by Alissa Levenberg from Children with Diabetes
(in reverse alphabetical order by last word)
Z #1: Type 1 (aka Juvenile or Insulin Dependent) diabetes is caused by an immune system misfire. The body attacks the cells that make insulin, leaving one 100% dependent on external insulin administration in order to stay alive. A Type 1 diabetic produces no insulin at all; zero, zilch, zippo.
Y #2: The cells that make insulin are called Beta Cells and live in things called “Islets” which are located in the pancreas. Once the immune system has begun the attack on the beta cells, there is absolutely nothing that can stop it. Yet.
X #3: Cutting edge research has allowed scientists to breed mice with fluorescent T-cells (immune system cells). This makes it possible to understand the process of autoimmunity by observing the life cycles and structures of these cells using MRI and X-rays.
W #4: The vast majority of people who have “diabetes” have Type 2, so people tend to think of Type 2 when they think of diabetes. Type 1 diabetes accounts for 5-10% of all cases and is linked to genetics rather than lifestyle. Annually, 70,000 children (almost 200 children a day) develop Type 1 diabetes worldwide.
V #5: The complications from Type 1 and Type 2 diabetes are the same. High blood sugars cause damage to delicate blood vessels and can lead to heart and kidney problems, neuropathy of the hands and feet, or loss of vision.
U #6: The hormone insulin is responsible for bringing glucose (sugar) from the bloodstream to the body’s cells. All cells require glucose for energy, but if there is no insulin present, sugar just builds up in the bloodstream and can’t be used.
T #7: When not enough insulin is present, cells begin to starve and start burning fat in order to survive. This creates a byproduct called “ketones” and causes dehydration, acidic body chemistry, and can quickly lead to coma or death if not aggressively treated.
S #8: Injectable insulin first became available in 1922, allowing people to live many years after diagnosis. It was very slow acting however, so people with Type 1 diabetes had to rigorously control their diets and severely restrict their intake of simple sugars.
R #9: Until recently, the only way to take insulin was via multiple daily injections. New technologies have produced pager sized insulin pumps that are worn externally and deliver insulin through a catheter. Insulin pumps cannot yet “control blood sugar” as many news stories falsely report.
Q #10: All carbohydrates produce a rise in blood sugar, regardless of whether they have actual sugar in them. “Sugar free” items still have carbs. Also, the high fat content of foods like regular ice cream or chocolate will prevent sugars from entering the bloodstream too quickly.
P #11: Many families who live with this disease will report that nothing quite tops having people suggest their kids try some diet, exercise, or herbal supplement “cure diabetes” scheme as their biggest pet peeve.
O #12: Once you inject or infuse insulin with a syringe or pump, there is no way to take it back. That is why there is such a high frequency of hypoglycemia (low blood sugar). With a functioning pancreas, when blood sugar levels start to drop, the insulin gets automatically turned OFF.
N #13: Nocturnal hypoglycemia (night time low blood sugar) is one of the most frightening aspects of Type 1 diabetes. When a person is sleeping, they may not feel lows and it is possible to die in one’s sleep (DIB = Dead In Bed). Many parents of Type 1 children get up and check their sugar several times every night.
M #14: Every time a person with diabetes eats, they must calculate: How many carbs is that? What is my current ratio of insulin to carbohydrates? Do I have any active insulin still in my system? etc… This never ending pre-meal exercise leads to the saying: What do diabetics have as an appetizer? Math.
L #15: It is very important to make sure that children with diabetes get to be “kids first”. People often express worry about these kids having occasional sugary treats but they need to understand that a) sugar is not the biggest challenge when it comes to messing up blood sugars, and b) you have to make sure you don’t let diabetes take over their lives.
K #16: Illness is one of the top challenges when living with diabetes. Blood sugars spike quickly, “ketones” develop, and the body becomes highly insulin resistant. Often it is necessary to get emergency medical treatment to deal with DKA: Diabetic Ketoacidosis.
J #17: Just about everything can affect blood sugar levels. Trying to balance insulin dosing, exercise, food, sickness, hormones, growth spurts, schedule changes, weather changes, stress, pump failures and (seemingly) the current location of Jupiter requires the full time skills of an expert juggler.
I #18: Hypoglycemia is when there is too little sugar (glucose) in the bloodstream. Since the brain needs a constant source of glucose in order to function, the result of a severe low blood sugar is a seizure. Brain damage and death can occur if the low blood sugar is not treated immediately.
H #19: The normal average range for blood sugars in a person without diabetes is 70-120 (or post meals, 140). Having a blood sugar above range is called HYPERglycemia, while having blood sugars below range is called HYPOglycemia.
G #20: The liver stores “backup” glucose in the form of “glycogen”. Between meals and during extended exercise, the liver will release part of this store in order to keep blood sugars from going low. The hormone that triggers this release is called Glucagon.
F #21: People with Type 1 diabetes should always be carrying an Emergency Glucagon Kit to be used in the case of seizure or severe low blood sugar. This shot will trigger the liver to release its store of glycogen. Here (http://www.childrenwithdiabetes.com/d_0n_022.htm ) is where pictures of the kit can be found.
E #22: Continuous Glucose Monitoring Systems are among the most exciting new technologies. In current systems, a tiny wire or probe is inserted under the skin that reads “interstitial” (fluid that is found between the cells) glucose levels. This gets calibrated to actual blood glucose levels. When blood sugars go too low or high, a receiver device will sound an alarm. I have one word for this: Excellent.
D #23: Symptoms of Type 1 diabetes include: frequent urination, excessive thirst, fatigue, rapid weight loss, fruity smelling breath, sweating, blurred vision, nausea or vomiting, and rapid breathing. Tragically, many children die each year from the unrecognized onset of Type 1 diabetes.
C #24: There is nothing a person with Type 1 diabetes can’t do. From Miss America to Mr. Universe, from professional bicycle racers, to Iditarod mushers, to climbers of Mr. Everest, there are examples everywhere of people who rejected “you can’t” and instead figured out what they needed to do to prove that “you can”.
B #25: Insulin pumps greatly facilitate diabetes management. Instead of injecting multiple daily shots, the user can deliver constant micro doses throughout the day. When they eat or need to correct a high blood sugar, their pump calculates the proper dosage. Only about half the total daily dose of insulin covers food. The other half is just for the steady background infusion, called the “Basal”. The one-time doses to cover food or highs are called the “Bolus”.
A #26: There are several groups dedicated to finding the cure for Type 1 diabetes. Among them are: JDRF (Juvenile Diabetes Research Foundation) and the DRI (Diabetes Research Institute). The day our kids can throw away their glucose meters, test strips and lancets, lay down their pumps, glucose tabs, frosting tubes, spare pump supplies and Glucagon kits, and we parents can sleep soundly through the night will be truly Awesome.
