It's Invisible, But You Need to Know It: Type 1 Diabetes

Today marks World Diabetes Day, raising awareness about a condition that has become a global epidemic.

It's important, so important. To hear about ways to prevent diabetes, about the right diet, advanced medications, risks and complications, and how to prevent them, and more.

But all this mostly refers to Type 2 diabetes. Yes, there are two types. And while most people with diabetes do indeed suffer from Type 2, about 15% actually have Type 1 diabetes. Like me. This week, l'chaim, I'll celebrate 10 years from the day my life was saved - when I was diagnosed with Type 1 diabetes at the last possible moment.

This disease, for some reason, is much less known than Type 2 diabetes. When I tell people around me that I'm diabetic, I hear a lot of responses stemming from a lack of knowledge and familiarity with the illness, such as:

"What? But you're not overweight at all!". Exactly. I'm slim and have never been overweight. Because fats are indeed related to the development of Type 2 diabetes, but they have no connection to Type 1 diabetes.

"But you're young! Isn't this an older person's disease?". Yes, Type 2 diabetes usually appears later in life, though the average age is dropping. But I have Type 1 diabetes, which is more common in children, although it can appear at any age.

"So you always have to diet?". Um... no. Just need to watch what I eat and manage it properly with insulin.

So what is Type 1 diabetes anyway?

Type 1 diabetes was once called "juvenile diabetes" because it was thought to occur only in adolescence. In reality, that's not true. I myself was diagnosed at 23, already a mother to a child, and there are people diagnosed even in older ages - I recently heard about a woman over 70 suddenly diagnosed with Type 1. Yet indeed, it is mostly common in childhood.

Type 1 diabetes is a chronic autoimmune disease where the body's immune system attacks the beta cells of the pancreas - those responsible for producing insulin. Consequently, the pancreas can no longer produce insulin. Without insulin, the sugar produced by and entering the body from the foods we consume remains in the bloodstream and does not enter the body's cells as energy. When sugar stays in the blood, it causes long-term serious damage to organs.

Hence, Type 1 diabetes is also called "insulin-dependent diabetes" - medications won't help because the body has no insulin. At all. It needs to be introduced from the outside. This is done via insulin injections or through an insulin pump connected to the body that administers insulin throughout the day, functioning like an external pancreas.

So in short, Type 1 diabetes:

• Means a lifelong dependence on insulin
• Can occur at any age
• Can cause significant damage and complications without treatment
• Requires meticulous lifestyle planning to prevent life-threatening situations like very high or very low blood sugar.

Type 1 diabetes is not:

• A disease caused by a problematic lifestyle
• Something that passes with age
• Contagious
• Caused by sugar consumption or obesity
• Preventable
• Curable... yet.

Done with myths and misunderstandings? Perhaps.

I've shared my diagnosis story before, and you can read it here. It's a stressful tale, as the discovery of juvenile diabetes often comes with a highly dangerous condition called DKA, or diabetic ketoacidosis. When blood glucose levels are extremely high over time, the body cannot produce energy from the carbs and sugars we consume and starts to derive it from body fats. This causes the blood to become acidic, which is life-threatening.

So how is Type 1 diabetes diagnosed?

The symptoms accompanying the onset of juvenile diabetes aren't complicated to identify. It's important to know them because if they appear, early intervention can prevent complications and mainly, prevent life-threatening situations like the one I was in. Ten years ago, I didn't know the signs or how to recognize what was happening to me, but today I understand how crucial it is for others to know them to avoid reaching a situation like mine.

These are the symptoms that accompany the outbreak of Type 1 diabetes:

• Severe thirst, frequent drinking, and frequent bathroom visits
• In children: sudden bedwetting or very wet diapers
• Headaches and vision changes
• Increased appetite
• Rapid weight loss (I lost 7 kilos in two weeks. I promise you, it's not the most recommended diet).
• Irritability and impatience, sharp mood swings
• Extreme fatigue and weakness
• Stomach pain, nausea, and sometimes vomiting
• Heavy and rapid breathing
• Fruity smelling breath

Sometimes, these symptoms are mistakenly diagnosed as a virus or a stomach flu, a growth spurt - when it comes to children and teens, or a urinary tract infection. Yes, it could be one of those... but it doesn't hurt to do a small blood sugar test. Just for peace of mind.

What do I wish people knew?

Not long ago, a question was raised in a Type 1 diabetes forum I'm part of: What do you wish people knew about Type 1 diabetes?

The answers were fascinating, so I chose a few to share with you. Just so you know.

Type 1 diabetes is completely different from Type 2. It's caused by entirely different reasons, and its treatment is usually entirely different too. Type 2 is mainly managed with diet and drugs, while Type 1 is only managed with insulin.

If I pass out on the street, and you give me insulin thinking it will help, you could kill me. Yes, it almost happened to me personally, more than once. One of the risks of Type 1 diabetes is the imbalance between the amount of carbs I've eaten and the amount of insulin I've introduced to my body. If I injected too much insulin, my blood sugar could drop too much. It's a dangerous state, and the initial symptoms include weakness, hand tremors, sudden hunger, and more - but it can quickly worsen and lead to unconsciousness. If you give me insulin in that state... need I explain? In a situation of lowered blood sugar, one needs to drink something sweet, and in cases of unconsciousness, there are injectable medications that are meant to raise blood sugar levels. In short, if I fainted, call an ambulance, and don't decide on your own which medication I need.

This disease demands a lot from me. I don't think there's any other condition where its management is so significantly in the hands of the patient. I need to monitor what I eat, ensure the correct amount of insulin - and not too much, I have to measure my blood sugar 10-12 times a day to make sure I'm in a normal range, and I need to plan every outing in advance to ensure I have enough insulin with me, the necessary accessory backups in case the insulin pump fails, and enough juice or candies for a sugar drop.

You can't cure it with diet. Type 2 diabetes can often be cured or at least delayed with diet. For Type 1, it just doesn't help.

Having Type 1 diabetes doesn't make me handicapped. I can do pretty much anything I want, even with diabetes - as long as I manage it consistently. So no, thank you, there's no need to carry the suitcase for me. I can haul the suitcase to the third floor, and diabetes doesn't change that fact. Oh, you just want to help lighten my load? Sure, why not...

This isn't a clear equation. Just because I inject insulin, doesn't mean my sugar levels will be perfect. So many factors influence blood sugar levels that it's almost impossible to predict what will happen in the next hour. Some days, I inject more than usual, and my sugar is still high. Why? I don't know. Other days, I inject much less than usual, and the sugar is low and won't go up. Why? Just because.

It feels awful, sometimes. Very high or very low sugar makes you feel awful, puts you in a bad mood, and creates overall imbalance. On the other hand, I know how to care for myself. So give me a bit of space for a few minutes, I'll manage myself and get back to you, smiling and happy as usual.

There's no vacation. This is a condition that accompanies me 24/7. There are no vacations, not even on Shabbat or holidays. Sometimes it's exhausting, physically and mentally. Usually, I know how to manage, and I'm happy and content with what Hashem has given me. But if I'm having a harder day, just be there for me.

I won't die if I eat a slice of cake. Calm down, guys. I'll just need to inject a little more insulin. Don't keep delicious things away from me.

There's no cure. But maybe one day there will be, with Hashem's help. I continue to pray for that, every single day.