I was using Humulin� N and Humulin� R synthetic insulins.I had switched from beef-pork insulins to synthetic insulins when the former was discontinued in 1999. I would like to make these observations known about my changeover from beef-pork (animal source) insulin to Humulin� (synthetic) insulin. 1.I used a few units less insulin. 2.On beef-pork insulin I could tell what my blood glucose was within a range of 20-40 (mg/dl) points. 3.Humulin� necessitated more frequent glucose monitoring because: a. Fluctuations in blood glucose were more extreme b. They were less pronounced 4.Overall glucose control was better but fluctuations were worse than on beef-pork. 5.Although I felt better on Humulin�, there was an unexplainable, permanent change in my mood (dulling), as if I had been happier on beef-pork (almost like I was missing it.) My primary care doctor dismissed all of these observations in 1999.He did suggest referring me to an endocrinology specialist. In March 2001 I changed insurance plans.I now had a no referral insurance plan that made it easy for me to choose and change doctors.I could now see any specialist without having to go through a primary care physician.I started to see a new endocrinologist because of new hypothyroidism.At that time we discussed diabetes treatment.This doctor was more open-minded and listened to everything I had to say.He dismissed much of what I would present, but he would still listen to me with interest and respect.He promised me better blood sugar control (HbA1c) with optimism.So he became my diabetes doctor.Without him the mystery of my condition could never have been solved. He recommended that I go on an insulin pump.I was not excited about this for various reasons.A colleague of mine at the Research Foundation who was diabetic told me that he had perfect blood glucose control.This was the first time I had heard of this from a diabetic.He suggested that there were many treatment options available, that my doctor should tell me about, and that it was up to me to choose the best option for me and not the other way around. So I became more open to working with my doctor.Following my colleague�s advice I asked my doctor to come up with other alternatives, and he did. On May 29, 2002, I began using Lantus�, a 24-hour, no-peak basal insulin.Within three days I knew it would change my life and it would help me demonstrate all the unexplainable events in my hyperglycemic condition that the doctors say do not occur. I was using 60-65 units of Humulin� N insulin a day.When I started on Lantus�, it worked at 30 units a day.I used to use 20-30 units of Humulin� R per meal, but with Lantus� I used only 3-10 units per meal.After ten days I switched to Humalog�, which uses the same dosing scale, but the peak lasts only 3 hours, the tail effect ends 5 hours after injection.It starts to work in 15 minutes. Before Lantus� I was averaging about 120 units of insulin a day.With Lantus� it dropped to 40-60 units a day.Because of this, I was able to quickly lose a lot of weight with no exercise.I refrained from exercise so I could observe and learn how to use this new insulin.I had normal blood glucose control for the first time in 20 years.Everyone noticed the change in my mood and personality, as if I was a different person. For the first time since I first began using insulin, I could now skip a meal or even fast.Basically I could now by choice control how much food enters my body because there are no peaks, and no meal planning is necessary.Blood glucose fluctuations were not pronounced at all and I had to monitor my blood glucose frequently, since otherwise I had no idea.On Lantus�, hypoglycemia was now easily corrected with very small amounts of sugar instead of the large amounts. As I was losing weight, I had to reduce the amount of insulin I was using.I believed it was possible that if I lost enough weight I could walk off insulin, given that I was using so little of it now. After two months, something began to go wrong.Mysteriously I had to increase the amount of Lantus� that I was using. There were some conceivable explanations such as the honeymoon effect, but by the end of September I was very concerned that something was defective with this new hi-tech insulin product, which I was the guinea pig for.My decision to stay on this product even though it was obvious that the dose was not stabilizing was on a wait-and-see, almost day-to-day basis.I felt normal again after 20 years.I did not want to change that.Many times I considered switching to the pump, but always hesitated.I really believed in this product, Lantus�, I wanted it to work. I noticed the dose would stabilize for a while, then after having certain feelings I noticed it would begin to climb again over time. Since August, I was feeling tired and low on energy all the time.I thought it was because of the weight loss and the major changes to my body. By February the dose was 70 units a day.The way that I dose Lantus� is by taking a blood glucose reading before going to sleep, then taking a blood glucose reading first thing in the morning.By comparing the overnight change in blood glucose levels I would change my dose accordingly. By March I began to feel seriously out of it, I suspected my thyroid condition, so I went to see my endocrinologist to do a TSH (Thyroid Stimulating Hormone) test.He said my blood glucose was about 230 mg/dl and when blood glucose is elevated it is a good time to do the C-Peptide test. "What is this test?" I asked. �It's a test for natural insulin production. C-Peptide is released in equal amounts to natural insulin.Bottled insulin does not contain C-Peptide.�Then he said, out of experience or earlier hints that I had given him: "Maybe you have some insulin production, let's see."I replied: "Doctor, you are the first person to do this test." I had no knowledge about this test, because information is not readily available.Even if I did, I would not have dared to ask about it because I have long felt stigmatized about second-guessing a doctor due to my experiences with doctors and the way they treat diabetes. I said to him that previously I was using 65 units of Humulin� N a day which was similar to using 70 units of Lantus� a day.I said to him: "It is amazing that Lantus� worked for two months at the lower 30 unit dose." The day after the visit, I started to get really congested, I was reading my original diagnosis (1981) and I noticed a pattern with the way I was feeling.I was feeling bad for a month but had no symptoms until the end of March (2003), just as I was sick three weeks before hospitalization (1981) and most symptoms went away, but I still had something, and I remembered that I received no antibiotics.Normally I tough out cold-like infections, but this time I decided to see a doctor about it.So I did, he said that I had a serious infection in my nose and because I was diabetic I should take care of it.I was prescribed antibiotics.I predicted to myself that this would require a drop in insulin use due to hypoglycemia and within 24 hours of starting on antibiotics I had to.Within the first 6 hours of their effect I could already feel myself becoming hypoglycemic. A week later, my doctor and I spoke over the phone.He said: "The TSH test came back normal, but we have a little surprise."I said: "What is the surprise?" "Your insulin production is above normal.You are by definition a type 2 diabetic." I said: "That is no surprise to me; I knew something was wrong all along.That changes everything doesn�t it?� He replied, �Yes, we will have to switch you to oral medication.� Then I added, �I think I have a reasonable explanation of why I became diabetic. I will tell you about it when I see you.� During the visit I explained and showed him my graph, which I was using to track my treatment and progress on Lantus�. After two weeks on antibiotics and by fasting, I was able to be off insulin for a day and have normal blood glucose levels.This was short lived because I was still overweight. In May I was able to cut my insulin use in half and eventually be off insulin for a day, again, when I started using Glucophage� XR, an insulin sensitizer.Strangely, the dose was creeping back up. In August I went to see an ear, nose, throat doctor who confirmed that I have a chronic sinus infection. He put me on antibiotics. I now note that I have always had nasal and sinus problems, but never gave it enough consideration.I just lived with it. Mystery solved. Whether the goal is to stabilize blood glucose fluctuations or to cure diabetes, the path remains the same. If there were a term for what I have lived through, I would call it: Insulin Induced Diabetes - A condition where the symptoms of hyperglycemia are treated without identifying its cause:By either administering exogenous insulin or increasing endogenous insulin release. This results in higher insulin amounts in the body, which result in more blood glucose fluctuations and more difficult blood glucose control.This does not eliminate the cause, and serves to feed infections: creating a vicious circle which results in a more unresolved diabetic hyperglycemic condition due to more resistant disease. Hyperglycemia is a glucose load that surpasses normal human insulin capacity. I hope that in the future doctors will view elevated blood glucose, apart from diet, as an early warning symptom of infection. < PREVHOMENEXT >