Diabetes

I was diagnosed with Type 1 diabetes in November 1955 at the age of 18 months. At the time it was believed that I was the youngest known diagnosed case of diabetes.[1]   I recently read a story of a young man that was diagnosed at the age of 16 months in the 1980’s.[8]   I am not a doctor nor have I had any medical training. I do not profess to be an expert or have any special knowledge about diabetes. My intent is to share a little of my life's story with you and a few things I have learned along the way.


"My Baby is a Diabetic" is a true story. It was written by my mother about 1957. There have been many advances in medical technology since then. Today I use a glucose meter to check my blood sugar level rather then doing urine tests and I use an insulin pump rather than shots. We also have biosynthesis human insulin (insulin analog), glycosylated hemoglobin (A1C) tests and many more tools that allow for better control of diabetes.



What is diabetes


Diabetes Mellitus is a chronic disorder in which the body uses carbohydrate, protein, and fat abnormally. After time, complications involving both small and large blood vessels and nerves often accompany diabetes. Diagnosis requires a fasting plasma glucose of 126 mgldl or a random blood glucose of 200 mgldl. in a medical facility.[2]


Digestive System

In simpler terms, there is too much sugar (glucose) in the blood stream. The reason that there is too much sugar is because insulin is not doing its job. Insulin is a hormone that tells your body's cells that it is time to eat.


When you eat, the digestive system breaks the food down into a form that can be absorbed into the blood stream. Most of the food you eat gets converted to glucose. Specialized cells in the pancreas, called beta cells, recognize the increase in blood sugar and they release insulin into the blood stream. Cells in the body have specialized insulin receptors on them that snare the insulin. When these receptors on a cell snare the insulin released from the pancreas, the cell sends glucose transporters to the cells' surface to collect the glucose and transports it to the interior of the cell where it is used to produce energy. As the level of glucose in the blood stream drops, the pancreas stops releasing insulin.


For a diabetic this system does not work as nature intended it to. If the body does not produce enough insulin (Type 1 diabetes), then the bodies cells cannot extract the glucose from the blood stream. If the body produces insulin, but the cells ignore it (Type 2), then the cells cannot use the glucose present in the blood stream.[3]





Type 1 diabetes


Type 1 diabetes is an autoimmune disorder that is caused by a person's own immune system destroying the insulin-producing beta cells of the pancreas. Type 1 is lethal unless treatment with insulin via injections replaces the missing hormone. Currently there is no cure for Type 1 diabetes.[4]


Type 1 diabetes is also known as "childhood", "juvenile" or "insulin-dependent" diabetes. It is not exclusively a childhood problem and can occur in adults. Many adults who contract Type 1 diabetes are misdiagnosed with Type 2 due to the misconception of Type 1 diabetes being a childhood disease. Because there is no cure, Type 1 diabetic children will grow up to be Type 1 diabetic adults.


Most people affected by Type 1 diabetes are otherwise healthy and of a healthy weight when onset occurs, but they can lose weight quickly if they are not diagnosed in a relatively short amount of time. Diet and exercise cannot reverse or prevent Type 1 diabetes. Clinical trials are ongoing to find methods of preventing or slowing the development of diabetes but so far none have proven successful.



A few facts about Type 1 diabetes.[5]

  • Abrupt onset, usually before age 30, with symptoms of marked high blood glucose and Ketoacidosis.
  • In most, the immune system destroys the beta cells in the pancreas that manufacture insulin; this is a process and the time required varies.
  • When process is complete, these people depend on insulin treatment for survival.
  • There is a strong genetic predisposition to Type 1.
  • About 10% of known cases of diabetes in the U.S. are Type 1.


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Type 2 diabetes


Glucose Transporters

With Type 2 diabetes, the pancreas still produces at least some insulin. But the cells are ignoring insulin's request for glucose transporters. For a time, the beta cells respond to this cellular insubordination by pumping out more and more insulin. But eventually the beta cells get fed up with the overtime and quit overproducing insulin. Type 2 diabetes is often managed by engaging in exercise and modifying one's diet, but may also be managed by antidiabetic drugs and even insulin injections.[6]



A few facts about Type 2 diabetes.[7]

  • Diagnosis is usually after age 30. It is now more frequent in younger people.
  • Often identified during routine screening without any symptoms of diabetes.
  • 80% are obese when diagnosed.
  • Complications may be present at diagnosis.
  • It is slowly progressive.
  • Not prone to ketoacidosis except with severe physical stress.
  • Treatment needed to control high blood sugar varies over time.
  • May require insulin treatment to control blood sugar.
  • Cause is combination of resistance to insulin action and inadequate insulin supply.
  • Genetic and environmental factors involved. (Abdominal obesity and inactive life style are both important risk factors).
  • Type 2 accounts for about 90% of diabetes in US.


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Gestational Diabetes


Gestational Diabetes is diagnosed during pregnancy. It is like Type 2 in that the body is still producing insulin but the body has become resistant due to hormonal changes. This condition normally clears up after the pregnancy, but is a risk factor for developing Type 2 diabetes later.



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Other forms of diabetes


Other types of diabetes result from specific genetic conditions (such as maturity-onset diabetes of youth), surgery, drugs, malnutrition, infections, and other illnesses. These types of diabetes account for 1-5% of all diagnosed cases. Corticosteroids are a type of drug that can cause diabetes. These drugs can also cause a diabetic even with very good control to experience problems. The best advice for someone with diabetes (Diabetes mellitus) is that if your doctor prescribes a new medication, ask how it will affect your diabetes.






References

  1. ^ Mrs. George B. H." Dear Editor: Letter Box" ADA Forecast  Vol.9 No. 8 Sept-Oct 1956 pp 28
  2. ^ "What is Diabetes?" Saint Joseph's Hospital - Speciality Center for Diabetes Care - class handout  September, 1997
  3. ^ Erika Gebel, PhD, "What is Diabetes?" Diabetes Forcast  April, 2008 pp 49-50
  4. ^ Erika Gebel, PhD, "What is Diabetes?" Diabetes Forcast  April, 2008 pp 49-50
  5. ^ "What is Diabetes?" Saint Joseph's Hospital - Speciality Center for Diabetes Care - class handout  September, 1997
  6. ^ Erika Gebel, PhD, "What is Diabetes?" Diabetes Forcast  April, 2008 pp 49-50
  7. ^ "What is Diabetes?" Saint Joseph's Hospital - Speciality Center for Diabetes Care - class handout  September, 1997
  8. ^ "American Diabetes Association - Life Story " ; AMA Gift of Hope; 2008; pp 23