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Dr. Cassel
13 April 2018
The Meaning and Management of Type One Diabetes
I have always had the luxury of eating whatever I please whenever I please. I would eat
mac n’ cheese, french fries, chicken nuggets, and all the terrible food that kids eat today. My
favorite as a child was always the trusted cheeseburger and coke. I never had to worry about my
how my body digested that food or even gave thought about how my body regulates my blood
sugar. In the past year I have learned that not everyone has that luxury. My girlfriend was
diagnosed with type one diabetes when she was eleven. This chronic condition and what she
must go through every day has taught me valuable lessons about how life can be so different for
others.
Having type one diabetes will cause blood sugar levels to remain high within the body.
Long exposure to hyperglycemia, meaning high blood sugar, over time can cause life-threatening
damage. When a person eats food, it is then broken down within the body. Foods that break
down into sugar will cause a rise in blood sugar. Someone without diabetes has a response
system that works effectively in releasing the hormone insulin. Insulin will unlock the cell for
glucose to enter and be used as energy. Diabetics require insulin to be administered through
injections or an insulin pump. Beta cells found within the pancreas secrete the hormone insulin.
Type one diabetes is an autoimmune disorder, which means that the body will for unknown
reasons attack itself. When diagnosed with type one diabetes insulin is required my injection for
life. This is because the beta cells are attacked by the body causing the produce of insulin to be
Diabetes is not far from the top of the list on the leading causes of death in the United
States coming in sixth. A mere 5% of the people diagnosed with diabetes have type one. The
other 95% have type two. These conditions are rather different though they share a similar name.
Type one diabetes has no known cause and is an autoimmune disorder. Type two can be avoided
and prevented. Type one diabetes is significantly harder to deal with, especially since it usually
develops in children. Although someone can be diagnosed at any age with type one diabetes,
most cases are diagnosed in adolescence. Type one diabetics are often called insulin dependent
due to the need for insulin to be administered for the remainder of the diabetic’s life. Type two
diabetics make insulin but their cells have become resistant to the insulin, or they simply just do
not make enough. Type two diabetes is more common. Not exercising and a bad diet will put a
person at a higher risk of developing type two. While both diseases cause the same symptoms,
they differ in the cause and treatment of the disorder (“Introduction to Diabetes…”) (Klandorf &
Stark) (Basile).
Figure 1 graph shows the percentage of all type 1 and 2 diabetes cases in the United States (Berry)
Insulin was isolated for use in diabetes patients in 1922. Insulin was identified, isolated
and extracted from cow and pig pancreases. This worked completely functional within the
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human body. This was a discovery that changed medical history. Before insulin was isolated for
patient’s usage, diabetes was a fatal disease. The patients would often starve to death or die from
hyperglycemia. One year was the average time after diagnosis that patients would live. That year
involved strict carbohydrate intake diets, but this did not help with the cells intake of sugar for
energy. Development into better and more pure forms of insulin would go on to be the next
advancements, and researchers are able to now grow and harvest insulin within labs instead of
extracting from animals. More research into insulin is still ongoing today. The research into the
cause for this disorder is still ongoing. Researchers have found that type one diabetes have both
genetic and environmental factors responsible (Moroder & Musiol) (Klandorf & Stark) (Basile).
Everyday life with diabetes is a challenge. It is ridden with stress of hypoglycemia, stress
of counting carbs for correct insulin injections, and the constant pricking of fingers to check
blood sugar levels. In a study conducted by Kyngas and Barlow in 1995, 51 Finnish adolescents
fluctuating from ages 13-17 diagnosed with type one diabetes were evaluated. The teens were
asked how they perceived and their personal meaning of their diabetes. Many teens described
this diagnosis as the beginning of the end of their lives. Some of the other teens accepted the
diabetes as part of who they are. Peer support for these teens was a huge factor in the ease of
maintaining their diabetes. Many teens claimed that they felt controlled by their parents or health
care providers. Health care providers are notorious for being very strict on their diabetic patients
due to the seriousness of the disease. Emily Axt who was diagnosed at age eleven with type one
diabetes says, “health care providers treat diabetes as if the same simple math formula involving
insulin and a diet plan will work for every diabetic. The actual truth is that everyday my insulin
is affected by different environmental and physical factors. Certain times of the month will affect
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my insulin, so health care providers really should do more research into what it’s like living
Advancements in continuous glucose monitors have helped with easing the tiresome
pricking of fingers for blood to check blood sugar levels. Having a 24-hour monitor that checks
and records glucose levels is an exponential advancement for diabetics. This makes sleeping and
doing other daily activities a lot easier to perform. Having this helps the diabetic, but it also helps
health care providers in giving better care when real-time glucose levels are being recorded
Buckingham, and David Maahs for the Journal of Pediatrics in 2016, they state:
Investigation into patients’ attitudes and beliefs surrounding CGM is an emerging area of
research. These studies show positive themes of improved blood glucose control, reduced
with interpreting CGM data, lack of device accuracy, intrusiveness of alarms, and
Before insulin pumps, multiple insulin injections were required. Insulin pumps were
introduced in the early 1970’s and dramatically increased the ease of management of diabetes.
An insulin pumps stays in the body, being changed frequently, and will release insulin into the
body from an external device that is operated by the diabetic. Insulin pumps are attached to the
body, but the device that operates it can be done with Bluetooth or manually with a wire. The use
of insulin pumps improved glycemic control in early studies. Having both an insulin pump and a
Control over glucose levels is most important in prolonging the life expectancy of a
diabetic’s life. Studies show that diabetics live 11-12 years shorter than the average person. This
is due to the long term wearing down of cells and tissue, due to hyperglycemia, having major
affects on major organs. As a person gets older the organs begin to wear down, but with diabetes
the process seems to be faster. Diabetic retinopathy, which affects the eyes, is the number one
cause of blindness in people aged 20-74. Diabetics are more likely to have kidney failure, limb
amputations, and suffer from heart disease. The burden of the cost of health care is much higher
for diabetics ranging from ten to twelve thousand dollars a year in medical treatment and
supplies. This is for the rest of the diabetic’s life. An average healthy person will spend 3-4 times
less than that a year on health care. This makes life even harder on diabetics (Lewine)
(“Introduction to Diabetes…”).
Strict control over blood sugar levels lengthens the life of a diabetic dramatically, but it
also makes hypoglycemia more prevalent for diabetics. Hypoglycemia is low blood sugar. It can
be a fatal nightmare for diabetics. When a diabetic’s sugar gets too low they could fall into a
hypoglycemic coma, have a seizure, and die. The nondiabetic response to low blood sugar is the
hormone glucagon to be released along with epinephrine in the brain which stimulates glucose
production from stored fat within the body to help rise the bodies blood sugar levels
There are three factors that make hypoglycemia harder on diabetics than the average
healthy person due to malfunctions in the body’s normal process. First, the body can suffer from
hyperinsulinemia, meaning too much insulin is circulating in the blood stream. This is caused by
the obvious need of foreign insulin injected into the body. Second, after five years of being
diagnosed with diabetes, the process that normally would react to low blood sugar (glucagon
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being released) is weakened and not sufficient. Third, after ten years of being diagnosed the
body’s automatic response system is suppressed and will no longer make the event of low blood
sugar a priority. Diabetics should always carry a sugary food or drink, like a juice box, incase of
an emergency low. Diabetics also carry a glucagon kit in case of extreme emergencies in which
they are unconscious. These kits are filled with the hormone glucagon and will cause a rise in
blood sugar almost immediately and cause the diabetic to vomit. Exercising for diabetics can be
difficult because it lowers the blood sugar, and can cause extreme lows if not monitored
tediously throughout the workout. This can make going out for a jog a scary thought for diabetics
Diabetes can be psychologically taxing for people who suffer from it. The mental
stability that is required of a diabetic is high. A study conducted by Grey and associates (Grey,
Boland, Davidson, Sullivan-Bolyai, & Tambor-lane, 1998) analyzed the stressors involved with
having diabetes among 34 teens aged 12-20. The results were broken down into seven different
The first stressor, nature of the condition, was described by the teens as both a part of
their lives, but also something that hindered them from normalcy. Optimism was hard for the
teens when regarding their disease. The second stressor involved personal matters. This made
many of the teens feet a sense of pride and accomplishment within themselves being able to
handle such a disorder. Many teens said that some of their classmates would not be able to
handle it. “Care constancy, complexity, boredom, rigidity, visibility, and feeling guilty about bad
numbers were some of the pervasive themes”, says Davidson from the results of her review of
the study regarding care management, the third category. Relationships were important for the
teens. Although, relationships also caused stressors as seen in the fourth category. Many of the
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teens said friends and family can cause stress over being overprotective, telling others about their
diabetes, and asking personal questions in public. The fifth stressor, situational, was simply
caused by not being at home in the diabetic’s comfortable environment. Any outing would cause
stress because of fear of hypoglycemia, not having enough insulin, or insulin pumps/continuous
glucose monitors needing to be changed suddenly. The sixth stressor, coping behaviors, involved
having both problem-solving and emotion-based coping behaviors. Many teens admitted to
guilting themselves about having “bad number” so they’d do better. Many teens would ask their
parents for help in carrying out maintenance due to them being too tired. The final stressor,
dilemmas, helped explain the many dilemmas that diabetics must go through throughout their
lives. These are questions that diabetics are struggling to answer within themselves every day.
“To tell or not to tell, to ask for help or not ask, “normal” or reveal difference, to tell the truth or
lie regarding self-care deviations, to complain or not complain, to be “good” or “cheat” in food
decisions, and to stay on track or stray with the demands of their diabetes regimens”, were some
of the dilemmas the teens mentioned in the study. This study helped to see inside the brains of
people struggling with the every day stressors that come along with type one diabetes (Davidson,
Although there is no cure for type one diabetes currently, research is being done every
day. I have been changed forever seeing first hand the demand of type one diabetes. I will always
fight for the end to this disease. It is crucial to keep in mind the many advantages of having
normalcy and good health. I often took for granted the many privileges I have when picking
foods, exercising, having relationships, a good night’s sleep, and many other daily activities.
Knowing the struggle that so many other people must go through has helped me realize how
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fragile life can be. I help in any way I can in helping with my girlfriend’s control over her
glucose levels, because I want her to live the longest live she possibly can.
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Works Cited
Basile, Maria. "Diabetes." The Gale Encyclopedia of Genetic Disorders, edited by Stacey L.
http://link.galegroup.com.sinclair.ohionet.org/apps/doc/UXFXSY107416458/OVIC?u=da
Berry, Jennifer. “Type 2 diabetes statistics: What's to know?” Medical News Today.
Davidson, Maryanne, Penney, Erika, Muller, Beth, and Grey, Margaret. “Stressors and self-care
challenges faced by adolescents living with type 1 diabetes.” Applied Nursing Research,
Forlenza, Gregory, Buckingham, Bruce and Maahs, David. "Progress in Diabetes Technology:
doi:10.1016/j.jpeds.2015.10.015.
Viewpoints In Context,
http://link.galegroup.com.sinclair.ohionet.org/apps/doc/EJ3010291101/OVIC?u=dayt304
Klandorf, Hillar and Stark, Sharon. "Diabetes Mellitus." Magill’s Medical Guide (Online
sinclair.ohionet.org:80/login?url=http://search.ebscohost.com/login.aspx?direct=true&db
=ers&AN=86194054&site=eds-live.
Lewine, Howard. “People with type 1 diabetes are living longer.” Harvard Health Blog.
https://www.health.harvard.edu/blog/people-type-1-diabetes-living-longer-
McCrimmon, Rory, and Sherwin, Robert. “Hypoglycemia in Type 1 Diabetes.” Diabetes 59.10
Moroder, Luis, and Musiol, Hans‐Jürgen. "Insulin—From its Discovery to the Industrial
56, no. 36, 2017, pp. 10656-10669. OhioLINK Electronic Journal Center,
doi:10.1002/ANIE.201702493
Prospects." Indian Journal of Endocrinology & Metabolism, vol. 19, 2015 Supplement 1,