The trick was to get a prescription for Lidocaine ointment and apply this topical anesthetic an hour before the appointment, telling Karl that this would help a lot, and doing the blood draw in a different room from usual. This process was more to his liking, which is just as well, because it took the nurse quite some time to find the vein!
Blood Sugar Well-Controlled
Two years after being diagnosed with Type 1 diabetes, his average blood sugar level, as measured by the Hemoglobin A1c test, is at 5.3% -- within the normal range! Yay, Karl! This presumably means that he is no more likely to have diabetes-related health complications than a non-diabetic. Whew!
How do we do this? Karl's rigid dietary preferences help, because we know how many grams of carbs are present in everything he eats. And the sensible use of intensive insulin therapy, with long-lasting basal insulin and fast-acting mealtime insulin, is essential.
Adjusting insulin dosage. One thing we do that many people don't do is to adjust Karl's dosage based on experience. We don't wait for a doctor's okay -- or even ask, for that matter. Some people wait until the next time they see their doctor to adjust anything, even if their next appointment isn't for a year and their numbers are way out of line! That's a bad idea.
For his basal insulin -- we use Lantus -- you can find the "titration" recommendation online. Basically, we look at the morning blood-sugar levels and adjust the dose until they're in the right range. This can be repeated if they wander out of the range again (looking at a few weeks as an average). Karl started out with about 7 units of Lantus a day and is getting 18 now. We split this into a morning injection and an evening injection.
Similarly, for mealtime (bolus) insulin, if the blood sugar numbers are consistently high or low after meals, we're clearly giving the wrong amounts of insulin. Over the past two years, the right amount has drifted from 20 grams of carb per unit of insulin to 10.
Being willing to adjust the dosage according to the data is probably a big reason why Karl's A1c numbers are so good.
Pancreas Hanging in There
Another important test, C-Peptide, measures how much insulin Karl's pancreas is still making. The "acceptable" range is 0.9-6.9 ng/ml, and Karl came in at 0.7. It was actually in the "acceptable" range last time we tested it, two years ago, which shows how blood tests don't tell the whole story, since being hospitalized with extreme levels of blood sugar isn't what I'd call acceptable!
People will tell you that Type 1 diabetics don't have any pancreatic function at all, and their C-Peptide tests will come in at zer0. That's nonsense. Pancreatic function in Type 1 diabetics is impaired, and typically declines, often to zero -- but writing the pancreas off is pessimistic and stupid.
To help preserve the pancreas, we do a few simple things:
- Maintain excellent blood-sugar control. This puts less of a load on the pancreas, which isn't literally killing itself by producing all the insulin it possibly can, 24/7, because the injected insulin is removing much of that load.
- Supplement with niacinamide and vitamin E. A few studies show benefit from this.
- Maintain a low-ish carb diet. The more carbs you eat, the poorer you blood-sugar control and the more your blood sugar spikes. Carbs reach the bloodstream faster than injected insulin, but the fewer carbs you eat, the smaller the spike And an error of, say, 20% in estimating the carbs in a meal makes only half as much difference if you're eating only half as many carbs. Karl eats only about half as many carbs as are recommended for a typical diet.
