Tuesday, January 15, 2008

How is diabetes treated?

So, to live, you need insulin. You need a background or small amount all the time. You also need larger amounts when food is digested and sugar produced. There are two main ways to do this.

The first is to have a pump that slowly pumps insulin all the time through a tube into a small needle that is left inserted under the skin for several days and can be increased when a meal is eaten.

The second is to take a long acting insulin that gives a slow basal or background level. Then a fast acting insulin can be taken during meals. These are given by short needles in the stomach, thighs, back hip or back of the arm. The injection is below the skin, not into the muscle, and in areas with few nerves so the pain is (usually) not too bad. This is what I do even though the pump works very well for many people.

Before insulin is given the blood glucose level should be tested. Glucose monitors have come a long way. Now, in a few seconds with a drop of blood the level of glucose can be monitored so that the insulin dose can be adjusted. There are some continuous glucose monitors on the market but still are not completely reliable and are expensive as they are not covered by most insurance.

The Trick (where people get confused about diabetes)
Before (or soon after) you eat something you need to take a shot or have the insulin pump give you some insulin. There are several scenarios:

  1. You take a dose of insulin but don't eat anything. Result: the insulin takes affect and strips your blood of sugar and you lose the ability to think clearly. You get shaky and sweaty from the body releasing adrenaline. You may also act drunk. This is called hypoglycemia. "Normal" people feel this when the sugar drops slightly below normal. After a few years with diabetes you may not feel this until it's too late. If you still don't eat the sugar level keeps dropping and you can go into convulsions, pass out and go into a diabetic coma. If you are unconscious, someone can give you a shot of a hormone called glucagon, which causes your liver to deliver stored sugar from glycogen (a glucose polymer like starch). If you just ran a marathon, there may not be stored glycogen! Or the emergency crew will give you glucose intravenously. This is why it might be nice to carry sugar with you or tattoo "diabetic" on your forehead....
  2. You take a dose of insulin and eat but it isn't digested as fast as normal and the above conditions apply. This happens with me if the food is richer and digested more slowly.
  3. You take a dose of insulin but the insulin was injected into an area that for some reason absorbs faster than you think and the above conditions apply.
  4. You don't eat or take a shot. The long acting insulin keeps working no matter what and the above conditions apply.
  5. You take a dose of insulin and eat but eat more than the insulin will "cover" and your blood sugar will climb higher than is healthy.

Now factor in exercise.... Actually I think exercise makes control (keeping glucose levels as close to normal as possible) much easier.

What levels of glucose do you strive for?

Normal blood glucose, bg, is 80 mg/dL. If it drops below 6o you may get loopy as above. The worst thing to do is think that you can operate at low levels safely, but I have no problems with levels of 40.... Not funny says Anne.

If it drops below 30 you are probably going to pass out very soon.

High glucose is above 180. If it is high, like 180-400, for long periods you can develop a host a problems. The most common ones are neuropathy (nerve damage-hence you lose feeling in places like your toes), blindness, and impotence. Poor circulation and the neuropathy lead to the loss of toes and maybe a leg or two.

Before I go to exercises I like the bg to be 150-180. It can drop very quickly when exercising.

At bed I like my bg to be about 16o. This avoids lows when you sleep--most of the time.

Before meals the bg should be 80-120 if you're lucky.

Next post? So what is the Grand Traverse and how do I train?

1 comment:

Matthew Tyler said...

Just don't let your insulin freeze this time buddy. Also it is a good thing I taught you how to ski so well! Matt