RICE & MICE: November is national diabetes month

In case you were wondering, November is national diabetes month and the blue circle is an international symbol for world diabetes day on November 14 – so if you happen to see a blue circle, chances are it is tied in some way to diabetes awareness.

People also may be wearing blue on Fridays to support the cause. Yes, I know it’s also Movember and I’ll get to that in another piece, but today I’m discussing diabetes. More specifically, I’m talking about Type 1 diabetes (commonly referred to as juvenile diabetes, insulin dependent diabetes, or my personal favorite: the sugar) and what it is, how it is diagnosed and a little bit about Bobby Clarke, the remarkable Hall of Fame hockey player that just so happened to also have Type 1 diabetes.

The onset of Type 1 diabetes is typically childhood and as old as young adulthood. This type of diabetes is genetic, meaning people are born with it and may or may not know about it until they develop symptoms. Most people think of high blood sugar when they think of diabetes. 

With Type 1, the level of sugar in the blood is elevated because the cells in the pancreas, the beta cells, which produce insulin, are damaged, usually by the immune system. Sometimes it occurs for other reasons, but the majority of Type 1 diabetes is generally it is an auto-immune process, meaning the body doesn’t recognize the beta cells as its own, so it kills them. The autoimmune process is thought to be triggered by something like a virus or another environmental factor. Most of the time people who have diabetes seem healthy until the beta cells and subsequently, the insulin is lost.

Insulin is the hormone responsible for helping to carry glucose into the cells of the body so they can perform necessary functions, to convert glucose to other necessary molecules, or  to help convert excess glucose (sugar) to be stored in the liver. Insulin is used by about two-thirds of the body’s cells. When we eat, blood sugar rises and insulin is released in order to accomplish these processes. If blood sugar is too low, another hormone uses the stored glucose in the liver and releases it into the blood stream. When beta cells are lost, blood sugar rises and there is no release of insulin.

So in a basic sense, diabetes is too much sugar in the blood. Sugar stays in the blood and people may feel hungry because their body needs sugar, but without insulin sugar cannot be utilized properly and it stays in the blood.

When there is too much sugar in the blood, a few things happen. There is more glucose than the kidneys can handle, so more sugar ends up in the urine. When there is more sugar in the urine, there is more water in the urine, so people get dehydrated which means they are very thirsty and they are peeing a lot. Because they lack to fuel needed, the body gets energy from other places, such as fat and muscle, so there is usually a rapid weight loss.

When there is a prolonged period of high blood glucose as in Type 1 diabetes, the excess glucose can cause temporary changes in the shape of the lenses of the eyes, resulting in blurred vision. When blood glucose is returned to a sensible level for a period of time, the lens will revert to its original shape.

To summarize there is no insulin so blood sugar stays high, because the body needs glucose in the cells, hunger increases and blood sugar rises more. Kidneys can’t handle that much sugar and sugar and water are lost in the urine, so dehydration sets in and at the same time the vision may or may not be blurred due to the change of shape of the lens of the eye. The body still needs a source of energy so the person remains hungry while the body looks to fat and protein stores for energy and there is weight loss.

As you can see, there is a tendency for this to spiral a bit out of control and the symptoms may present and worsen over a matter of a few weeks. Sometimes the symptoms are recognized before serious complications, but sometimes a person develops diabetic ketoacidosis (DKA), which causes nausea, vomiting, abdominal pain, deep rapid breathing, confusion and possibly coma.

Bobby Clarke was diagnosed with Type 1 diabetes when he was just 13. Back then, people that were newly diagnosed with diabetes were admitted to a hospital while their insulin was managed and the dosing schedule was determined. In the 1960’s blood glucose was tested at home with urine strips. Insulin came in vials and single-use disposable syringes were brand new, and most people didn’t have that luxury, so reusable syringes and needles were used and had to be cleaned and boiled after each use.

Insulin was refined from animal sources and had to be kept refrigerated. People with diabetes had to be strict about diet and portion control because they basically got one insulin shot per day, so if their sugar was up as indicated by the urine test strip, they just had to modify their diet the next day. If their sugars were low, they never really knew how low, they just had to judge by how they felt.

Since exercise helps lower blood sugars, athletes who had diabetes had to be extremely careful and mindful of how they felt. They always had to have a source of sugar available in case they experienced symptoms of a low blood sugar, or lows.

In Clarke’s case some trial-and-error allowed him to develop a routine in which he drank 2 cans of Coke with extra sugar added before games, drank half of a glass of orange juice with added sugar at each intermission and a full glass of OJ after the game. He also had to bring candy bars and glucose gum with him just in case he developed symptoms.

Symptoms of low blood sugars include: shakiness, anxiety, heart palpitations or rapid heart rate, sweating, feeling warm, pale and/or clammy skin, feeling pins and needles, hunger, nausea, vomiting, headache, irritability, confusion, mood swings, slurred speech, clumsiness and sleepiness.

In light of the obstacles that diabetes presented Clarke, it’s remarkable that he met them head on and had such a long and successful career. I think the most important aspect of his dealing with diabetes was that he took responsibility for it and didn’t use it as any type of excuse or crutch. The doctors that worked with Clarke at the time told him the most important thing that anyone with diabetes will hear: that he had to take care of his diabetes. It was up to him. It was his responsibility, not the team doctor’s, not the trainer’s, not his parents’ or his coach.

Treatment of diabetes has come a long way since the 1960’s. Today, blood sugar can be accurately checked with a blood glucose meter the size of a pocket calculator. Insulin comes in several different varieties, including long acting, intermediate acting and rapid acting versions to allow people to keep very tight control of their blood sugars. Insulin may come in a vial just like the “old days” or it can come in a convenient and portable pen system that does not have to be refrigerated.

Perhaps one of the best inventions to happen to a person with Type 1 diabetes has been the development of the insulin pump. There are various varieties of the pump, and they keep getting better and better. Most pumps today have the capability of detecting blood sugar levels without extra needles and portable glucose meters. They can provide both a baseline level of insulin for all day as well as allowing the user to give themselves insulin after meals to help keep blood sugar from jumping too high. The pump isn’t necessarily better than injections via pens or vials; it’s more of the preference of the individual.

Other athletes that happen to have Type 1 diabetes include former Flyer Nick Boynton who was diagnosed at age 19, and Chicago Bears quarterback Jay Cutler, who was diagnosed at age 25.

Boynton uses an insulin pump and finds it convenient to not have to take a shot before each meal and give himself 6-8 injections per day. During workouts, Boynton would simply detach his insulin pump.

When Cutler was first diagnosed, he preferred the insulin pens over the pump. These “pens” allow the dose of insulin to be dialed up and the needle is often less than a half-inch long and a very small gauge to lessen the discomfort of the injection, which goes into the fat under the skin of most commonly, the abdomen or thighs.

Other current NHLers that have Type 1 diabetes are Toby Pederson of the Dallas Stars and B.J. Crombeen of the St. Louis Blues.