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Question:

From Quebec, Canada:

I've been living with typeá1 diabetes for 15 years now. I've had my share of ups and downs. Recently, I've found it harder and harder to keep my sugars within a normal range. My HbA1c has been creeping up. I started a new regimen using Humalog and NPH in the last year rather than just Regular and NPH, and I am injecting four times a day. My endocrinologist believes I need to check my blood sugars two hours after I've eaten as well as after midnight to determine if my sugars are riding up because, they appear to be only slightly elevated on average before meals. The motivation to stop work in a meeting or get up in the middle of the night to check my blood sugar is just not there.

My spouse and I married shortly before my diagnosis. We've had two wonderful children since then (both have tested negative for islet cell antibodies). I've gone on to get a Masters in Health Administration, and I am currently working on a PhD in Applied Health Sciences while working full-time for a University Department in Research. I am very busy trying to get ahead at 38 years of age.

In thinking back about my education to the disease and my approach to handling it, I was given a crash course on how to eat right and take insulin during the two days I was admitted to hospital. The diabetes day unit was not open during the time I was in hospital because it was so close to the Christmas holidays. In the early years, I was very religious about weighing the food and checking sugar levels. I even wrote myself a software program to record levels and events to allow adjustments, etc., but over the last five to ten years, I've put diabetes on the back burner while I worry about all the other pressures that we face on a day-to-day basis. Recently, I've become angry about my disease, thinking that it has prevented me from achieving certain goals. It has affected my perceptions in a negative way. I wonder how things may have been different without diabetes, and I yearn for a resolution to the problem.

I have no one close who suffers from diabetes. I find it hard to explain how I feel to my wife or members of her family. Many of whom still don't seem to understand the difference between typeá1 and typeá2, and if questioned what should be done if I was to suffer an insulin reaction, there would be a 50% chance that they would want to inject insulin into me rather than glucose. My own family is very small and in different parts of Canada and Asia.

I am intrigued about the possibility of an insulin pump, hoping that it might be able to provide me with more freedom and allow me to attain better control. Your thoughts would be much appreciated. As well, the research that has been done in Canada on islet cell transplantation looks very promising. I understand that there is a good deal of U.S. money going into clinical trials on this new technology. Any possibility of becoming a candidate for one of the trials? I wonder if the possible side effects of the anti-rejection medication are worse than the longer-term outcomes associated with diabetes?

Look forward to your thoughts on dealing with the depression and anger, and treatment options such as insulin pumps etc.

Answer:

You have a few issues to deal with here. First, I would encourage you to never give up and take care of your diabetes. It is okay (and very common) to get discouraged about your diabetes. The main thing is not to give in. To use a metaphor, don't go over to the "dark side." Tell your family how you feel. If you have mental health services available, check to see if you can spend some time with one and discuss your feelings. This is very common.

The good news is that there are a lot of things to do about your level of control which has drifted upwards. I believe that lispro is a very good product for better control of your sugars around the meal time because of its rapid absorption. That is why your doctor has asked you to monitor more frequently after meals. I think it is very important for your physician to be able to communicate with you what your blood sugar goals are. If this means you need to enroll in a diabetes education program, I would recommend it. I think the theme should be that we educate patients for issues related to a lifetime of diabetes. If these things do not work, I also feel insulin pump therapy is a very useful tool for improving blood sugars. I have used this technology a lot and feel many patients have benefited with improved blood sugars and increased flexibility. The flexibility is a very significant quality of life issue.

Finally, it is true that there is a lot of anticipation about islet cell transplants. I would contact your local Juvenile Diabetes Foundation (JDF) affiliate about the JDF-funded islet cell transplant centers in your region of North America.

JTL

Additional comments from Stephanie Schwartz, diabetes nurse specialist:

See Is pumping for you? for information about insulin pumps. Also, ask your endocrinologist about The Continuous Glucose Monitoring System. Your situation might well be clarified by monitoring sugar levels continuously for several days to try to sort out what's happening in more detail.

SS

[Editor's comment: You and your spouse should look around for a diabetes education program that can give you both an in-depth review of current treatment options and coping skills. WWQ]

DTQ-20001012232423
Original posting 18 Nov 2000
Posted to Behavior and Daily Care

  
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Last Updated: Tuesday April 06, 2010 15:09:16
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