By Patrick Totty
All of us carry around mental images of various things, such as grocery stores, freeways, baseball stadiums, bank interiors, and Thanksgiving dinners. The images aren’t all that detailed and clear, but they don’t have to be. They’re a simple, shorthand way of grasping a concept, such as when you’re talking to a friend about the ballgame she recently saw or the recent traffic jam you were caught in.
But some mental images are skewed and don’t really give the people who think them a very accurate take on things. I’m thinking of how most non-diabetics think of our disease. It’s something like an image of a X drawn across a giant sack of sugar or pile of pastries, maybe accompanied by an endless procession of long, thick syringe needles. I know this from talking to many non-diabetics along the way in the 12 years after my diagnosis. Their mental shorthand is based on the two things that many people who don’t have diabetes think when they hear the word “diabetes:” no sugar; painful shots.
When I talk to somebody like that, I try to introduce more accurate images by giving the simplest illustrations possible.
So, just what is diabetes?
It’s the inability of the body to regulate the amount of sugar (glucose) in its system. Too much sugar leads to inflammation of the cardiovascular system and organ damage. Too little can lead to a coma.
So, how does insulin work into this?
It’s the hormone that regulates the amount of glucose (sugar) in your system. The bodies of people who don’t have diabetes manufacture sufficient insulin by themselves with no assistance. But if you are born with a genetic makeup that predisposes your autoimmune system to attack the glands that produce insulin, you have to bring in insulin from the outside or you will waste away and die. That’s type 1 diabetes. For type 2 diabetics, who still produce insulin, the problem is that they may not be making enough of it or they have become resistant to it.
People who use insulin know that there are two types: basal and bolus. Basal is once-daily shot of long-acting insulin that works as a background check on blood sugar levels. Bolus is shorter and quicker-acting insulin used to keep post-meal blood glucose levels from spiking too high.
If type 1 is genetic, what causes type 2?
Most people are vaguely aware that there’s a form of diabetes called “type 2,” but if you press them they can’t really describe it. The simplest description is that it is a form of diabetes that usually occurs in adults after years of bad food habits, lack of exercise, and being overweight. It also has a genetic component, in that people who belong to certain ethnic groups, can acquire it more easily than others.
Type 2s form about 90 percent of the population of people with diabetes. It is a diabetes that most people can prevent or forestall if they make the right lifestyle choices.
Since type 1 is a genetic disease, the people suffering from it cannot cure it or make it go away. Until the invention of a reliable artificial pancreas, or breakthroughs in stem cell research leading to genetic engineering, type 1s are the people most at risk from diabetes.
Can you ever have sugar again?
Yes. You can still consume refined sugar, which is what you’re talking about, but you have to do it only occasionally and in small amounts. There are several types of sugar besides table sugar (sucrose), including dextrose (the other name for glucose), fructose, and lactose (milk sugar). The body metabolizes some sugars faster than others, which is why type 2s tend to know a lot more about sugar than most people who don’t have diabetes.
Sometimes people who are injecting insulin will use bolus shots to “cover” for a meal that is high in sugar and carbohydrates. The increased dosage prevents the post-meal blood sugar spike that everybody experiences from going too high. It’s not a healthy practice: Even though insulin is nothing short of a miracle drug for people with diabetes, it can be too much of a good thing. The less insulin that people have to use, as opposed to opting to use, the better.
How come they haven’t yet found a cure for diabetes?
Answers can run to extremes here. Some people say diabetes will never be cured because the people capable of curing it—the big pharmaceutical companies, university researchers, doctors—don’t because they would lose billions of dollars in medicine sales and research grants if the disease were cured.
Other people are very optimistic about a cure for diabetes in our lifetimes, possibly by 2025. They point to the assault on diabetes that’s now coming on several fronts: the quest for a reliable artificial pancreas; genetic modification of a patient’s own adult stem cells to “redirect” the autoimmune system to not attack itself; and nanotechnology, tiny machines tasked to protect insulin-producing cells from autoimmune attack.
What about bariatric surgery as a cure for diabetes? Can type 1s undergo it?
In the strictest sense of the word, bariatric surgery is not a “cure” for type 2 diabetes. There has been a high percentage of obese type 2s who have undergone the procedure and experienced a total remission of their diabetes symptoms. Their blood sugars return to normal (70 to 90 md/DL), their neuropathy ceases, and they lose weight. However, nobody is going to call it a cure until there has been several more years worth of study, including how long remissions last.
For type 1s, bariatric surgery cannot and does not address their primary concern: the autoimmune attack against their own insulin-producing cells.
Don’t you dread pushing into your body?
No. Today’s needles are very short and thin. Yes, they can sting if you push them through a nerve-rich patch of skin, but you can get around that simply by moving your syringe an inch or two to a different, less sensitive location. After awhile, quickly and deftly filling and using syringes becomes second nature to most insulin users.
When I answer people’s naive questions, I never become testy or sarcastic. All of us are deeply involved in our own affairs, so none of us can be expected to know what’s going on in other people’s lives until you talk to them. Even with every incentive in the world to learn about diabetes after I was diagnosed with it, I still had big gaps in my knowledge after a couple of years. So it’s unfair to expect people who don’t wake up every day with the disease to know that much about it.