9/12/2018
Ask the Doctor:
An Insightful Q&A

During a recent program for children with type 1 diabetes (T1D), Berrie Center pediatric endocrinologists, Drs. Rachelle Gandica and Natasha Leibel led a session called “Ask the Doctor.” What follows is an edited transcript of an insightful Q&A filled with everything the kids wanted to know about diabetes and weren’t afraid to ask.

 

What is the highest blood sugar you have known someone to have?

Dr. Gandica: The highest blood sugar I have ever seen was around 1,100 mg/dL. That patient actually had type 2 diabetes (T2D) and was really sick in the hospital. He was very dehydrated and after he got a lot of IV fluids and insulin, he did very well. 

Dr. Leibel: A lot of times when people are diagnosed, they’ve had diabetes for a long time, and that’s why their blood sugars are so high. I think the highest I’ve seen was 1700, and that was also a patient with T2D. The highest blood sugar level I’ve ever seen in a patient with type 1 diabetes (T1D) was 700. 

What year was the first person diagnosed with diabetes?

Dr. Leibel: That’s actually a very interesting question. Diabetes has been recognized for over 3000 years. The first written description of diabetes was from the Greeks who explained it as water pouring through you, like a siphon. The word diabetes is Greek and means siphon. The word Mellitus is Latin for honeyed or sweet. In the 1500s someone named it diabetes mellitus when they realized that the urine of people with diabetes is sweet because it has sugar in it.

Do people with diabetes sweat more?

Dr. Gandica: One of the signs of having a low blood sugar is sweating, and the reason why is that when your blood sugar levels head a little low, your adrenal gland releases the hormone adrenaline to try to raise the blood sugar which can cause your heart to beat really fast and can cause sweating. Otherwise, in general, people with T1D shouldn’t sweat more if their blood sugars are in range. 

What if your blood sugar is out of range and super high? Does that cause sweating?

Dr. Gandica: Symptoms of high blood sugar are increase in thirst, urination and weight loss, but not necessarily increased sweating. 

Dr. Leibel: Some people sweat more than other people whether they have diabetes or not.

How many ways can you get diabetes?

Dr. Leibel: In our pancreas, there’s a special cell called the beta cell and that’s the cell in the body that makes insulin. If that cell is in any way damaged, you can get diabetes. For some reason in T1D your body says to those cells, ‘we’re not going to work anymore.' It’s never because of something you did that caused it to happen. There are many genes in our body that contribute to the risk for diabetes. 

There are other types of diabetes also, like T2D.  This is a kind of diabetes where you may make enough insulin for a while but it doesn’t work properly. It usually happens in adults.  T1D does not turn into T2D or the other way around.  Sometimes people have to have their pancreas removed. That’s going to give you diabetes. Some people need to take certain medications that can stop the beta cells from working. Sometimes pregnant people get diabetes because their bodies need more and more insulin and their beta cells don’t keep up. There are many different kinds of diabetes actually. 

How does the beta cell get damaged in T1D?

Dr. Gandica: So it’s actually because of an autoimmune process. Autoimmune is a fancy word that basically means the immune cells of the body get tricked and start to target and reduce the number of beta cells in the pancreas because they don’t think they belong there. There are a lot of other examples of autoimmune disorders besides diabetes. The most common is autoimmune thyroid disease.

Is T2D more dangerous than T1D?

Dr. Gandica: Both can be controlled really, really well. We have good medicine to treat both, but if a patient’s blood sugar is high for far too long, that person can become sick. 

Can you get type 1 from eating too much candy? People always ask me that.

Dr. Leibel: This is where a lot of people get confused between T1D and T2D. You can never get T1D from eating too much candy, or from eating any other type of food. But T2D can be related to our body weight and food choices. It’s also related to what kind of lifestyle you have. Do you eat well? Do you exercise?  Why people get diabetes is also tightly linked with the genes we have in our body that can make it more or less likely to get certain diseases.  

Dr. Gandica: But for kids with T1D, it’s never because of decisions you made before you had diabetes. 

Does age have something to do with getting diabetes?

Dr. Gandica: T1D can be seen in patients as young as 6 months of age. My youngest patient was diagnosed at 8 months of age. And then there are 80-year-olds that can get T1D. Their doctors might be fooled into thinking that they have T2D. But T1D can happen to anyone older than 6 months. 

How did I get diabetes at 3-years-old, if no one in my family has T1D?

Dr. Leibel: Most people with type 1 do not have anyone else in the family with T1D.  But often there will be family members with other autoimmune conditions like thyroid or celiac.  Those things make you more genetically likely to get T1D, but it’s still a small risk. 

What is an A1c test?

Dr. Gandica: Hemoglobin A1c is a blood test that actually measures what your average blood sugar has been over the last 90 days or 3 months. It is not only an average of numbers on your meter—that’s only little tiny snapshots of when you tested. If I could test your blood sugar every second over the last 90 days and take an average—that number would correlate to you’re A1c. For children under 18, we want your A1c to be under 7.5%. If you’re older than 18, we like to see your A1c under 7%.   

Why did you become a diabetes doctor?

Dr. Gandica: My sister is also a doctor and she was a big inspiration to me to become a doctor. When I went to medical school I loved pediatrics. I loved taking care of children and I loved developing strong relationships with the families of my patients. Later, I was introduced to endocrinology, which is the study of hormones. Insulin is a hormone and part of the endocrine system. I found endocrinology and how hormones work to be fascinating. I spent a lot of time at the Berrie Center during my fellowship. I really loved the team approach to treating diabetes. The Berrie Center is really what brought me to where I am right now. 

Dr. Leibel: I love to get to know families really well and work with them for a long time.  I think that’s what is very special about being a diabetes doctor. That means a lot to me.  One of my first patients is married now!