For young people, managing and monitoring one’s health can be a challenge — but for young people with Type 1 diabetes, just a few small steps can be the difference between life and death.
Andrew, who asked to remain anonymous, is a 13-year-old boy who lives in Wake Forest, N.C. He found out he is diabetic when he was 10, when he had to get a physical to go on a Boy Scout trip. The doctor called for more tests because his blood sugar levels were much higher than safe, even for a diabetic, and Andrew said he found out he has Type 1 diabetes that day.
Andrew says that diabetes doesn’t stop him from being a normal 13-year-old and doing all of the things he wants to do. He loves science and math, and he’s involved in his local Boy Scout troop — and while he has to monitor his blood sugar and watch what he eats, his diabetes doesn’t affect him much beyond that.
“If my blood sugar gets too high, I’m generally in a bad mood and a little low on energy,” he said in an email. “Low blood sugars are worse, though. When low, I usually feel tired, hungry, dizzy, and a little nauseous. It’s a very distinct feeling that makes you feel horrible.”
For many years, people labeled Type 1 diabetes as the childhood diabetes or “juvenile diabetes,” a term still used today. But Dr. John Buse at the UNC Diabetes Care Center says it’s not just a childhood disease — you can be diagnosed with Type 1 or Type 2 diabetes as a child or as an adult, although Type 1 diabetes is more commonly diagnosed in children and Type 2 diabetes is more commonly diagnosed in adults.
The peak age for young people to be diagnosed with diabetes is puberty — in the early teens, Buse says. But that doesn’t mean someone who is 13 is at a much higher risk than someone who is 17.
“You can develop Type 1 diabetes at age 90. The whole idea that one is a childhood disease and one is an adulthood disease is just a fallacy. It probably was never true, but it certainly isn’t true today.”
Maintaining your health
When Andrew is sitting down to eat lunch, unlike many 13-year-olds, he can’t dig right in. He has to go through a few steps. First, he has to test his blood sugar — pricking his finger and testing the blood with a glucometer. Next, he has to enter into the device how many carbs he’s eating. The glucometer calculates how much insulin Andrew will need and communicates that to a pod, which is attached to his stomach. That pod then pumps the insulin into his body — and only then can he start eating.
“If you’re really going to do a good job of taking care of your diabetes, you need to know what your blood sugar is 24 hours a day,” Buse said.
Dr. Zhen Gu, an assistant professor in the joint biomedical engineering department at UNC and N.C. State, has been working to develop new technology to help people with diabetes. He says the traditional method of monitoring blood sugar and injecting insulin, either with shots or with a pump, isn’t always the most accurate.
“It’s kind of painful for the traditional method, and it’s very hard to tightly control the blood sugar level for the traditional method because you just simply inject the insulin to the body and the dose could be not exactly accurate,” Gu said.
And the traditional method can sometimes be dangerous.
“If you inject too much insulin, it can cause hypoglycemia. The blood sugar level comes too low and sometimes it’s even fatal.”
Mark Baumgarten is a senior at UNC who doctors diagnosed with Type 1 diabetes about the age of 10. He started giving himself shots when he was first diagnosed, but by about age 13, Baumgarten switched to the pump.
Injections are cheaper than using a diabetes pump, according to the Joslin Diabetes Center, but people often encounter more highs and lows throughout the day than with a pump, buy generic cialis here https://www.topcanadianpharmacy.org/product/cialis/. The insulin pump also allows for more flexibility and normalcy.
As a young person grows and changes, his or her body’s requirements for insulin does too.
“When I first got diabetes, I was taking 3 shots a day,” Baumgarten said. “When I was 12, I was taking anywhere between 5 and 8 shots a day.”
“I tend to be pretty strict with what and how I eat, but even then, my blood sugar still gets out of whack every once in a while,” Andrew said. “Since I’m growing at a pretty rapid rate at this point in my life, the amount of insulin I need on a daily basis is constantly changing. It gets pretty frustrating.”
Monitoring one’s blood sugar to prevent the highs and lows is a frustration, but Baumgarten says after a while, pricking his finger and testing his blood sugar, along with all of the other necessary steps, became a normal routine.
“(Using the pump is) something you can get used to quite easily … If you think about it, brushing your teeth was probably uncomfortable the first few times you did it because it could even be painful, but now you brush your teeth every day and don’t even think about it,” Baumgarten said.
Buse, who has studied and worked with diabetes patients for about 50 years, wonders if he could do what his Type 1 diabetes patients do every single day.
“You don’t have to think about it every second, 24 hours a day, seven days a week for the rest of your life, but you probably do really need to think about it with some focus several times a day and think about it sort of in background all the time.”
The cost of diabetes
Aside from a time commitment, the equipment necessary to maintain one’s health is incredibly expensive.
Buse lists all of the things someone with diabetes must have to monitor his or her blood sugar and administer insulin.
An insulin pump, if you choose to go that route — that’s $6,000 every 5 years, so $1,200 a year. All of the disposables that go along with the pump — $100 a month. Glucose monitoring strips, at least five a day, although many people use 10 or 20 — $1 a piece. Glucose meters — about $100.
The insulin itself is $200 a month, $400 a month if you use insulin shots instead of a pump.
Then, add in visits with your specialty diabetes team once or twice a year, at least one visit with an eye doctor, blood tests.
“If everything is going well, it’s $10,000 to $15,000 (a year), but if you have any complications, it can get really expensive really fast,” Buse said.
“The truth of the matter is, if you have really good insurance, you’re paying for the insurance, and then you’ll have co-pays. If you have crummy insurance or no insurance, it basically boils down to the cash price.”
The smart insulin patch
Dr. Zhen Gu is making waves in technology that can help people monitor their blood sugar quickly and easily — he’s developed a smart insulin patch.
“For the traditional method, the diabetes patients need to monitor their blood sugar levels frequently then perform the multiple injections everyday, which is quite painful,” Gu said.
But the smart insulin patch monitors a patient’s blood sugar levels, and when the device detects an increase, it automatically releases insulin.
“That means the people they don’t have to perform these kind of injections frequently, and also since it is very small and painless just simply put it there,” he said. “The more important thing is they can ‘smartly’ control the blood sugar level so only once blood sugar level goes high, the insulin can be released from the patch.”
But Buse said while the smart insulin patch could make a difference in the lives of people with diabetes, it’s too early to tell what that impact could be. It will be a while before the technology is finished and tested.
“It all works pretty well in the short term in animal models,” Buse said. “None of (Gu’s devices) have been tested in humans, so it’s a little early.”
It gets easier
Baumgarten is fairly used to his insulin pump now and doesn’t think he’d be able to make the switch to the smart insulin patch — but he can see that it would be beneficial for people newly diagnosed or young people.
“I could see it being helpful for a lot of people, especially children who don’t know how to manage their diabetes,” he said. “The pump is a very powerful tool and for a little kid who doesn’t know what he’s doing or hits the wrong button, he could really endanger himself.”
But it’ll take a little bit of time for the smart insulin patch to make its way to children if it’s fully developed, tested and approved, Buse said.
“In pediatrics, usually, the way new product development happens, it gets developed first for adults and then once it’s shown to be safe and effective for adults, then it’s studied and adapted for children.”
Andrew recommends that people recently diagnosed with Type 1 diabetes be responsible and diligent in managing their diabetes from the start.
“The better you are at managing diabetes, the quicker you can move from taking insulin injections to using an insulin pump,” he said.
And Buse thinks the people with diabetes who have to do so much to monitor their health are heroes. In 1921, when insulin was first discovered, the life expectancy for someone diagnosed with diabetes was about a year. Now, most people diagnosed with diabetes will almost certainly live a completely normal life span, Buse said — but it isn’t easy.
“What an amazing thing, that people with Type 1 diabetes can care for their disease in the way that they do.”