Wednesday, November 6, 2002/lk
Doug Degeus is not your typical diabetic. He’s razor thin, active and in good shape. But he knew something was wrong two years ago on a drive to Tillamook.
“I stopped about 15 times to pee and drank about 17 bottles of pop,” Degeus recalled. When he got home, he went to his doctor and a blood glucose test showed his blood sugar level was over 700 — more than 500 points above the normal range.
“My doctor said, ‘How are you still standing?’” said Degeus, who was diagnosed with type 2 diabetes, although he’s since been placed in a new category called late onset, slowly-developing type 1 diabetes — informally referred to as type 1 1/2 diabetes.
Degeus is one of more than 11 million Americans diagnosed with diabetes, a disease that affects the body’s ability to produce or respond to insulin, a hormone that allows blood sugar to enter the cells of the body and be used for energy. Type 1 diabetes usually begins during childhood or adolescence, and is characterized by a complete failure to produce insulin. Type 2 diabetes, the most common form of the disease, usually occurs in adults after age 45. People with type 2 usually still produce some insulin, but not as much as they need, and their bodies don’t make efficient use of it.
Because diabetes can go undetected for years, the American Diabetes Association estimates there are 8 million more Americans who have the disease and don’t know it. There is no cure for diabetes; patients have to manage the disease with diet and lifestyle changes, oral medication or insulin shots — or a combination — for the rest of their lives.
Jennifer Price, a certified diabetes educator at Providence Hood River Memorial Hospital, explains diabetes — and its complications — with the help of two glass tubes filled with red liquid and dozens of little white balls. One tube represents the blood of a “normal” person, the other someone with diabetes. Price shakes both tubes and holds them upright. In the “normal” tube, the white balls — representing white blood cells — descend quickly through the liquid and settle on the bottom in a few seconds.
In the “diabetes” tube, the balls sluggishly make their way toward the bottom, still not settled after nearly a minute.
This is what the blood of a diabetic is like, according to Price.
“Normally, white blood cells travel quickly,” Price said. “We use (the tubes) to illustrate how much more slowly white blood cells move in diabetics.” It’s this phenomenon that brings about several complications of the disease, including difficulty with infections and wounds not healing properly or quickly.
“It also shows how much thicker blood is when you have diabetes,” Price said. This leads to blood clotting more easily and to an increase in cardiac complications. Price said that people tend to be more frightened of some of the other complications of diabetes, like blindness and kidney failure. But in reality, those are far less common than cardiac problems related to the disease.
“Eighty percent of people with diabetes die from cardiac complications,” she said.
When Degeus was diagnosed his doctor started him on oral medication, but that didn’t regulate his blood sugar enough. So Degeus began giving himself insulin shots several times a day. But last month he got an insulin pump, one of the newest tools diabetics have to manage their chronic disease.
Pumps deliver small amounts of insulin throughout the day and night through a small needle that stays in place for a few days at a time. The needle is attached to a tube that connects to the pump, which fits into a small holster that can be worn on a person’s belt much like a cell phone. The pump can be programmed to deliver specific amounts of insulin at different times to coincide with meals — or the lack of meals. It also keeps a digital log of when and how much insulin was delivered so the wearer, by testing his blood sugar frequently, can closely monitor blood sugar levels and make adjustments.
Degeus has been meeting with Price and Kelly Chambers, another certified diabetes educator at the hospital, frequently for the past month as they work to refine how much insulin he needs and when to deliver it.
So far, Degeus has been pleased with his switch from insulin shots to the pump.
“I was giving myself four to five shots a day,” he said. “There were times when I’d say, ‘Screw it, I’m not giving myself another shot.’” Along with being less painful than stabbing himself with a syringe every few hours, the pump gives Degeus more freedom and helps keep his insulin level more stable.
“Before, Doug would have to eat meals to match up with his insulin shots,” Price said. Now, he can give himself a surge of insulin with a snack, or delay insulin delivery if he happens to miss a meal. “Now, he coordinates his insulin with when he eats rather than eating to coordinate with his insulin,” Price said.
Degeus does have to diligently check his blood sugar with pin pricks to his fingers — up to six times a day. And he must do calculations of the food he eats, mentally translating portions of starches, fruits, and vegetables into their equivalent grams of carbohydrates in order to calculate how much insulin he’ll need to process it.
“It’s not hard, but it’s not easy,” Degeus said. The pump also helps to stabilize his insulin levels better over time, which could help stave off complications that come with wildly fluctuating insulin levels. That’s good news for Degeus and all diabetics who must work to control their disease for the long term.
“You don’t have to have diminished quality of life when you have diabetes,” Price said. “Doug’s a perfect example of that.”