So, are you sitting comfortably? Got your tea? Grand, well, there are a few things I need to explain. I didn’t know the answers to ANY of these questions until recently. I had no idea the differences between Type One and Type 2 diabetes. If I’d seen someone collapsed with sweet smelling breath, I’d have assumed alcohol, not DKA (see below). And I certainly had absolutely no idea what a hypo (see below) was.
So I know these are questions that need answering. Friends I’ve not seen since D-diagnosis often ask questions like these. Initially I’d bemoan my overnight hypos (I’ll get there in a minute, promise) on my personal Facebook page but I realised after a while that while my friends were sympathetic to ‘something’ not being right, most of them didn’t really know what that 'something' was.
So I thought, well, we can’t really go on in the same vein, so here follows some diabetes basics. I’ve added links to other sites for further reading, should you so wish. If you have any questions not answered below, please leave them in the comments box below, or on @ditzydiabetic on Twitter or Facebook, and I’ll either answer, or find an answer.
Hopefully this helps us. Enjoy your cuppa, it is a longer than I’d like post.
- So, what is Type One Diabetes? It’s an auto-immune condition. This mean the body’s immune system, usually the first line in defence against infection and illness, go a bit haywire and, on a particularly bad day, mistakes cells in body as harmful and starts killing them off. It’d be a bit like Jackie Chan deciding one day to fight himself in the mirror and losing. In the case of Type One diabetes, the cells that are killed off are the insulin producing cells (beta cells). This means the disease affects how the body uses glucose, the body’s main source of fuel. Important point, it’s an auto-immune condition, just like my thyroid condition, Vitiligo and asthma. I didn’t do anything to bring it on, ‘get’ it, and now I’ve got it, well, I can’t get rid of it. No matter how much I shout, or cry.
- Why is Type One Diabetes bad? In a Type One Diabetic, the body has killed off the insulin producing cells. When you eat carbohydrates your body gets glucose from these foods to be used as energy. Insulin is the key that is needed to ‘unlock’ the energy. Without insulin, the glucose from the foods stay in the blood and isn’t used as fuel for energy. Eventually increased blood sugar/glucose levels seriously damage the body’s organs. Without insulin, your body breaks down its own fat and muscle, resulting in weight loss. I’ve lost three stone but wouldn’t advocate diabetes as a weight loss programme! High blood glucose can lead to a serious short-term condition called diabetic keto-acidosis (DKA), where the bloodstream becomes acidic and you develop dangerous levels of dehydration. Insulin is not a treatment for diabetes; it’s a necessity to stay alive.
- How do you get your insulin then? In a Type One Diabetic naturally produced insulin must be replaced by self-administered injections. Currently I take two types of insulin – long-acting and short-acting. This long lasting insulin (Levemuir) is taken twice daily injections, once at 7.30am and 10pm. The short acting insulin (Novorapid) is taken before food to emulate the pancreas’ production of insulin and ‘unlock’ the energy from the glucose. On a normal day, I take 4-5 injections of Novorapid a day. So in total, usually 6-7 injections a day. For those Type One diabetics on a pump, the way their receive insulin is entirely different.
- How and why do you test your blood sugars? It’s important to know the level of blood sugar in my body at any given time, especially if I’m planning on doing any of the following activities, eating, driving, exercising/activity e.g. housework, shopping, having symptoms of low blood sugars (hypo, see below). What my blood sugar levels are will determine the course of action, for example, how much insulin to take for food, or as a correction dose (to bring blood sugars down), or if I need extra carbs before driving the car, or am having a hypo.
- Within what range should a diabetic’s blood glucose levels be a.k.a the amount of energy currently in your system at your disposal? Before breakfast 5.5-7.5 mmol, other meals 4.5-7.5mmol and before bed 6.5-8mmol.
- What is a hypo? Hypoglycaemia, or a ‘hypo’, means that glucose levels have dropped to a dangerously low level (less than 4mmol, or a severe hypo, less than 2.8mmol) .When your glucose (sugar) level is too low, your body doesn’t have enough energy to carry out its activities. Mostly it happens if someone’s taken too much insulin, misses a meal or exercises too hard. I’ve had hypos from playing ‘tig’ with Boy Child. Most people will have some warning that their blood glucose levels are too low, which gives them time to correct them. My signs are trembling, shakiness in my core, and grumpiness, and if very low, sweating, confusion and difficulty concentrating. Very often you can correct a hypo quickly and effectively but the effects are lasting, for example, it takes 45 minutes for brain function to return to normal and you can’t ‘correct’ high blood glucose at the next meal, so may have to stay high for several hours . In very severe cases, a person experiencing hypoglycaemia can lose consciousness, which is where help from external parties is needed. It’s not fun having to educate loved ones on what to do if you fall unconscious. Hypoglycaemia can also occur during sleep, waking in the middle of the night dazed and confused, sweating, with your heart racing isn’t much fun.
- What is the treatment for a hypo? Quick acting carbohydrates will raise blood sugars quickly, for example, glucose tablets, dextrose tablets, Lucozade. Taking enough carbohydrates to raise blood sugars but not push them too high for the rest of the day/evening is a balancing act.
- Why doesn’t it just work that you take insulin and then all is good in the world?Everything impacts on your blood sugar levels, eating carbohydrates, exercise, hormones, stress, activity (shopping, housework), alcohol, infections. So a Type One Diabetic must take into account everything that happens in their daily lives when deciding on what insulin to take for food and in relation to blood sugar levels, for example, the food I am eating needs X amount of insulin but I need to reduce insulin because I plan to swim later, or I ran around with Boy Child earlier, or I had a hypo earlier so need to account for this.
- What is carbohydrate counting and ratios? For every 10g of carbohydrate, I need to take 1 unit of fast acting insulin (Novorapid) – mostly. Insulin resistance in the morning and insulin sensitivity at night does change these ratios slightly.
- So now you take insulin you can eat what you want, even sugar, right? Well not quite. I was told initially I could still eat what I wanted but I can’t. For example, you can take insulin to cover a Mars Bar, for example, but the way the insulin injection works (starting to reduce blood sugars after 5-20 minutes, then peaking at two hours and carrying on working for five) means that the sugar spikes and is used up before the peak and subsequently my blood sugar crashes. Or if I have a fatty meal, (pizza/meatballs) I need to split the dose of my insulin (fat inhibits the uptake of carbohydrate) or I face having a bad hypo as my insulin peaks but the food hasn’t fully gone into my system. Another example is that for months I carried on eating the same breakfast of cereal (bran flakes have a surprising high level of sugar). But due to my natural blood sugar rise I was facing blood glucose levels of 18 – 21 mmol every morning after breakfast and unable to live my life until they came down. Now I tend to have a carb-free breakfast and take insulin to keep that natural morning rise a bit more under control (although it doesn’t always work!).
- What impacts on blood sugar levels? Eating too much and not covering with insulin. A natural rise in blood sugars in the morning called the Dawn Phenomenon (which I struggle with lots, for example, my blood sugar can rise from 8.8mmol on waking to 15.6mmol without having any carbohydrates). This makes me feel dizzy, disorientated, visually impaired, sweaty, and generally sick.
- What can be done to help? Learning! Diabetes education helps to teach those suffering from Type One how to try to better ‘manage’ (not control) their blood sugars, in order to try to life the life they want. Diabetes will never go away, nor will those of us with a defective pancreatic function ever not need insulin but sending Type One’s like me on an education course (I attended DAFNE course in August 2014) helps them to understand what they live with every hour of every day, understand what they can do to help themselves (diet, best use insulin, correcting blood sugars, what to do on Sick Days) and ultimately reduced the cost to the NHS. Diabetes UK recently launched a new campaign Taking Control #takingcontrol and you can support their call for everyone to get the education they need to ensure they can live their life. Sign up here > diabetes.org.uk/Taking-Control
A few people asked me while proofing this post for me why does is people’s diabetes better controlled than others? For me that question turns around to ask, for example, why can some people drink ten pints and others can’t? Why do some people have hay fever and others don’t? We are all different, and that’s the problem with diabetes. There is no one size fits all solution. Each person reacts to insulin differently, their metabolism is different, requirements for insulin different, changing at different types from person to person. Thus the need for good quality education to allow us all to self-manage and become our own (well-informed) doctor is even more paramount. After all it is us that wield a needle at least eight times a day, making decisions to keep us alive very hour, every day, every week.
For more general information about Type One Diabetes, visit Diabetes UK or NHS website
For more information about Dose Adjustment for Normal Eating (DAFNE) visit DAFNE website