Plenty of questions...

[realdealbneal]

Okay, I'm 24 and I've had diabetes since I was 10. For the first five years, I was doing very well, taking 70/30, Regular and NPH. Eventually, I fumbled, and started going out of control. When I was 19, I was rushed to the ER for ketoacidosis, and the doctors changed my insulin.

Since then, I've been taking Lantus and Humalog, one shot of Lantus at night, and three shots of Humalog for each meal.

I'll admit that I still haven't been taking great care of myself...all except for the last 9-10 months. I have taken all of my shots, increased insulin to bring my blood sugars down, stopped eating sweets and all those bad carbs, and did everything possible to make things right.

January, when I started all this, I was perfect. Vision included. For the next eight months, still perfect. However, last month, I woke up with a floater...and was eventually diagnosed with diabetic retinopathy.

Also, for just this year, it has been very difficult to run my blood sugars lower than 150. I have, but it almost feels like I'm going into a convulsion.

Even then, my health is going to hell. I have less feeling in my feet and ankles. I'm tired after only three hours of working (and I can't even work right now because of my vision).

Yesterday, I went in for my second laser eye treatment, on my good eye (no floater or blurriness). Over 24 hours later, I can't read a thing and can barely type (using the corner of my eye).

Questions...

1) Why does it seem like taking care of yourself is a bad thing?
2) After the laser treatment on my good eye, is it supposed to be blurry, and how long will it be that way?
3) Aspartame...is this a true story, that it causes problems with diabetics? I drink a great deal of diet soda.
4) In your opinion, what's the best insulin to use (or combo, however you regulate your sugars)?
5) I heard a rumor that too much insulin can ruin your nerves in your hands and feet, and lead to neuropathy. Since taking more insulin and "taking care of myself" I've started to experience this with larger doses of Humalog. Any truth behind this?
6) Is there any alternatives to taking insulin without injections for Type I diabetics? The inhaler? Anything? Not as important, but it would be nice.

Thanks for any replies. I really appreciate it.

[blondy2061h]

I can't answer all of your questions, but I can touch on a few.

Aspartame- I personally do not see a problem with this. I use it regularly with no problems.

Best insulin- I personally feel whatever basal/bolus regimen works best for you is best. This includes either Lantus or Levemir as the basal insulin, and Apidra, Humalog, or Novolog as the bolus insulin. The bolus dose should be based on your pre-meal blood sugar and how many carbohydrates you are consuming for that meal. An injection should be taken every time you eat. Or you can use a pump, which I feel is the best method overall, though understand is not feasible for everyone either due to financial or personal concerns.

Insulin does NOT lead to neuropathy, uncontrolled diabetes does.

The insulin inhaler was the only alternative to injected insulin, and that was just pulled off the market. You could use a pump if you wanted, or a device called the IPort if injections are a concern. The IPort is like a pump infusion set, except you inject into it. There's also the Insuflon, which is line an angled version of the IPort.

[Coravh]

Hi Neal. I'm really sorry you are having such a hard time. The good news is that even with some problems, you can still continue on to lead a wonderful life. I was a bit younger than you when I started having lasers on my eyes. Here I am, 44 years old, and still have almost 20/20 vision. Granted, I have had my cataracts done, but I really can see just fine.

Before I get to your questions, I just wanted to talk to you about a comment you made. You said that you feel awful if you are below 150. Unfortunately, you body can get used to too high blood sugar so that when you get close to normal, you feel very low. I'm afraid that you are just going to have to bite the bullet and work at getting used to more normal blood sugars again. Once you spend more time below 150, you will feel much better. Sorry, but there is just no way around that.

So, on to your questions.

Questions...

1) Why does it seem like taking care of yourself is a bad thing?

It never is. Keep in mind that complications are a long term thing and you have only been working at taking care of yourself again recently. This damage was in part caused by blood sugars from years ago. Also keep in mind that while tight control can help reduce complications, it is possible that no matter how good care you took care of yourself as a teenager, this might have happened anyway. But that said, the tighter your control now and in the future, the better off you are going to be.

2) After the laser treatment on my good eye, is it supposed to be blurry, and how long will it be that way?

Because the laser heats up the retina, the retina will swell up which makes things blurry. It basically depends on how extensive the treatment was and how your body reacts to it. I know that for me it usually took a couple of days and I felt a bit lopsided for a while. The good news is that lasers are a really effective treatment.

3) Aspartame...is this a true story, that it causes problems with diabetics? I drink a great deal of diet soda.

I don't believe it does cause problems unless you are allergic. My own personal preference is to drink water or club soda with a tiny splash of juice for flavor. I don't like the after taste of artificial sweeteners.

4) In your opinion, what's the best insulin to use (or combo, however you regulate your sugars)?

The best insulin to use is the one that works the best for you. I have been on a pump now for almost 5 years and it is the best thing I've ever done. While it takes some work (you really have to know your ratios and sensitivity factors) it frees you up a lot.

5) I heard a rumor that too much insulin can ruin your nerves in your hands and feet, and lead to neuropathy. Since taking more insulin and "taking care of myself" I've started to experience this with larger doses of Humalog. Any truth behind this?

Nope. None whatsoever. Insulin does not cause nerve damage. It is uncontrolled glucose that can cause nerve damage. BTW, supplements such as ALA (alpha lipoic acid) and GLA (gamma linolenic acid) are know to help with neuropathy complications. Check with your doc if it is ok for you to take. As I said before, neuropathy and retinopathy are long term complications. While they may have appeared recently, they have been brewing for quite a while. Tighter control can decrease the neuropathy and help prevent further complications.

6) Is there any alternatives to taking insulin without injections for Type I diabetics? The inhaler? Anything? Not as important, but it would be nice.

I LOVE MY PUMP!!!!!!!!!!!!!!!!!

Whoops. Sorry, that tends to slip out. I can sleep in and not have breakfast and not worry about taking my shot. I take a slightly higher basal rate overnight to combat the dawn phenomeon. I can have a nice lunch and then decide to indulge in dessert and rather than having to stab myself again I just dial up the right amount of insulin.


So, hope this helps a bit. I really would investigate getting a pump. It can be expensive, but it is definitely worth it. I could never go back to mdi (multiple daily injections). In part because it's so inconvenient (4 shots per day versus one insertion every 3 days with a pump) but also because I can take a bolus in increments of 0.1 units. I could never do that with a syringe.

Best of luck to you.

Cora

[realdealbneal]

Thanks for the replies so far. You know how it is when you read and hear all these different things, especially on here, and you start wondering how many of them are true, and how many just pertain to that person...which is why I'm asking those questions in one thread, instead of reading 300 different ones and taking in all the different answers.

The thing that I don't like about the pump is the chance of infection when you slip the needle in. I knew a guy who had one for a while, and he had very ugly, infected "wounds" (I call them that because that's what they looked like to me) from the pump. I figured it was awesome until I saw those, and decided that the injections were much better. Shots don't hurt me, although I'm fairly thin, I could care less. I was just curious, because I get annoyed by all the injections, not so much the pain, but the inconvenience.

About feeling low at 150, it's weird...and I understand what you mean by me getting used to the high blood sugars. However, I had a convulsion at 256 once, so it was something I really couldn't figure out and thought I was just the odd man out.

This eye situation has really put me in a hole, though. I'm very active...especially playing basketball. I coach it, play it, and watch it all the time. If you can't see, you can't do any of that. This blur that I'm seeing right now has to be gone by Sunday, also...or I lose my job. Pretty sad situation, especially when these laser treatments are $2,000 each and I'm without insurance (had the job for just a month, no insurance yet).

[Coravh]

Originally Posted by realdealbneal

Thanks for the replies so far. You know how it is when you read and hear all these different things, especially on here, and you start wondering how many of them are true, and how many just pertain to that person...which is why I'm asking those questions in one thread, instead of reading 300 different ones and taking in all the different answers.

The thing that I don't like about the pump is the chance of infection when you slip the needle in. I knew a guy who had one for a while, and he had very ugly, infected "wounds" (I call them that because that's what they looked like to me) from the pump. I figured it was awesome until I saw those, and decided that the injections were much better. Shots don't hurt me, although I'm fairly thin, I could care less. I was just curious, because I get annoyed by all the injections, not so much the pain, but the inconvenience.

About feeling low at 150, it's weird...and I understand what you mean by me getting used to the high blood sugars. However, I had a convulsion at 256 once, so it was something I really couldn't figure out and thought I was just the odd man out.

This eye situation has really put me in a hole, though. I'm very active...especially playing basketball. I coach it, play it, and watch it all the time. If you can't see, you can't do any of that. This blur that I'm seeing right now has to be gone by Sunday, also...or I lose my job. Pretty sad situation, especially when these laser treatments are $2,000 each and I'm without insurance (had the job for just a month, no insurance yet).

Infection from pump sites? Are you kidding me? How long was this guy leaving them in? A month? I'm so sorry that I sound incredulous, but I've been pumping for almost 5 years now and I've never had an infection. Sometimes if I leave a site in for too long (yes, I've been bad on occasion) I'll get a bit of a "hole" that looks like a large bee sting, but I just wipe it off with an alcohol swab and it's fine.

As for the vision - try to do whatever you can to not make the pressure go up in your head. So that means no bending over from the waist, no straining and picking up heavy objects, and try not to let yourself get constipated (believe it or not, straining that way can increase the pressure in your head tremendously). Your blurring should go away soon.

Best of luck, and when you get insurance, definitely think about the pump.

Cora