Type 1 Diabetes “My husband and I live with a pin cushion. She’s our only child and that’s how she feels despite her spunky cartwheel legs and strong monkey bar arms. Her friends see a gymnast, a dancer, a kind person who loves animals and other children. I see that too, but… For four years, people didn’t notice the holes, the places in her tender skin where she’d been repeatedly stabbed three to six times a day. Nor did they hear the screams or witness the kicking of legs in a body too young to understand why her parents were hurting her. Insulin injections were keeping my daughter alive. But, as her mother, how could I better nurse her wounds, the mental ones and the ones left by the needles?” (Canfield, Hansen, Hoogwerf 106). Diabetes is a difficult disease to live with, for a child with diabetes and their parents. Physical, emotional, and psychological tolls exist on a daily basis for those living with diabetes. The rate of newly diagnosed patients has increased exponentially over the years, inexplicably by doctors, yet awareness and education has not. It is crucial that in order to work towards a cure for type 1 diabetes, an awareness of the disease, symptoms, treatment, management, complications, and prevention must first be established. Diabetes exists in two forms—type 1 and type 2. Approximately 95% of people suffering from diabetes have type 2, while only 5% of Americans suffer from type 1. Though type 2, sometimes referred to as adult on-set diabetes, is more prevalent, type 1, otherwise known as “juvenile” diabetes, is often considered the more serious of the two. Type 1 diabetes is most commonly diagnosed in children; however, it is possible to be diagnosed in adulthood. When the body ingests food, the stomach begins to break down its contents into protein, fat, and carbohydrates. It is carbohydrates that further break down into glucose, which the body uses for energy. In a normal, healthy body, the pancreas releases a hormone called insulin, which helps the cells absorb and use the glucose. The insulin acts as a key to the cell, so that when it is released, it opens the cell allowing glucose to be absorbed. However, when insulin is absent, the cell cannot open and absorb the glucose from the bloodstream. A type 1 diabetic’s pancreas does not function properly—it releases little to none of the hormone, insulin, as it should. Therefore, when glucose enters the bloodstream, it is forced to remain there because insulin is not present to open the cell for absorption. It is key to understand that type 1 diabetes is “considered to be an auto-immune disease because the insulin-producing beta cells in the pancreas are attacked and ‘erroneously’ destroyed by the immune system early on in the disease process, resulting in little to no insulin production in the pancreas” (Renosky 1). Thus, a type 1 diabetic requires insulin therapy to maintain normal blood glucose levels. Diabetes is an auto-immune disease that scientists believe has to do with genes. Genes are “like instructions for how the body should look and work…but just getting the genes for diabetes isn’t usually enough. In most cases something else has to happen—like getting a virus infection—for a person to get Type 1 Diabetes” (Type 1 Diabetes 2). In other words, diabetes is not considered to be an infectious disease, and it is not like a cold that can be caught from being in contact with someone who suffers from the disease. Unfortunately, doctors still cannot predict who will develop the disease and who will not. There are many classic symptoms associated with type 1 diabetes that can develop either suddenly or gradually. The most common symptom is frequent urination, followed by increased thirst, weight loss, fatigue, and increased appetite. If anyone experiences these symptoms, especially if there is a family history of diabetes, it is important to seek medical attention immediately. Failure to treat these symptoms could result in other health problems such as “stomach pain, nausea, vomiting, breathing problems, and even loss of consciousness. Doctors call this diabetic ketoacidosis, or DKA” (Type 1 Diabetes 2). Currently, there is no cure for type 1 diabetes; however, there are some treatments being explored. The three main treatments being explored are Pancreas transplants, Islet cell transplantation, and Stem cell transplants. Pancreas transplants are quite rare because of the risks associated with them. Upon transplantation, one would need a “lifetime of potent immune-suppressing drugs to prevent organ rejection” (Mayo Clinic 4). In addition to these immune-suppressing drugs, a “high risk of infection and organ injury” exists among those receiving a transplant. Islet cell transplantation “provides new insulin-producing cells from a donor pancreas” (Mayo Clinic 4). Similar to a pancreas transplant, islet cell transplantation requires the use of immune-suppressing drugs, which carry the same risks. The risk of the immune system destroying the transplanted cells is also a risk. Finally, stem cell transplant is another treatment being explored. Stem cell transplantation involves “shutting down the immune system and then building it up again—[which] can be risky” (Mayo Clinic4). All three of these treatments are promising, yet scientists are still working toward finding a more successful and permanent treatment for diabetes. While there is no cure for diabetes, it is important to follow a strict diabetes management plan in order to live a healthy life. Regular blood glucose monitoring and insulin therapy are two important forms of proper diabetes management. Fortunately, technology advancement over time has allowed blood glucose monitoring to very simple. Upon diagnosis, patients receive a blood glucose meter to carry with them at all times for blood glucose testing. This meter allows a diabetic to monitor their blood glucose, or “blood sugar” level, at liberty in order to maintain better diabetes control. A meter only requires a small drop of blood, and readings are available in approximately five seconds. It is important to keep blood sugar levels between 80 and 120 as much as possible. If steady glucose levels are not maintained or diabetes management is neglected over time, serious complications can result such as “seizures, blindness, kidney failure, heart attack, amputations and strokes...” (Juvenile Diabetes 11). Insulin therapy is another key to healthy diabetes management. Regular insulin doses help control blood glucose levels following meals and overnight. There are two main types of insulin: short-acting and long-acting. Short-acting insulin is administered during the day or following meals. It is called short-acting because of the small amount of time needed for the insulin to take effect. This is especially important following meals because, as the body absorbs the glucose from food, blood glucose levels rise quickly. Short-acting insulin combats the swift rise in glucose levels and helps maintain a steady blood glucose reading. The second type of insulin is long-acting insulin. This is administered before going to sleep at night because the insulin slowly acts upon glucose levels. Instead of immediately having an effect on blood glucose levels, the long-acting insulin slowly applies itself keeping glucose levels steady throughout the night. The amount or type of insulin that a diabetic receives varies from person to person—no one person is the same. As a diabetic becomes adjusted to their body and the disease, they will begin to assess their body's need for insulin. Some will require more insulin than others, and this generally happens over time. As a diabetic patient continues to live with the disease, their body will become more and more dependent on synthetic, or manufactured, insulin rather than its own. In addition to blood glucose monitoring and insulin therapy, a healthy diet and active lifestyle are key to proper diabetes management. Living with diabetes can mean making a significant dietary adjustment for a newly diagnosed patient. While fats, proteins, and carbohydrates may have never been considered prior to diagnosis, a type 1 diabetic's diet revolves around them. Careful planning and measuring of food intake to insulin ratio is strenuous and time-consuming, yet essential. It is important for the body to receive all of its essential nutrients while maintaining proper blood glucose levels. This requires careful calculation of carbohydrate, or carb, to insulin ratio. Each diabetic has a standard ratio of insulin per one carb. Fifteen grams of carb is, for general purposes, considered one carb. Based on how many grams of carb are in a meal, the ratio of insulin can then be calculated. It is difficult to imagine doing calculations like this for every meal, but that is the reality of living with diabetes. The final element of proper diabetes management is maintaining an active way of life. A healthy lifestyle allows a person with diabetes to maintain better control over their diabetes. Being active helps lower blood sugar because “muscle contraction, increased blood flow and increased body temperature cause the body to be more responsive or ‘sensitive’ to insulin during and soon after exercise. In addition, when muscles contract, they can take up glucose from the bloodstream independently of insulin” (Australia 1). Since muscle contraction can take up glucose from the bloodstream without insulin during exercise, being active is particularly encouraged when blood glucose levels are elevated. This will help bring high glucose levels down to a more normal reading quickly. Thus, a well-balanced diet and active lifestyle are imperative to proper diabetes management. Serious complications can evolve from poor management of diabetes. Seizures, diabetic coma, ketoacidosis (ketones present in the blood stream cause the kidneys to shut down), loss of vision, depression, amputation, and premature death are all complications of diabetes. Lauren Stanford, at 13, felt the frustrations of living with diabetes: “I wanted so bad to be like my other teenage friends who were free to worry about nothing more than boys and movies and fun,” she says (Juvenile Diabetes 66). Lauren, like many teenagers, began to neglect her diabetes in order to feel “free” like other children her age. Not only did she neglect to monitor her blood glucose levels, but she began skipping insulin doses as well. Lauren went on to say that, “On October 30th I collapsed and was rushed to Children’s Hospital in Boston where I was put in the ICU. I could have died. Diabetes almost got me” (Juvenile Diabetes 66). Ignorance and neglect of diabetes management can carry serious health risks as seen in Lauren’s story. It is important to realize that diabetes is not a disease that will go away if ignored. Rather, serious complications can evolve from neglect. Therefore, it is very important to handle Diabetes in a serious and responsible manner. Type 1 diabetes is a serious disease that carries serious consequences and health risks from poor management. Therefore, the bruises, holes, and tender skin from finger pricks and injections are a necessary part of life for one living with diabetes. Many parents suffer from the guilt of hurting their child with daily sticks, but this is what keeps a child with diabetes alive. Regular glucose monitoring, insulin therapy, a healthy diet, and active lifestyle are the most important steps in proper diabetes care. Many children and adults suffer from type 1 diabetes, but with the advancements of technology, those suffering from diabetes are able to live a healthy and happy lifestyle until a cure is found.
