As a teenager I had my first introduction to what was once termed juvenile diabetes. A friend of mine was over for dinner at my parent’s house. He happened to be a strapping football player. That comes into play later. 😉 During the meal I turned to ask him a question and he appeared to be fiddling with a pager. A pager? First of all, this was not the early 90s. Second, I though it was kind of rude to be paging people at the dinner table. (To this day I have no idea how a pager works).
Not one to keep my mouth shut, I later asked him who he had been talking to. Needless to say he was very confused, until I pointed at the contraption I could see bulging under his shirt on his belt. Did that ever get a laugh. He pulled up his shirt to reveal…
His insulin pump. (I1)
Type 1 diabetes is a “chronic condition in which the pancreas produces little or no insulin, a hormone needed to allow sugar (glucose) to enter cells to produce energy.” 1 The body likes to keep a very particular amount of sugar in its bloodstream. In healthy adults this number is 4-7mmol/L when fasting, with a slight increase after meals of 5-10mmol/L. 2
Diabetics without the ability to produce enough insulin will have too much sugar build up in their bloodstream (more than 10mmol/L). This (hyperglycemia) can cause all kinds of nasty effects. Hypoglycemia can also cause major problems.
You can check those topics out here… https://vanessajunkin.wordpress.com/2013/12/06/sugar-bear-investigating-type-2-diabetes/
Type 1 diabetes has also been referred to as insulin dependent diabetes, because the body is generally dependent on an external source of insulin in order to function. It was also once called juvenile diabetes because it usually appears during childhood. However since it can also appear as an adult, and because type 2 diabetics can also be insulin dependent, the names have become obsolete.
“The exact cause of type 1 diabetes is unknown. In most people with type 1 diabetes, the body’s own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys the insulin-producing (islet) cells in the pancreas. Genetics may play a role in this process, and exposure to certain viruses may trigger the disease.”3
Type 1 diabetes is neither preventable or have a cure, but it can be managed.
Most known insulin dependent diabetics will have insulin injections or an insulin pump prescribed. This way they can control how much insulin is delivered into their system. My friend, for example, had been dialing up his insulin in preparation for one of my mother’s famous desserts: cheesecake.
(Polydipsia: extreme thirst, Polyphagia: extreme hunger, Polyuria: frequent urination, Gylcosuria: excretion of glucose in urine)
Something to be aware of, particularly with Type 1 diabetics, is the risk of developing DKA (Diabetic Ketoacidocis) which may result in a diabetic coma. When there is no sugar available to cells, they begin to break down fatty acids to use for fuel. This is difficult for the body and also produces waste products called ketones. At certain levels ketones become poisonous which is referred to as ketoacidosis.
Signs/Symptoms of DKA are: changes in consciousness, “Kussmals” deep/rapid breathing (the body is trying to get rid of the blood’s excess acid as CO2), signs of dehydration, fruity/acetone smelling breath, N/V, headache, muscle stiffness, stomach pain. DKA can be determined with blood/urine tests in the hospital. It is also a medical emergency and you should call us immediately (911-ambulance).
On a side note for medics, a study in Iran has found that a quick way to rule out suspected DKA is through capnography. According to the study, “End tidal CO2 values >24.5 mm Hg had a sensitivity and specificity of 0.90 for ruling out DKA.” 4 So basically anyone with a normal C02 end tidal value can be reasonably ruled out for DKA. JEMS concurs that “in patients with diabetic ketoacidosis (DKA) and Kussmal respirations, the EtCO2 will be very low secondary to depleted bicarbonate and deep and rapid respirations.” 5
Fluid replacement is also going to be important for patients in the pre-hospital setting. This will begin to reverse the patient’s dehydration. It will also begin to dilute the high concentrations of sugar and acid in their blood. Potassium levels will also likely need to be corrected (however at my practicing level this would be done in hospital).
Some complications of DKA are cerebreal edema, myocardial infarction, intestinal infarction, and kidney failure. “Cerebral edema complicating DKA is a syndrome unique to pediatrics. While described in a few adults, this complication occurs predominantly in children, most of whom are experiencing their onset of diabetes mellitus with the presentation of DKA.” 6 According to Elliot J Krane, MD, “[W]e now recognize that the cerebral complications of DKA (including much less frequent cerebral arterial infarctions, venous sinus thrombosis, and central nervous system infections) are the most common cause of diabetic-related death of young diabetic patients, accounting for 31% of deaths associated with DKA and 20% of all diabetic deaths, having surpassed aspiration, electrolyte imbalance, myocardial infarction, etc. 7 What a great reason to be able to recognize the signs/symptoms of a diabetic emergency early!
So, why is it significant that my strong, athletic football playing friend is a type 1 diabetic?
It is simply a reminder that despite obstacles and odds, people are capable of anything.