Kendea Smith saw her mother, grandmother and two aunts succumb to type 2 diabetic complications, but the type 1 diabetic, who has been living with and managing type 1 diabetes for 21 years, said she hopes to live a long life. She has learnt that diabetes is not a death sentence, even though she has lost four members of her family due to complications from type 2 diabetes.
“It’s a very manageable disease, but you have to watch what you do and what you eat,” said Smith, 35. “I hope to live a long life, and hope to see 30 to 50 more years.”
The main difference between the two types of diabetes is that type 1 is a genetic disorder that often shows up early in life, and type 2 is largely diet-related and develops over time.
“Type 1 diabetes occurs when the pancreas loses its ability to produce insulin,” said Dr. Kristine Parker-Curling, an internist. “When you eat and digest food, you absorb nutrients and sugars and they enter your circulation. It is the job of insulin to get the sugars out of your circulation and into your muscles and tissues where the sugar is used as fuel.
“In type 1 diabetes, the body’s immune system ‘attacks’ the pancreas and causes inflammation and scarring of the pancreas and it eventually loses its ability to produce insulin. Because of this, blood sugar levels rise and can lead to symptoms including excessive thirst, excessive urination, weight loss, blurred vision and this usually leads to the diagnosis. Patients are generally diagnosed at a young age, even in childhood,” said Parker-Curling.
Smith was diagnosed with type 1 diabetes at age 14.
“That summer, I remember I had an insatiable thirst and couldn’t stop drinking – and I drank sweet things, and lost a dramatic amount of weight over that summer. I drank and urinated and drank and urinated. I thought something wasn’t right, but was happy with the weight loss. I thought, drink and pee it out. One day, my mother came home and she met me sleeping, but it didn’t really seem like I was sleeping, more like I was out of it. She took me to the doctor and at the time, my sugar was over 1,000.”
Normal blood glucose (while fasting) ranges within 70 to 99 mg/dL. Higher ranges could indicate pre-diabetes or diabetes.
“They said I was at the point of death,” Smith recalled. “This was right before school was opening and I was more concerned about getting ready for school and not being in the hospital, where I stayed for about a week. The doctor explained to me that I had diabetes and that moving forward, I would have to be careful about what I ate, how I ate and when I ate.”
Smith said initially, she thought that meant she could not have any sugar whatsoever and she was miserable, that is until the medical professionals introduced her to artificial sugar and told her if she wanted something sweet, that she would have to use them. That, she said, helped.
She and her mom then came up with meal plans, even consulting dietitians, and speaking with her school nurse to ensure they understood her situation, and ensure they had her medication on hand.
Smith has had to inject herself daily with insulin since her diagnosis. Today, she has to inject herself four times a day.
“Diabetes changes. Before, I injected myself twice a day, and as I grew older, the needs got more. So, I’m now up to four times a day.”
Parker-Curling said treatment of type 1 diabetes involves administration of insulin in a way that mimics what the pancreas would have done. Generally, insulin is administered via an injection or a continuous infusion just under the skin.
“Injectable insulin can be supplied in a vial and injected with a syringe, or it can be supplied and injected via a pen device. Insulin pumps administer insulin continuously and avoid the need for multiple daily injections.”
The doctor said during treatment, patients should monitor their blood sugars to make sure that they are meeting their blood sugar goals. And that patients can use glucose monitors that monitor glucose from finger sticks or patients can also use continuous glucose monitors that give more detailed information about blood sugar numbers and patterns which avoids the need to stick their fingers.
Smith prefers to prick herself; she does not like the pump because of its visibility under clothing. She also does not test daily, and said if her glucose levels are good one day, that it should not be too bad the next day.
And she is active, opting to run at least five miles, four times per week.
“Exercise has been really important. For me, I had to figure out my rhythm. I run four to five times a week, five miles per run. When I don’t exercise, I don’t feel as great. It’s important for any type 1 diabetic to be active,” she said.
While she has had family members succumb to complications from type 2 diabetes, Smith is the first person in her immediate family to be diagnosed with type 1 diabetes. The mother of two daughters said seeing as it is a genetic disease, she is concerned about her children.
She eats well, opting to consume lots of vegetables and lean protein with very limited fruit options as a rare treat, so she tries to ensure that her children eat well, too.
She is also strict with an exercise regimen for them; both of her girls swim.
When blood sugar levels remain elevated for long periods of time, the blood vessels can become damaged and lead to complications of diabetes such as heart disease, stroke, blindness, kidney damage and foot problems. Complications of diabetes are completely avoidable in the patient who is well controlled.
While Smith has been living with and managing type 1 diabetes for more than two decades, she does not think the disease has disrupted her life. But she said having low blood sugar is the worst feeling. She describes it as “annoying”.
“Luckily, my body warns me. I sweat, I shake and I need to get something sweet right away. So, I have low blood sugar rather than high blood sugar and have to have a piece of bread to get back up. I can’t take very long to eat, I start to feel weakish, and I get disoriented, but other than that, day to day is quite normal.”
As attention is brought to diabetes, it is Smith’s hope that someday a cure is found.
“I look at myself and knowing I have to stick myself for the rest of my life, I feel like a pin cushion and always tell my children they don’t want to be where I am. Sticking yourself with a needle four times a day does not feel great, but it’s also not a death sentence,” she said.
“Looking back 21 years ago, I thought I was going to die. I didn’t understand the disease at the time.”
Watching family members succumb to the disease, said Smith, including her mother, at age 57, wasn’t a pleasant experience, but she had to learn that diabetes is not a death sentence and once diagnosed, a person has to adjust what they eat, how much they eat and how they eat.
“It’s a manageable disease. You just have to do the right thing.”
Diabetes Month is recognized during November. This year’s focus is on prediabetes and preventing diabetes, which is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. According to the United States Centers for Disease Control and Prevention (CDC), more than one in three US adults have prediabetes – that’s 88 million people – but the majority of people don’t know they have it.
Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads, over time, to serious damage to the heart, blood vessels, eyes, kidneys and nerves. The most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin, or doesn’t make enough insulin.
Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself.
Approximately 422 million people worldwide have diabetes, according to the World Health Organization (WHO), the majority living in low and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year.
The WHO says both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades.