Wil Dubois

Hey, All -- Got questions about life with diabetes? Then you've come to the right place! That would be our weekly diabetes advice column, Ask D'Mine, hosted by longtime type 1 and diabetes author Wil Dubois, who spent many years working as a clinical specialist in New Mexico.

This week, Wil welcomes a new "type awesome" girlfriend of a fellow type 1 person with diabetes (PWD), and offers some introductory advice. If you happen to have any additional thoughts for her, please drop that in the comments below, too!

 

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

Margie, type 3 from California, writes: Hi, I’m dating someone who takes insulin shots two times per day. I’m trying to learn more about type 1. My partner can’t perform sexually, but I’m OK with that. Please let me know of a website where I can get my questions answered and get great information.

 

Wil@Ask D’Mine answers: Thanks for letting me be the first to kiss the “bride” on the cheek! Welcome to the wild, wild world of diabetes. I’m happy to give you the T1D 101 course, then I’ll refer you to some go-to websites where you can learn more about it, and others where you can actually engage with type 1s and their partners to ask questions.

Type 1 diabetes is an autoimmune disease. Why is that important? It’s important because the person who has it was completely powerless to prevent it, or even to slow its progression. What happens is that the immune system freaks out and attacks the part of the body that makes insulin—beta cells that live in the pancreas.

Insulin is a hormone that the body needs to properly move sugar from food into individual cells, which is what they need for energy. Without insulin two things happen: First the cells can’t get the energy they need for normal function, and second, the levels of sugar trapped in the blood rise to toxic levels, which can actually kill you. 

Type 1 can strike at any age, but commonly starts before adulthood. Once it hits, it’s an unstoppable freight train. Within one year, often less, the body is unable to produce any insulin whatsoever. At the current time, there is no cure, and in fact, the cause isn’t fully understood yet. Perhaps, someday, we’ll have a cure, but your guy should live his life as if there never will be one, and you should adopt that view, too, as people who are too cure-orientated sometimes don’t take proper care of themselves. 

And how is that done?

Type 1 is largely treated by taking injections of artificial insulin. Injections may be made by old-fashioned syringes, pre-loaded disposable “pens” that last about a month, refillable pens, or fancy electronic devices called pumps. Generally speaking, most people with type 1 need two types of insulin. One is called basal. This is a long-lasting insulin to keep the sugar at bay overnight and between meals. We also need shots of bolus insulin, a different, faster-acting version with virtually every meal. It does concern me that you say your new beau takes only two shots a day. That suggests to me that he’s not doing a very good job of taking care of himself. This is something you need to investigate, because now your destiny is linked to his. Of course, it may be that he only eats twice a day, and that you’ve never observed his basal shot, which is usually either taken at bedtime or early in the morning.

Another major component of treatment is blood glucose (sugar) monitoring. Glucose is checked by poking a finger with a needle called a lancet, and testing a small drop of blood with a tiny machine. Most lancets are built into spring-loaded devices making the process quick and largely painless. How often someone with type 1 should check depends on a lot of things, including how stable their sugar levels run, and how good their insurance is (to get the needed supplies). But good control dictates, at a minimum, morning and bedtime checks plus checks before each meal. People who really take their diabetes seriously will also check several hours after each meal to monitor how well the insulin shot from the meal is working. Too little insulin leaves you high, which makes you feel crabby and can damage your body over time. Too much insulin can trigger a reaction called hypoglycemia, sometimes called a “low” because the sugar in the body drops too low, causing a range of symptoms including drunk-like behavior. If not immediately treated, lows can actually develop into life-threatening emergencies, which leads me to the next component of treatment. 

Therefore people with type 1 diabetes need to have a supply of something sugary in easy reach at all times. I’ve personally become fond of the Transcend brand of glucose gel pouches. They are small, thin, and tough. I can carry one in the front pocket of my jeans for weeks with no worry about them rupturing. A single pouch has enough glucose to reverse a typical low. The orange flavor is OK (not good enough that I’m tempted to slurp one down just for the taste of it) but beware the Strawberry—it’s nasty tasting. Other PWDs just carry some candy. I know one lady who always has a box of Hot Tamales in her purse. The problem is she likes them, and sometimes they get eaten recreationally, and then she can get high gluose, and doesn’t have any of the candies when she needs them. This is the risk of mixing medicine with pleasure.

Diabetes Complications 411

Speaking of pleasure, I noticed that you said you partner was unable to perform sexually and that you were OK with that. All sorts of things can cause a man to not be able to perform, but I’d put money on that in his case it’s a “complication” of diabetes called ED (erectile dysfunction). Complications are a variety of bad things that happen to the body that are indirectly caused by diabetes. Most complications are the result of damage to nerves or small blood vessels caused by high blood sugar, which in turn is caused by poorly controlled diabetes. The organ systems we worry about most are the kidneys and eyes, followed closely by the nerves in the hands and feet—which can either lose sensation or trigger phantom pain.

Some complications can be reversed, some can’t, but all can get worse, so good blood sugar control is the key to a long and happy life. Oh, and speaking of happy, make sure you communicate other ways that you can be satisfied on the sexual front, given his lack of access to the commonly used first weapon of choice (if you follow my drift).

It all sounds like a lot to deal with, and it can be. We all risk burnout, and sometimes even severe depression, just trying to keep up with it all. A good support system is helpful, but by the same token too much support can ruffle our feathers, as it comes across as nagging, so how you’re going to fit in to your partner’s diabetes will be the trickiest part of your relationship, and is something that the two of you will need to negotiate.

As a starting point for that, and as your next stop on your diabetes education journey, I’m handing you off to my good friend and colleague, Dr. Bill Polonsky who runs the nonprofit Behavioral Diabetes Institute. He’s given a lot of thought about (and done a lot of research on) the "soft" side of diabetes -- how it affects us, not medically, but psychologically and emotionally. He was also one of the first to focus on how diabetes affects the non-diabetic people in our lives. He understands the friction and flash points.

Here are some key resources that come to my mind:

  • First, when talking about the BDI above, be sure to check out his Diabetes Etiquette Card for important tips on how to interact with the diabetes portion of your guy’s life.
  • Next, if you want to learn a bit more about the nuts and bolts of type 1 diabetes I refer you to: Our parent site, Healthline, which has lots of practical information as well as "medically reviewed content," and The Mayo Clinic.
  • To dig more into the medical science side, visit MedScape.
  • To learn what it is like living with this bitch, dive into the DOC, or Diabetes Online Community. We're glad you found us here at the 'Mine, and there hundreds more patient-written blogs, community forums, Twitter accounts (with many hashtags) to follow, and even groups on Facebook and places on Instagram and Pinterest where people share photos and images of their lives with diabetes. It can be overwhelming, but take it slow and find your tribe at your own pace. You can start with this official tip sheet.
  • Lastly, as a place to ask questions of both PWDs and others like you in “mixed marriages” with us, JDRF, the largest type 1 research and advocacy organization for type 1s, hosts an online forum called TypeOneNation where you can find “coping and support.” It’s billed as being for type 1s, their families, and friends, so it sounds to me like you’d be welcome. You’ll also find powerful discussions and a rich community over at Beyond Type 1 and its TuDiabetes community. 

Good luck on your quest, and thanks for caring enough to want to learn more. Your dude is a lucky guy!

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.