First thing’s first, living with diabetes isn’t bad. It really isn’t. Second, I do not like discussing diabetes frequently as I do not consider it a huge part of my life and do not want the disease to be associated with me. Nevertheless my hope in writing this article is to enlighten those who have always heard about diabetes but have never talked to anyone as to what it really means to have diabetes. And to be clear, if you have questions about diabetes I will answer them–I simply don’t want the diabetes conversation to be the common point of discussion between myself and any of my friends.

Diagnosis

Note: Somewhere out in the ether are a few pictures of my diagnosis in Cincinnati Children’s and a truly awesome visit from my friends Stephane and Grace. I’ve got detective Mom on the case to find them and will be sure to add them to this post when I can.

I was diagnosed with Type I Diabetes on December 16, 2008. I was 16 at the time the two biggest issues in my life were writing my campaign speech for my run at the senior class president of my school as well as working with my friend Stephane on our emcee video for the annual school talent show:

In the weeks leading up to my diagnosis, I was having some odd ailments, but I hadn’t been feeling particularly sick. The most apparent symptom I suffered from was an unquenchable thirst and frequent urination. Members of my family are all big water drinkers and proud of it. At first I simply attributed my seemingly endless thirst as my superior ability to drink water, however with vast amounts of water consumption comes vast amounts of urination. Suddenly my ability to out drink everyone went from a point of pride to a point of hassle. In school I couldn’t go more than fifteen minutes without needing to excuse myself from class, get a drink of water, go to the bathroom, and get another drink on my way back to class. I would do this three to five times each class period, and began to worry my teachers thought I was using drugs. A few of them put me on the spot and asked why I needed to go so often, and the best answer I could muster up was “I don’t know”.

I also lost significant weight. Again, I noticed this, but I just thought I had grown extra buff in the last month or two, and it wasn’t a problem I was concerned about (I was looking good!). I didn’t really take notice of the weight I had lost until very close to my diagnosis in December, but I estimate I had lost upwards of twenty pounds by that point.

On Thanksgiving morning I was watching an episode of Scrubs, a medical comedy sitcom following the lives of J.D. and Turk, two best friends from college who joined the same teaching hospital. In one of the episodes, it’s alluded that Turk has diabetes but doesn’t yet know it. Finally one of the characters spells it out for him by describing the symptoms of one of her patients:

1. Always sleepy
2. Losing weight
3. Frequent urination

Turk responds “Oh you should have him checked out, he might have diabetes,” before realizing she was describing the symptoms he’s having.

I never felt particularly tired, or more tired than normal (I was a teenager after all), but the other two were definitely what I was feeling.

My family was having a joint Thanksgiving dinner with two other families at our house, and it was over dinner I told my Mom I thought I had diabetes. “You don’t have diabetes,” she laughed. The next day I was working on a carpentry project with my Dad and he noticed just how frequently I was going to the bathroom. Finally he said something to my mom and I went to the doctor. They took a urine sample and a few other tests and I left without any indication of what I might have. About a week later I got picked up from school and admitted into Cincinnati Children’s hospital for Type I Diabetes at age 16.

People often ask if I was born with diabetes, or what caused it after 16 years. Often type 1 diabetes is found in infants, but occasionally there are the Taylor White’s of the world who are diagnosed at age 16 or even age 50. Although I can’t say for certain, I believe I know what caused my diabetes. One night in mid-November (2008) I went to urgent care at the local hospital in my town with my mother. I had mono and my throat was very swollen. The doctor gave me a steroid pack and instructed me to take the pills. It said to take one every hour and yet the doctor said to take them all at once since it was night-time. My Mom begged me not to, but in a typical teenage fashion I felt I knew better and did what the doctor said (or rather–the opposite of what my Mom instructed).

Steroids’ affect on blood sugar is well-known. Corticosteroids, or simply steroids for short drastically increase your blood sugar upon reaction with the body. The theory is that this triggers the beta (islet) cells in your pancreas to kick into double duty, pumping out large amounts of insulin to counteract the glucose that’s been released into your system. One’s immune system sees a set of hyperactive cells create mass amounts of protein and goes to eliminate the offending cells, and this is how diabetes is started. That’s the theory anyways, and I believe it. I have read a lot online from others who have had the same experience. I was completely healthy leading up to this event and have no family with any type of diabetes. The biggest lesson I’ve learned both from working at Epic (and actually seeing how little time the average doctor spends on their patients) and from my experience being diagnosed with diabetes, is that only you can make a decision about what is best for your body. Doctor’s don’t know as much as you think they do, and they won’t always be right.

About Diabetes

Here’s an interesting excerpt from the Wikipedia page on the history of diabetes:

Many people know that there are two types of diabetes, type 1 and type 2 and often think them to be similar. In fact, the two diseases are really quite different.

Type 1 diabetes is an autoimmune disease, where type 2 is not. Type 1 diabetes results from a trigger that causes one’s immune system to see beta cells in the pancreas as a foreign substance that must be eliminated. After this trigger has been fired an individual with type 1 diabetes will produce less and less insulin until all of their beta cells have been killed off by their immune system. Type 1 diabetes is often associated with children, hence the term juvenile diabetes.

Type 2 diabetes occurs as a result of being overweight, and there is significant evidence that it is passed through a person’s genes. With type 2 diabetes, an individual builds up a tolerance to all of the insulin that is being produced from their islet / beta cells, but the beta cells are still functioning. As an individual loses weight, blood circulates better, less insulin is produced, and their tolerance goes down. Often times those with type 2 diabetes may not even have to inject insulin at all, and simply will take pills to increase their sensitivity to insulin. Type 2 diabetes is associated with a ten year decrease in lifespan and often chronic¹.

The Facts

The Scale of Diabetes

• Nearly 26 million Americans have diabetes (8.3% of the population).²
• Diagnosed: 18.8 million
• Undiagnosed: 7 million
• As many as 1.25 million Americans may have T1D.³
• Diabetes currently affects more than 371 million people worldwide and is expected to affect 552 million by 2030.⁴
• In the U.S., a new case of diabetes is diagnosed every 30 seconds; more than 1.9 million people are diagnosed each year.⁵

The National Cost of Diabetes

• Diabetes is one of the costliest chronic diseases.
• Type 1 diabetes accounts for $14.9 billion in healthcare costs in the U.S. each year⁶, while all types of diabetes combine to account for $245 billion in annual costs.⁷
• The annual cost for healthcare was $11,700 for each person with diabetes in the U.S. in 2009, compared to $4,400 for each person without diabetes.⁸
• Americans with diabetes incur medical expenses that are approximately 2.3 times higher than those incurred by Americans without diabetes.⁷
• The average annual medical costs of children and teens with diabetes in the U.S. is $9,000, compared to about $1,500 for those who don’t have diabetes.¹⁰

The Healthcare Toll of Diabetes

• Diabetes is the leading cause of kidney failure, nontraumatic lower-limb amputations, and new cases of blindness among adults in the U.S.²
• Diabetes is a major cause of heart disease and stroke.²
• Poorly controlled diabetes before conception and during the first trimester of pregnancy among women with T1D can cause major birth defects in 5% to 10% of pregnancies and spontaneous abortions in 15% to 20% of pregnancies. Furthermore, for women with pre-existing diabetes, optimizing blood-glucose levels before and during early pregnancy can reduce the risk of birth defects in their infants.²
• Diabetes is the seventh leading cause of death in the United States. The risk of death for people with diabetes is about double that of people of similar age without diabetes.²

Living With Diabetes

Living with diabetes really isn’t that difficult in the scheme of things. When I first was diagnosed, I began insulin treatment through injections. In clinical practice injections work like this:

1. Get Ready

• Remove the cap with clean hands
• Check the reservoir to make sure the insulin is clear and colorless and has no particles–if not, use another pen.

Step 1: Get Ready

2. Attach the Needle

• Wipe the pen tip (rubber seal) with an alcohol swab
• Remove the protective seal from the new needle, line the needle up straight with the pen, and screw the needle on
• Do not make the needle too tight. If you have a push-on needle, keep it straight as you push it on
• After you have attached the needle, take off the outer needle cap and save it (you will need it to remove the needle after your injection)
• Remove the inner needle cap and throw it away

Step 2: Attach The Needle

3. Perform A Safety Test

Step 3: Perform A Safety Test

• Dial a test dose of 2 units
• Hold pen with the needle pointing up and lightly tap the insulin reservoir so the air bubbles rise to the top of the needle. This will help you get the most accurate dose
• Press the injection button all the way in and check to see that insulin comes out of the needle. The dial will automatically go back to zero after you perform the test
• If no insulin comes out, repeat the test 2 more times. If there is still no insulin coming out, use a new needle and do the safety test again

4. Select The Dose

• Make sure the window shows “0” and then select the dose. Otherwise you will inject more insulin than you need and that can affect your blood sugar level
• Dial back up or down if you dialed the wrong amount
• Check if you have enough insulin in the reservoir. If you cannot dial the dose you want it may be because you don’t have enough insulin left
• You cannot dial more than 80 units because the pen has a safety stop. If your dose is more than 80 units, you will need to redial the rest of your dose. If you don’t have enough insulin for the rest of your dose you will need to use a new pen

Step 4: Select The Dose

5. Inject Your Dose

Step 5: Inject Your Dose

• Clean site with an alcohol swab. Please see injection site options
• Keep the pen straight; insert the needle into your skin
• Using your thumb, press the injection button all the way down and slowly count to 10 before removing. (Counting to 10 will make sure you get your full insulin dose)
• Release the button and remove the needle from your skin

6. Remove The Needle

• After injecting, always remove the needle to prevent contamination and leaking
• Put the outer needle cap back on the needle and unscrew (or pull) the needle from the pen
• Throw needle away in a sharps container. For more information on disposing needles please see disposal information
• Put the pen cap back on the pen and store in a safe place at room temperature

Step 6: Remove The Needle

In reality it goes something like this:

• Find a needle, preferably unused, screw it to the pen.
• Find a spot on your stomach or legs that isn’t bruised from the last injection, and shoot up in front of friends, family and even strangers!

Note: The needle in this GIF is significantly larger than the typical insulin syringe or pen needle.

I took a basal insulin (Lantus) injection in the morning, and bolus insulin (Novolog) injections with each meal.

You can think of basal insulin as your “base rate”. This is the amount of insulin the beta cells in your pancreas create, on average, throughout the day. Since no one is able to inject small amounts of insulin every couple of minutes in the same way your pancreas is creating small amounts of new insulin all the time, a once-daily basal injection inject slow-acting insulin so that it reacts in your body throughout the day.

As you eat a meal, your body is flooded with carbohydrates and your blood sugar begins to climb as the carbohydrates are broken into sugars and make it into your blood stream. The basal rate is still chugging along at its same pace, but suddenly the need for insulin has dramatically risen. Thankfully I have another type of insulin, bolus insulin, which is akin to “fast-acting” insulin. The protein is injected the same way that basal is, but it doesn’t have the same acidic sting to it. Bolus insulin runs through your body in about two-three hours.

These are all the potential injection sites for insulin. When using syringes or pen needles, I only inject in the thighs or lower abdomen, as I find the back, triceps, and upper abdomen have too little fat / too much muscle to be comfortable.

If you ever see a diabetic “shooting up” they are likely injecting bolus insulin as a result of high blood sugar or preparing to eat a meal.

In May 2014, I actually switched to a new method of insulin delivery called a pump. A pump has some positive and negative features which I’ll explain in this nifty table below:

ProsCons

My Tandem Pump

Although there are significantly more cons in my list than pros, I am still happy I have a pump. The “much healthier” point outweighs all of the con points combined, and the tracking of insulin delivery is particularly helpful to those that are willing and excited to stay on top of their diabetes.

Concerns With Diabetes

I don’t put too much thought into diabetes. I want to be healthy, and I am concerned about dying earlier and some of the health concerns that are associated with diabetes–poor circulation, glaucoma, etc., but I try not to get too down. It sounds cliche, but it’s true, no matter how bad your situation is, there is always someone out there who is going through something worse, and that’s something I’m cognoscente of everyday.

I’m very grateful I’m still able to do all of the activities I did before, I’m still able to play sports, go swimming, etc. and I can live a relatively normal life. One thing I’m sad to have lost is that sense of invulnerability. Growing up I always had the thought of “oh that won’t happen to me”, “I can climb and wrestle and do XYZ dangerous activity and I’ll be okay, because I’m healthy”. Today I still am more daring than the average person, but I do carry some extra weight on my shoulders. I can’t up and leave for Costa Rica tomorrow because I need to determine where I’m going to get my insulin from, what medical supplies and documentation do I need to take with me? My health is something I must think about before going to sleep each night, and occasionally prior to any heavy drinking.

So that’s my story. Living with diabetes, kind of sucks. But it’s a part of me now, and just like the great Tim Howard does with his turrets, it’s something I own. Each day there is some advancement that takes place and I am confident that someday I will be lucky enough to have my diabetes completely managed or cured. I cannot wait for that day. Until then, we can all just crack on (2:30 at the video below!).

Sources:
Lantus
Juvenile Diabetic Research Foundation (JDRF)

Related articles across the web

• About Diabetes and Exercise
• Health Beat: Islet cell transplantation for Type 1 diabetes