Diabetes Awareness Month

November is American Diabetes Month®.  The American Diabetes Association notes that 1 in 11 people have Type 2 Diabetes – 1.4 million people in the United States are diagnosed with diabetes annually.  In 2012, 29.1 million Americans had diabetes.  While more attention is focused on Type 2 Diabetes, the numbers are staggering, today’s focus will be on Type 1 – of the 29.1 million Americans, 1.25 million American children and adults had Type 1.  So what is Type 1 (insulin-dependent or juvenile) Diabetes?  Type 1 Diabetes can occur at any age, but most commonly is diagnosed from infancy to the late 30s.  In this type of diabetes, a person’s pancreas produces little or no insulin. 

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The causes are not entirely known, but scientists believe the body’s own defense system (the immune system) attacks and destroys the insulin-producing cells in the pancreas.

The causes are not entirely known, but scientists believe the body’s own defense system (the immune system) attacks and destroys the insulin-producing cells in the pancreas.  People with type 1 diabetes must inject several times every day or continuously infuse with insulin through a pump. 

Symptoms – may occur suddenly, however, the process may have been going on for some years:

·         Extreme thirst

·         Frequent urination

·         Drowsiness, lethargy

·         Sugar in urine

·         Sudden vision changes

·         Increased appetite

·         Fruity, sweet, or wine-like odor on breath

·         Heavy, labored breathing

·         Stupor, unconsciousness

If you think that you or someone that you know has these symptoms, call a doctor immediately.  Drink fluids WITHOUT SUGAR, if able to swallow, to prevent dehydration.  (If there is not enough insulin to get glucose into the cells to use for energy, the body turns to an alternative source of energy, and burns fat.  Ketones are a waste product of the body using fat for energy and if ketone levels get high, this can lead to a serious medical situation call diabetic ketoacidosis (DKA).

There are an estimated 29 million Americans with diabetes; about 1.25 million have Type 1.  This smaller proportion of people with type 1 might be part of the reason that the condition is so misunderstood.

Here are a few common tales that will set the record straight and help gain a better understanding of Type 1 Diabetes:

Tale:  You must have OD’d on sugar to get type 1 diabetes.

Fact:  No one knows the exact cause of type 1 diabetes.  Researchers are still trying to get a clear picture about genetic and environmental factors that might play a role.  The one thing we DO know is that it’s NOT brought on by too much sugar.  Oh, and they CAN have desserts (more on that later).

Tale:  Could it come from getting a vaccine as a kid?

Fact:  Scientists have NOT found a link between vaccines and Type 1 Diabetes.

:You put on too much weight.That’s what caused it.

Fact:  Weight is not to blame for this disease.  Obesity and inactivity are big risk factors for Type 2 Diabetes and many other health problems, but there’s no connection to Type 1.

Tale:  You have the “bad” kind of diabetes.

Fact:  This is often a common comment in my ‘Diabetes Made Simple’ class.  There is no “good” kind of diabetes, nor is it a matter of being better or worse.  Type 1 and Type 2 diabetes are different, and therefore have to be managed as such. 

Tale:  Do you really think you should be eating that?!

Fact:  People with type 1 diabetes can eat or drink anything they want as long as they take the right amount of insulin to balance out the carbohydrates.  Now as a dietitian I’m always teaching patients, type 1 or type 2, healthy, balanced eating.  It’s not a free for all when it comes to desserts.  However, people with type 1 diabetes should not be made to feel that there are foods that they shouldn’t eat. They can and should.  I had a 7-year old child in my office recently diagnosed (spunky as all get out) ask me, “Can I have cake on my birthday?”  I promptly responded, “Of course you can!”  She then followed up with her spunkiness and told me that she had lots of friends and they have birthdays too. Can she have cake on their birthdays?  I of course had to outwit this 7-year old and proceeded to ask how many friends did she have??  She wanted me to tell her she could have cake every day!!  I explained to her that cake is exactly that, meant for special occasions and she really shouldn’t be having sweets every day (and that other kids her age shouldn’t be either). 

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Tale:  It’s probably not a good idea to play sports.

Fact:  Jay Cutler, Ryan Reed, Gary Hall Jr – all athletes with Type 1 diabetes.  If you pay attention to how you feel and closely watch your blood sugar levels adjusting as you need to, you can stay safe and play any sport you want to.  Kids blood sugar levels during practice might react differently than during their actual game (adrenaline can make their blood sugars elevate), so I always tell my patients to know that they can actually have different reactions from practice versus game day – the key is to always be monitoring and aware.

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Tale:  You were feeling so good last week.  Why are you having so much trouble this week?  Don’t you have it all figured out?

Fact:  Managing diabetes can change daily.  Many things, including stress, hormones, periods of growth, and illness, can cause your blood sugar levels to swing out of control.  These ups and downs don’t mean you’ve done anything wrong.  Even if you stick to your meal plan and follow the same schedule daily, these other factors can affect your blood sugar levels.  Again, managing diabetes is a daily job and it’s not something that can be forgotten about – it takes effort daily.

We teach a program four times a year called Mastering Your Diabetes – it’s an intensive course helping patients to understand their diagnosis, the mechanism of action of insulin (CHO counting, Insulin to CHO ratio, Insulin Sensitivity Factor, Insulin Adjustment Guidelines), Technology in DM, Exercise, and MORE!  Diabetes is a 24/7 job that requires attention and management – there are no days off – we help patients learn to manage it, but the truth is that there will be days with hyperglycemia and hypoglycemia – our hope is that they learn to “sugar surf” 

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Tale:  When can you stop the insulin?  Shouldn’t you be cured by now?

Fact:  People with type 1 diabetes make NO insulin and taking insulin keeps them alive.  They must have it, but it doesn’t make the disease go away.  This is one of the biggest misunderstandings between type 1 and type 2.  Let me repeat, Type 1 DM requires insulin, it is their life line.  There is no cure, but there have been lots of advances.  And as the research continues, there have been advances in treatment of diabetes as well as technology – insulin pumps, continuous glucose monitors and, someday, maybe even an “artificial pancreas”. 

DRI's BioHub Transplant Technique

Diabetes can be a complicated disease as it can affect all areas of your life.  However, it shouldn’t keep you from doing anything you put your mind to.  You can eat what you want, play whatever sport you want, have a healthy pregnancy, and travel the world…you simply have to be aware of your blood sugar levels and begin to think like a pancreas.   I always tell my patients that while they self-manage their diabetes daily, it’s important to have a nurse educator, endocrinologist, and dietitian that can help support you.  We’re there to help interpret your numbers, help adjust basal rates, and remind you that you’re doing an amazing job!! I have been working at the DRI for almost 3 years now.  I can tell you that I’ve been forever changed from the kids (and adults) that I’ve met. 

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