From Allentown, Pennsylvania, USA:
I am 25 years old, an engineer, and I travel around the world (due to work). My father is from Spain and my mother from Venezuela. I was diagnosed about two months ago with diabetes. In addition, over that same period of time, I was very thirsty and had the increased urination, but I did not feel "sick."
My C-peptide, taken 40 minutes after lunch and two weeks of insulin shots was 1.9 ng/ml (Normal range:0.8 to 4.0), and the islet cell antibody screen was negative. My A1c, after two months of treatment, was 6.8% (non-diabetic range: less than 6%). My endocrinologist did not see the point on doing an A1c during the first week of diagnosis since she knew it would be high, but - I now wish I had done it to measure the progress.
My insulin dosage is very small: 15 units of mixed insulin in the morning, 4 units of Humalog before dinner, and 8 units of NPH before bedtime. It varies with my menstrual cycle by 1-4 units, and I check my blood sugar level at least four times a day. My GAD-65 antibody, after two months of treatment, was 1.1 (Reference range: 1.0 or less).
Since the diagnosis, I do aerobic exercise seven days a week for a minimum of 30 minutes. I carb count, and I am very stringent about timing my shots, meals, and exercise. Also, my TSH was normal, but I had a goiter. So now, I am taking thyroid hormone. The goiter is reduced and my recent, after two months of medication, TSH was lower.
- Do I have type 1A, type 1B, or type 2 diabetes? I have not been able to get a clear answer from my doctors. Is my ethnicity the biggest factor into me maybe having type 1B diabetes (the doctor's first hunch)?
- Since I was diagnosed before I had any real problems, and I am in such low insulin dosage, could I be going through a honeymoon without knowing it? Can I expect low insulin dosages for life, or will they more than likely rise with time?
- I have been reading everything on diabetes I can find. Could the chickenpox vaccine I received last year have anything to do with the onset?
- Could I be controlled without insulin?
- Should I have other antibody tests done (I read about ICA 512, insulin autoanitodies, EMA, and anti 21-hydroxylase.)? When, if ever, do I need to do these tests?
- Is there anything to be gained from going to the pump if I am controlling my A1c and blood sugar readings? I am thinking about it since my insurance covers it and I travel over many time zones. My doctor says with the low dosages I use, I might be more comfortable without it. What do you think?
- I consider my readings not to be under control (my doctor says I am doing pretty well.) My blood sugar levels range 50-158 mg/dl [2.8-8.8 mmol/L] with averages are in the high 90s mg/dl [5 mmol/L]. In general, I am symptomatic with lows (higher incidence of lows) but yet have not recognized a high (they are always a surprise.) My goal is to always be within an 80-120 mg/dl [4.4-6.7 mmol/L] range. Is this realistic? Could it be achieved 95% of the time?
- I read that weight training should be avoided for diabetics to avoid neuropathy, nephropathy, and retinopathy. Nobody else I talk to seems to be aware of this restriction. How do you feel about weight training (in addition to aerobic exercise)?
- I also read long distance swimming should be avoided (because of hypoglycemia.) I love to swim, I do not do it very often but knowing I cannot do it anymore really bothers me. How do you feel about long distance swimming? Should it be avoided?
It sounds like you need a doctor you are comfortable with. If you travel so much, you have your choice of locations.
I have only heard of weight lifting being a problem if you already have retinopathy. The strain may cause bleeding due to build up of pressure in your eye. Long distance swimming is only a problem if you don't work out a plan to avoid lows. It could be dangerous to have an unrecognized low while in the water or be in a position where you can't treat it. If you are trying to compete and can't take a few seconds to somehow eat if necessary, it might be a problem. If you aren't rushing by the clock, you should be able to work out something "creative" with your physician.
Whether you use injections, or the insulin pump, or a combination, is a personal decision that needs to be made with your own physician and your life style will influence it (switching time zones frequently, long distance swimming, etc.). As you have diabetes longer, your needs may change.
Additional comments from Dr. Stuart Brink:You ask great questions but much too detailed for an Internet response. You should ask them of your doctor and perhaps get a second opinion if you are not comfortable with your doctor's responses. Time will likely answer most of these questions. Your clear goal is controlling the day to day blood glucose variables and doing so by knowing as much about your own day to day pre and postprandial glucose values.
You may want to get a teaching manual by Ragnar Hanas (Insulin-Dependent Diabetes in Children, Adolescents and Adults) that is available at this website as well as from amazon.com, Barnes and Noble.com, etc. This is an excellent and detailed teaching manual that will answer all of your questions in great detail.
Original posting 29 Jul 2002
Posted to Daily Care
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