Taking Insulin

I have occasionally mentioned that I am a diabetic in my social media writing. But I have rarely dwelt on it. I position it more as an incidental fact about me, than something at the core of what I am about. I'm a blogger who has diabetes, not a diabetic blogger and I hope you see the difference.

 There are nearly 24 million diabetics in the US and 250 million in the world, The World Health Organization says that on the average, five percent of deaths each year are caused by diabetes.  So having diabetes is not even slightly unique.

Nor does having a life-threatening health condition. I know of no family that does not have a member at risk of at least one of the myriad things that kill or debilitate us. I have no friends my age who have not yet experienced the death of a friend, which is a far different experience than losing a parent or elder.

So I write now, not to share how I feel about diabetes; nor do I in this case look for support on the subject and I do not think that I will write about it again in the near future.

I write now, because I just went through an experience that millions of other diabetics will have. It was emotionally difficult for me and involved a change in my daily activity. It involved a sense that I had failed and I want to share with others who may follow my path, that it really is not so bad as I had thought.

I am the son and grandson of diabetics. They both got it when they were in their middle 40s and had become moderately obese. So did I. Sometime around my 42nd birthday, I was about 20 pounds overweight. I had abandoned a very long routine of exercising and I had developed a love of starchy delights like pasta, pizza and San Francisco sourdough.

A routine physical exam showed my blood glucose had gone through the roof. A dormant beta gene that I had inherited from my dad was triggered somehow by the obesity. I had diabetes. I would always have diabetes and it is a degenerative disease. In short, no matter what you do, diabetes gets worse over time for almost anyone who gets it.

The good news for me 23 years ago was that I would not need to take insulin. I could control my diabetes by diet, exercise and a few pills taken every day. I got fairly obsessive with the diet and exercise, but still every few years my Glucose measurement would spike and another pill would get added on, despite the diet, the exercise and a headstrong determination that I would never, NEVER have to jab myself in the belly with a syringe.

This became personal between me and insulin. It was the enemy and if it won, I would have to concede that diabetes was defeating me. I would have to concede, that at age 65 I was closer to my death date than I was at 42.

About a year ago, my glucose number spiked again. It was the 5th time in 23 years when I had a spike, but this time there were no more pills. My doctor told me it was time to start taking insulin, and that insulin regulates sugar in my blood better than the pills. In fact, he said I would be overall healthier on insulin.

I refused. I started working out for longer periods of time and more times per week. I cleaned up my diet habits. I lost 8 pounds. A six-month glucose test indicated I had improved, but was not out of the danger zone. Then this past November, I registered some truly awful numbers and there were no more pills left to take.

I had lost. If I wanted to live a longer life I had to start using insulin. I posted a single comment on Twitter saying that I felt like I had failed and got all sorts of supportive and sympathetic tweets. While I appreciated all the words of kindness, I found myself feeling more embarrassed than supported. I felt that my tweet had a certain "oh poor me," tone.

I know that many people with conditions more threatening than I had found support, encouragement and strength in social media. I am happy for them and have written about why this is a good idea, but for me it didn't seem to work that way. I felt worse after tweeting about insulin than I had before.

On Dec. 14, I met with an extremely well-informed nurse nutritionist at the Palo Alto medical Center in Palo Alto. Her job was to educate me and get me to start on insulin. In our conversation, I realized that over the years, I had forgotten a great many tings about carbohydrates and fiber and so on. They were all minor, but over time they had accumulated.

I also took a lesson in self injection using a harmless saline solution. It was easy and did not hurt. That night, I began a ritual that I will continue for the rest of my life. I gave myself my first insulin injection.

Before bed, I use a device that looks like a big fountain pen. I turn a dial and give myself the measured dosage. The process is painless and takes less than 5 minutes. It is nearly foolproof for taking the right quantity and using sterile procedures. I use a form of slow insulin that seeps into my bloodstream slowly over the next 24 hours.

My blood sugar has been reduced but I am not there yet. Every couple of nights I increase my dosage by a couple of units. When my blood sugar settles into a reading between 150 and 100 every morning, then I will be "in control." There's a chance, even a likelihood, that I will need to take a "fast insulin" before and after dinner to avoid big spikes.

This is not pleasant, but the nightly shots have already become part of a nightly routine. Before I go to bed, I check email and twitter, brush my teeth and take a shot of insulin.

I share all this now, so that other people who have this experience understand what I've learned in two weeks. Insulin, for some of us is a genetic necessity. Taking it is not a failure. It allows you to live longer and better. It allows you to watch grandchildren grow. Injections do not hurt and require no more time than brushing your teeth.

I hope you never have to learn what I have learned; but if you do, it simply isn't so bad.

Live long and prosper.