The Princess and the Pancreas: A Fable About Type 1 Diabetes

| Nov 21, 2007

Once upon a time in a land called Sweeten, there lived a beautiful princess named Princess Tootsweet. She had long flowing hair, large dark eyes, and a lazy pancreas.

"Lazy pancreas? What does that have to do with a lovely princess?" one might ask.

And one might answer thusly: For some time Princess Tootsweet had been feeling a little too fatigued to enjoy the kingdom's intramural jousting events. Because she was constantly halting the exhibitions to take a trip to the royal outhouse, the members of her court would whisper, "Gee, Princess Tootsweet sure does pee a lot."

Princess Tootsweet became so thirsty that the royal water bearers were running out of royal water to bear. She felt hungry and tired and irritable, and that's when she decided it was time to visit her royal doctor, Doctor Langerhans.

"Oh, Doc, I just feel so tired that I can't enjoy the jousting events anymore. I've lost weight, and...." The princess paused. Dr. Langerhans finished, "And you're making so many trips to the royal out-house that your subjects are whispering, 'Gee, Princess Tootsweet sure does pee a lot.'"
 "Yes, precisely. That is why I came to see you."

"Hmmm…." said Doctor Langerhans, "Are you thirsty a lot?"

"Well, yes."
 "I could eat a royal unicorn if I could find one!"
 "Irritable?" asked the doctor. 
This really irritated the princess, who answered, "Hel-LO, I am the princess of SWEET-EN. I am always sweet. I am NEVER irritable!"

"Not irritable….Okay." Dr. Langerhans looked over his spectacles, "Well, let's get some blood work done, and we'll get a better idea of what's going on."
 "Blood work, what kind of blood work? I am a princess, and my blood works just fine." 
Dr. Langerhans replied, "Yes, perhaps, but I want to give you a test called a fasting plasma glucose test. The results will show whether or not you have diabetes."

The princess looked dismayed and bewildered. "Diabetes? What are they?"
 Dr. Langerhans also looked dismayed and bewildered. "Not 'They.' It's a disease, singular..."
"Huh?" was the royal reply. "Diabetes is a disease in which the body does not produce or properly use insulin." "Huh?" again, the royal reply. "Let's get the fasting plasma glucose test done," smiled the doctor.
 "Very well then," stated the princess with a grand gesture. "Let the bleeding begin!"

"Okay, so what about the lazy pancreas?" you're wondering. Well, I'm getting there. Dr. Langerhans received the results of Princess Tootsweet's fasting plasma glucose test. Princess Tootsweet listened as the doctor told her that she had type 1 diabetes. The doctor explained that her pancreas has stopped making insulin and that insulin is needed in the body to deliver energy in the form of glucose to all the parts of the body. Without insulin, glucose builds up in the blood and can cause all kinds of problems.

Now, Princess Tootsweet was quite upset by this news. She yelled, "I will not tolerate such insolence, such, such, laziness! from any one or any pancreas! Can't I just command my pancreas to work again and make this, what's it called? Insolence... insomnia... instant coffee...?"
"Insulin," answered the doctor. "No, Princess Tootsweet." "What do I do now?" The princess choked back tears. "This pancreas of mine is lazy, and the intramural jousting exhibition is coming up soon, and what's going to happen to me? Oh, peppercorns! My life is never going to be good again!"

Dr. Langerhans understood the princess's frustration and anger. Finding out that you have diabetes can be devastating news, be you a princess or a pauper. Princess Tootsweet gathered her crown and scepter quickly, wanting only to be left alone to try and forget all about this diabetes stuff. Doctor Langerhans stopped her and said, "Princess Tootsweet, you can have a normal life. With medicine and the right diet and exercise, with careful monitoring of your blood glucose levels, and, most importantly, with knowledge of how to manage diabetes, you, Your Royal Highness, can have a wonderful, royal, and groovy life."
 But Princess Tootsweet did not want to listen any more.

Princess Tootsweet retired to her chambers. As she paced about, angry and upset, she decided that she did not feel too bad and that perhaps the doctor had made a mistake. So she ignored everything the doctor had told her to do. She refused to test her blood sugar - Oww! That thing hurt! She refused to follow a balanced diet. She refused to believe she had this, this "disease." (She could not even bring herself to say the word DIABETES.). Then, one day as the princess was walking in her garden, she felt terribly, horribly sick, sicker than she had ever felt in her life. Suddenly, she collapsed beneath her favorite weeping willow tree.

Princess Tootsweet woke up in the hospital. Tubes and wires and all sorts of things were attached to her in all sorts of odd ways. 
Dr. Langerhans came in to see the princess. "What happened to me, Doc? And what is up with all these tubes and whatnots going in and out of me?"
 Dr Langerhans replied, "Princess, you have ketoacidosis." The princess made that scrunched-up face that she always made when she was confused. "Ketoacidosis? Who are they and what do they want from us? Don't I have a war adviser or something to tell me about these things? Oh, I don't care about invading barbarians with goofy names. They can have the kingdom! I just want to know what happened to me."

Dr. Langerhans explained. "Not 'They.' 'It.' It's a condition, dear Princess. It's what happened to you. You have ketoacidosis." "Oh!" was the royal reply. Dr Langerhans went on to explain what ketoacidosis was and how it is caused. He told her that she was being given fluid intravenously (in the vein), along with insulin, to get her blood to have just the right amount of glucose in it. 
The princess could not deny it any more. She slowly came to accept her diagnosis.

While the princess was in the hospital, she learned more about diabetes. Ken RN was one of Princess Tootsweet's nurses. It was his job to make sure that she knew how to manage her diabetes when she left the hospital. Ken RN advised the princess to eat well balanced, healthy meals and to check her blood glucose regularly. He showed her how to administer insulin, what to do when she got sick with a cold or flu and was not feeling quite so royal, and where she could get more information about diabetes. Ken RN made sure that Princess Tootsweet had a clue before she was discharged from the hospital.

After Princess Tootsweet was discharged, she wanted to learn even more about diabetes. So she read books about diabetes, subscribed to Diabetes Health magazine, and surfed the web for more information. She learned so much, and she used all that knowledge to get her diabetes under control. When her diabetes was controlled, the princess felt so healthy, so in control, and so groovy that she was soon considered by all her subjects, and by the royal court as well, to be quite the expert when it came to managing her diabetes.

Yes, indeed, the royal unicorn was spared. The water supply returned to optimum levels, and the intramural jousting exhibitions resumed. The pancreas, so lazy! stayed on vacation, but none of Princess Tootsweet's subjects or royal court members whispered about her frequent trips to the royal outhouse anymore. Instead they proclaimed, throughout the land of Sweeten and beyond, how smart the princess was when it came to staying healthy and managing her diabetes. And, of course, they all lived quite happily and healthfully ever after! 

Royal Glossary

Fasting Plasma Glucose Test: This is a blood test to see if you have diabetes. First, you fast (no food!) for about eight hours. Then a little bit of blood taken from a small vein and is put into a little test tube. Off it goes to a laboratory, where the amount of glucose in the blood is measured. A person who does not have diabetes will have under 100 mg/dl (milligrams of glucose in a deciliter of blood). A person who has diabetes will have 126 mg/dl or more. The test is repeated if the number is high, just to make sure that everything was done correctly and that the high number is not just a fluke. 

Diabetes: Princess Tootsweet had type 1 diabetes. Type 1 diabetes is caused by an autoimmune disorder, which is a problem with the body's immune system. When a pancreas is working the way it should, specialized cells (called beta cells) in the pancreas make insulin. Insulin is a hormone that allows the body to use energy from food. In type 1 diabetes, the immune system mistakes beta cells for invaders and attacks them. After enough beta cells are destroyed, insulin is no longer produced and symptoms of diabetes appear.

In type two diabetes, the beta cells still produce insulin. However, the other body cells do not respond properly to the insulin, or not enough insulin is produced naturally to meet the needs of the body. Insulin is usually still present in a person with type 2 diabetes, but it does not work as well as it should. Some people with type 2 can keep it under control by losing weight, changing their diet, and increasing their exercise. Others take one or more medications, including insulin.

Dr. Langerhans: Dr. Langerhans was a real doctor who discovered the little groups of cells in the pancreas that produce insulin and other hormones. When he looked at the groups of cells, he thought they looked like little islands, so he named them the islets of Langerhans.

Glucose: Generally, glucose starts out as carbohydrates. Carbohydrates are found in foods like rice, pasta, fruit and bread. The digestive tract breaks down the carbohydrates into something the body can use for energy: glucose. In the small intestine, the glucose is absorbed into the bloodstream, and there it meets up with insulin.

Insulin: Insulin is like the cool knight in shining armor who knows the secret passwords to all the best castles in the neighborhood. Everyone knows you can't get into the super-secret castle on Eighth Street without the secret password. Glucose does not have the password, so he pals up with Insulin. Insulin and Glucose together go to the muscle cells and knock on the cells' doors. There Insulin says the secret password, and Glucose enters the cells, providing energy to the cells. If Glucose is running around in the blood without Insulin, he never gets in the cells of the muscles because...why? He doesn't have the secret password!

Ketoacidosis: Ketoacidosis is a serious complication of diabetes. When Glucose is not hanging out with Insulin, Glucose does not get into the cells of the muscles to provide energy. So the body starts using fat for energy. When fat is broken down, some of the little by-products are called ketones. If all this happens at a very fast rate, the ketones build up in the blood, making the blood acidic.

Blood loaded down with ketones is like a poison. Why so hungry? Because the muscles are not getting glucose, they "feel" like they are starving. And they are starving for the energy that glucose gives. Why so thirsty? All that extra glucose in the blood draws water out of the blood like a sponge as it passes through parts of the kidneys. If this goes on too long, the body becomes dehydrated. Sometimes the diabetic person starts vomiting, and this causes even more dehydration. Severe dehydration can cause a collapse of the whole body, coma and even worse. If you have type 1 diabetes, your body needs insulin everyday, which brings us to.... 

Denial: Sometimes the news can be too horrible, so we just decide it is not true. This is a big problem for diabetics and other people who have just received bad news. Although you might feel better for a little while by just blocking out the bad news, in the long run the problems get even worse.

Acceptance: If you can accept the bad news, then you can start getting on with making your life groovy. It takes work, but a groovy life is worth it: just ask Princess Tootsweet! 

RN: RN stands for Registered Nurse. RNs are specially trained healthcare professionals who must go to school, pass rigorous exams, and keep up with new developments. Nursing has traditionally been viewed as a woman's profession, but more and more men are becoming nurses, attracted by the good pay, flexibility, opportunities for advancement, and their desire to help out their local princesses and fellow men.

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Nov 21, 2007

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