December 10, 2003

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I think he's only half joking when he says
he'd knock over pharmacies to get supplies if
he couldn't afford them.

Unpredictable blood sugars mean Kyle
always carries around emergency rations
(usually a few granola bars). Low blood
sugar reactions can happen unexpectedly
and quickly. Without sugar to fuel the brain,
a diabetic may lose concentration, con-
sciousness, or slip into a coma.

Kyle staggers into the kitchen, bounces off
the edge of the counter. His glazed eyes
blink at the fridge, the cupboard, the floor,
at me. “I’m low,” he says, his voice a thick
slur.

I pour him a glass of apple juice, a quick
fix. He’s tall, muscular and healthy looking,
but right now I could knock him over with
a finger. It never fails to surprise me how del-
icate this business of balancing blood sugars
is.

The pump gives Kyle better control, but
he still has reactions, which can interfere
with vision, mood, and muscular control.
Reactions can be hard to understand, espe-
cially for my children. I explain the logistics
of diabetes as I learn them myself. We talk
about the disease and what to do if Kyle has
a bad reaction. They know when to offer a
glass of juice and when to call 911.

I gradually learn. I figure diabetics must
have to be their own scientists to manage
blood sugars properly, let alone achieve and
maintain good health. I
think about how easy it
is for me to grab and eat
an apple, a muffin, din-

ner. I may be aware of in my sinuses when my

what I’m eating, but my
life doesn’t depend on
precise calculations of
what I ingest.

But it’s not only food
that affects blood sug-
ars: stress or illness
boosts them up, exercise

and medications drop my thr oat.

them down. Roving

blood. sugars have the year-old suffering from
Diabetes

unpredictable power to
cancel plans at the last
minute, confuse com-
munication, and cause genuine worry. But
steady small doses of fast-acting insulin from
the pump are supposed to regulate blood
sugars better than the long-acting insulin
Kyle used to take by injection. The pump
often improves a diabetic’s blood sugar con-
trol, but it’s not a cure.

Kyle shifts uncomfortably in the too-small
metal-framed chair in Victoria's Harbour
Towers hotel meeting room. Several times a
year, the Canadian Diabetes Association in
Victoria, BC hosts seminars about diabetes.
Its March 2003, and we've come to hear
Vancouver endocrinologist Dr. David
Thompson talk about islet (or pancreas) cell
transplants.

Thompson calls islet cell transplants the
beginnings of a cure for Type 1 diabetes.
Diabetes, he says, is an immune-system
response—something environmental trig-
gers a diabetic’s body into attack mode.
Receiving cow’s milk as an infant is likely
one environmental trigger, he says.

“That fits me,” whispers Kyle. “I had
cow's milk as a baby.”

I shift uncomfortably as we're reminded

blood sugars are high.
It’s like a taste that I
can feel at the back of rei"

how high and low blood sugars damage the
body over time. Heart disease, kidney fail-
ure, blindness, impotence, and limb ampu-
tations are some complications faced by dia-
betics.

Kyle already has some kidney and eye
damage. And the toe next to his left baby toe
sometimes shines red with infection. Last
summer it flared and the red flush of infec-
tion started to crawl up his foot. The doctor
gave him a mega-dose of antibiotics and
drew a purple magic marker line along the
advancing red tide to mark the infection. If
red spread past purple, Kyle was to head to
the hospital. The infection receded, but his
toe is still discoloured, a startling reminder
of the diabetes package.

It used. to be much worse, says Dr.
Thompson. Fifty years ago, before the dis-
covery of insulin, diabetes was a death sen-
tence. Even today, he says, many diabetics
who could live healthier lives are restricted
by the high costs of treating the disease.

No kidding, I think, recalling Kyle’s occa-
sional need to leave his infusion site in
longer than he should.

“The government doesn't fund diabetes
care anywhere near where they should,” says
Dr. Thompson, who is conducting a five-
year study on the costs associated with the
treatment of diabetes. “It saves the health
care system to treat diabetes intensively, but
the government has to be constantly

reminded of that.”
‘Pay now or pay

oe get this fu nny fe eling sae later” is the

message.

Diabetes, which
affects over two
million Canadians,
is a personal dis-
ease—each individ-
ual’s needs vary. On

to five times more

for a diabetic’s rou-
"—Kyle > a — tine health care

needs than it does
for a person with-
out diabetes and
the cost can sky-
rocket if a diabetic’s
kidney fails or a limb turns gangrenous and
needs amputating. But Dr. Thompson
hopes to prove that it saves money and pre-
serves health to help diabetics treat their dis-
ease properly.

As we listen and watch the pictures of
damaged and diseased eyes, hearts, kidneys,
and yellow pancreases in Dr. Thompson’s
PowerPoint presentation, I silently worry
about the costs of supplies and the damage
caused by corner cutting.

I imagine Kyle receiving an islet cell trans-
plant—collected pancreatic cells from a
cadaver injected into the liver, which can
kick-start a diabetic’s system into producing
insulin. But there aren't enough organ
donors to meet the need.

And it’s tricky business. Dr. Thompson
says that freeing islet cells from a donor pan-
creas is like mining for gold. It usually takes
two pancreases to harvest enough healthy
islet cells for one transplant recipient. Still,
Dr. Thompson sounds confident that treat-
ments from current research will result in
the disappearance of Type 1 diabetes.

I imagine Kyle free from needles and

tubes, and from having to calculate every
morsel that passes through his lips. I imag-
ine him not having to cancel plans at the last
minute because of an unexpected reaction. I
imagine him feeling well. I decide right then
to donate some of my islet cells to Kyle, once
they perfect the technique, and tell him so.
He smiles and touches my cheek.

But islet cell transplant therapy is in its
research phase—it’s not available to most
diabetics. And the daily anti-rejection drugs,

which recipients need to take instead of

insulin after a transplant, have side effects
that can be fatal.

“It's a balance of risks,” says Dr.
Thompson. “You're essentially trading one
illness for another—diabetes for chronic
immune suppression caused by the anti-
rejection drugs transplant recipients must
take for the rest of their lives.”

Research in other areas continues: stem
cell therapy, live donor transplants, and
xenotransplantation (using pig islet cells,

which Dr. Thompson compares to the pig _

valves used in heart surgery).

After the seminar, people gather around a
white-clothed table of cookies, coffee, and
water. Beeps and clicks sound throughout
the room like dueling dialing cell phones as
people program their pumps for a cookie
bolus.

Later, in bed, we spoon. I snake an arm
around Kyle’s waist, accidentally grazing
both the pump and the infusion site. (I keep
doing that—it’s like constantly whacking a

sore finger.) I flinch and retract, imagining _

that I’ve dislodged the works, forcing Kyle to
prematurely change his site and thwarting
the moment of closeness. But he grabs my
hand and moves it higher up.

“It’s okay,” he says.
that to rip it out.”

“Tt takes more than

His confidence and the snapping click
every few minutes assure me that the pump
is still doing its 24/7 job. I relax and coil into
pre-sleep mode. My brain deciphers the dis-
ease.

Sleep comes and swaddles my mental slide
show review, blurring the images of bleeding
eyes, clogged arteries, and yellow islet cock-
tails. Gradually I learn. Seeking balance is a
daily ritual.

http://www. otherpress.ca_

 

 
 
  
  

 
 

“patient's

 

What i is diabetes? _

_ A diabetic’s body cannot properly
store and use fuel (glucose) for
energy. To use glucose, your body

needs insulin. Insulin is made by a

gland in your oe called the
ae ;

 

 

rype 1 diabetes: The a

_makes too lirtle or no insulin.

_ Type 1 diabetics always need _
daily injections of insulin.

  
  
   

* Type 2 diabetes: The body can't

use the insulin it makes. Type 2
betes i is usually controlled or
en prevented through
ifestyle: healthy diet, weight
control, exercise, and some __
times medication. © .

 

 

 

not cued by eating too.
_ much sugar

. Over two million Canadians

have diabetes

: * Diabetes is the leading cause of

 

: death by disease in Canada

 

 

| Diabetes History

«1552 BC Earliest known record
of diabetes found on_ third

_ Dynasty Egyptian papyrus.
* 1 AD Diabetes is described by
_ Arateus as “the melting down of

flesh and limbs into urine.”
¢ Up to I1th century “Water
tasters’ commonly diagnose dia-
betes by drinking a suspected
urine, which was
thought to be sweet tasting.

_ * 1850s French physician Priorry

advises diabetes patients to eat
extra large quantities of sugar as a
treatment.

_* 1921 Insulin is discovered and

successfully tested on a de-pancre-
atized dog.

—Canadian Diabetes Association
(www.diabetes.ca)

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