To New Diabetics and Those Interested

It’s been a long time since I’ve written something geared specifically toward the newly diagnosed, or family of the newly diagnosed (or newcomers to a diabetic family)… or those who are just curious about diabetes.

So here are some common questions and topics:

What is the difference between type 1 and type 2 diabetes?  Type 1 diabetes is an autoimmune disease and it is more rare than type 2.  It kicks in usually in childhood but sometimes it can kick in in adulthood. In type 1 diabetes the body’s own immune system decides it hates the insulin producing cells that live in the pancreas. The immune system screams, “fuck you assholes!” and murders them all in a brutal and heartless massacre. This leaves the body forever unable to make it’s own insulin and regulate the body’s blood glucose level (Insulin, cells, and glucose interaction and functions is a complex process that is all about making energy for the body to be able to properly function). The effect of not being able to make insulin and regulate blood glucose causes a body-wide turmoil. It is not as simple as just needing to avoid sugar and take shots all the time. But that is the very basics of it. Anyone can develop type 1 diabetes. There is no cure or vaccine.

Type 2 diabetes is a commonly misunderstood metabolic disorder. Most people think it is caused by a poor diet and sedentary lifestyle, this is one of the big misconceptions. Although a poor diet and sedentary lifestyle raise ones risk of developing type 2 diabetes, they are not the cause of the disorder. Absolutely Anyone can develop type 2 diabetes, no matter their lifestyle. It just happens. Type 2 diabetes is when the body is unable to properly take up and use insulin (insulin resistance) or the body is not making enough insulin to properly lower blood glucose (it is a complex process, how insulin, cells, and glucose function to make energy). Some people believe type 2 diabetes can be cured. It can not. If you have been ‘diagnosed’ as pre-diabetic this means you do not yet have diabetes… it is a kind way of saying you are at extremely high risk of developing it and you need to get your health in order. Pre-diabetes can be cured, but it is NOT diabetes. Once you actually have type 2 diabetes you can’t cure it, but you can get it under such good control that you do not have any symptoms. But if you fall off that good control, you will be sorely reminded by your body that you are still type 2 diabetic. There is no cure or vaccine for type 2 diabetes. Most people think that having type 2 diabetes just means you need to avoid sugar, get exercise, and maybe take a pill everyday. Sadly, it is not that simple, but those are the very basics.

What do carbs have to do with diabetes? Carbohydrates (carbs) are sugars. Most diabetics (type 1 and type 2) closely count how many carbohydrates they eat, and limit them per meal and day in order to best help keep blood glucose levels in the healthy range. Carbs are found in a vast majority of foods and drinks and are identified by many, many different names. Most people assume diabetics just avoid sweets, but it is more complex than that. Yes, things like candy, cookies, ice cream, etc. are packed with carbs, But so are potatoes, rice, pasta, starchy vegetables, fruits, and so much more.  Diabetics are not forbidden to eat carbs, we just need to be very careful about it.

Why do diabetics have to check their blood sugar? A ‘normal’ persons blood glucose (sugar) level does not change very much, but for a diabetic it is unstable and needs to be monitored in order to best be able to regulate it.

A type 2 diabetic’s blood sugar changes fairly often and can fluctuate a lot, especially when carbs are eaten, so it is essential that they check their blood glucose level usually about two hours after eating to make sure it has not risen too high. This gives them very important insight into how their eating habits and lifestyle are affecting their blood glucose levels, and how well their medication (if they are on meds) is working for them. Their doctor can look at the BG (blood glucose) charts to get a good picture of their patterns and adjust meds and lifestyle recommendations to better regulate BG.

For a type 1 diabetic, everything stated for type 2’s applies, but checking BG is not just a good idea, it is essential for a type 1 to keep living! A type 1’s BG fluctuates (often rapidly and  potentially to extremes) all the time, it is like balancing on a tightrope, the slightest little thing (practically anything) can and will make it go either up or down. A type 1 diabetic who is truly serious about their health and BG control will check their BG a bare minimum of four times a day…but usually much more often. And type 1 diabetics (and some type 2’s) often use a device called a Continuous Glucose Monitor (CGM) that automatically checks BG every 3-5 minutes and can alarm when BG is too high or too low or headed those ways.

What is hypoglycemia and hyperglycemia? Hypoglycemia is commonly called “low blood glucose” or “low blood sugar”. When there is too much insulin in the system it depletes the glucose in the body and this causes a whole lot of trouble. Too little glucose in the body means there is too little energy and the body can not function properly. This can cause fatigue, sleepiness, shakiness, confusion, ‘drunken’ behavior, sweats, unconsciousness, coma, and even death. Hypoglycemia is treated by eating something that has adequate carbohydrates in it (glucose tablets, glucose gel, fruit juice, etc.), or injecting  the sufferer with glucagon.

Hyperglycemia is commonly called “high blood glucose” or “high blood sugar”. When there is not enough insulin in the system then glucose builds up to a dangerous level and this causes a whole lot of trouble. Over time, when BG runs too high too often, widespread inflammation of all the body’s tissues causes damage and any number of illnesses and disorders can occur such as chronic dry skin, chronic yeast infections, heart disease, kidney failure, blindness, etc.. Where low BG is immediately life-threatening, high BG will kill you over time. This is why it is so important to work hard to keep BG under control. Symptoms of high BG include excessive thirst, frequent urination, itchy skin, blurry vision, irritability, chronic fatigue, and more… Really super high BG or high BG combined with another illness can lead to a really super life-threatening condition called Diabetic Ketoacidosis (DKA). DKA can be mistaken for a bad case of the flu but symptoms include all the symptoms of high BG and also nausea, vomiting, a ‘fermented fruit’ smell on the breath, severe dehydration, muscle cramps, uncontrollable fast, short breathing… Yeah, get to the ER quick. Extra insulin (commonly known as a ‘correction bolus’) is usually used to treat high BG. In extreme cases, especially when in DKA, a diabetic will be hooked up to an IV and given insulin drip to lower BG, and fluids to correct dehydration.

Why are there different types of insulin and what’s the difference? Basically there are two types of commonly used insulin, rapid acting and slow acting. Slow acting insulin is called basal insulin and it is used to basically cover the body’s very basic needs to just stay alive and keep BG normal if you were just lying around and not eating or moving at all. Super basic description there.

Rapid acting insulin is commonly called ‘bolus insulin’ and it is used to keep BG from totally spiking and ruining your perfect day when you eat. It is also used to correct your high blood sugar if you, for whatever reason, go high.

The above descriptions were given assuming the diabetic is using syringes or insulin pens to administer their insulin. If the diabetic is using an insulin pump, then both their basal and bolus insulin will be rapid acting insulin. This is because there are not only different types of insulin but also different types of insulin therapies. Insulin therapy is the method in which you  administer, and manner in which you use, insulin to regulate your BG.

Multiple Daily Injections (MDI) Therapy is commonly when slow acting insulin is injected once or twice a day and covers the body’s basic needs (as simply explained above) and rapid acting insulin is injected multiple times (as needed) a day to cover meals and high corrections.

Insulin Pump Therapy is when a pump is used to administer insulin needs. A basal rate is programmed into the pump and every few minutes all day long, everyday, a small amount of rapid acting insulin is pumped into the body to cover the body’s basic functioning needs. You can program different basal rates for different times of the day, as needed for tighter BG control. As needed, the diabetic can pump boluses (food coverage and high corrections).  Only rapid acting insulin is used in pumps.

What does immunocompromised mean and why are type 1 diabetics considered to be? It depends on how you look at it. In my experience, many doctors automatically consider type 1 diabetics to be immunocompromised.  But, in actuality, it really depends on the person. I, for one, do not catch viruses (colds, flu, etc.) very easily or often… but I have a huge weakness for staph infections.

Immunocompromised means the immune system is weak (or not working at all) and therefore the body cannot resist or fight off infection normally (or at all).

In my humble opinion a diabetic (type 1 or 2) is not automatically immunocompromised, but can become immunocompromised if they are not keeping their BG under control. Chronically high BG can compromise the immune system just like it destroys every other part and function of the body.

The better you control your BG, the healthier you will be. Plain and simple.

 

 

Do you have any other questions? Ask in the comments. 🙂

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Author: Tamra K. Garcia

Stephen King says to "Write what you know." I know diabetes, I know me; so this is what I write about.

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