Author: Shawn

I had a recent appointment where I shared a laugh with the person receiving me at the fact I was carrying a backpack to said appointment. The irony is that the location wasn’t all that far from my home and the appointment would likely only take about an hour but as a responsible person who has Diabetes, it’s up to me to have everything I need in order to ensure I don’t run into issues.

For the most part, unless I know that the outing/errand I’m running will literally only take five minutes (for example, going to my 7-11 convenience store on the corner) I bring a bag with me. This bag contains AT LEAST the following: nasal spray, hand gel, blood sugar meter, cereal bars and jelly beans, a book, my iPhone’s earbuds and business cards for my blog. Yes, I have business cards for my blog. It’s much easier than trying to give someone the website address…

If I travel to any great distance, for example flying back to New Brunswick, my carry-on bag will contain all the above-noted items as well as reusable insulin pens that simply require me to step into a pharmacy and purchase insulin over-the-counter should my pump fail or I run out of pump supplies. I started taking that last precaution after an issue I ran into last September when I returned home for some job interviews.

Usually, I’ll calculate my equipment needs for all my absent days, plus three. This means that I should have enough supplies to last me three days longer than my intended trip. That way, should there be flight delays, equipment issues or problems along the way, I’m all set. But last September, I flew to Fredericton, New Brunswick for a full week on a job competition. This meant I would need at least three pump change-ups with a fourth set to accommodate any failure or delays, and about 600 to 800 units of insulin for those seven days. Sounds reasonable, right?

During the second or third day that I was in Fredericton, I received an email from one of the other agencies in New Brunswick I had applied with and they required that I attend in person for an interview the following Tuesday. This meant that my seven-day trip would be extended to twelve days or more to accommodate the interview. I discussed what I should do with my wife and it was agreed that I should stay. All of a sudden, I scrambled to change my flights and cancel my hotels as I would simply stay with my family for the added days in between.

I still had plenty of Humalog (short-acting insulin), so I went to a local pharmacy and purchased disposable syringes as well as a bottle of Lantus (long-acting insulin) in anticipation of my pump running out and no longer having access to an automated basal rate. In the end , I was able to stretch out my pump sets to accommodate the additional time and I made it home to Saskatchewan under the wire. But it makes me wonder: what if I were isolated someplace where I didn’t have the option of buying added supplies?

In my late teens and early 20’s, I went on a number of nature treks where a friend and I would canoe or kayak down the Restigouche River. We’d get a ride west to where we would “ship off” and time on the river would usually see us locked away from civilization for at least three days. I was pretty cheeky in my late teens, early 20’s and not always cognizant of the danger I may have been putting myself in. I always brought plenty of insulin and test supplies, but I’d be lying if I said I had plenty of fast-acting carbs to shore me up if I dropped. I had SOME, but probably not enough for a multi-day excursion that required me to paddle a canoe for hours on end.

So this begs the question: how does one deal with a situation where one has run out of supplies with no ability to obtain replacements? What if my insulin spoiled in the summer heat while I was out on the river? What if I dropped my pen and smashed the only remaining vial I had? These are possibilities that I would have to deal with. I’ve always been pretty careful have luckily never had to deal with such situations, but being two days or more away from civilization would throw a serious damper on the trip.

I wrote a post last April entitled Don’t Fear The Reaper, Kick His Ass Instead, which covered off some of the issues that one could face and how long a Type-1 Diabetic could live without insulin. You can click the link to give it a read, it’s pretty bleak. The reality is the average Type-1 Diabetic has a life expectancy without insulin of about 7 to 10 days at most. Nice, eh? And that’s under some pretty particular conditions. Having an adequate supply of water to stave off dehydration is a great start, since most adults can only survive three or four days without. And bearing in mind my scenario involves being on a fresh-water river, I’d likely be okay in that regard (barring bacterial contamination from drinking river water).

I had linked an article posted on Healthline.com that explained that without insulin, your body can’t use glucose as fuel and begins to break down fatty tissue as a replacement, which causes those fats to turn into acids called ketones.  These ketones build up in the bloodstream and eventually get expelled through one’s urine. However, when these ketones accumulate in the bloodstream, your body chemistry begins to change and the blood starts to become acidic. This causes a condition called Diabetic Ketoacidosis.

Any of the even moderately serious side-effects of Diabetes could kill you, including dehydration or hunger, but if you manage to make your way through all of that, DKA is what would do you in. What to do if you’re in a life-or-death scenario where you don’t have access to a hospital or extra supplies? There isn’t really a happy answer. The reality is that you’ll likely expire, unless you’re some sort of super-human Diabetic who can stave off all those symptoms for a longer period of time.

Situations are much easier to deal with nowadays with the common use of cell phones. Back when I used to travel the river, cell phones weren’t a commonality yet. At least in the modern age, you could potentially call for help so long as you can find a cell phone signal. But even cell phones can fail, get dropped in the river, lack a signal, etc…

IS there a perfect solution to any of it? Unfortunately not. Diabetes makes for an imperfect life. But you can ensure that you take every precaution and make certain that you pack/bring/include everything you need with multiple extras. Having Diabetes absolutely doesn’t mean you can’t do any particular thing. You simply need to be prepared and take the precautions necessary to prevent finding yourself in a bad situation. Hope for the best, but be prepared for the worst. ☯

This is one of those posts where I need to reiterate at the outset that I am not a doctor or medical practitioner and have absolutely no formal medical training. What I DO have, is 38 years of combined experience, private study and use of therapy for all things related to Type-1 Diabetes. In fact, if one were so inclined, one could easily believe that enough years have been spent and enough private study has been done to equivalate the knowledge of a doctor, if not the skill. But I’m not that vain… (wink, wink). Totally kidding, let’s move on…

Now that the disclaimer portion of our day has been completed, let’s move on to the actual subject of today’s post: pancreas transplantation. A pancreas transplant is one of those things that everyone with Diabetes has at least wondered about, at some point in their lives. It would make sense, right? If you have a faulty heart or kidney, you can try and have THOSE transplanted, provided you’re lucky enough to find a donor that matches you and all goes well. All sorts of other organs have been transplanted, including livers, lungs and even eyes! So what’s the problem with pancreas transplantation, and why isn’t it more of a thing?

To answer that, we need to start by doing the same thing I’ve done a dozen times since starting this blog page. We need to properly define the two mainstream types of Diabetes. Although there are a number of various types and sub-types, for the purposes of this post I will limit these definitions to Type-1 and Type-2.

In simplified terms, Type-1 Diabetes occurs when your body’s own immune system seems hell-bent on destroying your body’s insulin-producing cells, namely the ones in your pancreas. Once these cells are destroyed, your pancreas effectively stops producing insulin. In a normal body, insulin is a hormone that allows glucose to enter the bloodstream. If the amount of glucose gets too low, your body reduces or limits the amount of insulin it produces and the vice versa. Still with me? Good, moving on…

Type-2 Diabetes is a bit different on the sense that one’s body is either resistant to insulin and its effects, or one’s pancreas creates little to no insulin. This used to be referred to as an “adult-onset” Diabetes, much like Type-1 used to be referred to as “Juvenile Diabetes,” but some children have been shown to be diagnosed with Type-2 in recent decades, due a number of different factors I won’t bother getting into. Despite different treatment and dietary regiments, there is no cure for either type. No matter what you’ve read.

Now that we’re all caught up, let’s discuss the reasons behind why a pancreas transplant may not be the thing for you. First and foremost, like any organ transplant, you need a donor. Unlike liver transplantation where a portion of healthy liver can be taken from a living donor, there’s no way to replicate this with the pancreas. So simply put, you need an organ from a deceased person. There are a number of difficulties behind obtaining such an organ, including but not limited to making your way up a donor list, having the donor be a match for you and trying to determine if a transplant is right for you based on your specific set of Diabetes-related symptoms and complications.

So pancreas transplantation CAN be done, it just simply isn’t the norm. It also isn’t permanent. And apparently we live in opposite world because the worse your Diabetes may be and the harsher your complications, the better odds that you’d qualify for a transplant. This is because they usually look at the fact that your Diabetes can’t be treated with traditional therapy methods. So THAT’S weird, but Type-2 is more likely to be a fit for a transplant, since its cause is mostly the lack or reduced production of insulin in the pancreas, so replacing it would typically fix that.

So let’s say that the stars align, you pass all the tests and get a donor organ and are approved to go through with the transplant. You’ll need to undergo a rigorous regimen of anti-rejection medications. A lot of things will remain the same for you, including all the medications and constant medical check-ups to ensure your proper recovery and the acceptance of your new organ. The next issue is that the very same immune system that attacked the first pancreas will begin to attack the new one. Shortly, you’d be faced with the very same issue that caused your Diabetes in the first place.

This means that part of your new medication regimen will require immunosuppressants in order to limit your immune system so that it won’t attack the new organ. Limiting one’s immune system will lead to a greater risk of infection and you may need a whack of antiviral and antibacterial drugs. Then, one needs to consider all the complications related to the surgery and the after-care involved in any surgery, the side effects of the anti-rejection medications and the drugs you’ll need to take for the rest of your life, as well as the potential for rejection after all that pain and suffering. Are we still on the transplant gravy train or are we running scared yet?

I’m making it sound pretty horrific, but the reality is that a pancreas transplant CAN work for some individuals. It simply isn’t the standard therapy to deal with it. And even if a successful transplant will eliminate the immediate need for insulin therapy, it doesn’t actually CURE Diabetes. And if the transplant fails or one rejects the organ, one can simply go back on insulin therapy. No harm, no foul. Minus major surgery, that is.

The Mayo Clinic actually has a good article that outlines the specific procedure and the complications associated with a transplant, so give it a read. There is no cure for Diabetes. As much as I’d like to add the word “yet” to the end of that statement, I believe much as most Diabetics do, that a cure won’t be forthcoming in our lifetime. But therapies have come a long way, and if I compare being on an insulin pump, using CGM and the effectiveness of my insulin compared to 1982 when I had to guess my manual injections, carb counting wasn’t a thing and I carried a glucometer that was effectively the size of a brick, I’d say we’re pretty spoiled. ☯

We are the product of our environment. Part of your environment is the job you do. It’s inevitable. My chosen career usually has me seeing the world through those lenses, and Diabetes is very much the same. I’ve had Type-1 Diabetes for so long that I have a nasty habit of throwing out Diabetes-related terms that the average person may not understand. After several years of hearing them, my family is still left reeling by some of the terminology.

With that in mind, here are some of the most commonly-used terms I tend to throw around. These were taken from a previous article I posted last november:

1. Basal Rate:  This refers to the constant supply of some given medication that is delivered over time. For someone with Diabetes, one’s basal rate refers to the dosage of insulin, which is slowly delivered throughout the day, usually by way of an insulin pump;
2. Bolus:  Unlike one’s basal rate, a bolus refers to a singular dosage of insulin that is delivered within a fixed period of time, either by manual injection or by way of an insulin pump. For example, before eating a meal, one would “bolus” a specific dose of insulin in response to the amount of carbohydrates in the meal;
3. Blood Glucose:  This one should be pretty straightforward, but I’ve been surprised at how many people honestly don’t understand what is meant by blood glucose.  This term simply refers to the sugar carried through the blood stream in order to supply the body with energy. Having either too much, or too little sugar in the blood stream is one of the main issues with Diabetes;
4. Carbohydrates:  Considering all the “nutritional gurus” and fad diets on today’s market, this one comes as a surprise as far as people not understanding what carbs really are. Carbohydrates are the body’s main source of fuel, and includes sugars, starches and fibres. This is why it’s so important for someone with Diabetes to properly calculate their carb intake; because all these components (except fibre) will affect blood sugar;
5. Fasting:  Although not unique to Diabetes, fasting is often required prior to certain blood collection or medical examinations. It basically means that one abstains from ingesting any food or drink for a prescribed period of time;
6. Hemoglobin A1C:  Although more complicated than what I’ll explain, A1C refers to the average of one’s blood sugars over a 3-month period. This is a test frequently used to see if a person’s blood sugars are staying within acceptable range. This test has become less of a favoured method, since one’s A1C can be manipulated through extreme highs and lows. Methods of measuring a person’s “time in range”, such as continuous glucose monitoring have become more of an accurate method;
7. Hyperglycemia:  High blood sugar. That is all;
8. Hypoglycemia: Low blood sugar. Bam!
9. Insulin:  This is a hormone produced by the pancreas, which regulates the level of glucose in the blood stream. In someone with Type-1 Diabetes, this hormone is no longer produced, which causes the need for a synthetically created insulin to be injected;
10. Interstitial Tissue:  This is the tissue that connects your outer flesh with the really bloody stuff underneath. This tissue is important for someone with Diabetes because it is where blood glucose levels are measured using a continuous glucose monitoring system;
11. Ketoacidosis:  This is one of the more common complications of Diabetes. As I understand it, ketoacidosis happens when there isn’t enough insulin in the system to help the sugar enter the cells. Without sugar as fuel, the body begins using fat stores for energy. This causes certain acids to start spilling into the system, which can be spilled out through one’s urine. It’s very dangerous and usually requires medical attention if your blood glucose level won’t come down or your ketones are unusually high;
12. Subcutaneous Tissue:  This refers to the layer of fat and connective tissue beneath the skin and is generally where injected insulin NEEDS to end up once injected from one’s pump or syringe.

There are probably some other terms that Diabetics use that confuse people, but these are the only ones I can think of. If you have any words or terms that you’re wondering about, drop them in my comments section and I’ll provide an explanation for those who may not know. ☯