Letter to a new Diabetic: Welcome to the Club

Dear Concerned:

Good to hear from you but sorry it had to be under these circumstances. No doubt your head is spinning from your recent diagnosis and this is last thing you want to have to deal with. I'll not belittle the medical issues but, frankly speaking, have no doubt that you will do fine. Diabetes is a completely self-managed condition and if you pay attention to it you'll not be precluded from doing anything. There are type 1's (insulin dependent diabetics) who are in the Olympics, climb Everest, etc. I've traveled literally all over the world and have never had any issues. Some advance planning, yes, is needed. But nothing that you can't handle.

I can remember when I was diagnosed back in '99. It was a real surprise because I didn't know anything about diabetes nor even what a pancreas did. Mine, like yours, just burned out and quit making the hormone insulin. Like you, I had no family history and no one I knew who could answer my many questions--once I had enough information to even begin to formulate them. If you haven't already done so, you should find yourself a good Endocrinologist and Certified Diabetic Educator (CDE).

The first goal you and your doctor will work on will be to get your current blood sugars lowered from their high levels. There are two "numbers" you will soon learn are important: your at-the-moment blood sugar reading from your meter and an over-three-month reading (called your HbA1C) which gives you an average of the three months blood sugar levels. The aim of the diabetic management "game" is to get your HbA1C down to a normal level, i.e. something ideally in the 5 to 6 range. Mine was 14 or 15 when I was diagnosed. Yours is likely pretty high right now as well. The two weeks or so it will take to lower your blood sugar will, frankly, suck because your body had become used to the high levels so don't be surprised if you are irritable, tired, have headaches and the like.

There are essentially two types of insulin families: the first is for "basal" rates, that is to say a sufficient amount of insulin to keep your blood sugar level over a long period of time. The second is for a "bolus" or giving yourself an injection of insulin before you eat or to lower your blood sugar. Ideally, you want the basal amount to always remain steady so if you don't eat your blood sugar remains the same (say, 100). Then before you eat something, say a cookie, you give yourself a shot of enough insulin (a bolus) to balance out the increase caused by the carbohydrates in the cookie. Simple. ;-)

The days of "two shots only, one in morning one at night" pretty went out the window 15 years ago. My suggestion is that you immediately ask to get into multiple daily injection (MDI) therapy. If your current doctor doesn't know what that is then get another doctor. Essentially, that allows you to replicating a pancreas by giving yourself some shots of a basal rate insulin and separate shots of insulin before you eat to cover the carbs.

Oh, yes, carbs. They are every diabetic's craving and aversion. As you probably know, everything you eat is made of three things: fat, protein, or carbohydrates. The first two don't have much of an affect on blood sugar (although fat can cause change in the rate the body uses the carbs). Carbs, on the other hand, get turned into glucose, which is the form of sugar your body runs on. So before you eat a food, you just have to look up the amount of carbs in the food to figure out how much insulin you have to inject to "cover" the carbs and return your blood glucose level to what it was before you ate.

The other think you need to be aware of is a "low" blood sugar, called "hypoglycemia." That is what happens when you either take too much insulin or do something (such as exercise) which causes the body to use the insulin more effectively. If you do, you'll need to eat something to raise your blood sugar. I'd suggest you get some glucose tabs for the car and some Juicy Juice boxes or the like to keep on hand for when you go low, which you inevitably will.

The last thing to remember is that if you don't test your blood sugar, you don't know what the number is. Sometimes it is high and you feel one way, the next time you feel that way it is low. Check your blood sugar often.

Drop me a line if you have any more questions. Oh, and welcome to the club!

Niko