Learning About Type 1 Diabetes Can Help You Support Your Partner
Insulin, CGMs, Humalog, Novalog, Lantus, infusion sites, transmitters, A1c, and ketones... Initially, type 1 diabetes (T1D) may sound like a foreign language! Although it is a lot to learn, your efforts to become familiar with T1D terms and concepts will not only allow you to better support your spouse/partner, but also give you a sense of empathy for the learning curve he or she went through at diagnosis. Research suggests that your sincere efforts to understand your spouse/partner’s experience with type 1 diabetes can both strengthen your relationship and equip you with skills to lend positive support in their diabetes management. In this blog post, we hope to provide you with a basic explanation of T1D and a reference guide for common T1D terms to support you in these endeavors.
What is Type 1 Diabetes?
As stated by the Center for Disease Control, type 1 diabetes is a chronic condition that occurs when the body’s immune system disables the insulin-producing cells of the pancreas. When the pancreas no longer releases insulin, the body cannot bring sugar from the blood stream into muscles and organs, and thus it can’t use the glucose in food for energy. Insulin can be thought of like the key that allows glucose into cells where it is then packaged as energy units for the body. Without insulin, glucose builds up in the blood stream, causing damage to blood vessels and nerves, and eventually to vital organs. Additionally, the life sustaining energy that insulin would have made available from food is now obtained through processes that don’t require insulin but that release toxic chemicals and eventually poison the body.
To understand this further, let’s take a closer look at the process our amazing bodies go through when we consume food. Then, let’s compare that to what happens in the body of someone with type 1 diabetes. The following example involves a female with T1D and their male partner.
Person without T1D: You feel a little hungry and excitedly remember the chocolate chip granola bars you just bought! Opening the cupboard, you grab a granola bar, tear open the wrapper, and take your first bite, and then your second. Mmm... a perfect mixture of sweet and salty. Satisfied after your last bite, you toss the wrapper into the trash, grab another granola bar for the road, and run out the door to go play some soccer with your buddies. Unbeknownst to you, even before you swallowed your last bite, enzymes in your stomach began digesting the food, breaking down the carbohydrates in the oats and chocolate into smaller molecules called glucose. Not much later, your stomach and small intestines absorb the glucose and release it into your blood stream. Your pancreas, a long gland that lies behind the stomach, senses how much glucose is in your blood stream and immediately releases the appropriate amount of a hormone called insulin. Insulin, like a key to the cell door, lets the glucose from your blood stream into your body’s cells where it is turned into energy, empowering you on the soccer field or stored for later. As the insulin allows the glucose into the cells from the bloodstream, your blood glucose levels drop. The pancreas senses the drop in blood glucose and stops the insulin secretion. It knows that certain organs, like the brain, must have some sugar in the blood to stay alive, and too much insulin could drop blood glucose to dangerous levels. Well, your soccer game goes great! With one assist and one goal, plus some time with the guys, you feel rejuvenated and thankful for your body. Pulling off your cleats and reaching into your bag, your hand brushes across the granola bar you grabbed on your way out. Happily, you tear off the wrapper and take a bite, relieving the little pang of hunger that has now got your attention. Now, the digestion enzymes begin working, the glucose is absorbed into the blood stream... you know the rest.
Now, let’s look at the food metabolizing process for your spouse or partner with T1D when no insulin is produced by the pancreas.
Person with T1D: Spotting you enjoying your snack, your wife wants one too! She does those sweet puppy dog eyes and how can you resist? You toss her a granola bar. But rather than tear open the wrapper, she goes through the process that by now, you may have observed hundreds of times. Perhaps she reaches into her pocket and wakes the screen of her continuous glucose monitor, a device that displays her real-time glucose values from a sensor inserted into her abdomen or arm. Or maybe she goes looking for her glucometer, a device she regularly uses to check her blood sugar. With a little prick, a small drop of blood is produced at the end of her finger. She applies the blood droplet to a small plastic strip inserted in the meter, and her blood sugar level is then displayed on the small screen. After checking her blood sugar, she looks briefly at the back of the wrapper to check the carbohydrates, does a little multiplication in her head (who needs a calculator?), and may administer a very specific dose of insulin (either by injection or through her insulin pump), depending on her blood sugar level. As she eats, the enzymes in her stomach digest the food, turning the carbohydrates from the granola bar into glucose. The glucose is then absorbed by the stomach and small intestine and released into her blood stream. Unlike your body, your wife’s pancreas does not sense the glucose in her blood stream, nor does it release insulin to help the glucose get into the cells. Luckily, the insulin she injected before eating is now starting to enter the bloodstream, letting glucose into cells to be used as energy. It’s a good thing your wife has an excellent endocrinologist and diabetes educator who have helped her learn to count carbohydrates and calculate the correct amount of insulin she needs. If she accidentally gave too much insulin, her blood sugar levels could drop to dangerous levels and she would experience hypoglycemia. On the other hand, without this insulin she injected, glucose would build up in your wife’s blood stream, she would experience hyperglycemia and begin feeling extremely fatigued, hungry, and perhaps experience flu-like symptoms. As you have probably seen, your wife may do all she can to minimize hypo- and hyperglycemic events and still experience blood sugar swings, sometimes multiple times a day. Medical professionals understand that some blood sugar swings are normal and therefore use average blood glucose, (or A1c) as a primary indicator of diabetes management. If your wife’s average blood glucose remains in the hyperglycemic range, the overabundance of glucose molecules can begin causing damage to her blood vessels and nerves, eventually leading to organ failure. In order to obtain some sort of energy necessary for survival, your wife’s body would resort to a dangerous process in which fat is broken down with the release of acidic chemicals called ketones that would eventually result in ketoacidosis or poisoning of the body by ketones. As you can see, lack of insulin or too much insulin are both extremely dangerous.
As illustrated in the scenario above, in type 1 diabetes, balancing food intake with the appropriate amount of insulin is critical to your spouse/partner’s physical and emotional well-being. It’s no wonder he/she sometimes feels overwhelmed with the responsibility of it all. Not only does your spouse/partner have to act like a pancreas, he/she has to think like one too – which can prove very tricky when dozens of other factors besides food and insulin influence blood sugar levels (e.g., stress, exercise, menstrual cycle, etc.). As you take the time to learn about T1D and the challenges your spouse/partner faces, research suggests you will better be able to provide empathy and positive support, which can both strengthen your spouse/partner and your relationship.
(If you’d like to see a visual representation of carbohydrate metabolism, check out this short clip!)
- A1C: Measure of a person’s average blood glucose level over the past 2 to 3 months. Hemoglobin is the part of a red blood cell that carries oxygen to the cells and sometimes joins with the glucose in the bloodstream. The test shows the amount of glucose that sticks to the red blood cell, which is proportional to the amount of glucose in the blood. Results are given as a percentage or as an average glucose value.
- Blood glucose meter (or Glucometer): a medical device used to determine the concentration of glucose in the blood.
- Continuous Glucose Monitor (CGM): A device that continuously monitors blood glucose levels, providing a new reading every 5 minutes. A small sensor wire is inserted into the abdomen or arm, just under the skin, and held by an adhesive patch. Connected to the sensor wire patch is a small, reusable device called a transmitter, which sends blood glucose information to a receiver, where blood glucose values are displayed.
- Diabetes Educator: A healthcare professional who has specialized in diabetes and provides personalized education on diabetes management. Since they cannot prescribe medications, they are usually seen in conjunction with an endocrinologist.
- Diabetic Ketoacidosis (DKA): A serious emergency condition in which high levels of ketones begin poisoning the body. Signs of DKA include nausea and vomiting, stomach pain, fruity breath odor, and rapid breathing. Untreated DKA can lead to coma and death.
- Endocrinologist: A doctor that specializes in glands, hormones, and metabolism and can treat type 1 diabetes. A person with type 1 diabetes usually visits an endocrinologist every 3-4 months.
- Glucose: A simple sugar that is a component of carbohydrates. The body’s preferred source of fuel.
- Hypoglycemia: Also called low blood glucose, a condition that occurs when there is not enough glucose in the blood stream, or below 70 mg/dL. Hypoglycemia can be caused by too much insulin, not enough food, or exercising without decreasing insulin and/or increasing food intake. Symptoms may include hunger, shakiness, perspiration, dizziness or light-headedness, sleepiness, confusion, and irritability. Hypoglycemia is treated by consuming carbohydrates or in severe cases, by injecting a hormone called glucagon. If left untreated, hypoglycemia may lead to unconsciousness, seizure, and death.
- Hyperglycemia: Also called high blood glucose, a condition that occurs when one’s blood glucose is higher than normal, or above 180 mg/dL, (some endocrinologists will say above 130 mg/dL). Hyperglycemia can be caused by insufficient insulin, sickness, fluctuations of certain hormones (like adrenaline and progesterone), and stress. Symptoms may include headache, thirstiness, fatigue, stomachache, increased urination, and irritability. If left untreated, hyperglycemia may lead to damage of the body’s blood vessels, internal organs, and systems; diabetic ketoacidosis; and death.
- Insulin: A hormone produced by the pancreas that brings glucose from the blood stream into the cells. Cells then use the glucose as energy, allowing the body to function. When the pancreas does not produce insulin, insulin must be taken by injection or insulin pump infusion.
- Insulin Pump: An insulin-delivering device about the size of a deck of cards that can be worn on a belt or kept in a pocket. It connects to a narrow, flexible plastic tubing that ends with a needle which is inserted just under the skin. With the help of an endocrinologist, users program the pump to give specific amounts insulin automatically delivered as a trickle throughout the day. This is called basal insulin. Pumps are also programmed (based on inputs of blood glucose and carbohydrate count) to calculate bolus insulin, which users manually deliver before consuming food or when blood glucose is too high. Through Bluetooth technology, newer pumps use information from compatible continuous glucose monitors to predict high and low blood glucose then increase or decrease basal insulin to keep blood glucose in target range.
- Ketone: When the body’s cells do not have access to glucose needed for energy (through lack of insulin or insufficient nutrition), the body will break down fat as an alternative fuel source, releasing toxic chemicals called ketones. Buildup of ketones increases blood acidity and can lead to diabetic ketoacidosis (DKA).
- Pancreas: the organ between your stomach and your spine that releases the hormone insulin. The immune system of someone with T1D destroys the cells in the pancreas that make insulin
- Type 2 Diabetes: A condition characterized by high blood glucose levels caused by either insufficient insulin production or the body’s inability to use insulin efficiently. Type 2 diabetes develops most often in middle-aged and older adults but can appear in children, teens, and young people.