Need help navigating life with diabetes? Ask D'Mine! That would be our weekly advice column, hosted by veteran type 1, diabetes author and community educator Wil Dubois. This week, Wil tackles two questions about insulin pumping, one about being "forced" into pumping and one on whether pumpers can disconnect and keep your blood sugars in range with only exercise.

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Brad, type 1 from Connecticut, writes: Last year I got very sick, my blood sugar spiked to 800, and my blood potassium was almost immeasurable. My doctor tried to put me on type 2 meds, then when they did nothing, he put me on insulin. That manages my blood sugar but it leaves me with more questions than answers. I have lived a year with this and wonder if it is truly diabetes or something worse? Is there someone I should talk to, to voice my concerns, because my doctor doesn't hear me. He says I can go see a specialist but then tries to scare me by saying they will try to force me on an insulin pump. Is this true?

Wil@Ask D'Mine answers: Is there anything worse than diabetes? I mean, seriously, what are you worried about? For what it's worth, I think there's very good evidence you have diabetes, and not much evidence it could be something else, worse or not. I'm glad you mentioned your high blood potassium, because that's part-and-parcel of diabetic ketoacidosis (or DKA), which is a classic type 1 diabetes smoking gun.

But I do understand why you're having a hard time wrapping your head around your dx, and your worries about it being something worse. I've been there myself. Let me tell you the story of my own diagnosis denial.

Now remember, this was a while back. Before the web and the DOC and all the wonderful sources of info that enrich our lives today. So I didn't really have any way to learn the facts of type 1. I was, like I think you might be, freaking out about my dx and was unable to believe it. No one in my family's history had diabetes. Ever. My wife's family has type 2, and at the time I assumed type 1 had the same family-friendly style (since then I've learned that type 1 commonly pops up without warning in "fresh" gene pools).

Anyway, I managed to convince myself I had pancreatic cancer, as that made more sense to my misinformed brain than lone-wolf diabetes did. And then I read up on pancreatic cancer and updated my Last Will and Testament. Of course, at this time, my blood sugars were a mess and I was sick and bone-tired. My endo humored me by ordering an MRI on my pancreas.

It was on Christmas Eve that I talked to her nurse and got the news: no cancer or anything else unusual. But instead of rejoicing, I was overcome with depression. I was totally bummed out. As crazy as it sounds, I was bummed I wasn't going to die because that meant I was going to have to go on living; I assumed I'd never feel any better than I did at that moment. And at that moment I felt like crap. And living feeling like crap just seemed like more work than I could handle. At that moment, not having cancer seemed like a terrible Christmas present.

Of course, once my blood sugars came under control, I started to feel more like my old self. And soon, even better than I had felt for years.

So I'm glad I didn't die. I'm glad I didn't have something "worse." So, as much as a challenge diabetes can sometimes be, I guess there are worse things, after all.

Still, I see no reason to think you have anything worse than diabetes. But if your doc isn't listening to you, you can always go talk to another. Get a second opinion. There's nothing disloyal about doing that, and it might give you the peace of mind you need. Even if it just comes from hearing the same thing from two people.

And one last thing, Brad: no one is going to make you their pump slave. You cannot be forced on to an insulin pump by anyone. Specialist or not. So please don't worry about that. But for what it's worth, there are "worse" things than insulin pumps, and lots of people find them VERY helpful for managing their diabetes!


Don, type 1 working in the North Sea oil fields, asks: Are there cases of people that produce no insulin but are able to maintain a A1C below 7 (or even below 9) with only exercise and diet? I thought my understanding of type 1 was very advanced, but then I started thinking about the idea of taking off your pump during exercise where it seems that there are other routes for sugar to get into the cells other than with insulin. How does that work? And for that matter why does alcohol, which can be converted into sugars, usually lower blood sugar? Help me understand!

Wil@Ask D'Mine answers: Cadavers can maintain excellent A1Cs without insulin. But that's about it. Any post-honeymoon type 1 can't live for long without insulin. So if you're really* a person that produces no insulin, you cannot control your sugar with exercise and diet.

*More about that really: assumes you were properly diagnosed. As we've talked about before a few times, very high blood sugars in type 2s can result in glucose toxicity, which mimics type 1 diabetes for a time, sometimes leading to miss-diagnosis. And of course, LADA type 1s have extended honeymoons, giving them more options in the short term.

But you also asked about exercise and alcohol, my least favorite and most favorite topics, respectively. So let's get exercise out of the way, so I can talk more about booze.

Sorry, Don, there are no secret routes for sugar to get into cells. Insulin is the only way. But your pump isn't a "just in time" inventory system; the fast-acting insulin in a pump really isn't that fast at all. It starts working in about 20 minutes, peaks in two hours, and lasts for four hours. So if you turn your pump off right now, you've still got four hours of insulin in your system. Normally, that wouldn't be a smart thing to do, of course.

But exercise isn't normal. At least not in the strict biological sense. Muscles in action burn more glucose than they "normally" do, sucking it out of your system faster and more efficiently than "normal." So shortly after exercise, you need less insulin. If you left your pump doing its normal thing, you'd have a mild overdose of insulin, and your blood sugar would go too low.

So the reason we can (and should) take off or suspend our pumps for a workout is that we're using the residual insulin already delivered by the pump to fuel the body's standard metabolic processes. Nothing new, mysterious, unique, or special is happening. It's all about how fast modern insulins act and how long they last.

Which, interestingly enough, has a lot to do with the alcohol question, too.

Now first, most booze doesn't really have that much sugar. Unless it's one of those girly drinks like a daiquiri or a piña colada. Don't get me wrong. Being a feminist, I'm a huge fan of girly drinks, but the sugar in these kinds of drinks generally comes from the mixers. Hard liquor and wine don't really have all that much sugar at all.

Oh. Off tangent trivia question: why do heavy boozers have damaged livers?

Answer: because, among all its other jobs, the liver is the filter that removes alcohol from your system, but there's only so much it can take.

Confession: I tricked you. It isn't off tangent at all. Among all the liver's other jobs I alluded to, is the duty of removing excess insulin from the blood. Unless it's busy removing alcohol. The liver, like a drunk janitor, doesn't do its other jobs very well when it's drinking.

Heavy levels of alcohol in your blood get your liver drunk. It stops filtering out the excess insulin, allowing the insulin levels in your body to supersize. Oh. Right. And at the same time, the liver stops doing another one of its jobs, making sugar. So a drunk liver supersizes your insulin and stops making emergency sugar. The result: your blood sugar drops. Sometimes low enough to let you become a cadaver.

And then, and only then, you can maintain a wonderful A1C without insulin.


This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.