Living with Type 1 diabetes

Living with Type 1 diabetes is all about controlling risk. Those with the condition, which usually comes on in childhood and needs to be strictly managed with insulin injections, are unable to make insulin which regulates blood sugar levels. Daily life is dictated by measuring blood sugar levels, food intake and energy expenditure. Failure to do so can result in bouts of hypoglycaemia where blood sugar drops too low. This can cause trembling, sweating and palpitations to slurred speech, coma and even sudden death.

For nearly 30 years, Leanne has lived with Type 1 diabetes, having been diagnosed when she was eleven. As an adult she says living with the disease is difficult. “Everything from stress, emotion, hormones, hot weather, can affect your body. You have to be on the ball to manage it.”

Leanne was part of a recent study to assess the effect of education on sufferers’ glucose levels and quality of life after using the latest diabetes management technology. This involved wearing an insulin pump and Real Time Continuous Glucose Monitoring (RT-CGM); a sensor inserted under the skin measures sugar levels every five minutes. The study was led by the NHMRC-funded Diabetes Centre for Clinical Research Excellence (CCRE), administered by the University of Melbourne.

Dr David O’Neal from the University’s Department of Medicine, based at St Vincent’s Hospital says that there were no protocols advising patients on how to respond to the data created.

“These technologies do not control the amount of insulin given. The patient has to interpret the information and decide how to respond, whether it is eating and/or adjusting the amount of insulin delivered.

”If a patient is unable to properly interpret the information provided, then errors of judgment may occur resulting in high sugar levels, which if continued can cause long-term health complications.”

These can include kidney disease, blindness, amputations, heart disease and stroke.

A person with Type 1 diabetes needs to maintain their blood glucose level either by adjusting food or drink intake or insulin dosage. Researchers say that despite their best efforts sufferers can get it wrong.

Pat, who has had Type 1 diabetes since she was a baby, said there were many times she was caught out. “No matter how careful I was, I would inevitably get it wrong.”

There were many times when her husband found her unconscious on the floor at home or when she lacked energy while travelling on public transport.

“My husband knew what to do, but when I was out it was more worrying.” she says.

Results of the study show that early education is critical for sufferers to know how to read and act upon the data from the latest diabetic technology.

The study found that nearly 50 per cent of sufferers wearing a pump and sensor for 16 weeks, who were educated early on how to read the data generated by the devices, achieved their target glucose level (HbA1c <7.0) compared with only 25 per cent of those who had not been educated, but given the devices and instructed on how to operate and wear them. Results also revealed an improvement on sufferers day-to-day functioning.

Leanne said using the technology gave her the ability to tighten control on her day.

“I could get on with things without so many complications,” she says. “I can’t afford the sensor all the time but I do use it to get the balance back when I find my levels rise up every couple of months.”

It is hoped the latest technology will complement the traditional finger-pricking method of monitoring blood sugar levels.

“Using fingerpricks alone is like driving blind and opening your eyes for a few seconds, between four to six times each day.” Dr O’Neal says.

“Fingerpricks provide a snapshot at times usually convenient for the patient, which leaves them vulnerable for the rest of the day when they have no idea of their blood sugar level.“

Unfortunately due to cost, the technology is not readily available to all Type 1 diabetes sufferers. “It is hoped that as the technology evolves, so too will health policy enabling more access to those who will benefit,” he says.

Another treatment which has become available in recent years, for more severe Type 1 diabetes sufferers is the transplantation of insulin-producing cells. Professor Tom Kay, Director of St Vincent’s Institute, has led the research into the treatment, and says it has provided people who have unmanageable disease with an effective alternative to injected insulin.

“In particular, sufferers who have increasing hypo-unawareness, where they experience no symptoms but still the extreme health risks, are the ones benefiting the most.” In many cases it has reversed the clinical problem with several people stopping their use of insulin altogether.

The first transplant of islet cells was conducted in 2007 at St Vincent’s Hospital, Melbourne, by a team of clinicians and scientists from the University of Melbourne, St Vincent’s Institute, St Vincent’s Hospital and Austin Health.

 “It has been and continues to be a massive team effort which shows how important collaborations are between clinicians and scientists in making a real difference to people’s lives,” Professor Kay says.

“We have had many good results and have conducted 15 transplants.”
www.diabetesccre.unimelb.edu.au