Responding to Catherine – Does Diabetes Get Better?

Dear Catherine,

You wrote just the other day about the constant struggle of exercise with diabetes. It made me think about many things, and I wanted to reply, but I had more to say than would fit in a comment, so I decided to reply here.

Firstly, I am so with you — one morning with diabetes is one thing, and the next, I think I’m doing exactly the same set of things, but my body begs to differ. It’s frustrating and I think the difficulty of exercise in particular drives a lot of diabetics to unfortunately avoid it altogether.

But I disagree with one sentiment you expressed:

Diabetes presents the exact same challenges (in a maddeningly revolving and unpredictable format) every single day. And no matter how many times I try to face those challenges, I’m never going to “conquer” them. I feel like I’m stuck on a permanent plateau.

Diabetes is indeed a pain in the neck each and every morning. But, we’re not on a plateau. It’s not exactly the same from one year to the next– things get better! Things have gotten better, and they will get better still!

Granted, I am a relentless optimist, but consider: when I was diagnosed almost two decades ago, I had a blood glucose meter, 30U insulin needles, regular insulin, and NPH. That was craziness. Up and down, and I would try to measure out half units of insulin in those needles, which was more of an art than a science. But even with that regimen, each year, I knew more than the prior. I knew how to handle one more situation, one more type of food. There was always an infinity of new problems, so maybe it felt like I was running as fast as possible just to stay in place, but still– I learned. And, given the list of general trends that work for exercise and you at the bottom of your post, I think you know you learn too.

But it’s over the decades that improvement becomes more apparent to me. At some point, I started using fast-acting insulin, and all the sudden I had a little bit more control. In 2005, I got an insulin pump. That was huge. No more “slightly under the 1U line,” and no more, well, this NPH should hit me at some point around 2AM? Maybe? And I could bolus a little at a time, adjusting for food or exercise as it progressed, rather than having to guesstimate everything up-front.

Three years ago, I got a continuous glucose monitor (CGM), and that too changed everything. Sure, diabetes is still the same in the morning, trying to drive my BG up when yesterday it went down. But now I see it as I reach 110 instead of after I’ve already hit 220. Now I can start responding earlier, and I can trace my numbers overnight, looking for clues as to what was different between yesterday and today. With the pump in tow, I can start to bolus to correct early and often, and don’t have to guess ahead of time for the entire dose.

Of course it’s not perfect, and it’s not easy, and I wouldn’t even call it good most of the time. But it’s better than it has ever been before, and that means something. That means we’re not on a plateau; we’re climbing, and it will get better still.

What comes next? I think the next big step forward is bi-hormonal treatment with glucagon. I have had a chance to observe some glucagon treatment first-hand, and it’s incredible. In terms of exercise and diabetes, that will be a game-changer. No more eating to keep BG up during exercise, which makes the whole thing feel like a waste. Mini-dose up-front, wait 15 minutes for your liver to kick in, watch your BG rise with no calories ingested. Magic drug for the vain among us.

I hope this doesn’t come off as insolent– you are the first diabetic I have ever read on the internet, and no one makes me laugh more than you. I just wanted to keep us off that damn plateau. I hate plateaus, and I hate that moment in traffic when the speedometer drops to zero, and my husband jokes, “Well, at this rate, we’ll never get there.” It may be slow-going, but at least we’re still moving forward!

So, in conclusion, thanks for making me consider these things, and I would like to close with my favorite joke. (This particular writing of it is pulled from here, which is from a book about Reagan, as it was apparently his favorite joke, too. That should imply it’s a good, aisle-crossing joke, not that I’m a Reaganite, I hope!)

The joke concerns twin boys of five or six. Worried that the boys had developed extreme personalities — one was a total pessimist, the other a total optimist — their parents took them to a psychiatrist.

First the psychiatrist treated the pessimist. Trying to brighten his outlook, the psychiatrist took him to a room piled to the ceiling with brand-new toys. But instead of yelping with delight, the little boy burst into tears. “What’s the matter?” the psychiatrist asked, baffled. “Don’t you want to play with any of the toys?” “Yes,” the little boy bawled, “but if I did I’d only break them.”

Next the psychiatrist treated the optimist. Trying to dampen his out look, the psychiatrist took him to a room piled to the ceiling with horse manure. But instead of wrinkling his nose in disgust, the optimist emitted just the yelp of delight the psychiatrist had been hoping to hear from his brother, the pessimist. Then he clambered to the top of the pile, dropped to his knees, and began gleefully digging out scoop after scoop with his bare hands. “What do you think you’re doing?” the psychiatrist asked, just as baffled by the optimist as he had been by the pessimist. “With all this manure,” the little boy replied, beaming, “there must be a pony in here somewhere!”

There must be a pony in there somewhere!

Best,
Karmel