Type 1 Diabetes: A Life Changing but Manageable Disease

By Melissa Cross

In January of 2009 I thought I was doing well – in my job, in life and in my health.  I was slim and active and, except for some things that could be attributed to being in my early 50s, I felt good.  I heard about All About Women’s Health Fair at the Nashville Convention Center and thought I’d go to take advantage of the free osteoporosis screening, as my cousin had recently been diagnosed with it.

When I got there, the line for screenings was for all the different tests, so I went ahead and got them all done. My weight: good. My bone density: good. My blood pressure: good. But then there was the Blood Glucose testing. The staff at the Diabetes counter immediately sought me out and sat me down. My blood glucose was 490 (normal is 100). “Well I did just have some gum,” I confessed. “Oh no, gum wouldn’t do that,” explained Katheryn Wolfe, Nurse Practitioner with the Eskind Diabetes Center at Vanderbilt. I made an appointment to come in first thing Monday morning. That was the beginning of a new life for me. And that trip to the All About Women Health Fair saved my life!

I later learned that with a 490 blood glucose level and an A1c level of 14, I was in serious trouble – diagnosed with Type 1 Diabetes. My pancreas was probably not making much insulin and I would immediately have to go on daily insulin, eventually using the insulin pump.

So what Type 1 Diabetes? Formerly known as Juvenile Diabetes, Diabetes Mellitus Type 1, or Type 1 Diabetes or T1D, is actually anyone who is insulin dependent. And yes, you can get it at any age. Mary Tyler Moore, a well-know spokesperson for Type 1 Diabetes was diagnosed when she was 33, at the prime of a very healthy life and the beginning of The Mary Tyler Moore Show.

The causes of Type 1 Diabetes are unknown although theories include: genetics, environmental factors, caused by a virus that attacks the pancreas or chemicals or drugs that destroy pancreatic cells.  There is no way to prevent it and no cure for Type 1 Diabetes – there are only ways to manage it and lead a healthy lifestyle.

  • It is estimated that up to 25 percent of all diabetics are undiagnosed!
  • Approximately 1.25 million American children and adults have type 1 diabetes.
  • Classic symptoms of diabetes (both Type 1 and Type 2) arefrequent urination (polyuria), increased thirst (polydipsial), increased hunger (polyphagia) and weight loss.
  • Complications and Co-Morbid Conditions from diabetes include: Hypoglycemia, Hypertension/High Blood Pressure, Cardiovascular Disease, Heart Attacks, Stroke, Blindness and Eye Problems, Kidney Disease, Amputations.

Type 1 Diabetes:  In type 1 diabetes, the body (pancreas) does not produce the insulin hormone. Because the body needs insulin to get glucose (sugars) from the bloodstream into the cells of the body, to produce energy, type 1 diabetics need to administer insulin through daily injections with an insulin pen, syringe or pump. How much insulin is needed depends on many factors including food intake, nutrition and exercise, all while monitoring blood glucose levels through blood glucose testing. That is done using a simple glucose meter and a lancing device to get a drop of blood onto the test strips.

Type 2 Diabetes: Once called adult-onset or non-insulin-dependent diabetes, Type 2 Diabetes is a chronic condition that affects the way the body metabolizes sugar (glucose). The body either resists the effects of insulin or doesn’t produce enough to maintain a good glucose level. There is no cure for Type 2 Diabetes but there is some promising research and treatments. And Type 2 Diabetes can be managed by eating a healthy diet, exercising, keeping a healthy weight and taking medications that help the body utilize the insulin that the pancreas makes and lower blood sugar.

Bolus insulin: the body normally produces the right amount of “bolus insulin” when you eat, depending on the glucose in that food. Type 1 diabetics need to input that information and give themselves the needed “fast-acting” insulin to work with that food intake. They do that by counting the carbohydrates of a meal or snack and testing their blood glucose at that time – and then injecting the insulin through an insulin pen, syringe or pump. A low-carb diet is recommended – meaning foods that are low in sugars or starch, which converts to sugars. That excludes breads, pasta, potatoes and some of the more sugary fruits. Diabetics can have these things on occasion but must calculate the needed insulin to inject at that time.

Basal insulin: is the “background insulin” that is needed 24 hours a day. An insulin pump is the best way to schedule basal doses.

Counting carbs: once carbohydrates are consumed the body breaks it down into glucose (sugar) which your body then uses for energy. Carbs can be tricky because there are simple carbs (absorbed quickly – they’re the bad ones and lead to quick spikes in blood sugar) and complex carbs (they take longer to digest, give you steady energy and fiber and are better for you). The challenge for those with type 1 diabetes is to choose nutritious options to help control blood sugar levels and to count those carbs correctly to input the needed insulin.  There are several good low-carb diets, such as the Atkins Diet or the South Beach Diet. The trick is to also avoid fats, which many low-carb foods actually have (yes, bacon is low-carb!)

The Glycemic Index ranks foods on how much they raise blood sugar – which makes it easier to tell the difference between the “good carbs” and the “bad carbs”. The smaller the number, the less impact the food will have on your blood sugar. There are many free food, carb and glycemic index apps available including the Atkins Carb Counte, My Fitness Pal and Glycemic Index & Load Diet Aid App.

Hyperglycemia: is high blood glucose and the excessive amounts of sugar in the bloodstream can lead to longterm complications such as heart disease, neuropathy, eye problems (cataracts, glaucoma, retinopathy), foot problems, and poor wound healing. Some symptoms of hyperglycemia and diabetes are: excessive thirst, increased volume of urination, blurred vision, weight loss, poor wound healing and fatigue, among others.

Hypoglycemia: is low blood sugar and needs to be treated immediately. Some signs that I experience are blurred vision, shakiness, sweating and general clumsiness.  For me that’s a glucose level of 80 – 60. When it’s extreme it can result in seizures, loss of consciousness and even death. The immediate treatment for low blood sugar is to ingest simple sugars, glucose tablets, high sugar foods (soda, oranges, candy) or an injection of glucagon. Sometimes you just can’t tell when your blood sugar will drop. I’ve woken up many times in the middle of the night and had to eat some candy. It’s not really the way I want to splurge on sweets.

A1c Test: the A1c blood test is used to diagnose both type 1 and type 2 diabetes and provides an accurate measure of blood sugar management over a 2-3 month period. The test measures what percentage of hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar (glycated). Since red blood cells live for about 3 months, the test shows how much sugar has been in the blood for those 3 months, and allows doctors to see “the big picture” of the patient’s blood. The test does not require a fast before taking. The normal amount for most diabetics is above 6 percent. A result of over 7 percent generally indicates poor diabetes management. People without diabetes are usually at the 5 percent level and those between 5.7 and 6.4 are diagnosed as “pre-diabetic.”

The A1C test may be recommended:

  • Twice a year if you have type 2 diabetes, you don’t use insulin, and your blood sugar level is consistently within your target range
  • Three to four times a year if you have type 1 diabetes
  • Four times a year if you have type 2 diabetes, you use insulin to manage your diabetes, or you have trouble keeping your blood sugar level within your target range

 

The good news is that advances in research look promising for both making it easier to manage and treat Type 1 diabetes as well as the development of drugs that may prevent T1D, preserving beta cell function and prolonging the body’s ability to produce insulin. New automated insulin pumps and glucose monitors are being developed and Google is even designing a contact lens that will test blood sugar in the eye, eliminating the need to prick the skin for blood samples several times a day – something many diabetics hate the most!

In the long run, both Type 1 and Type 2 Diabetes are very manageable – IF you do the work and stay on top of it. Most diabetics that I know actually lead healthier lives than others as they adhere to a low-carb diet and try to exercise often, which helps lower blood sugar levels. I have no idea how I came to have  Type 1 diabetes or how long I had it before being diagnosed. But I thank God that I went to the All About Women Health Fair and quickly got into the fine program at the Eskind Diabetes Center at Vanerdbilt!

Links:

Eskind Diabetes Center at Vanderbilt

American Diabetes Association

JDRF (formerly Juvenile Diabetes Research Foundation)

JDRF of Middle Tennessee has a Walk to Cure Diabetes event every September at the Bicentennial  Capitol Mall Park.