I was called this summer when a patient of mine was in the emergency room for hypoglycemia. She had been on the miniature golf course at the beach. She is a high power attorney, who when relaxing, had lower glucoses and hadn’t adjusted her glucose levels downward on vacation.

The pancreas of a person with type 1 diabetes, just can’t accommodate to stress or relaxation. All these insulin changes in times of work, school, play, vacation, relaxing on the couch has to be done by the patient or the family and sometimes it’s pretty hard to know what to do. There is no single guidebook about how diabetes works. Each person is different. Insulin sensitivity varies throughout the day. The reality is that most of the time, despite knowledge, new insulins, pumps, sensors, type 1 can be an impossibility to manage.

If you have type 1 diabetes, it’s just not fair. A type 1 pancreas has very few functional beta cells making little, if any, insulin and amylin. Without beta cells, the connections between the other cells in the islet, the alpha cells, delta cells, epsilon cells and pancreatic polypeptide cells, all become interrupted and over time islets die. Studies have shown that among type 1 patients, there are not only, limited numbers of beta cells, but reduced islet numbers.

human_islet_mouse_islet

Without fully functional islets, as in the case with type 1 diabetes, normal glucose levels just don’t happen, even with insulin injections. Those without type 1 have islets that literally signal to each other, the brain, the liver and muscles more than one million times a day in order to keep glucose levels less than 120 mg/dl, 95% of the time. That’s how

the performance artist, David Blaine hung over the river Thames in London for 44 days without eating, and at the end of his fast, his glucose level was 94 mg/dL, similar to where it had started. That’s how those without type 1 can eat 4 slices of pizza, for example, and their blood sugar never exceeds 140 mg/dL

For decades, we have known how hard it is to manage glucose levels after eating pizza in those with type 1 diabetes. There have been dozens of recommendations on what to do when eating pizza and there is even a “pizza bolus” setting on some pumps. Scientific studies have shown that glucose levels can be more altered than with most other foods for 4-9 hours after eating pizza

There are no foods off limits and no diet that can be successful if there is deprivation from the foods we love. Dr. Elliott Joslin, a diabetes hero, said in 1924, that “insulin is a remedy, not a cure…and only for the wise and not the foolish, whether they be patients or doctors. Everyone knows it requires brains to live long with diabetes, but to use insulin successfully, requires more than brains.”

Having type 1 requires you, friends and families to stretch your brains far more than you ever dreamed you’d have to do. Kudos to you for taking on this disease!