The Goofus and Gallant of Diabetes

Remember Highlights? For over 60 years it has been a very popular magazine for kids with lots of stories and games that make you think. (Quite different than building a a transformer, Optimus Prime!)  When I was younger, one of the regular sections I liked was called Goofus and Gallant. They were two guys, one of whom was kind of dorky and goofy and always did everything wrong, and the other was polite, proper and did everything right. Look at some of these scenarios below and see if you relate to Goofus or Gallant.

Scenario # 1

Goofus has type 2 diabetes and hates to take prescription medications, adamantly refuses insulin, and his goal in life is to “get off my medications”. As a result, he stopped his medications or takes them very sporadically before his doctor visits…if he shows up at all. He has type 2 with poorly controlled glucose values (A1c above 9%), elevated cholesterol levels, and high blood pressure. He does, however, take tons of over-the-counter supplements from the vitamin store to treat anything from diabetes, memory loss, and male pattern baldness to daytime tiredness and reduced energy. He never misses his Viagra! He constantly brags to his friends and family that he does not take any prescription medications at all for his diabetes!

Gallant also has the diagnosis of type 2 diabetes, as well as the commonly associated cardiovascular issues of abnormal cholesterol and high blood pressure. His diabetes medication list includes Glucophage (metformin), Jardiance (empagliflozin), Bydureon (once weekly exenatide), Novolog (insulin aspart) and Lantus (insulin glargine). He is also taking two drugs to control his blood pressure (fosinopril and diltiazem) and one pill for his cholesterol control (simvastatin).  Gallant would rather not have to take the long list of medications; however, he has a good relationship with his doctor, understands how important medications are for the prevention of complications down the road, and takes his medications religiously (not just on Christmas and Easter, like Goofus). His A1c is 7.2%, LDL cholesterol is at goal (below 100), and BP, measured at home with his BP cuff, on average is extremely good (~125/82 mmHg).

If you have type 2 diabetes, are you more like Goofus or Gallant?

Scenario # 2

In this scenario, Goofus has type 1 diabetes and wears an Omnipod insulin pump, but his A1c has been well above 9% for years. He tests his blood sugar level using a glucose meter, from zero to two times a day because he says, “I can feel what my BS is so I do not need to test.” Goofus drinks regular soda because he “does not like the taste of diet”. He adamantly refuses to use a continuous glucose monitor that has been offered to him by his endocrinologist even though he has had several severe hypoglycemic reactions at work, while driving his car, and at home; some so severe he required assistance from others including a paramedic! When he recognizes his lows, he typically eats two or three Snickers bars. He gets up at night to urinate two or three times, and then is really tired during the day and falls asleep on the job. His wife repeatedly threatens to divorce him because she is tired of watching over him. He was prescribed an ACE inhibitor (medication that protects the kidney) and a statin to keep his LDL cholesterol low, but he stopped taking them because “he felt the same whether he took them or not” and he read on the internet that statins cause liver damage, memory loss and muscle aches. He does take his Viagra regularly!

Gallant also has type 1 diabetes and doesn’t have an insulin pump, but instead he takes multiple daily injections of his long-acting basal insulin (Tresiba or Toujeo), as well as his pre-meal fast-acting insulin (Lyumjev or Fiasp). He also uses Afrezza when he plans on eating a carb-heavy dinner and needs to correct for a high glucose level.  He wears a Dexcom CGM and looks at it quite a bit to make daily adjustments. Gallant struggles somewhat with the daily ups and downs, but at least his A1c is 6.8%  and his time in range (TIR) is 81%. He has a few mild hypoglycemic reactions a week.

If you have type 1 diabetes, are you more like Goofus or Gallant?

I know these examples may seem extreme to you, but I see these types of folks in clinic every day! There is no question that Goofus wants to live a long and healthy life, but he has many misbeliefs and misaligned priorities. He may have fear, guilt, depression, or just a plain old lack of motivation to take control of his diabetes. As a caregiver, it is disheartening and frustrating to see Goofus as a patient year after year with little or no change. I rarely give up on these folks because I know if you continue to give support without judgment, the Goofuses of the world eventually do come around!  For me, I personally can only relate to Gallant, as I am perfect…hahaha!

 

 

 

 

 

10 Comments
  1. I am frustrated by frequent lows followed by highs. My Dexcom continues to alert as I am treating my low which disturbs my husband’s sleep. When it finally calms down I am going high quickly. Also my pump will often not deliver insulin sufficient to keep me in target range. Endocrinologist and I have been tweaking and changing basals but I have unexplained highs for hours despite delivering insulin to correct this. Sometimes I can correct this by redoing pump setup, changing insulin or changing sites. I have had type 1 diabetes for 40 years. It was adult onset. I have large areas of scar tissue which affects pump efficiency I know. These high sessions influence my HbA1C levels so I seem to be in very poor control although my time on target (when/if that is considered at appointments) isn’t that bad. Also I am obese (5’6” and 230#, 74 years old) so any dieting only seems to increase lows. Jan 4 this year I had an aortic valve replacement at UCSF using TAVI procedure. My recovery is progressing well. I would like information about losing weight without going low. I walk daily for exercise.I have been to many TCOYD conferences with my husband and have been a strong supporter of your information. Very enjoyable and informative. Life changing.

    • Wow…a lot going on and really too complicated to address here, but I would make sure you are wearing the Tandem CIQ or Looping. Also important that the settings are good. See the lecture by Gary Scheiner (Strike the Spike) on our diabetes video vault: https://tcoyd.org/video-vault/
      As for weight loss, we also have great dietitians who have recent lectures in our video vault as well. The basics are to slowly reduce your calories with the foods you like, but reduce your insulin first by 10 to 20% to avoid lows. SPEAK TO YOUR ENDO FIRST BEFORE MAKING ANY CHANGES.

  2. Type II diabetic here; HA! boy do I know Goofus; that was me for years: Scenario #1; I didn’t wise up until 6 months ago. At 67 years old. Truth is as Goofus I didn’t do well; but, kept my a1c below 8 and around 7 a lot, til the cancer. But, I did eat the right things (except initially during Covid-19, when I snacked way too much.) But, I was sick and tired of being sick and tired. The cancer meds did not help.

    Now, with my Medtronic Pump with CGM (and let me stop a sec to praise the people there, they really do care!) They’re fantastic, and no I’m not a stock holder (do they have stock?) and not affiliated, just a customer! Anyway, I’m glad I can use them. I am controlled; I have yet to drop below 7.0, but will be tested again soon. It’s only been six months. I now check my sugar regularly.. (118 BG right now as I write.) I hope to go below 7 on a1c. I’ve lost almost all the weight I can now. Can’t lose much more than 20 more lbs.

    But, I once weighed 380lbs. (I’m at 240 now) Jardiance (as Goofus) helped me a lot as well as Metformin before that; but, controlled… not really… unless 220 to 280 BG is controlled. I also used Lantus, too much, learned later that most of it was wasted. Seldom took a bolus for meals unless I went above 250, had sleep problems, and was always hungry and ate everything in sight quite often.

    Now, I’m never hungry, sleep better than ever, BG Averages 100 to 140. Eat to keep from losing more weight; and snack on low carb snacks. I still take too many medications; but, some for cancer I cannot avoid now; and take nothing for my sugar except using a pump. Every day, and in every way, I’m getting better and better… at least as far as my body will let me. Being a passenger in a total car wreck is a life changer. Still, I troop on! My limitations are mostly physical. While I appear normal; my back is my problem… I work to keep inflammation under control.. but, pain is the enemy. sometimes I just can’t do it. The kind where the body just shuts off control and that part just shuts down. So, Blood Pressure is also an issue. After Covid, I’m getting an appointment with an endocrinologist… and it’s about time.

    So, Goofus is still with me; but, I’m fighting him off, and think I’m being fairly successful. My wife says I’m galant! 😉 FWIW though Viagra doesn’t work on me. Too much nerve damage from the accident. (sigh) Thank God for a good woman.

    So… to sum up… I’m a former Goofus who is working hard at becoming a Gallant; but, I’ve got a lot to learn. Type II, still figuring out when my body will decide to help me with my Blood sugar, how much fiber do I claim when doing a bolus, what eating that ‘rare’ Artichoke and butter did to my sugar… oops. IOW that darn fat! And, since I’m primarily a tee totaler, how to compensate for that truly occasional drink or beer. So, lots still to learn. But, for me especially… how to stop losing weight, now that I’m almost where I want to be. I’m almost there; but, it’s hard. I wish I’d gotten a pump 20 years ago; but, at least I have one now… and with CGM, it’s a lot easier. I was waiting for that, I know. But, yep, it’s still a new tech for sure. I’m fortunately a technophile, and a science guy by profession (now retired)… so, just have to find, read, and learn the right things; and my wife would like me to stick around a while. 🙂 It’s looking better every day. Finally!

    • Thanks Chip! If you haven’t yet, please check out our video vault for more in-depth videos on insulin adjustments for alcohol and also compensating for complex foods. And yes, your wife is a keeper!

  3. I have been a T1D for 55+ years. One of my endocrinologist prescribed 1.8 units of Victoza for me daily — in addition to my Medtronic 670G pump a couple of years ago, and I have now lost about 40lbs. It’s been slow — about 10-15 pounds per year — but steady. It’s also reduced the amount of daily insulin that I use. Good luck to you!!

  4. I am in my late 50’s and have had T1D since I was 2 1/2. For over 30 years I kept my A1C at 6.0. It started to creep up, 6.2 one visit and then 6.4 the next. My doctor suggested I try the “new” insulins – Lantus and Novolog – to keep my sugars steadier. My A1C went VERY high (over 10)as I struggled to get control on these new insulins. So, my endo suggested a pump. Since being on the pump, my A1C has fluctuated between a 7.6 and 6.2. I have never gotten back to a steady A1C, or to a 6.0.

    I’m wondering, does my age have something to do with this or are my settings just not correct on the pump? My endo keeps adjusting the settings, but the best we’ve gotten is a steady 7.0 for a month or two. Every time I try for a lower A1C, my blood sugars go crazy.

    I never had this issue on MDI with Humalin/Novolin. My only concern were overnight lows, but eating a snack when my bedtime BG was below 100 usually took care of that. I would only have severe lows 2-3 times per year. Thus, I feel I was better off on these older insulins and on MDI. My endo does not seem to agree. He wants me to stay on the pump and Humalog, as he thinks better control is achievable with these. **Note: my current endo is not the same doc I was seeing before going on the pump, so he never saw those results. Only the results since being on the pump.

    I’d love to hear your opinions. The only good thing I can say about the pump is the convenience of it. From my outlook, I think my control has suffered on it. I love my CGM and would definitely keep using it! – – I use the T:slim X2 with a Dexcom G6. I tried the CIQ, but my A1C went from a 7.0 to a 7.6 my first month on it. My endo agreed that to get the tight control I am use to, that I should not use the CIQ.

    • Your case is very complicated for me to give specific advice on, however, people on MDI with CGMs can do extremely well. In my experience, people do the best on the CIQ that regulates your basal automatically, and it also helps to avoid hypos. But take a look at our video vault – there are some great videos there that can help you in the type 1 sections. There is one on MDI, one called Finding Your Sweet Spot, and one called Strike the Spike that may be of particular interest.

  5. Thank you for your response. CIQ did not work for me. I started on it with an A1C at @7.0 going in. At my first 3 month appointment, my A1C had gone up to a 7.6 with CIQ. My endo thought it was because the preset 1:10 carb ratio did not seem to work well for me. So, at his suggestion, I stopped using CIQ, but stayed on the pump with the CGM.

    I will take a look at the videos you suggested. Hopefully, they will help me in figuring out if I can get the results I want with a pump or not.

    Thank you again,

  6. Just asked my endo about Afrezza for stubborn highs and she was on board for it!! I’m intrigued with the scenario here of using it in anticipation of a high carb meal. Would love to hear some ideas on how it is used besides stubborn highs!!

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