Differences Between Type I and Type II Diabetes

I hit my reader yesterday, and it suggested a post I might be interested in. It was from a diabetic guy, talking about his diabetes. The first thing he said was I am Type 1, so I can only really speak for myself. I can’t really speak for Type II diabetes. It’s funny because on my journey, one of my first questions was what’s the difference? I don’t know the full story but here is what I do know:

Diabetes (any type) is high blood sugar. Beyond that, there are several forms of diabetes. Type II is by far the most common, covering 80-90% of cases. Then comes Type I, covering about 10% of cases. There are other forms of diabetes too, but they are rare in comparison to the two biggies. These different types cover not the raised blood sugar itself, but the causes. Once your sugar is raised, you can look forward to the same lovely benefits, whatever type you have.

Type I is where your body attacks itself – it’s an auto-immune thing, resulting in no insulin being produced. Insulin counteracts glucose (sugar). If T1 is detected, it is often detected early, although in some people it can come on as an adult. The tratment is clear – insulin. There is empirical evidence to suggest a familial link, but the causes ultimately are not yet known, although links with lifestyle or weight have been ruled out.

Type II is where you don’t produce enough insulin, or where the insulin you do produce doesn’t work. It usually gets detected when you’re a bit older. In my case, I think of things degrading over time. There are various treatments which do various jobs – reducing sugar directly, or poking various organs to work harder. Ultimately, there is the same treatment as T1, insulin. T2 is often associated with lifestyle, although in my case the familial link is very strong, though the lifestyle link pretty much non-existent.

There is no cure for either T1 or T2, although with T2 things like what we eat and how much we exercise play a part, so some people can go into remission by changing their lifestyle. I didn’t, so this rule does not apply to everybody. I guess one of the reasons that there are more options with T2 than with T1 is research – I suspect that T1’s cause being as yet unknown is largely down to funding.

Either way, your body has an intolerance to carbohydrates. Many T1s will religiously carb-count, for the simple reason that it guides their insulin dose. I don’t carb-count, although possibly I should. My dose instead is guided by the less specific what did I eat (good/bad)?, or how much did I eat (big/small)? If I ate a lot of carbs, say, I take a 10% higher dose, but again this is empirical, not scientific.

Note that I am using the word carb above. Not sugar. Although sugar is a carb, so there is a link. But a bowl of pasta will do as much damage as a packet of candy.

The insulin that I take is pre-mixed. A fast acting insulin plus a slower-acting insulin. I did post about this ages ago here. The pen is marked just in “units”. Exactly what a unit is, I can look up, but the point here is that working out how many millilitres of a particular insulin I am getting requires a couple of calculations, plus the proportions of the two types of insulin are fixed at 3:1, so for every 3 of slower insulin, I am getting 1 of fast insulin. For these reasons, mixes tend not to be prescribed to T1 diabetics. (That one comes from my wife, who is a diabetic nurse.) The guy whose blog I was reading yesterday did, however, take the two types of insulin – they were different brands to what I take, but the same kind of thing – but took them separately, so he could vary the proportions.

As I said at the top of the post, I don’t consider myself an expert here, but this is just knowledge I have picked up along the way. In many ways it is immaterial, because regardless of the cause, we’re faced with the same problems. I chuckle, too, when I hear new stroke survivors talk about whether their stroke was due to a bleed, or due to a clot. Because that’s the language they hear from the staff. Whatever the cause, we’re all still in the same boat. But maybe that’s just me?

Better Days

I’ve had better days. In fact so far today, everything that could go wrong, I think it probably has.

It started innocuously enough. One of the daily tasks in my getting up routine is to test my sugar. I posted about diabetes a little the other day. I mentioned the word test, but beyond that, I didn’t elaborate. I shall do so a bit here, and also tell you why it went wrong this morning.

There are various ways of testing your sugar. The most lo-tech is just peeing on a strip. The strip goes different colours depending on your sugar. As you can imagine, because you pee on it, it is totally painless. It’s also not very accurate. So most diabetics don’t rely on it. I don’t even have the strips.

By contrast, the most hi-tech is a full-on blood test. You go to your doctors surgery, there is a needle and syringe, they take some blood, send the sample off to the lab, and the next day you get your results. We’ve probably all had this test as part of a standard blood test, but if the value is in the expected range, generally nobody says anything.

There is a middle way, one favoured by most diabetics. It’s in the privacy of our own bathrooms, so there’s a big advantage straight away. It’s still a blood test, but only a drop of blood is required. Just like the image. You push the drop of blood onto a (nother type of) strip, and this goes into a machine called a glucometer. These things are tiny, easily fit into the palm of your hand, run off batteries, nice and portable. In about 5 seconds, the glucometer will tell you how much sugar is in your blood at that time.

I don’t know how they work, but it has got to be something electrical, because the machine is basically a circuitboard with a screen. At a guess, the drop of blood makes a circuit, they measure the voltage across the blood, and I guess that thanges with your sugar level. So they probably do a little conversion, and the number is on the screen.

Did you note back there I briefly mentioned pricking your finger? That in itself has become an art-form. I mean, you could start with a knife and cut yourself, but that’s way more blood than required, and way more pain!

So these machines have evolved where you pull a kind-of trigger, and they thrust a piece of sharp metal about 1mm into your skin! You know, shallow enough that you only bleed a drop of blood. But at the same time, that’s all the machine requires.

Now, these little pieces of sharp metal are called lancets. They come out of the factory sterile, and that’s just how they are intended to be used – a new lancet every time. But most diabetics don’t bother. I am the only person who uses my lancing machine, so I’m not particularly worried about catching something (new 🙂) from the last person who used it! So, the measure of when to change one of these lancets besically becomes when it gets blunt. Normally every month or so.

So, as you can imagine, all sorts of various finger-pricking contraptions have come along. They’re only really a bit of plastic, so every glocometer comes with one – the glucometer is the smart device here. It’s a bit like the wild west – every manufacturer, and pretty much every model, does its own thing.

And that’s what started the ball rolling this morning. I decided that the lancet was a bit blunt, so hunted out my stash of new lancets. It didn’t fit. Or rather, it did fit, but the bit of metal was too short to come and poke me. Even on maximum. You’re using the wrong lancet with that device, my wife says. I’m pretty sure I’m not, but I check anyway. So I raided a brand new glucometer. Fresh finger-pricker, fresh lancet. Same result. Thirty minutes of faff, and at that point the hammer came out – well at least that gave me some closure, made the outcome a bit more final! So, a big Thank You to Onetouch, for their totally shitty finger-prickers.

Not to worry, I have a backup. I measure myself twice a day, it is important so I keep backups of backups of backups… Basically, I take a new glucometer every time it is offered, and with every glucometer comes a finger-pricker.

I go to the bathroom to find the backup – not there. Well, it’s not where it is meant to be. It might be somewhere, but there is so much crap in there… So, I’n searching on my hands and knees – I’m never too sure I can get back up from there! In the end, I find the backup – some dozy twonk has put it in another cupboard, safe and sound. And, that dozy twonk might well have been me!

So, not quite midday – we still have things to do today – and all I really feel like doing is going back to bed.

Anatomy of a Hypo

What is a hypo?

A hypo is hypoglycaemia. hypo = low, glycaemi* = blood sugar. Stick the two together, and, hey presto!

My body is not much good at regulating my sugar, and when I measure it, it can easily vary 300% during the course of a single day. Ideally, it should be a low value anyhow, and shouldn’t vary much beyond that.

I take insulin to lower my sugar, and it works brilliantly, except if I’m not careful it works too well! I can dip too low. So, I also need to stay high enough – which means I need to eat regularly, to keep my sugar above that lower-limit. Not, like, every 10 minutes, but I can’t afford to skip meals. Insulin is quite powerful stuff, because if I our sugar does go too low, we go kaput. Too much is fatal, too little is fatal. So if I suddenly stop posting one day, that’s why! (unless I was really pissed with someone the day before 🙂).

Over the years I have spotted trends. If you’re diabetic, I really can’t recommend that enough – to measure your sugar, learn how your body responds to different foods. A few times, I have measured myself every hour, all day, just to build a picture of how my body regulates (or not) itself. My lowest points tend to be in mid-afternoon (so I can’t leave lunch too late) or the middle of the night. I’m highest around six o’clock – just before my evening insulin – especially if I eat a larger lunch than I ought. I tend not to get lows very often, because I like my sugar to run at maybe 25% higher than a non-diabetic. I can tweak my insulin to take account of what my sugar is, and what I want it to be, but it’s not an exact science.

Foods which I consider good (i.e. they don’t much raise my sugar) are things like nuts and cheese. I enjoy tofu and stir-fried vegetables, this is also good. Foods which are bad are things like bread (white bread in particular), pasta and potatoes. Basically, carbohydrates. Ironically, chocolate or candy don’t make much of a difference – I guess that’s because (a) I’m very aware of eating them, and (b) when I do eat them (and who can resist a bit of chocolate now and again?), it is just a few grams, so it doesn’t make a big difference. Crisps (chips) although generally not sugary, are potato and therefore quite bad. In case you’re wondering, corn chips tend to be just as bad as potato – I’m not too sure why this is. But there is this impression, fuelled by the media, that links sugary food to diabetes, and that’s way too simple a model, although there is a passing resemblance.

So, a hypo. Despite not having them often (at least that’s the plan!) there have been two times recently, and several in the past, where I thought I could feel a hypo coming on. You can feel them coming on – you recognise the feeling, it’s like the rumble of distant thunder. If you’re asleep, you can wake for no apparent reason, and then you feel the rumble. In fact, two distinct feelings inter-mingle.

First, there is that feeling of exhaustion. That you just want to drop, to rest. Yep, even if you just woke up. You have to fight this feeling like crazy, because if you give in to it and don’t take any action, you’ll just continue to go lower.

Second, you feel ravenous. As in, eat everything in the house ravenous. It really is an effort not to eat everything in the house! And, bear in mind that when you do eat something, there is a lead-time before it gets absorbed into your body. For that lead-time (which varies depending on the food you eat, but most people on insulin will keep jelly babies – a fast hit – to hand) your sugar is still low, so you have to train yourself to eat, then to stop eating.

When you mix these two effects, it gets interesting. Imagine being really hungry, but being too tired to eat. I know, it’s perverse, but that is what happens. Do you know sometimes when you eat a meal which involves lots of chewing, and you sometimes just need to stop chomping and give your jawbone a break? Again, it is mind over matter. You tell yourself that you have to eat something before you crash out.

One other effect of a hypo is loss of co-ordination. The food you eat needs to be ready-prepared, or at least quick to prepare. You don’t want to bake a soufflé here! You can’t be doing intricate things with your hands, and sometimes even walking is difficult. The closest I can think of, ironically, is drunkenness, where that straight line is oh so elusive.

Hypos are not limited to insulin. With any med that actively lower your sugar, you run the risk. It gets complicated because not all diabetes meds are aimed at lowering sugar – some are aimed at promoting your body’s natural sugar-combatting abilities. If you don’t combat sugar much anyway, these meds are pretty ineffective, but they won’t cause a hypo.

And, it is possible to have phantom hypos. All the feelings are there, but you measure your sugar, and there is no need to worry – it’s not gonna be fatal. I suppose your body gets used to a certain sugar level, and if it dips below that, these feelings start to kick in. Withdrawal.

In fact, the medical advice is, as soon as you feel a hypo coming on, to measure yourself and check. With respect, bullshit. That’s fine for the text books, but when you feel one coming on, you have one urge, to eat. You can worry about the numbers later.

All of this is a very long-winded attempt to explain why I was eating jelly beans at four o’clock the other morning 🙂.