Blood sugar regulation
People with diabetes cannot control the amount of glucose (sugar) in the blood. We require glucose for energy, and a hormone called insulin allows the glucose to enter from the blood into the cells in our bodies. Our bodies have some fantastic mechanisms, and one of them is blood sugar regulation.
We get glucose from the carbohydrates we eat. In a non-diabetic, two hormones; insulin and glycogen work to stabilise the amount of glucose in the blood. Normal values are between 5 and 7 mmol of glucose per litre of blood.
Insulin is produced by the pancreas, and acts like a key, letting the glucose in the blood gain entry into cells to be used for energy. When blood glucose rises, eg after eating carbohydrates, the pancreas produces more insulin and the excess glucose goes into the cells. If the blood sugar drops, there is another hormone called glycogen, that causes the liver to release some of its stored glucose.
Types of Diabetes
In type 2 diabetes, the receptors on the cells do not work properly – they do not recognise the insulin, so glucose cannot enter the cells. The pancreas works harder to create more insulin and eventually 'tires' and stops producing insulin all together. Type 2 diabetes is associated with obesity, and lack of exercise.
In type 1 diabetes, the cells in the pancreas that produce insulin (beta cells) are attacked by the immune system, and there is no insulin produced. Type 1 diabetics always have to inject insulin.
There are over 3 million people with diabetes in the UK (29million in the USA). By far the majority – 90% are type 2.
I am a type 1 diabetic, so not producing insulin. I have to inject insulin 4 or 5 times per day.
Basal insulin. One injection per day of long acting insulin, a kind of background insulin that counteracts the liver’s own production of glucose.
Bolus Insulin. Injected before each meal depending on amount of carbohydrate consumed.
I use this ‘Multiple Dose Insulin’ regime, but some people have a pump, permanently attached which drip feeds small amounts of insulin constantly, more like the pancreas in a normal person.
Hypos and hypers
There is always the possibility of the blood sugar going outside the ‘normal’ range, especially as other factors apart from food can affect the blood sugar too, such as activity levels, illness, stress and alcohol.
Hypoglycaemia. When the blood sugar goes below 4mmol/l, it is called a ‘hypo’. This can be caused by too much insulin on board, and/or exercise, etc. Hypos can be a bit scary, as you can feel quite unwell, sweaty, dizzy, jittery, nauseous, confused. You need to treat the hypo as soon as possible by consuming fast acting carbohydrate such as fizzy sugary drink, jelly babies, dextrose tablets etc. If not treated, it can become a medical emergency as you can slip into a coma and die.
Hyperglycaemia. When the blood sugar goes high, ie above 7mmol/l, it is a ‘hyper’. This can be caused by not enough insulin on board to cover the carbs in the meal, stress or illness etc. If blood sugar is constantly high, the risk of complications such as blindness, heart attack, stroke, nerve damage leading to amputation and dementia increases. There is also the risk of DKA (diabetic ketoacidosis), a nasty condition where the blood gets acidic and you can become very unwell very quickly and require hospital treatment.
Measurement of blood sugar
Consequently, I check my blood sugar at least 5 times per day. I used to use a blood sugar meter like this, and have to by prick my finger and use a drop of blood on the test strip that goes in the meter.
Abbott Freestyle Libre
Nowadays I use a flash glucose system called the 'Libre'. I have a sensor stuck to my skin (on my arm) and swipe a meter over it from time to time. It gives me a reading of my blood glucose plus an arrow showing me which way it is going, up, down or stable, and a graph of how my blood sugar has been over the last few hours. Here's a picture of my reading just now. I try and keep the line within the blue band. The Libre has helped type 1 diabetics get their blood sugar under much better control, and is beginning to be available on the NHS. (At present I do not qualify for the libre, as my control is quite good, so I buy it myself. It is quite expensive at £100 per month!)
I always carry a blood sugar meter and hypo treatments, especially when walking the dog!
Low Carbohydrate diets
Many diabetics are finding that a low-carbohydrate diet helps, and some type 2 diabetics have been able to reverse their disease with this diet plus exercise. I have been trying to eat low-carb, but it is difficult! I avoid starchy food such as potatoes, rice and pasta, and limit the amount of bread I eat. No cake, sweets or biscuits as a general rule!
It has been an emotional rollercoaster. From shock at first diagnosis that I have a life long medical condition, to fear about the future and the complications, to sheer desperation that I can’t seem to get my blood sugar levels right, and depression for the relentless slog of having to think about it all the time.
However, after 4 years I am getting used to the daily slog, and realise that there are worse diseases to have! I can continue my life reasonably normally, I still exercise, I still drive, I can still do all my crafts. I am grateful for that, and that Insulin was discovered and it keeps me alive. I am grateful too that I became diabetic in my 50s and haven’t had it all my life. It must be really hard if you have a small child with type 1 diabetes.
Do please let me know in the comments if you have any questions and I’ll try to answer them. I don’t claim to be an expert, but it’s amazing how much I do know about the disease now!