Wal Mart Insulin didn't kill anyone.
Diabetic Ketoacidosis did.
Wal Mart insulin is getting a bad rap lately because at least two people with type 1 diabetes, who had been denied access to healthcare and their usual analog insulin, have died of diabetic ketoacidosis. Both of these insulin-depending diabetics had switched to wal-mart insulin from their usual analog insulins because of its price and because of its over-the-counter availability.
And the interwebs are going batshit insane. The media isn't helping.
Here's what everyone's saying:
Don't ever use Wal Mart insulin! It will kill you! - this is just not factually correct.
He should have learned how to use the Wal-Mart insulin the RIGHT way - this is victim blaming and no one should ever do it, ever.
Our healthcare system failed these people! - BINGO.
Now. This is not a political post about the state of our healthcare system. We all know it's broken and we can certainly all take sides and bash the crap out of each other in an effort to convince the other side to come around to our point of view. But, my friends, we don't have time for that.
Our people are dying, Senators. We must do something quickly to stop the Ketoacidosis.
What I'm trying to do is three things:
1. Help you feel less apprehensive about Wal Mart Insulin, and convince you that even though it's not as precise as the newer analog insulins, Wal Mart insulin can be a totally acceptable stopgap for people who have temporarily lost access to their usual insulin.
2. Help prevent lawmakers from getting their pants all bunched up so they don't do something stupid like make Wal-Mart insulin prescription-only, which would likely kill many, many more people with diabetes.
3. Tell anyone who will listen that diabetic ketoacidosis can kill you FAST when you are insulin dependent.
First things first.
Dude. Don't blame Wal-Mart for diabetics dying.
Blame Diabetic Ketoacidosis, also known as DKA.
Note: people with insulin-dependent diabetes can also, although very rarely, die from low blood sugar, but that is not discussed in this article.
While I cover the full details of DKA in one my online classes, I'm just going to summarize DKA in this article, because if you're not diabetic, you probably won't have the patience for all the medical mumbo jumbo.
Diabetic Ketoacidosis is caused by having too many ketones in your body for too long.
Let's talk about your body. When you consume carbohydrates, your body turns those carbs into glucose in your blood, and then your pancreas (or, if you're diabetic, a very precise injection, injected at the exact right time, in the right spot, with the right dose) causes insulin to go into your body, which helps the glucose get into your cells.
Your cells get energy from glucose, ergo, your cells get energy from carbs.
Note: there are other biological processes that can cause glucose to get into your blood that don't have anything to do with eating carbs, and you can certainly become an expert on those details in this class, but for the sake of brevity, we won't discuss those things here.
Your cells need to use energy in order for you to stay alive.
Your cells can use the energy they got from the glucose in your body, or your cells can burn fat for energy. Fat burning is what happens when you go on the keto diet, or when you starve yourself - your body starts burning fat because there's not quite enough glucose in your cells to provide you with the energy you need.
But guess what. Burning fat for energy instead of carbs creates a nasty by-product in your body called ketones. Ketones are nasty because they are acidic, and your body doesn't like them. Your muscles can feel tingly when you have ketones. They don't like being surrounded by acid. You can feel nauseated when you have ketones. You can barf. You can have general malaise. Your body doesn't like the acid. Your body tries to pee the acidic ketones out. You pee a lot. Your body loses water and necessary electrolytes. That's why you get so thirsty and feel so crappy when you starve yourself of carbs.
Note: The people with diabetes who died were not doing the keto diet. I'm simply using keto/starvation as an example to illustrate how ketones feel and to compare how non-diabetics are able to deal with ketones naturally, while insulin-dependent diabetics have a much harder time doing so.
When your body gets ketones, your body will usually compensate by generating and releasing glucose via gluconeogenesis in a desperate effort to give the cells at least SOME glucose energy, and, for non-diabetics, the pancreas will release some insulin to help that glucose get into the cells, and most non-diabetics on keto or starvation diets will stay alive. Mostly.
But guess what.
An insulin dependent diabetic can get ketones from OTHER STUFF, and not just by doing a keto/starvation diet. And guess what else. An insulin-dependent diabetic's pancreas DOESN'T release that life-saving insulin to move the glucose into the cells. :\
An insulin dependent diabetic can get ketones simply from having a cold, or a 24 hour stomach bug. From taking steroid medication. From taking biguanides, which, incidentally, is a great way to save money on insulin (and lose weight). Or from exercising. Or by forgetting a SINGLE dose of insulin. Or by not taking enough insulin. Or by having a low blood sugar scare and avoiding insulin because they're afraid to have a low blood sugar reaction. Or from trying to save money by not eating. Or from trying to save money by rationing insulin. Or, by getting sick, barfing, getting ketones, and not taking insulin because they CAN'T because there's no glucose in their body and they can't eat anything because they'll barf it up, so if they take insulin without having any carbs in their body, they'll just die from low blood sugar. And much, much more.
The point is, there's an abundance of causes for diabetic ketoacidosis in people with insulin-dependent diabetes, and, once an insulin dependent diabetic IS in ketoacidosis (DKA), there's only one thing that will happen if they can't get the medial attention they need: Their body will shut down and die.
DKA kills. Insulin doesn't.
Let's not blame victims of DKA.
Let's not blame Wal-Mart insulin.
Let's put the blame where it belongs: lack of access to adequate healthcare.
For more information on how to use the Wal-Mart insulin, see my How to use the Cheap Old School Insulin article.
Here's a small sample of the headlines. Imagine how well they get parsed and handled by the masses.
Drinking ketones is a follow-on fad to the keto diet.
Today I'm going to discuss the dumbest idea in the world: drinking ketones that you bought from the store.
Some people follow the keto diet to lose weight or to control blood sugar. Other random folks, who are looking for a miracle weight loss cure, have decided to avoid common sense, research, and their own burning esophagus in order to drink acid for fun.
This is dumb. Here's why.
First, I have to tell you what ketones are. Ketones are a waste product produced when your body burns fat instead of glucose for energy. Yes, the presence of ketones is an indication that you're losing weight if your body produces its own ketones.
But guess what. Your body doesn't like having ketones. It tries to piss them out. That's why you're so thirsty on the keto diet and can dehydrate easily. Ketones raise the PH of your blood. Ketones can make you feel sick and nauseated. They can make your legs feel numb.
When your body produces ketones, it means your body is burning fat, and guess what: the keto diet WILL cause you to lose some weight
But listen. This is true if and only if your BODY produces the ketones.
Note: I'm not recommending the keto diet here - I'm just stating some basic facts about the usage of fat for energy in the absence of glucose.
Your body must burn fat in order to produce ketones. Again, ketones are by-products that result when fat is "used up" as energy instead of glucose. Ketones are subsequently peed out of your body rapidly because your body doesn't like how the ketones raise the acid level in your blood.
If you drink ketones, your body will have ketones in it (yay? NO!). But, your body will NOT have burned any fat cells if you just drink ketones. The fat cells will still be there in your body. So, in addition to not losing any weight, by drinking ketones, you're just filling your blood with acid and causing yourself to feel like crap.
The only way to lose weight by drinking synthetic ketones is if the nauseating side effects of having your body eat itself from the inside out cause you to lose your appetite.
But, if nausea as an appetite suppressant is what you're looking for, I can think of a bunch of safer ways to nauseate yourself, such as hotboxing yourself with a stinky fart, or drinking rotten milk.
Dude. Don't drink ketones.
Note: Only a certified medical professional can diagnose diabetes. BootCamp for Betics is not a medical center and nothing in this article should be interpreted as individual medical advice.
Type 1 diabetes is a rare but serious medical condition. For education and courses on diabetes and blood sugar management, visit the BootCamp for Betics Online School.
There's a ton of articles on the web describing the symptoms of type 1 diabetes in children. If you don't yet know what those symptoms are, you should read about them on one of the many sites that describe type 1 diabetes symptoms in children.
Sometimes, doctors misdiagnose diabetes as something else, such as the stomach flu, or dehydration. Undiagnosed type 1 diabetes can add serious risk to your child's life. The longer the diabetes does undiagnosed, the sicker your kid gets. And yes, you can die from undiagnosed diabetes. It's rare, but a few cases happen every year.
But all is not lost, my friends. You don't have to spend every hour of every day fretting that your kid might become diabetic on the sly.
Let me tell you a little known secret:
You can test your kid for diabetes. It's really easy. And pretty darn cheap.
First, buy these Keto-Diastix urine test strips:
NOTE: THESE STRIPS MEASURE KETONES *AND* GLUCOSE. THE GLUCOSE COMPONENT IS EXTREMELY IMPORTANT. MAKE SURE YOU BUY STRIPS THAT TEST KETONES *AND* GLUCOSE!
(Disclosure: I make a commission if you use the Amazon affiliate link below)
Next, have your kid pee on one of these strips whenever he or she shows symptoms of type 1 diabetes, OR whenever he or she seems sick (especially with vomiting or diarrhea), or, if you're a super-paranoid type 1 mom (like me), just test your kid any time you feel paranoid.
Is it difficult for your kid to pee on a stick? No problem. Catch some of their urine in a paper cup.
Is your kid in diapers? No problem. Do this:
Once you're waited the required amount of time for the test strip to develop, compare the two squares on the strip to the colors on the Keto-Diastix bottle.
NOTE: KETONES ARE NOT NECESSARILY BAD. PLEASE READ THE CHART AT THE BOTTOM OF THIS PAGE BEFORE DECIDING HOW TO REACT TO THE URINE TEST!
Let's practice this by looking at the example below:
WARNING: IF YOUR CHILD HAS ALREADY BEEN DIAGNOSED WITH TYPE 1 DIABETES, DO NOT USE THIS CHART TO TREAT YOUR CHILD. USE YOUR CLINIC’S PROTOCOL FOR THE TREATMENT OF HIGH GLUCOSE AND KETONES.
If you've got a t1d kiddo or you've tried to use these test strips, please use the comments section below to tell us your story!
Hey Betics -
Is anyone else freaking tired? Like, ALL the time?
I can't remember the last time I woke up feeling "refreshed" and ready to start the day (who ARE these people who can wake up "refreshed," anyway?)
Well, I've been doing some research and some experimentation for this past somewhat sleepy and miserable year.
You might be surprised to learn that there are more than fifteen possible reasons that a person with diabetes might suffer from chronic or incidental inexplicable fatigue, and most of these causes can be tested for, and treated.
I want to produce a free community webinar about this very topic, but first, I'd like to know whether you'd be interested in attending or not.
If you'd be interested in learning more about battling diabetes fatigue,
vote in my poll
and let me know!
With Betic Love,
P.S. Tell your friends
I totally tried Afrezza. Here is my official review of this high cost, inhalable insulin:
About a year ago, I decided I wanted to try Afrezza, the new (at the time) inhalable insulin.
My Endocrine PA wasn’t comfortable prescribing Afrezza (it had never been prescribed by anyone in her clinic before), and she wanted me to meet with one of the M.D. Endocrinologists in the office before getting the prescription.
Naturally, getting an appointment with the Endo M.D. took 8 months.
During that 8 months, I did some research and prepared my presentation to the Endo.
I’ll spare you the details, but here are the resultant highlights of the proposal I submitted to the Endocrinologist:
My Endocrinologist is pretty practical, and I think the fact that I'd done so much research helped me establish credibility with her, so she agreed to let me try the Afrezza.
But first, I had to wait for the insurance company to deny coverage.
Then, I had to wait for the insurance company to deny the appeal and prior authorization for coverage.
After receiving the expected insurance denials, I found and printed a coupon from the Afrezza webpage. Then I went into the pharmacy, coupon in hand, and shelled out $150 cash for my box of Afrezza cartridges, which is a pretty great discount, considering I would have paid more than $300 without the coupon.
That afternoon, I ate a carby snack and chose not to take any insulin, so that I could purposefully cause my blood sugar to go above 250 so that I could try my Afrezza.
After thoroughly following the instructions on the Afrezza package insert, I took my first “puff.” Then I waited. You can watch what happened in the video below, or your can read the short version below (just scroll past the video).
Here’s the short version:
Since the initial experiment, I’ve tried Afrezza numerous times and had a bunch of interesting experiences. Here’s what I’ve found:
Do you have experience with Afrezza? Leave a note in the comments!
I get a lot of questions from folks asking about natural remedies for diabetes, and I thought this short video would help clear things up.
I get a bit of mail from folks wondering about my thoughts on the low-carb-high-fat (LCHF) diet (also known as Way-Of-Eating or WOE) and why I'm not pushing this as a lifestyle to everyone who has diabetes.
Here's one of my latest responses to one of the more polite inquirers about this:
Thanks so much for you email! How funny you should ask about LCHF - I'm actually in the middle of Dr. Bernstein's book right now. I'm pretty familiar with the LCHF movement, though I wouldn't call myself a dedicated subscriber at this time.
I think the LCHF results that people are reporting are really promising, but absent a comprehensive study similar to the DCCTs that occurred in the 90s, I'm forced to hold back a true opinion because the only published evidence of LCHF's success is anecdotal and/or represents results from a very small study (though the evidence is, admittedly, quite compelling).
My focus is to spend less time encouraging others to conform to a specific treatment method (and LCHF is certainly one method that has resulted in success for many), and instead encourage people to focus on getting their blood sugar into target range as often and as safely as possible. For some, that might mean adopting the LCHF lifestyle. For others, it might mean something completely different.
There are three other concerns I have about LCHF. Since you've been working with this WOE for awhile, maybe you can share your thoughts on them?
1. One concern I have is its sustainability. Are people actually going to be able to keep doing it for the rest of their lives? Obviously, some people are very successful at LCHF, but I'm not sure it's sustainable for every diabetic.
2. Next is affordability - eating healthful, unsaturated fats and ensuring you're getting enough protein, etc. can be expensive. This may not be practical for people in lower income brackets.
3. Lastly, and this is a big unknown for me - is adopting the LCHF way of eating a veritable rabbit hole of increased insulin resistance, essentially ensuring that if you start LCHF, you won't ever be able to stop, or even cheat? If you fail at LCHF, would you be worse off than if you'd never tried it in the first place due to the increased insulin resistance caused by the inevitable intake of saturated fat, the increased rate of gluconeogenesis, and the increase in hepatic glycogen conversion?
LCHF is a method of blood sugar control that I definitely intend to try, so perhaps I'll have more interesting things to say about it once I've done so.
Thanks for your email, it forced me to get my thoughts about this down on paper. I want my efforts with BootCamp for Betics/PureDiabetes to be as accurate and as helpful as possible, so, if you have some data that can help push me into the LCHF camp, I would love to hear it!
This video is a bit long, and I can't quite decide whether it's a rant or a plea. I'm feeling proud that I managed to keep my $--t together until the final minute or two.
This is an update based on a Facebook discussion about how successful Metformin is, overall, at reducing weight in the general diabetic population.
Note: Studies don't show consistent weight loss with metformin use, that's for sure. My hypothesis is that in order to experience successful weight loss on Metformin, you have to meet some very specific conditions. First, you have to be euglycemic virtually all of the time before starting the metformin. This is hard to do, especially when you're on insulin. You also have to remain euglycemic as you continue to take the metformin. And insulin dependents have to do this by adjusting (read: reducing) basal and bolus dose calculations. This is not easy. But starting metformin while euglycemic and remaining euglycemic throughout the treatment will, I hypothesize, result in weight loss, because it results in less sugar in the blood, which means less required insulin, which means less fat storage. I was a sample size of one, of course. And my experiment was driven by personal curiosity, not scientific inquiry. I will post this on the blog to make that part more clear. I would like find some research on whether metformin has caused weight loss in people withOUT diabetes. I'm sure it's out there, and that I just haven't found it yet.
Now, continue on to the article below.
Many of you are aware that I recently started experimenting with metformin, which is a medication typically prescribed to people with type 2 diabetes. But, according to many reputable sources, metformin can also help type 1 diabetics (along with insulin, of course, which is required for type 1s) with blood sugar management.
I wrote about metformin in my I'm using a diabetes drug recreationally article a few months ago. Feel free to read that at your leisure.
My main goal in starting metformin was to see if this medication could help stabilize and flatline my blood sugar levels during and after exercise.
Exercise had been so frustrating. Every time I went to an exercise class with a perfect blood sugar, my blood sugar would go up by 60 to 100 mg/dL. Yes, you read that correctly. Exercise *raised* my blood sugar.
Now, you might be wondering, "Why the heck did your blood sugar go UP during exercise? Isn't it supposed to do DOWN?"
Let me explain.
I take insulin. I take basal insulin, which is used to counteract the baseline level of glucose that's always hanging around in my blood thanks to my liver's gluconeogenesis. I also take bolus insulin, which helps the food I eat (mostly carbohydrates), once it's digested into glucose, get into my cells. I also use bolus insulin to treat incidental high blood sugars. Insulin moves sugar from my blood into my cells. My cells like this, because my cells use that sugar for energy (and some other stuff).
I did a bunch of experiments with exercise. More specifically, I wanted to compare my blood sugar's reaction to exercise while my cells were in a starving state vs. my blood sugar's reaction to exercise when I had bolus insulin on board (non-starving state).
I started capturing blood sugar data surrounding my exercise events.
RESULTS OF EXERCISING IN A NON-STARVING STATE
Let's say I eat breakfast at 8am, and take 4 units of bolus insulin.
The insulin helps my breakfast carbs get into my cells to give me energy.
Yay! Now, let's say I exercise at 10am, with a starting blood sugar of 140. I still have some insulin in my blood, and I have some very satisfied cells that are full of energy.
But, during the exercise, my cells start using up that energy. And my cells start to run out of energy. So my cells get hungry.
But guess what. There's still some sugar in my blood because my blood sugar is 140, AND there's still some insulin in my blood because, well, even short acting insulin stays in the blood for up to 6 hours.
So, my body uses the remaining insulin to suck as much sugar as possible into my cells to give me more energy.
At the end of the exercise, my blood sugar is down to 40, and I'm shaky, clammy and need a snack.
Naturally, because I feel so awful, I eat and eat and eat, which results in a high blood sugar a few hours later, and then I get to enjoy a blood sugar roller coaster for the rest of the day.
RESULTS OF EXERCISING IN A STARVING STATE
I'd wake up, and I would NOT eat anything for breakfast.
Then, at noon, I'd go to my exercise class with a blood sugar of, for example, 120. I'd exercise for the full hour, and then check my blood sugar immediately after the exercise. 200. My blood sugar was 200.
Here's what happened. My cells were hungry. Since I hadn't eaten breakfast, those cells didn't have much energy to start with. So, I started exercising and I pretty quickly used up all the energy in my cells. But, since I didn't have any extra insulin in my body, there was no insulin available to pull sugar from my blood into my cells to give them more energy.
But it didn't end there. Did you know that you liver is supposed to store glucose, and give you a few squirts of that glucose when you need it?
Well, one of the times you need glucose is when your cells become starving. So, noticing that my cells were starved of energy, my liver helpfully squirted a bunch of glucose in my blood, raising my blood sugar to 200.
And...guess what. I didn't have any bolus insulin on board to carry that sugar into my cells. So basically, my cells were starving, and there was plenty of sugar in my blood to feed them, but unfortunately, the insulin required to move the sugar into the cells just wasn't there. So I had starving cells and high blood sugar.
So, HOW THE HELL is someone on insulin supposed to exercise while keeping their blood sugar at a flat line (or as close to target as possible)???
I contemplated three potential solutions to this problem.
One potential solution was to do my exercise in a starving state, and then use Afrezza, the super-fast-acting inhalable insulin, right after exercise, to lower my blood sugar. This is something suggested by my friend Dr. Gaja Andzel, whom I trust completely to give me diabetes-related advice. But, my doctor here in Wisconsin is pretty risk-averse, so I'm still in the process of convincing her to let me try Afrezza.
Another potential solution was to try metformin, a drug that suppresses the liver's glucose-squirting activities and reduces insulin resistance, to see if I could exercise in a starving state without getting that extra sugar kick from my liver.
Another potential solution was to try experimenting with the timing of my breakfast, insulin doses, basal rates, etc. I've been there, done that. It's pretty hit or miss at first, but you can eventually get it right. I know some athletes who've been really successful with this method. If you need some coaching on this, Dr. Matt Corcoran from Diabetes Training Camp is a great resource.
My goal was to flatline my blood sugar during and after exercise. Since I couldn't get access to Afrezza (that's coming soon, I promise!), and since mucking with my dosing and rates is not easy and affects everyone differently, I decided to try metformin to suppress my liver from squirting a bunch of sugar into my blood during exercise.
I did some research. Then I did some asking around. Then I talked with my doctor and she agreed to prescribe me metformin. Then I did some more research and wrote the I'm using a diabetes drug recreationally article. And then I started taking metformin.
I decided to take the extended release version of metformin (marketed as ER or XR), because I'd heard horror stories about side effects from the "regular" metformin. The effects of extended release metformin apparently aren't as severe.
That's not to say there weren't side effects. For me, the side effect was pooping. Lots of pooping. It lasted about six weeks and then I didn't have the effects anymore. Other than that, I've experienced no other negative side effects.
My instructions were to start taking 500mg/day for a week, then increase by 500 each week until I reached the max dose of 2000mg/day.
During the dose increases, my blood sugars were all over the place. I was playing with basal rates, recalculating insulin sensitivity factors, adjusting bolus ratios, etc., and my blood sugars were all over the place. I was high, and low, and high, and low and on a total roller coaster for a few months. I decided to stick with 1500 per day, and do somebaseline testing.
Once I reached a dose of 1500 mg per day and did some baseline testing, I noticed three things:
1. I didn't need as much basal insulin. Due to the metformin, I had to reduce my original basal insulin by about 15%
2. I didn't need as much bolus insulin. Due to the metformin, I had to reduce my bolus insulin by about 10%
3. I had VERY little, if any, increase in blood sugar during exercise. Metformin solved my "exercising while starving" problem.
Once I reached 2000 mg per day, I noticed two more things:
1. I had to reduce my original basal insulin dose by 20%
2. I had to reduce my original bolus insulin dose by about 15%
So, overall, I'm getting exercise without screwing up my blood sugar. I'm also taking less insulin overall. Do you know what that means?
It means that since I finished the baseline testing and got the initial metformin-induced roller coasters under control, I've lost about a pound per week.
Why? Well, insulin is a hormone that helps glucose get into your cells, which your cells use as energy. If there's an overabundance of energy in your cells, your cells store that energy as fat. Yep. Insulin is a fat storage hormone.
You NEED insulin to survive, though. If you don't have insulin (either from a vial, a pen, or from your own pancreas), you will die.
Striking a balance among exercise, blood sugar levels, insulin, metformin, eating, and weight loss/gain is hard. Like, really hard. But I'm not going to complain about that.
What I will continue to complain about, however, is how much we have to FIGHT to get the diabetes supplies, education, and care we need in order figure stuff out like this.
Next up, Afrezza. They're marketing it all wrong. I'm going to run some experiments with it starting in May, and perhaps we can set Mannkind straight.
With Betic Love,
This video contains instructions for drawing insulin into a syringe from a vial.