Tuesday, October 12, 2010

About the 'betes

Sorry about the long time period period between posts.  With graduate school, working full time, training and an extra job working a few events on the weekends sometimes I just don't want to spend the time on the computer writing.

My cousin Chris sent me an interesting email this last week.  He congratulated me on writing the blog and the training but said he doesn't always understand the 'betes part.  This got me thinking, sometimes I just throw out terms and talk about diabetes as if everyone knows what I am talking about.  A lot of times, my close family members don't even understand what I am talking about.  Although 'betes is a lot like riding bike, meaning I can explain to you how to ride a bike but you'll never fully understand until you try to actually ride the bike, I can hopefully assist in your understanding of it. 

Type 1 Diabetes is (Diabetes Mellitus Type 1, also know as Juvenile Diabetes) is simply when your body does not produce insulin from the pancreas.  At some point a person with type 1 diabetes had their immune system attack the pancreas and destroy it's ability to produce insulin, which in a non-diabetic controls the level of glucose in the blood stream.  As stated by my friend Blair Ryan, another type 1 athlete, "my body is so strong it can simply take out an organ".

This is all completely different from Type 2 Diabetes (Diabetes Mellitus Type 2), which is a metabolic disorder.  A person with this disorder has a functioning pancreas but their body is resistant to insulin.  Simply put, a type 2 diabetics body does not accept the insulin.  This can be treated by exercise and managing diet and sometimes pills or insulin.  Juvenile diabetes (type 1) is when the body attacks the pancreas from no fault of the person.  It really upsets me and other type 1's when people confuse the two, they shouldn't even have the same name. 
Since my body and the body of anyone with type 1 diabetes does not have the ability to produce insulin, we take insulin to regulate the level of glucose in the blood system.  The easiest way to describe this is the riding the bike analogy.  Lean to much to one side, you fall over, lean too far to the other side, you fall over, you need to be somewhere in the middle.

A person with a functioning pancreas typically has a blood glucose (also known as blood sugar) somewhere between 75-120.  When a person without diabetes wakes up in the morning, their blood sugar will be on the lower end and after eating on the higher end of 120.  There are many ways to treat the diabetes; shots, the pump, there are even oral insulins now.  Personally, to control my 'betes I use the pump.  I feel this is the best way because I can live a much more "normal" life.  I describe the pump much like a manual car, a nondiabetic drives an automatic, I drive a manual.  This is better in my mind than the old horse and carriage of giving shots.

The pump gives me a "balas rate" throughout the day, a prescribed amount that drips through the tubing of the pump all day.  The "infusion set" or needle at the end of the tubing of the pump is changed every three to four days (if you work for the FDA I promise I change it every three days, which they require).  This "needle" however is actually just tubing in the body that moves with the skin, I don't even feel it.  When I change the infusion set, I change the insulin, which otherwise would go bad because due to the heat of the body (insulin goes bad in heat).

There are many types of insulin, however in the pump I use a type called Novolog.  It acts within about ten (10) minutes of hitting the fat cells the tubing sits in.  When I eat, I give myself a "bolus", meaning a dose of insulin for the amount of carbohydrates I eat.  This is one of the common mistakes nondiabetics make about diabetes, diabetics don't measure the amount of sugar in food, we measure the amount of carbohydrates.  Personally, in the morning I use a ratio of 1:1, meaning if I eat ten (10) grams of carb, I give myself one full unit (1.0) of insulin.  This amount changes to around 1.5:1 later in the day when the insulin becomes more active as the body awakens.  All diabetics are different though, everything depends on height/weight, level of fitness, level of activity, sensitivity to insulin, everyone is different.

Now with the pump most people ask "o so that takes your blood sugar too".  No.  This has to be done separately.   Basically I take my blood glucose with a glucose meter (prick my finger), figure out my level (hopefully between 80-120) then make corrections if my levels are too high (give insulin, a bolus) or eat carbohydrates if it is low (below 80).  The bolus (giving insulin) always takes into consideration both the correction factor and the carbohydrates I eat.  There are also devices known as a CGM (continuous glucose monitor), this measures your blood sugar from fat cells so there is lag time.  This is like being the back car in a roller coaster, as the first call goes over the hill, the back car doesn't feel it yet (meaning the diabetic must still take their blood sugar from their finger).  



What many also do not understand is that there are many factors a type 1 diabetic has to take into consideration when checking blood glucose levels and giving a dose of insulin.  Factors such as stress, illness and adrenaline must all be taken into consideration.  One of the best examples I have heard about adrenaline affecting blood glucose levels is through my friend Peter Nerothin who started InsulinDependence.  When he did his first Ironman, he exited the swim with a blood glucose of 120, after only 45 minutes on the bike his level was around 450.  It's literally almost impossible to have an increase happen that fast, he later found out from another diabetic Ironman that it happened because of adrenaline.  

Stress levels affecting blood glucose is one of the major reasons I love exercising.  With exercise my stress levels are much more under control.  The exercise then allows my body to require much less insulin as I have talked about in previous discussions.  Exercise is literally the most important thing in my mind in controlling my blood glucose.

The final point I would like to make is that many people believe a diabetic person is limited.  This is absolutely not true.  Currently, three diabetics have scaled everest, diabetics have ran a 9:07 Ironman and previously won an Olympic Gold Medal.  These are things the average population without diabetes can only dream about.  I had a diabetic friend once tell me "if you aren't type A, diabetes will make you type A".  I'd like to think that's what drives me, that the 'betes actually makes me better than I otherwise would have been without it.   


My friend Blair Ryan has also written a similar blog to this one, explaining how the 'betes works and exercise.  To learn more about the 'betes and exercise please read her blog here.

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