Anyone living with Type 1 Diabetes knows that it is a huge part of their life. But it is manageable with many supplies such as pumps, CGMs, syringes, meters, testing strips, and most importantly, insulin.
What is Diabetes? Type 1 Diabetes (T1D) is an autoimmune disease that attacks pancreatic beta cells and their production of insulin. The pancreas in a person without Type 1 Diabetes has beta cells that produce a hormone called insulin. When they drink carbohydrates like apple juice, it breaks down into glucose (sugar) in your bloodstream. The beta cells release insulin to the bloodstream where it turns the glucose into energy.
The pancreas is an organ near your stomach that gives off a hormone called insulin. Insulin turns glucose into energy. The pancreas in a person with TID no longer creates insulin. The glucose stays in their bloodstream leaving them very tired. So they must now inject insulin, through a syringe or a pump, into their body.
What is insulin? Insulin is a hormone created by cells the pancreas that turns the food in your stomach into glucose (sugar). Without insulin, blood sugar will spike or get high. Blood sugar is the amount of glucose is in your blood. Insulin allows the glucose in your blood to go into your cells to be used for energy. When the pancreas no longer makes enough insulin, the glucose does not pass into the body’s cells. This causes feelings of exhaustion and sickness.
Blood sugar, also known as blood glucose (BG) is also an important part of your digestive system. There are three different ranges of blood sugar: high BG (also known as hyperglycemia), low BG (sometimes called hypoglycemia), and in range. A person without T1D usually has a BG range between 90 and 120. A person with T1D aims for a BG between 80 and 180.
Living with T1D is a constant reaction to treating either high or low BGs and calculating the amount of insulin need for the amount of carbohydrates they are about to consume.
To do this you must always know what your BG level is. In order to figure this out you need what is called a Blood Glucose monitor. It is an electronic device that can read how much glucose is in your bloodstream with a small sample of your own blood. You use a lancer, or what some T1Ds call a “finger pricker” and lance your fingertip for a small drop of blood. You take that drop of blood and put in on a testing strip that is inserted in the monitor. The monitor then calculates how much glucose is in your blood stream and gives you that number on a screen.
If the blood glucose monitor reads a high blood glucose range you have what is called hyperglycemia. This number is most likely higher than 180. Signs of a high BG is stomach aches, irritable, low energy and illness. To treat a high BG you need insulin. To get the insulin into the body, you use either a syringe or a pump. You must calculate the amount of insulin needed. Each T1 Diabetic will have a different ratio to calculate that they work out with their Endocrinologist (a doctor that specializes in diabetes) When hyperglycemia is not treated, the BG will continue to rise and ketones can develop.
When your cells don’t get the glucose it needs for energy, your body begins to burn fat for energy, which produces ketones. Ketones are acids that build up in the blood and appears in the urine when your body doesn’t have enough insulin. High levels of ketones can poison the body. When levels get too high, you can develop diabetic ketoacidosis (DKA) Treatment for DKA takes place in a hospital.
The scientific term for “low blood glucose” is hypoglycemia. This is when your BG is less than 80. Low BG means that there is not enough carbohydrates (sugars/glucose) in your body to balance the insulin. Signs of low BG is hunger, tired, feeling shaky or weak, and confusion. You must treat a low BG immediately or you can become unconscious, slip into a coma and in some circumstances, die. To treat a low BG, you need to consume 15 to 20 grams of simple carbohydrates like candy or juice. You then must recheck your BG every 15 to 20 minutes until it is back in range. Once your BG returns to normal, you should eat a small snack with protein to keep your BG in range.
Carbohydrates are important part of diabetic treatment. Carbohydrates turn into glucose in the body. Scientifically, carbohydrates (carbs) are a neutral compound of carbon, hydrogen and oxygen (sugars and starches) and is typically broken down to release energy in the body. To find out how many grams of carbohydrates a food has, you can either check the label on the back of a package of food or if you are eating a whole food like an apple, you can look in up through a variety of sources such as books, or the internet. Once you know how many carbs you are about to consume, you can then determine how much insulin you will need to “cover” the carbs. You will work with your Endo to determine the ratio of carb:insulin units you need for your body. So for each meal, you have to sit down and do math.
Treatment of T1D is getting much easier with the use of insulin pumps and continuous glucose monitors (CGM). Pumps are like a syringe. They start with a site that has a small cannula, which is inserted into your body with a fast acting needle. You only need to give yourself this “shot” once every three days. Attached to the cannula is a small tube that is connected to the pump. The pump is an electronic device that hold a vial of insulin. You program your carb:insulin ratios into the pump. When you are ready to eat or have a high BG you input the numbers into the pump and it will do the math and deliver the correct amount of insulin into the body through the site. There is also a tubeless pump, called OmniPod, which fits on your body and injects insulin like the tubed ones. You use a PDM to input all the numbers for insulin. Insulin pumps have dramatically relieved the stress of everyday treatment of T1D. Taking a lot of the stress off of multiple shots and mathematics out of the daily routine.
CGMs are small devices that read your blood like a BG monitor do. They are similar to the pump in the fact that you don't have to prick your finger several times a day. The continuous glucose monitor is just that, it is a monitor that you attach to your body. It has a wire that is inserted into your bloodstream where it reads your blood glucose level every 5 minutes. You start by calibrating it by telling it what your BG monitor reading is. Then you can find out what your BG is during the next 12 hours by pressing a button on the CGM. CGMS are small and fit on your arm and the PDM is the size of a small cell phone.
The diabetic community is working on creating a way to allow the CGM and the pump to communicate to each other. Imagine you have this new device and you want an apple to eat for a snack. You would simply eat the apple and your CGM would tell your pump what your blood glucose is. The pump would inject the correct amount of insulin. You could eat the whole apple without having to remember how many carbs were in that food!
There are many supportive communities surrounding Type 1 Diabetics and their families. There are camps, research programs, and online communities. Diabetes camp is one of the best experiences that a child with diabetes can have. They build safe environments around kids so they can learn to independently manage their diabetes surrounded by other kids who are also living with diabetes and dedicated doctors, nurses and trained counselors who usually also have T1D in an atmosphere of excitement and adventure.
There are several research programs for Type 1 and 2 Diabetes. Some of the larger groups are the American Diabetes Association (ADA) and Juvenile Diabetes Research Foundation (JDRF). ADA is “leading the fight against the deadly consequences of diabetes and fighting for those affected by diabetes.” JDRF is the “only global organization with a strategic plan to progressively remove the impact of T1D from people's lives until it is no longer a threat to anyone.” Both research programs offer free resources and information to support a T1 Diabetics and their families. They also each have fundraisers for scientific research to better treat, prevent, and ultimately cure type 1 diabetes, such as “Walk for a Cure”. The fundraising events are a fun, happy, healthy, and effective way to show your support for all those living with type 1 diabetes and grow your T1D community.
There are also many, many, many online communities that you can join where members support each other during different life stages and experiences with diabetes. Members who have undergone the challenges first hand reach out to newly-diagnosed families, or to families dealing with a new diabetes-related side effect, also be available to lend an ear for important emotional support. These communities help you feel less alone while living with T1D.
The key to living with T1D is finding balance between food, exercise, and insulin. It’s a juggling act to keep BG levels within range. People with T1D serve as an inspiration by facing the disease’s challenges with courage and they don’t let it stand in the way of achieving their goals.
H. Peter Chase M.D.
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