My mother, who lives with us, has diabetes, but hers is not the type I need information on (and she doesn’t know much about it beyond the fact that she is very glad she is not insulin-dependent) so I can’t really ask her these questions, and when I try to do an online search I get a lot of good information, but I can’t find anything that would give me the kind of specifics I need in this situation. So can anyone help me, please? Thank you very much in advance!
What is the likelihood of type-1 diabetes showing up in an Italian/Puerto Rican man in his early 20’s (I mention race because, as I understand it, diabetes is more common in certain ethnic groups)? Also, I know that it is typically genetic, but are there other factors (such as heavy drinking, drug use, and smoking -- all of which apply to this character) that can bring it on?
Skip ahead about 15 years. The man is now in his mid-30s and is insulin-dependent (one injection per day). Given the fact that he now takes good care of himself, being certain to go to a doctor whenever anything “odd” happens, how likely is it that he will still have complications? Say, with his eyes and so-forth. I realize that there are some things that a doctor cannot make “go away” with medications, but with this man’s clean living (after years of not-so-clean living before he developed diabetes, that is) are there some things that just cannot be prevented? The little do I know about insulin tells me that it tends to make people gain weight, unless they are very careful with their diet. Say this man WAS careful with his diet -- what might that diet consist of? I know that refined sugars and excessive alcohol are out of the question, and that several small meals a day are better than three large ones, but what would a typical day’s menu be if he wanted to keep his weight at a decent level? Are carbohydrates off-limits, or a good idea? Red meat?
Now say this man, who is insulin-dependent, but of average height and weight, suddenly found himself in a situation where he was without both his insulin and any real food to speak of. He’d taken his insulin the day before making a trip and had his insulin kit with him. He was out in the middle of the woods on what was supposed to be a day-trip, but he and some others got stranded there and his kit and the snacks he brought were lost at around 3:00 in the afternoon. He normally takes his insulin at around 4:00 pm, but that time comes and goes and until around 9:00 the next morning he has nothing to eat and all he has to drink is water and beer/wine coolers (the people he is out there with brought that along -- they do not know that he is diabetic). Still, all he has at around that 9:00 hour is a Coke, and he still has yet to take his insulin or eat anything until around 10:00.
With the lack of food and no drinks besides sweet stuff and alcohol, along with the lack of insulin, the physical exertion of walking through the woods, and the stress of dealing with all this (as well as another, more emotional situation -- an argument with a family member who is out there in the woods with him) what state could this man possibly be in by this time? I’ve heard that shaking, thirst, dizziness, and so forth are common (I have seen that with my mother, but as I said, her diabetes is not insulin-dependent), but as far as complications go, is it possible that a more severe problem could develop because of it? I have read about ketoacidosis and hypoglycemia -- but are either of those likely to develop so quickly? Also, Being of average weight, would the lack of food actually be more of a problem than if he had a larger amount of fat on his body? I don’t want to kill the guy or anything, I just want to know the potential complications.
Thank you again! Please forgive all these questions -- as I said, I am pretty clueless on this!
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Mayo 17, 2008 - 13 21
When you're writing a story about a specific person, statistics don't really matter. In your situation, you happen to have a SINGLE Italian/Puerto Rican male in his 20s with insulin dependent diabetes. Which means, in real life, you'd only have to point to an individual event where this occurred, not hundreds or thousands, just one. On the other hand, if you were saying it was something that every male in his family got or, everyone in his neighborhood---whatever that equals more than one person then you'd have to worry about it. When was the last time you cared about statistics when you were reading a novel?
Now...onto the rest of your questions.
Type I diabetes is not something to mess with, so I have a few concerns about what you've said here. With as long as he's had diabetes, he'll most likely need to take an insulin injection with each meal and snack, and possibly once more before he goes to bed. Which would mean, by what you've said with how long it is between doses (plus the exercise) he could quite easily go into a diabetic coma (or worse)
One thing that doesn't make sense is that you said the people is on a day hike with don't know he's diabetic. He's had it for over ten years, why doesn't he have a Medic ID bracelet? Why is he going on a hike with people he doesn't trust enough to let them know something that could save his life? Granted, it was only supposed to be a day trip, but for people with Type I diabetes, this is a big deal. If he has any sense (and I'm sure he does), he would talk to the people about splitting up his kit so just in case something would happen to his kit. He'd even bring along extra needles, pills, a spare glucose tester, etc. so he'd have this back up kit in someone else's backpack.
Here's a link you can use for the rest of your questions (such as his diet, etc):
Lifeclinic: Diabetes Information Guide
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Mayo 17, 2008 - 14 31
Thank you. The statistics were more for my benefit than for putting in the novel, itself. Even if it isn't mentioned, it helps for me to get a feel for what he is going through. I was unaware that someone would have to take an injection with every meal. As I said, my mother doesn't know that much about it, herself, but her friend (who recently died of a heart condition) had been taking insulin for 10 years (which was actually how long I meant to say the man had it -- not 15 years) and took only one injection a day.
As for the reason the people didn't know about his diabetes -- well, that is getting into specifics and is a plot-point, actually. Nathan (the man) is intensely personal (or you could say stubborn) and doesn't want many people to know that he has this condition (I'm sure we all know someone like that -- we had a friend living with us for a year and he never told us that he had a heart condition until he had a heart attack in our living room). Nate does realize that it is dangerous to let it go completely unknown, though, and there is one older man (the landlord of his building -- he lives in the apartment next to Nate) who is "in on it", and Nate does have a Medic ID necklace.
This takes place on a weekend in the summertime and the power in his building goes out, so rather than suffering the heat, the others that live in Nate's building (two women and two men -- one of them is his brother, though they had not spoken much in the past decade) decide to go for a drive to this one fishing hole that one of them knows about. Nathan is reluctant at first, but the landlord convinces him to go, reminding him to "take it easy" and so on and so forth. The landlord has to stay behind, though, to "mind the store" (literally -- he works in a store). The trip was not supposed to be a hiking trip, just a drive out to this lake in the woods, and they were supposed to be back by dinnertime, but one of them accidentally drives the car into the lake and Nate's backpack and his kit and snacks are inside (before you ask why he can't swim down and get it -- the car goes off an underwater ledge). The cooler with the beer and such was not in the car at the time.
Now a trip that was supposed to be just a few hours long gets longer when the weather acts up, Nate blames his brother for getting them in this situation (guess who drove the car into the lake), and they get all turned around trying to find their way out. A fisherman gives them a ride in the morning, but all he has in his truck are sodas (which is where Nate gets the Coke).
Well, that is the reason, though I know it may be "out there" a bit. Thank you again.
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Mayo 18, 2008 - 14 52
My son-in-law is an insulin dependent diabetic and he would go into a diabetic coma (or worse) without his insulin given your scenario. What my son-in-law does do, sometimes when he is low on funds (and this IS VERY DANGEROUS, we try to help him when we can) is take a partial dose of his insulin to try to make it last. I would check with a doctor about this to find out technical results, but a partial dose of insulin may be your answer, rather than a complete loss. Also, if your character is with friends, they would recognize the symptoms of an oncoming coma, such as dizziness, slurred words, uncomprehending. Diabetics suffering from shock have been mistaken for drunks because of their loss of motor control. My daughter knows before my son-in-law if he is low on insulin. The character, himself, should also recognize the signs in advance.
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Mayo 18, 2008 - 16 07
Thank you very much! I have been revising my storyline somewhat, so Nathan will have just taken his insulin before he lost his kit, it will start later in the day, and they will be picked up earlier in the morning. Hopefully that will help to keep him alive :)
A major point of the brothers' conflict is that Nathan used to be heavy into drugs and such, and though it has been a long time since he last used them, his brother doesn't believe that Nathan really stopped (mainly because the brother was unable to stop drinking and refuses to believe that Nathan could do something that he, himself, couldn't do). So when Nathan gets angry about his backpack getting lost, his brother assumes that it is because there are drugs in there and that it's better that the bag was at the bottom of the lake. That is when Nathan tells him what was really in the backpack. Cue his brother's guilt trip...
I know, a lot of exposition there :) Thank you again!
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Mayo 19, 2008 - 07 23
As someone else has said, the statistics aren't so important. You're focusing on one character so you just need to know what is possible, rather than what is likely.
You said he gets diabetes in his early 20s. This is unusual because type 1 diabetes generally presents itself in childhood or early teenage years, and type 2 diabetes usually presents itself in middle aged patients or older, or those who are particularly obese. However my husband developed type 1 when he was 22- unusual but possible.
Secondly, if he is insulin dependant, chances are he will take insulin before each meal. If he's having something with a lot of carbs in he will need a bigger dose. He will keep track of his blood sugar levels (probably using a finger-prick testing kit) and he may have to take extra shots in between to keep things under control. He may also take a once a day shot of slower acting insulin- missing this for one day wouldn't kill him but would mean he needs to keep a tighter check on his blood sugar levels and possibly take slightly larger doses.
How long someone can last without insulin varies from person to person.They would become hyperglycaemic and if their blood sugar level gets very high it could do them some serious damage. However being slightly high, or high for a short period of time is not likely to kill them (though in the long term if this happens often it will certainly take it's toll on their health). My husband has missed the odd shot here and there will no awful side effects other than dehydration. That's not to say it is a good idea, but some people can manage for longer than others.
If my husband was in the situation you described my main concern would be the lack of food. If his blood sugar were to drop too low (because he took too big a dose of insulin for the amount he ate, or because of the exercise) he would need to eat something sugary and quickly to bring it back up. Failing to do so would mean weakness, shaky arms and legs, cold sweats, confusion, clumsiness, loss of conciousness, convulsions and eventually death. This can happen fast- he would need to eat as soon as he recognised the symptoms. In my experience the symptoms of low blood sugar can come on much faster and be more dramatic than high blood sugar (but again, each person will react differently). I think he would be pretty worried if he was stranded without any food, even if he didn't get low. He would start to recover quickly once he got some sugar.
On a blood test meter in the US, a reading of between 80 and 120 is reasonable. 70 is about as low as you want to go (maybe if you are hungry between meals) and any lower you will start to feel ill. Any higher than about 130 you will start feeling dehydrated. About 300 is the point where you will start to suffer.
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Mayo 21, 2008 - 21 28
I'm a medical documentalist/records clerk/filer in a Diabetes office, and I've seen people go into hypoglycemia when they haven't had food for 10 hour,s without exercise. He could be in trouble.
----------Nano 2005: Legend of Jael (Won)
Nano 2006: Diary in the Attic (Won)
Nano 2007: Reel Smuggling (Working Title, will not break the streak)
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Mayo 22, 2008 - 08 33
You might want to check out the website of the American Diabetes Association for more information. http://www.diabetes.org/type-1-diabetes.jsp
I can't add much to what others have already said. Let me just tell you that not taking care of diabetes properly leads to very bad things. My dad has Type 2 and didn't manage it very well. He has had a toe amputated because of an infection that set in that he couldn't feel. He has very little feeling in his extremities. He has no night vision. His day is completely structured around his finger sticks, shots, pills, and other medical procedures. He's been on kidney dialysis for several years now. This has led to some infections and hospital stays. The sad thing is that he is only 54 and most of this could have been prevented (or at least delayed considerably) if he had listened to the advice of his doctors.
----------First you're an unknown, then you write one book and you move up to obscurity. Martin Myers
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2007 NaNo: Leap Year
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Mayo 22, 2008 - 15 57
You have all been a great help, and I believe that I now know where I need to go with this. Thank you all very much for the information and links!