When we think about insulin, we know that all of our bodies have a pancreas that sits in the middle of it and, within the pancreas, there specialized cells that go ahead and release insulin. The way I like to think about it is it’s a key that unlocks ourselves so that the food and nutrients we eat are able to be metabolized and used for fuel by our body.
In Type 1 diabetes, we always tell families it’s an autoimmune process. So for some reason, your body sees those insulin producing cells within your pancreas as being foreign, so it starts attacking those cells. So going back to that key analogy, we think about, all of a sudden there’s not a lot of keys available.
Youth with Type 2 diabetes have a different situation going on. In that situation., it’s an issue with insulin resistance and so the way that I think about it is that you still have keys, but the keys are the wrong shape now. The difference between Type 1 and Type 2 diabetes is really the fact that, in Type 1 diabetes, you are relying on exogenously administered insulin for survival.
In Type 2 diabetes, you have insulin that your body’s making. However, you cannot use it appropriately and so youth present with high blood sugars, but in conjunction with that, they often have high insulin levels and so we need to initiate insulin therapy. So giving injections, but over time we may be able to transition to alternative means to manage their glucose levels and I have to say, Yale is at the cutting edge of developing new treatments for kids diagnosed with diabetes.
When using injected insulin therapy or pumping insulin, what we’re trying to do is closely match what your body should be making and so there’s lots of different insulin therapies out there and the amazing thing to think is, you know, 100 years ago this was just discovered, it was one of the initial presentations on insulin therapy. It was here at Yale. People started on insulin therapy in 1922 and it’s come such a long way.
As somebody living with Type 1 diabetes, I can share with you that in 1987 when I was diagnosed, I was on purified pork insulin and so I don’t feel very old, but saying that I took a purified pork insulin therapy makes me feel very, very old and very grateful for how these therapies have improved and how we’re better able to match the physiologic profiles of what your body should make.