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?

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.