What is type 1 diabetes?

Diabetes mellitus type 1 is a disorder affecting glucose metabolism. Glucose cannot enter cells due to a lack of the hormone insulin. In people with diabetes, insulin-producing cells in the pancreas are destroyed.

Insulin injection

Unused glucose accumulates in the blood and the urine. Fats are used as an alternative energy source, which leads to a build-up of ketones in the blood that may eventually cause convulsions and diabetic coma. Treatment is based mainly on taking insulin by injection or pump to maintain normal blood-sugar levels.

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My child has type 1 diabetes

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It is extremely worrying when you and your child first receive news that he or she is suffering from diabetes. Calm soon returns when you understand that modern treatment for diabetes allows kids to lead normal, active lives.

I was skiing in Grand Targhee, Wyoming when I received the terrifying news that Maja, my 11-year-old daughter, was in the intensive care unit of a European hospital having just been diagnosed with type 1 diabetes (T1DM, or type one diabetes mellitus).

Symptoms of T1DM

She had been extremely thirsty combined with a need to pee way more than usual. Maja's mother, a registered nurse, suspected diabetes and rushed her to hospital.

I knew very little about the condition, I felt hopelessly far from my beloved daughter, and I had only a poor cellphone connection to the hospital in Europe to let me know what was going on.

Emotional response

My first questions were basic and emotional: Is Maja ok? Is she going to be fine? How will this affect her life?

Maja's ok, her mother reassured me. With regular insulin injections, she will be just fine.

I wanted specific details. Maja's mother explained our daughter would need to check her blood glucose levels at regular intervals through the day. This would be done with a small testing kit comprising lancets to prick her finger tip to release a drop of blood, plus a glucose meter with test strips to measure whether her blood glucose (sugar) level was high or low.

Role of insulin

She would need to self-inject her abdomen (in the belly fat, of which Maja had very little) with fast-acting insulin before meals, and she'd need a longer-acting insulin injection called Lantus to be taken once every 24 hours by self-injection in the leg (the instructions said subcutaneous, i.e. below-the-skin injection).

It was a lot of information to take in all at once, but I needed it. I had to know that everything was under control. Most of all, I needed to know whether Maja could continue living the active, sporting love she loved. Yes, she could continue to lead an athletic life, but she would have to change her diet; she'd have to learn to take a keen interest in her health, and she would never be able to put herself in a position of being without insulin or the glucose tablets that are sometimes needed to quickly reverse low blood glucose level.

Extreme thirst

During my first conversation with Majai, with me in Wyoming and her in Stockholm, I seemed more nervous than she was. She explained in a matter of fact manner how she'd been extremely thirsty but no matter how much she drank the thirst wouldn't go away. Plus, she felt like she wanted to pee all the time. Soon after explaining this to her mother she was in hospital, and very soon after that she was in intensive care. Everything's ok, dad, she said while I was trying to fight back tears.

Life with diabetes

Now, four years later, I am amazed at how well Maja has adapted to being a diabetic. In restaurants, she is not at all shy about taking out her insulin pen, lifting her blouse just slightly, then pinching her stomach to self-inject before a meal. If curious onlookers want to know what's going on, she tells them: I am a diabetic and this is my insulin injector. I need to take insulin before I eat.

She has used such encounters to educate people about diabetes and let them know there is nothing to fear.

Road runner

Maja keeps up with me on five-mile road runs. Her speed and stamina are not affected by her condition. In fact, you would not know that she has a potentially life-threatening condition. She says that she is healthier than she was before because she closely monitors her health, her moods, and diet. She has almost entirely eliminated candy and soda (except when her blood glucose level is low) and doesn't miss them.

She's gifted at math and science and has used that interest and ability to track and monitor her blood glucose levels. She's charted how certain levels correspond with definite moods and feelings. Slight confusion, anxiety and an inability to concentrate mean a low blood sugar level, for example.

Motivation

She has not suffered from lack of motivation to monitor her blood glucose level, something which happens to a number of young people with diabetes. Maja is firmly committed to staying active, alert, and healthy. She attends an annual summer camp for diabetics her own age, but she is thinking of dropping out of that because all they talk about is how difficult it is to be a diabetic and I don't think it's difficult at all. I encourage her to keep going so she can help others with her positive outlook.

Hypoglycemia

Occasionally, she will suffer from low blood glucose (Hypoglycemia), the side effects of which are one or more or all of the following: hunger, nervousness and shakiness, sweating, dizziness or light-headedness, sleepiness, confusion, difficulty speaking, feeling anxious or weak. When Maja's hypoglycemic she's anxious and rather shaky. The cause is usually that she has over-exerted herself at tennis, or hasn't eaten enough. She promptly treats the condition by eating a couple of glucose tablets or drinking juice or soda.

Hyperglycemia

The opposite condition, when blood glucose levels are too high, is hyperglycemia. It can be brought on by not getting enough exercise, not following the treatment plan, eating too much for the amount of insulin taken, or by flu or stress.

If hyperglycemia is untreated it can cause damage to the vessels supplying blood to vital organs, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems. These conditions are usually seen in adult diabetics who have not followed their treatment plan properly.

Ketoacidosis

A term you should be aware of is diabetic ketoacidosis (DKA). This occurs because glucose stays in the blood and can't get into the body's cells to be used for energy. This can happen when a person skips doses of insulin, or when the need for insulin suddenly increases (such as when you are sick with flu) and the doses are not adjusted. When the body can't use glucose for fuel, it starts to use fat. When this happens, chemicals called ketones are released into the blood making it acidic.

Too much acid in the blood throws off the body's chemical balance and causes dry mouth, tiredness, wanting to pee and drink a lot, fruity (or pear drop) breath, pain, nausea, vomiting, rapid breathing, vomiting, and confusion. It is easy to buy test strips to check for ketone levels.

Ski trip

I tried to talk to Maja about this and other side effects of fluctuating blood sugar levels when she joined me on a skiing trip to Utah last year. My memories of first finding out about her diabetes came flooding back to me and I started to cry. She, like the trooper she is, patted me on the back as if to say Don't worry dad before lifting her jacket to inject herself with insulin. It was time for a hot dog and soup. Maja had no time for sentimental reminiscences. She wanted to wolf down her food and get back to the slopes.


By David Hay Jones