Until I wrote the post about clinical trials, I hadn't realized that I'd become eligible for an islet cell transplant through a clinical trial. That is, I'd seen it before and realized that I would be eligible as soon as I passed the fifth anniversary of my diagnosis, but I hadn't though about it since then.
So I looked at the listing and I thought about it a little bit, and I thought, what would happen to this blog? What would happen to my membership in the diabetes community? What would it be like to be on immunosuppressants? Can I even learn to swallow pills? Would I turn out to be eligible if they did all the tests on me anyways (for all I know I might have a measurable provoked c-peptide level, or my history of pancreatitis would be a problem, or my liver enzymes would be elevated like they sometimes are, or in the opinion of the investigator my other health issues would be too much)? Would I be healthier with a transplant? Would a transplant help me more than it would help somebody else waiting for a pancreas? I'm really small- would I get a pancreas nobody else could use anyways?
Then I had that really awful hypo, followed by a second hypo that began during the day but which lead to a real change in consciousness/ hallucination anyways about two weeks later. So that made me think. Islet cell and pancreas transplants are supposed to be pretty good at preventing hypoglycemia.
In the end, I don't think I've reached the point where a transplant would clearly be the healthier option, and I'm not that tired of diabetes yet. Maybe sometime in the future. I don't know.
The other thing that my research makes me think about is my insulins. As my long time readers know, I used Lantus and Novolog from September 2006 until July 2011. Then I added Regular to the mix and within a couple of weeks decided that I liked Regular better than Novolog. Now I'm using Lantus and Regular. The research papers I've read strongly support the theory that Lantus is not really better than NPH at allowing people to get lower A1cs (in fact, NPH is better than Lantus in that respect). And NPH is cheaper, and I could mix it in a syringe with Regular. So why don't I switch?
There are, at this point, a lot of reasons why I haven't. For one thing, I kinda know what Lantus does in my body. I have only used NPH for one week back when I was wet behind the ears still and all I really remember from that was that I woke up hypo twice that week, and after switching to Lantus four months went by before I woke up hypo again. For another, it was drilled into me that on NPH, everything must must be scheduled- including the shots must be on scheduled, and meals must be consistant and on schedule. From my more recent readings, I think this is something that can be worked around, especially with a Dexcom and using regular that is not pre-mixed. But it might leave me more susceptible to lows when I'm sick, and we all know that I'm sick way too often. And taking two shots at a scheduled time 12 hours apart would be rough- although maybe a bedtime and a wake up time (the only two times I think I could schedule consistantly) shot wouldn't be too bad.
I also feel like this would be a difficult conversation to initiate with my current endocrinologist, even though we've both been feeling that Lantus isn't doing a great job with my basal needs- he's suggested Levemir. Lastly, the research suggests that Lantus does reduce hypoglycemia, particulalry night time hypoglycemia, and I already have a problem with nocturnal hypoglycemia- would NPH make it worse? I'm not sure.
But for now, I intend to keep things the way they are.