About Health TV with Jeanne Blake Type I Diabetes
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JEANNE BLAKE:
Welcome to About Health TV Im Jeanne Blake One hundred and fifty
thousand children in the United States have diabetes Thats the bodys inability to use or metabolize sugar properly There are two types of diabetes On this edition of About Health TV well focus on type I diabetes, and well do so with the help of Dr Laurie Lafell, the chief of the pediatric and adolescent unit at the Joslin Diabetes Center here in Boston, and Tim, a patient of Dr Lafells Thanks to both of you for coming in to talk with us Were going to talk about type I Dr Lafell, what is going on when somebody has type I or type II diabetes? Whats not happening in Tims body that needs to be happening, that results in his being diabetic? DR LAFFEL: In order for the body to use sugar for energy, you need a hormone made in the
pancreas which is called insulin In type I diabetes, the body has destroyed the cells that make insulin They are very specialized cells called beta cells in the pancreas, and the bodys immune system has somehow been triggered to self-destruct those insulin-producing beta cells This is a gradual process, but over
time Tims body no longer has the insulin-producing cells So in order for Tim to look as healthy as he does today and to do everything that every other 14-year-old does, he needs to take insulin by injection, because his body no longer makes it JEANNE BLAKE: right? DR LAFFEL: JEANNE BLAKE: DR LAFFEL: Right Is there any other distinguishing difference? Type II previously was called adult onset diabetes because type II would be Now, when you say his body no longer makes it, Tims type I is something that is
early onset, or juvenile onset, as it used to be called The other kind, type II, is adult onset, basically,
distinguished by age, but types are not distinguished by age any more It can happen at any age The difference with type I and type II diabetes is, in type II diabetes the insulin-producing cells are still present in the body The body is just not making enough insulin for the bodys needs because of something thats called insulin resistance This resistance occurs in the setting of obesity, in the setting
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of sedentary lifestyles, lack of physical activity, and then certain populations are at increased risk for developing insulin resistance
JEANNE BLAKE: do? DR LAFFEL: In contrast to type II diabetes, in which we understand a little bit about the bodys So do we know why Tims insulin cells decide to not do what theyre supposed to
developing insulin resistance and the obesity or inactivity, in type I diabetes, there was basically nothing that Tim did or nothing that his parents did that caused the diabetes to happen There is some trigger, some trigger in the environment that lets the immune system self-destruct, doesnt reproduce beta cells JEANNE BLAKE: DR LAFFEL: Its something in the environment literally? Thats something were not quite sure of What we know about type I diabetes is,
its a combination of having genetic susceptibility to developing auto-immunity, and autoimmune diseases are things like arthritis, some bowel disease, thyroid disease, and vitiligo So there are many diseases that people have heard about I mentioned vitiligo, because Michael Jackson may have vitiligo, and it is an immune disease that causes the skin to lighten, for example JEANNE BLAKE: DR LAFFEL: Okay So theres susceptibility to autoimmunity, but theres some external trigger that
then tells the immune system to destroy those
insulin-producing beta cells JEANNE BLAKE: In fact, the Centers for Disease Control has ruled out that childhood vaccinations
are a cause of type I diabetes That was a published report about a year ago, I think DR LAFFEL: Well, the scientific community has been looking to find what is this environmental
factor that may be triggering autoimmunity, and its probably multiple environmental factors But its not just one factor It may be many factors in different people; it may be different factors at different times at different ages But the important point is that the immune system has been turned on to destroy the insulin-producing beta cells When I talk about the self-destruction, what I mean is, if my pinkie was cut off by a paper cutter, it would hurt My body would not be able to grow back another pinkie, because we only have the potential for one digit, because the cells that would make another pinkie dont exist If
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I skinned my knee, the skin on my knee would grow back in a couple days and you would not even know I skinned my knee, because the skin on my knee has the potential to grow back into skin that covers the knee Unfortunately, those
cells in Tims pancreas are like my pinkie If they are destroyed by the immune system, there is no potential for them to grow back JEANNE BLAKE: Now, were going to talk with Tim in just a moment about what its like to live with
that reality, but before we turn to Tim diabetes when its, I guess at any age its more dangerous than a lot of people give it its due But the complications are potentially pretty awful if you dont take care of yourself They include can you just give us some breadth of what the complications are? DR LAFFEL: Well, the complications are frightening, because it involves loss of vision, loss of
kidney function, diabetes is the leading cause of amputation, non-traumatic amputation in this country, and blood vessel disease So you get early heart disease as well, possibly JEANNE BLAKE: Can you help us understand the role that insulin plays and why that variety of
potential complications is there? I mean, what does insulin do? DR LAFFEL: Well, what insulin does is, it helps control the blood sugar level Everyone has
blood sugar levels that sort of rise and fall in response to food That is normal metabolism In the setting of diabetes, blood sugars rise too high
in response to food So if diabetes is either untreated or treatment may not be adequate, the sugar levels rise too high There have been large studies in this country and around the world which have proven without a shadow of a doubt that the higher the blood sugar levels are, the less well-controlled the diabetes is, the greater the chance of developing these complications JEANNE BLAKE: want to know why DR LAFFEL: If a person doesnt have diabetes, they dont get these complications, so these But do we know why? Every program I get this why, why, and Im like a child I
complications are related to the abnormal metabolism Theyre related directly to how high the blood sugar is When the sugar isnt being used normally, the body resorts to using other fuels as well So when our sugars are high and the body cant utilize normally in the absence of sufficient insulin, lipid levels cholesterol, triglycerides also rise, so you have this combination of sugar levels are out of control and then lipid levels go up, and so on But the point is, these complications are incredibly frightening, but theyre also preventable
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JEANNE BLAKE:
Right And well be talking
about that treatment as we go on But thats the first
time in my life Ive understood that Very good explanation, Doctor It really does let everything else that creates all these complications get out of whack All right Well, Tim, you were diagnosed youre 14, right? TIM: Im 15 Youre 15 You were diagnosed with diabetes when you were 11?
JEANNE BLAKE: TIM: Yes
JEANNE BLAKE:
What was it like? What were you feeling that you knew that something was
wrong with your body? TIM: Well, when it first started, my heart was kind of beating irregularly, like when I would be doing
activities and stuff such as mountain biking, skateboarding, and stuff And I would always be very thirsty and very hungry and I would also have to go to the bathroom a lot JEANNE BLAKE: TIM: And did you wonder, Whats wrong with me?
Yes, I kind of wondered that, but I just thought it was because of my activity, because I was
really active, so it really didnt bother me too much JEANNE BLAKE: And then how did you find out? What then went from it not bothering you to your
actually going to the doctor and finding out what was wrong? TIM: Well, it was kind of getting worse, because I was getting more thirsty and Id be
drinking a lot
and then Id just be going to the bathroom just as much I would also be losing weight, and so we went to the doctor and it was right around Christmas vacation, right around the 18th, I think We went to the doctors and they said I had diabetes JEANNE BLAKE: TIM: And what was your reaction? First of all, did you know what that meant?
I had no idea I just thought Hey, something is screwed up
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JEANNE BLAKE: TIM:
Did the doctor explain it?
She kind of said a little bit like your pancreas is not working, you should go to Childrens
Hospital, and thats what we did JEANNE BLAKE: TIM: And what was your reaction?
I was just like, oh, I thought, Oh my God I didnt know what was going on So it was frightening?
JEANNE BLAKE: TIM: Yes
JEANNE BLAKE:
And do you remember then when you started to find out more and more about
what it was what your reaction was? TIM: It was just like I have really no idea what I was like I was just kind of like a little bit shocked
knowing that I would have to go through this for the rest of my life JEANNE BLAKE: Its hard, especially when youre 11 years old thinking of forever Its a tough
concept for a young
person TIM: Yes, exactly So you had to start getting insulin injections?
JEANNE BLAKE: TIM:
Yes When I was diagnosed I took like two shots a day, one in the morning and one at dinner I
was taking very little insulin because my cells in my pancreas were still alive and kicking; they were getting destroyed JEANNE BLAKE: I see And so what was that like, to have to get a shot? Most young people,
most people dont like shots What was that like? TIM: Well, the needles were a lot smaller than the flu shot or something
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JEANNE BLAKE: TIM:
Oh, they were?
It was still a pain, because you had to test your blood sugar four times a day and take a shot
So it was just like you just really didnt want to go through it JEANNE BLAKE: TIM: Were you giving yourself shots at that point or do you now?
Yes, I give myself And when did you start giving yourself shots?
JEANNE BLAKE: TIM:
Probably like a month right after I had it Really?
JEANNE BLAKE: TIM:
Yes, because I kind of wanted to be independent and do it myself An 11-year-old Do a lot of 11-year-olds give themselves their shots, Doctor? Well, Tim does a great job with his diabetes and he does a great
job because his
JEANNE BLAKE: DR LAFFEL:
parents are with him all the time Tim obviously has the understanding to hold a syringe and to drop a dose and to inject the insulin But he does this because his parents are right there with him and his parents are helping with the dose and theyre helping to make the right choice for his meal planning and his exercise Hes right He has the independence because he can hold the syringe but this is all within you know, he has a safety net around him and thats why hes doing so well JEANNE BLAKE: friends? TIM: Yes, I told many of them Right away? Its incredibly important to have that family support to do as well as Tim is doing
Tim, when you had to tell your friends, or Im assuming that you told your friends did you tell your
JEANNE BLAKE:
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TIM:
Yes, probably like the next time I saw them I told them And what was their reaction?
JEANNE BLAKE: TIM:
They were like, Whats that? Whats diabetes? And I had to explain it to them and they were
just like, Oh, that really stinks JEANNE BLAKE: TIM: And did anybody ever tease you or make comments about it?
No, no one ever did that Thats good How did you find that
it affected I know that youre doing well, I
JEANNE BLAKE:
know that youre active in sports, but how did you find that it did affect your life? TIM: Well, right from the get-go I kind of found that it affected me How?
JEANNE BLAKE: TIM:
Because, like, before I could just, like, I could just wake up whenever I wanted to I can do that
now, but I just have to incorporate the shots into that You could eat whenever you wanted to without having to do anything, you wouldnt need to test your blood sugar, so its almost like you have more freedom But now you still have the same freedom, but you just have to, like its all a matter of just taking a shot at the right time or testing your blood sugar JEANNE BLAKE: Dr Lafell, when we were out in the lobby before Tim came in, I saw a snapshot
of what thats like, because I think that your mom or dad mentioned Wheres the testing kit, and its in the car, and do you need a snack, and should we get a snack, and it seemed to be sort of a microcosm of life with Tim Right? I mean, thats what the managing of diabetes is like, making sure youre always thinking ahead TIM: Yes Do you think it has a negative effect on your life in any way, or at this
point now
JEANNE BLAKE:
for a 15-year-old is it pretty routine?
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TIM:
I think its really routine, its just like an everyday thing So, Doctor, talk with us a bit about Tims treatment Its typical, right? Two shots
JEANNE BLAKE:
a day are you still taking, Tim? TIM: Im taking three now Three a day Because your cells more have died off, right?
JEANNE BLAKE: TIM:
Yes, pretty much He takes a minimum of three shots a day Because if he ever has a day where
DR LAFFEL:
he needs to eat a little bit more or his sugars may be running a little bit higher, which happens all the time, he would actually then get an extra fourth or fifth shot a day What we try to do is, we try to give insulin to match the childs lifestyle The treatment programs for children with diabetes, for adults with diabetes, are individualized, because diabetes doesnt go away Its a 24/7, 365-days-a-year job You dont go on vacation from diabetes, and in order to keep up with the rigors and the demands of diabetes management, you at least want to make it fit easily into Tims lifestyle That Tim could learn as an adolescent how to sleep late with diabetes is wonderful Thats key, and
you learn how to do that by changing the timing of some of your insulin injections And you dont do this in isolation JEANNE BLAKE: Give me an example Changing the timing of your injections, what does that
mean? Help me understand DR LAFFEL: Tim TIM: I take one in the morning when I wake up, I take one at dinner, and I take one when I go to bed Okay And so the change is where? By taking insulin he has to take insulin before breakfast and before supper Well, right now, Tim, for the most part, takes insulin, and you can tell us when,
JEANNE BLAKE: DR LAFFEL:
You also take different kinds of insulin, because you have insulin thats called short-acting insulin that sort of covers a meal, and then you take long-acting insulin, which covers what is called the basal insulin needs in the body Even when we are fasting, the body still needs insulin in order to use sugar
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for energy So you take different kinds of insulin and at different times of day to match what the pancreas used to do JEANNE BLAKE: DR LAFFEL: I get it And now by moving that supper shot of insulin, Tim still covers his dinner and
even a bedtime snack if he wants to, but taking a
long-acting before his bedtime allows him coverage overnight and into the morning and lets him sleep late JEANNE BLAKE: TIM: Terrific Youre involved in sports, yes, Tim?
I play hockey, I mountain bike, Im going to be playing on the lacrosse team for my high school Wow
JEANNE BLAKE: TIM:
I play paintball Thats not a sport, young man
JEANNE BLAKE: TIM: Oh, yes it is
JEANNE BLAKE: TIM:
Paintball is a sport?
Its a professional sport Oh no Whats happened? Paintball is a sport?
JEANNE BLAKE: TIM: It is a sport
JEANNE BLAKE: TIM:
The look on Tims face is like, Boy, you dont know very much
No, I mean, my friends and I are in a five-man tournament team now Its just as competitive as
a hockey tournament
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JEANNE BLAKE:
I stand corrected But you dont find Doctor, what about Tim putting that
stress on his body? I mean, does that require a closer management? DR LAFFEL: JEANNE BLAKE: DR LAFFEL: The exercise isnt stress for his body The exercise is health for his body Well, you know what I mean Demanding, demands on his body Its just like for everybody else Maybe we dont have to play paintball, but
exercise is healthy for all of us JEANNE BLAKE:
DR LAFFEL: But doesnt that demand on the body change the requirements? It means he needs to be more vigilant about his diabetes management, because
when youre exercising your muscle cells need more energy, they need more sugar for energy, so you have a chance for your sugar to fall rapidly So Tim has a bigger job than other people when he exercises, because he needs to check his sugar before exercise, check his sugar after exercise, he needs to provide a snack before exercise And not only that, even hours after the exercise sometimes, youre at risk for your blood sugar dropping He needs to be checking his sugars at bedtime and providing an overnight snack to make sure there isnt a lull I give Tim a lot of credit JEANNE BLAKE: This rigorous schedule that youre describing, that takes so much vigilance on
Tims part and on the part of his family Is there anything in research right now where you could see this becoming a little bit easier? DR LAFFEL: Theres a huge amount of research going on in this country and elsewhere, trying
to learn what causes diabetes, ways to hopefully in the future prevent diabetes, in the future to cure diabetes by replacing those cells that have been
destroyed in the body While were waiting for these really important scientific advances, every single day there are improvements in technology that is a very important part of Tims diabetes management I mean, the way you check blood sugar today can take as little as five seconds When this technology came out only about 20 to 25 years ago, it would take over two minutes and would not nearly be as accurate So five seconds isnt a whole lot of Tims time for checking Tims blood sugar There are new insulins around to add to Tims flexibility What families tell me is that, besides knowing diabetes doesnt go away and its frightening to be living with it, the thing they miss the most is the lack of spontaneity, what you heard Tim mention before about how he has to think about diabetes before sports and so forth New technologies will help bring back some spontaneity Those include possibly using an insulin pump, using a new kind of insulin that provides
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some basal insulin coverage, and then you just take small injections when youre going to eat, and quicker ways to check your blood sugars and more continuous ways to check your sugars JEANNE BLAKE: There are
pumps on the market now, and I guess, from what Ive read, they are
in the process of being refined and made more like the natural body process DR LAFFEL: Pumps are one of the choices for treatment, and Tim could elect insulin pump
therapy The thing about a pump now is, pumps still have to be managed Theyre whats called openloop systems; all they do is deliver insulin Just like a syringe, they just deliver insulin They still need the programming of the person to decide how much insulin to give JEANNE BLAKE: DR LAFFEL: And that has to change all day long, right? It needs to change as you eat The basal amount of insulin can be
preprogrammed, but it doesnt help you every time you need your sugar changed JEANNE BLAKE: I see Okay, that makes sense to me All right I could keep talking to both of
you Tim, Im going to say goodbye, because we want to get your mom out here to get her perspective on all this But I applaud you for coming in to tell your story so that other people can understand what its like for a 15-year-old to live with diabetes And we wish you continued good luck and good health TIM: Thank you So well be back in just one moment with Kathy, Tims mom, to learn about
what
JEANNE BLAKE:
its like to have a child with diabetes in your family Stay with us We continue our discussion now about type I diabetes with Kathy and Skip, Tims mom and dad Thank you for coming in today to talk with us and to shed some light on what its like for a family to go through this Skip, when you learned that your 11-year-old athletic son was living with diabetes, what went through your mind? SKIP: I was pretty scared I was scared for him because of the infringement that it would have on his activities throughout the rest of his life Plus, I really didnt know a whole lot about the treatment of it All you hear about is the fears of the long-term consequences of the disease And through his stay at Childrens, through the education program actually that was set up over at Childrens and also at Joslin, we started to learn more and more about it The part of the whole treatment, I think, which is the key, is
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that the whole family gets connected with it Thats the whole learning process, and I think Tims a really good candidate, hes a good kid to be able to let us help him with it, and we in turn are more than happy to help him JEANNE
BLAKE: SKIP: Thats right JEANNE BLAKE: the routine big time KATHY: Oh yes In the beginning its overwhelming, and Tim will probably tell you, I think I was What is it like for you, Kathy, to sort of have to monitor that, every day, day in and So you really do take the team approach? And Dr Lafell has said that that is key
to managing it as well as his disease is being managed
day out? Were four years into his diabetes so now its somewhat routine, but it had to have shaken up
counting Cheerios for the first month, because you start with a meal plan and you start counting carbohydrates and its an entire learning process that we went through The one thing that we kept telling ourselves, and weve talked about this before, was that its a lifestyle change, its not a life sentence And keeping that in mind, we worked to make the right changes for Tim, and yes, it was difficult, and we luckily had a lot of support from the team at Joslin, and there are parent support groups that we went to So we saw other people dealing with the same issues JEANNE BLAKE: group? KATHY: Just the fact that a lot of the things that we were experiencing were common to many Thats what I was going to ask you
What did you take away from that support
people, to many families, and yes, there is stress related to learning about diabetes and to learning how to deal with it There are joys when you learn to do things right, when youve given your child a shot and you havent had any seepage, the insulin stays in his body, because sometimes that can seep out onto his skin, when his blood sugar levels seem to be leveling off There are a lot of successes that we saw too JEANNE BLAKE: guilty? Dr Lafell said that we dont know what causes it I just cant imagine that you
didnt go back and wonder what caused it, and Im wondering if you felt if you had angst over that or felt
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KATHY:
Not guilty, because immediately at Childrens we were taught that its no ones fault, its
something that takes place Its almost I can picture it like a puzzle There are a number of different pieces that if they all fall into place, then if the puzzle is complete with diabetes, then that could be the onset of the illness But its not anything that either one of us could have done to prevent it or either one of us could have done that caused it It was just a series of things, a series of
incidents, perhaps, that took place in Tim and then here we are JEANNE BLAKE: What do you think, and Id like either one of you to respond to this, your son seems so very well adjusted with this and as the doctor says, hes doing extremely well Hes sort of the model diabetic patient KATHY: Id like to think that, but hes just a regular kid and he always was He was a happy
fellow before diabetes, and hes going to be a happy fellow throughout his life SKIP: We just didnt want anything to basically restrict anything that he wanted to do, and I think through the education he can learn to live with it The fact of all the activities that he does and different sporting activities, I mean the one thing were concerned about is him being by himself, like if hes mountain biking or if hes biking around town with his friends, if he gets low, how to be able to be treated The next fear that were going to be going through is, two years from now hes going to be driving The more that he can be adjusted and learn about his body right now, the better off hes going to be JEANNE BLAKE: Im wondering what advice you have for other parents who are just learning
about this, about their child living with
diabetes, and what advice you have that can help them deal with it as successfully as the doctor thinks that your family is dealing with this KATHY: What would I tell people first? Id say be gentle on yourself and dont beat yourselves up
about something that you cant change, that with support between one another, the support you have among family members, with your friends, with loved ones, there are so many ways you can get support to feel more confident about dealing with any issue in life Thats what people need to hear SKIP: Youre not alone Youre not alone There are a lot of groups out there and everybody has been through it before And I think thats probably the whole key We were so paranoid at the start I mean, we had scales and this and that and how much is four ounces and this I think the one other thing, too, with the program is that they had a phone call system, so if you didnt know how to take the shot or you didnt know how to do something, you could make the phone call
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KATHY:
Call right into Joslin They walked us through what we needed to do to adjust Tims
insulin level It was great JEANNE BLAKE: Well, this program does air in other
communities and other cities, so we hope
that they have programs that can address those needs and give parents that kind of support Thats a good note to end on, that you guys are feeling that its important to reach out, and hopefully other families that are hearing this will know to do the same Thank you so much to both of you for coming in Ill see you next time Im Jeanne Blake
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