Samantha Pack

ENG 1101
Dr. Cassel
13 April 2018
The Meaning and Management of Type One Diabetes
I have always had the luxury of eating whatever I please whenever I please. I would eat

mac n’ cheese, french fries, chicken nuggets, and all the terrible food that kids eat today. My

favorite as a child was always the trusted cheeseburger and coke. I never had to worry about my

how my body digested that food or even gave thought about how my body regulates my blood

sugar. In the past year I have learned that not everyone has that luxury. My girlfriend was

diagnosed with type one diabetes when she was eleven. This chronic condition and what she

must go through every day has taught me valuable lessons about how life can be so different for

others.

Having type one diabetes will cause blood sugar levels to remain high within the body.

Long exposure to hyperglycemia, meaning high blood sugar, over time can cause life-threatening

damage. When a person eats food, it is then broken down within the body. Foods that break

down into sugar will cause a rise in blood sugar. Someone without diabetes has a response

system that works effectively in releasing the hormone insulin. Insulin will unlock the cell for

glucose to enter and be used as energy. Diabetics require insulin to be administered through

injections or an insulin pump. Beta cells found within the pancreas secrete the hormone insulin.

Type one diabetes is an autoimmune disorder, which means that the body will for unknown

reasons attack itself. When diagnosed with type one diabetes insulin is required my injection for

life. This is because the beta cells are attacked by the body causing the produce of insulin to be

stopped or reduced (Basile) (Klandorf & Stark) (“Introduction to Diabetes…”).

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Diabetes is not far from the top of the list on the leading causes of death in the United

States coming in sixth. A mere 5% of the people diagnosed with diabetes have type one. The

other 95% have type two. These conditions are rather different though they share a similar name.

Type one diabetes has no known cause and is an autoimmune disorder. Type two can be avoided

and prevented. Type one diabetes is significantly harder to deal with, especially since it usually

develops in children. Although someone can be diagnosed at any age with type one diabetes,

most cases are diagnosed in adolescence. Type one diabetics are often called insulin dependent

due to the need for insulin to be administered for the remainder of the diabetic’s life. Type two

diabetics make insulin but their cells have become resistant to the insulin, or they simply just do

not make enough. Type two diabetes is more common. Not exercising and a bad diet will put a

person at a higher risk of developing type two. While both diseases cause the same symptoms,

they differ in the cause and treatment of the disorder (“Introduction to Diabetes…”) (Klandorf &

Stark) (Basile).

Figure 1 graph shows the percentage of all type 1 and 2 diabetes cases in the United States (Berry)

Insulin was isolated for use in diabetes patients in 1922. Insulin was identified, isolated

and extracted from cow and pig pancreases. This worked completely functional within the
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human body. This was a discovery that changed medical history. Before insulin was isolated for

patient’s usage, diabetes was a fatal disease. The patients would often starve to death or die from

hyperglycemia. One year was the average time after diagnosis that patients would live. That year

involved strict carbohydrate intake diets, but this did not help with the cells intake of sugar for

energy. Development into better and more pure forms of insulin would go on to be the next

advancements, and researchers are able to now grow and harvest insulin within labs instead of

extracting from animals. More research into insulin is still ongoing today. The research into the

cause for this disorder is still ongoing. Researchers have found that type one diabetes have both

genetic and environmental factors responsible (Moroder & Musiol) (Klandorf & Stark) (Basile).

(“Introduction to Diabetes…”) (Tandon).

Everyday life with diabetes is a challenge. It is ridden with stress of hypoglycemia, stress

of counting carbs for correct insulin injections, and the constant pricking of fingers to check

blood sugar levels. In a study conducted by Kyngas and Barlow in 1995, 51 Finnish adolescents

fluctuating from ages 13-17 diagnosed with type one diabetes were evaluated. The teens were

asked how they perceived and their personal meaning of their diabetes. Many teens described

this diagnosis as the beginning of the end of their lives. Some of the other teens accepted the

diabetes as part of who they are. Peer support for these teens was a huge factor in the ease of

maintaining their diabetes. Many teens claimed that they felt controlled by their parents or health

care providers. Health care providers are notorious for being very strict on their diabetic patients

due to the seriousness of the disease. Emily Axt who was diagnosed at age eleven with type one

diabetes says, “health care providers treat diabetes as if the same simple math formula involving

insulin and a diet plan will work for every diabetic. The actual truth is that everyday my insulin

is affected by different environmental and physical factors. Certain times of the month will affect
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my insulin, so health care providers really should do more research into what it’s like living

everyday with this” (Axt) (Davidson, Penney, Muller, & Grey).

Advancements in continuous glucose monitors have helped with easing the tiresome

pricking of fingers for blood to check blood sugar levels. Having a 24-hour monitor that checks

and records glucose levels is an exponential advancement for diabetics. This makes sleeping and

doing other daily activities a lot easier to perform. Having this helps the diabetic, but it also helps

health care providers in giving better care when real-time glucose levels are being recorded

(Forlenza, Buckingham, & Maahs). In an article written by Gregory Forlenza, Bruce

Buckingham, and David Maahs for the Journal of Pediatrics in 2016, they state:

Investigation into patients’ attitudes and beliefs surrounding CGM is an emerging area of

research. These studies show positive themes of improved blood glucose control, reduced

worry/uncertainty, and improved overnight control; negative themes include: uncertainty

with interpreting CGM data, lack of device accuracy, intrusiveness of alarms, and

discomfort with wearing the device.

Before insulin pumps, multiple insulin injections were required. Insulin pumps were

introduced in the early 1970’s and dramatically increased the ease of management of diabetes.

An insulin pumps stays in the body, being changed frequently, and will release insulin into the

body from an external device that is operated by the diabetic. Insulin pumps are attached to the

body, but the device that operates it can be done with Bluetooth or manually with a wire. The use

of insulin pumps improved glycemic control in early studies. Having both an insulin pump and a

continuous glucose monitor is called sensor-augmented pump (SAP) therapy (Forlenza,

Buckingham, & Maahs).

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Control over glucose levels is most important in prolonging the life expectancy of a

diabetic’s life. Studies show that diabetics live 11-12 years shorter than the average person. This

is due to the long term wearing down of cells and tissue, due to hyperglycemia, having major

affects on major organs. As a person gets older the organs begin to wear down, but with diabetes

the process seems to be faster. Diabetic retinopathy, which affects the eyes, is the number one

cause of blindness in people aged 20-74. Diabetics are more likely to have kidney failure, limb

amputations, and suffer from heart disease. The burden of the cost of health care is much higher

for diabetics ranging from ten to twelve thousand dollars a year in medical treatment and

supplies. This is for the rest of the diabetic’s life. An average healthy person will spend 3-4 times

less than that a year on health care. This makes life even harder on diabetics (Lewine)

(“Introduction to Diabetes…”).

Strict control over blood sugar levels lengthens the life of a diabetic dramatically, but it

also makes hypoglycemia more prevalent for diabetics. Hypoglycemia is low blood sugar. It can

be a fatal nightmare for diabetics. When a diabetic’s sugar gets too low they could fall into a

hypoglycemic coma, have a seizure, and die. The nondiabetic response to low blood sugar is the

hormone glucagon to be released along with epinephrine in the brain which stimulates glucose

production from stored fat within the body to help rise the bodies blood sugar levels

(“Introduction to Diabetes…”) (McCrimmon and Sherwin).

There are three factors that make hypoglycemia harder on diabetics than the average

healthy person due to malfunctions in the body’s normal process. First, the body can suffer from

hyperinsulinemia, meaning too much insulin is circulating in the blood stream. This is caused by

the obvious need of foreign insulin injected into the body. Second, after five years of being

diagnosed with diabetes, the process that normally would react to low blood sugar (glucagon
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being released) is weakened and not sufficient. Third, after ten years of being diagnosed the

body’s automatic response system is suppressed and will no longer make the event of low blood

sugar a priority. Diabetics should always carry a sugary food or drink, like a juice box, incase of

an emergency low. Diabetics also carry a glucagon kit in case of extreme emergencies in which

they are unconscious. These kits are filled with the hormone glucagon and will cause a rise in

blood sugar almost immediately and cause the diabetic to vomit. Exercising for diabetics can be

difficult because it lowers the blood sugar, and can cause extreme lows if not monitored

tediously throughout the workout. This can make going out for a jog a scary thought for diabetics

(“Introduction to Diabetes…”) (McCrimmon and Sherwin).

Diabetes can be psychologically taxing for people who suffer from it. The mental

stability that is required of a diabetic is high. A study conducted by Grey and associates (Grey,

Boland, Davidson, Sullivan-Bolyai, & Tambor-lane, 1998) analyzed the stressors involved with

having diabetes among 34 teens aged 12-20. The results were broken down into seven different

categories of stressors (Davidson, Penney, Muller, & Grey).

The first stressor, nature of the condition, was described by the teens as both a part of

their lives, but also something that hindered them from normalcy. Optimism was hard for the

teens when regarding their disease. The second stressor involved personal matters. This made

many of the teens feet a sense of pride and accomplishment within themselves being able to

handle such a disorder. Many teens said that some of their classmates would not be able to

handle it. “Care constancy, complexity, boredom, rigidity, visibility, and feeling guilty about bad

numbers were some of the pervasive themes”, says Davidson from the results of her review of

the study regarding care management, the third category. Relationships were important for the

teens. Although, relationships also caused stressors as seen in the fourth category. Many of the
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teens said friends and family can cause stress over being overprotective, telling others about their

diabetes, and asking personal questions in public. The fifth stressor, situational, was simply

caused by not being at home in the diabetic’s comfortable environment. Any outing would cause

stress because of fear of hypoglycemia, not having enough insulin, or insulin pumps/continuous

glucose monitors needing to be changed suddenly. The sixth stressor, coping behaviors, involved

having both problem-solving and emotion-based coping behaviors. Many teens admitted to

guilting themselves about having “bad number” so they’d do better. Many teens would ask their

parents for help in carrying out maintenance due to them being too tired. The final stressor,

dilemmas, helped explain the many dilemmas that diabetics must go through throughout their

lives. These are questions that diabetics are struggling to answer within themselves every day.

“To tell or not to tell, to ask for help or not ask, “normal” or reveal difference, to tell the truth or

lie regarding self-care deviations, to complain or not complain, to be “good” or “cheat” in food

decisions, and to stay on track or stray with the demands of their diabetes regimens”, were some

of the dilemmas the teens mentioned in the study. This study helped to see inside the brains of

people struggling with the every day stressors that come along with type one diabetes (Davidson,

Penney, Muller, & Grey).

Although there is no cure for type one diabetes currently, research is being done every

day. I have been changed forever seeing first hand the demand of type one diabetes. I will always

fight for the end to this disease. It is crucial to keep in mind the many advantages of having

normalcy and good health. I often took for granted the many privileges I have when picking

foods, exercising, having relationships, a good night’s sleep, and many other daily activities.

Knowing the struggle that so many other people must go through has helped me realize how
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fragile life can be. I help in any way I can in helping with my girlfriend’s control over her

glucose levels, because I want her to live the longest live she possibly can.
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Works Cited

Axt, Emily. Personal Interview. 20 March 2018.

Basile, Maria. "Diabetes." The Gale Encyclopedia of Genetic Disorders, edited by Stacey L.

Blachford, Gale, 2010. Opposing Viewpoints In Context,

http://link.galegroup.com.sinclair.ohionet.org/apps/doc/UXFXSY107416458/OVIC?u=da

yt30401&sid=OVIC&xid=c8783b0c. Accessed 2 Apr. 2018.

Berry, Jennifer. “Type 2 diabetes statistics: What's to know?” Medical News Today.

https://www.medicalnewstoday.com/articles/318472.php. Accessed 15 April 2018.

Davidson, Maryanne, Penney, Erika, Muller, Beth, and Grey, Margaret. “Stressors and self-care

challenges faced by adolescents living with type 1 diabetes.” Applied Nursing Research,

Volume 17, Issue 2, 2004, Pages 72-80

Forlenza, Gregory, Buckingham, Bruce and Maahs, David. "Progress in Diabetes Technology:

Developments in Insulin Pumps, Continuous Glucose Monitors, and Progress Towards

the Artificial Pancreas." Journal of Pediatrics, 2016, p. 13. EBSCOhost,

doi:10.1016/j.jpeds.2015.10.015.

"Introduction to Diabetes: Contemporary Issues Companion." Diabetes, edited by Louise I.

Gerdes, Greenhaven Press, 2003. Contemporary Issues Companion. Opposing

Viewpoints In Context,

http://link.galegroup.com.sinclair.ohionet.org/apps/doc/EJ3010291101/OVIC?u=dayt304

01&sid=OVIC&xid=e22d3901. Accessed 31 Mar. 2018.

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Klandorf, Hillar and Stark, Sharon. "Diabetes Mellitus." Magill’s Medical Guide (Online

Edition), 2013. EBSCOhost,

sinclair.ohionet.org:80/login?url=http://search.ebscohost.com/login.aspx?direct=true&db

=ers&AN=86194054&site=eds-live.

Lewine, Howard. “People with type 1 diabetes are living longer.” Harvard Health Blog.

https://www.health.harvard.edu/blog/people-type-1-diabetes-living-longer-

201501087611. Accessed 20 March 2018.

McCrimmon, Rory, and Sherwin, Robert. “Hypoglycemia in Type 1 Diabetes.” Diabetes 59.10

(2010): 2333–2339. PMC. Web. 2 Apr. 2018.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279554/. Accessed 2 April 2018.

Moroder, Luis, and Musiol, Hans‐Jürgen. "Insulin—From its Discovery to the Industrial

Synthesis of Modern Insulin Analogues." Angewandte Chemie International Edition, vol.

56, no. 36, 2017, pp. 10656-10669. OhioLINK Electronic Journal Center,

doi:10.1002/ANIE.201702493

Tandon, Nikhil. "Understanding Type 1 Diabetes through Genetics: Advances and

Prospects." Indian Journal of Endocrinology & Metabolism, vol. 19, 2015 Supplement 1,

pp. S39-S43. EBSCOhost, doi:10.4103/2230-8210.155391.