Blog Entries With Tag: diagnosis

Posted: Feb 16, 2012
It's a place of shock, bewilderment, desperation, sadness, fear, or sometimes, misplaced relief or joy. 

It's a diabetes diagnosis.

Sometimes, it might come at us in a tactful way, but more often than not, it gets thrown at us like a volleyball in a game of tag. "You're it! It's your turn now, to go, and get it figured out!" 

A diabetes diagnosis may be paralizing for a patient, especially, when little is known about the disease, or when the diagnosis was not expected. However, few medical professionals seem to realize this, nor the need for essential information right from the start to communicate not just the seriousness of the disease, but to ease feelings of helplessness or resignation that a patient might experience. Insurance hurdles, often limiting helpful actions a medical professional might take, usually end up making matters worse. 

So, what can we do? Where can we start? How do we help ease the fogginess of confusion?

Well, if Bob's crazy journey in the movie "What About Bob?" taught us anything... the answer begins with "Baby Steps."    

Bob is right: "All I have to do... is take... one little step at a time... and I can do anything..." Truer words were never spoken by a "crazy" man. 

See, Bob isn't really "crazy." He's just soooo overwhelmed by looking at the big picture of life, and everything, all at the same time -- that he's distracted from the little baby steps, and the things that matter. His psychiatrist, just wanting to get rid of him, unwittingly gives him the answers.

Type 2 Diabetes is much like this; a baby steps adventure. Yes, it's an adventure! Just as Bob goes on, exploring a brave, new, and often frightening world... so must we, also, discover that we can do this, and much, much more. 

Just what do baby steps look like? Well, I find that learning what the problem IS before I even start, can help signifficantly. So, let's begin. 

Just what exactly IS diabetes? (THIS is the real problem. The equation to solve.) Diabetes is a condition in which the body does not use glucose adequately. 

  • What in the world is glucose? Is this sugar? Well, yes, and no. Glucose is definitely a type of sugar, but it's not 'table sugar,' and it's not exclusively derived from any sweets, or treats, you might like to eat. Glucose is the fuel your body uses to power itself so that it can do tasks, perform bodily functions, exercise, etc. In short, it's the gasoline that powers your vehicle. Your body will take ALL the food you eat (from one degree to another), and turn it into glucose so that it can power itself. Most of that power will come from carbohydrates (around 98% of them will get turned into glucose), some from protein (around 58%), and a little bit from fats (around 10%.) 
  • What does it mean to not use glucose adequately? Well, it usually means that your body's red blood cells, and muscle tissues, etc. cannot allow glucose to enter them because: a.) they are not communicating well with insulin (insulin is like a door man, allowing glucose to enter cells when it's present), b.) there is not enough insulin present in the body to even try to communicate with glucose, OR c.) both a & b.  
When insulin cannot communicate effectively with red blood cells, and tissues, etc., we call this "insulin resistance." When there is not enough insulin to simply help glucose enter cells, at all, we call this "insulin deficiency." Both insulin resistance, and insulin deficiency, can vary. Some insulin resistance is very advanced (meaning, the pancreas has failed again and again to produce insulin that can communicate effectively with tissues), and some insulin deficiency is absolute (meaning, there is no insulin production left, in any real signifficant levels.) 

If you have insulin resistance, your pancreas will try to continuously make insulin until it can process that extra glucose in your blood stream, allowing it to enter your body's cells and tissues, etc.

This means that if you have pre-diabetes, your pancreas has to work a little harder to process that glucose because it is struggling to keep up with the demands. It might take a few cycles of insulin production for it to get that extra glucose into your cells and tissues, but it can still get the job done.

If you have Type 2 Diabetes, your pancreas can no longer meet these insulin production demands adequately, and your blood stream will start to carry unsafe levels of blood glucose long past digestion. Any extra insulin your pancreas might produce is not communicating adequately, or quickly enough, with your cells and tissues to allow glucose to enter them effectively. Sometimes, the level insulin resistance is so great, that a person may need to supplement with oral medications, or even insulin, to help overcome it. 

If you are insulin deficient, this means that the beta cells -- the little cells within the Islets of Langerhans, inside your Pancreas, which are responsible for insulin production -- have become exhausted from the constant insulin production cycle, and have "pooped out." A good amount of them have died, if not nearly all of them. Your pancreas can no longer make a safe level of insulin to help keep you healthy, and processing glucose, so that you don't starve. (Yes, our body's cells, and organs, will starve without glucose!) Patients with insulin deficiency, must supplement with insulin therapy, or risk fatal consequences.

Some insulin deficiency is absolute, and it is brought on by the body's own immune system suddenly attacking these beta cells, for currently unknown reasons, until there are none or virtually none, left. This is called Type 1(a) (or Type 1) Diabetes, and though it is often seen in children, it can present at any age. The fact that it is brought on by an autoimmune attack, makes it distinctly different than Type 2 Diabetes, and it is the main reason why Type 2 Diabetics do NOT turn into Type 1 Diabetics if they become insulin deficient.

Knowledge is Power
And this is our FIRST baby step. Now that we are armed with at least, some of the most basic concepts of Diabetes, and the problems and hurdles it may present, we can live with a little less fear. Do you see the light yet? A little bit?

Is it too much? Read it... just a little paragraph at a time. Try to visualize it.    

Next blog post, we will discuss what we can do... with ALL this power. :) Stay tuned. 
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Posted: Feb 7, 2011

FatCatAnna at diagnosis in 1968

It's not a question I really have ever thought about - with becoming diabetic at a young age.  Sometimes I think perhaps getting it so young, is the reason I am able to handle it better then some who become diagnosed later on in life.  All I know is that I don't know life any other way then then this.  Do I get worried sometimes about it?  Yes, but the fear is more so when I become much older, and I'm not capable of taking care of myself like I do now.  To have someone else taking care of me scares the crap out of me.  I'm probably like this because my parents had me taking care of my diabetes probably much younger then today's generation of parents would do.  I am glad that they did this with me, as I had to learn how to cope.  Anyway, I think I'll be around for a while, hopefully with a body/brain intact enough to deal with the roller coaster ride of diabetes - through good and bad.  This is what I think makes long term diabetics like myself survivors and strong willed.

What started off this whole blog title is an article that popped up on my desktop from the UK, stating that a virus called Enterovirus is the 2nd leading cause of the common cold virus could perhaps be the cause of Type 1 diabetes in children.  The article goes on to say " that children with Type 1 diabetes are nearly 10 times more likely to show signs of enterovirus infection than children without Type 1 ".  The genetic factor has sort of been tossed around for awhile and is still up for debate amongst the medical community to this day.  What has been revealed with combined studies is that they can't pinpoint the exact environmental factor that sets off Type 1 diabetes but this virus is now being more thoroughly researched.

I know over the years with discussions with other diabetics that were diagnosed at a young age, that many of us have muddled this idea in our hand that it could be to do with the environment we lived in, as well as genetically being passed on to us.  I know my great grandmother who died at quite an old age, was discovered to have diabetes, probably Type 2.  This wasn't the cause of her death though, it was just time for her body to go onto the next life (or that's the way I like to think of it through rose coloured glasses).

I don't really remember too much about having colds before I was diagnosed  - but I remember getting hit with the chicken pox.  I was so angry to not be able to go outside to play in the snow - and basically bashed in my parents front bay window with my foot while my older brother teased me outside the window.  So, who knows, maybe that set things in motion for me? 

The way I'm reading the article which is based on 4,440 patients in Europe, is how hygenic our society has become which causes our body not to develop antibodies to ward off viruses.  This in turn makes children more susceptible to infections since they have not acquired antibodies.  Of course, this is one of their theories, but it's always been something that's bugged me in the back of my mind with how many people nowadays are always somewhat fantical about things being squeaky clean/sterile.  I'm imagining if I'd had children, they all be running around dishevilled and snotty nosed (visions of Pippy Longstocking here), but happy little buggers as they played with the dust bunnies in the house.  Along with how many Mums now breast feed?   It has been shown that breast milk helps build up a child's immunity (and it's way cheaper then formula). 

So, what are your thoughts?

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Posted: Sep 8, 2009

This article in yesterday's edition of Endocrine Today makes me scratch my head.  First and foremost, had this study been conducted in 1976 in the US and not in Germany, I would have been included in these statistics.  Given that, why did they spend money on this?  What do they hope to attain by learning that ketoacidosis in juvenile onset diabetes is frequent?  Do they think somehow they can prevent the phenomenon? 

I don't think a high incidence of ketoacidosis in true juvenile onset type 1 diabetes diagnosis is particularly preventable.  Why?  Let's start with the fact that the progression of the disease normally goes from 0 to 100 mph very rapidly.  Then continue with the fact that kids normally only go to the doctor for a routine annual physical at most annually.  Then there's the fact that glucose and c-peptide tests are not part of a physical. 

I would expect that glucose testing due to the high incidence of type 2 might be added sooner or later but the real indicator of juvenile onset type 1 is in insulin production and beta cell destruction which would more likely be seen in a c-peptide test.  When does beta cell destruction start in earnest?  Is it consistent? 

There's no way anyone is going to mandate a c-peptide test at a routine annual physical AND force insurers to pay for it primarily because the incidence of true juvenile onset type 1 diabetes is so low relative to the total population.  They are truly more concerned with the incidence of type 2 in the total population.  No big surprise - higher incidence means higher cost means more interest in preventing problems. 

Why do I think that a standard A1C, random glucose or glucose tolerance won't catch juvenile onset type 1 before ketoacidosis?  Because unless someone gets real lucky it happens too quickly for a routine annual physical to catch.  And unlessl you've got a PCP who is really on his/her toes the early symptoms are pretty darn subtle.  That's if you go to one 'just cause.

I remember being particularly thirsty for about 3 months prior to my diagnosis.  But it was hot and I was 12 and spent a lot of time outside.  I was active.  So, thirst by itself just wasn't going to stand out by itself.

Then there was the hungry horror stage which quickly ran into the weight loss stage (10 pound loss of a 72 pound child in one week) which only started one week before diagnosis.  The final stage was what we know as the ketoacidosis stage which to the normal average bear initially resembles a flu.  And who on earth takes their kid to the doctor immediately upon flu symptoms?   Who can get an appointment immediately at flu symptoms?  Two days later ... ya, well that's what got everyone's attention. 

The stench of ketoacidosis, the lethargy and being totally out of it stage.  That was it.  Apparently, I couldn't even walk because I remember my mom carrying me to the car. 

But I had only missed one day of school at that point.  It really is fast.  My birthday was Thursday.  I went to school on Friday.  We moved on Saturday.  I went to a Halloween party on Sunday.  I was notably drinking soda I didn't drink and eating much more than normal.  But again, we had moved on Saturday and I wasn't the type to wait around for someone to unpack my belongings so I was active - translation - hungry.  Who knew?

Monday was All Saint's Day and we had the day off.  I was sick.  My sister was getting me tea.  But again, only it was only day 1 of being sick so who would take the kid to the doctor's.  I'm a kid; I get sick.

Tuesday was the difference.  My sister went to school; Mom went to work and she did not like what she saw when she got home so off to South Shore Hospital she carried me.  Thanks Mom.  Thanks South Shore Hospital.   Thanks Banting and Best.  I felt better in short order.  I remember being quite perky on the trip to the Deaconess/Joslin. 

I do not think my diagnosis could have happened much more quickly.  The early symptoms resemble nothing important, nothing notable.  I had seen commercials pointing out the symptoms and had mentioned them but to repeat - being thirsty during the summer and being hungry when running around is just not remarkable to the average bear. 

So do we demand that extensive tests be run on kids at routine annual physicals just in case?  Urine testing as they do in parts of Tokyo (mostly catching type 2)?  Do we demand A1Cs every three months which MIGHT pick something up?  Will more education of symptoms to parents and PCPS/pediatricians help? 

See I don't think so.  Paranoia is expensive and not all the helpful considering the relatively low number of juvenile onset type 1 diagnoses per year.  (I'm having trouble finding a total number of juvenile onset type 1 diagnosis.)  A 1999 study employing genetic testing and CONTINUOUS beta cell damage testing results in "less severe disease presentation."  Not the word "continous."  There is certainly nothing cheap about genetic testing and there is nothing cheap about continuously looking for autoimmune destruction of beta cells thus rendering the concept unrealistic.

I just don't think there is a simple, cost effective answer to preventing ketoacidosis.  I'm sure parents will disagree with me.  I hear screaming from the rooftops.  However, if this were your business and you had to determine cost benefit, what would it show?  Not much benefit.  The benefit is emotional and, right or wrong, that just doesn't (usually) count in business decisions.  So, in this world of capitalistic, shareholder or taxpayer owned insurance companies, it's not likely to count here either.  Sorry.

Doris J. Dickson

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Posted: Jul 18, 2008

On Saturday, October 30, 1976 we moved out of my first childhood home in Rockland, Massachusetts and away from my best friend.  She was 15; I had just turned 12 on the 28th.
Sunday, October 31st I went to a halloween party and drank regular soda - something I never did.  Alas, I was still thirsty .. imagine that.
Monday, November 1st was All Saints Day so we had no school.  I was sick as a dog anyway, presumably with the flu.  Mom went to work, my father slept (he worked nights), and my not usually loving sister, brought me tea.
Tuesday, November 2, 1976 my mom came home from work and decided it was time to pick me up and take me to South Shore Hospital in Weymouth, Mass. where I was diagnosed and promptly sent by ambulance (iv in arm) to New England Deaconess. 
Three days later I was sent in the tunnel to the Joslin.  Since I'd been asking all sorts of questions for a few months, about why I was very thirsty and urinating constantly, when my mother said "do you know what you have," and I responded "yes, diabetes," she darn near fell on the floor.  Then she felt guilty because she had dismissed my questions as it being hot outside.  No big deal to me I remember thinking.  We're dealing with it now.
A total of 10 days later I went home to my new house.  My father bought and stained a desk I had wanted but we couldn't afford ... guilt I knew even at that age.  I had wanted to pay for it with my birthday money but that wasn't happening.  I went on about life, went back to school, unpacked boxes, etc.
Around Thanksgiving I received a letter from my best friend ... she was in
Floating Hospital.  She had been diagnosed with an inoperable tumor between her heart and her lung.  She was to received radiation and chemotherapy.  Susan, as I said, was just 15 years old. 
I was stunned.  I wanted to see her but I couldn't.  Our parents didn't get along.  They eventually both gave in and I was able to spend one afternoon with Susan.  It was probably the one and only time in my life I was afraid to tell someone I couldn't have sugar iced-tea.  I drank some of it to be polite and enjoyed my afternoon even if I didn't enjoy the aftermath.  It was what I had to do.
I saw Susan one more time.  Her mom drove her by my new house.  I gave her a gift of earrings. 
Then one cold morning following the blizzard of 1978, I had teeth removed.  I had just come home cotton balls in mouth.  The phone rang.  It was a former neighbor, we fondly referred to as "Mrs. Ellie."  I knew instantly.  Susan had died.  I didn't even know she was that close to death.  They'd all hid it from me.  I was instantly furious because they had not allowed me to say goodbye to my best friend.  I ran screaming out of the house and found yet someone else had known for a week that she wasn't going to live.  He hadn't told me either.
I went to her wake with my mother and Mrs. Ellie but attended her funeral by myself.  I walked a snow covered street approximately 1 mile with tears running down my face.
We can pick our butts up, take control and "just do it."  Susan never had the chance that we do.  I have never and will never complain about being a juvenile onset diabetic.   "


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