Diabetes and legislation

Generally, it can be demonstrated that knowledge and pictures about diabetes are badly understood and badly viewed. There are several reasons for this, like the lack of information for the public, the lack of information about the disease and new technologies lead to new treatments, confusion between the 2 types of diabetes... That is why employers are scared to recruit diabetics and why relationships are sometimes not easy. They often think that a diabetic patient always has a lot of problems due to the disease and so he can't be efficient at work. Or this is totally wrong, as a patient who is taking care of himself correctly can be like any other person.

In the legislation, diabetics have some restrictions or more exams to pass to get different things like a driving license:
. To work in public functions, a diabetic must have the approval of the Comité Médical in France. Moreover, he can be fired if the Comité Médical declares that he or she is no longer able to do their work correclty. Even if it is a serious organization, the choice can be subjective, due to a bias about diabetics.
. Some jobs and sports are forbidden, like scuba-diving or truck driver, bus driver... Some schools too, like the ENPC (Ecole National des Ponts et Chaussées). To sum up, all the military schools and army jobs plus some engineering schools and public functions, and sport where the total master of oneself is mandated.
. They have to mention their diabetes when they pass their driving license, which has a maximum validity of 5 years (it can be just 6 months).

There are a lot of other details in the legislation where diabetes is mentionned, and this is why a lot of associations are fighting to make the life of diabetics better.

Diabete and Stem Cells Therapy

A Stem cell is a cell which has the possibilty to reproduce itself and to develop into specific ones present in all the organs in the human body, through cell division. Each cell of the human body is differentiated, they have a specific function. However, stem cells are undifferentiated. They can generate various specialized cell types and then they can be used to repair damaged organs and tissues. Due to this, stem cells are nowadays considered as an anwser to incurable diseases like Leukemia or Parkinson's disease, and Diabetes too!! They are the object of a lot of research.

According to the Times, in an article dated 11 April 2007 "Diabetics using stem-cell therapy have been able to stop taking insulin injections for the first time, after their bodies started to produce the hormone naturally again." The experiment has been done on "15 patients with newly diagnosed type 1 diabetes", an important point here because it seems that it doesn't work with old ones. However, only two of them have been able to live without insulin for 3 years since the therapy, while the others keep needing some injections, but just once a week and in small quantities.

The treatment is quite simple. Doctors have isolated stem cells from the blood of patients, who then "underwent a mild form of chemotherapy to eliminate the white blood cells causing damage to the pancreas". Afterwards, "they were given transfusions of their own stem cells to help rebuild their immune systems".

Eventhough this is a simple operation, it is not yet applicable to all patients, because of the randomness of stem cell differenciation, which can degenerate into tumor cells. Moreover, the patient has to have been diagnosed with type 1 diabetes for less than 6 weeks, otherwise it is inefficient.

Tools of a diabetic

Here are objetcs that a diabetic always has with him (I mean at home at least):

. Insulin (Lantus, Novorapid...) :

.Glycemia meter :

.Needles: .Specific Rubbish bin:

.Glucagon:

Diabetic retinopathy

The main cause of blindness in France and many other countries is retinopathy, generally called diabetic retinopathy because it affects more than 80% of 15-year diabetic patients. This disease is another consequence of badly-controlled diabetes, with lots of hyperglycemia. It affects blood vessels which form at the back of the eye, and when there is hyperglycemia, it creates some small vesicles leading to aneurysms that can explode at any time, bleeding in the retina. These bleedings are responsable for an inflation of the retina: these are the first symptoms of retinopathy. There are two levels of retinopathy :

. Non proliferating retinopathy : deterioration of the eyesight but generally undetectable.

. Proliferating retinopathy : to repair deteriorated vessels, the retina makes new ones but more fragile. They can bleed and then affect a part of the eye leading to badly blurred vision. And if the retina heals itself, it can cause blindness.

(pictures from wikipedia)

There are some treatments to counter retinopathy, but generally it is too late when it is detected. The best option is to be treated by an opthalmologist. I have a check-up each year.

"Diabetic Foot"

20% of diabetics may present lesions leading to amputation.

There are 3 000 to 5000 amputations a year due to Diabetes.
Risk of amputation is 15 times bigger for a diabetic than a non-diabetic.
55% of diabetics don't know risks that their feet may have
(as a consequence, they don't take care of them).
42% of diabetics (generally old people with type 2 diabetes) can't wash their feet alone.
(http://jvalla.club.fr/piediabintro.html)

A lot of diabetics may have complications with their feet. In effect, the foot is a complex but a highly important structure of the body. With a lot of muscles and tendons, and at least 26 bones, the foot has a well defined architecture in order to respond to its fonction which is to support the body, from its weight to its different movements. Complex structures are fragile, and diabetes is responsable for lots of problems with feet.

Each hyperglycemia leads to a thin coating of sugar on the body's nerves, preventing them from working well. In this case, the foot can't detect injuries anymore, and many infections may appear. Moreover, it affects the immune system of the patient. That is why a diabetic foot may develop some skin deseases like Vitiligo (a skin condition that causes loss of pigment). Last but not least, diabetes attacks arteries and blood vessels.

The consesquences of these three main complications are that the diabetic feels no more pain in his foot, its architecture is changed and the foot can't function anymore. Any infection can affect the body and the life of the patient will be in danger.

Insulin pump therapy

The regulation of blood glucose level is not that easy. Even though you take care of it, there are always some unpredictable variations just by eating a simple sweet. Moreover, it is much harder for young people, I mean those who are 8, 10 or 13 years old, and for those who already have another handicap. And as said before, if glycemia is not well regulated, it leads to big complications, illness and death. That is why doctors and researchers developed a method based on an Insulin pump. They are an answer to these kinds of problems. This involves an external pump, working with a battery, and delivering rapid insulin continually, under the skin with the help of a catheter. It injects insulin automatically without any variations, permitting diabetics to live a bit more "normally", avoiding hyperglycemia or hypoglycemia. The pump is checked every day, and you can inject more insulin, if you want to eat more, by pressing a button.

However, this therapy is not allowed for everybody. There are specific requirements :
. patients who have difficulties to keep the objectives of good glycemia: too much hypo or hyperglycemia (generally young people or those who already have a handicap)
. patients who want to increase their traitement to have a better control
. people who need smoothness for their meal, and who have problems with the mix of different types of insulin (slow and rapid)
. very active people
. pregnancy
. and other people with medical prescriptions

Diabete estimates for 2025

from the site http://www.eatlas.idf.org/

(click on the picture to zoom)

It represents the purcent for the entire country. It includes both diabete type 1 and type 2.

#3 Daily

Since I have been diabetic, I have learned how to check myself. The thing is to inject insulin before each meal or each sugary food, for example sweets or chocolate. Usually, I do 4 injections a day: one in the morning for the breakfast, another one for the lunch and 2 in the evening. There are 2 types of insulin. Rapid insulin (I use Novorapid), is used to regulate sugar quickly. Its delay is about 15min, and it works for 2-6 hours. This is the one that I take 3 times a day. In the evening, I inject slow insulin (Lantus) too, which works 15-24 hours, but has a long delay. To know how much insulin I have to take at each meal, I used to do a lot of glycemia tests, before and after each meal. Now, I just check in the morning, and I'm not afraid about this.
Unlike northern countries, like Finland or Sweden, French people are not used to seeing a diabetic in action. They generally make weird faces in front of a needle. That is why I inject insulin when nobody knows (friends apart) in the toilet or anywhere I can be alone.
In fact, I do not have a special diet. I eat what I want, and if it is really sweet, then I take more insulin. I eat like everybody does, and I can do the same things. However, some sports are forbidden, climbing and scuba-diving for example.
Sometimes, I can have some problems with insulin level. If I take too much insulin before a meal, and then I don't eat sugar, I would be hypoglycemic or lacking sugar. Symptoms are a raging hunger, dizziness and weakness. The only thing to do in this case is to eat!!

Pancreas's Job

Blood glucose level, called glycemia, is controlled by a well defined process, involving several organs like the liver or the pancreas, and some hormones like insulin. After a meal or whatever you could do (physical exercices, stress...), glycemia tends to increase (or decrease sometimes, with some stress factors). Glucose, which is one of the most important sources of energy for the cells of the organism, needs then to be absorbed. This is one of the jobs of the pancreas. The pancreas contains cells called Beta cells which produce insulin. Insulin is a hormone that will, to put it simply, catch glucose particules and allow them to be absorbed by muscles, organs and cells. The insulin production rate depends on glucose concentration. The more sugar you eat, the more insulin you produce to absorb it, feeding the organism. On the other hand, the pancreas makes glucagon, which produces the opposite effect. When you lack sugar, you produce more glucagon. Those 2 hormones have an important role in the regulation of glycemia.

When you have type 1 diabetes, Beta cells in the pancreas do not work anymore. They are totally destroyed under an auto immune effect of the organism. The pancreas then doesn't distribute insulin anymore. Glucose is not absorbed by the organism, and finally you start to show symptoms of diabete presented before.

#2 The first months

When I left the doctor to go to the hospital, I wasn't in good shape. I could hardly keep walking and I was more thirsty than ever. Moreover when I was on my hospital bed, I got horrible cramps that I couldn't stop on my own. My dad who was there, tried everything but it was hard, and I waited for 10 minutes until the doctor who was taking care of me give me potassium to stop cramps. I was really tired. My blood glucose level was around 5mg/dL and my blood cetone lvl was around 0.8 mg/dL. Normally the correct concentrations are 0.85mg/dL and 0mg/dL (cetone is a poison). My view was also blurred, because of the high variation of glucose...
The first week at the hospital was really strange. With the first treaments, I was starting to realize how ill I was, and it was a pleasure to have some good night's sleep. I met the dietician who told me how I had to eat and what too. I was wondering if I would be able to eat everything I liked before and if I could live like I used to do. I met a lot of doctors, and my family, as shocked as me, went every day and I remember that the nurses were really nice to me. During those 2 weeks of hospitalization, I had to learn how to inject insulin and which dose I had to take. Everything was new for me. I had to regulate my blood glucose level with a small object called a blood glucose meter before each meal, and after too. Sometimes I was crying and it was really hard to inject myself insulin. At school, friends and teachers were really careful with me...

Symptoms of Type 1 Diabetes (insulino-dependant)

Insulino-dependant Diabetes (DID) is more and more well-known, because of all the associations and events it has caused. The symptoms are quite easy to see, and it's important to check with a doctor if you think you have it. Symptoms of Diabetes are all a consequence of high blood sugar concentration. The main ones are generally:

. a quick loss of weight (between 1 to 2 stones)
. a terrible feeling of hunger. You need to eat all the time. (increase of appetite)
. a need to drink all the time. This results in frequent urination.
. a bad mood due to hyperglycemia.

. painful cramps because of a high ketone concentration in the blood, produced by the muscles due to lack of sugar.
. tiredness, for the same reasons.

#1 Why and when

If I'm making a blog about Diabete, and specifically about Type 1, it's just because I have been diabetic insulino-dependant since September 2004. The first symptoms of this disease appeared in August 2004, when I was in holidays near Biarritz. It was incredible how thirsty I could be, and I needed (I could say I have to) to drink all the time. At the beginning it was at each hour, and just before beeing hospitalised, it was every 10 minutes. A complicated situation which was really horrible, I couldn't have a walk or go to the beach without minimum 2 bottles of water just for me. As a result of this, I needed to go to the toilet, at any moment. 2 times an hour, even the night. I didn't sleep well this summer, you guess why. The third week of this August month, I discovered that I had lost around 1,5 stones (10kg). I wasn't excepting anything weird, I was just thinking that it was a hot summer and that I was doing lots of physical exercices. The more weeks went and passed, the more I was tired. In addition, around this same third week, I started to have painful cramps during nights, which woke me up everytime. When I remember that, I say to myself how stupid I was to not tell anything about all those shitty things. In September, when I was at College, some of my friends said to me that I was an undead looking boy. Surely because I wasn't sleeping anymore. Another symptom of the diabete was my terrible mood. I was angry against everybody all the time. I can say I was Hungry too all the time. I needed to eat and eat sweets and sugar and fruits and foods and anything that can be eaten. This situation became really horrible and one day, after I was in trouble with my father due to teenager's cries, I said to him all thoses things. The next day, we went to see the doctor, who said direclty after I had explained him my problems that it was Diabete. My father and I were like chocked and scared, because we didn't know at all what this disease could be. The hour which followed, I went in a specialized hospital by ambulance. I've been hospitalized for 1.5 weeks. Everything was new for me, and during this hospitalisation, I was really lost...

Introduction

Type 1 Diabetes (insulino-dependant) is a disease which affects specific cells of the pancreas, involving the regulation of blood glucose. The Pancreas, when there is Diabetes, doesn't produce insulin anymore, which results in high blood sugar. If it is not treated, Diabete can kill. This blog, created for an English Elective Lesson at ESIEE, aims to describe Diabetes, its causes and consequences, and its importance all over the world.