switched to auto-pilot, functioning in some kind of dream world. Now and then I have really given my body a beating with all the sports activities. Like the time I was stationed as a postdoc at the MD Anderson Cancer Center in Houston, Texas, playing basketball almost every night with the med-students at the campus courts. It happened a few times, getting to bed at home afterwards, that I woke up in the ambulance. Whatever sweets I ate or drank during and after the games, the muscles apparently wanted more and more sugar from the blood resulting in hypoglycaemia, which for me indicated that my blood glucose levels must have been under 2 mmol/l (36 mg/ml) for quite some time.
No fun! Especially not for my next of kin. When, after a glucagon injection, I would regain conscience, in an ambulance or not, I would be overwhelmed by a tremendous sense of guilt. I should have monitored my glucose levels more frequently, I should have eaten more, I should not scare my wife and children so badly, …
Having diabetes never stopped me from travelling, neither privately nor work-related. In case of transatlantic flights to the U.S. I would remain on the European time schedule with my two Novomix injections for as long as possible, and would take one extra injection before American supper. To calculate the extra units of insulin I did the following. The total number of insulin units of one day divided by 24 hours would give me the number of units per hour – with a time difference of 8 hours (the west coast is 8 hours behind) I would inject 8 times that number of units. On the return trip I would reduce the total amount of insulin with that number of units. Always seemed to work quite well.
With today’s knowledge …
With an active lifestyle, travel and/or sports it can be of benefit to have an insulin therapy that fits that lifestyle and is flexible. Although I have been able to live my life the way I wanted with a mixed insulin therapy, in hindsight I think it might have been easier if I had made a switch sooner, to a treatment with separate long-acting and short-acting insulins.
Novomix 30 is a mix containing 30% fast-acting insulin aspart, and 70% long-acting insulin aspart protamine crystals. The insulin mix starts working within 10 to 20 minutes and the fast-acting insulin reaches a maximum effect between 1 to 4 hours after injection, whereas the long-acting lasts up to 24 hours (steady state).
The term hypoglycaemia is used when blood sugar level drops to below 3.8 mmol/l (70 mg/ml). The symptoms and the severity can vary per person. With the body trying to increase blood glucose you may experience shaking and sweating. When still capable, best remedy is to consume sugar (monosaccharides), like Dextro Energy. You can purchase glucose/dextro tablets that are easy to carry with you – also effective, but with a lesser fit in your pockets are the so-called high-energy sports drinks. When eating or drinking is no longer possible, glucagon can be injected. Glucagon is a hormone acting on the liver via the blood to release glucose.
Red blood cells transport oxygen in your blood using the haemoglobin (Hb); during their lifespan of approximately 3 months Hb will bind sugar: the higher the blood sugar the more will be bound and the higher the HbA1c value.