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Dr. Bill's Commentaries

You get the beer, and I'll get the Lantus   (November 29, 2006)

The other day, Steph and I were divvying up the shopping that we had to do. I was running low on Lantus, and our refrigerator was also running low on beer, so it was pretty obvious that someone had to get the refills. She also suggested that she would pick up some takeout pizza for supper. And I went to the pharmacy and picked up the insulin.

The concept of beer, pizza, and insulin all being part of a tight-control diabetes program might strike some people as unreasonable. But let me assure you that it can work. My tight-control program consists of Novolog given immediately after most meals plus Lantus as basal insulin. Since starting this program a bit over a year ago, I’ve averaged 110 mg/dl on my blood glucose levels, and had normal A1cs, most recently 5.9 You might ask: do I have any restrictions on what I eat? Yup, but they have nothing to do with diabetes. If I eat too much, I’ll gain weight, and like most other people, I have no need to gain any more weight.

How can such a program work?

1) Zillions of blood glucose measurements. For example, I always check my BG before driving. To be sure, once in a while, I’ll do only two BGs a day, but if things are exceptional, I have no hesitation to check 6-10 times in a day.

2) Figuring out how much insulin is needed for my routine foods. For me, 1 slice of pizza takes 4 units of Novolog; 1 bottle of beer is 3 units; 1 English muffin with peanut butter is 3 units.

3) Counting carbs and taking the Novolog after eating. I simply add up the number of units of insulin I’ll need as I go, from salad (no insulin coverage needed) to main course to dessert. Then I pop the total number of units right then and there, using an insulin pen.

4) Injecting through clothing. I discussed this a while back at my other blog, in an article entitled Injecting Through Clothing. To date, I’m doing this about 80-90% of the time, without any harm except astonished looks from friends and physicians that I actually do it!

5) Splitting the Lantus into two shots. I draw up 15 units each evening into a standard insulin syringe, and inject, then immediately draw up another 15 units and leave in the basket on our breakfast table for the next morning. (If I forget the evening shot, which has happened, the empty spot in the basket is the tip-off - and I simply give 20 units instead of 15 that morning.)

6) And I do try to keep stashes of sugar stuff everywhere: in the bathroom, in the car, etc. I’ve listed some of the places that you might keep sugar here : Hypoglycemia.

7) Finally, I always wear ID that I have diabetes, and it’s prominently displayed in my wallet. Although I have the best of intentions, there’s always the chance that something will screw up royally, and if I’m unable to tell folks I might be low, I want to have the paramedics to find out ASAP! My choice is MedicAlert®, as they have an 800 number and a 24-hour call center as well as bracelets and dogtags.

Do I expect you to handle your diabetes this way? Not really. Not unless you’re willing to jab your skin at least 8 times every day. Not unless you want normal BG control, while still eating with absolutely no restrictions. It can be done with an insulin pump, or multiple injections. Maybe it’s worth it for you - it definitely is for me.

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Dr. Bill Quick began writing at HealthCentral's diabetes website in November, 2006. These essays are reproduced at D-is-for-Diabetes with the permission of HealthCentral.

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