Our goal here is to answer some of the initial questions many people ask. For those on Team Shelby who are soliciting new supporters, this can offer some good information to share with people who have wildly wrong or outdated conceptions of diabetes. For others, it's a good place to check back on every so often to be reminded of those things you already know but might have just forgotten.
Most of all, this is not meant to be medical advice. This is just what we've learned and how we understand this disease that our daughter lives with every day. If you or someone you know has diabetes or is showing any symptoms, seek medical advice immediately about your specific condition.
1. What is diabetes
2. Why the two types of diabetes?
3. Can you outgrow juvenile diabetes?
4. Can Shelby eat sweets?
5. Insulin is cure for Type I diabetes, right?
6. Why does Shelby prick her finger?
7. What are hypo- and hyperglycemia?
8. What does an insulin pump do?
9. An insulin pump is basically an artificial
pancreas, then?
10. What's the cure?
What is diabetes?
Diabetes is a malfunction of the body's insulin response system. The pancreas creates a hormone called insulin to assist the cells of the body to take in glucose, or simple sugar contained in everything we eat. Glucose is used to fuel the cells and allow them to carry out their work, from fighting disease to regular growth and development to supporting normal brain function. But cells can't take up the glucose they need without insulin, which acts as a gatekeeper allowing the glucose to enter the cells. For a variety of reasons, some people don't produce enough insulin or require more than their pancreas can produce. When there is a shortage of insulin, the glucose builds up in the bloodstream, creating a condition we often call high blood sugar. The short-circuiting of the insulin response is called diabetes.
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Why the two types of diabetes?
We hear a lot today about the exponential growth of diabetes cases in America. It's linked to soft drinks at school, people whom never exercise and those who just plain eat too much. Experts are regularly on the news talking about how America's obesity epidemic is causing the rising in diabetes cases. What they are talking about is known as Type II diabetes. It is the form of diabetes that the American Diabetes Association focuses on. It is usually found in older people, those who have unhealthy lifestyles or those whose pancreas is still making insulin but it's just not enough.
Type I diabetes, also called juvenile diabetes, is much different. While the symptoms and many of the treatments are similar to those for Type II, someone with Type I diabetes has a pancreas that produces no insulin. For reasons that are still the subject of robust research, the white blood cells attack and kill the islets in the pancreas that make insulin. We posted a research development on that in July.
The differentiation is necessary because the treatments used for each kind is much different. In those with Type II diabetes, lifestyle changes are often the first line of treatment. If doctors can get that person's lifestyle to match his or her body, with some minor medical interventions, the symptoms often subside or disappear. However, those with Type I diabetes need an exterior source of insulin to maintain proper bodily functions. That difference provides a host of lifelong challenges for the person with Type I.
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Can you outgrow juvenile diabetes?
The name seems to suggest that this is a temporary or childhood condition that will go away as the body matures. But that is not the case. The term "juvenile" in this case refers to when the disease is most often first discovered. The vast majority of those with Type I develop it before they are teens. Shelby was diagnosed just before her third birthday. We've heard of some case where infants as young as 6 months have been diagnosed.
Type I diabetes is a lifelong condition.
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Can Shelby eat sweets?
Absolutely! In fact, she loves ice cream, cake and just about every type of chocolate.
The key is keeping track of how much she eats and giving enough insulin to allow her body to absorb it without triggering high blood sugar. We do some things that are easy and just make sense to us. For example, she drinks diet soda instead of the sugary kind to save having to deal with the 41 grams of carbohydrate in one can of regular soda. Heck, that's equal to almost 3 cups of fresh watermelon, which is a whole lot of watermelon.
Before there were advanced types of injectable insulin that reacted quickly and blood glucose monitoring was streamlined, adjusting insulin levels to match the high carbohydrate content of most sweets was very hard. Sugar-free everything was the order of the day. For some with Type II diabetes that's still the case, mostly because they are trying to control their disease with diet. For a child with Type I diabetes, our treatment team advocates counting the carbohydrates in what Shelby eats, then compensating with the appropriate amount of insulin.
Shelby absolutely eats everything any other child does.
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Insulin is cure for Type I diabetes, right?
In a word, no. Insulin is a natural hormone everyone needs to metabolize nutrients properly. Insulin shots are a crude substitute for what the body usually does on an on-going basis.
Why does Shelby prick her finger?
At least 8 times a day, Shelby pricks her finger to get a small amount of blood that is used in her glucose monitor to measure her blood sugar, or blood glucose, levels. The monitor we use requires only a small drop of blood and takes 5 seconds to give a reading.
We use that reading to calculate how much she may need to eat or drink and how much insulin to give her to keep her readings in the normal range, between 70 and 120.
While the prick is not a walk in the park, it isn't incredibly painful. Shelby usually sleeps through the tests we have to do at 11 p.m. and 3 a.m.
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What are hypo- and hyperglycemia?
Those are the fancy medical terms for what we call "low" and "high" blood sugar.
The normal blood glucose reading is between 70 and 120. Any number below 70 is called hypoglycemia or low blood sugar. When this happens, Shelby's skin tends to get clammy and pale, her speech becomes slurred and unfocused, her hands might start shaking, or she may become irrationally emotional. Have you ever been in the middle of a major project and worked through lunch? Pretty soon you feel kind of rundown, confused and perhaps nauseous? That's hypoglycemia. If left untreated, someone with diabetes can go unconscious.
On the other end of the range is hyperglycemia or high blood sugar. Readings over 120 indicate that the body isn't absorbing nutrients properly. The immediate indicators of this condition are sometimes hyperactivity, uncontrollable thirst and urination, and nausea. While someone with diabetes rarely blacks out from hyperglycemia, if this condition is not controlled it can produce irreversible, long-term complications, such as kidney failure, blindness and circulatory problems.
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What does an insulin pump do?
An insulin pump in a device about the size of a pager that is worn under clothes that houses a supply of fast-acting insulin. A small catheter connects the computerized device to the patient. The pump can be programmed to deliver a steady flow of insulin constantly and enables a quick and painless way to deliver an additional dose, called a bolus, after meals or when the blood sugar is running high.
Using a pump eliminates the need to give numerous shots to deliver required insulin. The location where the catheter is inserted is changed once every three days, far better than having to take up to 10 shots a day. The pump also reduces the amount of gear someone with Type I diabetes has to carry around and eliminates the safety problems loose syringes can cause on school campuses.
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An insulin pump is basically an artificial pancreas, then?
The pump we recently got for Shelby is state of the art. It can be programmed in dozens of ways. But we still have to tell it what her blood sugar readings are and we still have to input how many carbohydrates she has eaten. While it's an major advance, it is not an independent artificial pancreas.
We've definitely come to respect the work the pancreas does. This one little organ, in conjunction with others inside all of us, measures how much carbohydrate we've eaten, how much activity we're engaged in and sends out the right amount of insulin to keep everything running smoothly. It is so efficient the most of us play sports, work in the yard, stroll to the store, gobble up pizza, slurp Starbuck's drinks and grab a quick bowl of ice cream as a treat without giving it a second thought. While someone with diabetes can do all those things, he or she has to think about each and every step of it and prepare accordingly.
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What's the cure?
There isn't one, yet.
Isn't that frustrating? You are faced with watching your 3-year-old having to deal with this disease, which could end her life prematurely or change her lifestyle in a million unimaginable ways, and there is no way to fix it.
That's what we wanted to do – just fix it. Give the magic pill. Make it go away. But we couldn't. The awful truth is there is no cure for Type I diabetes. In 1970, parents of children with juvenile diabetes felt just as frustrated and couldn't sit still and do nothing. So they formed the Juvenile Diabetes Research Foundation on the basic idea that Type I diabetes was a solvable puzzle if modern medical researchers had the tools and time to find that solution.
Since its inception, the JDRF has become the largest non-governmental funder of research into the causes and cures of Type I diabetes. The foundation has awarded more than $800 million to diabetes research, including more than $80 million in fiscal year 2003. That year alone, the foundation funded 500 research centers, grants and fellowships in 19 countries, according to its Web site. Results are coming in everyday from faster acting types of insulin to advanced insulin pumps to research into insulin islet transplants to isolating the genes that cause all of this in the first place.
We believe there will be a cure in Shelby's lifetime. We are determined to do everything we can to help. That's why we support the JDRF and ask our friends and family members to do the same. Finding a cure is the sole reason there is a Team Shelby.
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