Most of my worst insulin experiences hitherto were while I was on a brand called “Humulin 70/30,” a combination of a fast-acting insulin and a medium-acting one. When first diagnosed, I was without health insurance, and this, my doctor said, was the best insulin therapy I could afford. I used it for almost six months; by the beginning of May, when I switched, I would often feel as terrible by the end of the day as I had before I’d been on any insulin at all.
Thankfully, The L offered me health insurance; New York State has a provision that forbids insurance companies from denying coverage to diabetics; and I can now (just barely) afford what’s widely considered a better regimen: a long-acting insulin before bed, and a short-acting one before meals. The downside is that I have to take four injections a day, including one at my desk before lunch that burdens me with untucking and unbuttoning my shirt. (At my other job, I lock myself in the toilet.) But, it has marked an improvement. I feel less prone to the severe lows, though they’ve been replaced with often hours-long episodes of mental fog that I usually can’t identify until they’ve waned. The other day, I repeatedly read the same page in a Paul Auster novel for about 30 minutes, not understanding why I couldn’t just focus, before putting the book down. Checking my blood sugar shortly after, I discovered it was 45.
Also, as a diabetic, I’m still relatively young: it has not been a year since mine was diagnosed. Every day I’m becoming a better guesser about dosage sizes; my blood sugar readings have become more stable. But even adults who have tightly controlled their diabetes from childhood are known still to slip on occasion into severe hypoglycemic episodes. (Arguably, the worst of these happen while driving. In Cheating Destiny, the diabetic author James S. Hirsch describes driving his young son home from soccer, when the next thing he knows the car is upside down in a ditch, his son, also a diabetic, moaning for help.)
The truth is that as long as diabetics’ only course of treatment is a capricious compound—which sometimes does what it’s supposed to, but just as often seems to do its job too well, or not at all, depending on factors the patients can’t even imagine—they will never really be doing “well”. Insulin miraculously keeps diabetics alive another day, to lead a Normal Life while suffering and struggling with the side effects of insulin.
Improvements in insulin have occurred over the last century. It’s no longer mass produced from pig parts. Different kinds act at different speeds. There are insulin pumps and promising advances towards an “artificial pancreas”. Needles have become less painful and invasive; blood glucose monitoring systems have become faster, more accurate and more portable.
But, for most people with diabetes, the essence of insulin therapy has barely changed since its pre-Great Depression introduction: it’s still an unstable hormone that must be injected, sometimes several times a day, each one of those shots bringing a new risk of gradual-onset torpor or too-low lows. Diabetes is far from a medical problem solved; it’s simply no longer guarantees a quick death—as long as I eat enough, and soon enough, after taking my medicine.