At the Crossroads, I Choose Insulin

I was diagnosed with type 2 diabetes 10 years ago. My response to the news, very typical, was to begin a routine of vigorous exercise and dieting. With a beginner’s enthusiasm, I lost almost 30 pounds (down from 220) and drove my A1c three months after my diagnosis down to 5.6%.

It’s easy to be a golden boy at the start of a long slog. When I was a new track runner in high school, starting fast in a race was a cinch. Nervous energy and fresh legs assured that I’d be able to dart out to a quick lead in a distance event. But the real art of the race-which took me some time to learn-was knowing how to allot my energy so that I would still be in contention at its end.

Dealing with type 2 was much like my high school experience. Over the years, as my diabetes became a simple and unavoidable part of my life, my initial enthusiasm for dealing with it simply ran out. You can only keep up that level of intensity for so long before it exhausts you.

So I learned that doing something is better than doing all or nothing. I accepted that over the years my A1c’s were not going to stay at 5.6% without almost fanatical effort, or that my weight would remain close to what it was in high school. I accepted that eventually my best efforts at dieting and exercise, and diligently taking my meds (sulfonylurea to start, later metformin by itself), would not stop my numbers from gradually rising.

Still, there was one last good try left in me. Last June, when my fasting numbers were hovering around 220 mg/dL, I returned mentally to 2003 and began an intense low-carb/low-cal diet and lots of vigorous walking. The old formula worked for awhile-my A1c dropped to 6.5%, I lost 20 pounds, and my fasting number averaged around 140 mg/dL.

But it didn’t last. Last month I saw my numbers creeping up again, despite my not having gained weight or going off my diet and exercise routine. I’d finally smacked into the wall I’d been dreading hitting for almost 10 years.

It forced me to make a decision I’d been putting off, mostly because I feared it would be a sign of lack of self-control or the surrender of my fantasy that there is some final, decisive control I could have over this disease if I only reached down deep enough to pull it out. 

That decision was to start taking insulin.

I began taking it in March, starting with 5-unit injections just before bed, with a goal of reaching morning pre-breakfast numbers of 130 mg/dL or under. My numbers started budging a little, down into the 180s, so I began adding 2-unit increments to my injections every three days. The goal is to see what dosage level will consistently get me down to or under that 130 mg/dL mark. 

At this point I’m up to 11 units nightly, which so far has produced a one-time low of 123 mg/dL, but seems to have me more in the 150 to 160 range. Close, but no cigar. So, I’ll continue experimenting with the number of units I take until a consistent low range emerges.   

Though I’m new to insulin, I already have some observations about my decision:

What I once feared has turned out to be a new source of confidence. “Crossing over” to insulin was not a concession so much as an acceptance. In this case, I have accepted the use of a drug that is dramatically effective in managing blood sugars. In that sense, it is more of a wonder drug than any of the ones I’ve been taking since 2003.

I don’t intend to use insulin as an excuse to neglect my commitment to healthier eating and routine exercise. I’m an admirer of Dr. Richard Bernstein (“Dr. Bernstein’s Diabetes Solution”), who advocates taking as little insulin as possible to manage blood sugar levels. So I intend to use as little as possible by “helping” the insulin in any way I can. (Besides, there’s evidence that insulin sometimes leads to weight gain, something I’m not eager to experience.)

Injections are a chore, not a pain. My syringes come with 30-gauge needles, which are extremely thin and can easily penetrate my old hide with nothing more than a minor sting or prick. Almost all of us type 2s are finger-stick veterans, so plunging a skinny needle into abdominal fat is pretty unremarkable. 

Maybe the hardest part so far has been establishing the habit. My wife still has to remind me half the time to inject myself. Eventually, though, it will become a habit like all my other type 2 routines. 

My gratitude grows toward type 1s. I could afford to wait a long time before starting insulin, and even now my routine is a once-a-day, small-dose basal hit. Type 1s have never had that luxury, and their persistence and endurance in managing their diabetes makes mine look like, in the immortal words of saloon owner Rick Blaine (Casablanca), “a hill of beans.” Thanks to the efforts type 1s have made over the years, I am the beneficiary of inexpensive analog insulins and almost pain-free insulin delivery systems. Hats off to the trails they’ve blazed.

I’ll report back here from time to time on how things are going with my insulin regime, as well as other aspects of the type 2 life.