Optimal Life: The Essentials of Insulin

CHAPTER ONE

What is Diabetes?

One of the most critical components for successful insulin treatment is education and support. Everyone who uses insulin should learn all they can about the basics of insulin therapy. I wrote this book because I’ve met many people who use insulin but don’t understand some of the important principles associated with it. These include the concepts behind their dosing regimen, the importance of timing insulin injections, carbohydrate counting, their insulin-to-carbohydrate ratio, what a correction factor is and how to use it correctly, and how to recognize a trend in glucose levels that would require a change in dose beyond using their correction factor. This indicated to me that some people who require insulin do not seem to understand how it is keeping them alive. This lack of understanding was not entirely the patient’s or the physician’s fault, but a combination of issues of which the greatest factor is a lack of education on insulin. My aim is to clarify and demystify insulin and insulin calculations to make it all easier to understand.

Knowledge about your insulin therapy will help you gain control over your diabetes and allow you greater flexibility in lifestyle so you can do the things you want to do. It can also help reduce your anxiety because you’ll feel more confident that you’re handling your diabetes properly. Please remember to discuss the information in this book with your physician before you make any changes to your insulin dose.

Throughout the book I will refer to insulin by both its brand and generic names. Here’s a table to help you become familiar with them:

Diabetes mellitus (DM) is a disease state in which too much glucose accumulates in the bloodstream. The medical term for this build-up of glucose is hyperglycemia. The two key players in diabetes are glucose and insulin.

Glucose is a form of sugar that supplies energy for all your body’s functions. You need a constant level of glucose throughout the day and night.

There are two main ways that glucose can enter your bloodstream:

From an outside source: The food you eat contains carbohydrates. Carbohydrates are converted to glucose in your body. The carbohydrates you eat may be simple or complex, but both are broken down into glucose by your body.

From an inside source: Glucose that is produced in your body by your liver and, in smaller amounts, by your kidneys. Your liver provides small amounts of glucose throughout the day and increases production when your body signals glucose levels are low.

Insulin is the great communicator. It is a hormone produced in the pancreas that works with many systems in the body. Insulin is instrumental in: 1) allowing glucose to enter cells so it can be used for energy or stored for later use; 2) decreasing fat breakdown; 3) triggering the liver to convert glucose to glycogen and store it, and; 4) decreasing or slowing the release of glucose from the liver into the bloodstream. Insulin is like a key that fits the lock on the door to the cell to allow glucose in. Without insulin or when insulin is not working efficiently, glucose cannot enter the cell. Then glucose builds up in the bloodstream and cells become starved for energy. Many factors may contribute to the decreasing effectiveness of insulin, but, with that said, insulin and glucose are still the two key players.

Diabetes occurs when the beta cells of the pancreas are destroyed by an autoimmune response and insulin production stops (type 1) or when the pancreas does not create enough insulin due to insulin resistance (type 2). Whether there is no insulin or not enough insulin to overcome insulin resistance, glucose builds up in the bloodstream, leading to hyperglycemia or diabetes.

Type 1 Diabetes

Type 1 diabetes is characterized by the inability of the pancreas to make insulin and, therefore, being unable to secrete it. Type 1 diabetes develops when the body produces antibodies that kill special cells on the pancreas called beta cells that make and secrete insulin. When your body makes antibodies that kill off its own cells it’s called an autoimmune response. This response is not normal because the body’s immune defenses are meant to kill harmful substances, such as bacteria, but not your own cells. Currently, there is no definitive evidence that explains what triggers the autoimmune response that leads to type 1 diabetes. Researchers do not know if or to what degree environmental factors play a role or how genetic factors predispose certain people to the disease.

The classic symptoms of type 1 diabetes are the three Ps: polyuria (urinating a lot), polydipsia (extreme thirst) and polyphagia (hungry all the time). Because individuals with type I diabetes can no longer produce insulin, glucose can’t enter cells to be used as energy. The cells become starved for glucose, which promotes the feeling of hunger, called polyphagia. As glucose builds up in the bloodstream, it increases urination, called polyuria. The body attempts to replace the fluids lost, which results in being thirsty and drinking lots of fluid. This is called polydipsia. The body then begins to burn fat for energy. This is why people with type 1 diabetes are often quite slender (they are usually very thin at the time of diagnosis).

Of all the people who have type 1 and type 2 diabetes, only about 5-10 percent have type 1. Type 1 usually develops early in life and the diagnosis is quick because of the acute or severe symptoms. However, the autoimmune destruction of beta cells can develop later in life and it’s estimated that 5-10 percent of people with type 1 develop it after age 30. Overall, the risk for developing type 1 is relatively low: If a parent has type 1, the risk of developing the disease is between 3-4 percent and 5-15 percent if a brother or sister has type 1. Looking at these statistics, you can see that many individuals with type 1 diabetes do not have a first-degree relative (mother or father) with this disorder. There are also certain areas of the world that have a greater population with type 1. Geographically, Scandinavia (Finland, Sweden, Norway, Denmark) has the greatest incidence of the disease. The United States and Northern Europe have an intermediate rate and the Pacific Rim (Japan and China, for example) has a much lower incidence.

Type 2 Diabetes

Type 2 diabetes is characterized by the pancreas failing to produce enough insulin because of insulin resistance, progressive beta cell failure with increasing duration of diabetes, being unable to use insulin efficiently or a combination of all three. Insulin resistance is a term that describes a cell’s decreased ability to use insulin. Following the key (insulin) and lock analogy used above, when insulin resistance occurs, the lock becomes distorted and it becomes more difficult for the insulin-key to fit. To overcome this, the body secretes more insulin to increase the chance that some of the insulin will fit in the lock. Over time, the pancreas cannot keep up with the body’s insulin needs; the quantity of insulin released actually decreases as the pancreas wears out. As the available insulin decreases, it has less effect on the glucose from food and the liver’s glucose production; therefore, glucose levels will continue to rise. The pancreatic cells that secrete insulin will begin to fail entirely and insulin production will stop altogether.

Type 2 diabetes has a strong genetic factor. If both parents have type 2 diabetes, there is a 40 percent chance their children will inherit it. Type 2 is also associated with environmental or lifestyle factors, such as obesity, lack of physical activity and poor nutrition habits. Other