Life of a Diabetic

Melissa Jefferies was diagnosed as a Type 1 Diabetic at 14 years old. Watch this video for a glimpse into her life as a diabetic.

http://diabetes.webmd.com/video/struggling-with-type1-diabetes

Transcript of her interview:

Narrator:

Melissa Jefferies is the picture of health. It's hard to believe that she's lived half of her life with seizures.

Tim Falkner:

It's terrifying. Her eyes would roll back in her head and she would not be conscious of anything I was doing.

Narrator:

Melissa is a Type One diabetic. Diagnosed at age 14, she struggled with seizures from the beginning:

Melissa Jefferies:

We had this seizure and my parents didn't know what was going on, the EMT guys wouldn't treat me for a seizure because they hadn't been trained that diabetics had seizures… people are trying to tell my sister just tell us that she's on drugs so we know how to treat her, and my sister's going she's not on drugs! There's nothing going on here. I ended up in a coma for two days because they waited so long to treat the seizure.

Narrator:

Type One diabetes occurs when the body's own immune system attacks and destroys the insulin-producing cells of the pancreas. Insulin is critical to the body's absorption of nutrients, so when none is available, the cells of the body begin to starve. At the same time the nutrients, or glucose, build up in the blood. Over time, those high blood sugars can damage vital nerves and organs. Treatment consists of insulin carefully measured and timed with the intake of food. Like many teenagers, Melissa wasn't very cooperative with her parents' efforts to control her sugars:

Melissa Jefferies:

I started hiding food. It's horrible to eat when you're not hungry so I started hiding it places so I wouldn't have to eat any. and that was a great part of the management because of course I was taking insulin for the stuff that I was doing, so then I'd have a low blood sugar and I'd have to go sneak some food, because why am I having a low blood sugar, and it was an endless, vicious, cycle …of lies.

Narrator:

Low blood sugars can be life-threatening. Left untreated, the result could be a coma and death. Luckily, there are warning signs.

Melissa Jefferies:

You feel shaky, you feel really really weak, you're actually really hungry I know instantly if I have low blood sugar if I think anything I'm thinking of sounds delicious. Sometimes you'll sweat, and when you sweat you'll sweat profusely, like you wake up and the sheets are totally soaking wet.

Narrator:

Getting just the right dose of insulin is a tricky business. Exercise and stress, as well as highly sugared foods, can cause levels to change daily. And for Melissa, the long lasting insulin often prescribed as a base dose didn't work.

Melissa Jefferies:

That was the main thing my doctors kept playing with, certain things peaked dramatically, others peaked less, and they kept playing around with which ones were going to use for me, and none of them worked. They would all send me into seizures.

Tim Falkner:

Between 3 and 5 in the morning it seemed to be when the insulin would drop out and her blood sugar would just totally bottom out to zero. I would jump up with a start, run to the fridge, grab a juice, Are you ok? I thought she was dying, I didn't know what to do, and so I would get mad. I would get mad because I thought it was her fault, she wasn't taking care of herself, why are you doing this to me…and not realizing of course that it's the insulin, it's not her at all.

Diabetes.. Then?

Diabetic Complications

Diabetes can result in many severe complications due to the implications of long term hyperglycemia. Complications include:
1.

http://www.stlukeseye.com/Conditions/DiabeticRetinopathy.html  

Eye problems, such as trouble seeing at night and sensitivity to light. Blindness may eventually occur.

2. 

http://biofilmbook.hypertextbookshop.com/v003/r002/contents/chapters/chapter003/section002/blue/page001.html

Sores and infections on feet and skin. If it goes on too long, the foot or leg may need to be amputated. Infection can also cause pain and itching in other areas.

3.

http://familydoctors.blogspot.sg/2011/01/top-10-tips-to-diabetes-patient.html

Due to Diabetes, blood pressure and cholesterol levels may be harder to control. This can lead to heart attack, stroke, and other problems. It can become harder for blood to flow to the legs and feet.

4.

http://www.diabetesinfo.org.au/about-diabetes/what-is-diabetes/diabetes-complications/nerve-damage

Damage to the nerves, causing pain, tingling, and loss of feeling.

5.

http://www.diabetestreatmentguide.org/diabetes-and-the-prevention-of-kidney-disease/

High blood sugar and other problems can lead to kidney damage. They might not work as well and may even stop working.

Generally, these complications are a result of damage done to blood vessels, catagorized into  Microvascular(relating to damage to the small blood vessels) and Macrovascular(relating to damage to arteries) Complications. 

Preventing such Complications

In order to prevent complications, it is very important to keep blood sugar, blood pressure, and cholesterol level in a healthy range.

This will include having a proper diet, exercise, and sometimes medicines. Blood sugar should be checked daily. These will help to keep complications of diabetes away.

However, many diabetics may not have the chance to do so, especially in Type 2 Diabetes as organ damage may already be present at the time of diagnosis. 

Take a look at this interesting video and learn more about complications of Type 2 Diabetes!

Citations
1. Dugdale, D. C. (11, November 2010). Long term complications of diabetes. Retrieved from http://www.nlm.nih.gov/medlineplus/diabetescomplications.html

How is insulin injected into the body?

While injection with a syringe or insulin pen is the most common method for insulin delivery, there are other methods.


1. Insulin Pump

 http://www.bd.com/us/diabetes/page.aspx?cat=7001&id=7263 

Insulin pumps mimic the way a healthy pancreas works, providing a controlled flow of insulin. For people who keep a close eye on their blood glucose levels, activity levels, and diets, insulin pumps may provide better glucose control and allow for greater flexibility.

2. Insulin jet injector

http://www.typefreediabetes.com/Articles.asp?ID=150

http://www.diabeteshealth.com/read/1992/11/01/32/jet-injectors-vs-needles/

Jet injectors are devices that force a tiny stream of insulin through the skin by pressure. Unlike syringes and insulin pens, jet injectors don't puncture the skin, so it's good for patients who are afraid of needles.


Citations
1. Devices that can be used to inject insulin. (n.d.). Retrieved from http://www.bd.com/us/diabetes/page.aspx?cat=7001&id=7263

Types of Diabetes-Type 2 and Gestational

Type 2 Diabetes

http://www.symptomsofdiabetic.com/2012/01/28/information-about-type-2-diabetes/

Type 2 diabetes occurs when the body cannot utilize insulin effectively even though sufficient amounts of insulin are produced. Hence, the pancreas tries to overcome this resistance by secreting more and more insulin. People with insulin resistance develop type 2 diabetes when they fail to secrete enough insulin to cope with their higher demands. This disease usually develops in middle age, and is heavily dependent on lifestyle factors.

Some causes of Type 2 Diabetes

1. Genetics
Similar to Type 1 Diabetes, genetics play a part in causing Type 2 Diabetes.

2. Age

http://agingwelltiptop.blogspot.sg/

People who are 45 years and above have a higher risk of getting Type 2 Diabetes, because cells age and they deteriorate and lose their function over time.

3. Obesity

http://topnews.com.sg/content/26886-docs-call-obesity-epidemic-bigger-hiv

http://www.wellsphere.com/wellpage/normal-glucose-levels-gestational-diabetes

Overnutrition is believed to create endoplasmic reticulum stress, which reduces the response of insulin receptors to insulin temporarily, so that the endoplasmic reticulum is able to catch up with its workload. However, obesity creates a continuous state of overnutrition, so over a period of time, insulin resistance is developed. This is just a theory of how obesity causes diabetes, but it has not been proven yet.

Symptoms

Often, people with Type 2 Diabetes may not show any symptoms for many years as the disease is slow-developing. The symptoms they will display are similar to those seen in Type 1 Diabetics.

http://www.rxprescriptionguide.org/diseases/diabetes

Early symptoms may include,similarly: 

-Bladder, kidney, skin, or other infections that are more frequent or heal slowly
-Fatigue
-Hunger
-Increased thirst.
-Blurred Vision
-Erectile Dysfunction
-Pain or numbness in the feet or hands

Diagnosis and Prevention

Since most cases of type 2 diabetes is a result of obesity, overweight people who have no symptoms of diabetes should go for regular diabetes screenings, and urine and blood sugar level tests.

Treatment

http://diabetes.niddk.nih.gov/dm/pubs/eating_ez/

http://thediabeticyou.com/bloggers/celebrity-blogger-charles-mattocks/114-exercise-for-life.html 

For type 2 diabetics, exercise and a monitored diet are the main approaches used to control diabetes. Medication in the form of drugs and insulin is also administered when dieting and exercising alone are not able to control the blood sugar level.

Gestational Diabetes

Gestational diabetes is a temporary condition of high blood sugar which develops anytime during pregnancy in a woman who does not originally have diabetes.
During pregnancy, hormonal changes causes cells to be less responsive to insulin. Although the body may produce more insulin, the insulin production may not be able to meet the high demand and therefore result in high glucose levels. 

http://actoslawyer.pro/uncategorized/gestational-diabetes-test

Usually, women with gestational diabetes don’t remain diabetic once pregnancy is over, BUT have a higher chance of contracting diabetes.




Citations

1. Babycenter.com. (2010). Gestational diabetes. In Retrieved from http://www.babycenter.com/0_gestational-diabetes_2058.bc
2. Michelle, J. (n.d.). How does obesity cause diabetes?. Retrieved from http://www.ehow.com/how-does_4923548_obesity-cause-diabetes.html
3. Eckman, A. S. (2011, June 28). Type 2 diabetes. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001356/
4. Chandler, S. (2010, January 25). Factors that contribute to diabetes. Retrieved from http://www.livestrong.com/article/76390-factors-contribute-diabetes/
5. What is type 2 diabetes?. (n.d.). Retrieved from http://dtc.ucsf.edu/types-of-diabetes/type2/understanding-type-2-diabetes/what-is-type-2-diabetes/
6. Gestational diabetes test. (2012, January 28). Retrieved from http://actoslawyer.pro/uncategorized/gestational-diabetes-test

Types of Diabetes- Type 1

There are 3 main types of Diabetes, namely Type 1, Type 2, and Gestational Diabetes. These types are generally referred to as Diabetes Mellitus.

Type 1 Diabetes

http://dtc.ucsf.edu/types-of-diabetes/type1/understanding-type-1-diabetes/what-is-type-1-diabetes/

Type 1 diabetes is believed to be an autoimmune disease, in which the body's immune system attacks the Beta cells-which produce insulin-in the pancreas. This results in little or no insulin being produced. This type of diabetes can occur at any age, but is mostly diagnosed in children, teens or young adults. Type 1 patients need daily injections of insulin as their body makes little or no insulin.

Some causes of Type 1 Diabetes

1. Genetic

http://www.myvisiontest.com/newsarchive.php?id=1362

One can inherit Diabetes from their parents. The chance of inheritance will depend on various factors, such as the age at which the parent was diagnosed, and whether both parents were diagnosed with diabetes. However, genetics alone do not determine the onset of the disease- sometimes, environmental factors are needed to trigger the disease.

2. Caused by Virus

http://www.healing-diabetes.com/21-causes-of-diabetes

Some research suggests that viral infections may trigger the disease in genetically susceptible individuals.

3. Lifestyle and Age

http://powering-society.blogspot.sg/2012/03/exercise-getting-you-down-not-any-more.html

Type 1 diabetes can occur in an older individual due to destruction of the pancreas by alcohol, disease, or removal by surgery. It also results from progressive failure of the pancreatic beta cells, the only cell type that produces significant amounts of insulin. However, it is usually diagnosed in young individuals.

Symptoms of Type 1 Diabetes

http://www.rxprescriptionguide.org/diseases/diabetes

Symptoms of diabetes include blurry vision, excess thirst, fatigue, frequent urination, and hunger and weight loss. Symptoms may be seen immediately for type 1 as it develops over a short period of time, unlike Type 2(Which we will talk about in our next post)

Diagnosis

There are several blood tests used to diagnose Type 1 Diabetes, such as testing of fasting blood glucose level, non-fasting blood glucose level, and Hemoglobin test.

Treatment 

Though all types of Diabetes are treatable, there is no cure currently. The treatment for a patient with Type 1 is mainly injected insulin, plus some dietary and exercise adherence.


Citations

1. Zieve, D. (2011). Pubmed health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002194/
2. Christian, N. (2010, april). Medical news today. Retrieved from http://www.medicalnewstoday.com/info/diabetes/
3. Wagers, A. P. D. (2011, May 19). Understanding the stress of aging and diabetes. Retrieved from http://www.joslin.org/news/understanding-the-stress-of-aging-and-diabetes.html
4. Ferry, R. (n.d.). Diabetes risks, symptoms, treatment. Retrieved from http://www.emedicinehealth.com/diabetes/article_em.htm
5. Eckman, A. S. (2011, June 28). Type 1 diabetes. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001350/
6. What is type 1 diabetes?. (n.d.). Retrieved from http://dtc.ucsf.edu/types-of-diabetes/type1/understanding-type-1-diabetes/what-is-type-1-diabetes/ 

I

Introduction to Diabetes

What is Diabetes?

To understand what is Diabetes, lets first introduce a very important hormone, called Insulin.

About Insulin

Insulin is a hormone produced by the pancreas, used to convert glucose to glycogen for storage, and facilitate the uptake of glucose from the blood stream. 
As you may remember from our previous post about carbohydrate metabolism, glucose is produced when consumed food is digested via metabolism, which refers to the way our body use digested food for energy and growth. 
Most food is broken down into glucose, which is a form of sugar in blood – a principal source of fuel for our bodies. 
Usually, an adequate quantity of insulin is released after meals to move the glucose present in our blood into the cells, lowering the blood sugar level. 
 However, if insulin is absent, glucose is unable to enter our cells, making it impossible for cells to take in and utilize glucose.

Diabetics

Diabetes patients have a common life-long health condition in which excessive amount of glucose is developed in blood (hyperglycemia). 
This is because the body either does not produce enough insulin/no insulin(Type 1 Diabetes) or has cells that do not respond properly to the insulin the pancreas produces(Type 2 Diabetes). the body cannot store glucose in the form of glycogen, resulting in too much glucose building up in the blood. 
This excess blood glucose eventually passes out of the body in urine. 
So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements.
Diabetes is a chronic disease and, if not managed well, can deteriorate steadily to cause devastating complications such as blindness, nerve damage, kidney failure, heart disease and limb amputation. 


Studies show that about half of patients already have diabetes-related complications at the time of diagnosis, and in Singapore, one out of 9 people aged 18 to 69 has diabetes. That’s about 11.3% of our population or more than 400,000 people!

Lets wrap up this post with a short video about insulin, and the importance of it!

Citations

1. King, M. W. (2012, May 17). Insulin secretion. Retrieved from http://themedicalbiochemistrypage.org/insulin.php
2. Diabetes information hub. (2012). Retrieved from http://diabetesinformationhub.com/DiabetesandInsulin.php
3. Diabetic society of singapore. (n.d.). Retrieved from http://www.diabetes.org.sg/

Carbohydrate Metabolism

What is Metabolism?

Metabolism is the sum total of all chemical reactions involved in maintaining the living state of the cells, and thus the organism. Proteins, Carbohydrates, and Fats all undergo metabolism.

In general metabolism may be divided into two categories: catabolism or the breakdown of molecules to obtain energy; and anabolism or the synthesis of all compounds needed by the cells.

Fig 1: Summary of all the metabolic processes in the body

What is carbohydrate metabolism?

Carbohydrate metabolism is the formation, breakdown and inter-conversion of carbohydrates involving metabolic pathways such as glycolysis, glycogenesis, glycogenolysis and gluconeogenesis.

Specifically, glycolysis breaks down glucose, gluconeogenesis synthesises glucose, glycogenesis synthesizes glycogen, and glycogenolysis breaks down glycogen. (Please refer to the diagram above for a clearer picture of the processes)

Carbohydrate metabolism is important as it affects the body’s ability to process carbohydrates. If there is a problem with one’s carbohydrate metabolism, this can lead to disorders. There are many disorders of carbohydrate metabolism. Some examples include lactose intolerance, fructose intolerance, diabetes, and Galactosemia. The most commonly known carbohydrate-related disorder is diabetes; and this is what we will be focusing on in this blog.

So what is diabetes?

Diabetes is a condition where the amount of glucose in blood is too high because the body cannot use it properly. This is because the pancreas does not produce any insulin, or not enough, to help glucose enter the body’s cells – or the insulin that is produced does not work properly (known as insulin resistance).

We’ll be talking more about diabetes in our further posts, so stay tuned!

Citations

1. Carbohydrate metabolism. (n.d.). Retrieved from http://www.bioscience.co.uk/products/carbohydrate-metabolism

2. What is diabetes? . (n.d.). Retrieved from http://www.diabetes.org.uk/Guide-to-diabetes/Introduction-to-diabetes/What_is_diabetes/
3. Overview metabolism. (n.d.). Retrieved from http://www.elmhurst.edu/~chm/vchembook/5900verviewmet.html