Diabetes Crash Course 102

My worst subjects in school were foreign language and mathematics. T1 has given me the opportunity to revisit both those subjects and forced me to become proficient. Your kids health is a powerful motivator. In the beginning I felt like everyone was fluent in "Diabetenese" and I was baffled how fast people could calculate the amount of carbs in a dish with the serving size and then determine how much insulin to take to keep their blood sugar in the proper range. I don't have that many fingers.

I won't make you do math, but I hope to give you an idea of what it takes to co-pancreate 24/7, 365 to keep T healthy. You may not be fluent in "Diabetenese" at the end of class, but you will feel more comfortable with it.

Diabetenese 101

Common terms and definitions

Blood Glucose (Sugar)- the main sugar that the body gets from food to use as energy. Glucose is carried through the blood stream and delivered to all cells in the body. Every cell in the human body requires glucose to function.

Carbohydrates- Okay, most everyone knows what carbs are, but I felt like we had to cover this. Carbohydrates are a source of energy from food that is converted in the body into glucose.

Some foods contain carbs and others do not. Foods that contain carbs are breads, grains, rice, pasta, baked goods, desserts, fruit, some vegetables, (especially potato's), milk, flavored yogurt, etc., ect. Foods that do not contain carbs are meats, cheese, eggs and heavy cream. If you have T1, all carbohydrates consumed must be properly calculated to keep blood sugars in a range that keeps you feeling good.

We use our smart phones, books, labels and calculating recipes to determine how many carbs are in everything T puts in his mouth. We weigh, measure and SWAG (scientific wild ass guess) portions to determine serving size. Right now T takes 1 unit of insulin for every 20 carbohydrates he eats.

Pop quiz!!

Just kidding. We will quickly carb count a meal. A hamburger and fries. Buns have about 30 carbs, the meat is carb free and fries have 45 carbs per cup (or 100 grams) of fries. Here is where you get to SWAG or weigh. The typical serving T eats is about 60 carbs of fries. Don't worry, I will do the math for you- and I don't even need my fingers anymore.

60(fries) + 30(bun)=90

1 unit insulin/20 grams of carbs

90/20= 4.5 units of insulin

Insulin- The hormone produced by the pancreas, or if you have T1, is administered by shots or by insulin pump that allows your cells to use the sugar they need to function. It works like this- Your pancreas starts releasing insulin when you smell your food, before you even eat it. You eat carbs. Your body processes the food and releases sugar into your blood stream. The insulin acts as "the bridge" that goes from your blood stream into the cells, delivering the sugar the cells need to function and live.

High (Hyperglycemia)- "Are you high?" Try asking that to your thirteen year old in a public place and see how many heads turn. We joke about it all the time. Of course, we are talking blood sugars here! If there isn't enough insulin in the body, the bridge between the blood stream and the cells isn't there. The sugar accumulates in the blood stream and remains unavailable to cells, leaving them to starve and breakdown. A "high" leaves T feeling tired, lethargic, he gets a headache and his muscles hurt. Left untreated without insulin and fluids it can result in a serious life threatening condition called diabetic ketoacidosis (DKA).

Low (Hypo, hypoglycemia)- If there is too much insulin in the body it uses up all the sugar available resulting in a low blood sugar. Lows are treated with fast acting carbs that are high in easily absorbed sugar like glucose tablets, juice, honey, candy (not chocolate-I know, not fair but it has too much fat and slows the absorption), regular soda, graham crackers, etc. Low blood sugars left untreated are life threatening and can be fatal. They can happen from too much insulin, too much exercise or activity, excitement, hot weather and sometimes for no obvious reason at all. They leave T feeling, shaky, sweaty, dizzy, anxious and it also affects his ability to make decisions and treat himself. He usually gets a migraine after a low.

Correction- People without T1 have a blood sugar value on average of 70-120. People with T1 become manual pancreas's and keeping blood sugars in range is a constant balancing act. If blood sugar is too low (less than 65 or 70) then you would "correct" by eating a fast acting carb like glucose tablets or drinking juice.

If blood sugar is too high then more insulin must be administered. Calculating the amount of insulin needed to lower the blood sugar to a safer range requires MORE MATH. Right now for every 50 points of blood sugar that needs to be lowered T needs 1 unit of insulin. His target range is 70-120. We "correct" his blood sugar to 100 during the day and 150 at night. If his blood sugar is 175 here is how we would calculate how much insulin he needs.

175-100(his blood sugar target)=75

75/50=1.5 units of insulin

If he was about to eat, we would add up the carbs of his meal and calculate how much insulin he needed to cover his food, then we would add the "correction" amount of insulin.

4.5 units (meal) + 1.5 (correction)= 6 units of insulin administered by shot or insulin pump.

If his blood sugar was 75 before he ate we would subtract 1.5 units from his food insulin to help bring his blood sugar up to 100.

So how do you know what your blood sugar is? How do you know how to carb count? How do you get insulin?

Tools

The Poker-Spring loaded torture device that pokes T's finger and makes it bleed. He uses it every time he checks his blood sugar. Before meals, before exercise, when he wakes up, before he goes to bed and anytime he feels high or low.

Test Strip-Little strips of something scientific that have legs and travel when you aren't looking. You insert one into a glucose meter and apply the blood from the poked finger. I find these little buggers everywhere! (dryer, couch, floor, bed, the dishwasher?!, and yesterday stuck to my leg while outside working, wth?)

Glucose meter- This mini machine does something else scientific and magically determines the amount of sugar in the blood applied to aforementioned traveling test strips. As sophisticated as it seems there is a 20% margin of error in glucose meters. Frustrating and unacceptable, but at this point unavoidable. A story for another blog.

Insulin Pen- A device for administering insulin by injection that has a cartridge of insulin that is in a plastic device shaped like a large pen. It is easier to measure the insulin in an insulin pen than by drawing insulin into a syringe from a vial and then injecting it. These made our lives much easier. You attach the disposable, detachable needle, dial the end of the pen to the corresponding number of insulin units needed, insert it under the skin of the abdomen, buttocks, thigh or upper arm and push the plunger down.

Insulin Pump- A mechanical, manual pancreas. A pump is a computer that contains a resevoir of insulin. It comes with its own blood glucose meter that communicates with the pump. Insulin is administered to the body through a tube attached to a small cannula (a small catheter we call "a set") that is inserted and worn under the skin of the abdomen, buttocks, thigh or upper arm. It must be worn day and night and not be removed for more than an hour or so at a time. The set must be changed and new insulin put into the resevoir every three days. The tubing and pump can be removed from the set for showers and bathing. Some pumps are water proof and can be worn while swimming. T's is not.

Insulin is administered in a slow steady stream to help cover the amount of sugar the body needs to cover all basic needs. This is called a basal rate. It is the amount of insulin needed to make your heart beat, your food digest, your brain to function, your body grow (kids) and cells to regenerate.

Insulin is also bolused in larger amounts to cover carbohydrates. Blood sugar is measured by the meter that corresponds with the pump, the number is wireless transmitted to the pump. T then enters the amount of carbs he is going to eat. The pump calculates how much insulin is necessary based on the ratios manually entered and then saved by the pump. Any correction is calculated by the pump based on values manually entered that the pump saves. A total amount of insulin is shown and then T tells the pump to administer the insulin.

Continuous Glucose Monitor (CGM)- T's CGM is a wireless device that has a catheter (sensor) worn under the skin that measures the glucose in the tissue below the skin on the abdomen, buttocks, thigh or upper arm. It measures it frequently and then averages the readings and transmits it to T's pump. It requires frequent calibration with his blood sugar values. It is not as accurate as using glucose testing in blood sugar and it doesn't mean he tests his blood sugar less. It does help us see when his blood sugar is raising or lowering or if it is holding steady. It also helps predict when his blood sugar is changing rapidly. It has multiple alarm settings that can be set to help predict when the blood sugar values may be getting too low or too high. It is waterproof and the sensor can be worn for 6-10 days.

Whew! We covered a lot today. Thank you for taking the time to learn about what it takes to become a pancreas. There is a lot more to cover, but for now- enjoy summer. We certainly are!

Class dismissed.