Living with diabetes

Mind, Body, Spirit feature from Nov. 2 edition

Doug Degeus is not your typical diabetic. He’s razor thin, active and in good shape. But he knew something was wrong two years ago on a drive to Tillamook.

“I stopped about 15 times to pee and drank about 17 bottles of pop,” Degeus recalled. When he got home, he went to his doctor and a blood glucose test showed his blood sugar level was over 700 — more than 500 points above the normal range.

“My doctor said, ‘How are you still standing?’” said Degeus, who was diagnosed with type 2 diabetes, although he’s since been placed in a new category called late onset, slowly-developing type 1 diabetes — informally referred to as type 1 1/2 diabetes.

Degeus is one of more than 11 million Americans diagnosed with diabetes, a disease that affects the body’s ability to produce or respond to insulin, a hormone that allows blood sugar to enter the cells of the body and be used for energy. Type 1 diabetes usually begins during childhood or adolescence, and is characterized by a complete failure to produce insulin. Type 2 diabetes, the most common form of the disease, usually occurs in adults after age 45. People with type 2 usually still produce some insulin, but not as much as they need, and their bodies don’t make efficient use of it.

Because diabetes can go undetected for years, the American Diabetes Association estimates there are 8 million more Americans who have the disease and don’t know it. There is no cure for diabetes; patients have to manage the disease with diet and lifestyle changes, oral medication or insulin shots — or a combination — for the rest of their lives.

Jennifer Price, a certified diabetes educator at Providence Hood River Memorial Hospital, explains diabetes — and its complications — with the help of two glass tubes filled with red liquid and dozens of little white balls. One tube represents the blood of a “normal” person, the other someone with diabetes. Price shakes both tubes and holds them upright. In the “normal” tube, the white balls — representing white blood cells — descend quickly through the liquid and settle on the bottom in a few seconds.

In the “diabetes” tube, the balls sluggishly make their way toward the bottom, still not settled after nearly a minute.

This is what the blood of a diabetic is like, according to Price.

“Normally, white blood cells travel quickly,” Price said. “We use (the tubes) to illustrate how much more slowly white blood cells move in diabetics.” It’s this phenomenon that brings about several complications of the disease, including difficulty with infections and wounds not healing properly or quickly.

“It also shows how much thicker blood is when you have diabetes,” Price said. This leads to blood clotting more easily and to an increase in cardiac complications. Price said that people tend to be more frightened of some of the other complications of diabetes, like blindness and kidney failure. But in reality, those are far less common than cardiac problems related to the disease.

“Eighty percent of people with diabetes die from cardiac complications,” she said.

When Degeus was diagnosed his doctor started him on oral medication, but that didn’t regulate his blood sugar enough. So Degeus began giving himself insulin shots several times a day. But last month he got an insulin pump, one of the newest tools diabetics have to manage their chronic disease.

Pumps deliver small amounts of insulin throughout the day and night through a small needle that stays in place for a few days at a time. The needle is attached to a tube that connects to the pump, which fits into a small holster that can be worn on a person’s belt much like a cell phone. The pump can be programmed to deliver specific amounts of insulin at different times to coincide with meals — or the lack of meals. It also keeps a digital log of when and how much insulin was delivered so the wearer, by testing his blood sugar frequently, can closely monitor blood sugar levels and make adjustments.

Degeus has been meeting with Price and Kelly Chambers, another certified diabetes educator at the hospital, frequently for the past month as they work to refine how much insulin he needs and when to deliver it.

So far, Degeus has been pleased with his switch from insulin shots to the pump.

“I was giving myself four to five shots a day,” he said. “There were times when I’d say, ‘Screw it, I’m not giving myself another shot.’” Along with being less painful than stabbing himself with a syringe every few hours, the pump gives Degeus more freedom and helps keep his insulin level more stable.

“Before, Doug would have to eat meals to match up with his insulin shots,” Price said. Now, he can give himself a surge of insulin with a snack, or delay insulin delivery if he happens to miss a meal. “Now, he coordinates his insulin with when he eats rather than eating to coordinate with his insulin,” Price said.

Degeus does have to diligently check his blood sugar with pin pricks to his fingers — up to six times a day. And he must do calculations of the food he eats, mentally translating portions of starches, fruits, and vegetables into their equivalent grams of carbohydrates in order to calculate how much insulin he’ll need to process it.

“It’s not hard, but it’s not easy,” Degeus said. The pump also helps to stabilize his insulin levels better over time, which could help stave off complications that come with wildly fluctuating insulin levels. That’s good news for Degeus and all diabetics who must work to control their disease for the long term.

“You don’t have to have diminished quality of life when you have diabetes,” Price said. “Doug’s a perfect example of that.”

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Parkdale third graders sing "12 Disaster Days of Christmas"

Welcome to your sing-able Christmas gift list. What follows is an emergency rendition of “12 Days of Christmas” – for outfitting your home or car in case of snow storm, earthquake, flood or other emergency. Read it as a simple list, or sing it to the tune of “12 Days” – you know, as in “ … and a partridge in a pear tree…” Not to make light of it, but the song is a familiar framework for a set of gift ideas that you could consider gathering together, even if the recipient already owns items such as a bunch of coats, tire chains and flashlights. Stores throughout the Gorge are stocked up on all these items. Buying all 12 days might be prohibitive, but here are three ideas for checking any of the dozen off your list (notations follow, 1-12.) The gift items needed to stay warm, dry and safe are also coded to suggest items in your abode (A) in your car (C) or both (B). 12 Gallons of Water (A) 11 Family meals (B) 10 Cans of propane (A) 9 Hygiene bags (B) 8 Packs of batteries (A) 7 Spare coats (B) 6 Bright red flares (C) 5 Cozy blankets (B) 4 Tire chains (C) 3 Flashlights (B) 2 cell phone chargers (B) 1 And a crush-proof first aid kit (B) Price ranges? Here’s a few quotes for days Three, Two, Four and Nine: n A family gift of flashlights (three will run $15-30, Hood River Supply, Tum-A-Lum) n Cell phone chargers (two will run $30-60) n Tire chains (basic set, $30, Les Schwab, returnable if unused for the winter) n Family meals ($100 or so should cover the basics for three or four reasonably well-fed days) n The home kit should be kept in a handy place near an exit, and remember that water needs to be replenished every few months. If you have a solid first aid kit already, switch out the gift idea with “and-a-sto-o-u-t- tub-for it-all …” Otherwise, it’s a case of assembling your home or car kits and making sure all members of the family know what the resources are and how to use them (ie flares and propane). Emergency situations are at worst life-threatening, at best deeply uncomfortable if you and your family are left without power for an extended period, or traveling and find yourself in a situation where you need to wait out a storm, lengthy traffic delay, or other crisis. Notes on the 12 gift ideas: 12 – Gallons of water: that’s one per person in a four-member family to last for three days, the recommended minimum to be prepared for utility outages. 11 – Easy-open packaged goods, energy bars, dried food and nuts are good things to include for nutrition. Think of what your family of four needs for three days to stay fortified and hydrated (see number 12). Can-opener also recommended 10 – If you have a propane camping stove, keep extra fuel handy. 9 – Hygiene bags: put packaged moistened towelettes, toilet paper, and plastic ties in large garbage bags (for personal sanitation) Resource list courtesy of Hood River County Emergency Management, Barbara Ayers, manager/ 541-386-1213. The county also reminds residents to Get a Kit, Make A Plan to connect your family if separated, and Stay Informed. See to opt-in for citizen alerts. Enlarge

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