Reprinted from the Health District's quarterly publication mailed to district residents (winter 2000)
TOPIC: Living with diabetes
 
by polly anderson

It's almost noon, and Bev Crownhart is drawing her own blood with a finger stick for the second time today. Across town, reference librarian Sue-Ellen Jones is estimating how many carbohydrates are in the lunch she's about to eat. 

Both women are trying to avoid elevated blood sugar levels. Bev has Type I diabetes and has for nearly all of her 58 years. Sue-Ellen was diagnosed with Type II diabetes in March of this year. 

Although the blood sugar problems in both types of diabetes are similar, the cause for each is quite different. 
For most of us, a hormone produced in the pancreas called insulin helps cells absorb glucose, which is used for energy. In Type I diabetics like Bev, the immune system mistakenly attacks the insulin-producing cells in the pancreas, leaving them unable to absorb glucose from the blood stream.

Type II diabetics like Sue-Ellen are considered "insulin resistant." Although they make insulin, they may not make enough, or the body might not be using it properly. The result is the same: Type II diabetics are unable to use the glucose in their blood effectively. 

Bev's parents discovered her diabetes when she was only a year old. At such a young age, the typical symptoms such as unusual hunger and thirst, vision problems and fatigue were undetectable. The diabetes was discovered when Bev fell into a coma. 

High glucose levels, whether from Type I or Type II diabetes, can lead to other problems, including blindness, nerve damage, kidney disease, heart disease and stroke. Controlling blood glucose levels is key to managing both types of diabetes.

According to Karen Brueggen, RN, BSN, CDE, coordinator of the diabetes education program at Poudre Valley Hospital,

could you have diabetes?
More than 15 million Americans have diabetes; one-third don’t know it.
 
Symptoms of both Type I and Type II
diabetes include unexplained weight loss, excessive urination, unusual hunger, irritability and fatigue. People with Type II diabetes may also experience vision problems, frequent infections and tingling or numbness in the hands or feet. 

However, many people with Type II 
diabetes show no symptoms even though damage from high blood glucose levels could be occurring.

Adults over age 45 should be tested for Type II diabetes. If the glucose levels are normal, testing should be repeated every three years.		 Adults under age 45 should be tested if they are at high risk for Type II diabetes. The risk increases for people over age 45 and is greater for people who:
• have a family history of diabetes
• are overweight
• don’t get regular exercise
• have low HDL or high triglycerides
• are African American, Latino, Asian or Pacific Islander or Native American • gave birth to a baby weighing more than nine pounds or had diabetes 
during pregnancy

For more information, talk to your doctor about your risks for diabetes, or call the Health District at 224-5209.

resources

American Diabetes Association
Provides diabetes research, information and advocacy.
(800) DIABETES (342-2383)

Diabetes Management Services, 
Poudre Valley Hospital
Education and support for diabetics and their families.
495-8208
managing Type I diabetes usually means three to four insulin shots daily or use of an insulin pump. Management also includes eating a good diet, getting regular exercise and watching your health closely.

“Type II diabetics manage their disease with good nutrition and exercise,” says Karen. 

Obesity is a major risk factor for Type II, making weight loss and maintenance key to getting the disease under control. Some may also need oral medication or even insulin shots.

"It's the rule of thirds," says Karen, "one-third [of Type II diabetics] manage with nutrition and exercise, one-third with oral medication and one-third with insulin."
When Sue-Ellen found out she had Type II diabetes, she was stunned. She lost her father to heart disease that was complicated by diabetes. Her mother died of kidney problems, but not before Sue-Ellen had accompanied her to many dialysis appointments where she encountered many diabetics in kidney failure.

"I knew the worst that could happen," says Sue-Ellen. "But I can only do tragedy for so long. After 48 hours I was through with it."

Learning about her disease and how she could manage it helped Sue-Ellen cope. She credits Poudre Valley Hospital's education program with helping her accept and understand her disease. 

Like many diabetics in northern Colorado, Bev and Sue-Ellen were referred by their physicians to the program. The hospital offers classes and individual assistance for Type II diabetics and one-on-one help for Type I diabetics.

The program offers nutrition counseling with a registered dietitian. Registered nurses like Karen Brueggen show patients how to monitor glucose levels, give them advice for avoiding complications and help them time insulin doses. 

Sue-Ellen manages her diabetes by carefully monitoring her diet and by checking her blood sugar levels throughout the day. Counting carbohydrates, which are converted into glucose during digestion, help her keep her blood sugar stable. As a Type II diabetic, Sue-Ellen also takes an oral medication that helps her body utilize her own insulin.

Bev gave herself insulin shots daily until this spring when she began using an insulin pump. The pump, which is about the size of a pager, is worn on her belt. It pumps insulin continuously in prescribed dosages into a small hole on her abdomen, replacing injections. At meal or snack time, Bev hits a few buttons on the pump to send a bolus (a larger dosage) to help her body deal with incoming food.

With a goal of keeping blood sugar levels as close to normal as possible, the pump has been a blessing for many Type I diabetics. 

"(With the pump) I don't have to eat on a routine every four hours," says Bev. "I can eat whenever I want." 

And more importantly, she is avoiding the extreme fluctuations in blood sugar levels that cause insulin reactions and lead to diabetes complications. 

Although the pump is a great new way to regulate blood sugar, the biggest advance in treating diabetes probably came about 20 years ago when glucose self-testing became available. Based on the blood sticks taken throughout the day, diabetics can make good decisions about insulin dosages and what and when to eat.

"Prognosis has definitely changed since the advent of self-testing," says Karen. The research shows that tighter blood sugar control will either prevent or delay complications. [Diabetics] do frequent blood testing, generally at least four times a day." 

For both Bev and Sue-Ellen, a positive attitude helps them cope with the demands of their disease. 

"If you want to be a healthy person, you just have to accept it, and be healthy," says Bev.