I’m In Control
Volume 2, Issue 1 · April 2004

“The Insulin-Dependent
Diabetes Mellitus Newsletter”

In this Issue:

· I'm in control? ·
· Ask Dr. Travis ·
· About the Doctor ·
· T-Shirt Contest ·
· Resource Materials ·

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I'M IN CONTROL! - But, what does this mean???

   Since early in the course of your diabetes - maybe even from the day when diabetes was diagnosed - this is a phrase that, either partially or completely, you have heard many times. Your doctor and other health providers have asked you about “control” and have indicated that “you need to control your diabetes.”  Numerous articles and publications expound on the value of ‘control’ and it has become the catchword of diabetes care. But, what does it really mean? In this issue of the newsletter, we’ll talk a little about what ‘control’ means in our everyday lives. In subsequent articles, we will deal with more specific issues that allow one to control diabetes and outline some of the reasons why being ‘in control’ is advantageous.
   The meaning or definition of control depends somewhat on the context in which you use the word - or what the subject is that’s being addressed. The dictionary states that control means to dominate, to govern, to influence, to regulate or to manipulate. Thus, it is a term that is used to describe one of our behaviors. We have all heard it used from our youngest childhood experiences. Early in life, we were ‘controlled’ by our parents - they influenced us by their words and deeds and regulated or governed us as we were taught the various lessons of life and the differences between right and wrong. We learned! As we grew and matured, we were expected to take over some of the tasks of our life - we were expected to be in control of our sanitary habits (like bathing and brushing our teeth), in control of our dress and appearance, in control of our behaviors at school. Our brains learned how to dominate and influence our actions and our behaviors. Sometimes this was called taking “responsibility” for our actions.
   With further maturity, our parents - and then society - turned over more personal control to us - but always in the context that we regulate ourselves responsibly. ‘Control” implies desirable or admirable behaviors or traits. Being “In Control” is always perceived as something positive. The converse is certainly not desirable - being “out of control” is a trait that we all find unacceptable. No one wants to be “out of control” in any context. Such people - and we all know some like this - are not able to govern or regulate even their own life. They are not responsible!
   In the context of persons who have diabetes mellitus, the word “control” takes on an even broader meaning and it (i.e.; being ‘in control’) is a much bigger job. Let’s look for a moment at why I have said that it is a “bigger job.” As we noted above, ‘control’ generally implies our regulation or governance over our behavior. But, in diabetes, it also entails a control of one of the basic metabolic and physiologic functions of our body - the manipulation of blood glucose (sugar). In the non-diabetic, the day-to-day fluctuation in blood glucose is a finely tuned mechanism. It is so precisely regulated that, regardless of what we eat, the blood glucose rarely varies by more that 60 mg - from its lowest (around 60 mg/dl) to its highest (around 120 mg/dl). This regulation is automatic - we don’t have to think about it. When the blood glucose begins to rise (say after a meal), the beta cells of the pancreas immediately sense this and make the exact amount of insulin necessary for the metabolism of the glucose as it enters the blood - not too little, not too much, not too early, not too late - exactly right!
   If the blood glucose begins to decline excessively (say like when we don’t eat for very long times), the body automatically makes several hormones (i.e.; glucagon, adrenalin, growth hormone, cortisol, etc) which prevent further lowering and retain the blood glucose within these narrow ranges. This precise regulation of blood glucose is what is lost in the person with diabetes and, regardless of the type of diabetes, the fine-tuning of sugar metabolism in the body is altered. The person with Type 1 diabetes has the most profound alteration in this metabolism since their ability to make insulin is most severely impaired but the person with Type 2 diabetes also has altered regulation. In both, the body’s metabolism is “out of control.”
   Now, take this one step further..... the blood glucose is part of you! It is not something different from you or unattached to you - it is part of you. And, if your metabolism is ‘out of control’ then a part of you is out of control - not all of you or even most of you - but a part of you is not in control. Wow! Think about that for a moment.........It’s really not a good feeling to have lost the ability to regulate something that is part of you.
   So, what do you do? Do you just give up trying to control this blood glucose? Of course not. Throughout your life, your mind has learned how to handle new issues or problems as they arise. Otherwise, you would never have been able to learn how to ride a bike or to swim or to solve a riddle or math puzzle. But you did learn and you can control blood glucose - not automatically as was intended and maybe not as precisely as you would have liked - but you can still be in control.
   In the next Newsletter, we’ll look at some of the reasons why “control” is important in your life and we’ll explore how tightly or rigidly this control needs to be for you to feel successful. Later, we’ll get specific about “how’ to manipulate the tools you have (i.e.; insulin, food, activity) to gain even better control.

See you next time.......... Dr T

Ask Dr. T

   Do you have a question about issues regarding ‘control’ of diabetes, various insulin programs, supplemental insulin administration during ‘sick days’, planning activities or carb-counting?  This is your place to ask Dr. Travis whatever questions you might have about Type I Diabetes Mellitus.  We will answer a question or two each issue.  Send your questions to Diabetes@DesignersInk.com.

About the Doctor

   Dr Travis received his initial training in what we now call Type 1 Diabetes Mellitus when diabetes was part of a program called "Renal & Metabolic Diseases" and now is called Nephrology. His initial years of research, in both animals and humans, involved how the kidney helped the body to balance the sugars in our body. These studies led to an interest in the kidney in diabetes.
   After completing his training and becoming certified in both pediatrics and nephrology, Dr Travis joined the faculty of the University of Texas Medical Branch in Galveston and, over time, developed his skills in the care of young people with either kidney disease or diabetes mellitus. He became director of the Division of Nephrology & Diabetes in 1967 and initiated the Children's Diabetes Management Center, the first comprehensive diabetes education program for children in the Southwest, in 1970. Dr Travis and his associates opened a camp for children with diabetes in 1960 - a camp that 12 years later became the Texas Lion's Camp for Children with Diabetes. He served as Medical Director of this camp from 1960 to 1996.
   "Dr T" has had an active clinical practice of both nephrology and diabetes for over 43 years and still enjoys seeing young people with diabetes more than any other activity. He has been on the academic faculty at UTMB for over 40 years and has participated in the education of thousands of students, residents, fellows and other trainees. He has received "Teacher of the Year" awards on several occasions. He has also been active at the local, state and national level with the American Diabetes Association and was the 2nd person to the elected to the Texas Diabetes Hall of Fame.
   Dr T has been the author or co-author on over 300 publications in scientific journals and has given over 500 presentations at scientific and support meetings. He is the author of "An Instructional Aide on Insulin-Dependent Diabetes Mellitus."

T-Shirt Contest

   Log on to www.DesignersInk.com for a chance to win an “I’m In Control™” T-Shirt.  You only need to sign up once.  We will draw a winner each issue and profile them in the next edition of “I’m In Control™.”  We value your privacy and will never give out or sell your information.

Resource Materials

   The 12th Edition of “An Instructional Aid on Insulin-Dependent Diabetes Mellitus” has just been released.  The latest edition of this book covers insulin pump therapy, diet-nutrition aspects, carb-counting, food package label reading, multiple insulin regimens, use of lispro, aspart and glargine insulins and much more.  “An Instructional Aid on Insulin-Dependent Diabetes Mellitus” is easy to read and laid out as a workbook to teach children to “take control” of “their diabetes.”
   At the time of press, over 1 million of the English version have been distributed.  The book is also published in 14 other languages with additional foreign publications in progress.
   During the first 22 years of its existence, the ADA, Texas Affiliate, Inc. and the Division of Diabetes & Nephrology of Department of Pediatrics, Univ. Of Texas Medical Branch at Galveston shared equally in all profits from the sale.  Over 90% of all revenue form the sale of this book has been applied to support of the research and training programs at UTMB.

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Any information in this newsletter should be considered one doctor's opinion and does not constitute medical advice.  Always seek the advice of your own personal physician or health care provider regarding medical diagnosis and treatment of any medical condition.

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