Living with Diabetes Welcome. I was diagnosed with type 1 diabetes on April 28, 1998.

Maybe you've been through that trauma yourself, or perhaps a loved one has. You know the daily struggle. This booklet is simply a tool to help you, encourage you, and give you a few resources to help in your journey, your attempt to control the "beast" of type 1. The Lord is faithful! Welcome to the world of type 1. It may be a bit of a roller coaster ride at times. Are you ready?! Think of this as an exciting adventure. The moment of diagnses: You may be in a doctor's office or a hospital. Part of you is actually relieved to know what has been happening to you. I wound up inthe ICU for three days. The warnig signs of diabetes are rapid weight loss, frequent urination, nausea, and possibly a fruity smelling/sweet breath. You learn the routine of managing type 1 as you go along - carbohydrates, insulin, blood sugars. But your life has changed. You may wonder: can I still accomplish my goals, my ambition? What does my future hold? And what about the complications that may come? What can I do to live a full life? What about school, employment, marriage? TYPE 1 is different than type 2 diabetes in that type 1 is an auto-immune system attack against your pancreas and the insulin producing beta islet cells. You don't make much if any insulin. Type 2 is defined as insulin resistance. Your body can't utilize the insulin you produce. Approximately 92% of all diabetics are type 2. It's an epidemic. A lot of that is our diet and lifestyle. 80% of all diabetics are type 1. Much rarer. CARBOHYDRATES MOST foods have glucose from carbs, which will raise your blood sugar. Examples: Fruit - 1/2 cup/1 piece = 15 grams Bread - 1 slice = 15 grams Hamburger bun = 22-35 grams (Starchy) Vegetables - 1/2 cup = 15 grams Potato - 1/2 cup/1 small = 15 grams Rice - 1/2 cup = 15 grams Ice cream - 1/2 cup = 17 grams You will see a lot of "low sugar/sugar free" food labels in the stores. I try to avoid ANY artificial sweeteners. They are poison. Real sugar is actually much better for you. Follow your meal plan = carb allowance = given by the dietitian. Your doctor will use this carb allowance to set your carb to insulin ratio, to balance what you eat to your meal insulin. Simply make healthy chioces = you can still eat, just count your carbs. No "special" foods are required. SUPPLIES Blood glucose meter

Test strips Lance and lancets INsulins - meal and basil/fast and longer actng Pen and needles or syringes Glucagon kit - emergency low blood sugar kit Alcohol swabs Glucose tablets or a quick sugar Ketone test strips An insulin pump and sets - if you choose to go this route RECORDING BLOOD GLUCOSE READNGS Check your blood sugar often. I average 12 checks a day. Work with your doctor. I developed a spreadsheet on my home computer, with day of the week down the left side; and time of day across the top from 12 midnight to 11 p.m. Take these to your doctor appointments. Look for patterns in your blod sugars - high or low at certan tmes most day. You can also mark the long acting insulin dosages across the top, to see their effect. Blood sugar goal is around 120 - my target range is 70-160. Work with your doctor. A1C goal is under 7.0 (I run 6.2-7.0). Work with your doctor. The A1C (HbA1C) is a long term approximately threemnoth indication of your blood sugar control. CARE TEAM Dietitian - menu planning/nutrition Diabetes educator - resources/guidance Podiatrist - feet Cardiologist -heart Internist - internal medicne or a general practitioner Neurologist - neurological systems Endocrinologist - glandular systems/this is your diebetes specialist Dermatologist - skin Nephrologist - kidneys Physical therapist - exercise Ophthalmologist - eyes/annual retina exam Psychologist/counselor - depression/coping Dentist - teeth HYPOGLYCEMIA Low blood sugar = 70 or lower Symptoms include confusion, dizziness, sweating, slurred speech, muscle control, hunger. Test your blood sugar. If low, treat with 15 grams of quick carbs = 8 oz. juice, milk, regular pop (not diet), a banana. Retest in 15 minutes and retreat if necessary. I learned to keep a glucagon kit in the refrigerator at home for emergency use only. This is a shot someone has to give you when you are too low to eat or respond. You can get this by prescription. It releases stored glucose from your liver. HYPERGLYCEMIA High blood sugar. High for me is over 160. This is why you were diagnosed with diabetes and take insulin. Your blood sugar was too high.

Symptoms include the low blood sugar symptoms plus frequent urination. Treat with extra fast acting insulin on a sliding scale provided by your doctor. KETOACIDOSIS This is a dangerous situation as your body releases ketones when your blood sugar is too high. This is a poison that can be deadly. Ketones form from the breakdown of fatty acids by the liver. Treat with extra fast acting acting insuln on a sliding scale provided by your doctor. INSULIN PUMP This is a newer way of taking insulin. You only use fast acting insulin in a pump. There are several types of pumps available. Many now have a continuous glucose monitoring system so you have continual glucose control. There are alarms to alert you to a high or low bood sugar. Pumps are a battery operated system, about the size of a papger or cell phone. You wear the infusion set (tubing and needle) on your stomach or other fatty tissue area. Sets need to be changed every three days. You put insulin in a small reservoir and the pump runs on batteries. There a re clips to wear the pump on a waistband. They can also be placed in a pamts pocket. They are a big help in controlling your blood sugars, but are not for everyone. You wear them 24/7. Pumps come in different colors and with added features such as waterproof. I wore a pump for 2-1/2 years and loved it but the sites in my stomach wore out. Insulin pump companies have web sites with details on their specific models. DAWN PHENOMENON This is when your blood sugar rises dramatically in the early morning. My blood sugar rises between 6 and 10 a.m. - violently. It's so bad I usually don't eat until later in the day. Cortisol and other hormones like adrenalne rush towake up your body, causing a sike in yourblood sugar. Treat with extra long acting insulin at bedtime or overnight. I often have to take extra Humalog (fast acting insulin) about 6 a.m. SYMOGNI AFFECT This is when your blood sugar drops too low overnight, resultingni a rebound high blood sugar as a response. The treatment is LESS bedtime insulin and/or a bigger bedtime snack. You are trying to avoid the overnight low. INSULIN There are several insulins available. Work with your doctor. Fast acting - Humalog, Novolog Intermediate acting - R, N Long acting - Lantus, Levemir Pre-mixed - 70/30 R & N When first diagnosed, I was put on the old R & N routine. I wasn't comfortable with the blood sugar control and having to wait 1/2 hour to eat after takingthe injection. I most likely didn't know exactly what I'd be eating any way! I saw an ad for Humalog insulin and talked to my endocrinologist. He absolutely refused at first! I explained to him that what we were doing was not working for me. Needless to say - we made the adjustment; aaaand later transitioned to the pump - wth Humalog. My doctor apparently knew the first rule of patient care - listen to the patient. They usually know best. COPING Take each day - one day at a time. Set realiistic goals for yourself.

Develop a suppport system - you are not an island. Realize it is not an easy thiing to deal with a chronic illlness. It is 24/7, and very demanding. It can cause a great deal of stress. I rely a great deal on my faith. OTHERS You are not alone. Reach out and make a difference where you are. It may be someone in a pharmacy check out line. That's happened to me. Find or start a support group with your local hospital's support. They have diabettes educators on staff to handle this. EXERCISE Find a regular exercise routine that works for you. Swimming, walking, bicycling, yoga. FOOT CARE Check your feet DAILY! Enough said. MENU IDEAS Eat healthy - lean meat, fruits, vegetables. DOCTORS Work together as a team. However, there are timees when you may not find a doctor who relatees to you on the same level. If absolutely necessary, yoou can change - you are the patient, paying for professional care of a chronic illness. If that is not happenig, it's time to change, for your health's sake. EDUCAATION Learn as much about your condition as you can. It will help manage "the beast." Knowledge is power. CELEBRITIES Mary Tyler Moore Brett Michaels Nick Jonas Gary Hall Jr. Sonia Sotomayor Nicole Johnson Baker Crystal Bowersox Sean Busby Bobby Clarke Carlinde Calfing Jim Carter Chris Dudley Victer Gerber Darion Gregory Dana Hall Kathy Johnson Charlie Kimball Adam Manson Halle Berry COMPLICATIONS The least favorite topic to talk about.

Because of the extra sugar in your system, complications may - repeat, MAY - develop. Heart, eyes, kidneys, nerve damage. Keep your A1C level under 7.0 - and see your doctors regularly to help avoid complicatiions. Prevention is the key. Sometimes our best efforts just aren't good enough. RESOURCES The internet is full of resources for diabetics. The American Diabetes Associatiin has a website. The insulin pump companies each have web sites. There are internet blogs. There are even children's sites, designed specifically to support them. The world-renown Mayo Clinic and Joslin Diabetes Center each have web sites. There are on-line support sites. It's all there to help you. One day at a time. And please feel free to e-mail me for supprt. rbkeszler@yahoo.com Best to you!