Recently, while scrolling through discussions posted on an online diabetes forum, I came across one from a man in his thirties who wrote about how paramedics had found his twin brother face down in a sauna, in an insulin shock coma. How did he end up in such a state? The appalling answer is, he didn't have enough glucose strips to test before he got into the hot tub. A few weeks before the sauna incident, his insurance company had limited his glucose strips to just four per day.
One of the greatest technological advancements in diabetes care has been the insulin pump. For one, it gives you the illusion of being "normal" because you no longer have to inject insulin throughout the day. Instead, you "bolus" by pushing a button on the pump itself or using a remote control. It allows better glucose management because you can adjust your basal rate (the "background" insulin dose) by increments of one thousandth of a unit every hour. Especially when you're moving from the peaks and valleys of NPH or the restraints and hazards of Lantus, the freedom of living with an insulin pump is incredible. But pumps do not come without their kinks.
I've had type 1 diabetes for 14 long years. During that time, I have had five episodes of ketoacidosis, two of which were brought on by emotional stress. The one that happened eight years ago, shortly after the meltdown of a serious relationship, lives vividly in my memory.
You've heard of the blockbuster drug Byetta, a daily injection for type 2 diabetes? Byetta's sister product, Bydureon, which is injected just once a week, has just been approved by the FDA and is available in pharmacies.
Two years ago, I was a different woman. I was just beginning to come out of my diabetes shell, assessing my confidence with strangers by testing in public and telling friends about my disease. I can still feel the panic rising in my throat as I told people that I have diabetes and need to take injections multiple times per day. I was afraid of rejection, afraid that they would treat me like a sick person. But after eleven years of fighting for my life with type 1 diabetes, I was tired of being afraid. The more people I told, the easier it got.
Erin lay on a bed in the emergency room, finally serious about getting help. Her second episode of diabetic ketoacidosis in a single year had sent her to the hospital shaking and vomiting. For the past seven years, she had been driven by one desire: to lose forty pounds. She refused to give herself her full dose of insulin, fearing weight gain. She hadn't seen her endocrinologist or checked her blood sugar for a year or two.
Meet Mary,* a 16-year-old girl with type 1 diabetes. When her parents ask her how her blood sugar is, she always has a good number. She keeps a tidy logbook of her blood sugars, and they look fine, although her last A1C was inexplicably high. It's been a long time since she was diagnosed, and her parents are confident that she knows how to care for herself. She has been somewhat less energetic for quite awhile, but her parents attribute that to growing pains, as Mary has grown from a chubby child into a very slender young woman. She appears a little dehydrated and flushed sometimes, but she always drinks a lot of water and goes to the bathroom frequently, so her parents aren't concerned. They have also noted a fruity odor about her, which she attributes to a new lip gloss.
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