Wil Dubois

Hey, All -- if you've got questions about navigating life with diabetes, then you've come to the right place! That would be our weekly diabetes advice column, Ask D'Mine, hosted by longtime type 1 and diabetes author Wil Dubois.

This week, Wil takes two questions from a diabetes newbie, who just got his diagnosis at the age of 66 (!). He's curious about standards used by healthcare providers, and how to gauge the effect of insulin in his own body...

{Got your own questions? Email us at [email protected]}

 

Bill, type 1 from Pennsylvania, writes: I’m a newbie T1D at 66 years old, about 6 months in to this new reality. Doing pretty good managing my BG and I think I have just left my honeymoon period. But I have two questions I hope you can help we with:

1) My endo has me on a statin (atorvastatin 10mg) not because I have any cholesterol issues but as a “helper” to ease the work the heart is doing or something along those lines. She is also recommending a medication to help protect the kidneys as well, although I neglected to write down the name and my memory sucks. Again, not due to any bad test results but as a “helper” to protect the kidneys. So all that said, what is your experience or learned knowledge about these protector/helper drugs if any?

2) What kind of process can I perform that will give me an idea as to how much insulin equates to how much it will lower my BG by? I guess it’s probably the obvious, take your count, inject 1 unit from my pen then measure after 1 hr, 2 hrs, etc., but being that I squeak when I walk, is there a formula one might utilize to get a reasonable amount of reduction?

 

[email protected] D’Mine answers: Welcome to the family, Bill, and thanks for writing! I’m glad to hear you’re off to a good start, and I think you’ll find it’s even easier now that the honeymoon is over. Life is simpler with fewer variables.

As to your questions, let’s start with the statin. Prescribing a statin to people with diabetes is part of the standard of care, and it’s endorsed by both the American Diabetes Association (ADA) and the American College of Clinical Endocrinologists (AACE). The logic behind it goes something like this: Gee whiz, most people with diabetes die from cardiovascular problems. And you know what? That nasty heart plaque is a big part of that. And wow, those statins really do a good job of knocking down the cholesterol that causes the plaque. Maybe we should just put all those diabetics on statins before there is a problem, and maybe they’ll live longer.

It might have been a bit more scientific than that, but you get the idea.

Oh, and to be fair, the guidelines don’t recommend statins to D-peeps under 40 with no risk factors. So they aren’t really saying all people with diabetes should take a statin. Just most of us.

That said, despite the recommendations, docs aren’t having much luck getting us on board with these pills. An article in the Journal of the American College of Cardiology last year reported that fully 40% of D-folks in the NCDR’s PINNACLE registry were not prescribed statins—and that’s a database of folks that already have serious heart stuff going on—much less those of us who don’t “need” a statin yet!

Why? Well, historically statins were expensive, but that’s no longer true with most of the leading agents “generic.” It might be that statins can have a wicked side effect profile, making sugar harder to control in some people and giving others painful muscle aches. Plus, they can be hard on the kidneys.

Many type 1s feel that the heart attack risk with diabetes is a type 2 problem, but I’m here to burst that bubble. According to the ADA, 75% of us with type 1 will meet our maker through heart disease. I once heard that the other 25% are shot by jealous husbands, but I couldn’t find a study to back that up.

As an interesting side note, while the everyone-on-a-statin standard still stands, this year’s ADA standards also advocate putting D-folks who already have cardiovascular disease on either a GLP-1 or a SGLT-2 med for glucose lowering, based on the results of two large clinical trials that showed a significant reduction in cardiovascular deaths in D-folks on these anti-sugar meds. But the ADA isn’t going so far as to advise that everyone be put on these—yet—saying, “More research is needed to confirm if the heart benefits are a class effect or if the benefits persist in patients without established cardiovascular disease.” In the future your endo may be peddling yet more pills!

The kidney shield med is called an ACE inhibitor. It’s a blood pressure med, so if your blood pressure is elevated, it makes sense to use a med that has a side benefit. Of course, there are many docs who feel we should take one whether we need it or not, but studies show the higher the dose, the more effective it is. I recall one (fanatical) doctor who even recommended giving high doses at night so that if patients’ blood pressure fell so low they’d faint, they’d already be in bed.

Clearly, he didn’t have diabetes himself.

So the best evidence science has to offer shows both meds are a good idea, but the majority of D-folks I know don’t take either, especially the ones who have decent blood pressure and decent cholesterol. We’re a pretty stubborn—and some would argue foolish—lot.

As to your second question, what you’re trying to figure out is what the trade calls your insulin sensitivity factor—and, yes, there’s a formula for that! Simply add up your total daily dose of insulin, and then divide into 1,500 if you are using the older “R” insulin or into 1,800 if you use Apidra, Humalog, or Novolog. The result tells you how many points one unit of fast-acting insulin will lower your blood sugar.

Sorry, T2 cousins, this doesn’t work for you very well. Your bodies mess up the math by still making some insulin.

Hope that answers your questions, Bill. Again, I'll echo what many others have said before me: This Diabetes Community is one that no one wants to join, but one where there are many other people with diabetes who extend their hands and hearts to help their D-Brothers and Sisters when that time comes.

Whatever you need, don't hesitate to keep reaching out and asking. We're here for you.

 

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.

Disclaimer

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.