In addition to the amazing diabetics who have been following my posts displaying what a rollercoaster of a condition this is, there are plenty of friends and family members who have watched me grow up as a Type 1 Diabetic without every really knowing the nitty gritty details. I've been putting on display this crucial part to my life through social media, the part with blood tests up to seven times a day and the mood swings resulting from high and low blood glucose readings. As I’m putting this part of my life out there for everyone to see, I realized that diabetes has become like a second language to me. I was diagnosed at the age of 7 so I don’t remember a time not knowing what a “bolus” was or a time when I didn’t think about the 35 grams of carbohydrates in a burrito before thinking about the cheesy, meaty goodness waiting for me to engorge in. So I forget that the terms, lingo, and situations aren’t clear to someone without Type 1, or newly diagnosed with it.
Type 1 Diabetes has become more common without a clear reason why, but I feel as if there’s something important about educating those who are willing to listen about the condition. I think about the times when I’ve been alone, traveling, or just browsing a new part of my hometown and felt a drop in my blood glucose and being scared. What if I faint? Who will know what to do? How do I explain that I need to drink this juice before buying it because those minutes I’ll spend waiting in line are crucial to my life? Knowledge is power and the more you know the better, so below I tried my very best to break down the complexities of diabetes. Introducing you to the lingo, technology, and emotions that I’ll continue to post about on Instagram (@balanceandbolus).
I've also created a section under FAQ (top of the page) labeled "Diabetic Dictionary" to help out with the new diabetes vocabulary. I hope this gives everyone a new perspective and better understanding about this chronic disease. Feel free to click Contact if you have any questions or comments!
WHAT DOES THE PANCREAS DO?
The pancreas has a lot of responsibilities. One of them is the release of insulin through beta cells. This happens as a response to a rise in Blood Glucose (BG) levels. BG is the measurement of the amount of glucose in the blood that hasn't been utilized for energy. If you eat any form of carbohydrates, from bread to a candy bar, your body will convert those carbs to glucose. The pancreas will send out beta cells to release some of their insulin so the glucose from carbs can be used as energy. A common analogy that helps understand this is to think of insulin as a key. Insulin opens the door of our cells for glucose to be utilized as energy, whether it be running or just walking to the kitchen to get some more carbs.
The cells cannot use the glucose in our body (provided from the food we eat) without the help of insulin. As insulin unlocks the doors of our cells for glucose, our blood glucose levels go down. So with a lack of insulin, glucose does not enter our cells, causing BG levels to rise. Keeping BG levels at homeostasis or within a target range is important for providing us with optimal energy throughout the day. The target for someone with a working pancreas (not me) is 70 mg/dL (milligrams over deciliters) - 110 mg/dL. But mine is around 100 mg/dL to 150 mg/dL.
To sum it up: My body does not produce insulin. Insulin is needed to lower my BG levels when carbohydrates (glucose) raise them.
SO WHAT HAPPENED TO MY PANCREAS?
Once upon a time, I had chicken pox for about a week. A week of itching and scratching due to a virus that my body was trying to kick to the curb. It is believed that while my body was raging war on the chicken pox, it got caught up in the excitement and beat up my pancreas to the point that it will no longer release those handy little beta cells mentioned above (read about my diagnosis here).
Now that my pancreas no longer produces beta cells to release insulin, I have to step up to the position of being my own pancreas.This means that I'm doing exactly what is explained under WHAT DOES THE PANCREAS DO? I'm giving myself insulin so I can use carbohydrates as energy and keep my BG levels at homeostasis. There are quite a few ways to be your own pancreas, but here's what I do:
Insulin pump- A device that looks, and is commonly mistaken for, a pager. The pump holds a reservoir that provides me with about 3 days worth of insulin. Insulin is released into my body through a wire that connects to a catheter (a soft, flexible tube) under my skin. I manually tell the pump when to release the insulin (bolus) and the pump calculates how much to release based on the carbs I'm consuming or how over my BG target I am. This eliminates the need for shots but I do have to change the site every 3 days. The site is a small needle (1/4 of an inch, maybe) that is quickly inserted into practically anywhere on my body. When the needle is removed, the catheter is what's left under my skin. My pump is responsible for two ways to release insulin; bolus and basal:
Bolus- This is the big push of insulin given when I eat anything with carbs. I tell the pump when to do this by telling it how much I'm eating. This push of insulin is also necessary if my BG is high. Say I forget to bolus for a handful of grapes and my BG shoots up, I tell the pump this above target number and it will send the units to correct it.
Basal- a Basal rate is the amount of insulin slowly dripped into my body through the site to regulate my BG levels. We need insulin constantly, even without high BG or eating carbohydrates. This is adjusted to the diabetic and can be increased or decreased depending on external factors. For example, a new exercise regimen, where less insulin is needed or during a bout of the flu, when diabetics often becomes resistant to insulin and needs more.
To sum it up: I receive insulin through a machine called an insulin pump that gives me insulin slowly throughout the day and will give a burst of insulin when I eat or need to correct for HIGH blood glucose.
HOW DO I MAINTAIN BLOOD GLUCOSE LEVELS?
Keeping my blood glucose levels within target range is just as frustrating, time consuming, mentally draining as it is important. I use a device most commonly called a "meter" to test my blood around 7 times a day. This is done by inserting a strip into a device and feeding the strip a drop of my blood. In 5 seconds, the meter will read me my number.
Luckily, in the past year, I've begun using a device in addition to my pump that assists in keeping BG levels at homeostasis. This sweet new device is a Continuous Glucose Monitor (CGM) (pictured left).
The CGM is constantly measuring my BG levels and sending the results to my pump for me to see. The CGM eliminates the amount of times I use my meter. It also shows me the fluctuations in my BG, allowing me to catch lows and highs before they become too severe. I change this big guy every 6 days- the needle is a little bigger than the insulin pump's but doesn't hurt, I swear! The CGM is calibrated with finger pricks twice a day and in between measures the amount of blood in my body. The CGM communicates with the insulin pump and the two work together to keep my BG within target. So if the CGM tells the pump my BG (getting hang of the lingo yet?) is rising, the pump raises that basal rate to level the number out and keep it within the range (100mg/dL-150mg/dL).
To sum it up: I don't have to prick my fingers as often with the Continuous Glucose Monitor (CGM) and I really only have to tell the pump how many carbs I'm eating or if I'm significantly over my target (around 200mg/dL)!
WHAT HAPPENS IF MY BLOOD GLUCOSE IS OUT OF TARGET RANGE?
Two things happen when my BG numbers are out of target: hyperglycemia and hypoglycemia:
HYPERGLYCEMIA- This is the term used to describe a HIGH blood glucose level. High BG numbers mean that I did not get enough insulin from my pump. This could be because I thought a piece of cake was less carbs than it actually was and therefore, did not tell the pump the correct amount of carbs I was eating. Lots of things can lead to hyperglycemia (stress, hormones, caffeine etc.)
How does this make you feel? Well when my BG is high, I start to feel very lethargic. Think about it- all this sugar in my body and not enough insulin to unlock the door to my cells to be used as energy. Just like anyone who is tired, I become very grumpy and agitated. This isn't fun and if it goes on too long (say I'm sleeping and don't realize my BG is high), then I could end up in diabetic ketoacidosis (DKA) otherwise known as having ketones. We'll talk about this later. I deal with hypers (slang!) by giving myself a bolus of the correct amount of insulin to correct the high number and bring me back to target. This can take around 20-30 minutes.
HYPOGLYCEMIA- Otherwise known as LOW blood glucose levels. Hypoglycemia occurs with an excess of insulin. Maybe I thought the cake had 45g of carbohydrates when really it had 30g. This 15g difference could send me very very low and very very fast. Hypoglycemia also happens often with exercise as I'm exerting energy and getting that heart rate up, the glucose in my body can't keep up. The way to deal with both situations is by having MORE sugar. I have glucose tablets (fast acting and 5g of sugar) or juice (also fast acting). When dealing with a hypo (slang!), fast acting sugars like juice, soda, candy are best! Not things with equal parts fat or protein like bananas or milk because although both contain carbohydrates, the fat and protein in them will slow down the sugar and take longer for my BG to rise.
How does this make you feel? When I'm dealing with a hypoglycemic episode, my BG is usually under 90mg/dL. These are very dangerous because they really affect the way I communicate and move. I feel dizzy, lightheaded and my words become slurred. In these situations, I need to sit down and drink my juice or eat my candy until my BG is back within target. This can take 20 minutes! In this situation, I should not operate machinery nor be expected to participate in class or work responsibilities and especially no exercising.
To sum it up: If my BG is above 150mg/dL I am considered HIGH/HYPERGLYCEMIC and this can be corrected with a bolus of insulin. If my BG is under 90mg/dL, this is low and I have to find a concentrated form of sugar immediately
WHAT I CAN EAT?
ANYTHING. ANYTHING. ANYTHING. ANYTHING. ANYTHING.
Even people who don't know much about Type 1 Diabetes, they seem to always draw a connection to food in their heads when I tell them that I have the disease. This introduces questions like "Oh, so you can't have sugar?" or "Can you eat this?" when cookies are being passed around. But let me be as clear as insulin, I can eat as many cookies and chocolate bars as I want and I'll be okay as long as I give myself a bolus (remember that word from SO WHAT HAPPENED TO MY PANCREAS?)
When it comes to having sweets, or even foods like pizza or sandwiches (where the carbohydrates in the bread will be converted to glucose just as sweets will), it's usually a matter if I should. Is the cookie worth chasing a high blood glucose number? Is estimating the carbohydrate count in a slice off a birthday cake worth the possibility of going too low or high? The answer is usually no but sometimes the yearn to be a normal person who eats cake and stress eats Halloween candy is stronger than that no. So if I check my BG using my meter, or looking at my CGM, and see that my number is within target (or preferably on the lower side since the carbs will raise my BG) then I'll definitely go for it. I'm a big believer in not letting diabetes stop you from eating the foods you love.