Saturday, May 30, 2015

Diabetes 101

When people ask me about my diabetes (usually while I'm explaining my glucagon kit or awkwardly bolusing in front of them), I struggle with giving a good answer. On the one hand, I don't want to leave them with the impression that it's simply about sugar. On the other hand, I don't want to overwhelm them with a loooooong, drawn out, semi-scientifically accurate response pieced together from my doctor's visits, personal experience, and internet research.

If I had all the time in the world, though, this is what I would say. Who knows what I would say a year from now, 10 years from now, I'll probably still have diabetes then so I'll get a chance to find out I guess.

When people say, Does Type 1 mean you were born with it? I would say this: NO HELL NO!! No one was more surprised than me to discover that, at the ripe old age of 24, I had a disease with "Juvenile" in the name. Type 1 means this: Normally, your pancreas produces cells called beta cells. These cells contain, among other things, a hormone called insulin, which "unlocks a door" aka "signals a receptor" in your cells (which cells? I still don't fully know...) to take in glucose from your blood whenever you eat a meal with carbohydrates in it (the carbs are broken down at varioius rates and then flood your system as glucose). These beta cells also contain (and this is a growing list, I might add), a hormone called amylin, which controls the release of glucose into your body and helps you get that satisfied, "full" feeling after you eat. They also contain something (name??) that helps you absorb potassium, a key vitamin (mineral? nutrient?) that helps keep your heart rythmic and your brain not-swollen, among other things. When you have T1D, it's an autoimmune disease. Meaning that something (gluten before age 3 months? infection? rotten luck??) turns your immune system on and I mean TURNS IT ON. So now it's going crazy, attacking those very same beta cells and killing them just as fast as your panc can produce them. At first, your panc keeps on trying and produces beta cells at a normal rate, which then just keep getting killed off. AKA your "honeymoon period" adjustment into diabetes, where things are a lot more manageable with a lot less insulin. But over time, your pancreas gets tired of this shit and stops producing beta cells at all. So you're totally deficient. Insert something about a c-peptide test here, which I'm not really sure what that is, tbh. So for me, this basically means: something happened. Immune system on, beta cells dead, me in hospital, artificial insulin.

When people ask, So what is insulin? or So you don't eat sugar anymore? I would say, also, NO HELL NO. Sometimes I even wake up in the middle of the night to eat sugar, pure sugar, which is not a habit I was previously into. The way I think of it, is like, it's a BALANCE. So when you have sugar, which, I repeat, is broken-down carbs, any kind of carbs, including super-healthy high fiber/high protein cereal, fruit, nuts, and a lot of other things besides just candy and cake, enter your body, unless I do something about it manually it's just going to float around in my bloodstream and make me feel crappy. So enter the insulin boluses (aka doses) to balance this sugar out. Because your body needs carbs as an energy source, so giving the proper amount of insulin should balance these carbs out and allow them to enter your cells and give you energy. However, talk about easier said than done. There are many many many MANY oh did I mention MANY variables that affect how insulin, carbs and your body interact. Therefore this is less than an exact science, especially when you add in the human labor. So sometimes, due to miscalculating, or unexpected exercise, or illness, or bad luck, or a south-easterly breeze, there's too much insulin running through my system, looking for glucose to suck up. When there's none there, that's where the problems (read: dizziness, anger, general symptoms of starvation, fainting, seizures) start. So that's when I need to chow down on the sugar. And manipulate my basal doses. And make a million other small decisions based on a variety of information in order to save my own life.

What people don't ask (but should) is What does affect your blood sugar levels? My answer would be, virtually everything. Stress, illness, the slowness of injected artificial insulin as compared to the onset of food (meaning that timing is everything). Emotions, exercise, your period, medications, where you place the injection site for your insulin pump, whether or not you have eaten or given insulin recently.

When people say Yikes! That's a lot of shots my answer would be yes, it is. And no, they don't all hurt but a significant portion of them do. And in a non-self-pitying way, I can admit that that's not great. And I can also see that it's a lot less shots than I would have had to deal with 15 years ago, so I try to keep that in mind as I force the CGM dagger sensor in.

And finally, my personal favorite, when people say Wow! I could never... my answer would be, sure beats the alternative. In fact, I've LIVED the alternative, and I can say for certain that life with insulin, and carb counting, and hypoglycemia, and stress, and injection site scars >>>>>> life without insulin. 

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