San Francisco Bay Area resident Patrick Totty writes about his experiences living with type 2 diabetesSee all posts »
My Own Private Rubicon
The expression “to cross the Rubicon” means to make a choice that’s not only life-changing but may be impossible to undo.
It comes from ancient Rome when the city tried to protect itself from generals who were coming off of big victories in foreign wars. Fearful that they might come back to Italy and be tempted to go for the biggest prize of all, Rome itself, the Senate forbade them and their armies to cross the Rubicon, a shallow river to the city’s northeast.
But in 49 BC, Julius Caesar defied the ban, crossing the Rubicon with his battle-hardened legions and gambling that there would be no reprisal. It was a no-turning-back decision.
My Rubicon moment came earlier today during a visit to my doctor. A blood test from last week showed that my A1c had spiked dramatically over a three-month period, from 8.1 to 10.6. My years-long combination therapy of metformin and a sulfonylurea is no longer working. Exercise and diet are no longer sufficient to keep my blood sugars low.
So I’ve made the decision to cross the river and begin using insulin. I’m waiting for my insulin-taking paraphernalia to show up in the mail, and I am making an appointment to take a class to learn how to shoot myself with a syringe.
This day has always loomed, but it was way off in the future. My attitude was much like that of the writer William Saroyan, who once remarked, “Everybody has got to die, but I have always believed an exception would be made in my case.”
I’m aware that it may possible to skirt insulin therapy. Amylin Pharmaceuticals has released data that it says shows that its once-weekly injectible, Bydureon, outperforms insulin detemir and insulin Levemir when it comes to blood glucose control. (Bydureon is an extended form of Byetta—exenatide—a drug derived from Gila Monster saliva that has enjoyed considerable success among type 2s as both a blood glucose control and weight loss aid.)
But Bydureon is expensive. As my doctor said when I mentioned it, “Are you a rich man, Mr. Totty?” It’s not that expensive, but a month’s worth of weekly doses costs more than $400 retail. Five thousand dollars per year is one of those figures that makes me downright contemplative.
On the other hand, my health plan covers much of the expense of insulin and the paraphernalia for injecting it. So I think the prudent thing here is to at least try insulin, both for the experience and to set up a baseline if I do decide later on to try something like Bydureon.
It took me nine years to reach this point in my type 2 life. That makes me pretty average. With that in mind, I’ll report back as I start on insulin. Even as I do it, I’m re-examining my approach to living with diabetes. I don’t want a drug, wondrous as it is, to do all the work for me.
Time for me to add a second walk to daily routine—which I’m leaving to go on right now.