Ketones ūüė®

¬†When glucose levels in the blood become too high, ketones develop. Ketones are a byproduct of the body burning fat for energy instead of carbohydrates. In diabetics, this happens when there is not enough insulin to deliver carbohydrates to the cells to convert to energy. Ketones are dangerous for diabetics–Type 1s, that is–because they cause the blood to become acidic, a condition called ketoacidosis. Ketoacidosis over a prolonged period (weeks to months) can lead to kidney disease and other life-threatening problems.

This morning is the first time my son has had ketones since he was diagnosed in 2013. The only reason we can think that this happened is that his pump site has gone bad–this means scar tissue has formed around skin where the cannula (a hollow needle that delivers insulin) enters.

Treatment is straight forward–remove and replace pump, inject insulin every three hours, and drink plenty of water until there are no ketones. And if this doesn’t work…to the Children’s Hospital we go.

April 15th…a day that changed the world

April 15th is widely known as TAX DAY, but it is also the day that insulin was made available to treat Type 1 Diabetes.

Dr. Charles Best and Sir Frederick Banting
Dr. Charles Best and Sir Frederick Banting

German scientist Paul Langerhans discovered in 1869 that insulin was produced by the pancreas and it was largely responsible for processing carbohydrates.

In 1922, Dr. Frederick Banting and medical student Charles Best, using this knowledge, extracted¬†insulin from¬†a dog’s pancreas and injected it into a 14 year old boy with Type 1 Diabetes who had shriveled to 65 lbs. After a second injection two weeks later, the boy began to gain weight and his blood glucose returned to a normal level. A few months later, the two doctors visited a children’s ward for Type 1 Diabetics. Most of the children were in comas and near death. As the two injected insulin one child at a time, the patients began to wake from their comas. The nurses in the ward described the scene as a miracle.

insulin
Before and after insulin therapy

Later that year, Banting and Best began to work with Eli Lilly pharmaceutical company to refine the extracted animal insulin. By spring of 1923, Lilly was able to market the miracle drug world wide, saving thousands of lives that year, and every year thereafter. Banting accepted the Nobel Prize for Medicine in 1923 and shared his prize money with Best.

It wasn’t until 1978 that a synthetic version of insulin was invented by ¬†Genentech, improving insulin absorption and again saving the lives of millions in the years since.

Every day, I marvel at the miracles of science that have saved my son’s life. I am so very thankful for the innovations and perseverance of those working in the medical technology industries. ¬†This post celebrates all the innovators, past, present and future, who work tirelessly for a cure.


http://www.nobelprize.org/educational/medicine/insulin/discovery-insulin.html

http://www.yourhormones.info/topical_issues/animal_research_in_science.aspx

Type 1 Does NOT Discriminate

unnamedAnyone can get Type 1 Diabetes, but it is most common in the young–individuals under the age of 25. When I was entering adulthood, I had four friends diagnosed–Four! My friend Stef was diagnosed at age 22, just three days before we headed to the Bahamas for Spring break. I watched her give herself injections in her abdomen every morning and night during the trip, but I didn’t really have an understanding of the disease or how lifesaving these injections were. My close friend Aimee was diagnosed when she was 24. It was still called Juvenile Diabetes back then and I remember thinking how odd that two friends in their 20s got a childhood disease. She told me the disease ran in her family–her father had it–and she was not surprised when she was diagnosed. Her mom recognized the symptoms immediately and Aimee was able to avoid being hospitalized (very rare). My high school friend Stephanie was diagnosed when she was 28. As far as diagnoses go, this was rather late in age, but it is not unheard of. Stephanie, having lost her parents while she was in high school, had no idea the disease ran in her family–similar to my situation. The diagnosis was a shock, but of all my friends, I think she was the strongest. To this day, she is a strong advocate for education and acceptance of Type 1.¬† All three of my friends were lucky–yes, I call it luck. They caught the disease early and can manage the disease well. Not all of my friends have been so fortunate.

Kevin was the first person I knew who lived with Type 1. We went to the same church and attended school together. Kevin was one of those really smart, high energy theater kids. Everyone loved being around him, including me. Kevin was diagnosed in college when he was attending UVA. I don’t know if Kevin wantonly ignored the symptoms or just didn’t recognize them, but he fell into a coma and was rushed to the hospital for diabetic ketoacidosis (DKA). Unfortunately, Kevin was never released from the hospital and died at the age of 24–too young to leave this world.

Even though Type 1 is hereditary, it may not appear for generations. Aimee is the only one of my friends who knew the disease was present in her genetics and knew how to recognize the symptoms. Even though I knew people with diabetes, I never educated myself about the disease or learned to recognize the symptoms. We were fortunate that my son was not more ill than he was when diagnosed. We recognized something was wrong when we were on vacation–my son was waking in the middle of the night to drink water and use the bathroom–something he never did before. He said he had been doing this for weeks, but because our bedroom at home is on the opposite side of the house, we never noticed and he never said anything. Every day, I am thankful we went on vacation that week and stayed in the condo we did, where the bathroom was right outside our room. I think it likely saved my son from a medical emergency. But I also wonder that if I had known the symptoms, would I have noticed the problems earlier?

The real cost and burden of diabetes

Yesterday, I submitted a prescription to Anthem/Express Scripts for new glucose monitoring test strips, strips that work with his new Omnipod Insulin Pump. I received the shock of my life when my copay for a three month supply was $7,492. If you consider that my copay is 20% of the total cost, then the price tag for¬†the six boxes of test strips was $37,500. Based on that¬†$37,500 price tag, each strip cost about $62.50. Yikes.¬†Obviously, someone made a mistake but I spoke with three different supervisors at Anthem and not one of them would admit the cost was exorbitant. I ended up calling the manufacturer of the test strips and will be getting them through CVS with a prescription card supplied by the manufacturer for $15 a box–much better!

This got me wondering, however, just how much the average family or person with T1D pays for medical expenses. Not surprisingly, I could not find information specific to Type 1 Diabetes. I would likely estimate my out-of-pocket expense to be close to $3000 a year–including prescriptions, doctor’s visits, and medical equipment. That, of course, is only part of the picture, for my insurance company foots most of the bills (remember that 20% copay).

The American Diabetes Association estimates the total economic cost of all types of diabetes to be close to $245 billion per year (ADA). Problematically, the organization follows the estimate with this statement:

“This estimate highlights the substantial burden that diabetes imposes on society. Additional components of societal burden omitted from our study include intangibles from pain and suffering, resources from care provided by non-paid caregivers, and the burden associated with undiagnosed diabetes.” (ADA)

This is yet another example of how individuals with diabetes are held¬†responsible for and are perceived to be deserving of their disease, regardless of the type or the cause.¬†Statements such as the above, that use language such as “burden” when discussing diabetes,¬†are hurtful and relegate those who live with the disease as undesirable, unworthy, less human. There is no other disease that has been so vilified by the public health sector, except perhaps HIV/AIDS. ¬†Even those who smoke themselves to death via¬†lung cancer, COPD and heart attack are more worthy of public empathy than a child with diabetes.

Diabetes is NOT a societal burden. Those corporations, organizations and individuals who fail to educate themselves about the disease, and who price gauge diabetic supplies simply because they can, are the real burdens to society.

Advance in research brings us one step closer to a cure

Researchers in Great Britain have identified the cell responsible for destroying Insulin-producing beta cells in the pancreas, according to an article in A Sweet Life, an online diabetes magazine. The culprit, a type of T cell, has also been implicated in causing Lupus, another autoimmune disorder. Now that scientists know which cells are responsible, they can direct research toward a cure and, importantly, prevention of Type 1. To read more, visit http://asweetlife.org/news/british-researchers-discover-cell-behind-type-1-diabetes/ .

Diabetic Accessories

My son is starting on an insulin pump in March. We’ve been checking out accessories, and found Bands4Life, a family-based business that grew out of necessity when the owner’s child was diagnosed with Type 1. Bands4Life sells stretchy bands to fit over the omnipod pump so it stays in place. Such an accessory will be invaluable to my son once swim season starts. I am constantly amazed at how resourceful parents of children with diabetes can/have to be to make life a bit easier. Check it out: http://www.bands4life.net/pages/OurStory.htm

Food Rewards

imagesIts a simple principle of behavioral psychology–reinforce behaviors you want, discourage behaviors you don’t want. Reward. Punish.

In school, reward and punishment are used frequently to teach good study habits and to motivate learning. For the diabetic child, or for any child with food allergies or dietary restrictions, however, rewards based on food can have the opposite effect. In fact, food rewards can seem like punishment when one is unable to eat them.

This year, my son and I have really struggled with this issue, as he has a teacher who frequently uses candy and class parties to reward students for good behavior and good grades–and I should add here that my son is an intelligent student who constantly seeks to please, so he gets “rewarded” almost daily. ¬†Except that these rewards don’t motivate him or make him feel proud at all.

Last night, while doing the obligatory weekly backpack clean out, I found a bag of M&Ms, flattened into a chocolate mess. I assumed they had been in his backpack for weeks, but, on the contrary,¬†they were from that very day according to my son. He had apparently squished¬†them because he didn’t intend to eat them and they were “useless pieces of¬†crap¬†he didn’t want”–sorry, his words, not mine.

I was horrified, on the one hand, that my son harbored such anger and violent feelings about the candy, but I was equally¬†horrified that his teacher could have so little regard¬†or¬†respect for my son and the constraints imposed by¬†his disease. It is difficult enough for a child to adjust to having diabetes;¬†every time my son’s teacher gives out candy, and he quietly puts it in a ziplock bag to take home while the other kids enjoy the treats, he feels that difference ten-fold. It’s been tough for him.

I will talk to the teacher, as I have in the past, but since I know I have a few followers who are in the elementary education program, I would like to issue a call. Yes, as a teacher, it is important to reinforce good behaviors in the classroom, but understand that such reinforcement could undermine your efforts if the reward fails to match the needs (not wants) of the individual.

Revisiting T1D

images-5As I have acquired a few new followers, I thought I’d return to the basics by providing an overview of Type 1 Diabetes (T1D) and comparing it to the more widely known and prevalent Type 2.

Type 1 Diabetes, formerly referred to as Juvenile Diabetes, is¬†caused by an autoimmune disorder. It is NOT caused by obesity, poor diet, lack of exercise, viruses (though see below), spider bites, etc. It is not communicable,¬†so you can’t catch it from someone. There is no vaccination, there’s no magic pill to treat it, and there is, unfortunately, no cure. Type 1 usually strikes in childhood and young adulthood, though there are rare diagnoses in mid and later adulthood. Often times, however, these are misdiagnoses and the patient is later diagnosed with a monogenic form of diabetes such as LADA or MODY. Type 1 is the only form of diabetes that is caused by autoimmunity. It is unknown what, exactly, triggers the autoimmune response, but many researchers suspect that the body is fighting off a virus–a common cold, perhaps–and something goes awry.

With autoimmune disorders, the body attacks itself. In the case of T1D, the white blood cells attack and kill the insulin-producing beta cells in the pancreas. This process usually occurs quickly over a short period of time (usually a few weeks to a month or so).¬†Once the pancreas is close to or completely dysfunctional, symptoms set in quickly–excessive thirst, frequent urination, fatigue, weight loss. Though these symptoms might seem mild and primarily inconvenient, they mask a more sinister and dangerous symptom of T1D–high blood glucose.

In any kind of diabetes, blood glucose levels are elevated. In a T1D, this is because the body is not producing insulin, the hormone that delivers glucose to cells so they can be converted to energy. In someone with Type 2, the body produces insulin and it works fine…the problem is that cells have become resistant to insulin and do not convert the glucose to energy as they are supposed to. The situation in T1D is much more serious.

If glucose cannot be delivered to cells, two things happen. The body starts burning fat for energy (great for weight loss but…) and the blood gets overloaded with glucose and becomes acidic. This is known as ketoacidosis. Ketoacidosis leads to kidney failure, blindness, nerve damage, seizure, and death. This is why most people are hospitalized when they are diagnosed. They are often in ketoacidosis and their bodies and lives are in danger. My son was in the PICU for three days when he was diagnosed. His blood glucose levels were over 800 mg/dL.  For comparison, a normal range is 70-150 mg/dL. Ketoacidosis does not occur with Type 2 diabetes because blood glucose levels do not usually soar as high.

There is no cure for T1D, but the disease can be treated. Unlike Type 2 diabetes, which is usually treated with lifestyle changes and a pill such as Metformin or Warfarin which help the body’s cells use glucose, Type 1 can only be treated with insulin injections–every day for life. Individuals living with T1D must check glucose levels frequently, and inject insulin every time they eat anything with carbs–fruits, vegetables, breads, pastas, desserts, etc. About the only thing that doesn’t have carbs is meat‚Ķ unless it is processed.

A healthy diet and exercise are also necessary to help the diabetic body process the synthetic insulin. This is because the insulin that is injected lacks essential hormones present in an non-diabetic body that help the body process insulin. Exercise and the adrenaline produced as a byproduct of exercise sharpen the body’s reaction to insulin. Of course, a side effect of this is hypoglycemia or low blood glucose. This is why people with Type 1 must always carry candy or glucose pills because sometimes, the body uses the insulin more quickly or effectively than anticipated. Ironic, no?

If you want to know more about the physiology of Type 1 or what life is like with Type 1 in the family, read previous posts and, of course, keep reading, as I’ll try to post weekly until summer!

Forget the pumpkin pie this holiday season

I hate pie crust. It’s true. So when my son asked me to make pumpkin pie without the crust so he could eat a lot of it (pie crust is high in both carbs and fat) I was on it! I found a recipe for a Pumpkin Pudding Pie and adapted it to suit our needs. Here’s what we came up with:

pumpkin-chia-pudding-600x500-115020

Pumpkin Pie Pudding Parfaits

1 pkg. sugar free vanilla pudding mix

1 c. fat free milk

1 15 oz can pumpkin (not the pie filling)

3 c. whipped cream (I used the Redi-whip in a can)

2 t. Splenda-sugar mix

1 t. pumpkin pie spice

1/2 t. cinnamon

1/2 t. nutmeg

Directions:

Beat the pudding mix and milk with a mixer for three minutes. Fold in pumpkin until thoroughly integrated. Chill for 20-30 min. Meanwhile, mix the Splenda and spices in a small bowl.  Layer 1/3 c. pudding mix, followed by 1/4 cup cream and then another 1/3 c. pudding in a parfait dish. Top with a dollop of whipped cream and sprinkle the spice mix on top. Serve and enjoy! Makes 8 parfaits, each containing 9 g. carbs and 6 g. fat.

The Verdict:

My son and family loved the parfaits, but we all agreed that a bit of pumpkin pie spice mixed into the pudding would improve the already yummy dessert even more. My husband, a pie fanatic, missed the crust and ended up dipping Girl Scout Trefoil cookies into his parfait. Next time I make it, I will layer crushed cookies on the bottom of his parfait.