This picture was taken on the day in 2008 that Kenny went into DKA.  Hours later, he would begin vomiting; we thought he just had a stomach bug.  Unfortunately, we were wrong!  Can you tell that he is literally deathly sick?

 

A picture taken later the same day, with the ice cream cone that literally put him over the edge.  I refer to this as the "Ketoacidosis picture."  A day and a half later, he would be in the ER and soon thereafter on his way to the ICU at Children's National in D.C.  Our lives would never be the same!

There are two types of Diabetes, known as Type I and Type II.  Both are dangerous, require constant monitoring, and can be fatal if left unchecked. 

Type I
Type I diabetes was previously known as Juvenile Onset diabetes, and is sometimes still called this, even though it can strike adults as well (think Bear's quarterback Jay Cutler).  With Type I diabetes, the body is "insulin-dependent", because the islet cells in the pancreas no longer secrete insulin.  Type I is an auto-immune disease; the immune system attacks and kills the islet cells. 

Insulin is like a key that unlocks cells so that glucose can enter them and provide energy.  Without insulin, the cells literally cannot receive glucose, which is their source of energy.  Cells cannot survive without energy, so external insulin must be provided.  In principle, this sounds simple, but it isn't at all.  Too much insulin in the blood allows all of the glucose in the blood to be processed by cells, leading to potential death.  Too little insulin causes blood sugar levels to be elevated, which causes damage to organs over the long term.  The balance is extremely difficult to maintain and requires constant monitoring.

External insulin must be delivered on demand, to avoid potentially deadly lows (low blood sugars).  But herein lies another problem:  insulin is broken down by the digestive tract, so it cannot be ingested as a pill or in a drink.  Instead, it must be injected.  Thus, insulin-dependent diabetics require needles or pumps to receive their medicine.

Insulin was really only discovered in the 1920s.  Prior to that, a diagnosis with Type I diabetes meant almost certain death.  Now, various types of insulin are available, but a diabetic's life is not easy.  Type I diabetes is not curable - it lasts a lifetime.

Kenny has Type I diabetes.



Summer 2009 photo in his Red Rider jersey (people with Diabetes wear "Red Rider" jerseys in Tour de Cure)

Type II
Type II diabetes has some similarities to Type I, in that the body's glucose to insulin ratios get out of whack, but the results are somewhat different.  Type II diabetics may or may not need to receive insulin, because in most cases the insulin is there but it may not be able to "unlock the cell" to enable glucose to enter. 

Being overweight and eating poorly can bring about Type II diabetes.  It is easier to control than Type I,  but it can be equally deadly if not monitored.  About 90 percent of all diabetics have Type II.

ADA supports people with both types of Diabetes - about 23 million in the U.S. alone.


For more basic information about Diabetes, please visit Wikipedia:

http://en.wikipedia.org/wiki/Diabetes_mellitus

There is hope for the future, in stem cell research and artificial pancreases.  Insulin pumps are capable of delivering very small doses of insulin throughout the course of the day.  A pumps mimics the function of the pancreas, although the amount of insulin to deliver must be calculated by a person (needless to say, the pancreas performs that analysis in normal, non-diabetic people). 

Kenny began using an insulin pump at the end of April.  With the pump, he no longer has to take 4 shots each day, which is obviously a benefit.  He does, however, have to move his "infusion site" (e.g. the spot where the insulin enters the body) every third day or so.  And, pumps present other issues, like greater risk of DKA.  However, there are a lot of advantages to insulin pumps, not the least of which is not having to carry syringes and insulin bottles all the time.


Diabetic KetoAcidosis
On the first page, and above, I mentioned that when Kenny was diagnosed with diabetes, he was in ketoacidosis (DKA).  This is a potentially fatal condition that arises when the pancreas essentially shuts down insulin production and glucose begins to build in the bloodstream.  What basically happens is that cells are no longer able to get energy (which is supplied by glucose, but it must be "unlocked" by insulin).  In Kenny's case, when we got to the emergency room, he could barely walk down the hall!  DKA signals the onset of Type I diabetes.

Since Kenny was diagnosed, we may met many people who have had similar if not more harrowing experiences.  One teenage girl went into a diabetic coma for 4 days!  Another girl also went into a coma, after appearing to be fine.  Appearing "on the verge of death" is actually not that uncommon in undiagnosed DKA, and it requires treatment in Intensive Care, because it can be fatal.  People confuse Type II diabetes with Type I - the long term effects are similar, but the short term is not.. Type I Diabetes will be fatal if left unchecked!

Symptoms of DKA are extreme thirst, frequent urination, flu-like symptoms and appearance, lack of energy and, characteristic to DKA, a fruity "sugar-like smell."  That's right - people in DKA literally smell like sugar!  We didn't notice it, but a nurse did when she walked in the room.  Diabetes is extremely serious - and life-threatening!  We didn't know that until Kenny got it!  Don't be fooled - failure to produce insulin will lead to death if untreated!