Long Term Complications of Diabetes

Since I switched from thrice daily injections of Bolus insulin in the form of a Novolog pen to .5 mg doses of Prandin I have lost a degree of blood glucose control. For almost two weeks leading up to the switch I had managed to keep my blood glucose under 200 with few lows. It seemed that my average number would have been somewhere in the high 120s to the low 140s. The rules of the game had been set, and I had been able to take down enough data to conclude with precision how many units of insulin would offset a number of carbohydrates. If my pre-meal check was a little high or a little low I could modify the number of carbohydrates to end up where I wanted to a few hours later. The insulin reacted immediately, and if I injected properly and into a good site on my body the results were predictable. But that was synthetic insulin, bio-engineered in a factory somewhere, it was not mine.

Prandin is a pharmaceutical that activates the production of insulin by your pancreas and comes in different strengths from .5 to 4 mg per meal. I was started at .5 mg because of my active lifestyle and regular hypoglycemic spells. After the first pill it was clear that my body was responding positively to the drug since my blood sugar stayed level despite an intake of over 100 carbohydrates. However as the days progressed it became clear that Prandin did not work as mathematically as synthetic insulin. One day a pill metabolized 110 carbohydrates and left me stable, another time two pills were insufficient to metabolize 180 carbs and left me 100 points higher than I began. Another shortfall is the rate at which it stabilizes your blood glucose. With synthetic insulin I knew it would activate within 15 minutes and lose the majority of its potency in three hours. With Prandin it seems that the affects can be seen several hours later, and often don't effect blood sugar levels until almost an hour after being consumed.

The bottom line is that with Prandin I have lost confidence in my ability to adequately regulate my blood glucose levels and I wonder if the advantages gained by taking a drug that encourages your own insulin productions are favorable to taking synthetic insulin that offers you a stricter degree of control. Common sense may forgo sticking bits of metal into your skin and injecting something foreign if you can avoid it, especially if the thing your injecting can be produced naturally. However, common sense probably knows little of the A1C tests administered quarterly to well-monitored diabetics.

The A1C measures your average blood glucose over the past 90 days in the form of a percentage. This percentage roughly corresponds to the kind of numbers we're used to seeing on a glucometer. Here are some numbers presented by About.com:

A1c (%) to eAG (mg/dl)
6.0% = 126 mg/dl
6.5% = 140 mg/dl
7.0% = 154 mg/dl
7.5% = 169 mg/dl
8.0% = 183 mg/dl
8.5% = 197 mg/dl
9.0% = 212 mg/dl
9.5% = 226 mg/dl
10.0% = 240 mg/dl

Notice the pattern? For every half percent the eAG goes up 14 points (15 for every third). When I was diagnosed I had a A1C of a little over 13% and so following the pattern I extended the chart.

10.5% = 255 mg/dl
11.0% = 269 mg/dl
11.5% = 283 mg/dl
12.0% = 298 mg/dl
12.5% = 312 mg/dl
13.0% = 326 mg/dl

Three hundred and twenty six miligrams per decaliter! Holy hell! I was in some serious trouble. Why? Because A1C is one of the best indicators available to show your predisposition towards diabetes related complications. Wanna live with diabetes for 100 years and die of old age at home in your sleep? Keep your A1C under 6%. Wanna slowly watch your health deteriorate until you're on your deathbed at 40? Let your A1C live in the 9s and above. I'm not being hyperbolic. Look at the following chart taken from the Bayer website:



Let me translate. As your A1C grows incrementally your chance of developing diabetes related complication increases exponentially! And if you're not worried about contracting some disease with a long Greek name let me break it down.

Retinopathy is damage to the retina which can lead to blindness (and you'd better believe it will if you don't get it under control). "Almost everyone who has had diabetes for more than 30 years will show signs of diabetic retinopathy"

Nephropathy is damage to your kidneys which is usually not reversible and instead leads to dialysis, a procedure that is considered a temporary solution until a kidney transplant is available. "Diabetic kidney disease is a major cause of sickness and death in people with diabetes."

Neuropathy is damage to the nerves which can lead to a whole host of bigger problems from amputations to heart attack. "About half of people with diabetes will develop nerve damage."

Can you see now why it's so important to keep your A1C in check? Keep it under 6, live forever. Keep in under 7, live a long healthy life. Over 7? I don't want to find out.

Dailies:

11:10 -> 133 Alright, this number isn't so bad, but after the lowest post dinner number I'd yet had on Prandin last night I was hoping for lower. I took 2 Prandin with cereal 110c, banana 25c, and a piece of toast 25c = 160c.
1:52 -> 196 That seems unjustifiably high. Should I have taken 3 Prandin? Would it have helped? Three hours since taking the pills I should have leveled off a bit more than that.
5:37 -> 80 Wow, finally a good number, but what explains the drop from before. Could my Lantus have caused the drop, or simply a late reacting Prandin? Took 1 pill with Dinner: wild boar burger 35c and fries (7oz) 80c = 115c.
11:58 -> 113 Alright, that's another pretty good number. Took 5 units of Lantus and one Prandin with Supper: Salad w/avocado 32c, snow peas 12c, carrots 14c, celery 12c, peanut butter 6c, tahini 6c = 82c.
2:44 -> 172 Again, I seem to be higher than I should be at night.

Thoughts: All in all the numbers weren't too bad. I stayed below 200 (just) and my lowest was 80 which is a perfect number. Oddly enough an 80:1 ratio didn't seem to work for breakfast or supper but was more than enough for dinner... or was it? Does Prandin just work slower than synthetic insulin? A good indicator will be my number tomorrow because I had a relatively low fat supper so most of the sugars should have already been released. If Prandin works slowly I'd expect my number tomorrow morning to be low.

Tomorrow I think I'll also call the doctor and see if there are any adverse side affects to taking multiple pills of Prandin per meal because, to be perfectly frank, I often am hungrier than is reflected by my meals. I can't always stick to 80 carb dinners and have been known to eat upwards of 250 carbs at dinner. How many mg of Prandin would it take to offset that?

Day 57