Finding the chase and cutting to it

I love reading, but just fiction wanes after a few days. So, I’ve been catching up on some type 1 diabetes literature.

The American government is particularly keen on publishing papers, and Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association caught my eye.

One of the difficulties we have in replacing our insulin requirements with externally provided insulin is that’s only half the story.  Insulin production in humans is couple with C-peptide release, which shuts off glucagon production in the alpha cells of the Islets of Langerhans.

However, quite a few type 1s retain this ability, for as long as 40 years after diagnosis.  Only it’s not a constant, guaranteed rate.  If we imagine that my body, like yours, is still producing beta cells but, unlike you, then systematically destroying them – this makes sense.

But leaves us with an impossible conundrum – how much insulin do we need day to day?  “Madness is doing the same thing every day and expecting different results” is attributed to Albert Einstein.  With type 1, doing the same thing every day can lead to wildly different outcomes.

Hell, no wonder you sit there frowning at your meter!

Rude, that’s just rude  But yes, it is not always trivial.

Many see hybrid pumps as being the answer – I have to say the past few days, it has actually helped.  But that’s because I haven’t been eating and things have been crazy with my infection.   Who knew that’s what it would take to get it doing reasonable things?

Not eating is not a long term viable option though (my results when travelling into London have been helped a great deal by taking this approach, so short term: it’s fine).

One of the other things that’s been interesting with the articule has been the approach to care.  When I moved away from Ipswich, I found most GPs liked to “manage my diabetes” which was a different approach to the one I’d had in Ipswich, where the focus was training to allow us to make adjustments ourselves day to day and check it’s working every 12 to 6 months.

In my various type 1 groups, those of us who do better seem to be the self-managers. Long term. Surely if the numbers support this, that’s what every clinic and GP should be looking to do?