Living with Diabetes Mellitus

In keeping with our 2010 theme of “knowing your family health history,” this issue will cover Diabetes, commonly known as Sugar Diabetes. The reason it’s called Sugar Diabetes, is because the body is unable to process sugar (glucose) in foods in normal ways.

There are two main types of diabetes:

Type I commonly runs in families and is characterized by having little or no insulin produced by the pancreas. The pancreas produces insulin, which flows through the blood stream. Type I diabetes was previously known as insulin-dependent diabetes because the pancreas can no longer manufacture insulin properly. The patients are required to take insulin daily, either by injection or through an insulin pump. Type I was once was also known as juvenile diabetes because it most often occurred in children. The most common symptoms are: increased thirst and urination, constant hunger, weight loss, and blurred vision. It is important for patients with diabetes to follow a strict life management plan of insulin therapy, self monitoring of blood glucose (sugar), healthy eating, and physical activity.

With the increase in childhood obesity and alarming rates of childhood Type 2 Diabetes, Americans need to know what diabetes is and its effect on the body.

Type II diabetes used to occur mainly in adults who were overweight and older than 40 years. Now as more children and adolescents in the United States become overweight and inactive, Type 2 diabetes is occurring more often in young people. Type 2 diabetes is a significant and growing public health problem. Once known as non-insulin diabetes, Type 2 is characterized by slow development symptoms similar to those of Type 1: extreme fatigue, thirst, dizziness, frequent urination, weight loss, blurred vision, frequent infections, or slow healing sores. Girls may experience vaginal yeast infections or a burning sensation during urination. Some may have extreme levels of glucose associated with dehydration and coma. Additional physical signs to watch out for in children and adolescents would be the darkening of the skin around the neck and armpits. The skin may feel velvety to touch. Timely diagnosis and treatment of Type 2 diabetes can prevent or delay complications. Patients with Type 2 diabetes must eat healthy and always consider portion control, increase physical activity, which means exercising daily and taking prescribed medication as needed.

Gestational Diabetes Mellitus (GDM) is a form of diabetes that occurs in about 7% of all pregnancies. It is most common in obese women and women with a history of diabetes in their family. The risk of developing diabetes later in life is extremely high in these women. Overweight women with a history of GDM can take steps to reduce their risk for diabetes by losing at least 5-7% of their weight and increase physical activity by exercising daily.

I recently spoke with my nephew, Victor, who was only just diagnosed with Type I diabetes. Here is his story:

Victor Ravnell Jr. is a 35-year-old married African American male with three adorable teenage daughters, who lives in Florida. He considers himself relatively active and in good physical health. In September 2009, he began to notice a few changes in his health: Water would not quench his thirst, and he was thirsty all the time. Urinating also became more frequent. What became of particular interest to him was his loss of weight. Although he continued his weekly exercise program of weight lifting, he couldn’t understand why he was losing weight. There was also a persistent white rash in his mouth that would not go away. After sharing these unexplainable signs and symptoms with his mother-in-law, she suggested that he should use her glucose level meter. The normal level of sugar in blood before a meal should be between 70 and 110 milligrams per deciliter. After food, the level will rise between 100 to 140 mg/dl. If the level rises above 140mg/dl, this symptom could indicate the person has diabetes. The first reading Victor had was 215, the next hour it was 380. He called his wife, and she rushed him to the hospital. By the time he had his vitals taken through the emergency room, his glucose level was well over 400mg/dl; dangerously high.

Victor began an injection regimen of five units of Humalog, five minutes prior to mealtime; breakfast, lunch and dinner and 18 units of Lantus before bedtime. After a struggle to balance his glucose level, his Endocrinologist suggested the insulin pump.

According to dLife, For Your Diabetic Life, “for years people worldwide who depend on insulin to survive had no choice but to take daily insulin injections, sometimes up to ten a day. Today, those same people are offered a technology that allows them to replace the daily regimen of shots with a continuous flow of insulin in their bodies, through a ‘pump’. In addition to not having to endure the pain and inconvenience that multiple daily injections can sometimes cause, pump users have more control of their insulin flow than do people taking injections. With the press of a button, a pump user can stop or cut down the flow of insulin, as needed.

First introduced in the 1970s, today’s pumps are small, sleek, and safe machines, about the size of a beeper. Just like the pancreas, an insulin pump releases small, continuous amounts of insulin into the bloodstream. In pump terminology, this is known as ‘basal’ insulin. And just as a pancreas produces insulin quickly to counteract carbohydrate intake, an insulin pump allows its wearer to dial in additional insulin to cover the amount of carbohydrates ingested or to correct an abnormally high blood glucose level. This insulin is known as a ‘bolus’ of insulin. The combination of correct basil insulin rates with additional bolusing allows the person with diabetes to achieve the closest thing possible to a functioning pancreas.

Insulin is delivered through a thin tube that is connected both to the pump and to the person wearing the pump, through a needle or catheter, placed under the skin. The tubing needs to be changed every 2-3 days, meaning the user only needs to feel a needle that often. Most pump users connect at the abdomen, although others use thighs, hips, upper buttocks, or even arms. The tube can easily be detached for activities, such as showering. Many pumps are water resistant, allowing pump users to swim if desired.”

I asked my nephew what were some of the benefits of using the pump. You can maintain control and regulate your blood sugar level, once the Endocrinologist establishes your basal rate. You can make adjustments for different times of the day, more or less as needed. Also, you don’t have to worry too much about what you eat and when you eat. You can make the same lifestyle choices as do people without diabetes.

Currently, Victor is living a normal, productive life while controlling his diabetes. He has altered his diet by eating fewer carbohydrates per meal and has increased the number of fruits and vegetables per meal. He continues his weekly weight training and occasionally, he may have a bite or two of his favorite Snickers bar. He advises everyone to talk with family members about chronic diseases and to have annual physical check ups. It might just save your life.

Most of the information contained in this article was taken from the National Diabetes Education Program and other noted resources.