How many diseases do you know of where patients are required to calculate exact dosing, up to half-a-dozen times a day, of a medicine so potent that mistakes could literally knock them out or kill them? I hate to be fatalistic, but after a few serious insulin flub-ups lately, I just can't seem to get this thought out of my mind.
Of course we're all just winging it. Carb-counting isn't particularly exact, nor are our carb-to-insulin ratios. And as my esteemed co-author Dr. Richard Jackson likes to point out, there isn't any solid clinical data supporting the effectiveness of carb-counting. Is that true? Oy vey.
I know it's not exact science. But heck, it's the best method we've got right now, was my retort. It's at least a place to start as we all scramble to figure out which foods kick off which BG reactions for each of us individually.
Yeah, except confession time here: Most of the time when I eat, I have very little freakin' idea how many carbs are in that plate of food. I'm just taking one "educated guess" after another. I've been lucky that 1) most of the time I estimate reasonably well, 2) my pump helps me easily "correct" for underestimating my insulin needs, and 3) I'm very hypoglycemic aware, so I start sweating and getting a feeling I call "scratchy" long before I get low enough to start acting crazy-pants or pass out. But No. 3 won't always be the case, and that's what scares me.
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"Those new insulins push glucose levels around a lot quicker, so the risk is a lot higher," said a diabetes technology expert I was interviewing recently. "Older people are having tremendous problems with them — but you knew that." Did I know that? Did I want to know that? Sometimes this disease just makes makes me want to bury my head in the sand.
I'm so grateful for the advent of this insulin that keeps us alive. But sometimes I'm also angry and upset when I think about how we're all just betting our lives on guesses.