A Global Health Perspective of Type 1 Diabetes

Monday marked the 90^th anniversary of the first time insulin was used on a human diabetic patient. Thanks to Frederick Banting (hooray for the Canadian connection!), not only is type 1 diabetes no longer fatal, but technological advances since his discovery of insulin have brought us such conveniences as insulin pumps and continuous blood glucose monitors, allowing type 1 diabetics to live long, healthy lives. 

But from a global health perspective, this is simply not the case.  The number one cause of death in type 1 diabetics worldwide is still lack of access to insulin.  Insulin.  The magic hormone that gives me life, 9 ½ years after my diagnosis.  Yet it is so easy for most of us type 1 diabetics in developed nations to remain thankless for this life-saving hormone, and instead focus on the hardships of living with type 1 diabetes.  It is so easy to be flippant with blood sugar control, to indulge in sweets when blood sugars are high, and overcompensate with insulin.  How many times have I griped about a high blood sugar, or been annoyed by the paperwork that comes with ordering diabetic supplies?  Too many times to count. What are your most common diabetes complaints?

Maybe it is time to take a step back from the luxuries of life in a developed country, and be thankful for the most necessary component of our life: insulin.  What would we do without it? You know the answer, and it isn’t happy.  But it is a reality for thousands of children with type 1 diabetes in developing nations.  For those who have the opportunity to be diagnosed in a hospital, they may have access to insulin, though the access will likely be inconsistent and liable to stop.  But many people are unable to even receive a diagnosis, and pass away without ever having known their condition was type 1 diabetes. Without ever knowing that it is a treatable condition.

I realize that there are many complex political, economic and social issues which underlie this inequality between the life of type 1 diabetics in developing versus developed nations, and I don’t believe we should spend all our time being sad about this dismal reality. But knowing it exists may just be enough to shift our perspective on our own diabetes, and maybe from that shift, we can grow a global solidarity of type 1 diabetics.  Perhaps together we can invoke change.  May we mourn over the deaths caused by type 1 diabetes, but may we also rejoice over the many lives that insulin has saved.    

Today, I was thankful for Banting’s discovery of insulin. Were you?

Any facts listed in this post came from the following International Diabetes Federation's article: http://www.idf.org/global-idfispad-guideline-diabetes-childhood-and-adolescence

For an interesting read about Banting's discovery, check out the following BBC article: http://www.bbc.co.uk/news/health-16657425 

My Diabetes Success Story

This post is written as a response to the International Diabetes Federation's tweet: “We have the power to change. What is YOUR #diabetes success story? Let us know how you intend to carry on the success into 2012”.

My diabetes success story does not begin with success. It takes place 3 years ago, during my first semester of my first year of university, when I was struggling to balance the newness of university academic, extracurricular and social activities with all the usual inconveniences of life with type 1 diabetes. This story may not begin with success, but it does end with it.

Exam season of first year university is a stressful time. Personally, I found myself very stressed about my chemistry exam, as it was the course I found the most difficult, and my mark was consequently not as high as I would have liked, so I really had to ace the exam to get the mark I wanted. After long days of studying, I finally felt prepared for this beast of an exam, and the morning of the exam I ate a big bowl of Mini Wheats cereal (for comic relief, click the link), something I don’t usually have for breakfast because I do not find it very filling.  As a result of this highly sugary breakfast, my blood sugar an hour before the exam was sky high, and I felt terrible and thirsty. In my agitated state, nervous about the exam and feeling groggy from hyperglycemia, I over-bolused.

Flash forward to mid-exam, and the mixture of the sugary cereal carbs, that flashed through my system far faster than they should have, combined with my over-bolusing for a post-meal hyperglycemia, meant my blood sugars were low and dropping fast.  But because this was one of my first university exams ever, and because my mind was unclear due to hypoglycaemia, I didn’t immediately call on one of the invigilators to ask to go to my bag and test my blood sugars.  Instead I sat in my seat, attempting questions that seemed impossible to my sugar-deprived mind, and I believe at some point I must have momentarily blacked out (Note: I have never passed out from hypoglycaemia, although twice in my life, this being one of those times, I have blacked out, while still moving and functioning as normal to those around me, though I simply don’t remember time passing), because next thing I knew there was only an hour left in the three hour exam and I was barely half done.

I finally beckoned the invigilator and got some juice into my system, but by the time my blood sugar was up enough to function properly, I didn’t have enough time to do all the questions on the exam properly and I rushed through quite a few multiple choice questions in the end.

I did poorly on the exam, which was extremely upsetting given the amount of preparation I had done, and the potential I had going in to that exam to succeed, which was all wasted because of my low blood sugar.  I was furious. Furious at myself for allowing my blood sugar control to be so poor, furious at Mini Wheats for being such a terrible breakfast choice, and furious at diabetes for interfering with my life.

But I channelled that anger. I decided that from that day forward, I would not allow poor blood sugars affect an exam.  I strategized. I experimented with different breakfasts (peanut butter toast, oatmeal, eggs, etc.) to see which offered the most stable blood sugar control and minimized the effects of the Dawn Phenomenon (in case you’re wondering, oatmeal was the winning breakfast choice in the end).  I planned.  I made sure I always had juice and crackers in my bag before exams, and made a plan to test multiple times before exams (3 hours before, 2 hours before, 1 hour before, 30min before and 5 mins before) to track my blood sugar pattern.  I prepared for the worst by ingraining in my head that the moment I felt low during an exam, I would immediately summon the invigilator and test my blood sugars, to maximize the time that my blood sugars were normal.    

Now, 23 exams later, I can honestly say that my diabetes has not affected my success on any of my exams since that fateful chemistry exam.  Though this story does not begin with success, I can certainly say it ends with success.  Success that will continue throughout 2012 and that will see me through the rest of my undergrad career, and throughout whichever post-grad opportunities I pursue.    

“Our greatest glory is not in never falling, but in rising every time we fall.” -Confucius

A Cousin's Perspective on Type 1 Diabetes

My cousin, Rachel Zavarella, is a very talented artist studying Illustration at Sheridan College in Toronto.  She recently started a blog to share her artwork, and one of her few written posts was about the Aiming for Average artwork that she designed for me upon request (thanks cousin!), and her experience during my diagnosis.

Check out her incredible artwork, and the post, here.

Testing, Testing, 1, 2,3, Testing (….and 4,5,6,7,8,9,10)

I realize that initially I was going to post about the new diabetes app I got for my Android phone, dbees.com, however I had an incident at the pharmacy this morning that was both upsetting and frustrating and I feel the need to express a specific issue it brought up (in case you were really looking forward to hearing about the diabetes app, I will post about it sometime in the next 2 weeks for sure!)

Last night I called in my prescription for test strips as per usual, with the plan to pick them up this morning before commuting to school for my 10:30am class. Since it usually only takes about 5 minutes to pick up the prescription, I only left about that much earlier than usual to allow time to pick up my prescription.

When I arrived at the pharmacy, the pharmacy assistant told me that the prescription wasn’t ready because my order was too early compared to usual. Apparently I usually take 2 months to fill my prescription, and this time it had only been just over a month. What was upsetting was the way the pharmacy assistant was dealing with the situation. First of all, she seemed suspicious that I needed to refill my prescription so soon:

“You shouldn’t have to refill you prescription so soon.”

“Well I do. I need test strips!”

 I could not believe that this lady had the nerve to tell me when my prescription should be refilled. I’m a type 1 diabetic. I need test strips or bad things will happen (…such as high blood sugars, low blood sugars that go undetected etc.) I was clearly exasperated, but also adamant that I needed those test strips (Because I did! It’s not like I was stocking up to sell the test strips on the black market…I doubt a black market for test strips even exists! It's not like you can get high off test strips.) Yet the pharmacy assistant still didn’t seem to believe me:

“You would have to be testing about 10 times a day to fill out your prescription that fast.”

“Yes, that makes sense. I do test that much.”

In fact sometimes I test more than that. And the past month has been holidays so I’ve been testing more frequently than usual to combat holiday desserts. This isn’t a sin. I shouldn’t be made to feel bad about testing a lot. What really upset me about this encounter was that it’s the same sort of attitude I get from the nurses and my endocrinologist, when I visit my diabetic clinic. As if testing many times in one day is a bad thing. Do they really think I enjoy testing my blood sugars a lot? That poking myself with a pin is just the greatest feeling in the world? (It's not, in case you didn't catch the sarcasm. It is actually rather unpleasant.)

To  all the endocrinologists, nurses, diabetic health care practitioners, and apparently pharmacy assistants out there: the more times a day you test your blood sugars, the better idea you have about what your blood sugars are at any given time in the day. Makes sense, doesn’t it? I don’t have a continuous blood glucose monitor, so testing my blood sugars 10 times a day is sometimes necessary to achieve good blood sugar control. It’s the opposite of a bad thing, it’s a good thing if it helps me control my blood sugars.

So please don’t tell type 1 diabetics that we test too much. We don’t. We test just enough. 

New Year's Resolutions

“All changes, even the most longed for, have their melancholy; for what we leave behind us is a part of ourselves, we must die to one life before we can enter another.” –Anatole France

‘Tis the season for resolutions and new beginnings. I love beginnings. I love the excitement of starting fresh, of new ideas, daydreams, hopes and wishes. I have a lot of expectations for 2012, all of which I hope will come to fruition, but only a few of which I would like to list as my official New Year’s Resolutions.

As a diabetic, of course the first resolution I would like to make is regarding my blood sugar control. My HAICs have been consistently around 7 mmol/g in recent years, and my goal this year is to have an A1C of 5.8mmol/g before the end of 2012. But as any good diabetic knows, blood sugar control cannot be measured simply with an average, as an average can never truly tell the full story.  If I achieve that average through a rollercoaster of blood sugars that’s as crazy as this:

than it is not a fair representation of my blood sugar control. I’d like my blood sugar control to be quite a bit more boring and a lot flatter, probably something like this:

My second resolution is to prevent myself from taking on too many committments (work, volunteering, schooling), and by doing so, allowing myself the opportunity to truly give myself 100% to the commitments that I do make. I have the tendency to take on more than is healthy- in terms of levels of stress- (ahem the 4 jobs I was working plus full time school last semester) and I’ve found this to be not only unhealthy, but unsatisfying too.  I wouldn’t call myself a perfectionist, but I do take a lot of pride in what I do, and I get very frustrated whenever I’m time crunched and forced to do a mediocre job. So this resolution is designed to hopefully allow me the opportunity to excel at and enjoy everything I do this year.

A third resolution I would like to make for myself, and one which is quite easily measurable by the public at large, is to truly keep up with blogging once a week. There are so many benefits of weekly blogs, from developing a stronger online community to expressing myself in times of excitement and frustration, and I do believe that the act of blogging itself helps me maintain better blood sugar control, simply by being a constant reminder of my diabetes. 

My fourth resolution is simple yet difficult all in one, and it is to smile more. Cheesy? Yes. Difficult to measure? Certainly. Important? Immeasurably.  Many people describe me as a very upbeat, smiley person, but I want every smile to be from the inside out. I remember a quote I once read in a running magazine, “Wellness is the key to a long and healthy life. Many people have the wrong perception of it. Wellness is from the neck up, and fitness from the neck down. Too many people work out every day, but go around with the worst attitudes, which just wastes all their physical efforts.” I think that statement captures the importance of attitude and happiness, and I would like to be a more smiley, positive person this year.

My final resolution fits in nicely with these ideas of wellness and fitness. I’d like to run in more races this year. So far I’ve signed up for the Warrior Dash in July, which I’m extremely excited about, and as the warmer months near I’d like to sign up for some more 5 and 10ks, possibly even a half marathon.

Here’s to hoping the new year brings all sorts of good, and fewer sorts of bad.