Sunday, April 24, 2011

And now for something I keep meaning to write about but not having time. It's sort of a mental sorting-out process. The Simple Explanation for How We Manage Nat's Blood Sugar:

He doesn't make insulin. Normally the pancreas regulates the production and distribution of insulin. Insulin is the stuff that takes your food energy (glucose) from your bloodstream into your cells. No insulin, no food for your cells. Without insulin your body keeps putting glucose from your food in your blood and hoping it will get into your cells, and as your blood sugar goes up you start to feel more and more sick, hyper, and miserable. Eventually it causes capillary damage which leads to a host of problems.

In regular people, you eat something, it hits your blood, your pancreas releases the right amount of insulin to take it out into your cells. Diabetics don't have that. What we do for Nat is try to calculate (it sounds better than 'guess') how much he's going to eat and of what, and try to make sure that when it is digested and in his bloodstream he has the right amount of insulin hanging around. Too early and it will cheerfully carry off all the glucose in his blood (which leads to weakness, faintness, confusion, and coma), too late and he gets really cranky and could possibly have seizures.

So, he's on two different types of insulin. One starts working within ten minutes and is out of his system in an hour or so. The other is a slow-release, background insulin which starts working four hours after it's injected and is hanging around in Nat's body for about twelve hours, although it starts to fade about four hours after it kicks in. We give Nat both the slow and fast-acting together in the morning. The fast covers breakfast and snack. The slow is for lunch and afternoon snack. At dinner if he eats enough food with carbohydrates we'll give him some extra fast-acting insulin, keeping in mind that the slow stuff (which is called Humulin N, or, usually, N) is still working.

Right now we don't count his grams of carbohydrate carefully. He gets about thirty grams per meal, sometimes more and sometimes less. It's still hard to know how much he's eaten versus smeared. Different foods digest at different rates, and if I don't think he's gotten enough quick-digesting carbs I'll try to get him to take extra. Juice and candy are the best options. If he eats extra I compensate with extra fast-acting insulin (called Humalog, or H). Illness or excitement can send his blood sugar up, and hard exercise makes it plummet. Both need watching.

Even with the very best control possible we know it's not likely we'll get more than 70% of his numbers in acceptable ranges. That's okay. He's got pretty good blood sugar control, and we're hopeful that he won't get eye or circulation problems or nerve damage later on. And of course we hope that there will be a cure in his lifetime, God willing.


Ann Onimous said...

God willing, there will be a cure. We pray for that every day, for both Nat and Deirdre as well as everyone else with diabetes. You explained it all beautifully.



lissla lissar said...

Thank you. Yes, God willing, a cure soon. I am very grateful for all the advances in the past ten or twenty years, particularly the glucose monitors.

We have an elderly family friend whose sister died of Type 1 diabetes right after she got it. It would have been only a couple of years before they figured out how to extract insulin.