Type 1 Diabetes

   Moving Beyond Fear: Marlita Lucas

Marlita Lucas

Before age nine, I was a normal, fun-loving young girl.  I knew one person with Type 1 diabetes.  I watched Megan check her blood sugar, count her CHOs, and give herself injections each day at school.  Never once did I imagine myself having diabetes.  Prior to being diagnosed, I was the kid you heard screaming in the doctor’s office every time she had to receive an injection.  While visiting my grandmother, a retired nurse, she noticed my dramatic weight loss, decreased appetite, increased thirst, and frequent urination.  She urged my mother to take me to my doctor.  Upon my return home, my mother and I went to see my pediatrician.

I still remember the fear in my mother’s eyes when Dr. Little entered the room and told us that I may have Type 1 Diabetes.  In one minute I went from having to be comforted by my mother during every visit to having to comfort my mother.  Dr. Little had concern in his eyes; however, his concern was that I  would have  a hard  time  adjusting  to  giving  myself injections.

In that moment, I realized that this was something that was not going away.  So, instead of spending my time sulking over the way I thought things should have been, I used my time learning how I could make things better. As I became educated, my family became educated.  While my parents were there to help me, I knew that managing my diabetes was my responsibility.  Admittedly, I did not always take great care of myself.  There were (and still are) times when I did not feel like taking my blood sugar; I did not feel like having diabetes.  I just wanted to be a normal.  I enjoyed going to diabetes camp where out of 150 people all but five had diabetes. 

With time, I realized that slacking on my health meant slacking on my future.  This was a realization that was needed in order to get me through college.  Managing my diabetes meant allowing me to make it to class, to make good grades, and to be involved in many school and community organizations.  I left home to go to college.  Although my parents were supportive, they were concerned that I was moving away from them to a place where no one knew me and no one knew anything about diabetes.  Having diabetes affected everyone around me.  My roommates, classmates, and friends all learned something about diabetes from me.  My roommates tried not to seem scared; however, each of them feared the worst:  that I might have an insulin reaction and they would not know what to do.  I kept a flipbook with diabetes facts on my kitchen counter for everyone to read.  My goal throughout college was to educate those around me so that they would not be scared by this disease. 

I believe that the knowledge I received from Megan before being diagnosed helped me cope.  So, I gave my friends instructions as to what to do in case of an emergency as well as the names and phone numbers of family members as well as nearby fellow diabetics.  My dates were equally fearful.  They, too, received the same emergency information.  Although my friends cringed at the thought of giving me a shot, I urged each of them to give me insulin injections in order to prepare them for the possibility of having to administer the glucagon shot. 

As a child, I wondered why I was the only one in my family to have a disease often believed to be hereditary.  I believe that I have diabetes so that I may encourage others with this disease.  Diabetes is at times a burden, but, more so, it is a doorway to many friendships, a demand for responsibility, and an opportunity to educate others.  I am grateful to my family, Dr. Joseph Little, Dr. Revi Mathew, Dr. David Huffman, and friends for their support throughout the years.  Without their help, I might be defeated.  Instead, I am inspired to succeed.  

Marlita was born and raised in Murfreesboro TN, and recently graduated from the University of TN at Chattanooga with a Bachelor of Science in Biology. She looks forward to continuing her education in the fall of 2010, and is passionate about science.  She finds the medical field most intriguing, and enjoys learning about the latest in medical research.  Marlita says that people fear what they do not understand and she enjoys teaching people who do not have diabetes about diabetes. Much of her free time is spent exercising, cooking, and doing volunteer work, and her greatest enjoyment comes from working with youth. Marlita hopes to be a positive influence for children, just as the individuals who helped and supported her as a child.

 

Type 1 Diabetes Mellitus

Type 1 Diabetes Mellitus was once called insulin-dependent diabetes mellitus or juvenile diabetes, because it is commonly seen in young people. It is now simply called Type 1 diabetes mellitus, or T1DM, and it can occur at any age.

People with Type 1 diabetes are dependent on insulin replacement (by injection, insulin pump, or other external delivery devise) for life. They are unable to produce their own insulin because the pancreatic ß-cells that make insulin have been destroyed due to autoimmunity.

When people with Type 1 diabetes do not take insulin by injection or other means, their bodies are unable to transport glucose from the blood stream into the body cells for use as energy, and they begin to burn fat (lipid) stores. This rapid breakdown of fatty tissue causes a rise in ketones which can lead to an acidic state in the body, know as diabetic ketoacidosis or DKA. This highly acidic state causes an increased rate of breathing, excessive thirst and urination, lethargy, disorientation, and other metabolic changes that can rapidly lead to coma and death.

Type 1 diabetes accounts for about 5 to 10 % of diabetes in the United States.   

 

  Cool People Have Diabetes: Hillary & Kevin Eames

Kevin and Hillary EamesHillary: In 2009 I started my junior year. When lunch came, a group of sophomores planted themselves on our usual bench; right next to the statue we call the Purple Man.

I wasn’t that bothered. I like making new friends. I sat at Purple Man’s feet, directly below my best friend and a sophomore to whom I’d never spoken. Conversation got to rolling, my friend’s cookies had once again been stolen, and Purple Man’s silent, overshadowing presence gave our lunch an air of mystery. I pulled out my sandwich, an apple, and my Humalog pen.

“Anyone here scared of needles?”

No one was.  But I hate asking that question, especially because those who don’t know about my diabetes think I’m just awkwardly trying to start conversation. They understand once I’ve rolled up my sleeve and uncapped my insulin pen. My friends are fine with it, but there have been times a passer-by stared at my arm and the attached syringe. There have been times a class was interrupted because I was seen testing my blood. There’s the incessant “can you eat that?” as I reach for a friend’s cupcake or an ice cream cone. And one time I almost fainted during dance practice and had to send some poor freshman to retrieve my stash of juice boxes. Several times I’ve had to explain what it meant to have diabetes- that my pancreas can’t produce insulin, so I have to give myself what I need through shots. I’ve had to elaborate that my bloodsugar was high; that I myself was not wasted on drugs. And then there’s times where I’ve had to wait to eat lunch or dessert with my friends because I was running a 330 bloodsugar.

It’s not a horrible thing to have to live with. For one thing, I’m living with it. I can still dance and play hockey and go to parties and play improv. I can still eat, just not whatever and whenever I want. I can still sleep, even when it’s interrupted by a 3:00 AM low bloodsugar. And then there was the time a friend, after he found out I was had diabetes, mused about how “all the cool people have diabetes.”

Not a bad label to have, I suppose.

There have also been times a class was interrupted because I was seen testing my blood. There's the incessant "can you eat that?" as I reach for a friend's cupcake or an ice cream cone. And one time I almost fainted during dance practice and had to send some poor freshman to retrieve my stash of juice boxes. Several times I've had to explain what it meant to have diabetes- that my pancreas can't produce insulin, so I have to give myself what I need through shots. I've had to elaborate that my blood sugar was high; that I myself was not wasted on drugs. And then there's times where I've had to wait to eat lunch or dessert with my friends because I was running a 330 blood sugar.

It's not a horrible thing to have to live with. For one thing, I'm living with it. I can still dance and play hockey and go to parties and play improv. I can still eat, just not whatever and whenever I want. I can still sleep, even when it's interrupted by a 3:00 AM low blood sugar. And then there was the time a friend, after he found out I was had diabetes, mused about how "all the cool people have diabetes" . . . Not a bad label to have, I suppose.

 

Kevin: I was diagnosed with type 1 diabetes in 1965, when I was five years old. Having already successfully navigated the waters of potty training, I began to wet the bed again. I was always thirsty and always exhausted. A blood glucose test showed a blood sugar over 600 and my adventure with diabetes began. My earliest memories of having diabetes include watching my mother boil a glass syringe, having her give me injections, and doing urine tests with litmus sticks. I frequently had low blood sugars, which I referred to as being "cold and shaky." I must have had high blood sugars as well, since I don't remember making too many dietary changes after my diagnosis.

There are two overarching themes in my experience with diabetes: 1) A wonder that I am not dead, and 2) an ongoing interaction with medical technology. My childhood treatment, which actually extended past college, involved daily injections of regular insulin and infrequent urine tests. I had a healthy appetite and did not understand the difference between proteins, carbs, and fat . . . and I ate them all in generous quantities. In all those years of benign neglect (we just didn't know any better) I only went into ketoacidosis once.

I purchased my first glucose meter in 1982. It was a bulky thing that required some fancy maneuvering to use. However, at least I was now doing semi-regular blood glucose testing. I was also introduced to a new test called a hemoglobin A1C. Back then, blood sugars under 140 were considered good. I still have trouble not thinking that a blood sugar of 140 is OK, even though the literature has lowered the ceiling to 100.

In the mid 1990s, I went on a pump, which was good; and I developed some complications with my eyes that required laser treatments, which hurt. I'm not sure what motivated me to keep looking through the microscope-like lens so that the ophthalmologist could zap me, but I did. Perhaps the alternative of blindness was the prime motivator.

I was going blithely along with irregular exercise, poor diet, and high A1Cs when my heart revolted. A clot blocked a very narrow inferior artery one Saturday night (which I had no idea had narrowed) and I had a heart attack. They call these "cardiac events." When I think of events, I think of parties or conferences . . . menus, planning, live music, etc. I hardly associate these things with a heart attack . . . no menu, no live music, just several guys with stretchers asking me what day it was, and a doctor asking more questions in the ER. Angioplasty, a stent, and a week's hospital stay followed by a month's convalescence sobered me . . . along with all kinds of new medications for cholesterol and blood pressure. I dodged a bullet and began to recognize the seriousness of my disease and the necessity of taking better care of myself.

A further sobering event involved my oldest daughter. After having dinner in Nashville on our way to Atlanta, Hillary, who was then eight, began complaining about being excessively thirsty. All she wanted was water. With a sinking feeling in my stomach, I used my own glucometer to test her blood, and she was around 400 mg/dl. I was heart-broken and guilt-ridden. I had always been told that diabetes skipped a generation, but apparently no one told my daughter. Our return to Atlanta to sell a house now included a week hospital stay for her as she began adjusting to her new chronic illness. Now I had further motivation to set a good example for her, but I continued to struggle with blood sugar control and diet.

In 2006, I weighed 302 pounds (I'm 5'6") and my mobility was deteriorating. I had chronic pain in my back and knees and walked with a cane. Once again, I had reached a crisis point in my health and needed to intervene. I chose to get an adjustable lap-band, which facilitated a significant weight loss. The pain went away (for the most part) as did the cane. Better still, my A1Cs dropped dramatically, and for the first time I actually saw scores in the sixes. Around the same time, I added a continuous glucose monitoring sensor to my technological tool chest. This has provided the kind of real-time monitoring that enables me to keep a much better watch on my blood sugar.

I am enormously grateful for the technological advances that have both preserved and enhanced my quality of life. I am also continually reminded that the technology is only part of the picture; my state of mind, my motivation, and the strength I derive from a loving family, a strong faith, and a fulfilling career help me maintain a healthy balance between ignoring my disease and obsessing over it. My medical history is unfinished, and I am hopeful it will go on for quite awhile.

Hillary is a junior at Chattanooga Christian School, where she is actively involved in drama. She is very interested in the arts, and especially enjoys the visual arts of photography and graphic design. She has a passion for alternative rock music and enjoys reading and writing while listening. Hillary plans to attend Covenant College in the fall of 2011, where she hopes to major in Art or Literature.

Kevin holds a doctorate in Counseling Psychology from Georgia State University. He presently serves as associate professor and co-chair of Psychology at Covenant College, where he teaches courses in research, statistics, cross-cultural psychology, cognitive psychology, and the psychology of religion. Prior to coming to Covenant College and the Chattanooga TN area in 2003, Kevin was assistant professor of Psychology at Dordt College in northwest Iowa, where he collaborated with diabetes educators in the region to present seminars to professionals and patients on ways to better cope with and manage stress. In addition to academic publications, Kevin has written a patient's guide to diabetes and high blood pressure. His interests include reading and classical or ambient music. . . And he prefers to avoid the alternative rock that his daughter enjoys! 

 

Risk of Type 1 Diabetes Mellitus

Type 1 diabetes occurs equally among males and females, and is more common in whites than in nonwhites. Although the cause of Type 1 diabetes is not known, research indicates that genetic and environmental factors work together in triggering the immune system to destroy insulin producing ß-cells. Relatives of people with Type 1 diabetes are at a 10 to 15 percent greater risk for developing the disease.

Screening tests can be done to see if a person has autoantibodies associated with a risk of developing Type 1 diabetes. The presence of these autoantibodies indicates that a persons’ immune system may be attacking the insulin-producing cells of their pancreas, and potential risk for developing Type 1 diabetes.

If someone in your family has Type 1 diabetes, you may be at risk. Clinical research is being done to determine ways of preventing the autoimmune attack that destroys insulin producing ß-cells in people who are at greatest risk. Natural history studies help researchers identify at risk populations so they can closely monitor environmental factors which may contribute to the onset of Type 1 diabetes.

People who are newly diagnosed with Type 1 diabetes (within 3 months of diagnosis) may want to consider participation in clinical trials of promising treatment options that may prevent total destruction of insulin producing ß-cells.  

More information regarding Type 1 diabetes research is available at the following links:

JDRF: Juvenile Diabetes Research Foundation

Type 1 Diabetes TrialNet

Protégé Research to Protect Beta Cells 

 

 

Tool Box

  

What is Diabetes? Novo

Type 1 Diabetes: NIH Medline Plus

Diabetes Mellitus Type 1: UpToDate for Patients

Diabetes and Autoimmunity: Diabetes Health

National Diabetes Fact Sheet: 2007