Diabetes​—How to Live With It

KATHY is a young woman. She watches her diet and her weight, gets plenty of exercise, and follows her doctor’s instructions. She also gives herself insulin injections every day. Kathy is one of many millions of people who have diabetes.

In spite of all her precautions, Kathy admits: “I never can tell what my blood sugar will be. One afternoon it may be 300. The next day, on the same schedule, it may be 50 and I’m going into insulin shock.” Not long ago she developed a nonhealing infection and spent weeks in a hospital.

Mae is an older woman. She does not watch her diet and, as a result, is 50 pounds (23 kg) overweight. She admits that she does not follow her doctor’s orders very well. She shrugs off the fact that her blood sugar often hovers above 300, and she refuses to take insulin. Though she does take a diabetes pill daily, she seems surprisingly unconcerned about her disease.

Although they seem so different, both these women have the same disease. It is called diabetes mellitus. Why is there such a difference in the two of them? More importantly, what can they do to enable them to live with their diabetes?

Diabetes​—What Is It?

First, we need to understand what diabetes is. A key factor in the disease has to do with the body’s production of insulin, a hormone made by the pancreas. Insulin enables the body to pick sugar out of the bloodstream and to get it inside the cells where it is used for energy or is stored.

However, if the body does not produce enough insulin, little of the sugar will get to the cells to produce energy or be stored. Instead, sugar builds to high levels in the blood and begins to cause problems. Simply put, that is diabetes. And there are two main types, as illustrated in the cases of Kathy and Mae.

In Kathy’s case, the disease is called Insulin Dependent Diabetes Mellitus, or Type I diabetes. The problem here lies in the inability of the pancreas to make insulin. Recent evidence indicates that this type of diabetes may be caused, at least sometimes, by viral infections. The person with this type usually contracts it at a young age (under 30), is usually thin, and needs insulin shots to live.

In Mae’s case, the disease is called Non-Insulin Dependent Diabetes Mellitus, or Type II diabetes. It is often referred to as adult onset diabetes and is different from Type I. Here the problem is not that the pancreas makes no insulin but that it does not make enough. Much of the insulin it makes is soaked up by fat cells. The pancreas cannot make enough insulin to cope, and the blood sugar goes up. People with this type of diabetes are usually over 30, are overweight, and can sometimes get along without insulin shots. They also seem more likely to inherit their diabetes.

Treating Type I Diabetes

Kathy’s diabetes, Type I, is much more serious, though less common. It would seem that the solution to Type I is simple​—just replace the insulin. However, though insulin shots can keep a diabetic alive, they cannot account for the minute-to-minute fluctuation of insulin level that the body needs.

In order to minimize the complications of diabetes, such as blindness and kidney trouble, it is important to reduce the amount of sugar in the blood and in the urine. The need is to imitate the body’s normal and frequent fluctuations of insulin. But the question is just how to do that. The treatment is two-fold: (1) preventive maintenance and (2) insulin replacement.

With preventive maintenance, steps must be taken to minimize the daily fluctuations in the body’s need for insulin. A vital factor is the food that the person eats, for this is what the digestive system turns into blood sugar. The prudent person with Type I diabetes soon learns that he must have a well-regulated diet. This includes the more complex carbohydrates, as well as fats and proteins. This diet avoids sugar, honey, pastries, sugar-laden soft drinks, and similar sweets. These carbohydrates swiftly find their way into the bloodstream.

This diet must be presented to the body at regular intervals. If the diabetic becomes careless, eating whatever appeals to him at any time, the levels of insulin and blood sugar quickly get out of balance. This leaves the person open to quick and severe illness or to the long-term complications of the disease.

Exercise lowers blood sugar. So the conscientious Type I diabetic includes exercise in the daily routine, being careful to have available a quick source of sugar (such as hard candy) in case the exercise drives the blood sugar too low. That can lead to diabetic shock. Emotions, too, can wreak havoc with the blood sugar and may be a cause of poor self-control regarding the diet. Infection and illness must be quickly treated, since they can cause blood-sugar levels to swing widely.

Yet, in spite of taking all these factors into account, the patient with Type I diabetes, like Kathy, may still have trouble stabilizing blood sugar. What then?

The second main aspect of treatment is the use of insulin injections. When insulin was developed over 60 years ago, it was lifesaving for many diabetics. And later development of one-a-day shots was initially perceived as a great advantage.

Though the daily injections are more convenient, there is some concern about possible long-term complications, such as hardening of the arteries. Thus, some are recommending more frequent injections of short-acting insulin to control the blood sugar more tightly during the course of the day. Several recent developments have made this not only possible but also practical.

One advance for home monitoring of blood sugar has been labeled “the first truly significant therapeutic advance since the discovery of insulin.” Using a simple portable machine, the diabetic may check his own blood sugar several times a day. Thus he can make his own frequent adjustment of insulin dosage and can come closer to constant normal blood-sugar levels.

One disadvantage of home monitoring is that the diabetic must prick his finger for the blood test. But there are special lancets for this, and those experienced in the procedure say it really is not bad. Another disadvantage is the cost of the machine. However, that expense should come down with improved technology.

Other advances include the development of inexpensive, disposable, very sharp insulin needles. These have rendered the insulin injections less painful. Also, the insulin available today need not be refrigerated; thus serious inconvenience is avoided on trips.

Insulin that is equivalent to human insulin has now been marketed and is often recommended for newfound Type I diabetics. New also are the pressurized, needleless insulin injector and the insulin infusion pump. The pump is a portable insulin injector that the patient wears on his belt. It constantly injects insulin through a needle in the abdominal cavity. The infusion pump, although in use today, is considered by many doctors to be somewhat dangerous and should be used only under the supervision of a specialist.

Regarding children who are Type I diabetics, a recent trend has been to be less concerned about diet. Some feel that they can eat a relatively normal diet and then cover that diet with whatever insulin is necessary. Of course, such children still should not eat many sweets. The real basis for their living a relatively normal life seems to be close blood-sugar monitoring and frequent insulin adjustment.

Treating Type II Diabetes

There have not been nearly as many advances in the treatment of the more common Type II diabetes. As noted, the problem here is not the inability of the pancreas to produce any insulin at all. It is the inability of the pancreas to keep up with the body’s escalating need for insulin, usually worsened by excess weight.

Though pills are widely used, these serve to push the pancreas to put out more insulin. But there is a limit to how much you can ‘whip a tired horse,’ in this case, a tired pancreas. A good diet that reduces weight and cuts down on the simple sugars, accompanied by sensible exercise, may be more useful.

If diet, exercise, and abstention from sweets do not lower blood-sugar levels enough, then pills may be prescribed. Here, opinions differ. Some doctors prefer to use insulin injections rather than pills even in Type II diabetics. There may be side effects to the pills, and there is some question as to whether they really help prevent long-term complications.

In each case, all factors need to be weighed by competent doctors before treatment is recommended. And the diabetic must weigh the recommendations and make the final decision as to what he will do.

Living With Your Diabetes

Thus, coping with diabetes involves different steps, depending on which type a person has. For the Type II diabetic the solution may be diet and weight loss. But one doctor stated: “Realistically, my experience has shown that the likelihood of that happening is small. I am prepared in most cases to give my patients pills or even insulin from the beginning.”

For the Type I diabetic, the solution of living with the disease is not so simple. Here, too, part of the answer may lie not in the medical treatment involved but in the individual’s attitude toward the diabetes. True, it is not a pleasant thing to look forward to daily injections, perhaps several times a day, nor to pricking the finger to check the blood sugar. Neither is it easy to make sure one’s life is organized to the extent that one eats similar foods at regular intervals at about the same time each day and that exercise and rest are properly planned.

At the same time, a realistic outlook means accepting the fact that at present there is no cure for diabetes. But there is treatment that, while requiring discipline, can keep diabetics alive and reasonably well for many more years than would be the case without treatment.

Attitudes to Avoid

One needs to avoid two extremes of attitude. On the one hand, a person who has diabetes must avoid being careless about the problem, failing to follow sound medical direction, and perhaps hoping that the problem will go away. It will not.

On the other hand, since emotions cause erratic blood-sugar levels, it could be counterproductive to become overly worried about the problem. It will not help to be in constant fear and to be wrapped up in compulsive care of the diabetes to the exclusion of normal activities. Though the life of diabetics must necessarily be regulated, the vast majority can live well-structured lives.

Will diabetes, as well as other illnesses, ever be permanently cured? God’s Word, the Bible, gives the heartening answer: Yes, without fail! And that will happen in the near future! This cure will take place here on earth under the rule of God’s Kingdom, the government that Jesus taught his followers to pray for. (Matthew 6:9, 10) At that time, “no resident will say: ‘I am sick.’”​—Isaiah 33:24.

[Blurb on page 26]

Part of the answer may lie in the individual’s attitude

[Picture on page 25]

To help control the blood sugar, a diabetic needs to discipline himself to avoid sweets