Diabetes and Inflation

 As both of my regular readers know, I've known I've been diabetic since August of 2008.   Over that time, I've developed a routine that gets me through the day.

Initially I would start my day with finger-sticks.  That is, I'd deliberately poke the tip of one of my fingers with a tool that made it bleed, then put a drop of that blood onto a test strip - a little piece of plastic and other things, I'm sure, which, when stuffed into a meter, would tell me a number that represented the amount of glucose in my blood.  I'd look for a number above 100, below 120.  I say "above 100" because if it drops below 100, I can start feeling it.  

As a kid, there were times where I would skip supper in the evening.  It usually had something to do with what we were having for dinner.  It's not that my mother was a bad cook - she definitely was not - but there were times when I didn't like what we were having, and the rule in our house was that you ate what Mom put on the table - or you didn't.  And if you didn't, the alternatives were, well, for many years non-existent.  

Both of my parents were young during the Great Depression in the 1930s, so that might have had something to do with their attitudes about food.  I do know that one of their major mistakes had a pretty profound affect on me.  As a younger kid, still in the single digits, I recall wanting desperately to try Tomato Soup.  I thought it looked good with all of the commercials I'd see on TV where there would be Tomato Soup and grilled cheese, mac and cheese, or what ever combination.  I must have pestered my mother mercifully, for she gave in and bought a can of tomato soup.  It was all I got for dinner that night, I tried it, and realized the advertising wasn't for me - nor was the soup.  

My mother insisted I finish the bowl of soup, and me, being a stubborn little bastard, didn't.  I sat there at the table staring at the window, because I couldn't see the TV, but I could see the reflection.  I sat there staring at the bowl, the window, and waiting for the time between 5 pm and 8 pm to pass, because 8 pm was bedtime.  When my father said that I'd be getting that bowl of soup for breakfast, I "accidentally" spilled it on the table.  That was the end of tomato soup for me, and the last time I asked my parents to try a particular food.  I'm sure it had a deep effect on my trying other things, so I learned that lesson fairly well.  

The reason I mention this is because, after some evenings where I'd skip dinner, I'd get up the next morning with "the shakes" - I don't know if it happens to other people, but I'd wake up and feel my whole body almost shivvering, though it may not be or wasn't cold.  But when my blood sugars now drop below 100, I can feel it.  I can feel internally like I'm shivvering, but the actual visible manifestation of this doesn't usually occur until I get into the upper 80s.  I have been as low as 62, which is where I really feel it, but then again, I've also had blood sugars as high as in the 300s.  

But the finger-stick part was usually the most painful, but not always.  Once I had that number, the day went on to insulin injections.  I absolutely hate needles.  When I'm about to get a shot or an IV, I'll tell the nurse "don't tell me when you're about to insert the needle.  I will preemptively flinch flinch if you do. "  And I do.  But every morning I give myself two injections.  Initially I did it in my thigh, because when the nurses suggested I do it "in my stomach" I thought "oh hell no."  I've since learned that my waist, where I typically have my belt, has a rather wide band of ... well, I won't say insensitive skin, but there are spots I can inject myself and don't feel it.  There are spots around my waist where I can feel it, and spots where it definitely hurts.  But it is what it is.

I've come to terms with the injection by using a technique which works well for me.  My insulin comes in what are called "pens".  Unlike the writing sort, these are filled with liquid insulin, which I can see inside the container.  These have a dial on the end, and when I turn it, it changes a number in a window.  That number is the number of units.  Each pen comes with what should be 3 milliliters of insulin, and my doses are calculated in what I figure are probably micrograms of insulin. 

The insulins I use come in two forms - a long-acting type that stays in my body for hours, while another is the short-acting insulin which really changes that glucose number. Rather than simply reacting, over the years, I've developed a sort of system that works for me.  I don't know if it would work for anyone else, so I don't recommend it, but what I do works for me.  The short-acting insulin is pretty straight-forward.  I start with my blood glucose number, and based on that, I subtract 120 - where I want to be.  If I'm between 121 and 129, I'll inject 4 units of the short-acting insulin.  As the blood sugar number goes up, so does the insulin.  

That's the reactive part of the insulin math.  The proactive part is a bit more math.  I'll look at what I'm about to eat, because 90% of the time I'm looking at my numbers before a meal, and then we count carbs.  Carbohydrates are what my body does not handle easily.  And carbs are the bigger part of most people's diets.  Carbs are things that are naturally sweet, like candy and the like.  There are also many other foods that load up on carbs.  Pasta is one of those things.  My body is particularly incompatible over the last fifteen years or so with sweet corn.  Which is really ironic.  

As a kid, I used to love mowing down cobs of sweet corn.  Boiled, then doused with butter and salt, and look out.  When my mom would make sweet corn, she'd typically split each cob in half, so we'd get these half-size cobs.  We had holders that looked like ears of corn with two pins sticking out, that would go into the cobs, and away we'd go.  One evening I can recall eating 11-half cobs of corn, beating my dad by 2.  

My inability to process those carbs led to today's problems.  That's what makes me a diabetic.  My body has, over the years, used up a lot of kidney function, so I need to assist my kidneys in getting the glucose out of my body by using the insulin.  I'll look at the label or nutrition information provided, or do some back-of-brain calculations.  Every 15 grams of carbohydrates means another unit of insulin - usually.  Unless there's fiber or protein involved.  The nurses taught me that fiber, once it was more than 5 grams per serving where the carbs were in excess of 15 grams, I could subtract the fiber grams from the carbs when calculating.  I generally erred on the high side for insulin, because it's easier to fix when low than it is when high.  I'm expected to check my blood sugar and inject the short-acting insulin 4 times a day - before every meal and at bedtime.  

The problem is the Dawn Effect.  No, it's not named after someone named Dawn, it's the morning version of the word.  My body will "dump" stored sugars into my blood stream around 5 am, so I'll see my blood sugars pop up 6-10 units without eating anything or doing anything to change the number.  So i get to watch out for that every morning, as well.  

The point of this whole disquisition, however, isn't to explain my morning routine.  It's to point out how manufacturers are ... well, screwing people.  While my short-acting insulin dose changes, my long-acting insulin dose does not change day to day, only after doctor's orders.  Initially I started out with 24 units of long-acting insulin, now I'm up to 34 units per day.  For many years, my long-acting insulin pens were absolutely rock-solid reliable.  A box of pens is five of them, each one of them lasted for 8 days at 34 units per day until we got to the 9th day, when the final dose was 35 units.  That is, it made a lot more sense to me to bounce that last day dose up 1 unit, rather than throw that pen out with 1 unit left.  When I'd fill a prescription from my doctor at the pharmacy, a 90-day fill would consist of two boxes of five pens each - or 90 days.  

Back a year or more ago, a law got passed that limited the price of insulin for those on medical assistance programs to $25.  Which is the trigger point, I figure, that encouraged the manufacturer of my insulin to reduce the amount of insulin they put in those pens.  Today, day 8 on my most-recent long-acting insulin pen, the pen had only 41 units of insulin remaining.  That is, after today's dose, there were 7 units of insulin left, not the expected 35.  That means I'm not getting 28 units of insulin that used to be in those pens.  If this was only a one-off, I could understand, it happens sometimes.  But over the last year, my insulin pens (both from the same manufacturer, Lilly) have had less insulin in them and more bubbles.  I don't inject the insulin into a vein, it goes into a muscle, but I don't want to inject air, so I usually keep the tip of the pen in me below the other end, which keeps any air bubbles away from me.  

It just seems odd that, for at least four years, I could count on 9 days per pen with almost the exact same dose every day, then it changes to eight days, the last day the dose is variable.  I guess we'll all need to get used to it because according to the Supreme Court, corporations are people.  Personally, I do think that anything that we consider people should have a chest cavity where you can detect a heartbeat - which is probably going to rule out a couple of those stuffed robes on the Supreme Court.  

Anyway, still here.  Still grumphing along, working on my curmudgeon merit badge...  So I got that going for me, which should keep me going...