Two Years of Type 1 Diabetes

Next month will be the second anniversary of Karl's illness, hospitalization, and diagnosis of Type 1 diabetes, and it's so far, so good. 

His insulin usage has gradually increased, and is now at 17 units of Lantus per day for a basal dose, plus one unit of Novolog for every ten grams of carbohydrates in his meals. I rough figures, this is about twice his original dose, meaning that his pancreas has been gradually producing less and less insulin.

We were told to expect a "honeymoon period" of relatively low insulin requirements and stable insulin requirements that ended suddenly, but this didn't happen. 

Possibly this is because we deliberately decided to see what we could do to to stretch things out. Among these things were:

• Use of a relatively low-carb diet (averaging around 60 grams of carbs per meal, which requires less insulin and thus allows better control of blood sugar.
• Use of the Novopen Junior insulin pen, which officially allows insulin to be delivered with a half-unit resolution, but which probably allows precision to one-quarter unit or better. (For example, if we want to give 5.25 units, we dial in 5.5 units, then back off to halfway between the 5.5 mark and the 5.0 mark.)
• Karl likes the same meals over and over, so we get really good at comparing the before-and-after blood sugar levels to find the right level of insulin.
• Giving Lantus morning and night, rather than at bedtime only, because its response curve doesn't stay flat for a full 24 hours for everybody.
• Use supplements: Insulow and evening primrose oil at every meal and daily supplements of mutlivitamin, vitamin B3, and vitamin E.
• Refusing to freak out.

Karl's very fussy about maintaining his insulin kit just so, and that means we're almost never caught short when we go out to eat.

On the downside, Karl has refused to let the nurse take blood samples the last couple of times, so we haven't done detailed bloodwork recently. And his blood glucose regulation is getting less good as his insulin requirements increase, since the pancreas is far better at this kind of thing than any kind of insulin therapy, however spiffy and modern, so the less his pancreas contributes, the wider the blood-sugar swings, though we're still doing pretty well.

What's next? Perhaps reducing Karl's carbohydrate intake some more. The fewer carbs he eats, the less need for insulin, the lower the load on his pancreas, and the narrower his blood-sugar swings will be. We've done pretty well at keeping a typical meal at 60 grams of carbs, but Dr. Bernstein's regimen recommends no more than eight grams of carbs per meal, and that would be a huge change! 

So far, Karl has had no hypoglycemic episodes and no infections, and we'd like to keep it that way.