Treating Diabetes for Me

My current diabetes treatment isn’t quite the same as when I was first diagnosed. I no longer take insulin injections, but rather use an insulin pump to administer insulin into my body. It basically looks like an old school pager with a funny tube hanging out of it. That tube is connected to my body via a small plastic catheter at an infusion site on my stomach. On the other end of that tube inside the insulin pump is a reservoir of Humalog insulin.

Humalog is a type of fast acting insulin, like R. However, it is more rapid acting. Within 5 minutes of entering the body, it begins moving blood glucose out of the blood to cells. Its “efficiency” peaks about 45 minutes after injection and ceases any function after about 3 hours. R on the other hand takes about 45 minutes after injection to begin functioning at all. NPH, being a slow acting insulin, takes about 3 hours to start its job.

The strength of the pump is that it basically allows me to give myself tons of injections of tiny amounts of insulin. It accomplishes this by keeping that catheter in me at all times. Additionally, since Humalog is a fast acting insulin, if need be I can program the pump to alter my dosage with almost immediate results. With an injection, you have to either hope the amount of insulin you gave yourself earlier isn’t too much to incite low blood sugar (ie: hypoglycemia) or hope that it wasn’t too little to cause high blood sugar (ie: hyperglycemia), which may mean another syringe and injection. Basically with the pump, I have a little more inflexibility by way of having something attached to me all the time, but I get a little more flexibility in how I can treat my diabetes.

Now, to mirror the basal and bolus treatment I outlined with injections in the previous post, I administer insulin two different ways with my pump. The basal is done by continuously giving me insulin at a rate I program into the pump (usually quantified as a unit per hour, where a unit is scientifically recognized as 0.001 mL). This is important because sometimes you need less insulin at night than you do during the day or vice-versa. But ultimately it’s kind of a like an IV drip.

The bolus is taken care of by having the pump deliver extra insulin whenever I sit down to begin a meal. I do this by counting how many carbs I plan on eating and then using a ratio of insulin to carbs to figure out how much insulin to administer (eg: at dinner I give myself 1 unit of insulin for every 10 grams of carbohydrates I consume).

In between all of these measurements of insulin doses, I also have to keep an eye on my blood glucose with my (aptly titled) glucose meter. Ideally, I try to keep my glucose between 90-130 mg/dL (that’s milligrams per deciliter). That’s considered a roughly normal range and keeps me feeling all right without any symptoms of hypo or hyperglycemia.

There are definitely a lot of caveats and changes I make to this formulation given circumstances (eg: using my pump to treat glucose levels above 130), but basically this is my life with diabetes. I promise it’s not as bad as it sounds. If anything, I promise I can tell you the nutritional facts on just about any food you can throw at me. And it certainly hasn’t kept me from living a normal life.

My Diagnosis

I’m not certain what I did to piss off my body to the point to make it think attacking my insulin producing beta cells was a good idea, but I like to think I was innocent in the affair. What I do know is I was diagnosed with type 1 diabetes on June 2nd, 1997 at the age of 10. Fortunate to me, because my younger brother had been diagnosed far earlier in his life, my mother took notice quickly when I began exhibiting typical symptoms of hyperglycemia (ie: excess of glucose in your blood). Particularly, I was perpetually thirsty (nothing will quench the thirst of a burgeoning diabetic), and I literally had to urinate every 15 minutes. She checked my blood glucose level to find it was far above that of someone with regular insulin function.

I was consequently diagnosed with type 1 diabetes before hospitalization from DKA became necessary; by far, the most common introduction most type 1’s experience in their introduction to diabetes. From that point on, I began the regimen of twice daily injections of NPH and Regular insulin to act in the stead of the insulin my pancreas no longer made. NPH insulin is a “slow acting” insulin and acts to treat the base level absence of insulin in diabetics. Basically, this just covers the constant removal of glucose from the blood that any person requires even if they are fasting.

R is a “fast acting” insulin you take near a meal time that works to remove the sudden influx of glucose you experience when you eat any meal featuring carbohydrates (ie: bread, grains, sugar, etc.). There are different types of insulin and ways to administer it, but the typical prescription’s goal follows the outline above: You need to care for the base absence of insulin in the body, and then you need to also have the insulin care for the influx of glucose due to eating. Respectively, we refer to these different utilizations as the basal and the bolus. I’ll get back to these in the next entry.

But I guess this is the point where I should talk about how my life was never the same after that day or something. And I guess in a noticeable way it did change, but the truth is I’m a rather pragmatic person, even at the age of 10. Sure I had difficulties controlling my glucose levels at times, especially in my early teens (we’ll get to that later), but I felt better if I controlled my diabetes (which really means controlling your glucose levels). And there’s nothing to do about it for the present. So, I just sucked it up and got on with my life. That was a lot better than pouting about it.

Diabetes 101

As I'm surely going to spend a lot of time discussing diabetes on this blog, especially type 1 diabetes, I figured it's best if I give some background to the disorder as well as some info about how I personally manage my diabetes. So, consider this part 1, where I discuss the disease. Part 2 and 3 will discuss my diagnosis and current treatment.

There are two specific types of diabetes. They are known rather simply as Type 1 and Type 2. Type 1 is an auto-immune disorder in which a person’s body attacks and destroys the insulin producing beta cells of the pancreas. Type 2 involves the development of insulin resistance and/or a relative insulin deficiency.

As several of you are probably aware, the occurrence of either of these scenarios is a big deal. Insulin is the only hormone in the body that facilitates the removal of glucose (in so many words, sugar) from the blood and its passage into cells (eg: muscle, liver cells, etc.). There are many and several problems associated with not having insulin complete this task. If you’re ever in a doctor’s office, they usually get thrown under the umbrella term of “complications.” There are the “acute” or short lasting problems of diabetic ketoacidosis (ie: DKA, imagine your blood literally turning into acid), diabetic coma, or the very common hypoglycemia that can ultimately lead to seizures; then there are the "chronic" problems most people hear about that result in heart problems, blindness, and loss of feeling in one’s extremities (ie: feet and hands).

To prevent these complications, the goal of any diabetic is maintain blood glucose levels as close as possible to those of a person with normal insulin function. I am in no way equipped to speak on all the different methods for doing just that. And different methods work better and worse for different people. In general, they are all combinations of the same things though: Exercise, frequent blood glucose monitoring, finding the right balance of diabetes related prescriptions for you, and paying close attention to what food goes into your body.

It’s often a lot to ask of someone to take care of all those things. But as a diabetic, you eventually learn that they are necessary steps in order to live a good, enjoyable life. And that’s usually worth it.

My M.O.

This is where I introduce myself. So, that's where we'll start. I'm Nick.

I'm training for my first marathon. Of course, like most people, I get to juggle life and making sure I don't lose my job with training. It's not easy, but it's not too interesting when more than 500,000 people are training for marathons and doing the same thing too.

So, to make it more interesting to you, I have the added pleasure of training for a marathon while also managing type 1 diabetes (obviously not by choice) and a vegetarian diet (by obstinate choice). There are certainly people doing the same thing (see: Team Type 1), but I've never been able to observe the process of someone working through the difficulties of marathon training as a diabetic and vegetarian.

I want that to change for others out there. I want others to know it is possible to do whatever you want in spite of diabetes, but to understand it's a process --- a process that anyone with diabetes can complete with patience and persistence.

And so over the ensuing blog posts, I plan to post about the plans and methods I utilize to make sure I control my diabetes and glucose levels, to ensure I'm nutritionally fulfilled while maintaining my vegetarian diet, and to make sure I'm as fast as I can be come marathon day.