Diabetes 101

Though I am new to this particular blogging site, and have only provided my new audience with a small taste of what's to come, already I've had need of time away. I'm a type 1 (juvenile) diabetic, of about forty years now. This has cost me my sight in one eye, and threatens the other. There are things that I have thought upon many times in my life, I have learned things about, and have my own observations of. If for no other reason than simply to survive, I've studied diabetes of most types for a long, long time. Let me educate you on these various conditions known as "diabetes", maybe dispel some myths, and share what I've found to be true. The very fact that I can type at all right now is due to a very large monitor, Mac intelligence, a slight remission from the bleeding in my eyes and a large print keyboard. So – welcome to my world. Let's go.

Diabetes, being used as a generic term, is the inability to process glucose (sugar), the body's fuel. There are generally two reasons for this: either insulin resistance, or low (or no) insulin production. But understanding the basic function of insulin is necessary here. Imagine the cells of your body as houses – different kinds of cells means different kinds of houses, but in both cases, each have some common needs and attributes. The fuel that runs your house is glucose. The veins and arteries are the roads for delivery of fuel and other goods, which the houses must have to operate. Insulin is the key that unlocks the fuel door, similar to the one on your car. So imagine – you run out of fuel for your house, the fuel is brought to you via the roadways, but you lost the key to open the fuel lock! Your home runs out of fuel (dies) and the infrastructure must deal with the excess fuel clogging the roadway. This is, of course, a very simplistic rendering and hardly exhaustive. For instance: there is a phenomenon known as "caramelization". This is the effect of combining heat, oxygen, sugar and time. If any of the components in this formula are increased, you see the effect more rapidly. For instance: take whipped cream and apply a flame – instant caramelization (the browning of the surface). This condition occurs to our internal organs, too. So if I ran an incredible temperature, or had more sugar in my blood stream (which I do) then the process of "browning" occurs faster – artificial aging, if you will. And obviously, increased time increases the effects. Less oxygen would seem to help, but upon further consideration, seems to be a poor idea. Antioxidants do help though. But this browning is lethal.

Now I want to focus on a particular type of diabetes – what used to be called juvenile diabetes, because the majority of the victims are children when it is first contracted. Today it's known as type 1 diabetes. Type 2 diabetes is a condition where the patient produces some insulin, but either it's too little for the demands or the body has developed an insulin resistance. The pancreas has limits to it's production, so a person's size can be a factor. The organ was only designed for so many years, too, so age often is a factor. Oral pills which possess a pancreatic stimulant usually postpone or eliminate the need for insulin injection or infusion in these people (as will weight reduction among the overweight). But I have the more lethal type 1. More lethal because type one is a complete lack of insulin production. Now this group can be subdivided even further; I'll explain, and then move on. Your pancreas produces insulin, and some other fancy chemicals that allow you to survive. If you were to be impaled and it damaged that part of the pancreas (known as the Islets of Langerhan) that creates insulin, then you'd have type 1 diabetes, no matter what your age. There is gestational diabetes, which is caused by a woman's baby leaning on or kicking the pancreas. This can be temporary, resolving after birth, or it can be permanent. But some such as I appear to have a genetic component that tells our own immune system that our own pancreatic tissue is a foreign tissue. As it turns out, pancreatic tissue is the most rejected tissue among transplants. As a person who makes no insulin, my survival requires injection or infusion of insulin, constantly. And all the same, it's just avoiding the inevitable. Not that I'm giving up, mind you – it's just that living and survival can be greatly separated at times. This can be a most difficult life to lead.

I've seen every sort of method for controlling this disease, and could bore you with stories of crazy theories and whatnot, but instead, let's cut to the most modern of techniques. Currently, a blood test via a finger stick is the best way of getting current glucose data. The elusive non-invasive scanner with no blood draw simply does not exist yet. We used to study the urine, but that was idiotic as urine would have the glucose values of hours and hours, all mixed together. Today there are what's known as continuous glucose monitoring systems – far too expensive for the average person to utilize yet, but when the price comes down (which it will), this is a critical step in better control. Better control puts off or eliminates the risk of blindness, kidney failure, heart disease, and a long list of circulatory and neurological issues. Insulin pumps replace shots, and are programmable, something NO shot can achieve. Another revolutionary step in control. The old methods used insulin with efficacy curves, and you tried to match your exercise and eating patterns with the curves. This was poor control at best, and dangerous for some, such as myself, whose glucose levels seem to be sensitive, with frequent spiking. I'm currently on my third insulin pump, and removal because of insurance purposes (actually, lack thereof) cost me my right eye last time, in that my glucose levels directly affect the eye condition I have. Which brings up the next topic.

Today I face kidney failure in the near future. Any condition where the treatment centers have "end of life coordinators" is a place to avoid. Such are dialysis centers. I've developed a condition called diabetic retinopathy, where the circulation in the eye drops due to circulatory loss from sugar buildup over decades. The eye, being oxygen intensive as far as body parts go, sends out a call to the main system to create new roadways to bring in more oxygen. Enter the new veins, or neovascularization. These new veins are inherently defective, and rupture, bleeding into the vitreous humor. This is basically bleeding into the clear liquid that inflates the eye, blocking my vision with blobs of blood floating in my field of vision. The current treatment is painful, but it seems to be slowing the progress of the condition in one of my eyes, anyway. The surgeon burns a scar on the inside of my eye with a laser, all along the perimeter, destroying my peripheral vision (and some night vision properties). But scar tissue has nearly no oxygen demands, meaning that the new vein production should stop for awhile. It is NOT a permanent fix. But this is the only time I've ever let someone poke me in the eye with syringe needles while I watched! Then there's the pump. Life on the pump, vs life on multiple injections, is a breeze by comparison. You just have things like making sure that you don't snag the tubing on door handles and such – not anywhere near the problems of the past. Nonetheless, I nearly died of an insulin overdose shortly after moving to Washington State in January. It still has problems, and there are still things which we don't yet understand. For instance – one of the things that modern "smart" pumps do is decide your dosage depending upon how much insulin may still be in you from earlier activities, such as eating. The rule is that there's just one value of how long it takes to process any given dosage, when my experience shows that it's a function of the size of the dosage, and perhaps the ambient temperature as well. In time, we'll get it better.

So there it is, in brief. The struggles that accompany diabetes are many. When you see a picture of me, I appear as a (somewhat) normal person, so telethons have traditionally be failures at raising money for finding a cure. I may never know life without this. I can only hope that I'm one of the last.

John