This has been a crazy week. On December 10, 2008, we officially moved away from Alex’s pre-mix insulin to Lantus plus. Lantus is a basal insulin which she gets once a day, and which is intended to mimic the pancreas of a non-diabetic person which has a low level of insulin secreted all day long, thanks to the workings of the liver which pumps out low levels of glucose, day and night. I know, enough with the lesson – that was last post. Anyhoo, Lantus is injected once a day and that’s good, because Alex doesn’t exactly like it, as it stings going in since it’s more acidic than the other insulin.
With the Lantus, Alex also gets another 2 or 3 shots a day. “Ouch!” you say, and rightly so. But not for Alex. She really doesn’t mind, because it means that she can have her breakfast, lunch and dinner and all the snacks in between, whenever she wants. Just like a regular kid. Instead of me having to wake her up at 6:00 to have breakfast, as we had to before, she can sleep pretty much as late as she wants. Instead of ensuring that she eats lunch at 11:30, we can eat at 11:00 or hold off till 1:00. That’s pretty inconsequential for most people. I mean, who gives a crap what time you eat your lunch. But for a person with diabetes, it is a big deal. It means flexibility. It means freedom.
How it works is this: Alex eats her lunch, I estimate how many carbs she’s consumed and I give her an injection of soluble, fact acting insulin (Humulin R, in this case) to compensate for the elevated blood sugar that I know is going to come. In an ideal world, she’d get the shot before she eats, so that the blood sugar and the insulin meet at the same time. But this ain’t an ideal world. I never know how much Alex is going to eat. She is the original picky finicky kid. So, I’m a little bit slow on the uptake, because the sugar is already starting to rise, but I’ll snag it back down as soon as possible.
It’s a good insulin plan, but it isn’t an exact science. It’s still (and always will be) a lot of guess work, and a lot of checking her blood sugar to see where we are and how things are affecting her. The Lantus is not supposed to peak, but it does, but it happens to peak right around when she’s eating dinner so it often works to bring her blood sugar down without me giving her a separate shot for it. Sometimes. Her numbers are looking erratic with the change, but that's to be expected until we iron out the wrinkles.
Someone on the children’s forum board that I frequent coined an acronym that is absolutely perfect: YDMV: Your Diabetes May Vary. Everyone is different, and even a day that is the clone of a previous one won’t render cloned results. It’s weird. It’s like the Butterfly Effect as it applies to Diabetes.
This week, we also got Alex’s A1C report back. Without fanfare, it was a 7.4%. Now, granted, not as good as the 6.0% she had the last time, but it’s still a very good number for a child. Alex is definitely moving out of her honeymoon, and this number is evidence of that. But, I like this number. It’s doable. It’s livable. We’ll work to keep it here.
Alex and her brothers are now officially on school holiday, and will be home annoying us until January 8, 2009. Pray for us. Please.
Friday, December 19, 2008
Monday, December 1, 2008
A Type 1 Diabetes Primer
A lot of people have some serious misconceptions about Type 1 Diabetes, so consider this blog posting to be a little primer, intended to educate the general population.
Type 1 Diabetes used to be called juvenile diabetes, primarily because it affects children and young adults, in truth you can still “get” Type 1 Diabetes, even if you’re an adult. There’s no “safe” age. Type 1 Diabetes is not as prevalent as Type 2 Diabetes; if affects only about 10% of all persons who have diabetes. But, it is generally considered, the most serious type of diabetes to have because you will never "outgrow" it or take such good care of yourself that you can consider yourself "cured" (case in point -- Halle Berry -- a lovely woman, but certainly a bit of a misinformed nut job.)
Type 1 Diabetes doesn’t happen because a child is fat or lazy or makes poor lifestyle choices. It doesn't happen because a child eats too much candy or takes in too many sweets. It just happens. In technical/medical terms, it’s called an autoimmune disease. The body basically turns on itself. In this case, the pancreas are attacked and the beta cells that produce insulin are destroyed.
Simply put, without insulin, your body cannot effectively use the carbohydrates that it gets from food – not just sugar, by the way. So, instead of sugar and carbohydrates converting to energy, it stays inside the body and keeps building up and up and up. When the body needs energy (as of course, it always does), it turns to the fat stores already inside the body and uses those up. Before too long, unless the individual had a lot of fat stores, you will see a quick and very obvious weight loss.
Alex, for example, lost about 10 lbs, or about 20% of her body weight. At diagnosis, she weighed slightly less than 40 lbs; the previous year, almost to the day, she had a doctor’s appointment and weighed 44 lbs.
If this were a hundred years ago, Alex would be dead. These pictures are of the same child who was diagnosed with diabetes – before, during and after—sometime in the year 1922, when insulin was first discovered in Canada. What a difference a little insulin makes, eh?
Insulin was not “discovered” until 1922, but it is the only thing that saves her. INSULIN IS NOT A CURE. A cure means that you no longer have the disease. Insulin merely allows her to live, by utilizing the sugar in her body the way that it’s supposed to be used. By definition, cure means to heal, to make well, or to restore to health. Insulin doesn’t heal or make well her pancreas, and she’s certainly only in restored health with a lot of effort. But she’s certainly not “good as new.” No, insulin is not a cure. She will have to take insulin injections every day of her life. Without insulin, her days would be numbered.
Alex’s day consists of a never ending… wait, let me start that over. Alex’s life consists of a never ending series of glucose or sugar readings and insulin injections. And correcting a high with still another insulin injection and treating a low with juice, glucose tabs or candy. Yes, you read that right, candy. Type 1 diabetics can and do eat sweets -- occasionally to treat a low, but just as often, because they like it. The only difference between a Type 1 diabetic and me (a non-diabetic), is that they have to take insulin to "cover" the sugar, whereas my body automatically "covers" my sugar by making insulin in my pancreas. Remember, Type 1 diabetics cannot make insulin themselves.
Here are the most basic of diabetic accoutrements that Alex needs to survive:
Humulin 70/30 premix insulin: Twice daily injections before meals.
Humulin R insulin: Needed to correct a high sugar reading.
Glucose Meter: Readings are taken several times each day, before each meal (3 meals), before each snack (3 snacks) and in the middle of the night (1). That's a minimum of 7 sugar checks, plus additional ones, say if the previous number was too low or too high from the norm.
Glucose Tabs: To counteract a low, with quick results.
Glucose Gel: To counteract a more severe low, say if she is too disoriented to swallow liquids, with quick results.
Log book: Records all of Alex's ups and downs and insulin corrections. It helps to see trends to change the insulin regimen.
Glucagon Emergency Kit: Not pictured, because I don't have it yet. but expect it soon, thanks to a donation from some lovely ladies in the U.S. (Sadly, no, it is NOT available in Ghana.) Glucagon is an essential part of all Type 1 diabetics arsenal -- when a low is so low that a person loses consciousness, you cannot feed them food or drinks (d'oh!), so this injection elevates their blood sugar levels until they regain consciousness and can drink liquids or eat solid foods. Consider it a kind of home-grown I.V.
Because of where we live, a country with only the most basic of medical necessities, Alex is on a very simple insulin regimen. She takes two injections daily of insulin called Humulin 70/30 – a premix of long acting and short acting insulins.
This is not an ideal insulin treatment, because it requires strict regimentation of her meals and snack times. That is often easier said than done. It’s probably just barely manageable for an adult who understands the ramifications of not obeying, but for a kid, well, it’s near impossible. Consequently, we don’t have her diabetes management down as well as I’d like it to be.
When we see Alex’s pediatrician later this month, I’m going to ask about something called the MDI treatment. MDI is an acronym for multiple daily injections, and if she moves to this treatment, Alex will likely get between 3 and 5 injections a day. The goal is to match the insulin to the food, and not the food to the insulin. It may take some adjustment, but for her overall and long term health, I believe it will be a better option.
Sure, she’ll have more shots than she has now, but when you consider the trade-offs of poor diabetes management – blindness, nerve damage, etc. – I think a few seconds more of daily pain is a small price to pay. Alex may not agree with that assessment; she is only 7, after all. Tough love -- and it hurts me, too.
Type 1 Diabetes used to be called juvenile diabetes, primarily because it affects children and young adults, in truth you can still “get” Type 1 Diabetes, even if you’re an adult. There’s no “safe” age. Type 1 Diabetes is not as prevalent as Type 2 Diabetes; if affects only about 10% of all persons who have diabetes. But, it is generally considered, the most serious type of diabetes to have because you will never "outgrow" it or take such good care of yourself that you can consider yourself "cured" (case in point -- Halle Berry -- a lovely woman, but certainly a bit of a misinformed nut job.)
Type 1 Diabetes doesn’t happen because a child is fat or lazy or makes poor lifestyle choices. It doesn't happen because a child eats too much candy or takes in too many sweets. It just happens. In technical/medical terms, it’s called an autoimmune disease. The body basically turns on itself. In this case, the pancreas are attacked and the beta cells that produce insulin are destroyed.
Simply put, without insulin, your body cannot effectively use the carbohydrates that it gets from food – not just sugar, by the way. So, instead of sugar and carbohydrates converting to energy, it stays inside the body and keeps building up and up and up. When the body needs energy (as of course, it always does), it turns to the fat stores already inside the body and uses those up. Before too long, unless the individual had a lot of fat stores, you will see a quick and very obvious weight loss.
Alex, for example, lost about 10 lbs, or about 20% of her body weight. At diagnosis, she weighed slightly less than 40 lbs; the previous year, almost to the day, she had a doctor’s appointment and weighed 44 lbs.
If this were a hundred years ago, Alex would be dead. These pictures are of the same child who was diagnosed with diabetes – before, during and after—sometime in the year 1922, when insulin was first discovered in Canada. What a difference a little insulin makes, eh?
Little boy before diagnosis, circa 1922
At diagnosis, circa 1922
After diagnosis and insulin injections for 1 month, circa 1922
Insulin was not “discovered” until 1922, but it is the only thing that saves her. INSULIN IS NOT A CURE. A cure means that you no longer have the disease. Insulin merely allows her to live, by utilizing the sugar in her body the way that it’s supposed to be used. By definition, cure means to heal, to make well, or to restore to health. Insulin doesn’t heal or make well her pancreas, and she’s certainly only in restored health with a lot of effort. But she’s certainly not “good as new.” No, insulin is not a cure. She will have to take insulin injections every day of her life. Without insulin, her days would be numbered.
Alex’s day consists of a never ending… wait, let me start that over. Alex’s life consists of a never ending series of glucose or sugar readings and insulin injections. And correcting a high with still another insulin injection and treating a low with juice, glucose tabs or candy. Yes, you read that right, candy. Type 1 diabetics can and do eat sweets -- occasionally to treat a low, but just as often, because they like it. The only difference between a Type 1 diabetic and me (a non-diabetic), is that they have to take insulin to "cover" the sugar, whereas my body automatically "covers" my sugar by making insulin in my pancreas. Remember, Type 1 diabetics cannot make insulin themselves.
Here are the most basic of diabetic accoutrements that Alex needs to survive:
Humulin 70/30 premix insulin: Twice daily injections before meals.
Humulin R insulin: Needed to correct a high sugar reading.
Glucose Meter: Readings are taken several times each day, before each meal (3 meals), before each snack (3 snacks) and in the middle of the night (1). That's a minimum of 7 sugar checks, plus additional ones, say if the previous number was too low or too high from the norm.
Glucose Tabs: To counteract a low, with quick results.
Glucose Gel: To counteract a more severe low, say if she is too disoriented to swallow liquids, with quick results.
Log book: Records all of Alex's ups and downs and insulin corrections. It helps to see trends to change the insulin regimen.
Glucagon Emergency Kit: Not pictured, because I don't have it yet. but expect it soon, thanks to a donation from some lovely ladies in the U.S. (Sadly, no, it is NOT available in Ghana.) Glucagon is an essential part of all Type 1 diabetics arsenal -- when a low is so low that a person loses consciousness, you cannot feed them food or drinks (d'oh!), so this injection elevates their blood sugar levels until they regain consciousness and can drink liquids or eat solid foods. Consider it a kind of home-grown I.V.
Because of where we live, a country with only the most basic of medical necessities, Alex is on a very simple insulin regimen. She takes two injections daily of insulin called Humulin 70/30 – a premix of long acting and short acting insulins.
This is not an ideal insulin treatment, because it requires strict regimentation of her meals and snack times. That is often easier said than done. It’s probably just barely manageable for an adult who understands the ramifications of not obeying, but for a kid, well, it’s near impossible. Consequently, we don’t have her diabetes management down as well as I’d like it to be.
When we see Alex’s pediatrician later this month, I’m going to ask about something called the MDI treatment. MDI is an acronym for multiple daily injections, and if she moves to this treatment, Alex will likely get between 3 and 5 injections a day. The goal is to match the insulin to the food, and not the food to the insulin. It may take some adjustment, but for her overall and long term health, I believe it will be a better option.
Sure, she’ll have more shots than she has now, but when you consider the trade-offs of poor diabetes management – blindness, nerve damage, etc. – I think a few seconds more of daily pain is a small price to pay. Alex may not agree with that assessment; she is only 7, after all. Tough love -- and it hurts me, too.
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