As a kid with type 1 diabetes, Brett Rawlins was in and out of doctor offices — so often that one physician commented, “As much as you’re here in the clinic, why don’t you join the ranks?”
“I was like, ‘That’s a good thought!’” Rawlins says. He still thinks so — as a family nurse practitioner at Tanner Clinic specializing in diabetes management.
How to manage this incurable and progressive disease is foremost on his mind. Nearly three-quarters of his patients in Tanner Clinic’s endocrinology department deal with diabetes; of these, the great majority suffer from type 2.
In addition to the daily management of his own diabetes, Rawlins’ 2-year-old son has the disorder. “We’re highly involved,” he says. “We pray for a cure.” But in the meantime, “We do what we can do to make this disease manageable.”
For a 2-year-old, that’s as hard as teaching a tadpole to rest. “His appetite’s so crazy — sometimes he eats, sometimes he doesn’t,” said Brett. Every day, there are insulin shots and blood-sugar checks, but “he’s a pretty good little sport about it.”
For the rest of us, well, Brett is there with lots of guidance and support.
It all goes back to insulin
Types 1 and 2 diabetes may share the same name and end result — abnormalities in the way insulin is produced and used — but they’re completely different disorders, said Brett.
Type 1, which used to be known as juvenile-onset diabetes, is an autoimmune disease, where one’s own immune cells attack the insulin cells produced in the pancreas. The result is that this organ won’t produce insulin. “You have to replace that insulin; there’s no way around it,” he says.
Scientists aren’t sure what sparks the onset of type 1 diabetes, which most often manifests itself during or before the teenage years. Because the causes aren’t known, it’s hard to predict or prevent. There’s some kind of genetic predisposition, said Brett. But also, “there has to be some kind of environmental trigger that sets it off to attack the cells.”
Recent studies, he adds, suggest that the trigger may be a protein. “They’re thinking if they can alter it or suppress it, maybe we can stop the environmental trigger,” he said.
An upcoming epidemic
Type 2 diabetes, which usually appears after age 35, is the result of several factors, including genetics. But the largest influence is obesity. That’s what makes this disease so alarming.
Obesity, says the Centers for Disease Control, is at epidemic proportions, with one in three Americans overweight. If this trend continues, researchers anticipate that by 2020 nearly 50 percent of adults will have diabetes or pre-diabetes.
“That means one in two people will have type 2 diabetes!” said Rawlins.
Those extra pounds, Brett explains, cause cells to become resistant to insulin, which converts sugars in the blood to energy. The result is that glucose builds up in the blood instead of being absorbed by the cells. That, in turn, “will make your pancreas work harder — basically wearing it out faster.”
Type 2 diabetes sneaks up
Type 2 diabetes can be treated with the patient’s help — diet changes and exercise have a huge impact. Medications also play a role. However, said Rawlins, “A lot of type 2 patients will ultimately end up on (injectable) insulin because we’ve worn out the pancreas and it’s not producing insulin.”
The worry, said Rawlins, is that type 2 diabetes is often not detected in its early stages. Signs of the disease can show up in the blood tests done during regular physicals. But many times, it’s the complications caused by advanced symptoms that alert people, including kidney damage, neuropathy in the feet, and vision problems.
The disease, Brett notes, “is often diagnosed by an eye doctor” because the individual is suffering from blurriness and loss of vision.
Diabetes is managed, not cured
Diet changes, weight loss and exercise — these all work to control the symptoms and reduce the impact on sufferers’ daily lives. These factors can also keep a type 2 patient from having to receive insulin. But watch out, he adds, success often makes patients lackadaisical.
“A lot of people will say, ‘I changed my diet and lost weight, and now I don’t have diabetes’,” said Brett. “Well, yes, you have diabetes,” and it still needs to be managed.
Patients with diabetes — both type 1 and 2 — “can still live happy lives, there’s no doubt about it,” says Brett. “But you have to pay attention to it, you just can’t ignore it.”
And for many patients with diabetes, Brett is an effective guide as they walk that path. Because of his own daily battle, says Brett, “I’m in the trenches with them. I understand what it feels like.”
Brett encourages diabetics to remember “the big picture.” “There’s always going to be that random day when you don’t feel well’ But we’re shooting for the nine out of 10 days where we say, ‘This is great.’”