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.