NPH Exorcism

Editor’s Note: It’s Thursday, which means that something related to my CGM trial must have happened. That’s right, the CGM data from my endocrinologist’s office finally arrived. I’ve spent a little time looking over the graphs and charts and matching them up to my logbook. Let’s just say this: While my blood glucose did run high, I don’t think that’s related to food choices as much as other factors. I’ll write about that later, since I need to investigate more.

Welcome to my exorcism. I’ve already sprinkled some holy water Diet Coke around my laptop in preparation, so let’s get to it. Here’s our demon:

NPH insulin vial and packaging

It first got into my body eleven years ago, through one of the shaded areas shown below:

NPH injection sites

It would enter twice daily, at 7:00 AM and 9:00 PM. Here was how I was forced to summon it:

Preparing to draw-up NHP

The demon kept me in its power day and night, forcing me to eat six times daily whether I was hungry or not, causing me to stop eating after consuming exactly 15 or 60 grams of carbs depending on the meal, fogging my brain between 11:00AM and noon, and giving me high blood glucose readings the rest of the day. This demon starts out benign, gathers strength slowly, grows to full strength after 5-6 hours, and sticks around to toss my internal furniture about for another 12 hours.

Graph of insulin action times

NPH was the only insulin I was on at the time, and I hated it. Every day was the same, and every day sucked. When I think back on it, I’m amazed that my doctor never had me use Humalog with my meals and never swapped out this demon for a long-acting insulin like Lantus.

It messed me up right good, leading me to think that food is medicine and that the way to treat insulin issues was to eat. As my first diabetes experience — a very laissez faire one by my first endo, it seems to me — it also had me thinking that this might be what diabetes was supposed to be like, that it was the best I could expect.

Those thoughts are what we’re exorcising here today. In my mind, this is a crucial part of the reboot. And we’re going to do that with sunlight and the basics.

  1. Diabetes has very few absolute rules. Food makes blood glucose go up, but mostly just the carbs. Insulin makes blood glucose go down, provided you have enough of it. Activity brings blood glucose down, but often not if it’s anaerobic.
  2. Diabetes has many heuristics: insulin peak times, onset lag, and duration; glycemic index values; etc. . . . and Chinese food always needs more insulin than you think.
  3. Diabetes has a billion variables: other people’s food, the intensity of activity, insulin freshness, meter accuracy, stress, caffeine, temperature, weight, girly stuff. Even my pancreas’s beta cells, which continually regenerate just to be killed off again, are slightly more potent in their feebleness from one day to the next.

So while the biological rules are as close as we can get to absolutes in diabetes, the heuristics cover the basic things that we can almost convince ourselves are under our control. The variables, though . . . Oy! They make it impossible to predict anything 100%.

Not that I expect anything close to 100% predictability. I’m realistic, and I know the body has more subtlety than just food and insulin. There’s glucagon and amylin. In a healthy person, those hormones dump into the bloodstream quickly and are mutually self-correcting. This system is organic and continuous — unlike the discrete, large decisions we artificial pancreases have to make.

The reboot is all about learning more about my body’s variables and discovering my own heuristics, so that I can have confidence to follow the few absolute rules all of the time. But that demon NPH has had me thinking that 2 + 2 = 5.

So how do I exorcise NPH from my thinking? How do I get that little shoulder devil behind me? How do I banish the voices that say, “If you bolus for that snack, you’ll go low?” And, “Your numbers are great now, but shouldn’t you have a little snack anyway?”

I don’t know. Exorcising personal demons is hard, but naming them is a good start. And Lisa may have the best advice: “Snap out of It!”

Okay. Done! What’s next?

This entry was posted in Data-betes, Diabetes, Life Lessons. Bookmark the permalink.

One Response to NPH Exorcism

  1. Lisa Mather says:

    I’m so helpful.

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