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Insulin Planning
How to differentiate between Type 1 and Type 2 diabetes?
The primary difference between Type 1 and Type 2 diabetes is the need for insulin. Insulin is the pancreas hormone in your body that naturally reduces the glucose (“sugars”) in your blood.
What is Type 1 diabetes?
Diabetes Type 1 is caused by an autoimmune dysfunction that ultimately damages your pancreas. The pancreas is an endocrine gland producing insulin to help control blood glucose levels. When this is destroyed, blood sugars start to rise. For people who have type 1 diabetes, insulin is a life-saving drug that is necessary for survival. Before insulin discovery 1920s, the diagnosis of type 1 diabetes was considered a death sentence. Type 1 diabetes occurs in early adulthood but may occur at any age.
How is Diabetes Type 1 diagnosed?
- The classic scenario is someone becomes critically ill with a condition called diabetic ketoacidosis, or DKA, because of their inability to make insulin. They go to the hospital and improve once fluids and insulin are given.
- Antibodies help us decide if someone is Type 1: GAD, IA-2, islet cell antibodies, and zinc transporter antibodies.
- A low or undetectable C-peptide when glucose is high also proves that the pancreas cannot make insulin.
How is Diabetes Type 1 treated?
- All DM1 patients need insulin. Drugs like Metformin, Canagliflozin, or Liraglutide will not work for them. Patients do very well with insulin pumps that are linked to continuous glucose monitors (CGMs).
- There is new technology available among insulin pumps that functions quite a bit like an artificial pancreas.
- There are early studies underway for islet cell implants encapsulated in nanoparticles that keep the antibodies OUT while permitting insulin secretion–a cure may be on the horizon.
What is Type 2 diabetes?
Diabetes Type 2 usually occurs later in life but may be seen even at an early age. Usually, the disease occurs when two problems coincide. The first being, the pancreas is unable to meet the demand for insulin. The second reason is insulin resistance which means insulin has to work harder to control blood glucose levels.
What is insulin resistance?
Glucose is utilized by your cells to generate the fuel energy that is needed to survive. The blood transports the glucose from the stomach to different body organs. Insulin is regarded as the key to the cell’s door that helps the glucose enter inside a cell.
When you have insulin resistance, the insulin (key) doesn’t fit inside the door. This results in a build-up of glucose outside the cell, resulting in high blood glucose levels.
Does Diabetes cause health complications?
Think of it this way, the cells in your body are drunk with sugar. Over a more extended period, these excess sugars damage blood vessels, the nerves, and several organs.
Large blood vessel complications such as:
- Cardiovascular disease e.g.) heart attack
- Cerebrovascular diseases- e.g.) stroke
Small blood vessel complications such as:
- Chronic kidney disease
- Vision loss
Nerve damage such as:
- Erectile dysfunction
- loss of sensation of your feet
Other complications include:
- Skin infections
- Amputations
- Foot ulcers that don’t heal
What symptoms develop due to Diabetes?
Symptoms for both uncontrolled Type 1 and Type 2 diabetes are very similar. Type 1 diabetes patients have a story that occurs over a matter of hours to days. Type 2 diabetes patients, on the other hand, give a story that occurs over weeks to months. Some common symptoms include:
- Excessive hunger.
- Excessive thirst. Constantly thirst despite drinking ample water
- Fatigue
- Frequent urination.
- Blurry vision.
- Unexplained weight loss
- Sores take a long time to heal
How is Diabetes Managed?
It is vital to keep your blood sugars within a normal range to avoid the complications noted above. Dr. Rehman at District Endocrine can help you customize your plan and offer personalized treatment options to help control your Diabetes.
- Dietary and exercise changes
- Medications:
- For Type 1 with insulin injections
- For Type 2 with oral pills to injections
- Insulin pump technology: is used to continuously give insulin with a built-in Artificial intelligence (AI) technology without multiple insulin shots a day.
- Glucose sensor/Continous Glucose Monitors (CGMs): It is a new technology that constantly monitors your glucose levels and helps avoid finger stick blood glucose checks.
What kinds of insulin are used?
- Long-acting, or basal insulin (glargine, Lantus, Basaglar, Tresiba, Toujeo, etc.): This is administered once or twice daily. It mimics the “background” insulin secretion from your pancreas.
- Short-acting or mealtime insulin (lispro, aspart, Humalog, Novolog, etc.):
- This is administered before meals and when “correction” is required for sugars that are too high.
- You can learn to count your carbohydrates to administer the precise amount of insulin you need for a meal. This gives you the maximum flexibility in your lifestyle.
How to RESCUE hypoglycemia or a sugarless than 70 mg/dl?
- Glucose tablets are readily available over the counter. A bottle of 50 glucose tabs costs about $7.
- Consume 16g glucose, wait 15 minutes and recheck sugar
- 4 glucose tablets OR,
- 6 oz juice or cola OR,
- 2-3 packets of sugar in water and drink it
- If sugar is still less than 100, repeat step 1 until sugar above 100
- Once sugar above 100, eat a small mixed snack (protein, fat, carb etc.) to keep your glucose in the normal range.
- Avoid overtreatment – If you consume too many carbs, your glucose may end up at +300 afterward!
- After a hypoglycemic event, think about what caused your low blood glucose (hypoglycemia): did you miss a meal? Exercise too much? Miscalculated how much insulin you should have taken? We need to find the cause and avoid it in the future.
- NOTE: chocolate is not a good source of glucose as a rescue of hypoglycemia because it has lots of fat in it.
What to do if I RUN OUT OR LOSE my insulin?
- First, call your pharmacy to inquire if you have refills left on insulin.
- If you don’t have refills, call your physician’s office to get refills.
- If you are unable to reach anyone to refill your insulin supplies, here’s what to do:
- Go to Walmart and inform the pharmacist that you have Diabetes and you are out of insulin.
- Ask them to give you NPH insulin with needles/syringes, which are available over the counter. You DO NOT NEED A PRESCRIPTION for his insulin IN SEVERAL US STATES.
- Give yourself an NPH insulin shot every 12 hours — this will keep you OUT of DKA and the ER until you get the refill of your insulin. In such situations, it’s OK if your sugar isn’t perfectly controlled. It’s just a temporary issue till you get back to your insulin.
What can I do to make my life easier/get better control?
- #1: Take your medications as prescribed. Avoid missing any doses.
- #2: Always have your glucometer or a glucose log to an endocrine appointment.
What is a Continous Glucose Monitor (CGM)?
- Abbott makes a continuous sensor (CGMs) called Freestyle Libre 1 and 2. This CGM automatically checks your glucose. The device is suitable for 14 days and costs $35 with most insurances. You check your glucose with the scanning device/phone, a one-time cost of $75-$100. Medicare and commercial insurance usually pay for these.
- Dexcom and Medtronic manufacture continuous sensors that integrate with specific insulin pumps. These sensors (CGMs) are much more expensive than Freestyle libre. Unlike the older Freestyle Libre 1, these devices will ALARM if your glucose is fluctuating or if you are about to have hypoglycemia. Medicare and commercial insurances usually will pay for these CMGs devices if specific criteria are met.
- Eversense is the newest sensor that is implanted under the skin. This CGM is approved for 90-day wear for now. It communicates with a transmitter worn on the body. It will vibrate to alarm when there are changes in glucose.
Some products to help you control Blood glucose
(District Endocrine is not being sponsored or paid for the name brands listed)
check Target, Walmart, Costco, and Amazon for the best prices
- Apps: Figwee and MyFitnessPal for carbs, calories, and portions
- Bread: Nature’s Own Life Wheat + Protein or Wheat + Fiber
- Cereal: Steel-cut oatmeal, The Cereal School
- Frozen pizza: RealGood, Quest
- Welch’s Fruit Polaner spreads without added sugar
- Sweeteners: stevia, agave syrup, or Swerve (erythritol)
- Nut butter and Nuts(without added sugars)
- One protein bars & Pure Protein bars
- Premier Protein shakes
- Alternative pasta that is high in fiber: Weight Watchers Skinny Pasta made of konjac, Shirataki “miracle” noodles, or others made of banza, and adzuki, edamame; lots of different flavors and textures, you will find your favorite.
- Fit Greek yogurt, Dannon Light, or Sigge’s Skyr yogurt
- Gabriella’s Kitchen Skinny Pasta or Frozen meals; RealGood enchiladas
- [soft] cheeses, fatty fish, lean meats
- Strawberries, blackberries, blueberries, raspberries
- Bob’s Red Mill low carb baking mix
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