T-1 & 2 graph & FP’s no boluses)
I have NOT had formal education past high school (class of ‘57) except for 2
non-fiction writing classes one semester at a local liberal arts college. BUT,
the difference in Type I and Type II diabetes was explained to me by my endo was
with the graph I’m going to attempt to make.
On a non-diabetic (I refuse to call them normal people because sometimes I think
I’m more normal than they are) the BG runs according to the following lines with
snacks and meals indicated (it’s much easier w/pen & paper face to face):
____
__ _ ___ _ / \
- - -/br\- - -/s\ - - -/ Lu.\ - - -/s\ - - -/ Dnr. \ - - -^- -
A Type 2 diabetic still produces insulin, however it is not quite enough and is
late: Low & Slow. If we were sitting together, I would draw a line a little
underneath the graph and offset it.
A Type 1’s pancreas works like this: ————————————–
When I took 2 shots of NPH & Regular insulin, they peaked and that is when meals
were required:
v v v v
/ / \ \ / / \ \
With the pump, the basal rate controls the day and the boluses cover the meals &
snacks. Therefore, a pumper can follow the NON-diabetic’s graph above.
FOR THIS REASON, I was taught, a Type 2 having pancreatic activity can (will)
run into trouble with the constant infusion of insulin and natural body insulin.
i.e. a double dose.
Sleuthing, I have some other insights into FP’s problem:
a.. Since the BG was 8.5 (?) he/she is NOT from the USA where Type II
diabetics (except for Joan) are not encouraged to wear a pump. USA BG
measurements are in dl/ml.
b.. I was told in 1983 that one of the pump requirements was to be an
uncontrolled/brittleType I. FP is an admitted Type II.
c.. Not being aware of how long FP has worn a pump, perhaps it has been long
enough that the pancreas has sufficiently rested and no longer Low and Slow.
d.. Many pump wearers become a normal weight from the better control.
Perhaps FP has lost weight (I lost 20# - BUT gained it back) also allowing more
pancreatic activity. Others who need to gain weight, do.
e.. Being under better control perhaps the excersize has increased enough
that FP is unaware of the extra activity that is also lowering the BG.
Jan = age 60
Type 1, 49 yrs., pumping 16 years
July 14th, 2003 at 3:45 pm
Hi Jan…….
Subject: [Insulinpumpusers] T-1 & 2 graph & FP’s no boluses)
I have NOT had formal education past high school (class of ‘57) except for 2
non-fiction writing classes one semester at a local liberal arts college. BUT,
the difference in Type I and Type II diabetes was explained to me by my endo was
with the graph I’m going to attempt to make.
On a non-diabetic (I refuse to call them normal people because sometimes I
think I’m more normal than they are) the BG runs according to the following
lines with snacks and meals indicated (it’s much easier w/pen & paper face to
face):
____
__ _ ___ _ / \
- - -/br\- - -/s\ - - -/ Lu.\ - - -/s\ - - -/ Dnr. \ - - -^- -
A Type 2 diabetic still produces insulin, however it is not quite enough and
is late: Low & Slow. If we were sitting together, I would draw a line a little
underneath the graph and offset it.
A Type 1’s pancreas works like this: ————————————–
When I took 2 shots of NPH & Regular insulin, they peaked and that is when
meals were required:
v v v v
/ / \ \ / / \ \
With the pump, the basal rate controls the day and the boluses cover the
meals & snacks. Therefore, a pumper can follow the NON-diabetic’s graph above.
FOR THIS REASON, I was taught, a Type 2 having pancreatic activity can
(will) run into trouble with the constant infusion of insulin and natural body
insulin. i.e. a double dose.
Sleuthing, I have some other insights into FP’s problem:
a.. Since the BG was 8.5(153 USA) I think Iput both values on my first
post (?) he..He/she is NOT from the USA Canada where Type II diabetics (except
for Joan) are not encouraged to wear a pump. USA BG measurements are in dl/ml.
Who said that?
b.. I was told in 1983 that one of the pump requirements was to be an
uncontrolled/brittleType I. In 1990 it’s different FP is an admitted Type II.
c.. Not being aware of how long FP has worn a pump, (7 1/2
months)perhaps it has been long enough that the pancreas has sufficiently rested
and no longer Low and Slow.
d.. Many pump wearers become a normal weight from the better control.
Perhaps FP has lost weight (I lost 20# - BUT gained it back) Only 5 lbs or
soalso allowing more pancreatic activity. Others who need to gain weight, do.
e.. Being under better control perhaps the excersize has increased
enough that FP is unaware of the extra activity that is also lowering the BG.
I’m beginninning to believe this maybe the answer. I’ll be talking to the CDE
on Monday. will advise ya.
f.. Thanks for sharing, It’s appreciated.
Jan = age 60
Type 1, 49 yrs., pumping 16 years
Fp = age 60
Type 2, 20+ years, ID 2 1/2 years, pumpin 7 1/2 months
July 15th, 2003 at 3:06 am
Hi Jan…….
a.. USA BG measurements are in dl/ml. Who said that? We read our
meters and can tell that US & Canada go by a diff. numbering system. Canada and
South Africa and some other countries use the other measurement #’s. The numbers
come out something like 18 x Canadian numbers (simplified x20, roughly) to equal
the readings.
Type 2, 20+ years, ID 2 1/2 years, pumpin’ 7 1/2 months
I disagree on insulin dependent if you are Type 2. Type 1 is insulin
DEPENDENT. I left off of my graph that Type 2’s have 3 types of treatment
depending on severity: watch the diet, meds, or insulin. My endo says the way to
be sure if you are Type 1 is to not take your insulin for 3 days — then if
you’re dead, sure enough it was Type 1. Type II’s may take insulin but are NOT
dependent upon it. If you are insulin dependent, perhaps you are now full-blown
Type I and the diagnosis changed. I have a friend whose diagnosis was changed
from T-2 to T-1.
Jan
July 15th, 2003 at 8:00 am
Subject: [Insulinpumpusers] Re: T-1 & 2 graph & FP’s no boluses)
Hi Jan…….
a.. USA BG measurements are in dl/ml. Who said that? We read our
meters and can tell that US & Canada go by a diff. numbering system. Canada and
South Africa and some other countries use the other measurement #’s. The numbers
come out something like 18 x Canadian numbers (simplified x20, roughly) to equal
the readings.Or USA #’S DIVIDED BY 18.
Type 2, 20+ years, ID 2 1/2 years, pumpin’ 7 1/2 months
I disagree on insulin dependent if you are Type 2. Type 1 is insulin
DEPENDENT. I left off of my graph that Type 2’s have 3 types of treatment
depending on severity: watch the diet, meds, or insulin. A technicality really,
I’m a type 2 who became a type one, is the correct version (Pancreas is toast)
My endo says the way to be sure if you are Type 1 is to not take your insulin
for 3 days — then if you’re dead, sure enough it was Type 1. Type II’s may take
insulin but are NOT dependent upon it. If you are insulin dependent, perhaps you
are now full-blown Type I and the diagnosis changed. I have a friend whose
diagnosis was changed from T-2 to T-1.
Jan
Fp
July 15th, 2003 at 4:08 pm
Subject: [Insulinpumpusers] Re: T-1 & 2 graph & FP’s no boluses)
Hi Jan…….
a.. USA BG measurements are in dl/ml. Who said that? Sorry,
what I meant was who said Canadians are not encouraged to go on pump therapy??
I put it in the wrong place. LOL.. I’m An American by the way, GA. We read
our meters and can tell that US & Canada go by a diff. numbering system. Canada
and South Africa and some other countries use the other measurement #’s. The
numbers come out something like 18 x Canadian numbers (simplified x20, roughly)
to equal the readings.
Type 2, 20+ years, ID 2 1/2 years, pumpin’ 7 1/2 months
July 16th, 2003 at 11:37 am
Subject: [Insulinpumpusers] Re: T-1 & 2 graph & FP’s no boluses)
Hi Jan…….
a.. USA BG measurements are in dl/ml. Who said that?
Sorry, what I meant was who said Canadians are not encouraged to go on pump
therapy
b.. I didn’t know anyone said Canadians are not encouraged
to go on pump therapy. What word was misleading??
Jan
July 16th, 2003 at 7:44 pm
Subject: [Insulinpumpusers] Re: T-1 & 2 graph & FP’s no boluses)
Hi Jan…….
Type 2, 20+ years, ID 2 1/2 years, pumpin’ 7 1/2 months
I disagree on insulin dependent if you are Type 2. Type 1 is
insulin DEPENDENT. A technicality really, I’m a type 2 who became a type one, is
the correct version (Pancreas is toast)
Technicality my foot(prints) LOL. A fact is a fact. You are a
Type 1.
Jan
Fp
July 17th, 2003 at 10:10 am
Hi Jan:
your analogy is reasonably correct but is more wave like, depending upon our
activity. Yes, type 1 pancreas doesn’t work at all…couple of things I’ve
learned in my patho class is that there are genetic links,& possible viral
causes, that damage the pancreas so consequently, cannot produce the
necessary growth hormone which is insulin. The islets get covered with white
cells which prevent insulin production…one theory…..We are very
chemical…our bodies rely on hundreds of different chemical and enzyme
interactions in order to function.
Type 2 is anyone else…pancreas can be effected by obesity, (definitely part
of my problem), infection, which can impact on the islets of langerhans
(that’s the area in our pancreas that produces insulin) and prevent them from
working well; can also have hypertrophy of the islets in the pancreas which
means the particular area affected just poops out…that’s why some type 2s
do well on oral meds; while others are insulin resistant where the cells
won’t open up to let glucose in, there are many different types of
diabetics..as we are learning. Only about 14% are actually Type 1s.
Type 2 like fp and me, may have been on oral meds for many years (at least
me), eventually had to change to different types of oral meds, got to the
point where I was having insulin surges where sugar would go from 180 down to
59 to 203, etc. when the good old number hit 309, I knew that it was time to
take matters in hand. Got my internist to start me on insulin…but the
combination of 70/30 didn’t work well for me, started researching and found
that I was definitely insulin resistant.
Was taking high doses of insulin with still poor control, and not going nuts
with the food either. Told my internist that I needed a pump, he said I was
beyond his scope of care.
My timing was good. I had been looking for an endocrinologist, had already
started Nurse Practitioner training. One of my instructors worked with an
endocrine group here in new york, one thing lead to another and I met up with
a very nice endocrinologist who listened. First thing that happened was off
70/30 and onto NHP and Humalog (Lispro). What a change!!! My sugars started
to improve. In the meantime, he referred me to the rep for IIS (Insulin
Infusion Specialists) they market both the Disetronic and MiniMed. The
Disetronic was my choice given all my previous quips about it.
So there are some endocrinologists who will use a more aggressive approach to
diabetes control,,,namely the folks that are willing to put us on the pump
and work closely with us. And now I’ve accomplished one of my many goals and
am an official Pump Trainer…just got my certificate last week!!
The DCCT study has a direct influence on how diabetes is approached and
managed. Given all our risk factors, pumping makes sense.
Exercise (my bane) is another, so fp is seeing the effects that that
component in our care can truly work…now back to more homework and hope
that helped….Joan:)
July 18th, 2003 at 1:02 am
Subject: [Insulinpumpusers] Re: T-1 & 2 graph & FP’s no boluses)
Hi Jan…….
Type 2, 20+ years, ID 2 1/2 years, pumpin’ 7 1/2 months
I disagree on insulin dependent if you are Type 2. Type 1 is
insulin DEPENDENT. A technicality really, I’m a type 2 who became a type one, is
the correct version (Pancreas is toast)
Technicality my foot(prints) LOL. A fact is a fact. You are
a Type 1.
Ok, ok, now we’ve beat that to death, I’m a type 1, the
corrct label…….now what?? LOL
fp
Jan
Fp
July 18th, 2003 at 5:17 pm
This sounds very familiar, Joan!!!!
July 19th, 2003 at 5:07 am
Ok you guys!
Let’s not quibble….if you check with the American Diabetes Association &
the American Medical Association, the CDC & National Institute of Diabetes
and Digestive and Kidney Diseases (all have websites), the designations for
Type 1 and Type 2 have been clarified….Check the New York Times Website for
Tuesday, June 24, 1997 "Revised guidelines define diabetes in broader terms"
by Denise Grady…
(courtesy of my endocrinologist on my first visit)….
I quote "…Type 1, which is more severe, usually develops in childhood or
adolescence and is caused by a severe deficiency of the hormone insulin."
"adult-onset or Type 2 diabetes, which affects 90 % to 95% of diabetics and
which tends to develop after age 40…." do we sound familiar???
the quote further " The American Diabetes Association estimates that 10 % to
20% of type 2 patients are treated with diet and exercise, 30% to 40% with
oral drugs, and 30% to 40% with insulin or insulin and oral medications."
For everyone…the ADA’s new guidelines: bg levels < 110 mg - normal
> 110-125 mg impaired glucose metabolism - work it up
> 126 mg or more Provisional diabetes requires testing on 2 consecutive days
to confirm….
read the article, it is most informative….suffice it to say that both fp &
I and many others are type 2 that require insulin….fp may still be making
some insulin which is why those basals are within a normal range…I on the
other hand require basals in the 2.7 units/hr range because of my insulin
resistance…so, we all suffer from the misery, except in different ways and
approaches, ok???? check it out…Joan:)
July 19th, 2003 at 5:40 pm
Joan, it would appear that my unplanned exercise program may be the
culprit…. It’s the only thing that’s different in my life at the moment.
fp
"the saga continues….."