At seventeen-years-old, my sister, Rachel, was attending college in our hometown. She timed her entry to campus buildings with the movements of other students, as she was too weak to open doors herself. She had lost weight and slept all the time. When she finally went to the doctor, she was diagnosed with Type I Diabetes.
A non-diabetic person has blood sugar levels ranging from 80-130 mg/dl. At 180, you begin to experience the classic symptoms of diabetes: extreme thirst, frequent urination, fatigue, dry skin. Rachel’s sugars were over 600 mg/dl. She was admitted to the hospital for immediate treatment.
When you eat carbohydrates, your body turns them into glucose. Insulin is a hormone that allows glucose to be used by the cells of the body for energy. It’s frequently described as the key that unlocks the door to the cell to allow sugar in. Type I Diabetes occurs when, for unknown reasons, the immune system attacks and kills the cells of the pancreas that produce insulin. Without insulin, sugar builds up in the blood stream and the body begins to burn fat for energy instead of sugar, producing an acidic substance called ketones. The build up of ketones is known as ketoacidosis and, if left untreated, it is fatal.
At nineteen, my sister developed her own strategy for dealing with diabetes. She didn’t exactly like having to give herself shots all day, so she decided to take only a daily shot of long-acting insulin and forgo eating carbs of any kind. Needless to say, this strategy didn’t work so well. She kept losing weight and her hair began to fall out. One day she found herself vomiting uncontrollably with what she thought was food poisoning but was really ketoacidosis. She passed out in the bathroom and was taken to the hospital in a diabetic coma. Happily, she recovered.
Before insulin therapy was discovered in the 1920s, Type I Diabetes was a death sentence. Most patients lived less than a year after diagnosis and most of the victims were children (Type I is sometimes referred to as Juvenile Onset Diabetes). Diabetes treatment has come a long way since then. While the first blood glucose meters were as large as a backpack, modern meters fit in your pocket. There are several choices for insulin delivery (insulin must be injected, as it doesn’t fair well against stomach acids): syringes, pens or even pumps. Today, my sister wears an insulin pump, which delivers a steady dose of insulin through the day, and extra insulin at mealtimes.
As long time readers of this blog know, I also have diabetes. I was diagnosed with Type II Diabetes in June 2009. However, I don’t exactly fit the profile for Type II. Type II is categorized by insulin resistance. When a person eats too many carbohydrates, the body counters by over-producing insulin, and over time, cells become resistant to insulin, causing blood glucose levels to rise. Most Type II Diabetics are over forty and overweight. I was thirty-three when I was diagnosed, and not overweight. After diagnosis, I saw a nutritionist and began to limit my carbohydrate intake and increase my exercise, I was able to bring my glucose levels down.
However, recently, my sugars have been on the rise, despite my efforts.
There is a test for blood glucose called the A1C. It measures the amount of glucose that has attached itself to hemoglobin cells and provides an average glucose level of the last 2-3 months. The A1C results is represented as a percentage, a non-diabetic person has an A1C of 5% or less. Diabetes is diagnosed at a level of 6.5% and up. Last spring, my A1C was 5.85% — a good number that made me feel smug about my stellar efforts at Diabetes management. In November, it was up to 6.5%. I began testing regularly and was alarmed that my sugars were much higher than I thought.
I asked my doctor to put me on an oral medication called Metformin. It seemed to bring my sugars down, so after a week, I stopped my frequent testing and went back to my doctor’s recommendation of testing only a few times a week. But something was still bothering me. I had read an article about Latent Autoimmune Diabetes in Adults or LADA. It’s basically Type I, but instead of getting it in childhood, it happens in adulthood. People with LADA don’t fit the typical Type II profile, they are relatively young and active. The chances of LADA are increased if the patient has a family history of Type I or other autoimmune diseases.
A few weeks ago, during an office visit for a sinus infection, I asked my doctor for a referral to an endocrinologist, a doctor who specializes in hormonal conditions such as diabetes. My doctor assured me that the chances of my having LADA were slim, as the oral medicine I had been taking would not be working if I had LADA. But he gladly wrote me the referral.
I almost didn’t go. I felt like maybe I was over-reacting, or being a hypochondriac. But I went anyway, partly because I wanted to treat my diabetes as aggressively as possible to prevent kidney damage (as I only have one) and partly because my big brother told me to.
As the endocrinologist and I began our chat, I mentioned that I had been worried about LADA.
“I think that’s exactly what’s going on,” she said. She was gentle but honest. She told me it was just a matter of time — and not very much time — before I would need to begin taking insulin. The beta cells of my pancreas were steadily being destroyed by my immune system and I wouldn’t be producing insulin for much longer. She explained that in the early phases of the disease, glucose levels can be brought down by diet and exercise and oral medications because my body was still making some insulin, but the progression is inevitable. She wanted me to get used to the idea of taking insulin and meet with a diabetes educator to practice giving myself injections.
She ordered another A1C test, even though I had just had the test just a month ago. My number had jumped from 6.5% to 7.4% even with medication and increased diligence. With that result, she told me I’d have to begin insulin immediately. I would start with a shot of long acting insulin once a day and begin testing my glucose level four times a day. She wanted me to send her my levels in a week and see me again the week after that.
That night, Ben went to the pharmacy to pick up my supplies. He and Nora bought me two huge bouquets of flowers. Before bed, I gave myself my first shot in the abdomen. It didn’t hurt. The next morning, my fasting glucose level, always too high for my liking, was actually in the normal range.
I cried at least a little everyday for the first five days. But really, I’m quite lucky. Relative to many diabetics, my glucose levels have stayed low. And we caught the LADA before my pancreas had shut down altogether. If circumstances had been slightly different, diagnosis may have come only after a bout with ketoacidosis.
Over Christmas, I traveled to Minnesota where my sister lives and she showed me the ins and outs of her insulin pump and I showed her my phone, where I obssesively track my carbs, meds and blood sugar levels. (There’s an app for that!)
“Is it true some people have diabetes that’s harder to control?” I asked. I inherited a fear of the worst from my father.
She was encouraging, “You can handle the most bitch-ass diabetes ever.”
Likewise, my endocrinologist told me, “You can do anything anyone else can do, it just takes more planning and more work.”
Good thing I’m a bitch-ass good planner and hard worker.
Which leads me to my New Year’s Resolution. I’m not so worried about my ability to manage my diabetes. What I want to work on is the stress associated with it. Management and worry need not go hand in hand. Rachel’s husband, my brother-in-law, put it best. There will be times when I will feel down, out and frustrated by this chronic disease, at those times, the best way through it is to embrace it. I have the tools to live a long and healthy life, I may as well relax and enjoy it.
Happy New Year, friends. May the year to come bring you blessings that you fully realize.