When the Founding Fathers were putting their feather quills to work, do you think any of them considered the imminent and amazing advances in medical technology that would allow a person with diabetes to peruse their labors in relatively good health more than two centuries later? With July Fourth upon us, here are a few pertinent tidbits from when Nancy and I visited Washington a few years ago.

The above photograph was taken in the archival fiber-optic low-light conditions inside the Rotunda for the Charters of Freedom at the National Archives in Washington, D.C. on May 28, 2005. It is of the actual faded parchment copy of the Declaration of Independence that was presented to Congress for the signatures of delegates on August 2, 1776.

The document was drafted in a bricklayer’s Philadelphia home by 33 year old Thomas Jefferson of Virginia in June of that year, as British troops made their way toward New York Harbor. The Congress took to editing Jefferson’s draft, resulting in a July Fourth version that was about 25% shorter, and prompted Jefferson to call their changes “mutilations.”

The most recognizable signature, of course, belongs to John Hancock, the President of the Congress, who was the first to sign. The other 55 signatures are laid out geographically, with the southernmost state of Georgia’s delegates (more on one of them in a moment) on the far left, and the northernmost, from Hew Hampshire, at right.

In this photo, NancyTW looks over the Consitution.  If not for the crowds of people in line, I'm sure she would have read every last word! 

If you are interested, here are some higher resolution copies of my photos of the Declaration of Independence and the first page of the Constitution.

Also, here’s a site with a nice 360 degree view of the National Archives Rotunda.

For no special reason, I’ll throw this in. Among the signatures at the bottom of the Declaration of Independence is that of Button Gwinnett, a man who once farmed pigs in Georgia. He met his death at the age of 42 when his leg wounds turned gangrenous following a duel with another Georgian, General Lachlan McIntosh. Today, an authentic copy of Gwinnett’s signature is said by collectors to be worth upwards of $20,000.

The following information about how the Founding Documents are displayed for public viewing is according to the University Libraries of the University at Buffalo.

“Each sheet of parchment is enclosed in a separate sealed case that is made of special glass and bronze and contains only helium, an inert gas, and a carefully measured amount of water vapor. Dust and excess moisture, as well as free oxygen, sulphur, and other pollutants in the air, are all excluded. The cases also protect the documents from damage by handling or accident. At night, and in case of emergency, the documents are lowered into the vault below.”

Have a safe and happy Fourth of July everyone!

You know who they are. You know what they do. You know they are going to say something they have no business saying.

The thing is, they don’t know who they are. They don’t know what they do. They don’t know they are going to say something they have no business saying.

They are the Diabetes Nazis. And sooner or later, one of them is going to figuratively stop you in the street and utter the frightening diabetes equivalent of “Your papers, please.”

Recently, it was my turn to face the sudden interrogation of a D-Nazi, and although taken somewhat by surprise, I kept my cool and handled the situation without creating a scene. My first inclination was toward diplomacy, with reliance on undeniable diabetic truths and 26 years of my own first-hand diabetes experience to begin an intelligent discussion. But while even the most rabid D-Nazis may be entitled to their own opinions, many of them believe they are entitled to their own facts, too, and they are not about to let valid, correct information ruin their furtive schemes to show someone up in the presence of an audience.

In hindsight, I almost wish I had created the scene, and said exactly what I was thinking.

In many walks of life, people exist who see themselves as the arbiters of right and wrong, good and bad, healthy and unhealthy, for issues having to do with others. They can be well-meaning, expressing thoughts that they honestly believe are in the best interest of others. They come up short, though, by failing to understand that they aren’t the only people on Earth capable of caring for themselves.

All too often, they mangle reality by mixing third-hand versions of heavily embellished tales of gossip with their own unfounded and confounded assumptions, and then draw an ugly conclusion so far off the mark that it needs a GPS to find even a scintilla of sense and dignity. For them, it becomes truth, and they belch it loudly in a shameless display of ignorant preaching for all within earshot to smell. It is unpleasant in the extreme.

Interestingly, and almost laughably so, some of them demonstrate an appalling inability to mind even their own interests as they tend so readily to those of other people. This particular sort of D-Nazi exhibits an inexplicable infatuation with entrapping the diabetic in an embarrassing game of “gotcha.” Such was my experience, and I sensed that becoming ensnared in the silly trap is precisely what would satisfy my D-Nazi’s lifelong, fruitless yearning for esteem.

Regardless, the only way the Diabetes Nazi could have ruined my day was if I had allowed that to happen. An often overlooked, undeniable diabetes truth holds that doctors, CDEs, lab techs, insurance company reps, and D-Nazis are only as powerful as the person with diabetes allows them to be. I have the power to find a new doctor. I have to power to argue intelligently over coverage issues. I have the power to know when a lab test may need to be re-done.

And I also have the power to ignore a misinformed fool with bad intentions.

No way am I going to let myself be offended by a Diabetes Nazi mired in a senseless, ill-tempered game of “gotcha.” That would be a lot of power over me to simply give to a pitiful, ignorant, and small person.

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Recently, I’ve written about “brittle” diabetes and some insulin reactions of varying severity. Another thing has been on my mind for a while, and I’d like to toss it out there for what it’s worth.

The hypo episodes I’ve experienced have ranged from usually mild (giddy behavior,) to occasionally bad (inability to communicate,) to rarely severe (uncontrolled convulsions.) As I close in on fifty years of age get older, I’m in reasonably good shape, with good lab test numbers and an excellent BMI. But I’m always concerned about heart attacks, especially given my family history of heart issues.

What troubles me most of all is the possibility that I may someday be found suffering a heart attack, but the outward signs of it might appear as if I’m having “just” another insulin reaction. Because hypoglycemia and heart attacks can sometimes share a few similar symptoms, I’m afraid that the people around me who are aware of my diabetes might be inclined to automatically treat the suspected low blood sugar without realizing that the true problem is something very different. As they wait for me to come out of hypoglycemia, precious seconds would be passing by, wasted.

From now on, I am explaining to my friends and relatives that 99.999% of the time all I need is a little sugar. But not everyone around me has taken a CPR course, and that’s probably true for most of us. So when we tell friends and family about the ways to treat hypoglycemia, perhaps it’s a good idea to suggest that they check for a pulse, too.

On that happy note, I promise to try to come up with something slightly less morbid next time.

Now, here’s an issue that I haven’t written about, and a theory that NancyTW and I discussed a few days ago. It has to do with a specific element of severe hypoglycemia. While I’d venture to say that many, if not most, of us T1s have had serious lows, how often do they occur more than once in a single day? Often, we experience a rebound of higher blood sugar after an extreme low, and that was the case with me on one occasion about four years ago, when I had three harsh hypos within the span of about 18 hours.

Even with such a miserable day to look back on, I can’t attribute the events to being brittle. The ingredients were all present for a classic loss of control: it was a midsummer weekend; we had a house full of guests; I was having fun playing baseball out in the yard; NancyTW was busy entertaining her share of the crowd, and couldn’t be looking out for signs of hypoglycemia; there was the grille to start, drinks to distribute, and jokes, conversations, and small-talk. On top of that, we were already deep into the stress of preparing to relocate from New England to Florida.

With my attention drawn in so many divergent directions, self-testing took on less importance, and we all know what that means. Had I devoted myself every couple of hours to taking a minute for a test, the problems of the day might have been averted. It was my own negligence, not “brittality,” that led me to walk right off Blood Sugar Cliff.

The first insulin reaction occurred during the baseball game, and someone went into the house to alert NancyTW. A glass or two of OJ, a few minutes of rest, and I was fine. My liver, however, had already taken the precaution of opening the glycogen floodgates, and later on I dealt with the onslaught of hyperglycemia in the way any red-blooded American boy who puts his brain away on weekends would -- I Humalogged it.

After burgers, and my memory isn’t crystal clear at this point, we probably started right in on Game 2 of the doubleheader out in the yard. So again, through nobody’s fault but my own, I slipped quietly into the day’s second hypo. Again, more OJ brought me around. Again, I rested away the symptoms. Again, more glycogen filled my innards from my liver.

Again, more Humalog for the nasty rebound.

Now, none of this is going to get my name printed in the Mensa Bulletin. But there’s more. After getting back to normal sugarwise, or so I thought, we went to bed late that night after our company left. My next fuzzy memory is of a paramedic doing paramedical things to keep me from falling any deeper into the hole I had spent an entire day digging for myself. NancyTW had tried her best to bring me out of the nighttime low, risking loss of the finger she used to apply blue cake frosting to my gums. But I was having none of it, instead convulsing uncontrollably on the bed like Linda Blair in The Exorcist.

Nancy recalls me sitting upright at one point, still far from conscious, making ghastly sounds as I labored to inhale. I was not responding well to any attempts to revive me. The EMT had initially seen my blue lips, not knowing about the frosting, and thought to himself that I was a goner. (When someone says, “till you're blue in the face,” the connotation is not good.)

Eventually, the cake gel found an on-ramp to my bloodstream, and I slowly emerged from the hypo-stranglehold, to a degree of hypoclarity, and eventually to that happy place where the hypo-hangover begins and the regrets soon take over.

If you’ve read the Lord of the Rings trilogy, this third low was the Nazgûl of insulin reactions. The paramedic said something to Nancy about a “grand mal seizure,” and today she and I think that even though I was given glucagon, my liver was fresh out of glycogen after having already been called upon earlier that day to come to my rescue.

Is this possible? Based on what I’ve read, yes. Simply put, if the liver has a store of sugar, it seems likely that the supply could become depleted, at least for a time. This is what I believe happened to me after three reactions in the span of just hours. I think the emergency back-up glycogen supply was bone dry, like a sponge that had been thoroughly rung out.

But I don’t have a medical degree, and there may be many other factors that I am not considering here. Any comments or pertinent thoughts you’d like to share are welcome.

In the years since then, I have been fortunate enough to avoid such a severe repeat performance. Bad lows happen infrequently now, and I try always to keep my focus on blood sugar first, and peripheral activities second.

It would have been quick and easy to blame brittle diabetes for my wrongheaded lack of control on that sorry day. I could have gotten up the next morning, shaken off the cobwebs, and forgotten all about it, never bothering to figure out why it happened or how to avoid it next time. But if I’m using the term “brittle” to describe woefully inadequate control simply to feel better about myself, then I have to address another important issue: does feeling better about myself help me ward off the short and long term complications of diabetes if my sugars continue to rise and fall drastically out of control? I say no, it does not.

So I don’t call my diabetes brittle. My sugar swings like a pendulum just like everyone else’s does from time to time, but I gain nothing by denying the reality of my own human error. Nothing will continue to keep me out of the hypo penalty box better than a disciplined attitude toward strict control.

The only thing brittle that long ago day was my way of thinking.

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EXTRA, EXTRA!! Be sure to check out this super Feature Story interview given to Diabetes1.org by our great friend Kelly Kunik of Diabetesalisciousness.

Have a great weekend, everyone.

From the start, I have never thought of myself as a “brittle” diabetic. Why? Probably because no one ever used the word to describe my test results. Brittle diabetes was always something that happened to the other diabetic, the poor slob who hobbled into dialysis twice a week on half a foot.

Today, medical professionals like to use the word “labile” to describe something or someone they used to call brittle. Next time you hear them say it, ask them what it means. After a bunch of hyperinsulinemia, homeostasis, and glycosuria mumbo jumbo, they’ll finally get around to using the word “brittle.” Med school tuitions have to count for something, and “brittle” is far too common and self-explanatory a term to win a board certification all by itself.

A Type 2 diabetic I know injects himself with 50 units of Humalog just to cover lunch. Such a dose would probably kill me. I wonder if I could possibly consume enough glucose to counteract the blood sugar lowering effect of a single dose of that much insulin.

My point is that while we all share the same chronic condition known as diabetes (regardless of type,) we all are very different with regard to our management, our response to management, and even our desire for management.

Have you ever read one of those interviews of diabetics whose lives were just peachy since they started taking insulin? We were led to think that the interviewee never had a bad sugar day, never lost control to the throes of hypoglycemia, and never knew the frustration of being dog-tired at midnight after a long day and then discovering that an empty reservoir needed to be changed before hitting the sack. None of these unpleasantries ever seemed to happen to the diabetic whose healthy, happy, smiling photos gleamed back at us with perfect color and tone from the pages of a magazine.

Conclusion: No way are they brittle.

So, am I brittle? Was I brittle? Are we brittle? Are there varying levels of “brittality?”

Rarely does my day precisely match any other day in terms of activity, food, mental stress, physical exertion, exercise, and blood sugars. A few things, but certainly not all, stay the same from one day to the next. Mostly, though, I cannot expect everything on Tuesday to be identical to Monday. So it’s pretty tough for me to compare a high afternoon sugar on one day with a low the next. Everything has to be viewed within the context of my particular day. I often exercise at different times, eat at different times, and even sleep at different times. My guess is that any strange or severe fluctuations in my blood sugar would more than likely be attributable to this kind of schedule, and not to some associated condition or phenomenon.

Here are a few interesting statements concerning brittle diabetes from out there on the web at various medical or D-related sites:

--Overall, three in 1,000 people with type 1 diabetes will develop brittle diabetes.

--People with psychological problems . . . are at highest risk of experiencing brittle diabetes.

-- Individuals whose diabetes is "brittle" experience unpredictable, out-of-proportion rises and swoops in blood glucose, within short periods of time, as a result of very small deviations from schedule.

--The point at which these (blood sugar) swings become intolerable . . . depends upon the psyche, competence, and confidence of both the patient and his or her provider.

--The vast majority of (brittle diabetes) cases are due to psychological factors, with the metabolic abnormalities being secondary to poor glycemic control.

-- The person with brittle diabetes is frequently hospitalized, misses work and often has to contend with psychological problems.

--Labile diabetes is akin to . . . the patient whose life is constantly being disrupted by episodes of hypo- or hyperglycemia, whatever their cause.

--Labile diabetes is an insulin-dependent diabetes. In spite of careful treatment . . . this form of diabetes cannot be influenced.

Don’t take my listing of any of these statements as an endorsement or a claim to absolute truth. If you Google the topic (or almost any other topic, for that matter,) you’ll get these opinions and many others, and still may not come away with any satisfactory answers. But that last one raised an eyebrow. What does “cannot be influenced” mean? Hopeless? Unresponsive to any and all treatments? It doesn’t sound very encouraging, but nor does it sound entirely accurate.

I anticipated broad fluctuations and considerable loss of control on our trip to Ecuador and the Galapagos Islands earlier this year, but in reality I maintained fairly good numbers even faced with different foods, the stress of travel, and the tight schedules of up to seven hours of hiking tours spread out over each day. If I was brittle before (and I am not saying that I was or I was not,) it surely didn’t follow me to the equator.

Next post, I’ll be looking at my liver as a sponge, and try to explain that perspective with a series of events from a roller coaster day that I’d like to forget.

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If you watched the Boston Celtics win their 17^th NBA Championship last night, you probably saw the C’s guard Ray Allen poked in the eye by Lamar Odom. Allen got another poke in the eye during the finals when his 17 month old son, Walker, was diagnosed with diabetes over the weekend. I wish the best for the toddler, and hope he and those around him are able to control his blood sugars well and for a very long time.

When we were D-newbies, we had to familiarize ourselves with a bevy of words that previously held little or no meaning for us. What are these “ketones,” and why are they bad for me? How exactly do I pronounce “microalbumin?” Isn’t “lente” a kind of soup? “Reagent” was anybody’s guess.

Some familiar words, like carbohydrate, suddenly gained importance. For other words, you had to learn altogether new and very different definitions. Simple terms like “high,” "low," "complications," "honeymoon," and “exchange” took an unsuspecting (and not-so-simple) command of the lexicon. Until then, the neighbor’s trouble-maker son was a “juvenile,” and “rebound” was something done by men named Chamberlain, Russell, and Kareem. Even “regular” changed positions in the vernacular.

More recently, as those of us using pump therapy can attest, terms like “basal,” “bolus,” “occlusion,” and “cannula” now require our attention. In the old days, “rewind” was something you did before you went back to Blockbuster.

And then there were all those acronyms. It could have started when your GP or PCP ordered an FBS or an OGTT to confirm your DX of DM. For people with IDDM, the ADA said your CDE would teach you about NPH, R, and MDI, and how they affect your BS or BG. Folks with NIDDM heard all about OHAs. All of us, including LADAs, were told to keep our A1c below, or as close as possible to, 7%. Your doctor’s PA said that DKA is to be avoided, or soon an EMT will drive you to the ER. Because the DCCT showed that tight control was worth the effort, an RDN talked about your diet and your BMI. Today, some of us keep it all together with a CGMS.

But for me, one word has lurked in the shadows of diabetes since my diagnosis. It was used by the doctors, lab techs, nurses, dieticians, and pharmacists. It was defined on the pages of the books they gave me to read, and it was used in describing the horrific cases of diabetics for whom control was unreachable.

The word is “brittle.” It conjures a picture of something easily broken, and that once broken, might be glued or patched, but will never again be of the same original strength or quality.

Next post, I’ll write a few thoughts on brittle diabetes.

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Thanks to everyone who sent in the correct answer to the brain teaser in the last post. The question was: what nine-letter word in the English language contains just one vowel? The letter “y” is not in the word, and the vowel appears only once.

The answer: STRENGTHS.