Type 1 Diabetes For Dummies E-Book

Alan L. Rubin

• Herausgeber: John Wiley & Sons
• Kategorie: Ratgeber
• Sprache: Englisch

Seitenzahl: 574

Veröffentlichungsjahr: 2011

Beschreibung

Learn how to manage Type 1 diabetes for a healthier and happier life! Whether you have been living with type 1 diabetes for some time, or you have just discovered that your child is diabetic, there's a lot you need to know about the new developments in treating, controlling, and living with this disease. Type 1 Diabetes For Dummies, explains everything you need to know and do to make living with type 1 diabetes easier and healthier. This reassuring, plain-English guide helps you understand and mange the disease with tips on working with your doctor, administering insulin, developing a diet an exercise plan, and coping with illness and travel. You'll find out about the latest technologies of blood glucose monitoring and insulin delivery, and get a handle on everything you need to do to keep yourself or your child healthy, active, and feeling good. Discover how to: * Overcome short-term complications * Eat a diabetes-friendly diet * Use exercise to help control type 1 diabetes * Handle school, work, and other activities * Help your child maintain a high quality of life * Prevent long-term complications * Be healthier than your friends who don't have diabetes * Deal with the emotional and psychological effects of the disease * Choose an insulin pump for yourself or your child * Calculate insulin dosages Anyone can live a long, healthy, and productive life with type 1 diabetes. Small Type 1 Diabetes For Dummies delivers every drop of information you need to make sure that you or your child can do just that.

Leseprobe

Type 1 Diabetes For Dummies®

by Alan L. Rubin, MD

Type 1 Diabetes For Dummies®

Published byWiley Publishing, Inc.111 River St.Hoboken, NJ 07030-5774www.wiley.com

Copyright © 2008 by Wiley Publishing, Inc., Indianapolis, Indiana

Published simultaneously in Canada

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LIMIT OF LIABILITY/DISCLAIMER OF WARRANTY: The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by physicians for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom.

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Library of Congress Control Number: 2007943299

ISBN: 978-0-470-17811-9

Manufactured in the United States of America

10 9 8 7 6 5 4 3 2 1

About the Author

This is the fifth For Dummies book byAlan L. Rubin, MD. His previous books, DiabetesFor Dummies,Diabetes Cookbook For Dummies,Thyroid For Dummies, and High Blood Pressure For Dummies (all of which are now in second editions), have been major successes. Letters of praise from numerous readers verify the important role that Dr. Rubin’s books have played in their lives. The books have been translated into seven languages and adapted for readers in the United Kingdom, Canada, and Australia. Each of Dr. Rubin’s For Dummies books provides the latest information on every aspect of its subject while being written in an easy-to-understand format that’s full of humor and wisdom.

Dr. Rubin has practiced endocrinology in San Francisco since 1973. He teaches doctors, medical students, and nonprofessionals through classes, lectures, and articles. He has appeared on numerous radio and television shows to answer questions about diabetes, thyroid disease, and high blood pressure. He also serves as a consultant to many pharmaceutical companies and companies that make products for patients with high blood pressure.

Dr. Rubin discusses many health issues in audio “Healthcasts” that may be downloaded at his Web site, www.drrubin.com.

Dedication

This book is dedicated to my new granddaughter Eliana, the beautiful child of my daughter Renee and my son-in-law Marty, who was born on April 9, 2007, just as this book was being born. It is my fervent hope that she will never need the knowledge contained here, but if she should, I hope that it contains everything that she needs to know to live a long, healthy life free of the complications that make life difficult for so many people with diabetes. Eliana: Read this book carefully if you have to. I have tried to include all the available knowledge of this subject that you and your parents need. This book is the answer to the question, “If your granddaughter had diabetes, which book would you recommend?”

Author’s Acknowledgments

I wish to thank the numerous people at Wiley Publishing who have made this and all my books such a pleasure to write. The wise people at Wiley understand that type 1 diabetes is, in many ways, a different disease from type 2. Hence the need for this book. It has always been a pleasure to work with my friend Kathy Nebenhaus, Vice President and Executive Publisher of Professional and Trade Publishing at Wiley. Vice President and Publisher Diane Steele has been a valuable resource for the writing of this and all my books. Acquisitions Editor Michael Lewis served as my advocate as we smoothed out the many details that have to be agreed upon before such a project can begin. Project Editor Georgette Beatty offered valuable suggestions and questions that hopefully make this book more understandable and useful to the reader. Copy Editor Elizabeth Rea made sure that my words, my sentences, and my paragraphs followed the rules of the English language. The Technical Editor for this book, Rattan Juneja, MD, checked everything that I wrote so that you, the reader, may be certain that you can trust everything you read to be consistent with modern medical practice. Many other unnamed people are involved from the people who publicize the book to those who take the orders to those who ship out the books. Finally, the booksellers who put the book in your hands deserve my major gratitude. Every one of you is an essential cog in a beautifully running machine.

Publisher’s Acknowledgments

We’re proud of this book; please send us your comments through our Dummies online registration form located at www.dummies.com/register/.

Some of the people who helped bring this book to market include the following:

Acquisitions, Editorial, and Media Development

Project Editor: Georgette Beatty

Acquisitions Editor: Michael Lewis

Senior Copy Editor: Elizabeth Rea

Editorial Program Coordinator: Erin Calligan Mooney

Technical Editor: Rattan Juneja, MD

Editorial Manager: Michelle Hacker

Editorial Assistants: Joe Niesen, Leeann Harney

Cover Photo: Daniela Richardson

Cartoons: Rich Tennant (www.the5thwave.com)

Composition Services

Project Coordinator: Patrick Redmond

Layout and Graphics:

Contents

Title

Introduction

About This Book

Conventions Used in This Book

What You’re Not to Read

Foolish Assumptions

How This Book Is Organized

Icons Used in This Book

Where to Go from Here

Part I : Defining Type 1 Diabetes

Chapter 1: Dealing with Type 1 Diabetes

Understanding What Type 1 Diabetes Is (and Isn’t)

Handling the Physical and Emotional Consequences of Type 1 Diabetes

Treating Type 1 Diabetes Effectively

Living Well with Type 1 Diabetes

Chapter 2: Recognizing Type 1 Diabetes

Understanding How Type 1 Diabetes Works

Checking Out the Statistics on Who Gets Type 1 Diabetes

Making a Diagnosis of Type 1 Diabetes

Chapter 3: Excluding Other Types of Diabetes

Distinguishing Type 2 and Latent Autoimmune Diabetes from Type 1 Diabetes

Delving into Diabetes Caused by Other Diseases and Agents

Part II : Considering the Consequences of Type 1 Diabetes

Chapter 4: Overcoming Short-Term Complications

Managing Low Blood Glucose: Hypoglycemia

Dealing with Very High Blood Glucose: Diabetic Ketoacidosis

Chapter 5: Preventing Long-Term Complications

Focusing on Eye Disease

Coping with Kidney Disease

Knowing about Nerve Disease

Macrovascular Complications: Protecting Your Heart

Considering Associated Diseases

Chapter 6: Handling Emotional Effects

Coming to Terms with the Diagnosis

Realizing that Type 1 Diabetes Is a Family Disease

Handling Issues of Self-Esteem

Maintaining a High Quality of Life

Part III : Treating Type 1 Diabetes

Chapter 7: Undergoing Essential Tests and Monitoring Blood Glucose

Doing Key Tests at the Doctor’s Office

The Basics of Testing Blood Glucose at Home

Selecting a Home Blood Glucose Meter

Chapter 8: Eating a Healthy Diet

Carbohydrates: The Energy Source with the Biggest Impact on Blood Glucose

Looking at Other Sources of Energy

Getting Enough Vitamins, Minerals, and Water

Understanding Diet Challenges at Every Age

Focusing on Other Food Factors

Handling Eating Disorders

Chapter 9: Exercising to Improve Control of Type 1 Diabetes

The Benefits of Exercise for People with Type 1 Diabetes

Taking Care Before Starting an Exercise Program

Developing (And Sticking to) an Exercise Plan

Chapter 10: Understanding the Basics of Using Insulin

The Purpose and Types of Insulin

The Details of Insulin Doses

Injecting Insulin

A Major Advance: Inhaled Insulin

Chapter 11: Delivering Insulin with a Pump

Keeping a Few Considerations in Mind before Using an Insulin Pump

Using an Insulin Pump Properly

Checking Out Various Insulin Pumps

Chapter 12: Getting a Grip on Other Drugs and Treatments

Boosting Insulin’s Effect: Pramlintide

Surveying Different Treatments

Drinking Alcohol Safely

Avoiding Dangerous Drugs

Chapter 13: Surveying Kidney, Pancreas, and Pancreatic Islet Transplants

Receiving a New Kidney

Getting a New Pancreas (Alone or with a New Kidney)

On the Cutting Edge: Pancreatic Islet Transplantation

Dealing with Continuing Issues after Any Transplant

Finding More Information Online

Part IV : Living with Type 1 Diabetes

Chapter 14: Adjusting to School, Work, and Other Activities

Dealing with Diabetes in School

Living with Diabetes as a Working Adult

Driving Safely with Type 1 Diabetes

Tackling Insurance Issues

Chapter 15: Managing Illness and Travel

Dealing with Sick Days

Traveling with Type 1 Diabetes

Chapter 16: Going through Pregnancy and Menopause

Understanding Normal Female Sexual Development

Controlling Type 1 Diabetes before Conception

Ensuring a Safe Pregnancy and Delivery

Dealing with Type 1 Diabetes during Menopause

Chapter 17: Controlling Type 1 Diabetes in the Elderly

Making a Diagnosis

Recognizing the Challenges of Managing Type 1 Diabetes in the Elderly

Effectively Treating Type 1 Diabetes in the Elderly

Checking Out Resources for the Elderly with Type 1 Diabetes

Part V : The Part of Tens

Chapter 18: Ten Ways to Involve Kids in Their Own Diabetes Care

Set Some Goals for Care with Your Child

Show Your Child How to Test His Blood Glucose

Shop for Food Together

Plant a Garden Together

Have Your Child Help with the Cooking

Exercise as a Family

Show Your Child How to Administer Insulin

Plan a Trip Together

Have Your Child Do Household Chores

Encourage Your Child to Play Video Games (Really!)

Chapter 19: Ten Commandments for Good Diabetes Management

An Affirmative Attitude

Total Testing

Extraordinary Eye Care

Foolproof Foot Care

Mega-Monitoring

Dedicated Dieting

Emphatic Exercising

Mindful Medicating

Planning for Potential Problems

Lifelong Learning

Chapter 20: Ten Myths about Type 1 Diabetes

No Symptoms of Type 1 Diabetes Appear before Damage Has Occurred

Type 1 Diabetes and Type 2 Diabetes Are the Same

You Can’t Eat Sugar with Type 1 Diabetes

You Have to Eat Special Foods When You Have Type 1 Diabetes

If You Take Insulin, You Must Have Type 1 Diabetes

Insulin Causes Atherosclerosis

Insulin Cures Type 1 Diabetes

You’re More Prone to Illness When You Have Type 1 Diabetes

Women with Type 1 Diabetes Shouldn’t Get Pregnant

Doctors Are Hiding the Cure for Type 1 Diabetes So They Can Make More Money

Chapter 21: Ten of the Latest Discoveries in Type 1 Diabetes

The Development of the GAD Vaccine

The Possible Prevention of Type 1 Diabetes with Oral Insulin

The Possible Prevention of Type 1 Diabetes with Intranasal Insulin

The Study of Continuous Glucose Monitoring

Contact Lenses That Indicate Your Glucose Level

A Drug to Fight Diabetic Neuropathy

Drugs to Block the Immunity That Kills Beta Cells

The Regeneration of Beta Cells with a Protein

The Infusion of Stem Cells

The Use of Cord Blood to Regenerate Beta Cells

Part VI : Appendixes

Appendix A: Glossary

Appendix B: Resources for the Latest Information

My Web Site

General Web Sites

Government Web Sites

Companies That Make Diabetes Products

Recipes for People with Diabetes

Web Sites for Diabetes Complications

: Further Reading

Introduction

Although they have the same names (but different numbers), type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) are not the same disease. They share many features, especially the consequences of not controlling the blood glucose (sugar): microvascular complications like eye disease, kidney disease, and nerve disease; and macrovascular complications like heart disease, stroke, and obstruction of blood vessels, especially in the legs and feet.

The big difference is that T2DM is a lifestyle disease; T1DM is not. What exactly does that mean?

Type 2 diabetes is very often preventable by maintaining a normal weight and doing lots of exercise. And diet and exercise go far in preventing complications of the disease.

Diet and exercise can’t prevent T1DM or its complications. The big difference can be summed up in a single word: insulin. This chemical, present in T2DM for long after the disease begins, is partially or completely absent in T1DM from the beginning. T1DM can be cured by restoring insulin so that it’s available to the exact extent as in a person who doesn’t have diabetes. (Not that food intake and exercise are unimportant in T1DM. But whereas most people with T2DM are middle-aged, heavy, and sedentary, most people with T1DM are young, lean, and active, at least at the time of diagnosis.)

One important fact is true of both types of diabetes: At the present time, although there’s not a cure for either type, drugs and equipment are available to control the disease in such a way that your child need never suffer from long-term complications if you’re willing to take the time and put forth the effort to make this happen. In fact, your child may grow up to be healthier than friends without diabetes if you follow the recommendations in this book.

About This Book

Each chapter in this book is self-contained, like a short story. That way you can go just where you want and read just what you want. This book isn’t meant to be read from cover to cover, although I can’t stop you if that’s how you want to approach it. You may even want to do that the first time around, and then use it as a reference whenever you want to brush up on a particular subject. If you feel there’s an important issue that I haven’t addressed or that needs more discussion, please e-mail me at [email protected].

The subject of diabetes is vast and gets larger daily. Don’t believe me? I have an automated update that brings me new articles about diabetes from the National Library of Medicine, and I get three to five new articles every day! This book contains the most important information available on the subject of T1DM, but it can’t contain everything. For more on the subject, check the references that I supply at my Web site, www.drrubin.com, by clicking on Diabetes under Related Websites on the home page.

A characteristic of the For Dummies series is the use of humor. Readers of my previous books, Diabetes For Dummies,Diabetes Cookbook For Dummies, Thyroid For Dummies, and High Blood Pressure For Dummies, know that I use humor to get my point across. You may think that there’s nothing funny about diabetes, and you’d be wrong. Many patients have sent me humorous stories about their experiences, which I’ve included in previous books. If you have a funny experience associated with your diabetes, please e-mail it to me at [email protected].

One important note about the use of this book: Please don’t make any changes in your child’s treatment (or your own, if you’re the patient) based upon what you read in this book without discussing them with your doctor. He or she may have very good reasons, based upon your child’s particular situation, for doing something different from what I recommend here. This is exactly the reason I never offer specific advice to people who e-mail me the details of their disease without giving me the opportunity to question them, examine them, and do the tests I feel are appropriate.

Conventions Used in This Book

This book is meant to be read and understood by the non-physician. Therefore, I try to keep scientific terminology to a minimum. Where I must use it, I explain it clearly, and you can also look it up in the glossary at the end of the book. I can’t avoid the terminology completely because I want you and your doctor to speak the same language. You should clearly understand the reasons behind everything he recommends, so don’t hesitate to ask questions and quote chapter and verse from this book.

In order to save keystrokes, I use some abbreviations throughout the book. The main ones are “T1DM” for “type 1 diabetes mellitus” and “T2DM” for “type 2 diabetes mellitus.” You can find these and any others in the book in the glossary. How did these names come about? Good question! People used to refer to diabetes in young people as “juvenile diabetes.” In the past, “juvenile diabetes” was understood to mean diabetes due to a lack of insulin, but several years ago, the American Diabetes Association recognized that one result of the epidemic of obesity is the occurrence of T2DM in many juveniles. In addition, a lack of insulin often occurs in adults. Therefore, they changed the name from “juvenile diabetes” to “type 1 diabetes mellitus.” T1DM refers to the condition of any patient whose diabetes is due to insulin lack at the very beginning.

Because many T1DM patients are children and young adults, I’ve geared this book toward parents and caretakers; for the most part, when I say “you,” I’m speaking to someone who’s caring for a patient. However, adults with T1DM can still apply the information in this book to their own lives; in fact, several topics throughout the book are directed specifically toward adult patients (such as the work and driving information in Chapter 14).

Here are a few more conventions to guide you through this book:

Italic points out defined terms and emphasizes certain words.

Boldface highlights key words in bulleted lists and actions to take in numbered steps.

Monofont indicates Web addresses.

When this book was printed, it may have been necessary to break some Web addresses across two lines of text. If that happened, rest assured that I haven’t put in any extra characters (such as hyphens) to indicate the break. So, when using one of these Web addresses, just type exactly what you see in this book, pretending that the line break doesn’t exist.

What You’re Not to Read

Shaded areas called sidebars contain material that’s interesting but not essential to your understanding. If you don’t care to go so deeply into a subject, skip the sidebars. You won’t be at any disadvantage.

Foolish Assumptions

In writing this book, I assumed that you know little or nothing about diabetes and T1DM in particular. Forgive me if some of the material is too basic for you, but many of the people who read this, especially the children and young adults, will be learning about diabetes for the first time. I want all my readers to have a sturdy foundation upon which to build a skyscraper of knowledge. If you already know a great deal about T1DM, you’ll find new information that adds to your knowledge.

You probably fall into one of the following categories:

You’re the parent of a child who’s newly diagnosed with T1DM, or you just want an introduction to all that’s new in this field.

You’re a child or young adult who’s old enough to understand basic ideas about your T1DM.

You’re an adult who’s been recently diagnosed with T1DM. (Don’t worry; the information in this book applies to you, too!)

You’re a friend or family member of a person with T1DM, and you want to understand and help the person.

How This Book Is Organized

The book is divided into six parts to help you find out all that you want to know about T1DM.

Part I: Defining Type 1 Diabetes

In this part, you discover the central roles of glucose and insulin in T1DM and the way that one, insulin, controls the other. You find out what happens when this control doesn’t take place. I also explain who typically gets T1DM, how it’s diagnosed, and how to move forward after a diagnosis.

As I say in this introduction, there’s more than one kind of diabetes. You find out how to tell them apart in this part. It’s not always an easy task, especially when the patient is a child, so the info in this part is essential.

Part II: Considering the Consequences of Type 1 Diabetes

Uncontrolled T1DM has consequences, both short-term, which occur within days or even minutes of loss of control of blood glucose, and long-term, which occur after 10 to 15 years of poor glucose (sugar) control. This part goes in-depth on the topics of short- and long-term complications and also lets you know that your child doesn’t have to suffer any of these consequences.

As you find out in this part, in an effort to control glucose, it’s possible to overcompensate with insulin, leading to a condition of low blood sugar called hypoglycemia, a significant short-term complication. The long-term consequences or complications can all be detected early in the course of their development. With both short- and long-term complications, it’s important to know what they are and what the symptoms are in order to catch them early on and prevent further progression if they do occur.

In this part, I also cover the emotional and psychological difficulties associated with a chronic disease such as diabetes, telling you what they are and how to deal with them.

Part III: Treating Type 1 Diabetes

Treating T1DM requires a lot of effort, as you find out in this part, but I know you and your child can do it. What’s involved? For starters, you have to do a great deal of monitoring, which at this time still requires sticking your child’s finger four or more times a day. He also has to get certain laboratory tests on a regular basis and go to the doctor for regular checkups.

What your child eats and when he eats is a big part of managing his diabetes. Unlike the person without diabetes, your child needs to arrange his meals and his insulin so that the insulin is in his body when the food is. Then there’s exercise, an important part of treatment that lowers the blood glucose because the muscles need sugar to work. As I explain in this part, many patients use exercise in place of insulin and end up taking very few units of insulin.

The subject of insulin requires two chapters in this part. One chapter tells you what insulin is and how to use it properly. The other discusses a new and important device that supplies insulin 24 hours a day, the insulin pump.

Recently, other drugs have become available for treating T1DM. In this part, I make sure that you know about these and the role they can play in controlling your child’s blood glucose as well as the effect of drugs that interact with his insulin. I also address other methods of treating diabetes that involve attempts to replace the cells that make insulin and therefore cure the disease.

Part IV: Living with Type 1 Diabetes

The chapters in this part delve into a number of special considerations for the person with T1DM. If he goes to school, his teachers need to know some basic management strategies, such as how to deal with low blood glucose. At work, there are still some jobs for which the person with T1DM isn’t welcome. And there are insurance issues that a person with a chronic disease needs to consider.

In addition to these considerations, this part also tells you about how minor illnesses like colds may throw off diabetic control and how to accommodate the special needs of the traveler with T1DM.

Women and the elderly are two special populations when it comes to living with T1DM. In this part, I discuss how women can control their diabetes during menstruation, how a woman with T1DM should be in excellent control of her T1DM prior to conceiving a baby and throughout her pregnancy, and how menopause brings new considerations including whether or not to use hormone replacement therapy. I close this part with a chapter on the elderly population with T1DM and the unique problems that they face in treating their condition.

Part V: The Part of Tens

The Part of Tens is a staple in all For Dummies books; in this book, it provides an opportunity to emphasize some of the key points that I make throughout the book and to provide some material that you may not have found there, including the following:

T1DM is a disease mostly diagnosed in children, but after a while, the child must take over his complete care. The chapter on ten ways to involve kids in their T1DM management offers suggestions on how to start this process.

A number of management ideas are essential to good diabetes care. In this part, I point out the ones I consider the top ten.

Myths about diagnosis and treatment tend to develop around any disease, particularly a chronic disease like T1DM. In this part, I dispel ten of those myths. If you know of any that I don’t cover, please e-mail them to me.

I provide information on the latest and greatest discoveries on T1DM in this part so that you can stay on the cutting edge of treatment.

Part VI: Appendixes

If you come upon a term in the text that you don’t understand, turn to the glossary in Appendix A for a definition. And if you want new or extended information on any subject, go to Appendix B, where you can find resources for the latest information and numerous suggestions to further your education.

Icons Used in This Book

Books in the For Dummies series feature icons, which direct you toward information that may be of particular interest or importance. Here’s an explanation of what each icon in this book signifies:

When you find this alongside information, it’s time to dial the doctor for help.

When you see this icon, it means the information is essential. Make sure you understand it.

This icon points out important information that can save you time and energy.

This icon warns against potential problems.

Where to Go from Here

Where you go from here depends on your needs. If you want a basic understanding of what T1DM is and isn’t, head to Part I. If you or someone you know has a complication due to T1DM, skip to Part II. For help in treating T1DM using every available tool, turn to Part III. If you’re thinking of becoming pregnant, are going into menopause, are elderly, or have a parent with T1DM, Part IV is your next stop. Likewise, go there if you want to know what your options are for school, work, and other activities, or if you want to know how to manage travel or illness. For a bird’s-eye view of getting kids involved, key treatment strategies, the mythology that surrounds T1DM, and the latest discoveries, check Part V.

In any case, as my mother used to say when she gave me a present, use this book in good health.

Part I

Defining Type 1 Diabetes

In this part . . .

This part introduces you to type 1 diabetes mellitus. You start with a grand overview of this distinct disease’s development. Then you get into the precise symptoms and the diagnosis process followed by an introduction to the diseases commonly confused with type 1 diabetes, especially type 2 diabetes. Luckily, the information in this part helps ensure that you never confuse them again.

Chapter 1

Dealing with Type 1 Diabetes

In This Chapter

Discovering what type 1 diabetes is

Dealing with physical and emotional effects

Treating type 1 diabetes

Living life to the fullest with type 1 diabetes

In 2005, the most recent year for which there are statistics, there were 340,000 people in the United States with type 1 diabetes (T1DM) according to the Centers for Disease Control. About half were children up to age 20. There are 30,000 new cases every year, almost all in children.

Whether you’re an older child or young adult able to take care of your own diabetes, or a parent or other caregiver for a young child with this disease, you should be aware that there’s a great deal that you can do to minimize both the short- and long-term complications that may develop and live a long and healthy life with T1DM.

What! You don’t believe me! Consider the story of two brothers, Robert and Gerald. Robert is 85 years old and developed T1DM at age 5. Gerald is 90 and developed T1DM at age 16. The physician who follows them, Dr. George L. King, research director of the Joslin Diabetes Center in Boston, studies patients with T1DM who have lived more than 50 years with the disease. He has more than 400 such patients.

Dr. King says that these patients have a lot in common. They

Keep extensive records of their blood sugars, their diet, their exercise, their insulin dosage, and their daily food consumption

Do a lot of exercise

Eat very carefully

Have a very positive outlook

These actions form the basis of effective T1DM treatment, which I introduce in this chapter. I also give you an overview of the potential consequences of T1DM and tips for living well with it.

At the present time, there’s no way to prevent T1DM, but I believe a change isn’t far off and T1DM may be preventable in perhaps in the next five years. The breakthrough will come with the use of stem cells, transplantation, or the elimination of the cause of T1DM. You can read much more about this subject in Chapters 13 and 21.

Understanding What Type 1 Diabetes Is (and Isn’t)

T1DM, simply stated, is an autoimmune disease. Immunity is what protects you from foreign invaders like bacteria and viruses. In autoimmunity, your body mistakenly acts against your own tissues. In T1DM, the immune cells and proteins react against the cells that make insulin, destroying them. (Insulin is the chemical or hormone that controls the blood glucose; glucose is sugar that provides instant energy.)

Although it often begins dramatically, T1DM doesn’t occur overnight. Many patients give a history of several months of increasing thirst and urination, among other symptoms. Also, T1DM usually begins in childhood, but some folks don’t develop it until they’re adults. In either case, to verify a diagnosis of T1DM, a sample of blood is taken and its glucose level is measured. If the patient is fasting, the level should be no more than 125 mg/dl; if there’s no fast, the level should be no more than 199 mg/dl. For further confirmation, tests should be done at two different times to check for inconsistencies. However, a person with a blood glucose of 300 to 500 mg/dl who has an acetone smell on his breath clearly has T1DM until proven otherwise.

So how is type 1 diabetes different from type 2 diabetes (T2DM)? The central problem in T2DM isn’t a lack of insulin but insulin resistance; in other words, the body resists the normal, healthy functioning of insulin. Before the development of T2DM, when a person’s blood glucose is still normal, the level of insulin is abnormally high because the person is resistant to the insulin and therefore more is needed to keep the glucose normal.

To complicate matters, a type of diabetes called Latent Autoimmune Diabetes in Adults (LADA) is a cross between T1DM and T2DM; a person with LADA exhibits traits of both diseases.

Chapter 2 details the basics of T1DM, including how insulin works, what goes wrong when blood glucose levels are too high, the specific symptoms to watch for, and gathering a team of doctors and other specialists after a diagnosis. Chapter 3 fully explains how T2DM and LADA are different from T1DM.

Handling the Physical and Emotional Consequences of Type 1 Diabetes

What makes diabetes a difficult disease are the physical complications associated with poor control of the blood glucose. These complications are generally divided into short-term complications and long-term complications.

Short-term complications, which I cover in Chapter 4, are the result of a blood glucose that’s either very low or very high. Low blood glucose (called hypoglycemia) can occur in minutes as a result of too much insulin, too much exercise, or too little food, but high blood glucose often takes several hours to develop. Whereas low blood glucose often can be managed at home, severe high blood glucose (called diabetic ketoacidosis) is an emergency that’s managed by a doctor in the hospital. Nevertheless, it’s important that you understand how it develops in order to prevent it. Chapter 4 describes the signs and symptoms associated with both of these complications and the best ways of handling them.

Long-term complications, which I cover in Chapter 5, can be devastating. It’s much better to prevent them with very careful diabetes management than to try to treat them after they develop. Fortunately, they take 15 or more years to fully develop, and there’s time to slow them down if not reverse them if you’re aware of them. All long-term complications can be detected in the very earliest stages.

The long-term complications consist of eye disease known as retinopathy, kidney disease known as nephropathy, and nerve disease known as neuropathy. Diabetes is the leading cause of new cases of blindness; new cases of kidney failure requiring dialysis, which cleanses the blood of toxins when the kidneys can no longer do their job; and loss of sensation in the feet as well as other consequences of nerve damage.

Not only does T1DM have short- and long-term physical consequences, but as an autoimmune disease, T1DM also is associated with other autoimmune diseases such as celiac disease, an inflammation of the gastrointestinal tract; thyroid disease; and skin diseases. Chapter 5 explains the importance of checking for those diseases and correcting them, if present.

As you may expect, people with T1DM also have significant psychological and emotional needs. It’s important, first of all, to realize that T1DM has been present in some very high achievers. (I name names in Chapter 6.) In addition, T1DM is not only a disease of the particular patient but also a disease of the entire family. All family members are affected in one way or another. In Chapter 6, you find out ways that family members can help themselves and help the patient to maintain his self-esteem and a high quality of life.

If you’re the patient with T1DM, the people around you need to know that you have diabetes and how to help you when you can’t help yourself. Often people with T1DM try to keep their disease secret, as though it’s a blot on their character. T1DM isn’t your fault. There will be times when you may need the help of others, and it will be a whole lot easier for them to help you if they know about your condition and what to do in different circumstances. (All this is also true for your child with T1DM.)

Treating Type 1 Diabetes Effectively

Part III may be the most important part of this book. Your willingness to do all the things I recommend in that part (which I preview in the following sections) means the difference between living a long and healthy life or dying at a much younger age (whether for your child or yourself if you’re the patient).

Undergoing regular testing

There are a number of tests that your child’s doctor should be doing on a regular basis. Chapter 7 outlines all these tests, explains what they mean, and discusses how often they should be done. These tests include the following:

Blood pressure check

Height and weight check

Foot exam

Hemoglobin A1c

Microalbuminuria

Eye exam

Lipid panel

Thyroid function check

Ankle-brachial index study

Don’t leave it up to your child’s doctor to order these tests. On the Cheat Sheet at the front of this book, I provide a chart that lists the tests that need to be done and the frequency for each test; it also has spaces for you to enter the test results. Make copies of the blank chart, fill out a copy, and take it to your child’s doctor at every visit to remind him or her to do these tests.

Regular testing outside the doctor’s office is crucial, too. Daily self-monitoring of blood glucose may be the most important thing that you and your child can do to control his blood glucose. The available meters are simple to use, highly accurate, and require tiny amounts of blood. The more you know about your child’s blood glucose under all circumstances, the easier it is to keep it in the normal range — not too low and not too high. Flip to Chapter 7 for full details on monitoring blood glucose.

Eating wisely

If you’re a parent of a child with T1DM, you need to make sure that your child gets the right nutrients for proper growth and that he balances the food intake with insulin at all times. If you’re meticulous about the food your child eats, you’ll find that controlling his blood glucose is much easier. I have numerous patients whose blood glucose levels improved dramatically after I sent them to a dietitian.

Chapter 8 discusses how to count carbohydrates so that your child takes the right amount of insulin for the food that he eats. I explain how to include the right mix of protein, fat, vitamins, minerals, and water along with carbohydrates; the diet challenges you face when you feed a child of any age; and how to take other food factors into account, such as sugar substitutes and fast food. I also offer advice on coping with eating disorders.

Exercising for more control

Exercise helps to reduce the amount of insulin that your child requires and makes it easier to control his blood glucose. Any exercise is better than no exercise, but 30 minutes a day should be your minimum goal for your child. In Chapter 9, I explain how to take care before your child starts an exercise plan by talking to the doctor and adjusting insulin intake, among other tasks. I show you how to encourage your child to exercise at any age and help him pick an activity (even a competitive sport!). I also give you my picks for the best exercises around: walking and training with weights.

Taking insulin

Chapters 10 and 11 tell you all you need to know about insulin (including types and dosages), and all the old and new ways to administer it.

The types of insulin are long-acting, rapid-acting, and some in-between insulins. The insulins that most closely mimic the action of human insulin in the body are clearly the best. Insulin can be taken by shots, using jet injections, and by inhaling it into your lungs. I give you the pros and cons of each method in Chapter 10 and let you choose for yourself.

Delivering insulin with a pump deserves to have Chapter 11 all to itself because it’s quite different from the methods in Chapter 10. Many patients use pumps to administer their insulin. The clever manufacturers have tried to arrange the pump so that it delivers insulin just like your own pancreas. Unfortunately, the pump currently can’t detect the level of glucose in your blood and provide insulin accordingly just like your own pancreas, but modern insulin pumps aren’t far from that ideal.

Using other medications and treatments

At one time, insulin was the only drug given to the patient with T1DM. Today, there are some new drugs that can assist insulin in controlling the blood glucose. Chapter 12 looks into these drugs and some promising treatments for people with T1DM, such as acupuncture and biofeedback.

At the other end of the spectrum are drugs that make it even more difficult to control your blood glucose (or your child’s). Alcohol and nicotine in cigarettes top the list, but there are a number of illegal drugs that also complicate diabetes management. Avoid these drugs at all costs. In Chapter 12, I explain how they make glucose control so difficult.

Deciding to transplant

Chapter 13 could be called “the chapter of hope.” It discusses potential cures for T1DM. I tell you about transplanting a kidney, the entire pancreas, or both at the same time (now that’s a neat trick!). I also discuss transplanting only the beta cells that make insulin. I describe the preparation and process for each type of surgery and explain the continuing issues that you have to deal with afterward.

Living Well with Type 1 Diabetes

Unfortunately, type 1 diabetes is a lifelong chronic disease. As you find out in the following sections, it requires your child to make adjustments in his life that many people who don’t have diabetes take for granted. But making these adjustments is a small price to pay for being able to live life to the fullest!

Handling school, work, and other daily activities

A number of laws mandate the accommodations that schools must provide for your child with diabetes. Chapter 14 tells you how to get the school authorities on your side with the use of Section 504 Plans and individualized education programs. I also discuss how to handle T1DM in college.

Done with college? If you have T1DM, there are certain jobs that aren’t open to you. For example, you can’t serve in the military, and you can’t fly commercial airliners. There was a time when you couldn’t fly a private plane either, but fortunately that time is past. Chapter 14 discusses the jobs you can’t have when you have T1DM, what to do if you suspect discrimination at work because of your T1DM, and the ways that employers can integrate their employees with T1DM into the workplace. I also talk about some other issues for adults, including driving with diabetes and obtaining insurance.

Adjusting to sick days and travel

If your child has another illness in addition to T1DM, there are special adjustments that you have to make. He may not feel like eating, and you may think that he needs less insulin as a result. The truth is usually the opposite. Your child’s body responds to an acute illness by pouring out hormones that promote the production of more glucose, so his blood glucose rises. He may actually need more insulin during an illness when he can’t eat than he’d need when he’s healthy. Chapter 15 provides the information you need to manage your child’s illness when he also has T1DM.

Another special circumstance that affects diabetes care is travel. When traveling, you and your child may go through different time zones. This complicates taking insulin because each type of insulin has a certain duration of action, and you may lose or gain hours as you travel. In Chapter 15, I share suggestions for handling your child’s insulin smoothly and traveling with his supplies safely.

Getting through pregnancy and menopause

Women with T1DM have special needs. Starting with oral contraceptives, Chapter 16 takes you through preparing for pregnancy, getting through the pregnancy, and considering hormone replacement therapy during menopause. The surge of estrogens and progesterones that occurs every month in a menstruating female makes it even harder to control the blood glucose, so you find out the best ways to handle this tricky situation.

As a woman with T1DM, you shouldn’t even consider pregnancy without reading Chapter 16. The likelihood that you’ll produce a baby with malformations will be much lower if you understand the information that I present here and take care of yourself accordingly. Keeping your diabetes under excellent control throughout the pregnancy ensures a much easier delivery and a healthy child. I can’t overstate the importance of diet and exercise throughout the pregnancy. Every mother-to-be wants an easy delivery and a healthy baby; if you keep your blood glucose under control throughout the pregnancy, the healthy baby is guaranteed.

Aging with type 1 diabetes

The elderly person with T1DM deserves special consideration. He may not exhibit the same signs and symptoms as younger people. He usually has other illnesses and afflictions that complicate his diabetes care, including loss of hearing, diminished vision, and maybe even loss of mental function. All these circumstances may make insulin administration very difficult. The dosage of drugs given to the elderly is usually significantly lower than the dosage for the non-elderly. What’s a caretaker to do? Chapter 17 has the information that can make caring for the elderly person a lot easier.

Chapter 2

Recognizing Type 1 Diabetes

In This Chapter

Discovering how type 1 diabetes works

Determining who gets type 1 diabetes

Diagnosing type 1 diabetes

A wasting disease that was probably type 1 diabetes is mentioned in an Egyptian papyrus dated over 3,500 years. Although they didn’t call it type 1 diabetes, over 2,000 years ago the Greeks and Romans described many of the features of the condition exactly as doctors see it today. The difference is that the ancients could do nothing about it. In contrast, today’s doctors have all the tools needed to make type 1 diabetes nothing more than a major annoyance.

In this chapter, I provide some basic information about type 1 diabetes, or T1DM for short. You find out how it develops, who gets it, and how it’s diagnosed.

Understanding How Type 1 Diabetes Works

Type 1 diabetes is all about glucose and insulin. What’s the difference? Here’s what you need to know:

Glucose is one of many sugars, but it happens to be the specific sugar found in your blood that provides instant energy. Sugar is a carbohydrate, one of the three sources of energy in your body, along with protein and fat.

Insulin is a chemical known as a hormone, which means that it’s made in an organ, in this case the pancreas, and carried around the body in the bloodstream. The function of insulin is to act as a key to the “door” in each cell of the body that opens to allow glucose in. However, not every cell requires insulin to get its glucose; some cells and organs take up glucose without using insulin. These include

• The brain

• Nerve fibers

• Red blood cells

• The retinas of the eyes

• The kidneys

• Blood vessels

Figure 2-1 shows the pancreas and its parts along with its location behind the stomach. The insulin-producing and insulin-storing pancreas cells (called B or beta cells) are found in groups called islets of Langerhans throughout the pancreas. Other cells present in the islets of Langerhans include A cells, which produce glucagon, a hormone that’s very important to patients with diabetes because it raises blood glucose when it gets too low; and D cells, which make somatostatin, a hormone that blocks the secretion of other hormones but doesn’t have a use in diabetes because it causes high blood glucose.

In people who don’t have type 1 diabetes, the presence of insulin helps control the conversion of glucose into energy in the body. People with type 1 diabetes, however, go through a triggering event (most likely a viral infection) that leads to a lack of insulin in the body, which in turn leads to having uncontrolled glucose (and that can cause some bad stuff to happen). I explain how the whole process works in the following sections.

Figure 2-1: The pancreas, its parts, and its location.

Distinguishing between controlled and uncontrolled glucose

The definition of type 1 diabetes is simple: It’s the lack of control of glucose in the body due to a lack of insulin. In the following sections, I explain the differences between normally controlled glucose and out-of-control glucose.

Controlling glucose normally

Glucose from the blood gets into most cells (other than those previously listed) when insulin is available to let it in. In the cell, glucose is converted into energy. If there’s more than enough glucose to meet the energy needs of the individual, the excess glucose is stored in the liver and in muscle. When the liver and muscle are filled, additional glucose is converted to fat. Your body has an enormous ability to store fat, whether it comes from glucose or from the food you eat.

In a healthy person who diets, the release of insulin declines because glucose is what stimulates insulin to be released. The body then turns to the liver, where glucose is stored as glycogen. The A cells of the pancreas (refer to Figure 2-1) release glucagon, which breaks down the glycogen back into glucose to continue to provide energy.

When the glycogen is used up, the body turns to the other form of stored energy, fat. Fat is converted into compounds called glycerol and fatty acids.

Glycerol is changed into glucose to provide energy and is used up.

Fatty acids are converted into other compounds called ketones in the liver. Except for the brain, the entire body can use fatty acids for energy.

Over time, as the diet continues, the body begins to break down muscle to convert it into glucose.

Losing control of glucose

When the body experiences a complete lack of insulin, as in people with T1DM (see the next section to find out how a lack of insulin is triggered), glucose can’t enter cells from the blood with the exception of those it enters passively (as I note earlier in this chapter). These cells continue to take up glucose as long as the glucose inside them is less than the glucose in the bloodstream. When blood glucose is high as a result of inadequate insulin, the cells and organs that can take up glucose continue doing so even though other cells and organs that depend on insulin can’t do so. The latter cells and organs suffer the complications of type 1 diabetes that I explain in Chapters 4 and 5.

Despite there being plenty of glucose in the blood, insulin-requiring cells behave as though there’s no glucose. The body therefore begins breaking down fat and turning muscle into glucose for those cells, leading to a large amount of glucose in the body. If this process isn’t reversed by giving insulin, the person becomes very sick with diabetic ketoacidosis (see Chapter 4).

Other hormones besides insulin play an important role as control of glucose is lost. Each tries to raise the blood glucose to satisfy the needs of the tissues. I mention one such hormone, glucagon, from the A cells in the pancreas’s islets of Langerhans, in the previous section. In addition, the adrenal glands located above the kidneys begin to secrete two important hormones, adrenaline and cortisol. After a while, the pituitary gland in the brain secretes growth hormone. Following is more information on these hormones:

Adrenaline works with glucagon on the glycogen in the liver to break it down to produce more glucose. Adrenaline stimulates production of glucose from protein. It also decreases the glucose taken up by muscle and liver cells, thus making it more available to the brain. Adrenaline turns fat into fatty acids as well. Other effects of adrenaline are shakiness, sweating, rapid heartbeat, and hunger.

Cortisol increases the production of glucose by stimulating the breakdown of both proteins and fats while decreasing the uptake of glucose by tissues that require insulin, like muscles and the liver, to make it available for the brain.

Growth hormone breaks down body fat and decreases the uptake of glucose by blocking the action of insulin where it’s necessary to open the cells to glucose, such as in the liver and muscles.

Interestingly, these same hormones play important roles in raising blood glucose when it’s too low for any reason (not just a lack of insulin); such a condition is called hypoglycemia, and I discuss it in Chapter 4.

Figure 2-2 shows the origins of the different hormones that affect blood glucose.

Figure 2-2: The origins of hormones that affect blood glucose.

Sharing some patient stories

For some time, Vincent’s parents had noticed that their 8-year-old son didn’t have his usual energy. He was drinking more soda than usual and seemed to have an increased appetite. But despite eating more food, he was losing weight. Vincent looked tired, which his parents thought was because he woke up a few times each night to go to the bathroom. He even wet his bed for the first time in years. His concerned parents took him to his pediatrician, who measured Vincent’s blood glucose, did a few other tests, and informed Vincent’s parents that their son had type 1 diabetes. Vincent’s parents were quite upset by the diagnosis, but they began giving him insulin shots and carefully monitoring his food intake. In just a few days, Vincent put on weight, stopped urinating so frequently, and was able to sleep through the night.

Lynn was a 12-year-old girl who loved to play sports. In fact, she was the best soccer player on her team. Because she was so active, she drank a lot of sports drinks and water. One day, she complained to her mother that she was very tired after a particularly strenuous soccer game on a very hot day. Her mother felt this was normal, considering the circumstances. She noticed, however, that her daughter was looking a little thinner. Between soccer games the following week, Lynn was very thirsty and going to the bathroom frequently, but her parents thought it was normal for an active young girl. However, at her next soccer game, Lynn was too tired to play for very long, and afterward, she went right home and got in bed. Lynn’s mother couldn’t wake her for dinner, so she called an ambulance and took her daughter to an emergency room. The doctor did an immediate blood glucose test, found it to be 618 mg/dl, and had Lynn admitted to the intensive care unit with a diagnosis of diabetic ketoacidosis caused by type 1 diabetes. Lynn received intravenous insulin and fluids and was awake and alert within 48 hours. She was converted to subcutaneous insulin injections. Lynn and her parents followed up by participating in a diabetes education program, which taught them the skills Lynn would need for the rest of her life.

These two cases are typical of the way type 1 diabetes begins, and the apparent suddenness of the disease in both children obscures the fact that it was probably developing over several months. At one time, Lynn’s story was more common in that the condition was unexpected and the child ended up in the intensive care unit. Now, as a result of more awareness of diabetes in the general population, Vincent’s story is the more typical one.

Triggering type 1 diabetes

Not everyone can get T1DM. It begins with an inherited susceptibility for the disease, which means that chromosomes, the parts of each cell that contain the genetic material, are involved. Specifically, type 1 diabetes is connected to chromosome 6, which has an area called the HLA complex (human leukocyte antigen complex). There are many different HLA complexes on the chromosome, but only a few are associated with the development of T1DM. People who develop T1DM all have one or more of several HLA complexes associated with the disease.

If your child has the necessary HLA complex, he needs something in the environment — most probably a viral infection — to trigger T1DM. The viral infection causes his body to produce antibodies, protective proteins that try to destroy the virus. Cells that circulate in the blood, called T cells, make these antibodies. T cells can kill foreign invaders both by producing antibodies and by acting on them directly. It appears that the beta cells that make insulin in the pancreas share some antigens with the virus. Therefore, the T cells in the blood begin to attack and destroy the beta cells that make the insulin because the T cells mistake the beta cells for the virus.

So how does a person reach the point where type 1 diabetes has officially developed? Here’s a typical scenario: Your child is born with the HLA complex, and he gets a viral infection when he’s 2 years old or at any other age. Over the next six to eight years, the T cells slowly destroy his beta cells. However, he has no symptoms because he has sufficient insulin reserve in his pancreas to maintain normal glucose levels. Finally, enough beta cells have been destroyed that your child can’t make enough insulin to keep the glucose level normal. His blood glucose rises and begins to leak into his urine, drawing water with it. After a while, the lack of insulin becomes so severe that he has a condition similar to the ones described in the sidebar “Sharing some patient stories.”

How do doctors know all that’s happening in the body over such a span of time? They look for T1DM in family members of people with T1DM because the family members may have some of the same genetic material, in this case the gene that led to susceptibility to T1DM. A few years after the viral infection, your child’s doctor can measure the antibodies that indicate that the beta cells are being attacked — long before the development of clinical T1DM, the point at which symptoms are present. More than 90 percent of patients with new T1DM will have one or more of the antibodies. The most common antibody is called glutamic acid decarboxylase autoantibody, or GAD, and is found in 70 to 80 percent of type 1 patients.

Environmental factors that have antigens similar to the antigens on the beta cells include

Cow’s milk

Coxsackie B virus

Enterovirus

German measles (rubella)

Mumps virus

Rotavirus