“Worldwide, it afflicts 180 million people. And the World Health Organization estimates that by 2030, that number of people living with diabetes will more than double.”(-Diabetes Research.org) Carbohydrates are used as “energy” for the cells. Imagine a door with multiple locks. The door can not be opened without a key. That key, is the insulin. Without insulin being produced from the beta cells of the pancreas, there is no way for the carbs to be used as energy. The difference between type 1 and type 2 diabetes is that for those with type 2, the beta cells still produce insulin but that body is uncertain of what to do with the insulin. For people with type 1 diabetes (previously known as juvenile diabetes), the beta cells of the pancreas stop creating insulin altogether. When the body functions properly, Blood Glucose or BG levels remain between 70-126mg/dL. Also, people without diabetes have an HbA1c result 5.6% or less which is a 3 month average BG of about 126.
Initial signs and symptoms include excessive urination, thirst and hunger. No matter how much the individual eats, their body can not use the food as energy; since the carbohydrates the patient is eating can not be taken into the cells and used as energy, the sugar hangs out in the blood stream which causes high blood glucose levels.The patient begins to lose weight and the body begins burning stored fat as energy to maintain viability. This results in ketones. Ketones are the product the body spills from the burning of fat cells. Ketones are damaging to the kidneys first and foremost. This process of spilling ketones eventually causes vomiting and severe dehydration leading to Diabetic Ketoacidosis. The onset of T1D is generally rapid once the trigger for the gene has occurred. Much research is still taking place on recognizing what certain “triggers” may be. Some doctors and scientists believe it to be related directly to the immune system and then group T1D as an autoimmune disease. The body attacks and destroys the beta cells in the pancreas which then prevents them from creating insulin again.Once T1D is diagnosed an insulin regimen is started. The body begins to regulate and return to a healthy, safe state. Sometimes, patients bodies are still able to produce a little amount of insulin during the first few months to first year after diagnosis. This is known as the honeymoon phase. It is unpredictable and confusing. It is also generally not enough insulin to cover all of the patients needs-so they must continue with the insulin regimen to stay healthy.
There are two options for insulin delivery. Multiple Daily Injections (MDI) or Continuous Subcutaneous Infusion of Insulin (CSII) or “Pumping”. Basal insulin is the base amount of insulin needed even when sleeping and not eating. The body needs this base amount of insulin to maintain homeostasis.The basal type of insulin, also called Long Acting, is taken 1 to 2 times a day as prescribed by an endocrinologist. Throughout the rest of the day during meals or if the blood glucose level is above target range, a dose of bolus insulin is given. This kind of insulin is known as Rapid Acting insulin.In CSII, an insulin pump is worn 24 hours a day. It uses an infusion set that sits 6-9mm below the skin and insulin doses are given by dialing in the amount of insulin needed on the pump face. The pump infusion set and site must be changed every 3 days according to the FDA. If rotation is not done properly, scar tissue and absorption issues will form at the site which then results in above target BG levels and unpredictable control.Insulin adjustments are made according to a pattern management approach through Certified Diabetes Educators and endocrinologists. It is important to write down or log all BG data along with insulin dose and carb intake for the patient to be aware of patterns and know when to call their medical provider.
MANY things can effect BG control of someone living with type 1 diabetes. Living with type 1 is truly a balancing act at it’s finest. Most people living with well controlled T1D check their BG levels between 4-8 times per day. Some check more often if they are exercising more, changing insulin doses or are feeling ill.Timing of medication is very important. If the patient takes a dose even 20 minutes late, it may effect the next 6-12 hours negatively and cause above target BG levels. Also, if insulin is taken too soon before a meal, then this may result in a below target BG level.Nutrition is an important part of control. However, there is a misconception that people living with diabetes must eat “diabetic diets” and cannot have sugar/sweets. Just like everything else that a patient living with type 1 eats, as long as they can carb count it, they can eat it. However, just like everyone else in the world, a well balanced diet allows the body to function at it’s optimal level. Also, it is much more difficult to accurately carb count homemade foods like casseroles and pies. It doesn’t mean that someone with type 1 can’t occasionally eat these things and be healthy-they just must be prepared and willing to work at it to figure out certain meals or desserts carb counts.Illness and stress cause above target BG through release of certain hormones and potentially inflammation. Another hormone that causes change in BG levels is growth hormone. It is especially evident in young children and adolescents. Generally, it causes an above target BG level in the early morning hours-but it is not easily predictable.Exercise and activity generally cause below target BG levels as it helps burn energy/calories. Also, exercise and activity can help insulin work better and more efficiently by improving circulation and physical fitness.
All of these complications are more likely in people living with uncontrolled type 1 diabetes. Many studies show that patients who keep their BG in target most of the time and work to maintain an acceptable A1C range will live a healthy life. However, living with diabetes is NOT easy. It sometimes feels like it’s a 1 million pieces of a puzzle that must be put together over and over again. But with hard work and determination, control may be achieved and the likelihood of these complications decreases tremendously!
What is Diabetes? 180 million people world wide • Carbohydrates are the energy • Insulin is the “key” ~90% diagnosed with Type 2 Diabetes (T2D) • T2D-Insulin use issues-Genetic and lifestyle ~10% diagnosed with Type 1 Diabetes (T1D) • T1D-No insulin produced-Genetic and needs trigger
Signs and Symptoms of T1D“3 P”s • Polyuria • Polydipsia • Polyphagia Weight Loss Ketones
Insulin DeliveryMultiple Daily Injections (MDI) Continuous Subcutaneous Infusion of Insulin (CSII)MDI or “shots” of insulin given to CSII or “pumping” of insulincover basal needs of insulin and covers basal needs and bolus dosesbolus doses of insulin of insulin via a pump siteGenerally 4-6 subcutaneous shots Pump site must be changed andper day every 3 daysRotation of injection location is Site rotation is importantimportant