Thursday, September 01, 2016

10 years!

Today is ten years since I was diagnosed with diabetes and put on insulin!
At diagnosis, my A1c was something above 16% (could not be measured). The 28 readings since then have ranged from 6.0 to 7.2 and averaged 6.55.
I have spent roughly 7.5 years on Lantus, 1.5 pumping (regular), and 1 on NPH. I have spent roughly 5 years on Novolog and 5 years on Regular (the Novolog came first, just to be clear). I've gotten my insulin through NovoPen Jr, syringes, a minimed pump (the steel cannulas aka needles were the only way that worked) , jet injector, and a few other pens that I didn't use regularly. I've used two meters as my main meters- Accu Check Aviva and Relion Prime- and at least a half dozen others supplementally. I've used two types of minimed CGMs and two types of Dexcom CGM sensors with three types of monitors. I've spent about 4 years not CGMing.
I spent a few years (maybe 3?) counting, though not limiting, every carb I ate. I spent another few years (maybe 3?) counting carbs more sporadically, and the last few years not really counting carbs at all.
I have not taken any other diabetes medications (but I have gotten my flu vaccines).

Complications wise:
I've had dilated eye exams about annually and no abnormality has ever been noted. My myopia hasn't been entirely stable. And my night vision has noticeably gotten worse; I think that my peripheral vision has too although my eye doctor says I'm fine.
I've never had an EMG, and haven't had any tests of sensation in some years. However, I do not have a neuropathy diagnosis or any major symptoms of neuropathy.
My eGFR is fine. My urine has contained elevated microalbumin sporadically but has been totally normal for a few years now, including when tested two weeks ago. My blood pressure is fine.
Regarding lipodystrophy and scarring- the insulin pump folks strongly suggested that my difficulty with kinking cannulas was due to internal scarring. Perhaps. I did at one point develop some lipodystrophy in my thighs, which disappeared after about a year of not injecting there. I am currently injecting there without any issues. I have not had any flagrant problems with absorption except with cannulas.
My hearing hasn't ever been formally tested. My impression is that it's gotten somewhat worse over the last ten years, but normal hearing in a 27 year old is somewhat worse than normal hearing in a 17 year old anyways.
My dental health is not great but the only tooth I've had pulled was a wisdom tooth and none have fallen out, so that's something.
I have had no infections that would indicate poor circulation or impaired immunological function.
Other than at diagnosis, I have not had a blood sugar related hospitalization or emergency room visit- no DKAs, NKHHSs, or hypoglycemic episodes of severe symptomaticness.  In fact, my hypoglycemias have gotten considerably less problematic and symptomatic over the years.

Changes in the diabetes experience:
I've become less emotional and less interested in my diabetes.
I've tended to run more dramatic highs and less dramatic lows.
My insulin sensitivity over the last few years has been dramatically higher (with an ISF around 100) as compared to my first few years (when the ISF was about 35). I have persistently had higher basal needs at night.

My overall health has been better over the second five years as compared to the first five. During the first five years, I developed several major health problems and had my gallbladder removed and subsequently developed gallstone pancreatitis. I also had subacute thyroiditis and pain in my neck for roughly two years, and swelling in my hands and one foot (and a knee). I also experienced a cognitive decline that was very significant to me.
In my second five years, I've just about recovered from the pancreatitis, at least pain wise, have had no thyroid problems, way less vomiting (yay!), no cognitive decline I'm aware of (although I certainly haven't recovered to where I once was). I have had some issues with my feet, and the issues with swelling in my joints haven't disappeared.
Notably, I've worked full time only in the last few years.

Looking at the next five years or the next ten years, I think that my current health is a positive indicator. I'm hopeful that the next ten years will continue to see me staying out of the hospital, at least for diabetes related reasons. I'm hopeful that I will maintain blood sugars around the same as I have, though it would be nice to see an A1c in the 5s at least once. I suspect that I will stay on Regular and NPH, because they're cheap, but I don't know- the market and what's available may change. And maybe I'll even return to pumping. I'm not CGMing now, but I think it's likely I will resume doing so at some point.  I'm hoping to get another jet injector, one where a continual supply of vial adaptors is available. I think it's probable based on epidemiological data that I will develop detectable retinopathy in the next decade, but am hopeful it will not be vision-threatening. My weight remains at the bottom of the normal range for my height, but given its stability over the last few years, I'm hoping it will just stay there.
I anticipate my biggest challenge over the next ten years will not be managing my diabetes- it will be parenting and balancing parenting with everything else I need to do. My (foster) son, hereafter referred to as just my son, spent every weekend with me over the summer and officially moves in tomorrow. He's a handful! So far I haven't really had a problem managing diabetes with him around although I thought I would.

Some anonymous soul asked if I am a vegan minimalist and why I don't talk much about diet. I don't know what a vegan minimalist is. I don't talk much about diet because I didn't change my diet for diabetes. Depending on your standards of vegan, I may or may not have been eating a vegan diet for the last sixteen years- which is six years longer than I've been aware of having diabetes, and which is also more than half of my life. I give it about as much thought as I give the fact that I don't drive. It's very background to my life. I think, and have said so here numerous times before, that there isn't any one diet that's best for diabetes, or for people in general. I think there's pretty good evidence that a vegan diet can be healthy, and no evidence that it's unhealthy in my case. I think there's a lot more evidence that driving is unhealthy. But unless you like poring over maps, it's just not a really interesting topic.


Anonymous said...

what are your main reasons for being vegan ? a lot of vegans are into minimalism or are minimalists. you can learn about it on youtube.

Pharmacy Exporter said...

Vegan food is full of nutrition and proteins, it heps to keep our body fit n fine.
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cold chain pharmaceutical logistics said...

10 years is really a huge span of time. amazing.
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