Tag Archives: diabetic ketoacidosis

The Honeymoon Is Over

“The Honeymoon Period.”

Sounds like a good thing, right? Who doesn’t love a honeymoon? Me, that ‘s who. I assure you this is not the “take romantic walks on the beach” kind of honeymoon.

Let me give you a little background. (Remember, I am not a doctor, even though my initials are DR).

So, your body has decided that it is going to now attack the islet cells on your pancreas that produce insulin, thus rendering you diabetic. But your body doesn’t go out in one day and kill all of the cells. It starts attacking them and they systematically die off. When enough of them have been destroyed, the glucose is no longer being carried out of the bloodstream and into the cells to be used for energy, so you gradually start showing symptoms. Everyday, more islet cells are destroyed. Eventually, the insulin that is still working is over-worked and decides to go on strike. It can’t keep up, so it stops working. So one day your islet cells are producing insulin, and seemingly the next day (it doesn’t really happen that quickly), many of the cells are killed and the ones that aren’t killed, are refusing to work.  So boom! Virtually no insulin working in your body and you get really sick, really fast (DKA).

Not every person who is diagnosed with type 1 diabetes goes into DKA. In fact, Medium was one of those who didn’t. I like to think it was because of my keen awareness and attention to detail that I was able to identify his symptoms fairly early on, but who really knows. Nonetheless, the staff in the ER kept commenting on how kids usually are so much sicker than Medium when they come in. It was almost as if it wasn’t really happening because there didn’t really seem to be a real emergency, even though his blood glucose level was 565 mg/dL. (A healthy blood sugar level is between 70 mg/dL and 140 mg/dL). Everyone was very chill, everyone except Medium’s pediatrician whom I am sure was still sitting back at his office with his mouth agape. (He too didn’t think Medium looked sick and was quite shocked at the results in the office). As a former ER worker, I almost felt like I needed to apologize for disappointing them with our drama-free presentation!

But I digress.

Back to the honeymoon.

So, you’ve now been diagnosed with type 1 diabetes. (We aren’t even going to go into how sucky that is in and of itself, you’ve heard enough of those rants from me). And the treatment (not cure) for this diagnosis is insulin. So you start giving yourself synthetic insulin via injections into the subcutaneous tissue of your arm, thigh, belly or buttock and now your body has what it needs to carry the glucose, that comes from the foods you eat, out of your bloodstream and into your cells to be used for energy. Yay. (Please notice the purposeful exclusion of an exclamation point here. While all diabetics and their caregivers are ever-so-grateful for the invention of synthetic insulin, it is not a cure. So, until there is a cure, you get no exclamation point. Sorry.)

But guess what? Remember that insulin that your own body was still producing but had gone on strike? Well, it has accepted the terms of the negotiated settlement and has now agreed to start working again, now that it has the help of the synthetic insulin. So, you have synthetic insulin and your own insulin, and guess what? Now you have too much insulin. And guess what? Too much insulin will kill you. Yeah, this would explain my love-hate relationship with insulin. The very thing that my son needs to stay alive, can also kill him. Super.

This period of time right after diagnosis when your body’s own insulin starts working again, is called the Honeymoon Period.  (Hmmm, seems I could have gotten to this point faster, oh well.) The problem with the honeymoon period is that you don’t know when your body is going to kick out some insulin and how much it is going to kick out, so you are on the blood sugar roller coaster. Never really knowing how much synthetic insulin to give yourself. You do your best to come up with an insulin to carbohydrate ratio, but the hard truth is that, sometimes, you get it wrong.

While there is currently research being done on preserving those islet cells in those newly diagnosed with T1D, the outcome remains the same. Eventually all of those cells are going to be destroyed. So I have been saying all along, “just die already islet cells!” That way we don’t have to guess anymore how much insulin Medium really has working for him.

Well friends, I think the honeymoon is over. His blood sugars have gone up across the board. And I thought I would be relieved when this finally happened, but I am surprisingly saddened by it. I guess it just puts the proverbial nail in the proverbial coffin. The death of his pancreas.

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This Is Not A Joke

I’ve learned a couple of things about blogging in the last month.

#1  It’s kind of a lot of pressure once you know people may (or may not) be reading what you are writing.

#2  I cannot write when I am exhausted and stressed (which coincidentally is all the time now).  This past week has been especially bad as I have been working crazy hours all over the city supporting a go-live for work and I was on-call this week.  So I could barely form spoken sentences, let alone string together a series of meaningful, coherent words for a post.  Even as I write this my eyes are feeling heavy.  Small has been trying to come down with something for a few days and last night he succeeded.  He came into our room at 3 am barking like a seal and on fire.  This is exactly the same thing he had 2 months ago when Medium was diagnosed with T1D.  In fact, the only reason I took Medium to the doctor the day he was diagnosed was because I was already going with Small so I thought I would have this little “peeing” problem looked at.

Now Small is sick again.  And illness in this household is a whole new animal.  For starters, when Medium gets sick now we have to refer to a new chapter in our diabetes book called “Sick Day Management”.  I won’t go into details, because frankly, it confuses and scares me and I am floating down the river of denial thinking he will just never get sick and we won’t have to deal with it.  Think about it, if Medium gets insulin to cover food but then vomits the food, now he has too much insulin.  But if you stop giving him insulin altogether he will go into DKA (which if you remember is B.A.D. bad).  So what do you do?  Other illnesses jack with BG’s too, usually make you run high so you have to make adjustments in your insulin doses and constantly check ketones to make sure you are not going into the dreaded DKA.  It’s just a mess I don’t want to deal with. So, if I pretend it won’t happen then it won’t, right?

And as scary as it is for Medium to get sick, I think what scares me more right now is when either Large or Small gets sick.  It is believed that a person is genetically predisposed to developing T1D and that it happens as a result of the body’s immune system being called upon to fight an illness in the body and then it also decides that the islet cells (the cells that produce insulin) are intruders too so it attacks them.  When enough of those islet cells are killed, very little insulin is being produced and the next thing you know, you are very sick and someone in a white coat gives you the life-changing diagnosis of type 1 diabetes.  But when the body decides to do this, no one knows.  So now when Large or Small gets sick, I am freaking out wondering if this is the illness that is going to send their immune systems to battle with the wrong enemy.

Large and Small are more likely to develop T1D now that their brother has been diagnosed.  There is no way to know for sure if they will ever develop it.  I mentioned in an earlier post that they can test them for the auto-antibodies.  If they test positive for them, then it is likely they will develop T1D at some point in their lives.  If they test negative for them, it means that, for right now, they are not likely to develop T1D.  But they could develop the auto-antibodies at any time so a”no” isn’t really a “no”, it’s more of a “not right now”.  So I still have not decided if I am going to have them tested.  I know I could not handle finding out one of them tested positive right now, so for now, we are not testing.  Maybe someday, when Medium’s diabetes is like second nature to us, I will feel strong enough to hear the news, whichever way it goes.  But now is not that day.

So in a way, I worry less about Medium.  His cards are on the table.  We know what he has and we are dealing with it.  With the other two it is like a riddle that I have to solve.  Will they get it?  If so, when?  Can we prevent it?  Will we be ready for it?  Will we catch it early or will they get really sick?  How will they handle it? Are they worried that they might get it?  How could I possibly handle another child with this horrible disease?  This is not a joke, this is my life. Someone solve the riddle for me.

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Lesson #1: Type 1 Has Nothing To Do With Eating Sugar

Admittedly I have become somewhat of an expert in the field of “parenting a child with type 1 diabetes”, out of necessity, of course.  But it still amazes me how misunderstood type 1 is.  I can’t believe how many people make comments about how Medium can’t eat sugar anymore, or how much healthier we are going to be eating now.  But my personal favorite is the person who said, “Medium always did have a sweet tooth”, as if to imply that Medium did this to himself by eating too much sugar.  It is hard not to get angry. I so wish that I could have prevented this somehow or that I could take it away from him or turn back the clock, but I can’t.  No one can.  Medium got this because he was genetically predisposed to it (his aunt has it, too).  Then one day, while his immune system was busy fighting off some kind of cold/virus, it decided to also attack the islet cells that live on his pancreas and produce insulin. Type 1 (also called juvenile diabetes, but not as much anymore because adults can also get type 1) is an autoimmune disease.  So, now he has hardly any islet cells left that are producing insulin.  Without insulin, the carbohydrates that he eats (which turn into sugar) cannot get out of the bloodstream and into his cells where they can then be used for energy.  The carbohydrates (sugars) stay in his blood and makes his blood sugar levels too high.  Without sugar to use as energy, his body burns fat.  As fat is burned it produces toxic acids called ketones which poison the body when present in large amounts.  What happens next is bad, real bad.  It is called diabetic ketoacidosis or DKA for short.  DKA is a medical emergency.  So, type 1 diabetics have to give themselves the insulin that their bodies do not produce.  They give themselves fast-acting insulin with every meal based on how many grams of carbohydrates they are eating, (this is called a bolus) and they give themselves a slow-acting insulin once a day so they always have some insulin working in their body (this is called basal insulin).  They constantly have to check their blood glucose levels to make sure they are in a safe range, because the wonderful, amazing bodies that God gave us know exactly how much insulin to produce to cover the foods we eat, but diabetics can only guess.  So if a diabetic is managing his or her disease very closely, they are logging their blood sugars before and after meals and activity and logging how much insulin they are taking so they can find the right balance.  And the extra fun thing about kids (*sarcasm warning*) is that as soon as you find a good balance, they have a growth spurt, or get sick or go through puberty (all things that affect blood sugar levels) and then you are back at square one, making adjustments.  And a type 1 diabetic has to do this everyday, for the rest of their lives or until my prayers are answered and a cure is discovered.

Type 2 diabetes (also called non-insulin dependent or adult-onset diabetes) is very different.  Type 2 diabetics still produce insulin, their bodies just do not use it correctly/efficiently, this is called insulin resistance.  This is the most common form of diabetes and thus more people have heard of it and thus, thus people innocently confuse type 1 and type 2.  Low activity level, poor diet and excess weight are risk factors, so in some type 2’s this was preventable.  One of the biggest differences between type 1 and type 2 is that with a change in diet and exercise and lifestyle, type 2 can sometimes be curable.  Type 1 has no cure.  Type 2 diabetics can also sometimes manage their disease with just diet and exercise or a pill, no injections.

Whew!  That was kind of long and boring.  But while you are now half asleep, I feel better that I am doing my part to educate people.  And after all, it’s all about me!  Hee, hee.  And, believe it or not, I have oh-so-much more that I could tell you about, but boring people with long-winded stories about sugar is actually my dad’s department. (Sorry dad!  I just couldn’t resist!  Love you!) (My dad has worked for a sugar company for more than 25 years and he likes to tell detailed stories about beets vs. cane sugar……zzzzzzz).

So if each of you would take what you learned here today and tell 2 people and then they each told 2 people, and so on and so on, then everyone in the world would understand what type 1 diabetes is and then I don’t have to get angry at anyone. Plus that would get us closer to a cure, too!  Could you do that for me, please?

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