Healing Handbook for Persons with Diabetes
Chapter 3: Insulin Dependent Diabetes Mellitus (IDDM or Type I Diabetes)
Learning that you have Type I diabetes may be frightening, but you can help yourself by learning to control your condition. Keep the following goals in mind:
Becoming self-reliant and self-sufficient
Balancing diet, exercise, and insulin
Leading an active life that is as close to normal as possible
Protecting your heart, nerves, blood vessels, eyes, and kidneys by controlling your blood glucose level
Maintaining a good body weight
Growing and developing normally (especially for children)
If you have Type I (insulin dependent) diabetes, your body is producing no insulin. With an absolute lack of insulin, you have probably experienced the most common symptoms, excessive thirst (polydipsia), frequent urination (polyuria), extreme hunger (polyphagia), extreme fatigue, and weight loss.
These symptoms were caused by hyperglycemia and a breakdown of body fats. If you have had these symptoms, you are ketosis-prone (See Chapter 1).
When you were diagnosed with Type I diabetes your blood sugar was probably over 300 mg and ketones were present in your urine.
Without insulin, these symptoms progress to dehydration, resulting in low blood volume, increased pulse rate, and dry, flushed, skin. Ketones accumulate in the blood faster than the body is able to eliminate them through the urine or exhaled breath. Respiration becomes rapid, and shallow and breath has a fruity odor. Other symptoms indicating a progression towards diabetic ketoacidotic coma (DKA) include vomiting, stomach pains, and a decreased level of consciousness. Insulin and intravenous fluids can reverse this condition.
Although the DKA is unavoidable at certain times, the best way to reduce your risk of this condition is to always take your insulin and follow Sick Day Rules when ill. For information see Chapter 10.
To control your diabetes, your health-care provider will prescribe a regimen of insulin injections, diet, and exercise, and you will learn to monitor your blood glucose level.
- Insulin injections are necessary because your body does not produce insulin to funnel glucose into your cells. For information on insulin, see Chapter 8.
- Your diabetes diet Is a well-balanced meal plan that controls the types and amounts of food you eat. For information on the diabetes diet, see Chapter 6.
- Exercise reduces your insulin requirements by increasing the efficiency of the insulin you inject. Exercise also improves muscle tone and increases strength and well being. For information on exercise programs for people with diabetes, see Chapter 7.
- Monitoring your blood glucose provides the information necessary to design your diabetes care program and remain in good control. For information on monitoring, see Chapter 5.
To stay healthy, you need to learn to balance insulin, food, and exercise. The body of a person without diabetes produces just the right amount of insulin to maintain a normal blood glucose level. If he does not eat, very little insulin is produced. If he eats a lot, his body produces much more insulin.
Because your body is not producing insulin, you must obtain it through injections. The insulin you inject in the morning controls a predefined amount of blood glucose. If you skip a meal, the insulin keeps right on working, plunging your blood glucose lower and lower. If you eat more food than the insulin you injected can handle, your blood sugar will go very high. If you exercise, you need to eat more food, because exercise makes insulin work more efficiently.
BALANCING DIET, EXERCISE, AND INSULIN
To keep in balance, you must stick to your meal and exercise plans, maintain your proper weight, and follow your prescribed insulin injection schedule each day. Your daily insulin dosage may be adjusted to your diet, activity level, and weight.
On days when you exercise more than usual, you need more food to keep in balance.
On days when if you eat more food than your meal plan allows, you need to increase your insulin dosage or exercise more to stay in balance.
If you're gaining weight, you may need to increase your insulin dosage to balance the extra weight, or you may need to diet and exercise more to lose that weight. For growing children, the doctor or diabetes educator may adjust insulin to balance normal weight gains.
If you accidentally inject more insulin than you should one day, you must add extra food to keep in balance. Check your blood glucose every 2-3 hours (see Chapter 5
) and eat additional snacks or meals.
Why can't I take insulin by mouth?
- Insulin is a protein. If you swallow it, it is digested as smaller particles that are no longer insulin.
My friend takes pills for diabetes. Why can't I?
- The pills for diabetes you've probably heard about work by signalling the beta cells in the pancreas to make more insulin (see Chapter 1), and by helping insulin work better. Your beta cells have been destroyed and your body is producing no insulin at all, so the pills can't help you. Research is being conducted to find alternative ways to give insulin.
What if I just ignore my diabetes?
- You'll probably feel tired, you'll be thirsty, and you'll be running to the bathroom a lot. If you get seriously out of balance and ignore these symptoms for several days, you could face the danger of a diabetic coma.
What is Juvenile Diabetes?
- Juvenile Diabetes and Brittle Diabetes are other names for Type I or Insulin Dependent Diabetes Mellitus (IDDM). In this handbook, IDDM and Type I diabetes are used interchangeably. Some people refer to this type of diabetes as " juvenile" because people with Type I diabetes are usually young at the time of diagnosis.
What is Brittle Diabetes?
- The term "brittle" suggests that this type of diabetes is difficult to control, but when you follow a control regimen designed just for you, and learn to help in your own care, this term will probably not apply.
For more information on Type I diabetes, read A Diabetic Doctor Looks at Diabetes: His and Yours, by Peter A. Lodewick, M.D. You can order a copy from RMI Corporation, 341 Broadway, Cambridge, MA 02139, Attention: Order Processing Department.
REMEMBER: The care of diabetes is a team effort involving you, your physician, and the diabetes education staff where you receive your medical care. This handbook cannot-and was not meant to-replace this team effort.
This handbook embodies the approach of the diabetes care team at the University of Massachusetts Medical School. Different diabetes care teams may approach some aspects of diabetes care in ways that differ from those in this handbook. While most teams are in close agreement regarding the GENERAL PRINCIPLES of diabetes care, they may differ in the DETAILS. There can be more that one "right" way to approach a specific issue in diabetes management.
Always remain in touch with your diabetes care team, and bring any questions you may have about the materials in this handbook to their attention!
Copyright 1995-1999 Ruth E. Lundstrom, R.N. and Aldo A. Rossini, M.D. All rights reserved.
Feedback: send e-mail to Dr. Aldo Rossini