First of all, Dr. Costabile had me buy a glucose meter; this was a major breakthrough in diabetes care. No more urine tests which were not as reliable because they only measured the amount of sugar which spilled into your urine; the presence of sugar in the urine was not an indicator of current conditions in your blood. He then introduced me to Humalog insulin to replace the quick-acting regular insulin; I still took the long-acting NPH but now took it twice a day instead of once a day because it does not last as long as previously thought. The regular insulin did a poor job of bringing my high blood sugar down, the Humalog was dramatically better. The A1C test was in existence by this time; it measures diabetes control for about a three month period. My first A1C was over 11; normal at that time was said to be between 7 and 8; now the medical community recommends that it be under 7. Anything over 7 is a heavy damaging truck on a vulnerable highway; the higher the A1C, the more damage likely to all parts of your body. I also found that I had high cholesterol which is common for diabetics. This scared me into being very good for a while. I was very careful about what I ate, exercised regularly, tested my blood several times a day, and kept records. We had worked hard to try to bring my BG's (blood glucose) under control but it was extremely sporadic and I had a very strong dawn phenomenon. This is a natural occurrence early in the morning; your body elevates your glucose level to prepare you for getting up and moving through your day. My BG was extremely high every morning no matter what we tried. During the day anything and everything affects you blood glucose (stress is one of the big ones); it's a constant guessing game, very individualized, ie what works for someone else may not work for me, challenging and sometimes frustrating, . The doctor finally told me he would like for me to see a certified diabetes educator (CDE) at Edward Hospital's Center for Diabetes Education; he thought maybe this group could figure out what I needed to do to achieve better control. I was more than just a little bit skeptical; after all I had lived with diabetes for a very long time and sadly knew more about it than many doctors and other medical professionals I had seen. What could these people teach me? I went anyway and found that I was so wrong; there were so many innovations and new ways of thinking and treating my disease. |
Jacque McKernan, RN, PhD, CDE is Edward Hospital's Center for Diabetes Education Clinical Coordinator. In addition to being caring, talented, and knowledgeable; she absolutely without a doubt knows more about diabetes and its care than any medical doctor I've ever seen. She is adept at teaching her patients and always stays on the cutting edge of the latest technological developments. Besides training her staff, Jacque makes it her mission to impart knowledge to other medical professionals who definitely need to know more about diabetes as it relates to patients in their care. |
| Sending me to the CDE was one of the best things Dr. Costabile ever did for me. Jacque went through a whole program of so many things I had never heard. Among the many concepts she introduced was insulin pump treatment; she thought I would be a good candidate to wear one. I had a vague awareness of them but had no idea that using one was a possibility for me. She sent some material and videos home with me then I decided to try this; I chose the Disetronics H-Tron Plus pump. Disetronics is a Swiss company with a U.S. headquarters in Minnesota; the pumps are manufactured in Switzerland. An insulin pump operates more like a natural pancreas; it gives you a small amount of fast-acting short-term insulin constantly; you wear it 24/7. My CDE and I determined the amount of the basal rates which is the amount that it gives you each hour. You may need several different basal rates during the course of the day and night. I was a bit nervous at first but I soon saw my BG's level out to a more consistent pattern of acceptable ranges. Over time my A1C came down to a normal range as well! Another benefit is that you have so much more freedom with a pump. It allows you to eat whenever it suits you best instead of feeding your insulin and you can eat whatever you want (within reason) because you can take a bolus (extra insulin to cover your food intake or to bring down high BG's). Since it looks like a pager, phone, or PDA, I feel very comfortable taking it out and giving myself a bolus at work, in a restaurant, in an airport, or anyplace else. The insulin cartridge will last several days depending on the amount you need and the size of your cartridge (varies by manufacturer). We also had to determine my correction factor which is how far the BG will drop after taking one unit of insulin. |
Jackie Raleigh, RD, LD, CDE, Clinical Dietitian, Edward Center for Diabetes Education. Jackie, a very knowledgeable dietitian, has applied her nutrition expertise toward diabetes care. As a part of the education you receive at the center, Jackie empowers her patients with a thorough knowledge of carb counting and other factors that affect critical blood glucose control. Jackie also teaches proper nutrition and portion control. A table in her office is stacked with appropriate portions of fake food. Additionally she works with those who need to lose weight as a part of healthy diabetes management. She asks her patients to keep a diary, then goes through the diary and the glucose readings with the patients to help them identify their problem areas. |
The center's dietitian, Jackie Raleigh, taught me all about carb counting (nothing to do with the low carb diets) and together we determined my insulin to carb ratio. Carb counting is necessary for a type I diabetic to know how many units the bolus should be with a meal or snack. She also taught me about portion control and the fact that now it is believed that diabetics do not have to avoid sweets and other foods that used to be "forbidden." You just have to use some common sense, know how to count carbs, and take the right amount of insulin to cover your carb intake. Carbs are the food that turn to glucose the quickest and a word of caution, the net carbs that are often used on packages have no relevance to a type I diabetic. We have to go by the total or gross amount of carbs. Both of these caring professional ladies have made a real difference in my life; they have imparted so much knowledge; have given me so much helpful guidance and advice. I continue to see them a few times a year and even stop by to say Hi when I am in the building for other reasons. |
I've been "pumping" since February 2000; this is the most innovative thing that has ever come my way in diabetes care. I had a major concern in 2003 when the FDA decided to ban the import of Disetronics pumps; they didn't like something about the Swiss manufacturing process; this was about the time I was looking to upgrade my pump. Disetronics is a wonderful company with a wonderful product; I didn't know what to do; I searched their website and stumbled onto a link to Insulin-Pumpers.org which has a wealth of information about pumps and diabetes on their website as well as an online support group consisting of almost 5,000 members. I joined and from these list emails I learned so much more than I've ever know before, including facts about several pumps and pump manufacturers. The internet has the potential to give you so much information that will help you to have a better life. In the meantime I was referred to an endocrinologist who is a doctor specializing in diseases/problems in the endocrine system, including diabetes. Dr. Zeller works very closely with the Diabetes Center and is very "pump friendly." Some doctors are not. One member of Dr. Zeller's staff was concerned that I was still wearing a "banned" pump that was out of warranty, even though it still worked perfectly. I then ended up with a pump from the Animas Company (my choice) in Feb. 2004, their pump IR 1000 which has now been replaced by their newest pump the IR1200. In 2006 Dr. Zeller returned to his speciality of taking care of diabetic children and hired two other endos. He told me that he had hand-picked them and that they were very good. Since then I've been seeing Dr. Skjei who is a very good doctor. I found the Animas reps to be very helpful and customer-focused. I've learned from reading comments from other Animas users in my support groups that their customer service is tops in the industry. My new pump was more technologically advanced than the one I had been wearing; now just a few months later in July 2004 I have been upgraded to their newest pump which has "smart" functions. I still have to count carbs and test BG's frequently but you can put the total carbs and/or BG reading into the pump and it will calculate the number of insulin units you should take. Also has an "insulin on board" feature that will keep track of any residual insulin from a previous bolus so you are not taking too much. Since I've been a part of diabetes email groups, I've learned that many people name their pumps. I named my IR1000 Suelyn; the name suggested by an Australian teacher friend, Di Thompson. I liked the name so well I wanted to keep it for my newest IR1200; my friend Millie Carlstrom in Hawaii said I could think of the "older" pump as Suelyn as a child and the newer IR1200 as Suelyn all grown up. The data from Suelyn can be uploaded into a computer to be analyzed and studied to see trends and the possible need for changes. |
| Above is my first Animas pump the IR 1000. Below is the same pump with custom-made cover. It has a picture of my furgirls. |
| Different pump models shown above: On the right is my first pump, Disetronics H-tron Plus, in the middle is my Animas IR1000, on the left is the Animas IR1200. |
| Had a problem with my first IR1200 so Animas replaced it immediately with a new one (below). Chose a silver color this time; it's very cool looking! |
The glucose meters have vastly improved since their inception; my personal preference is the One Touch Ultra Smart made by Life Scan, a Johnson & Johnson company. You can test with the tiniest drop of blood and can also input other factors that may have affected your results. It keeps a history of readings and averages. All this data can also be uploaded into a computer and can be combined with the data from the Animas pump for a complete picture. Items in the works include continuous glucose monitoring systems; and the holy grail of diabetes care (other than a cure): a closed loop system which would include the continuous glucose monitoring system connected to a pump causing the pump to react to the data fed into it by the monitoring system, in other words AN ARTIFICIAL PANCREAS! When this happens, we can function as normal people. We will not have to count carbs or stick our fingers or do calculations or determine ratios or think about all the things that affect our BG's, all these actions that we have to perform now. We have truly come a long way. |
| IR1200 and Related Supplies. Top left to right: cartridge (holds the insulin), infusion tube (connects the pump to the cannula), cannula (goes into the skin and stays under), surgical dressing to cover cannula after connecting to help hold in place. Bottom left to right: IR1200 pump, adhesive remover pads to remove any adhesive left after removing a cannula (you need to change sites every 2 or 3 days), and site prep pads (contains alcohol and small amount of adhesive to cleanse site and to help cannula stick better) |
Update July 2006 I was very sad to recently learn that Jackie Raleigh moved to another state |
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| We've Come a Long Way, Baby! |
| Disetronics pumps: the H-tron lower and the newer D-tron on top. I had the H-tron plus. I used it for 4 years and was very happy with it. http://www.disetronic-usa.com |
| The One Touch UltraSmart glucose meter. http://www.lifescan.com |
| Link to: Insulin-Pumpers.org, for Diabetes Support and Information, especially about insulin pumps Site also contains a number of other good links. |
| This article on the Joslin website talks about the myth that diabetics must be on a "diabetes diet" and must avoid sweets. http://www.joslin.harvard.ed u/education/library/ nodiet2.shtml |
| A Continuation of My Diabetes Story from Preceding Pages |
| Every diabetic needs the services of a CDE and a dietitian to help manage the disease. It's a huge difference between the support and education I get there and the dread I used to feel every time I went to the doctor because I felt I had been "bad." These are the people who will help you to live a normal life. It is critical, absolutely positively critical, that you have the proper system of education and management as well as support. Diabetics need to realize that normally they may not receive the appropriate direction they need from a general practitioner. We diabetics are so fortunate that today we have much better resources to help us live better; we must utilize those resources otherwise the consequences are often heart-breaking. |
| Edward Center for Diabetes Education 120 Spalding Dr., Ste. 411 Naperville, IL 60540 left: Jacque McKernan RN, PhD, CDE Clinical Coordinator/ CNS Diabetes. right: Jackie Raleigh, RD,LD,CDE Clinical Dietician. |
| Academic Endocrine and Metabolism 120 Spalding Dr., Ste. 401 Naperville, IL 60540 left: Patrick Zeller M.D. right: Stephen Skjei M.D. |