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Redefining Diabetes

Azriela Jaffe

It’s not a disease. It’s a medical condition — and one that’s relatively easy to live with. Kids and teens with type 1 diabetes take us into the world of blood testing, carb-counting, and emunah-building.

Wednesday, July 27, 2011

“If you make a diabetes diagnosis a big secret, it’s going to take over your life. If you don’t make it a problem, it’s not a problem. You are controlling the diabetes; it’s not controlling you,” asserts Tzippy*, an outspoken teenager who has lived with type 1 diabetes mellitus since age three.

Diabetes is something Tzippy has, not something she is. She doesn’t hide it, isn’t ashamed of it, and she’s eager to educate people about what causes the medical condition and how she manages it.

“Hashem has a plan for all of us. He created us with, if we utilize it the right way, a way to advance our soul. I really believe that diabetes is what my neshamah needed to prepare for the Next World,” says Tzippy.

The unusually mature teen firmly believes that, as a rav once told her, “You are not sick. As long as you control your blood sugar, you can be as healthy as any of us.”


Diagnosing “Type 1”

If you know a diabetic, you’ll hear the term “blood sugar” thrown around a lot. But what exactly does it mean?

When a normal, healthy person eats a meal, the food gets broken down and converted into glucose — otherwise known as blood sugar — which fuels the body like gasoline does a car. The pancreas is an essential part of the process because it pumps out precisely the right amount of insulin, a hormone, to help the glucose move from the blood into the cells.

Type 1 diabetes occurs when the pancreas doesn’t produce enough insulin. As a result, the glucose builds up in the blood and, instead of going into the cells, overflows into the urine and passes out of the body. With its blood sugar reserves depleted, the body then turns to its “plan B” energy source — fat. This explains why weight loss is a red-flag sign of diabetes.

Within five to ten years of onset, the pancreas of a diabetic typically goes from less-than-ideal function, to minimal function, to entirely nonfunctioning. Since the body can no longer produce insulin, diabetics often require insulin injections to ensure sufficient blood sugar.

“Diabetes is basically an autoimmune response that ultimately leads to destruction of the insulin-producing cells in your pancreas. This process could be going on for months or years without you even knowing it. Once your pancreas’s ability to produce insulin drops below a certain threshold, your blood sugar starts to rise. This is when the typical symptoms of diabetes present,” explains Dr. Ian Marshall, chief of the division of pediatric endocrinology at UMDNJ-Robert Wood Johnson Medical School in New Jersey, who has treated newborns to twenty-one-year-olds with diabetes.

Years ago, this medical condition was called juvenile or insulin-dependent diabetes, but these days, it’s usually just called “type 1 diabetes.” Type 2 diabetes is similar to type 1 but it develops in adults, later in life.

It usually shows up in childhood, adolescence, or early adulthood and affects around 1 in every 400 children and adolescents. The exact cause is unknown, but researchers believe there is a viral or environmental trigger that causes an immune reaction in genetically susceptible people.

In most cases, the telltale signs of diabetes can help doctors correctly diagnose a child. Aside from weight loss, there’s also polydipsia (drinking a lot), polyuria, (urinating a lot), and nocturia (waking up at night to use the bathroom). But an accurate diagnosis can take longer if the pediatrician first suspects a viral infection or some other malady.

“I see children who are diagnosed later than should be,” says Dr. Susan R. Brill, director of Adolescent Medicine at Children’s Hospital at Saint Peter’s University Hospital in New Jersey. “Usually, excess urine and excess thirst brings them in. We dip the urine and send them to the emergency room because a child with a lot of sugar in his or her urine is a child who needs immediate medical attention.”


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