Ask D’Mine: No Insulin Needed?, Alternative Medicine’s Bad Rap

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}

Yup, you guessed it: it’s another edition of our new diabetes advice column, Ask D’Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

Alex from Canada, type 1, writes: I was diagnosed roughly 9 months ago. Since then, my insulin requirements have increased every now and then. Last week, I needed 16u of basal insulin in the morning, and from that I work on a sliding scale of rapid on a 15:1 ratio. But in the past two days, I have had so many lows that I didn’t take insulin with any meals. Now I’ve spent the last 48 hours without any basal or rapid insulin. My question is: why?

Wil@Ask D’Mine answers: As I read your email my head starting literally brimming with possibilities. I just love, love, love medical mysteries—this kind of stuff makes my job fun! The top three things that came to my mind were: Custer’s Last Stand, prairie dogs, and lazy stock boys.

Bear with me.

Custer first. So, as you’re somewhat new to the D-family, this could be a garden-variety case of honeymoon phase. We covered what that’s all about in our October edition here; just scroll down to the picture of the syringe and start reading at that point for a refresher on what type 1 diabetes and Col. George Armstrong Custer have in common.

Second, prairie dogs. There’s always a remote chance you were a glucose-toxic type 2 misdiagnosed as a type 1. We covered what that’s all about in November here; just scroll down to the second question to learn what the pancreas, eagles, high blood sugar, and prairie dogs have in common.

As to the third possibility, it’s time to break out a new analogy. Everyone, please meet the lazy stock boy. Lazy stock boy, meet everyone.

We all know what a stock boy is supposed to do, right? His job (or her job, I wasn’t dissin’ lazy stock girls) is to replenish the stock of goods for sale in retail stores. Done right, the job is much more than just putting boxes of Post-Toasties on the shelf at Safeway, because most grocery items have a limited shelf life. Milk goes sour. Bread gets moldy. Chips get stale. Even beer has a “best used by” date stamped on the can. Or so I’m told.

So a properly trained and motivated stock boy not only re-stocks the shelves, but rotates the stock—placing the newer stock in the back and pulling the older, but still sellable, stock to the front. Oh yes. And the stock boy is also supposed to pull stock off the shelf that’s past its expiration date.

That’s actually a pretty complicated job for one that pays minimum wage. At night. Which is why it’s so easy to get home with your groceries and find you just bought sour milk, moldy bread, stale chips, and un-drinkable beer. Milk, bread, chips, and beer, of course, make up the now-retired My Food Square Nutrition System. (Wink).

And this has, what, exactly, to do with diabetes?

OK. Now all of you. Get up. Go to the bathroom. Look in the mirror. Be honest with yourselves. Are you lazy stock boys and girls?

That’s right. All your diabetes meds and diabetes stuff are like milk, bread, chips, and beer. It’s only good for so long, and you and you alone are responsible for rotating the stock.

Alex, I see that you take 16u of basal insulin per day. Well, more correctly, you said last week you needed 16 and you had been titrating up. That tells me that a few weeks ago you were probably using even less.

So I gotta ask, when did you start using your current vial of insulin? ’Cause at 16u a day, a vial would last you sixty-two and one-half days. The problem being, of course, that once you pop the top it’s only good for thirty days. You might have been injecting sour milk for thirty-two and one-half days.

Now, of course, insulin’s useful life can be stretched. It’s really not like milk, good one day, vomit-worthy the next. But it can lose its potency pretty quickly. If you were titrating up insulin that was spooling down, and then popped open a fresh one, you might have effectively over-dosed yourself, leading to the chain of lows. Maybe I could be clearer: if you’re increasing doses of insulin that is getting weaker every day, then you aren’t really titrating to your body’s needs; you are titrating to the reduced action of the aging insulin. When you open a fresh one, WHAM! You have a boat-load more insulin than you need, and, to make matters worse, it’s a 24-hour-action insulin.

My advice to everyone who uses little enough insulin that a vial or pen won’t be empty in thirty days: get a sharpie out and write your own expiration date on the bottle or cartridge.

Then no more lazy stocking!

Jay from Nevada, type 2, asks: Why are medical associations against “alternative” medicine? My current doctor seems to think it’s all snake oil.

Wil@Ask D’Mine answers: Fish oil has been absolutely proven by Western Medicine to lower cholesterol. I’m sure it’s only a matter of time before the benefits of snake oil will be scientifically demonstrated as well.

But seriously, there’s an interesting history behind the attitude of many modern docs towards the universe of alternative medicine. And that history isn’t very old because, frankly, modern medicine isn’t very old either.

Here’s the story: Many of the practitioners of modern medicine would have you believe that Western Medicine traces its roots directly back to Hippocrates in ancient Greece. Nothing could be further from the truth. Our current tradition of Western Medicine, commonly called scientific medicine on the inside, really only goes back about 200 years to the early 1800s. At that time, in fact, scientific medicine was just one of a large pack of competing medicine systems to choose from that also included homeopathy and chiropractic medicine. Hard to believe now, but back then, the medical system we all take for granted today was a barely respectable trade, not well-regarded by much of anyone, and frankly, as likely to kill you as help you.

Then, in 1846, a rag-tag medical rabble formed the forerunner of the American Medical Association. This organization became the enforcer of scientific medicine over the years, using both fair means and foul. Don’t get me wrong, the AMA’s done plenty of good, and continues to up to this day; but its early mission was to simply put everyone else out of the medicine businesses.

They came damn close to doing it, too.

To their credit, however, they also cleaned their own house while trying to evict everyone else from it. Don’t forget that in the mid-1800s anyone could call himself a doctor; there was no accredited system of education or government licensure in place. Dentists had better training than doctors at the time. But by the end of the 1800s the AMA had successfully lead the charge to require a license to practice medicine in every state in the Union. In the early 1900s they took on initiatives that effectively overhauled medical schools, bringing them, literally, out of the dark ages.

But the AMA was also focused on the survival of the fittest, and went to great lengths to stamp out the competition: alternative medicine. Remember that at the time, alternative medicine included just about all the other guys in the field of medicine. You can read more details about the battles between the different “camps” of medicine in Jon Queijo’s entertaining book Breakthrough.

To this day, there are many bone-headed died-in-the-wool white coats that’re suspicious of everything that doesn’t smell like science, a legacy of the AMA’s work. In fact, most medical schools today teach the latest incarnation of Western Medicine, called Evidence-Based Medicine, that requires any therapy to be validated by clinical studies before being used in the health care trenches. That said, many modern docs are taking a longer view. A more open view. The sum total of what we do not know overwhelms the sum total of what we do know. A few medical schools are now teaching something called integrated medicine; and I’ve even seen doctor’s referrals for acupuncture. So the times are changing. I don’t think that would have happened in 1950. Or 1960. Or 1970. Probably not even in 1980, either.

Doctors, once banned from even associating with chiropractors by the AMA, now will send patients to them. Medical massage is widely recognized. Diet and exercise remains a valid therapy for type 2 diabetes—that’s a pretty non-medicine approach, if you think about it.

Scientific medicine has a great many strengths, but it does tend to micro-manage illnesses. It tends to single out symptoms and attack them. It sometimes ignores the person in purist of the illness.

Alternative medicines, on the other hand, while ranging from blatant quackery to highly effective treatments, tends to be better about viewing the person as a whole. And I mean that in the widest possible way: not a whole collection of cells, and organs, and systems; but rather body, mind, and soul. And that’s why alternative medicine is rapidly regaining popularity after two centuries out in the cold.

Personally, I don’t think alternative medicine has all the answers, but I know that scientific medicine doesn’t either. I believe that we can intelligently blend various approaches. But we can’t be kooks about it either. If you want to drink cactus juice to lower your blood sugar, be my guest. Just don’t stop taking your prescription medications in the meantime.

As to your doc, you’re not married to him or her (well, you could be, but I’m assuming you’re not); if you think your doctor is closed-minded, go shopping for a new one. Just be sure to check the expiration date to make sure his/her attitudes aren’t sour, moldy, or stale. Those damn lazy sock boys are everywhere!

Disclaimer: 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.