Scott Hanselman

I was talking with a friend and they asked some question about my insulin pump or something and I realized I’d never explained diabetes to him.  I did, and he said, “you explained this in 15 minutes better than it’s ever been explained to me. You should blog it.”

So I have a place to point people (and you do too!) here’s:

The Basics:

There are two types of Diabetics:

• Type I – also called Juvenile Diabetes or Youth-Onset or Insulin Dependant (IDDM).  These folks ALWAYS use Insulin.  If someone says “I’m Type I” you know theyinject insulin.
• Type II – also called Adult-Onset or Non-Insulin Dependant (NIDDM)

They are so different it’s a shame they are both called Diabetes.

• Type I – Typically these folks don’t produce any (or much) of their own insulin.  If I don’t make it, I need to get it somewhere.
• Type II – These folks typically have decreased responsiveness to their own insulin.  If they aren’t using their own insulin well, they need to be made more sensitive to it.  As with any drug, the more you take, the more you need.  If you’re a big carbo eater your whole life, you’ll produce a lot of insulin, and chances are you’ll eventually become resistant to your own insulin.

“Worldwide, there are about 171 million diabetics, but only about 10 percent of those have Type 1 diabetes. The vast majority have Type 2 diabetes, which is linked to obesity. In the United States, about 900,000 to 1.8 million people have Type 1 diabetes, the American Diabetes Association says.” [Wired]

The Airplane Analogy

 You are flying from L.A. to New York. You have to maintain a consistent altitude the whole way.

Note: For this analogy we will focus on a good cruising altitude and pretend that taking off and landings aren’t important.

Food raises blood sugar (altitude.)  Insulin lowers it.  Non-diabetics don’t have to think about altitude, as you all have a working pancreas (autopilot) and don’t sweat altitude.  Diabetics, on the other hand, have to constantly wonder if they are at a safe altitude.  Staying at a consistently high altitude (high blood sugar) will eventually make you sick; while a low altitude (low blood sugar) will kill you quickly.  

When I prick my finger to check my blood sugar with a glucose test strip, that’s an altitude check.  I want to know how I’m doing.  Each time I do it, it costs about 70 US cents.  So, I can only afford about 200 test strips a month, which is about 7 finger pricks a day.

Each time I feel I need to lower my blood sugar, I take insulin.  In the old days I took a manual shot by measuring the insulin and filling the syringe by hand.  I would typically take about 5 or 6 shots a day.  Now I have an insulin pump that’s attached to me 24 hours a day.  I attach it with a needle to a new place every 4 days or so.  I have a remote control that tells it what to do. I keep the whole thing in my pocket with a tube leading under my clothes. 

Note: I’m always asked if an insulin pump does things automatically.  Answer: I wish.  It is delivery only.  I have to “close the loop.”  There are currently no publicly available closed-loop systems that automatically test blood sugar AND deliver insulin.  Not yet.

Here’s where the analogy gets interesting.  Remember in the analogy we are flying from L.A. to New York, except we only get to check our altitude seven times.  And, we only get to change altitude (take insulin) less than ten times.  But, when I check my blood sugar, I’m actually seeing the past.  I’m seeing a reading of what my blood sugar was 15 minutes ago.  And, when I take insulin, it doesn’t start lowering my blood sugar for at least 30 minutes.

Now, imagine yourself in that plane with an altimeter that shows you the altitude 15 minutes in the past, and a yoke that changes the altitude – but when you press on the yoke, your altitude won’t change for a half-hour.  It would be a challenging trip. 

Kind of reminds one of the delays in controlling the Mars Rover by remote, eh?  This is what Type I diabetes is like.  It’s a daily “chasing of one’s tail.”  This is why I prefer to eat at Subway when I’m in NYC or SFO.  It’s consistent.  I can count on it.  I know how much insulin to take for a Steak & Cheese.  Believe me, I’d love to eat new kinds of food every time I visit a new city, but I’d have to discover how much insulin to take and that’s and exhausting series of calculations and trial & error.