This was originally posted to my blog, Diabetes Odyssey.
This post is meant to be a book review. As the title has already indicated, I recently read the book Think Like a Pancreas. This book was written by Gary Scheiner and I found it to be a great source of information on insulin therapy.
First of all let me tell you a little about Gary Scheiner. He isn’t just some guy who understands nothing about diabetes and decided to write a book just for the heck of it. This guy has a pretty impressive list of proof of his worthiness of our trust and attention. He is a Certified Diabetes Educator, and also a type 1 diabetic who uses and is a trainer for insulin pumps and CGM’s. He also is a Masters-level exercise physiologist. He gives his time on many advisory boards of diabetes device manufacturers and pharmaceutical companies. He is an avid volunteer for many diabetes foundations, associations, etc… And he has a private practice, Integrated Diabetes Services. You can check out his online services at www.inegrateddiabetes.com.
Right out the door I picked up on one pleasant note of this guy’s personality and writing style. I can only describe him as a guy with a ‘dad joke’ personality. He also has a pleasant and very positive attitude toward diabetes. He certainly understands and writes about the frustration and hard work that comes with being a diabetic (even when you’re under great control), but he points out that having control and understanding your diabetes takes away a whole lot of the bad stuff.
This book, as you may have already picked up on by the title, is not geared toward teaching about every single thing diabetes. Although the author does explain what diabetes is, covers very quickly all the different types, and discusses a bit about a lot of things diabetes related, the book is mainly and mostly all about insulin therapy and a detailed journey on how to gain and keep control of your BG via insulin.
As I read the book there were a ton of things covered that I already know, but there were a lot of things covered that I thought I understood but this author clarified, corrected, or put them in a new light for me. And there were some things I had no idea about before I read this book.
I’d like to discuss some of the things I found interesting and learned about. I am not going to go into detail about every little thing the author teaches because, well, you gotta read the book!
First, memory lane. The author was diagnosed in the same decade I was, the 1980’s, so a lot of the tools and education he got at first were the same as mine. I was so surprised that I had totally forgotten about the very first lancing device I ever used. It was so scary looking and painful! No wonder I hated checking my BG and tried to avoid doing it!
In chapter 2 the author drops a note on something called glycosylation. “Sticking of sugar to connective tissues like tendons and ligaments, thus limiting their ability to stretch properly”.
Of course, what is a book on diabetes that doesn’t cover diabetes complications? The happy news is that he doesn’t spend much time on this topic, he just makes it clear what uncontrolled diabetes can lead to. Alzheimer’s was one of the complications he listed. I’m fully aware of this, but I don’t know why it always hits me when Alzheimer’s and diabetes are linked. I guess maybe it’s just because it’s something I stress over, it’s scary, the thought of losing your mind/memory.
All throughout the book are lines like this one, “Just knowing that you are doing your best can be a tremendous source of personal satisfaction”. The author is fully aware and doesn’t mess around the fact that diabetes is constant work and even when you do your best you don’t always hit the target. He is positive, reassuring, while also being realistic and reasonable.
The author talks a bit about amylin, this is a hormone the beta cells secrete that does multiple things, including regulating the rate at which food digests. So type 1’s don’t make insulin or secrete amylin, either.
One thing I hadn’t known at all but should have is that type 2 diabetes generally has three stages. Now that I know about it, it makes perfect sense. “Onset of insulin resistance, followed by failure of the pancreas to meet the increased insulin need, followed by a reduction in pancreatic function”.
Another term I wasn’t fully aware of is glucose toxicity. “Occurs when high sugar levels do direct damage the pancreas, thereby further reducing its ability to produce insulin”.
One medication used for both type 1 and type 2 diabetics I had never heard of before is Pramlintide (Symlin) which works like the hormone amylin. The author explains how this medication works and when it is taken. He is very good at covering both the pros and cons of medications and who they would be good for and who wouldn’t benefit from them.
The author makes use of charts a lot, which is very helpful to the readers to further and better understand what is being discussed. Especially when he goes into numbers, rises, falls, time tables, etc.
I’m fully aware that there are many different types of insulin and each work a different way. One insulin I wasn’t aware of is U-500. As I was reading about it my stomach literally sank and I trembled a bit. This stuff is frighteningly potent! It is a regular insulin but is 5 times as concentrated! It is normally used for diabetics who are super insulin resistant (needing 300 or more units of insulin per day). My first thought was, OMG, what if a non-resistant diabetic were to accidentally take their normal dose but of this stuff! Frightening! My second thought was, geez, 300 units a day? And I thought I was resistant when I needed 100 units a day. I am glad, though, to know that those who need so much insulin have this to help them keep healthy.
One tool that I wasn’t aware of that is available to those who have trouble poking themselves all the time is called an injection port. You insert it once every three days and you can slide your needle into the port whenever you take your shot instead of having to poke yourself with each and every shot. It sounds to me like an insulin pump insertion sight, but without the pump part.
Let me make the point here that in this book the author’s main subject and goal is to teach about insulin therapy and how to best use it to gain optimal BG control. He covers all types of insulin that people use (because not every diabetic is the same, has the same needs, and has the same choices) and all forms of therapy options, and all tools available. Whether you use NPH and regular, or are on a pump, or anything in between, he covers it all.
I am fully aware of (and constantly annoyed by) the Dawn Phenomenon, and he covers it and offers ways to solve it, but I had never heard of the Somogyi Phenomenon. Let me rephrase that, I know about what it is but I had never heard this particular name for it. This phenomenon is when your BG falls in the middle of the night, which causes your pancreas to dump glucose to correct it, but then you end up high by morning! This doesn’t just happen at night, but night is when most unnoticed lows happen (and why we sometimes end up high with no obvious reason). It’s also known as ‘rebound hyperglycemia’. Of course he covers ways to prevent and/or correct this issue.
He covers ways on how to find a great starting point for your insulin to carb ratio. We all have to start somewhere, so how do you know where to start? He discusses the pros and cons of the 500 rule and also the weight method. He, of course, explains what these are and the formulas to work them. When I first started using insulin to carb ratio I was given my first ratio by using the weight method. It worked out OK, but, as with most people, adjustments were soon made. Just for funzies while reading this book I decided to use both methods to find my insulin to carb ratio, they both came out exactly the same 1:8. This is not the current IC I use, right now I am at 1:9 and in the process of fine-tuning it (which he teaches).
He also covers correction and sensitivity factors. He discusses the 1700 rule. Again he goes into detail as to what it is, why we use it, and how to find a good starting point and then how to fine-tune it. Again, I used this formula to find my starting point. It’s actually quite close to what I am already using.
Delayed-onset Hypoglycemia (D’OH) is discussed. I never realized a low one day could have been caused by something that happened the day before or even longer! A frightening thought. Of course, as is the point of the book, solutions are presented.
Sleep is discussed as well as many other things. I love that he addresses as many factors as possible in BG rises and falls and how to prevent and/or correct them. Some things we just can’t prevent or avoid, so all we can do is correct the BG as soon and as best as possible.
This is the opening paragraph to chapter 9. “Up to this point, I have focused all attention on matching insulin to our precise needs (thinking like a pancreas!). But let’s be realistic: with so many variables and factors influencing blood sugar levels, you are going to experience your share of both high and low readings. Even the best-managed people with diabetes have readings that are out of range up to 25 percent of the time.”
Chapter ten is devoted to providing as many channels to awesome support and resources as possible to the reader. Associations, organizations, financial, publications, websites, blogs, books, products, etc.
All-in-all I very much enjoyed reading this book. It made me feel less unique in my particular struggles with BG control, I’m not the only one experiencing certain issues, etc. It put so much in perspective, and I learned so much, which is the best tool out there! Knowledge! Knowing how to deal with something takes away so much pain and struggle. And Gary Scheiner lays it all out in a very logical, realistic, and easy to understand way.
Well worth the read, in my opinion.