My early insulin program also presented a challenge: NPH and regular, at breakfast and dinner.
NPH was the long-acting insulin in vogue at that time; regular was the stuff used to cover meals.
The regular insulin would peak in about two hours and last about six; the NPH would peak in six hours and last about twelve, although every day it seemed to have a mind of its own.
Everyone at the endocrinologist’s office kept telling me the same thing: “You can live a normal life as long as you take your insulin.” But that meant that I would have to eat certain things at certain times of day, exercise (with caution) at certain times of day, sleep only at certain times because of the need to take shots at specific times, and test my blood sugar at certain times.
What could be more normal than that?
Back in 1985, two shots a day was the norm.
So was making your life conform to your insulin program.
But things did improve over time.
I was given a sliding scale for adjusting my regular insulin, which was a good thing because I started to sneak lots of extra “exchanges” into my meals and snacks.
With all the exercise I did, I probably had as many lows as I had highs, so my glycosylated hemoglobin (precursor to the A1c) looked pretty decent.
However, the low blood sugars were becoming more frequent and more severe, especially during the night.
When I returned to college in the fall, my new endocrinologist in St. Louis suggested that I move my dinnertime NPH to bedtime. Although that helped cut down on the nighttime lows, I started having more lows before lunch. Oy vey .
My One Touch meter got a lot of use through college. Before dinner my friends would gather to wager on my blood sugar level. Everyone threw a dollar on the table, with the closest guess taking the loot. Some of them became pretty adept at the whole diabetes thing: They would ask questions like, “What did you eat for lunch?” and “Did you work out this afternoon?” Talk about getting by with a little help from my friends! Stuff like that kept me from getting down about my diabetes.
Frequent high and low blood sugars plagued me throughout college.
Anyone with diabetes knows how those blood sugar swings make you feel: fatigued and frustrated.
In addition to the support of my friends, exercise was a key to helping me keep my balance.
I had always been into sports, but after being diagnosed with diabetes my passion for staying in shape soared to a whole new level.
Every day I managed to find time for some form of exercise.
If no one was available to play basketball or racquetball, I would go to the gym to lift weights, ride my bike around the park, or jump rope in the dormitory lounge to the beat of Motown music.
Exercising made me feel strong, fit, and in control of my own health despite having diabetes.
Unfortunately, low blood sugar often followed the emotional high I got from exercise.
A month after starting my first post-college job, I showed up for work in a complete daze.
Some days I couldn’t even remember getting dressed or driving to work.
It was a miracle that I never crashed, buck naked, into a tree.
To make matters worse, I was no longer experiencing symptoms letting me know that a low blood sugar was coming.
Gone were the good old days of shakes and cold sweats.
Now mental confusion was the first noticeable sign that my blood sugar was dropping, and sometimes it was too late for me to handle it on my own.
Thank God for my wife, Debbie, whom I met at college. She’s very good at knowing when to step in and when to let me do my own thing. I knew I would marry her after our first Valentine’s Day together. She learned a few things about diabetes and went out of her way to prepare a huge heart-shaped box filled with popcorn and pistachios. You know what they say: the way to a man’s heart is through his pancreas.
Debbie and I left St. Louis and moved to Chicago after we both graduated. While in Chicago I met with a few more endocrinologists and other specialists for my diabetes. By that time, I was growing more and more frustrated with the constant swings between highs and lows. Nobody had any answers, just the same old rhetoric: “This is what your insulin is doing. You just need to adjust to it.”
Then I had the most severe low blood sugar of my life.
It came in the middle of the night after playing basketball earlier in the evening.
Debbie told me that I was pale and completely unresponsive, and my limbs were jerking uncontrollably.
She called for paramedics, and according to the reports, I fought them off pretty well while they were trying to put an IV into my arm.
When I finally regained consciousness, Debbie was standing next to me with an exhausted, worried look on her face.
I looked to the side and saw tubes coming out of my arm.
I also saw blood.
My blood.
On the pillow, on the sheets, on the floor, everywhere.
That experience really shook me up.
Then I met an exercise physiologist who worked part-time as a consultant at a nearby diabetes clinic.
He had diabetes himself and gave me some suggestions about eating extra food at bedtime and self-adjusting my long-acting insulin to prevent the nighttime lows after exercise.
Why had nobody ever taught me these types of tricks?
That exercise physiologist opened my eyes to more than just how to adjust my insulin doses.
He set me on an entirely new career path.
I liked his approach so much that I decided to become an exercise physiologist myself and focus on helping others with diabetes.
So what if there were no full-time jobs for exercise physiologists at diabetes centers?
I loved to exercise.
I had diabetes.
And I was on a mission to help others who were as frustrated as I was.
So I went back to school, earned my master’s degree in exercise physiology, and landed a gig with the Joslin Diabetes Center in Philadelphia.
Being a New York/New Jersey native, I felt Philadelphia seemed close enough to home, and it had its own NBA, NFL, and MLB franchises (I don’t think I could live in a city that didn’t have those).
So we packed up the car and moved to Philly, where I became the Joslin Center’s full-time exercise guru.
I have to admit: my office was pretty cool.
It had weights, treadmills, bikes, video equipment, and a great view of the sports complex in south Philly.
The only thing better than my office was the clinical team that worked around me.
The doctors, nurses, dietitians, and psychologists were heavily into the concept of flexible insulin dosing and self-adjustment.
I cross-trained with them at every opportunity and absorbed as much as I could about the many facets and nuances of diabetes care.
Perhaps the greatest breakthrough in my own self-care was my decision in 1994 to try an insulin pump. Nobody at our diabetes center had used one, but our patients expressed a mounting interest in pumps. So I was the designated guinea pig.
I’ll never forget how nervous I was the day I was trained on how to use that little gray box.
There were about twenty doctors and nurses watching my every move.
My first infusion set, the apparatus that delivered the insulin from the pump into my body, was a steel needle (the needle stayed in all the time).
Soon, a flexible plastic infusion set became available, followed by a set that could be disconnected and reconnected easily.
Before that, you had to stay connected to the pump all the time, during showers, sports, sex, and so on.
The pump was very simple compared to today’s models.
Nevertheless, just having the ability to adjust basal insulin levels and fine-tune mealtime doses really helped to stabilize my blood sugar levels.
For the first time in almost ten years I could sleep past 8 a.m. without having my blood sugar skyrocket.
I could delay my lunch without crashing.
And best of all, I could work out to my heart’s content without going low in the middle of the night.
In fact, I haven’t had a single severe low blood sugar episode since starting on the pump twenty-five years ago.
My first insulin pump, the MiniMed 506.
The very first continuous glucose monitor (aka “the black box”), circa 2003.
With pump therapy came a whole new approach to dietary management: carb counting.
By counting the grams of carbohydrates in my meals and snacks, I could eat pretty much whatever I chose as long as I covered it with the correct dose of insulin.
The introduction of rapid-acting insulin analogs (lispro, then aspart, then glulisine) in the late 1990s and early 2000s also had a positive impact on my diabetes management.
Unlike regular insulin, which takes thirty minutes to start working, two to three hours to peak, and five to six hours to fade, the rapid-acting analogs peak in about an hour and only last three to four hours.
They do a much better job of covering the rapid blood sugar rise that takes place after meals.
Of course, several other important developments came along, such as blood glucose meters that take less than half a micro liter of blood and produce very accurate readings in five seconds, adjustable lancing pens with lancets that are micro -thin and virtually painless, at-home kits for testing ketones and A1c, and insulin pumps that can practically do your taxes.
I began using a continuous glucose monitor (CGM) back in 2003, when the receiver was connected to your body by way of a cable and the information was kept secret until you removed the sensor (a nasty wire that stayed in your body for three days) and downloaded the device to a computer. Over time, the accuracy of CGMs has improved to the point that they can replace fingersticks; calibration has become optional or minimal; data transmits wirelessly to various pumps, phones, and handheld devices; information displays in real time and is shareable with loved ones; and a variety of customizable alerts can be used to guard against high and low glucose levels.
Personally, I’ve found CGMs to be the best thing since sliced sourdough bread (you’ll learn about the magical powers of sourdough bread in