100KM FOR 100 YEARS OF INSULIN

Hi everyone,

 

2021 is thankfully coming to a close, but I don't think I quite managed emphasise the significance of this year for those living with type one diabetes (T1DM) such as myself. In 1921 Banting and Best discovered insulin- 'the elixir of life' for those with T1DM and transformed the diagnosis from one that was imminently fatal to a manageable chronic illness.

 

In celebration of this centenary, and in support of what's to come, I'll be aiming to swim 100km in 100 days between pools (almost exclusively pools) and open water. I'll be aiming to share a little bit of awareness about T1DM- what it is, what it's like to live with, and some of the day to day considerations as well as struggles of my own management. I'll also be looking into how it's evolved in the last century, and hopefully touch base on some of the latest technologies on the horizon for the next century. Personally I believe that T1DM is a chronic illness that you can work around a pretty normal life, and I'd like a chance to showcase that.

 

I'll be raising money for the Juvenile Diabetes Research Foundation (JDRF), a British charity that funds over 500 research projects and 70 clinical trials at any one time. Not only do they fund research but they're a great first port of call for T1DM education, and are prominent activists helping to increase access to the latest technologies for T1DM management.

 

So that's the overview, but if you'd like to read a little more, then by all means scroll along. I'd massively appreciate any support, and will gladly answer any questions so feel free to ask,

 

Joe :)

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My Diagnosis

I've had T1DM for just over half of my life, I was diagnosed when I had just turned 12 (I'm now 25). My diagnosis was pretty textbook 'barn door DKA (diabetic ketoacidosis)'- I spent a month constantly peeing and drinking over 5 litres of water a day, I was totally exhausted and clothes were beginning to fit a little looser as I lost a bit of weight. As my symptoms progressed I felt more and more unwell until the time came to eventually google what was wrong and subsequently check my blood glucose... After that I was whisked off to A&E and spent a week at The Horton Hospital (Banbury), where I recovered from the DKA and learnt the basics of what T1DM is and how to manage it.

 

What is diabetes

Type 1 diabetes is an auto-immune disorder in which the immune system mistakes the insulin producing cells of the pancreas (The islets of Langerhans beta cells) as foreign. The immune system then attacks these cells resulting in the person affected being no longer able to produce insulin. The cause of T1DM is thought to be a combination of environment, genetic susceptibility and bad Juju (we're still working on getting to the bottom of it basically). All of this differs significantly to type 2 diabetes (T2DM) which is a disease of insulin resistance where the body still produces insulin but the cells of the body fail to respond. T2DM is caused by a combination of genetics, obesity, and advanced age.

 

So what's insulin? Insulin is a hormone produced by the pancreas that allows for carbohydrates and sugars to be transported from the bloodstream to the cells of the body where they can be broken down and used for energy. I can remember the model explained to me at The Horton was the 'lock and key model': insulin is effectively the key that unlocks the gate allowing for sugar to enter the cells of the body. So without insulin- the sugar just builds up in the bloodstream instead, which subsequently thickens up the blood and gives rise to a series of strains on the cardiovascular system. In the long run this high level of sugar in the blood can damage several major organs such as the kidneys, the retina, and the nerves in your feet which is why managing blood sugars well is so important.

 

How is T1DM managed?

T1DM is not particularly simple to manage, there are many different contributing factors and considerations but I'll do my best. Remember that bit before about how insulin allows uptake of sugar from the blood into the cells in your body? That's whats being managed- so through a combination of measuring blood glucose levels several times a day, counting the grams of sugar and carbohydrate eaten in the day, and injecting insulin doses accordingly blood glucose levels are maintained in a healthy range.

 

When blood glucose levels become too low (either due to not enough carbs or too much insulin), someone with T1DM will become hypoglycaemic (low blood sugar), this is sometimes called 'a hypo'. This can cause an array of symptoms such as dizziness, shaking, and general disorientation which not surprisingly can quickly become dangerous (e.g. behind the wheel... ).

 

When blood glucose becomes too high then it can cause all of the symptoms stated previously such as increased urination, increased thirst, tiredness, weight loss, confusion. Again as mentioned previously this can cause damage in the long run in particular to the kidneys, retina, and nerves in the feet.

 

That's the bare basics of whats going on- but there are many other considerations to take into account to juggle as well such as stress, illness, exercise, metabolic rate variation over 24hours, alcohol- just to mention a few. I'm sure I'll elaborate on these down the line.

 

My management

At that point when I left The Horton I was given a blood glucose monitor and two types of insulin to manage my blood sugars. Since then my managements upgraded a bit. Instead of using a 'finger prick' glucose monitor all the time I use a flash glucose monitor (FGM (unfortunate second use of that acronym)) called the Freestyle Libre 2- meaning I wear a small subcutaneous needle on my arm and check my blood glucose on my phone/smartwatch. These monitors have become popular and you may well have seen the little white frisbee on the back of someone with T1DM's arm.

 

Instead of injecting with insulin pens I now use an insulin pump called the Omnipod. This is a small device that injects the insulin for me but only on my command from the handset. Insulin pumps have got a few advantages, though a few disadvantages too which I'll be speaking about later on. For the purpose of this project though the pros outweigh the cons I suppose.

 

Hows my swimming?

...well I've been swimming regularly since this summer around June. At that point I could do two lengths (50m total) of freestyle (aka front crawl) after which I'd be fairly exhausted and need a lie down. I was never a swimmer in my childhood, though knew the bare basics. Since June, I've had a few basic lessons and have been putting the hours in on those drills. I can now manage a solid 1km freestyle in about 21 minutes, which isn't lightening pace but it's a lot better than I was in June let's just say that for now. Over these coming months I'll be keeping up with my drills and a few more lessons to refine my technique a little more.

 

Managing diabetes and exercise combined is somewhat of a fine art, but more on that to come too.