Who said sugar is sweet?: January 24

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Thursday, January 24, 2013

Two Year Anniversary

Two years ago today, at some forgotten hour in the afternoon my existence changed with a diagnosis of diabetes. I remember the relief I felt that day when the doctor announced my newly acquired accessory (because, let's face it, diabetes manifests itself as battery operated, pocket sized baggage) as if I'd some how dodged a bullet and gotten off easy -- it's not cancer, after all. But sitting here 730 days later I can't help but feel very sad that I wound up in such a serious, long term committed relationship with artificial insulin.

In a lot of ways I feel like I am married to my pancreas and not in a happily ever after, ride off into the sunset kind of way -- it is more like the drunken, bad idea, spur of the moment Vegas wedding with divorce banned in the prenup kind of way. I was a happy, healthy and independent woman before January 24, 2011 and then BAM! I woke up and found myself in bed (one that I did not make, by the way) with a disgustingly lazy pancreas that is inexcusably and exhaustively high maintenance. I don't like it, I certainly don't love it and I'm sick (literally) of it.

Honestly folks, I am tired of being diabetic. I am (postpartum-exacerbated) depressed about being diabetic. I mean when you get the flu it is horrible and you curl up in the fetal position for a week or so and then you're back up on your feet, good as new. But with diabetes, it's emotionally like I've had the flu ever since I left Georgetown Hospital. I rationally understand that the disease I have could be a worse one and that my diabetes is not nearly as bad as it could be (or as the flu feels), but the work it takes to keep it this way and to prevent all of the worse diseases that diabetes can cause takes constant attention. And I am tired. I want to be done. But there is no cure, there is just treatment. Maybe someday this will change, but until then the unfortunate relationship continues.

So, my non-honey, anti-sweet, not-so-dear pancreas, happy anniversary. Seeing as this is year two, I guess I'm supposed to give you something cotton and I think any one of these t-shirts expresses my true sentiments about you. Take your pick!

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Diabetic Vocabulary

Active Insulin: after injecting a bolus, the insulin in the body is "actively" working to lower out of range blood sugars or compensate for digested carbs.

Amylin: A peptide hormone that is co-secreted by the beta cells of the pancreas to help the body naturally control blood sugar. While insulin directly targets glucose in the blood stream, amylin slows the stomach from emptying and promotes satiety, which prevents post-prandial hyperglycemia. Just like with insulin, type 1 diabetics do not produce amylin and type 2 diabetics become resistant to it and both types may need for it to be synthetically substituted via injection. (Brand name I use is Symlin)

Basal: acting the way the pancreas does naturally, insulin therapy requires small amounts of "background" basal insulin to be continuously released throughout the day to manage normal blood sugar fluctuations.

Beta Cells: Composing 65 to 80% of the cells in an islet cell cluster, the beta cells of the pancreas produce insulin for the body to regulate glucose. In type 1 diabetics, there is an autoimmune response that destroys these cells and prevents the islets from natural insulin production.

Blood Glucose (BG): the amount of sugar present in blood. A non-diabetic person will maintain a blood sugar reading between 70 and 100 mg/dl. A type 1 diabetic requires the use of artificial insulin to manually replicate such control.

Bolus: additional insulin a diabetic administers "on demand" to compensate for high blood sugar readings or the number of grams of carbohydrates eaten at a meal.

Cannula: a small plastic tube that is inserted into the skin for insulin delivery. This is a specific part of the infusion set.

Continuous Glucose Monitor (CGM): an additional piece of equipment that is attached to the body and automatically checks the body's blood glucose levels every few minutes. It is used to track the upward or downward trending of sugars as they happen and thus allows for tighter glucose control.

Dawn Phenomenon: an abnormal early morning blood glucose rise between 2 AM and 8 AM caused by the body's natural hormone release cycle.

Diabetic Ketoacidosis (DKA): a potentially life-threatening medical complication that results from severe insulin shortages in type 1 diabetics. It is usually the first symptom of previously undiagnosed diabetes and is considered to be curable with adequate, timely treatment.

Glucagon: a hormone that is naturally secreted by the pancreas of non-diabetics to raise blood glucose levels. A diabetic patient needs an emergency injection of artificial glucagon when unconscious as a result of hypoglycemia. (Note: there is a glucagon injection kit in my purse at all times)

Hemoglobin A1C (HgA1C): a blood test reading that measures the average blood glucose of a person over the past three months. A non-diabetic will have a HgA1C between 4 and 5.9% where as a poorly controlled diabetic patient it will be above 8%. In well controlled diabetic patient it will be below 7.0%.

Honeymoon phase: a period following diagnosis where the pancreas may continue to produce or, in some cases, increase production of insulin. This phase may temporarily decrease initial insulin requirements, but will eventually end and cause the diabetic's biosynthetic insulin requirements to increases.

Hyperglycemia: a condition where there is an excess amount of sugar in the blood (above 200 mg/dl). If left untreated, hyperglycemia leads to DKA but it is entirely correctable with a bolus correction.

Hyperkalemia: a dangerous byproduct of DKA in which there is an elevated concentration of the electrolyte potassium in the blood. This causes arrhythmia and as such is potentially fatal. (Interesting related note: this is the condition that is intentional introduced by lethal injections cause in the US justice system).

Hypoglycemia: abnormally diminished amounts of sugar in the blood (below 70 mg/dl) due to too much active insulin. This can cause a diabetic to become disoriented or unconscious requiring an injection of glucagon.

Infusion Set: the port that is manually inserted (by me) into a diabetic's subcutaneous tissue and directly administers insulin to the body from the insulin pump. Diabetic supply companies provide different types of infusion sets to fit the needs and comfort of each individual person.

Insulin: a peptide hormone created by the beta cells of the pancreas that is central to regulating carbohydrate and fat metabolism in the body and removing excess glucose from the blood stream, which otherwise becomes toxic. (Brand name I use is Humalog)

Insulin Dependence: when the islet cells in a person's pancreas can no longer produce insulin, the person is diagnosed as "dependent" on artificial insulin and therefore type 1 diabetic.

Insulin Pens: a pre-measured, self-contained, multi-use syringe of insulin about the size of a large magic marker that you attach a disposable needle to for insulin injection. Pens also come with amylin for diabetics who require artificial administration of both hormones.

Insulin Pump: a medical device about the size of a deck of cards that is attached to the body via an "infusion set" that allows insulin delivery to occur automatically through pre-programmed settings rather than through multiple self-administered syringe injections a day.

Insulin Resistance: when the pancreas can still naturally produce insulin but is unable to use it effectively through metabolic irregularities, a person is diagnosed as insulin "resistant" and therefore type 2 diabetic.

Islet Cells: The pancreas contains clusters of cells, known as islet cells, that produce hormones such as glucagon (created by alpha cells) and insulin (created by beta cells). In type 1 diabetes, the body's immune system mistakenly destroys the beta cells of the islets and causes the pancreas to lose the ability to produce insulin naturally.

Ketones: an acidic product of DKA that are made when the body breaks down fat for energy. Normally, the human body gets energy from carbohydrates but the body produces ketones when there are either a) not enough carbs in your diet or b) when the body cannot use blood sugar properly (extreme highs).

Maternal Fetal Medicine (MFM): A branch of obstetrics that focuses exclusively on the medical and surgical management of high-risk pregnancies. These doctors are commonly referred to as "perinatologists."

Pancreas: A glandular organ in the digestive and endocrine system of the body that produces several vital hormones (like insulin) and secretes digestive enzymes that assist in the absorption of nutrients.

Postprandial: a blood sugar test that determines the amount of glucose remaining in the blood after a meal. In non-diabetics, the two hour postprandial will show bg levels back within normal ranges, but for those with diabetes it may still be elevated in abnormal ranges.

Type 1 Diabetes (previously known as juvenile diabetes, but also referred to as insulin-dependent diabetes): an autoimmune disease in which the pancreas fails to produce any insulin. It is currently incurable, but it is treatable with a rigid therapy of artificial insulin. This type of diabetes only represents about 5-10% of all diagnosed cases of diabetes.

Type 2 Diabetes (previously known as adult-onset diabetes): a metabolic disorder that results when the body develops a condition called "insulin resistance." This means that the person's body still produces insulin, but is unable to use it effectively. This form of diabetes is more common (90-95% of all cases) and is typically caused by poor diet and inactive lifestyle. If caught in early stages, the effects of type 2 diabetes are reversible with lifestyle modification.

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Thursday, January 24, 2013

Two Year Anniversary

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