Type 1 diabetes - every hour every day

Type 1 diabetes - every hour, every day

by Natasha Reddrop

In common with other sufferers of chronic illness, people with Type 1 diabetes face a number of challenges managing their condition on a daily basis. However, the moment-to-moment nature of controlling blood glucose levels, combined with the difficulty in accessing helpful and consistent advice, can make the experience of the condition particularly frustrating, and at times, lonely.

While it is impossible for all health professionals to be experts in Type 1 diabetes a compassionate and supportive approach is probably more important than technical expertise in many cases.

THE HIDDEN DIFFICULTIES

Type 1 diabetes requires daily, and often hourly monitoring of blood glucose levels and regular adjustments to insulin dosages throughout the day. The responsibility for managing the daily demands of Type 1 diabetes rests largely with the patient. The need to obtain and process all of the necessary information and manage blood glucose levels every day can result in burnout or even dcpression. Compounding this problem, the rate of complication screening amongst people with Type 1 diabetes in Australia is very low, especially amongst patients who were first diagnosed as adults.

Because of the relatively small number of people diagnosed with this condition, especially in comparison to the far more prevalent Type 2 diabetes, understanding of Type 1 in the community remains low. This can contribute to the feeling of isolation, as can the fact that it can be difficult to meet other people living with the same condition. Peer support networks, including online communities, are becoming increasingly popular as a way to overcome this isolation

DECISION-MAKING

People with Type 1 diabetes manage their health by making constant appraisals and decisions, sometimes on an hourly basis. These decisions include:

* assessing carbohydrate content of all food intake;
* administering appropriate doses of insulin depending on food, activity levels, illness, stress levels, hormonal changes and other factors;
* carryings out and responding to multiple daily blood glucose finger-prick tests;
* ordering supplies ahead to avoid running out of insulin/needles/pump equipment/test strips; and
* planning ahead to have snacks on hand at all times in case of low blood glucose levels.

Some examples of common situations in which additional planning is required to manage Type 1 diabetes include: going for a jog, giving a speech, travelling by plane, going away for a long weekend, being home alone (particularly overnight), attending a church service, going bushwalking or camping, and having a few alcoholic drinks.

RECOGNITION

The constant need for awareness and decision-making is a factor not often recognised by people who do not have close experience with Type 1 diabetes.

The analysis required to work out insulin dosages in relation to food while taking into account other confounding variables is fairly complex and takes considerable time and mental energy. Even then, this process is far from an exact science, so frustration levels can run high when a person invests the energy to work out
everything carefully but still comes up with a poor blood glucose result. For those with a higher psychological need for control, this situation will be especially emotive.

In combination, the intensive demands of managing Type 1 diabetes and the feelings of isolation can compound the difficulties faced by people dealing with what is already a complex and life-threatening condition. People with Type 1 diabetes may feel that they know more about their condition than many health professionals, which, considering the wide variability of the condition between people, may actually be true. As a result, taking a non-judgemental, supportive approach to the management of Type 1 diabetes is an excellent starting point for health professionals working in this field.

References relevant to General Practice

Anderson, R J., K. h. Freedland, et al. (2001). "The Prevalence of Comorbid Depression in Adults With Diabetes: A meta-arialssis" Diabetes Care 24: 11N,41078.

Gilbert, K., S.Thomley et al. (2006). Non-adherence to the' traditional model' of medical management in Australian adults with type 1 diabetes mellitus and its impact on complication screening and sell-management. World Diabetes Congress. Cape Town.

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