Welcome to Living Leashless! Some of you here may be diabetic pros of 50 years, but some of you may only know diabetes because your aunt gertrude’s cat has it, or thanks to our spokesman and his glorious mustache:
If you were born after the year 2000 or don’t know this inspirational man, check out this video here.
Because a good portion of this blog discusses diabetes and traveling with this condition, it is helpful to have a good understanding of what it is different ways that it can be managed. This post hopefully will answer any questions you have about type 1 diabetes, or give you a refresher if you’re already familiar. Strap in and hold on, It’s about to get sciency. (picture of bill nye)
So what is the deal with Diabeetus anyway?
To start off, there are two different types of diabetes with very original names, type 1, and type 2. (Doctors may be very smart, but sometimes not the most creative).
Type 1 diabetes is a genetic disorder in which the body’s immune system attacks part of its own pancreas. Scientists are unsure as to why this happens, and have been unable to identify any environmental factors that cause this. This means that type 1 diabetics do not develop it from eating too many pieces of cake, drinking too much soda, or from laziness, only from a bad luck of the draw.
The rogue immune cells specifically target the islet cells of the pancreas, which are responsible for creating a life sustaining hormone called insulin. When we eat food that contains carbohydrates, it is broken down into glucose (a.k.a. sugar) that is absorbed into the blood stream, where the glucose is then transported throughout the body. The job of insulin is to act like a key that opens the doors of our cells, and allows glucose to move from the blood stream and into the cells where they are used as fuel. Glucose is a necessity for the body to function, and without it, everything would eventually shut down.
Without insulin, too much glucose stays in the blood stream, causing excessive sweat and crankiness, and potential long term complications. Too much insulin, and there is not enough glucose in the blood stream, causing extreme hunger, confusion, and also crankiness. So if you meet a type 1 diabetic, give them a hug, chances are they could use it because they might be a little cranky.
So let’s recap:
Basically, type 1 diabetes is a very thin balancing act.
My double agent immune system attacked my body, leaving me with the inability to regulate the amount of glucose in my blood stream. If you can’t trust your own immune system, WHAT CAN YOU TRUST IN THIS WORLD???? 11p15.5 (aka insulin), that’s what you can trust.
While there currently is no cure, science is rapidly approaching the day where type 1 diabetes will be curable or possibly no longer exist. But until that day comes, diabetes can be controlled very well with insulin that is injected into the body. Let’s break down the different forms of management, and discuss the technology available to help diabetics live long, healthy lives, and yes, even eat a piece of birthday cake if they want.
I like to think of diabetes management as a triangle, with the three points being carbohydrate counting at every meal, delivering insulin, and blood glucose testing. (make some sort of triangle that illustrates this). Without doing all three of these things every day, it is hard to control the blood glucose and long term complications become more of a risk.
They may not admit it, but every diabetic is secretly a math whiz that can whip up calculations in their head while maintaining a conversation at the same time. Most diabetics could probably give Steven Hawking a run for his money in a mental derivative solving competition. I’m not one of those diabetics, my math career peaked at multiplication and division, but these are things that diabetics do every time food passes their lips. As we discussed above, certain food contains carbohydrates, which break down into glucose during digestion, which then raises the blood glucose. This is where insulin comes into play. A certain amount is injected into the body that transfers glucose into the cells, giving them vital energy needed to sustain life, and reducing the amount of glucose in the blood stream. If not enough insulin is given, too much glucose stays in the blood stream which can cause bad long term effects, but if too much insulin is given, there will not be enough glucose in the blood which can lead to passing out, and in severe cases death. Obviously it is very important to know how much insulin to administer, but how can you know how much to give with such a delicate balance? Guess and hope for the best, that’s how. Just kidding! It all goes back to counting carbohydrates, in order to know how much insulin to give, you must first know the amount of carbs being eaten. Carbs are measured in grams, and can be found on any nutrition label (show picture of a nutrition label with an arrow to carbohydrates). Most foods other than meat, cheese, most vegetables, nuts, and oils contain carbohydrates. In order to safely give the right amount of insulin, diabetics must know which foods contain carbs, and how many grams they are eating. This may seem like a daunting amount of knowledge to know in order to stay healthy, and it does take up a lot of brain space. But through much experience, a lot of trial and error, this becomes second nature and a diabetic can no longer look at a doughnut without automatically calculating how many carbs it has. When a diabetic sits down to eat, they are not only looking at a plate of delicious food, but also a plate of numbers and math problems.
This is how a normal person sees a plate of food and this is how a diabetic sees a plate (picture)
Once the grams of carbs are known, the amount of insulin is calculated using a carb to insulin ratio. This is different for every person, but my particular ratio is 8:1. This means that for every 8 grams of carbohydrates that I eat, I give myself 1 unit of insulin. If I eat 16 grams of carbs, I give myself 2 units. Pretty simple! Every time a diabetic sits down to eat, their stomach may be rumbling, but their mind is also churning.
Diabetes is a very counter intuitive kind of disease, you have to give yourself drugs to prevent being high, a stoner’s worst nightmare. The drug being insulin and the high being blood glucose. Trypanophobia is a crushing fear of needles. While there are different forms of management that involve less needles and sharp things, I can imagine it would be pretty difficult to have this phobia and live a happy life with diabetes. Every type of management of every day involves needles of some sort. Luckily we live in the era of technology, and advancements have been made so that a pancreas can be worn in a pocket, and the amount of times a diabetic has to stick themselves has been greatly reduced.
There are three major ways that insulin can be delivered. The first is the most basic and is the use of pens. Not the kind of pens that are filled with ink, but instead filled with insulin! (picture of a pen) One end has a dial that turns to select the amount of insulin desired (measure in units), (show a picture of the dial turning) and the other end has a needle that is injected into the skin. The dial gets pushed in, the insulin travels through the needle under the skin, and is delivered to start doing its thing! Every time carbs are eaten, this process has to be repeated.
The second type of management is called a pump, and looks like a pager attached to a string. Instead of sticking with needles to inject insulin multiple times a day, a small plastic needle, called a cannula, is inserted under the skin and stays there for 2-3 days using a sticky adhesive. This is commonly referred to as a “site”. After the 2-3 day period, it is removed and placed on another area of the body. Good site placements are anywhere that a small portion of skin can be pinched up including the stomach, butt, thighs, back of the arm, lower back, and forehead (just kidding, that would be a little painful).The pump is an electrical device that holds up to 200 units, and “pumps” (hence its name, The Pump, yet another super creative name) insulin through plastic tubing and into the cannula, requiring only the press of a button to deliver insulin. It is typically worn in a pocket or clipped to a waist band, or depending on who you are, sometimes a bra. The tubing can be disconnected from the site, and must be disconnected when swimming or showering because the pump is not waterproof. It can also be inconvenient when exercising because running with a small plastic brick in your pocket can be uncomfortable. It is also difficult when changing clothes because there is no where on my naked body I would comfortably clip the pump without my voice shooting up a few octaves.(Every day I’m pumping picture) The pump calculates exactly how much insulin is needed, so the only thing the pump user has to do is enter the amount of carbohydrates being eaten. The pump pretty much does all the hard work, which is great because carrying on a conversation over a meal while doing mental gymnastics can be difficult. Especially for an awful multi tasker such as myself. Without the pump, I end up ignoring everything around me and staring at my plate until I figure out my medical math problem. The pump not only helps keep my physical life alive, but also my social life.
The final form of management is the Omnipod, or pod for short (another top notch creative name). Like the pump, a cannula is inserted under the skin using a sticky adhesive. They are very similar because they use electrical devices to store and deliver insulin. However, they are very different because the electrical part of the pod that holds and delivers the insulin is connected to the site on the skin, rather than connected with tubing like the pump. A pod can hold up to 200 units, uses no wires, and stays on the skin for 2-3 days before a new one is placed on a different spot. It connects via Bluetooth technology to a remote controller called a personal diabetes manager, or PDM. (show picture of PDM) The PDM is how the user tells the pod how many carbs are being eaten and how much insulin to deliver. This is the closest thing that technology has come to making an actual pancreas because insulin is being delivered 24/7 until the pod is changed. Because it is connected directly to the skin and is waterproof, it is ideal for activity, convenient when showering and swimming, and not a problem when being spontaneously pushed into a pool (all you have to worry about is your phone).
I have years of experience in all three types of management, you can read about my personal pros and cons of each HERE!
The third and final component to having THE BEETUS is blood glucose testing. As we’ve discussed above, if the glucose is either too high or too low, something has to be done about it whether that is taking more insulin to lower it or eating more carbohydrates to raise it. To measure this, a tiny speck of blood has to be drawn, usually from the fingertips, and placed in a blood glucose monitor. Blood is drawn by a very tiny, very fast needle pricking into the skin using what is called a lancet. It’s so fast, and so tiny in fact, that it can barely even be felt.( show pictures of all of this). The minimum times for testing are waking up in the morning, before every meal, 1-2 hours after a meal, and before going to sleep. Other scenarios that require more testing include before and after exercise, illness, stress, or any time persons with diabetes feel a little weird. This can add up to a lot of finger sticks in a day, leaving the tips of fingers looking like swiss cheese (close up of finger tips). Just like with the insulin delivery, technology has improved this system dramatically, and developed devices to greatly reduce the amount of finger sticks to only 2 per day. This is possible through a device called a continuous glucose monitor, or CGM, which is very similar to a pod site. It has a sticky adhesive with a small wire that attaches underneath the skin, and is constantly reading the amount of glucose in the skin. Because it is not blood glucose, it’s not 100% accurate, but is close and gives a good general idea. It transmits to a sensor so the user can see what their glucose is at all times without ever having to prick their finger. And it looks like an old school mp3 player so you can look really cool and ironic around your friends.
So there you have it folks, a basic run down of how a diabetic keeps on living. I hope this answered any questions you may have, but if not, leave a comment down below or shoot me an email at firstname.lastname@example.org and I’ll be happy to answer anything!