Managing Type 1 Diabetes: Knowing your Insulin Tolerance, your Best Medications

Ginger Vieira Health Guide

    (I also write over at HealthCentral's! Also, check out my work as a cognitive-based Health & Chronic Illness Coaching Specialist.)


    When it comes to managing Type 1 diabetes, there are things you know about your body better than anyone else. Even if your blood sugars aren’t as “great” as you’d like them to be, even if your A1C is higher than you’d like it to be, even if your diet isn't as healthy as you’d like it to be. In the end, there are still things YOU know about your body that no doctor or parent or friend can know better than you.


    I’ve experienced two circumstances in which I felt like I would be in a dangerous situation if I didn’t speak up and argue with doctors about insulin and dosing. The first experience was during my hospital stay in 2003. I had spent all evening stringing Christmas lights for the movie theater I worked at, but I was outside in the freezing New Hampshire cold and the temperature killed the insulin potency in my insulin pump. I didn’t realize until the next morning when I woke up in severe DKA, puked at least a dozen times throughout the morning until I got to the hospital.

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    During my hospital stay, stringed with IVs pumping saline through my veins, two med-students stood before me and said they would give me 10 units per hour of rapid-acting insulin to bring my blood sugar down. Being 18 years old at the time with a correction-factor of 1 unit of insulin to drop my blood sugar 100 points, this seemed like an awful lot of insulin.


    Quietly, I said, “That seems like it might be too much...,” but they ignored me, so I got the nurse’s attention and said more desperately, “I really think that’s too much insulin. I’m going to crash if I get 10 units in one hour for several hours in a row!”


    The nurse chased after the med-students and convinced them to reduce the dose to 8 units per hour. Within the next two hours they were back at my side stringing me up with a new IV to pump me full of GLUCOSE due to the insulin overdose!


    My second experience was right after my reconstructive jaw-surgery when I was 20 years old. My head was the size of a watermelon, my jaw was wired shut, and I’d already thrown up twice since waking up from anesthesia...but I still knew it was time for my Lantus insulin dose. This is my background insulin, my “basal-rate,” the very small amount of liquid hormone that keeps me alive through the night and for the next 24 hours.


    I moaned to the nurse through my wired jaw, “I need my Lantus insulin. It’s in my bag, right there.” She looked at my medical chart and didn’t see Lantus listed anywhere, so she called the surgeon at 10 p.m. to check. But the surgeon (who is brilliant with bones and my jaw looks great) had never heard of Lantus, so he didn’t want me to take it. 


    I threw a fit. Practically incomprehensible, but nonetheless, I was angry. “I will be in a coma by morning if I can’t take my Lantus!”


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    Eventually, they let me take my Lantus dose, but it took a genuine roar to be heard.


    This is your body. Many doctors are brilliant. Your parents are brilliant. Your husband or your wife is brilliant...but this is your body. If you are uncomfortable with the decisions being made about your health and your life, then speak up. If your doctor doesn’t hear you, then speak a little louder.


Published On: July 22, 2010