Type 1 diabetes affects about 1.25 million Americans a year. (Timmons) Type 1 diabetics must rely on insulin in order to survive. They make little to no insulin. (Timmons) Sometimes, these diabetics are very sensitive to the insulin they are given. If they are given too much insulin, their blood sugar may bottom out and become what is called “low” or hypoglycemic. (Love) If they are not given enough insulin, they may end up “too high”, also called hyperglycemic. (Love) Both are very dangerous for diabetics, so extra attention must be given to them to control their blood glucose levels. “Your sensitivity to insulin can vary during the day based on your level of activity and your body’s rhythm of daily hormone secretion. Illness can also affect your insulin sensitivity.” (Love)
Pathophysiology of Type 1 Diabetes
Type 1 diabetes is an autoimmune disease. “It is caused by an autoimmune reaction that destroys the cells in the pancreas that make insulin. This process can go on for months or years before any symptoms appear.” (Center for Disease Control and Prevention) This means that there is no direct reason as to why the person develops the disease other than the body is attacking itself. This then leads to the pancreas not making enough or no insulin at all. (O’Keefe Osborne) If the pancreas does not make insulin, someone with diabetes must rely on insulin to live. Insulin is what causes the blood sugar to go up or go down. “The reason for insulin secretion is a high blood glucose in the body…although there is always a low level of insulin released by the pancreas into the body, the amount released into the blood stream increases as the blood glucose increases. Similarly, as blood glucose falls, the amount of insulin secreted by the pancreatic islets goes down.” (Norman 2016) A person with diabetes must be the one to inject the insulin into their bodies to be able to make their blood sugar go down when they are “high.” When a diabetic is low, they must intake some form of glucose to get their blood sugar up when they are “low.”
Being sensitive to insulin or changes in type 1 diabetes is fairly common. There is an insulin sensitivity factor that can be determined. First, one must figure out how sensitive they are to insulin. “The insulin sensitivity factor tells you how many points, in mg/dL, your blood sugar will drop for each unit of insulin that you take. The insulin sensitivity factor is also sometimes called a “correction factor.” You need to know this number to correct a blood sugar level that’s too high.” (Love) According to Love, the insulin sensitivity factor is how you determine how much insulin is needed. “For short-acting insulin, use the “1800 rule.” This tells you how much your blood sugar will drop for each unit of short-acting insulin. For example, if you take 30 units of short-acting insulin daily, divide 1800 by 30. This equals 60. This means your insulin sensitivity factor is 1:60, or that one unit of short-acting insulin will lower your blood sugar by about 60 mg/dL. Once you know how sensitive you are to insulin, you can figure out how much insulin you need to give yourself to lower your blood sugar by a certain amount.” (Love) Typically, the diabetic’s endocrinologist does this calculation. Figuring out the insulin sensitivity factor can also change throughout a person’s life. As stated above, sensitivity mostly happens in hormone changes, times of day, and how much activity a person gets a day.
During the interview, it was found that the person I was interviewing was actually very sensitive to changes that were made to her regimen. She is twenty-five years old and has lived with type 1 diabetes for 20 years. She was able to get an insulin pump when she was eleven years old. She told me a story about how the first time she met her endocrinologist now; he made a lot of changes to her insulin pump. The changes were very small, but she was so sensitive to them, that her blood sugar was low through the entire night. She said she set alarms every hour to get up and either drink some juice or eat a snack, which is her way of getting glucose. She said she has never been hospitalized, but she has been to the emergency department twice for going too low, one time going by an ambulance. The interviewee states she feels very irritable, short of breath, and exhausted when she becomes low and it is orange juice that is the best thing to get her blood sugar elevated. This person also has hypothyroidism, which is a slow acting thyroid, and she said if that is elevated, her blood sugar ends up being higher more often than being low. Part of that is because her hormones are not regulated, so it is hard for insulin to get its job done and be absorbed by the body. Since she is on an insulin pump, insulin is periodically given to her throughout the day and she also manually enters in the amount of insulin she needs when she eats. She tends to go lower in the middle of the night, so she said that she would not always give the entire dose of insulin before she goes to bed if she eats a snack just because she does not want to bottom out in the middle of the night. She said that she has no one else in her family that is type 1 diabetic. It was interesting to find that even the smallest changes to her insulin pump regimen affected her that much. Too much insulin at one time of day makes her blood sugar go low. This tends to get in the way of her everyday life if she is going low too often. This means she has to stop what she is doing and get a snack or drink juice. She works as a full time nurse as well so this really gets in the way of her patient care sometimes. She said that without her pump though, she would really not be able to work like she does. Being type 1 diabetic is a struggle in itself and being so sensitive to it as well adds a lot of stress to her life, but she said that she takes on day at a time and does the best she can.
Type 1 diabetics go through a lot of changes in their life and the disease changes with them as well. As stated above, hormonal changes can affect how sensitive someone is to changes that are made to their regimen. Someone living with type 1 diabetes must always pay attention to their body and how they feel. Although they try their best to live their life to the fullest without having the disease taking over their life, sometimes they have to take a step back to either have a snack or give themselves some extra insulin. It is all part of the disease and it takes a long time to learn how to manage it. Diabetics work closely with many people and physicians to help them manage this disease. Being sensitive to changes in their regimen does mean adjusting, but it does not mean life altering.