A diabetes primer
By Amy Carter, R.N.
People with diabetes, type I or type 2, lack the amount of insulin needed for their cells to absorb the glucose from their bloodstream, which is necessary for energy production. If blood sugars stay elevated for an extended period, people are at high risk for eye disease; kidney damage; numbness, poor circulation and amputation of extremities; heart attack; stroke; nerve disorders; and sexual dysfunction.
Type I diabetes is an autoimmune disorder — the body’s immune system turns against itself, destroying pancreatic cells that produce insulin. It’s not known why this occurs, but there are theories that it can be triggered by a virus and/or genetic and environmental factors. Most cases occur in children, but it can happen at any age. Once pancreatic cells begin to die the disease progresses quickly and the victim must begin therapy to replace insulin the pancreatic cells can no longer produce.
Type 2 diabetes covers 90 percent of all instances of the disease. It can occur at any age, developing through a combination of genetics, poor diet and lack of exercise. As it develops the pancreas is still producing some insulin but the body’s cells do not respond as they should, a condition called insulin resistance. It then takes more and more insulin to move glucose into the cells and the pancreas begins to release higher than normal amounts.
This can continue for years and eventually the pancreas can’t keep up with the demand. Insulin production then begins to decline and eventually the pancreas may stop making it altogether.
In type 2 diabetes the liver also releases extra glucose into the bloodstream, raising the glucose level even more. In majority of cases, type 2 diabetes can be prevented with proper diet and exercise; even a 10-15 pound reduction in weight can help restore insulin sensitivity.
As well, there are various oral medications to aid in cells becoming more sensitive to insulin, blocking the liver’s release of glucose and increasing the pancreas’ production of insulin. Some people may even need to begin insulin depending on the severity of the disease and their willingness to change their lifestyle habits.
Know that diabetes, whether it is type I or type 2, can be a very difficult and complex chronic disease to manage, but there are many professionals who can help. Certified diabetes educators and nutritionists, along with naturopathic doctors, can educate people on how they can feel better through a healthier diet and increased exercise.
Pharmacists can provide smoking cessation aids, hence lessen the risk for heart disease. Psychologists, counselors and social workers can help people manage the stress and depression. Podiatrists can help manage diabetic neuropathy, and primary care providers can help with pain. Nephrologists can assist in management of kidney disease, and ophthalmologists can help with eye care.
Finding a support group also is highly recommended.
Amy Carter is a diabetes educator with Providence Medical Group.
WALLA WALLA — Zachary Fraser would like the world to know something — the disease he has is not the result of bad diet decisions and it’s not something that can be exercised away.
No cinnamon pills, no low-carb eating plan, no nutrition counseling is going to change the type 1 diabetes Fraser lives with.
“The frustration for me is the perception that it’s a lifestyle choice as opposed to a genetic challenge,” he said.
Americans are far more familiar with type 2 diabetes, also called “adult onset diabetes.” Its victims have a reduced response to their own insulin, meaning their blood cells can’t efficiently use the blood sugar — or glucose — in their bodies for energy without help from medication.
The glucose builds up in the bloodstream instead. The body attains a high sugar content but the pancreas doesn’t get the memo — it keeps increasing insulin in an effort to keep up with rising blood sugar levels.
Eventually, type 2 creates a nasty health mess calling for medication, exercise and a changed diet.
But for people like Fraser, 35, diabetes is a whole different ballgame. The chief operating officer of Pacific Baseball Ventures — parent of the Walla Walla Sweets baseball team — was diagnosed with type 1 diabetes when he was 10, despite being a very active kid.
“I played four sports and I had a mom who was anal about healthy-type meals. Our Halloween candy? We had to put it in the freezer and we could eat one piece a day until it was gone.”
Type 1 diabetes was once referred to as juvenile diabetes, since it is most often diagnosed in children and teens. In this case, the body produces little insulin. Or, more typically, none whatsoever. All of the insulin a diabetic requires is man-made and administered through injections or a medication pump system.
There is no choice involved, Fraser said, but that doesn’t stop people from moralizing about everything from the food he eats to how he manages the disease.
It can be worse for type 1 diabetes suffers at this time of year, when sugar is everywhere.
Normally courteous people seem to forget their manners when one dares to enjoy a cookie at the company Christmas party, noted Maria Lizotte, a type 2 diabetes educator at the YMCA.
“People ask, ‘Should you be eating that?’ They don’t grasp the complexity of the situation,” she said.
Unlike those dealing with type 2 diabetes and ensuing dietary restrictions, type 1 people have it easier in some respects, she explained.
“If you have a type 2 kid, Halloween candy is not a good idea, their pancreas can’t handle it,” she said. “With type 1, you can balance the sugar with insulin.”
Lizotte, 44, learned she had the disease when she was 15 through a routine school physical, required to join the cross-country team.
“I got caught just in time,” she said. “If I had waited five days, I would have been really sick.”
Even with the magic of manufactured insulin, people living with type 1 diabetes must become expert at timing and calculating sugar counts and other factors, like stress levels that raise blood glucose levels, she said.
Some high sugar counts will respond to exercise, but type 1 diabetics often have to wait until those numbers drop before they can eat again.
“Everyone is sitting there eating dinner and you have to wait another hour,” Lizotte said. “It’s all confusing to people.”
People are not annoying about the disease on purpose, they simply lack education about the endocrine disease, Lizotte said. Type 1 diabetics, on the other hand, benefit from lots of attention from doctors and years of education about their health situation.
Amy Carter, 31, was 8 when she was told she has type 1 diabetes. Growing up in White Salmon, Wash., she felt alone in her affliction.
“I was the only kid I knew of there to have it,” she recalled. “It wasn’t until I was in my early 20s that I connected with someone else with type 1.”
In her job as a registered nurse and diabetes educator at Providence Medical Group, she councils those who have the type 2 version.
The two types involve the same organ — the pancreas — and have similar signs and symptoms. But the general population is not exposed to the process of the disease, Carter said.
“I completely understand why type 1’s would get offended by being put in the same category as type 2’s because type 2’s can prevent their disease; Type 1’s cannot,” she said.
It’s why she wants to work more with type 1 diabetics and is pursuing a doctorate to become a nurse practitioner with plans to specialize in caring for children with the disease, she said.
Like Fraser, Carter once found herself offended by the numerous misunderstandings.
“I hated growing up and people judging what I ate. I just thought I was never really normal,” she said. “But now that I work with type 2’s, the psychosocial factors that come along with type 1 and type 2 are actually quite similar.”
“Type 1’s are misunderstood basically because they haven’t had any control over getting diabetes. However, most type 2’s feel the same way about themselves — their lives are out of control and therefore their health is out of control.”
A more holistic approach within the medical community in treating diabetes will go a long way in changing attitudes, Carter believes.
“So whether you have type 1 or type 2 symptoms ... the way in which you got the disease is really the only thing that differs, and thus, how you control it once you have it.”
As for Fraser, he’s working to accept the ignorance of the general population in the same way he’s accepted the health card he was dealt.
“I’ve been diabetic for 25 years. Hopefully I’ve learned to let it go,” he said.
This story was updated Dec. 9, 2013, at 8:10 a.m. to reflect the following correction:
Zachary Fraser's last name was misspelled in a story from Sunday's Union-Bulletin. We regret the error.