What Is That Thing?!?

It's the question most often heard in monster movies. If not spoken aloud, you can bet comfortably that at least one character thought it. And if you think I'm referencing the title of those post, I'm not. I'm talking about, of course, diabetes. Don't scoff! Protagonists in monster movies are often thinking about diabetes. It's why they're willing to give their final convoluted plan a shot!

(Get it? "Give it a shot"? It is that I am being big jokester! Russian ancestors would be proud.)

Okay, okay. That's not a real thing. It'd be pretty amusing, though. Imagine Rick and Evelyn seeing the reanimated Imhotep for the first time in The Mummy (1999), and one asks in utter shock, "Is that... Is that DIABETES?!?" 🤣

The obvious thing I'm going to cover is the question, "What is diabetes." This is going to get technical in places, so I'm hoping to explain everything in a way that the average human can understand it. Most laymen only understand diabetes through some relative who has/had it, resulting in the generalized question, "You're not allowed sugar, right?"

(NOTE: Avoiding sugar is like avoiding air. It can't be done. But I'll get to that... someday.)

Complicating the question immediately is the fact that there are different types of diabetes. Allow me to go through them.

1. Type 1 diabetes - Also known as juvenile diabetes or Type 1 DM for short. (The "DM" stands for "Diabetes Mellitus." I'll cover its name in a future post.) The patient is incapable of making any insulin whatsoever and must get it from an external source. For the record, you don't need to be a juvenile to be diagnosed with juvenile diabetes. I once met someone who was 27 when they were diagnosed with Type 1 DM.
2. Type 2 diabetes - AKA adult onset diabetes or Type 2 DM. The patient with this version can't make enough insulin to cover the amount of food they eat, has become resistant to their own insulin, or their poor old pancreas just isn't making as much insulin as it had in its youth. This one can be controlled with diet and medication, although sometimes insulin injections are used to gain tighter control. (Having become a Type 2 DM to go along with my Type 1 DM, I did a deeper dive into Type 2... and I'm going to have to dive even deeper, since almost every source reads, "Obesity, obesity, obesity." But I'm not finding the answer to WHY obesity causes diabetes.)
3. Gestational diabetes - Yes, ladies, you get your very own special version. You find yourself eating for two, but only making enough insulin for one. Women with this version of DM often have to take low doses of insulin. Up to 7% of all pregnancies can be complicated by this type, and there's always a chance of the diabetes becoming permanent.
4. Prediabetes - I used to joke about this. "Prediabetes. It's like being 'pre-dead' or 'pre-pregnant.' It's silly. You are or you aren't!" But I've since learned more, and a person with prediabetes is someone who has all the markers to become a Type 2. This diagnosis is their big hint to make some serious lifestyle changes.
5. Diabetes insipidus - I consider this one a kind of "false flag diabetes." It will mimic symptoms of diabetes mellitus, specifically polyuria (frequent urination) and polydipsia (extreme thirst). I'm only mentioning it because it exists, but it's not the kind of diabetes I'll be writing about.

As stated previously, I'm a Type 1 AND a Type 2. I'm not making ANY insulin and my body isn't processing the insulin that I DO take. 

Since it's been mentioned so often, I'll explain insulin, its production, and its role in a person's metabolism. This will get VERY technical, but learning some of this will let your doctor know that you were paying attention at Diabetes School.

I used to think diabetes was about the body’s inability to break down sugar. Oh, how wrong I was! Insulin is a hormone that attaches to cells, allowing them to absorb sugar. Without insulin, the sugar stays in the bloodstream, causing all sorts of damage along the way. (Trust me. I'll get into the damage, probably in more detail than you'll ever want!)

There are areas of the pancreas called the islets of Langerhans. Those islets are where insulin is produced, stored, and released. Each islet has about 1000 to 2000 beta cells. Beta cells are primarily responsible for insulin production.

Other important regions of the islets of Langerhans are the alpha cells and delta cells. Alpha cells produce and release glucagon, which is used to raise blood sugar levels when they drop too low. Delta cells create somatostatin, a chemical that mediates on behalf of insulin by blocking glucagon. (For those familiar with the Greek alphabet, please don’t ask me where the "gamma cells" are. Someone somewhere skipped gamma altogether.) Finally, there are the PP cells that release pancreatic polypeptides to control all of the insulin, glucagon, and somatostatin activity.

A CORRECTION TO MY ORIGINAL MANUSCRIPT! I joked about the missing gamma cells, but it turns out that they're the "PP cells." Which brings about another complaint from me about diabetes education. There was so much commitment to use the Greek alphabet to list the various cells in the pancreas, but many of my sources skipped over "gamma cells" in favor of "PP cells." I'm starting to think they chose the latter for the sole purpose of being able to say "PP" in their scientific papers, and then giggle little children. ("Teehee! He said 'pee pee'.")

“How does all of this work together?” It’s like this... If you intake sugar, the regulatory parts of the brain tell the beta cells by way of the PP cells to release insulin. As the sugar gets broken down, the insulin attaches to various cells to allow the glucose (sugar) into those cells. Keep in mind that sugar is the major source of energy for EVERYTHING in the body, right on down to a microscopic level. If the cells inside your body can’t get their sugar fix, they will force other things in the body to become sources of energy. That’s bad. VERY bad!

It's a lot. I know it is. I'll admit that I don't have all this information memorized; I'm referring to my notes as I write this. So let me make it as simple as possible. If you eat a thing, and the thinking-thing tries to tell the other thing to make stuff so you can use the first thing, but the other thing is broken, you got diabetes.

Hmmm... Actually, that sounds like a few thousand other diseases. Let's try that again a little less generalized. If you eat something that can become sugar inside you, and the brain signals your pancreas to release insulin, but you have little or no insulin to release, then you're a diabetic.

Oh, I seem to have forgotten a detail about glucagon! Your pancreas makes this hormone when your blood sugar drops. It's the first line of defense against hypoglycemia, AKA low blood sugar. Too much insulin, too much physical activity, too little food intake, and your sugar levels can drop. Glucagon will signal sugar reserves throughout your body to be released.

This could be a glucagon molecule or a cake

molecule. I don't know. I just wanted to look

really smart.

If I ever get around to explaining The Somogyi Effect, you'll get a clearer view of what glucagon can do.

So that was lots of words to say, "You ain't got insulin? You got diabetes." But if you have any questions, feel free to ask me and I'll do what I can to answer. Yes, Google can probably answer your questions, but sometimes it's difficult to parse the information to find exactly what you want to know.

Until my next post, my friends, heed this sage advice: DO NOT FRY BACON WHEN YOU'RE NAKED!

An Explanation Is Absolutely Necessary

This one's going to be low on humor, but I need to explain WHY a new blog became necessary in my mind.

As far as I know, there are two kinds of Type 2 diabetes. Either the pancreas doesn't make enough insulin or an individual's body can no longer properly process the insulin they DO have. The latter's what's happened to me. I've always taken a lot of insulin because I was insulin resistant. In recent years, I've had to take more... and more... and more. There are 300 units in a single insulin pen, and I can go through one pen every day. I've had to start skipping meals once a day to make sure this doesn't happen.

Another recent development has been the addition of a CGM, or Continuous Glucose Monitor. I still have to check my glucose manually, as sometimes the CGM can be off, but it helps me track where my sugar has been and where it's going. Yes, there's an arrow that tells me if my glucose is trending up or down! It's exciting stuff.

A single sheet of paper would no longer be enough to track a month of my glucose readings. I needed room to note the date, the time, the glucometer reading, the CGM reading, and any comments I might have. And trust me, there were notes already showing up on the old single sheets of paper. The time had come to purchase a notebook dedicated to my diabetes management.

The result was a mess. I was starting to wonder how I'd managed a 6.8 on my last Hgb A1c. (I'll discuss A1c's another time. Suffice to say it measures a diabetic's recent control.) I'll use my readings from yesterday, 7 October 2023, as an example.

• 8:00 - Meter: 342. CGM: 374. Calibrated the CGM to align more closely to the meter. Took 80 units of Novalog. Skipped breakfast completely.
• 12:45 - Meter: 321. CGM: 277. Calibrated the CGM. Took ANOTHER 80 units of Novalog! Ate lunch.
• 7:30 - Late dinner. Meter: 247. CGM: 263. Calibrated the CGM. Took 72 units of Novalog! Had dinner.
• 9:10 - CGM read 312 and indicated I was trending upward. I felt like I was spiking. Took another 20 units of Novalog.
• 11:30 - Meter: 319. CGM: 311. CGM calibration wasn't necessary. Took 40 units of Novalog and skipped my evening snack.
• Somewhere around 3:00 - CGM read 150. Went back to sleep.

In a single day, I took 292 units of insulin. My average glucose for the day was 315 when rounded out. If we based my A1c on a single day, it would have been 11.0! I did no cheating whatsoever. No little treats at all! Just a lot of insulin and two skipped meals. It was absurd!

I need a greater understanding of Type 2 diabetes so I can understand where I'm at in my diabetic journey. I've started a medication to hopefully make my body more receptive to the insulin I'm taking.

There was a little humor when I shared the news that I had both Type 1 and Type 2 diabetes. A friend commented, "Clearly when you do something, you go all-in. That's your superpower." Yeah, pretty much.

So here we are, at the end of my second post, and I need a picture. This looks like a job for... SUPER SQUIRREL!

Faster than a speeding acorn!

More powerful than that kid with the BB gun!

Able to leap tall shrubberies in a single bound!

Look! Up in the trees!

It's a bird!

It's a frisbee!

It's... SUPER SQUIRREL!

I was going to go through a mimicry of the whole opening of the 1952 Adventures of Superman, but it was getting extra silly for me. "It's a bird!" Well, yeah, it could be a bird. I said it was in the trees. And mistaking a squirrel and a frisbee probably isn't a thing.

See you folks next week.

For Your Consideration

Welcome. I'm your host, Rob, and I'll be your diabetic for today... and every day... because in all honesty, there are no other diabetics accessing my posts directly. Oh, some diabetics might appear peripherally in the comments section, but none appeared in my previous attempt at a blog about diabetes, which was rather disappointing. I'd like to receive comments. Compliments, constructive criticism, corrections of misconceptions I might inadvertently perpetuate, etc. So long as it's not rude or inappropriate, it'd be nice to get feedback.

Look, I've tried to do this several times in the form of an autobiographical book. My first attempt was called The Suicide Note. Pretty grim, right? That title was chosen

 because I wanted to shock readers with the fact that diabetes could kill. But that's not quite accurate. Diabetes rarely kills; it's the complications of diabetes that kill. What's more, that title could scare off potential readers. My other idea for that version of my story was to have it bound in a metal cover so that if friends and loved ones couldn't get their poorly controlled diabetic to read it, it could be used to beat them about the head and shoulders to gain compliance.

Marketing ideas. I got them.

I then tried a more positive stance and started writing The Grand Inheritance. There is, however, a difference between writing to send a positive message and writing to get laughs. Besides, what was so grand about Type 1 diabetes? Nothing. At the very least, it's an ongoing annoyance. At its worst, it's crippling. 

No, wait... At its worst, it's deadly.

See? Much better.

Another thought eventually leaked into my head: What if I wasn't in the mood to write about whatever it was that was supposed to happen chronologically? Context can be everything. So let's say I'm writing about the history of diabetes, and suddenly I want to skip to some complication that happens to be bothering me that day. That would look like a mess in the pages of a book. But in a blog? I'm golden.

As mentioned, this is my second attempt at a diabetes blog. There'll be quite a bit of copying and pasting, with edits to correct my information when necessary, add clarity, and/or make something more humorous.

So allow me a moment to run down a few pertinent facts before I leave this post.

1. I have been a Type 1 diabetic since the age of seven, and I'm currently 56. That's 49 years of experience to share.
2. I am NOT a doctor. I'm a well-read guy who knows a lot, but not everything, and some of what I know may be outdated. If you want medical advice, seek a medical professional.
3. As I start this new blog on 30 September 2023, I am also a newly diagnosed Type 2 diabetic. Yes, I have TWO types of diabetes simultaneously!
4. Every diabetic is different. It's almost like we're human beings or something! Different people have VERY different experiences with medications, complications, doctors, and so on. What I write here will be about MY experiences.
5. I gotta say, being a July baby has given me easy access to the joke, "My sign? Oh, I'm a Cancer. Well, actually I'm a diabetic."

😂 I'm a card. (I should be dealt with.)

That's my introduction, folks. Good? Bad? Mediocre? Who am I to say? But I sincerely hope that this is the continuation of a journey that's both educational and entertaining. I'll be aiming for one post per week, so keep a lookout for my weekly ramblings.

Finally, I discovered that if I add a picture to my posts, it creates a thumbnail for me, which I think is a lot of fun. I usually tease something about a celebrity wife. That'll come in due time. Today, I choose to share the results on my physical therapy.

This is as far as I could get before it collapsed.

Yes, my physical therapy is all about creating things with Lego. Using only 2x8 bricks, I build a thing, take it apart, and build another thing, all in an effort to keep my hands functional. You'll just have to trust me when I say that this activity was approved by a neurologist. And for the record, I had many more white blocks to add to this monster, but it was all becoming unstable. In fact, I got two pictures of it before it collapsed. Oh well. It was fun while it lasted.