Such a thing as too much MDI?


#41

I remember when I “discovered” MDI about 30 years ago. My discovery was partly inspired by some remarks in one of Dr.B’s older books, jogging my memory about my brief time in DCCT, and me going from there to research stuff. My docs didn’t walk me into MDI, I read about it and implemented it myself.

(Now this was primitive MDI by modern standards, because it was done with NPH and regular. But it was a different mindset to do basal+bolus with 4+ shots a day, than to take 1 or two shots a day and then eat to the absorption curve).

I’m not sure MDI improved my lab numbers at the time (in fact it was kinda rare for the docs to even show me back then!).

But MDI sure as heck helped me adapt more to life as a college student and be more flexible with regards to eating and activities.

MDI significantly improved my quality of life and my attitude towards life. It gave me a very real feeling that I was in control of my bg numbers and gave me choices in my day-to-day life that I didn’t previously have.


#42

I had much the same experience as my treatment evolved from one or two NPH injections per day to adding Regular at meals. It did make my life better. Getting better is about the best we can do. Reaching for better provides sanity when trying to live 24/7 with such a demanding disease.


#43

I really think Seydlitz lives on another planet. It’s the only possible explanation. He claims to live in my country, but I am not aware of Canadian doctors forcing their patients into hypoglycemic comas so that they can maintain A1Cs in the 4s.


#44

Your comments are always about yourself and what you do. You project your negative experiences onto everyone else as if this is the only possible reality living with type 1. I’m not trying to personally attack you, as I said I agree with some things you say, but I think you should try to see things from other perspectives and understand that your experience might be unique rather than the norm.


#45

I’m no expert, but the only thing that comes to mind is scar tissue if you aren’t adequately rotating your sites. It sounds like you have several you are using!


#46

I don’t think it’s as simple as having a choice between these two extremes. In fact, I think I can safely say it is not. My son has his share of highs and lows, but none (knock wood) have been severe, and he’s maintained what I consider a terrific A1C ever since diagnosis, over ten years ago.

Managing diabetes most definitely has psycho-social impacts, but they, just like bgs, can be reasonably managed.


#47

The problem is that you never know at what point the elevation of blood sugar will be sufficient to cause complications, how severe they will be, and how soon they will come at any given A1c level, since each person’s physiology is uniquely sensitive to hyperglycemic damage. Studies of 50-year survivors with no complications have established that some people have a genetic protection against diabetic complications in the form of an insulation of their DNA against pathological changes. Other people have the opposite problem in that they are supersensitive to hyperglycemia, and I know from having observed my grandmother and aunts that the genetic profile of my family is highly disposed to developing complications, and yet somehow I have survived 52 years with the disease despite that. Were all the hypoglycemic episodes I suffered the necessary cost for that? No one knows, since we can’t conduct an experiment and see how I would have fared under one 52-year regimen or the other, nor can we determine how the genetic profile in everyone responds to which degree of hyperglycemia.

A friend of mine, who has now had diabetes for just 17 years and is in his mid-30s, has always had a very easy time controlling his blood sugar and always had much better blood sugar results than I did, since my physiology spontaneously produces huge variations in insulin sensitivity from one day to the next, so the same food, exercise, and insulin on Monday can keep everything fine but on Tuesday the identical program produces disastrous hypoglycemia, and then on Wednesday the same regimen cause massive hyperglycemia. Anyway, he is now blind and on dialysis after 17 years of excellent blood sugar results, and yet I’m still intact after 52 years of diabetes, despite having spent the first 20 years with a massively high A1c because that was in the era before home glucometers had even been invented.

Genetics is the key, and if you are hyperglycemia hypersensitive you have to decide which risk you will cultivate, complications or hypoglycemia? If you have huge spontaneous jumps in the body’s insulin response from day to day in addition to a large genetic risk, you are really in a difficult situation.


#48

Hmmm really? I remember you once said:

“My friend, for example, who was born in 1968 and diagnosed with type 1 diabetes in 1984 was treated entirely under the most modern regimens, advancing to each new form of treatment as the technology developed. He always had better blood sugar control than I did, but despite all of this, by 2000 he was blind and on dialysis.”

Pretty sure 1984 wasn’t 17 years ago and your friend isn’t in his mid-30s if born in 1968. Now I know you just make things up to suit whatever weird agenda you have. Good luck to you.


#49

I knew him in the late 1990s when I was working in the clinic where he was a patient, so I was talking about him as he was when I knew him. He got a transplant eventually and moved away


#50

No worries, Babs5… I google some “thumb text shortcuts” to avoid the eye roll I get if I have to ask! But we oldies can still write circles around the youngsters if communication in complete sentences with good grammer and (gasp) punctuation is needed.


#51

I think this is a very sad statement! Is this all our lives are? Deciding complications or hypoglycemia? I really think most of us have a whole lot more to think about each and everyday. Yes I worry about complications. Been doing this for a long time. Does it control my life? No, I do the best I can to live a happy, healthy and fulfilling life. Does genetics play into this? Sure but that’s true of everything in life. But do I want to curl up and die, nope, I’ve got way too much life to live.
So back to the question about can one use to many injections? Nope, it’s what works for you. I was up to five everyday before starting on a pump and yes there were days I took more due to food or blood sugar. I just think using every spare piece of real estate you can’t!


#52

You can be in a difficult situation medically because you are trapped between diabetic complications and diabetic hypoglycemia without it ‘controlling your life’ and without ‘wanting to die.’ It all depends on the weight you give to the medical and non-medical aspects of your life respectively, and I never said that the negative medical aspects of life had to color all of it, as you seem to have misunderstood me saying.


#53

Ala - At ADA2018 there was the “STAT” study presented on afrezza. It may be something you want to consider to reduce the injections.

Not only did it provide a 30% reduction in hypos versus RAAs but it was proposed that “stacking” afrezza can provide a one point reduction in A1c versus RAAs with no additional hypos. All that with no injections.

It is being presented in Berlin in October. Here is the abstract
https://easddistribute.m-anage.com/from.storage?image=4iBH9mRQm1kfeEHULC2CxoXyiiFRjEN8yzAwOStli6AVhLMkbVQ3fpwygOwycnZNBBuLGI3e5FQt31yfTgy2oA2