Wildcard #1 – Day 2 of 2017 RABlog week
Overlap – Discuss the medical conditions that overlap and sometimes mask or make the symptoms of autoimmune conditions worse.
I took this wildcard because I am often asked about the overlap of Type 1 Diabetes and RA. I am also asked which is worse. So with my site named RADiabetes, I thought lets be RADical and I chose the wildcard.
First, the main answer. My body is a system with two main issues. Diabetes and RA feed off and work against each other to make life miserable sometimes. One would think that after 43 years of dealing with Diabetes; I would be a seasoned veteran. The truth is, I learn new approaches all the time. I never really have it down to a science. Despite what it looks like there is no eat this/get that result, at least on an ongoing basis. With RA, after 17 years, I cannot say I have ever had it totally under control.
Infusions can be brutal
When I have an infusion, I also receive a high dose of steroid. According to my doctor, the steroid is part of the drug cocktail so some of those nasty side effects that are listed on the drug warning do not occur.
These lifesaving steroids are also life threatening for a person with diabetes. Typically my blood sugar will peak at a little over 300 and will remain there for about 12 hours. For reference this is like eating a coconut cream pie and not injecting insulin. It makes one feel awful.
So to counteract this upswing, I increase my basal or underlying insulin by three times. On a typical day, I use about 50 units of insulin. On an infusion day and the day after, I typically use about 100 units of basal and meal time insulin. That breaks down about 30 units per day of meal time insulin and about 75 units of long acting or basal insulin.
Taking insulin can be deadly
Taking this much insulin is dangerous. If the blood sugar is brought under control with too much insulin in my body I can have a severe low blood sugar event. If I do not get enough insulin my blood sugar can end up requiring hospitalization to correct. I do not want to sound all doom and gloom. I have learned by and large how to thread this needle. I have learned to make it work, just like all T1’s who use this steroids make it work.
So how do I do it? The truth is that one or two days of extreme blood sugar buys me four months of having my RA mostly under control. So, at some point, I have calculated that it is worth the risks.
Diabetes is impacted by more than infusions
RA impacts blood sugar in other ways as well. I have a small uptick in blood sugar when I use Methotrexate and while using Remicade I always had an uptick during and after infusion. So to answer the question, having both is tough.
However, it is also easier in some ways. I have no fear of needles. When I hear of needle phobia or the inability to self-inject RA medications, I do not understand the issue. Over the course of 43 years with Type 1 diabetes, I have made at least 30,295 insulin injections (likely more) so being told it is necessary to self-inject an RA medication is of little concern to me.
Which is worse?
So which condition is worse? I always say RA is worse, because it is the unseen enemy. With diabetes I can quantify it, I have machines and instruments to correct high and low blood sugars. I fight diabetes every minute of my life 365 days with no days off. But I see my enemy, I confront it and I deal with it.
RA is the opposite. I can feel RA, I know it is attaching but I cannot on a day to day basis make big corrections in the course of my disease. Yes I take pain medicine to mask the pain, I take all manner of pills to control it but I cannot fight it directly. There is no home finger stick to tell me how I am doing and I do not carry a machine to make immediate corrections.
I would rather see my enemy and fight with it fairly than have it hide and harass me with little means of correcting it. It is often said that T1 diabetes is a disease of machines, if so then RA is a disease where I take the medication and hope for an outcome. Give me the machine any day.