The management of TYPE-1 DIABETES is a challenge to all and indeed, not only needs special attention, but also extra time and energy to be spared by both healthcare team and family. Today, diabetes being such a common condition, to say that “you have diabetes” is probably OK, but to say “you need insulin lifelong(or You have Type 1 Diabetes)” would seem like a death sentence. There are many reasons and not all are same. But one of the most common question to all is “WHY me?Have a committed a sin?” ; this we believe is the toughest question to deal with & answer. But today, the availability of human and analog Insulins are actually a boon to those with type 1 diabetes.
The management of Type 1 diabetes is indeed a journey that has to be traveled by both the doctor and those with diabetes. It also demands the need for establishing partnership to set and develop common goals.
The common goals are two fold: medical and social
Medical: Never ketoacidosis , no severe hypoglycemia with good glycemic control i.e. A1c < 7-8 % along with delaying all the complications [ micro/macrovascular]
Social: Education [ school/college], Marriage & kids and work with ability to travel freely without fear
We believe that the progress in the management of diabetes care stands on two important ”pans” of the ”balance scale” and the role of a care provider is to ensure that the pivot is able to balance them equally.
1. Social network, motivation and support
2. Understanding own physiology and hence the management [insulin]
1. Social: “You are one among us and it’s not your fault”
We sincerely believe that the first information to share is that “YOU & your Child ARE NOT ALONE” and empathise with their sentiments and say that “It’s really true that type 1 diabetes is not some condition that is to be happy about”. We have to convince them that there are many of them across all age groups from kids to adolescents to adults and cutting across any religion, caste, creed, place or financial strata with Type 1 DM. They should not only see ‘unity in illness’ but also feel “united in adversity”. Bringing them together would help care for each other and remove the burden of lone_liness and low_liness.
2. Social: “Your motivation is your goal and you can do it”- “ Accept Less pain, for more gain”
All of us have something or the other to look ahead and seek motivation to do what we dream of. We all have to go through the hurdles and sacrifices to achieve them. People with T1DM have shown us that it is this goal of becoming a doctor, teacher, olympian, actor, mountaineer, cricketer etc that made them strong to learn more about overcoming adverse conditions and help break the barriers to make their dreams coming true. They learnt that taking insulin gave them less pain as compared to skipping it as not taking insulin made them weak and stopped them from thinking about their dreams. They made us realize this adage “No pain, No gain” and changed it to “less pain, more gain”. We sure don’t like it but people with diabetes have shown us and said “Though its not ok to have it, I with the help of people who understand diabetes am able to do almost anything I want from climbing the Mount Everest (Sebastien Sasseville) , running a marathon in the desert or be an actor, cricketer (Wasim Akram), doctor (Dr.Hirsch) or an Olympic champion(Gary Hall Jr ) ”. They say ‘In spite of it, I can do it’.
Physiology: “Insulin is must for life” “Insulin gives you the energy to achieve your goal”
We must share this information and Insulin is something present in all of us and that it a chemical called as a hormone that is essential for living just like air, water and food. Without insulin we can’t utilize the food we take and is lost in urine. Hence those who lack insulin lose weight inspite of eating well and thirsty in spite of drinking as both energy and water is passed out as excess urine. Hence insulin is a must for living and indeed it is not diabetes, but not taking insulin is the actual death sentence. The energy we derive from food and are able to store, is only because of the Insulin that is inside our body and the insulin we see in vials/pen is that same insulin.
3. Social: “Eating is essential, but remember taste is not everything”
We eat food to get strength and also because of taste. It is essential to learn about which food to eat and how much to eat so that we get adequate energy, nutrition and taste. Taste is not everything; it’s just a part of eating food. A mouthful of food gives same taste as a stomach full. Hence first eat healthy food and choose to eat tasty food in limited quantity.
Physiology: “Any food we eat has the capacity to increase blood glucose but the rise depends on the type of food”
Each and every thing we eat is a source of energy and helps to build, protect our body. Food is mainly divided into carbohydrates, protein, fat, vitamin and minerals and all are essential. Glucose is mainly derived from carbohydrates. The energy we need is got from the glucose [ sugar ] that is made by the body after digestion of the food particles. Our body has the capacity to convert even protein and fat to glucose to give energy. But the amount of excursion and drop in glucose levels actually depends on food and its content. Hence it is essential to find out from our dietitian, doctor and educator as to what to eat, and choose appropriate healthy quantities.
4. Social: “Being active gives you strength and keeps the mind fresh”
All of us do some work and need energy to survive. It may just be sitting in a place or actually work using our hands and legs. Any work including sitting needs energy and concentration. Hence whatever we do, we need energy i.e utilise the glucose in the blood and therefore sugar levels come down.
Physiology: “Exercise – activity reduces blood sugar”
Insulin is the key to open the door of the cells so that the glucose in the blood can enter them. Our muscles have additional property of using the blood sugar and reducing the total insulin requirement. The decrease depends on the type and amount of work – activity. At least 30 – 60min of daily physical activity keeps your body healthy and helps to prevent increase in insulin dose [need]. It also reduces the chances of overweight, high BP and heart problems.
5. Social: “Check sugars and move ahead in life”
In order to do our work and achieve our goal, we need our glucose levels to be as normal as possible. Hence it is essential to check if our sugar levels are normal and learn to act when it’s low or high so that we are fit to do what we want to do.
Physiology: “Understand the glucose variations with insulin, food and activity”
Unless we check and see the relation of the particular individual with food [ quantity & quality ], insulin dose and the physical activity, it is not possible to learn and understand the changes in our blood sugars. We need to check sugar values without which it is impossible to know what to eat, how much to eat, what is the insulin dose needed and how much work or exercise reduces the glucose.
Hence Eat Healthy, Be Active and Think Positive,
and never forget to check blood glucose.