Month: June 2009

Living with Type 1 diabetes, and making the correct decision on insulin needs, is like living everyday in a chess game. One moves determines the next move, and there is always waiting involved.

People with Type 1 diabetes receive insulin to live. The two kinds of insulin they use are basal and bolus. Basal insulin is the background insulin that is released into their body a tiny bit every few minutes. This is either through a basal insulin like Lantus given through a shot once every 24 hours, or through an insulin pump that delivers fast acting insulin every few minutes. How much insulin that is needed is determined through numerous factors such as weight, age, and time of day to name a few. The best way to determine how much basal insulin is needed is to log blood glucose values throughout the day when the person has not eaten any carbs. Not eating carbs allows the person to use only basal insulin. So if the numbers go up without eating the person knows they need more basal at that time, if the numbers go down without receiving any extra insulin then the person knows they need less basal insulin. See what I mean about a chess game?

Every decision on how much basal insulin depends on something else. If my son goes too high after not eating for several hours then I can determine that he needs more basal insulin at that time. I make the change, then I wait. I wait until the exact same time the next day, make sure he doesn’t eat again, and check his sugar to see if it remained stable thereby telling me that he is getting the correct amount of insulin for that time of day.

Basal rates are different for some people at different times of day. My son currently has 7 basal settings in his pump. He gets an enormous amount of insulin from 8:00pm to midnight and then is drops off and then remains even all day. The only way I was able to figure out the best basal rates for him was to test, make changes, wait, make more changes, etc.

People without Type 1 diabetes who have a working pancreas also receive a basal insulin. They don’t know about it, but the pancreas is working hard for them determining how much basal they need in order to remain an even blood glucose value. That is why they don’t have Type 1 diabetes, their pancreas can do that for them.

The second type of insulin that people with Type 1 receive is bolus. This is a fast acting insulin that is given any time carbs are eaten. This is usually give in the form of a ratio. For instance, my son now gets 1 unit of insulin for every 16 carbs that he eats at breakfast. The rest of his meals are different ratios. The only way I can determine if my son is getting the proper amount of insulin at meals and snacks is to test him 1 hour, 2 hours, 3 hours, and 4 hours after eating. You always look to get the best number possible for each time frame. This is where the waiting really takes place. It may take days to figure out one meal ration. If on Monday, my son’ number is too high at testing times after breakfast, the only way I can fix it is to change the ratio for Tuesday. If his number is too high on Tuesday at the testing times, the only way I can fix it is to change the ratio for Wednesday. Do you get what I saying. Waiting. Changing. Waiting and so on.

Now, I have to do this for 6 separate times a day over the course of several days. My son has different ratios for different times of day that he eats. Lots of testing, note taking, changing and waiting helped me determine what are the best ratios for my son at different times of day.

One move relies on the next. It is just like a chess game. You are always waiting to see what the previous move is going to do to the game. One change in breakfast ratio may have an effect on the snack ratio and so on. It is never ending. Like I once said before, living with Type 1 diabetes is like running a marathon that never ends. Well, it is also like playing a chess game that never ends. You are always waiting on your opponents next move to determine where your next move is going to be.

For most people with Type 1 diabetes every carb must be covered with insulin. There is no limit to the amount of carbs or the amount of insulin allowed in one day. A working pancreas does not limit insulin, therefore most people with Type 1 diabetes do not need to either.

A person without Type 1 diabetes has a working pancreas. The pancreas secretes a tiny little bit of insulin all day into the person’s body to keep their blood sugar steady. When the person without Type 1 decides they are going to eat a piece of cake, the working pancreas starts to put out more insulin to get prepared to cover the cake that is about to be eaten. The pancreas puts this insulin out before the cake hits the belly, to maintain steady blood glucose levels. Now, if this same person without Type 1 diabetes wants another piece of cake, the pancreas just puts out more insulin for the next piece of cake. The healthy working pancreas will never stop giving insulin, there is no limit to the amount of insulin it puts out. As long as the person is eating and living, the pancreas is supplying insulin. There is no insulin ration so to speak.

Now, a person with Type 1 diabetes does not have a working pancreas, so their pancreas does not produce any insulin, nada. They must take shots or wear an insulin pump to get their insulin. They need insulin to be running through their body 24 hours a day just like a person without Type 1 diabetes, and they need insulin to cover carbs. So, just like everyone else, a person with Type 1 diabetes can eat and eat and eat some more carbs, as long as they cover, cover, and cover some more with insulin. There is no ration with insulin even if it comes from an outside source such as a shot or an insulin pump.

A person with Type 2 diabetes is VERY different than both of the above examples. Their bodies do possibly still make some insulin. That’s why it is in their best interest to eat as little carbs as they can to allow their insulin to try it’s hardest to work properly. It is when a person with Type 2 diabetes eats too many carbs, that the pancreas may not have enough insulin to cover that food. If they stay within their amount of carbs per day they have a much better chance of keeping their blood glucose levels even.

This is not so for the person with Type 1 diabetes. If my son eats as little as 4 carbs without insulin, his blood sugar will start to rise and it will not come down on it’s own, insulin must be given. So, as long as my son continues to eat a healthy diet, and continues to grow ever so beautifully, then it does not matter to me if he eats 50 carbs a day, 100 carbs a day, or even 150 carbs a day as long as he covers each and every carb with the appropriate amount of insulin.

Think of his insulin pump and me as a team working as his external pancreas. I take all the notes, and program the pump to the appropriate settings for every minute of every day to keep my son healthy, and the pump gives insulin a little bit at a time all day and in larger doses to cover carbs. We are a team, the pump and me. We are the external pancreas that allows my son to be the happy healthy 5 year old that he is today.

While having Type 1 diabetes does not affect a person’s ability to learn in the classroom, lack of knowledge, improper care, and inflexibility by school personnel with regards to Type 1 diabetes could potentially affect a child’s success in the classroom.

While on the outside most children with Type 1 diabetes look and act exactly the same as everyone else in their class. They learn the same, the play the same, and most likely, they get in trouble the same. But one main difference between a child with Type 1 diabetes and a child without Type 1 diabetes is their blood sugar. A child without diabetes does not need to think about their sugar level before, during an after a test or activity. A child with Type 1 diabetes has no choice but to check and monitor their sugar before, during and after a test because it could mean the difference between an A or an F.

I saw this first hand when my son was on MDIs (multiple daily injections/shots). He was recently diagnosed and in preschool three days a week. The only thing he knew how to read at the time was his name. Having a name with 8 letters really helped him because he was able to pick it out of most of the names in his class because the other names were shorter. So, I got to the school and asked him to grab his work off of the table that his teacher would lay out at the end of each day.

My son could not find his paper. There were only 9 papers on the table. He looked at me and said, “I can’t tell which one is mine, could you get it?” I grabbed the paper that was covered on the entire top half with his 8 letter name. Immediately upon getting to our car I tested my son, his number was in the high 400s. Too high, yes. So high that he was unable to focus enough to pick out his own name. If this had been the SATs in Junior Year of high school, well, we all know where that would have ended, and it wouldn’t have been good.

All children with Type 1 diabetes have to have a 504 Plan or a Diabetes Medical Management Plan (DMMP) that stipulates, among other items, when a child is supposed to test their sugar, and in what range their number fall in order to perform at their absolute best.

This plan is something that needs to be discussed with all people involved with the education of children with Type 1 diabetes. While some teachers may think it is smart teaching to surprise the class with a ‘pop’ quiz, that teacher still needs to allow for time for the child to test their sugar and provide treatment if necessary in order for the child to do their best on the ‘pop’ quiz.

People with Type 1 diabetes are at their best when their numbers are in range. The only way to tell if their numbers are in range is to test, test and test some more. School districts need to follow these plans in order to keep the playing field level for all kids. In some states, the schools provide breakfast the day of a big test to make sure everyone is thinking at their best. This is the same for a child with Type 1 diabetes, they test to make sure they are at their best. That’s all anyone wants for their child, that they are able to perform at their best. Children with Type 1 diabetes can’t do it alone, they need the support of school personnel to understand, learn, and respect how knowing one’s blood sugar can be the difference between an A or an F.