This is a very good article from Joslin in which research on type 1 diabetics of different age groups (children, teens, adults) has been presented. Life expectancies have greatly increased, and likelihood of complications has greatly decreased, but there is still more to be done.
This sounds very interesting, but the link seems to be broken for me.
Link broken. Please replace, I am interested in this topic.
One would think that 10 years of reduced life expectancy would be a risk that could be actuarially accounted for and the life insurance “ban” could be replaced by appropriately underwritten coverage…
The gist seems to be that tight control early on exerts a lot of leverage over long term outcomes:
New research, particularly from the follow-up study of the DCCT, suggests that early interventions have positive repercussions later in life. “Twenty seven years later, this period of intensive control still impacted mortality and was able to benefit people,” says Dr. Katz. “Even though in the intervening period the two groups were really similar,” with respect to glycemic control.
(I was a bit confused by what was meant by “intensive” versus “conventional” insulin therapy, but in the original research article apparently it just means keeping A1C under 7—which I thought was fairly conventional.)
This bit caught me eye as well:
From the data presented in these articles, Dr. Katz and Dr. Laffel recognize that deaths occurring under the age of 50 are mainly the result of acute complications, like diabetic ketoacidosis or severe hypoglycemia, which are potentially preventable. These younger patients are likely juggling the many demands of type 1 diabetes as well as the demands of adulthood.
In other words, for a good long part of your life it’s not the cardio-vascular or renal complications of high BG that are liable to get you but the direct consequences of using (or failing to use enough) insulin, mainly because it’s hard enough to manage the regular pressures of adult life without the extra layer of complexity T1 lays on top of things.
Not exactly a huge surprise, either one of these findings, but still good to have them backed up by formal research. The plural of “anecdote” is not “data,” as they say…
Intensive is basal bolus with fast acting+ basal insulin (either pump or injections) , conventional is the regular/NPH method where the person has to time their meals to deal with insulin peaks. Most of us here probably use what’s considered intensive so we don’t understand what else existed. The other method is old school and while it helped people when insulin was new, it isn’t effective now compared to basal/bolus.
Oh I understand R/NPH, believe me. 20 years worth of far too much understanding. Guess that has made me resistant to thinking of that archaic form of torture–er, treatment as “conventional” but I guess you’re right.
I’ve asked questions before regarding life insurance policies… Didn’t get a whole lot of feedback but the only replies I remember we’re just saying that they had gotten term policies but had to pay slightly higher rates… If it’s a subject you know more about I would certainly be interested to hear.
Thanks for the link, DrBB.
If my memory serves me, in the original DCCT study, intensive meant either multiple daily injections using a basal/bolus regimen or pump therapy. The intensive group made liberal use of self monitoring of blood glucose and presumably took insulin corrections when needed. Conventional therapy meant 1 or 2 doses of insulin each day.
When I was diagnosed in 1984, my initial insulin therapy consisted of one dose of NPH insulin each day. Then I moved to two doses. With a year or two I evolved to basal/bolus therapy using NPH and Regular.
While I understand the truth of this statement, at what point does a tide of anecdotes hint at a truth that is simply undocumented because a study was just not done due to lack of funding. While anecdotes do not hold the weight of a valid scientific finding, neither can they be dismissed as false simply because the study has not been done. I believe within many anecdotes reside a seed of truth.
I totally hear ya regarding “anecdotes,” of course. Because we ALL have to manage that gap, sometimes quite a large one, between what the instruction manuals and professionals lay down as rules and what we actually experience when dosing our bodies with this stuff.
I was dx’d in December '84, was put on R/NPH from the start, and didn’t find my way to Lantus/Novolog MDI until 2000. I can’t think of R/NPH as the same thing at all. For me, eating for your dose (“Eat now or die!” as I referred to it) versus dosing for what you eat was the difference between prison and being handed wings and told “By the way, you can fly now.” But clearly our experiences differ. One of the odd thing about this site is finding out how ridiculously variable the treatment regimes, and experiences of people on them, are for this disease.
The “conventional” R+NPH insulin regime (2 shots a day) sucked rocks That tried to pair the morning’s shot’s R with breakfast and N with lunch, and evening shot’s R with dinner and N with some kind of overnight basal. N just twice a day does not make a good basal especially when it has to double-time as bolus for lunch.
But R+NPH could also be used in a MDI regime (4 shots a day) and I did that for several decades with great success. NPH 4 times a day is a dang good basal.
I do not feel that the modern analog insulins are all that much better. A lot more expensive, but not all that much better. They try to sell Lantus et al as a once a day basal but I have to do twice a day for it to even out.
The real breakthrough in the last 3 decades, was home bg testing. I was first diagnosed before widespread home bg testing, and it was like stone knives and bearskins back then. Ever couple months I would visit the doctor for a blood draw and then the next day my parents got a phone call with my bg number from the day before. Stone knives and bearskins man!!!
I sort of came up with MDI using R/NPH on my own, during the late 1980s. 2 shots/ day didn’t really cover late night beer blasts or burritos so I’d cover those things with some R too. It worked well but I think that it contributed to me gaining a lot of weight as it was very irregular. When I reread Dr. Bernstein, in between when I ordered a pump and when I got it, I did a very brief and unscientific experiement divvying up my say 25U shots into 4x6 shots (at a time…) of NPH and it seemed to help it deploy more smoothly but this was all done unscientifically. Unfortunately, when we moved in 2009, I tossed my log out. I really wish I’d have hung onto it as I always found it very funny that anyone would have gotten anything out of it but the doc pretty much nailed my doses (probably using a weight/ age calculation, rather than anything from my log…) right out of the gate with my pump.
I remember it more as sort of “management by superstition”. Am I low? Am I high? Well, what does it feel like? Does it feel high? Low? Let it be?
It was like trying to feel your way through a dark room filled with sharp edged & pointy obstacles, naked with your hands tied. Aside from the results from the occasional BG draw, the only time you were relatively sure about anything was after it had hurt you.
When I was on it, it was just one shot in the a.m., because you could combine R and N into a single shot, and I always had it that the R peaked at lunch time and the N at dinner (roughly). Whatever–“Eat now or die!” was what it felt like. I still remember my first appt with an actual T1 specialist at Joslin, who after looking at my bloodwork and A1Cs commented “Well you’re not doing too badly considering that the way you’re treating it makes no goddamn sense whatsoever.”
My first couple of years were pre-fingerstick as well, which certainly didn’t make it things very easy to manage. My experience totally agrees with yours there.
[quote=“DrBB, post:16, topic:46113”]
“Eat now or die!”
[/quote] Love it!?!
Yes, that is what is was like for me. When I “asked” to go on the pump, I told my endo that while I enjoy eating very much, the whole NPH thing that demanded feeding at specific times, was making me see eating as an unwanted chore.