Due to an absolute deficiency in insulin production resulting in elevated blood glucose levels - type 1 diabetes can lead to many life-threatening complications such as heart disease, eye damage, kidney damage and liver damage. In 2000, the WHO reported that less than 1 million global deaths were attributable to diabetes- in 2016 that figure had increased to 1.6 million (1). As a person with diabetes, I am interested in undertaking research on a condition that affects myself- and people worldwide.
My experience with developing type 1 diabetes and how I now manage it
Mitochondrial dysfunction is linked to the development of a series of non-communicable diseases such as metabolic syndrome, cardiovascular disease and pulmonary disorders- all which increase the risk of mortality. Inclusive to these, there is evidence to show that mitochondrial dysfunction may be related to Type 1 diabetes (2), therefore learning more into the role the mitochondria plays in the cell and how its dysfunction may contribute to causing type 1 diabetes, which I have- was an important aspect of my work experience.
A simple explanation between the differences of the causes of type 1 and type 2 diabetes (link) (3)
It was during my first year in the University of Limerick that I received a life changing diagnosis. I had been sick with a severe cough for a few weeks and was showing no signs of recovering, I went to the doctor in early November and was prescribed 6 steroid tablets to be taken daily- however I just kept getting sicker and sicker. For the next few weeks my health seriously declined. I dropped from a weight of 70kg to 52kg, my clothes no longer fit me, I would wake up exhausted each day and was permanently thirsty, barely had the energy to get out of bed in the morning and my eye sight had become very poor (I took a vision test in September for my provisional license and had 20/20 eyesight).
However, despite these serious signs I came up with an excuse for each symptom, but deep down- I believed I would have been told that I was going to die if I visited my doctor. I just tried to ignore what was wrong with me- dedicating what little energy I had to studying for my upcoming exams and looking forward to spending time with my family over Christmas. It was the day after I had finished my exams, that would lead to me finding out what was wrong. I got sick before I went to sleep and couldn’t even lift myself out of bed the next morning. My mother called an ambulance, and one of the first things they did was check my blood sugar. They told me that they suspected I was a type 1 diabetic. At this point my blood sugar levels were 34mmol/L- the blood sugar range of a non-diabetic is between 4-7mmol/L.
The difference in functioning between a normal pancreas and the pancreas of a type 1 diabetic (link) (4)
Type 1 Diabetes is an autoimmune condition- which means that the T-cells of the immune system attack and destroy the insulin producing beta cells in the pancreas. T cells are a key component of the immune system- which normally serve to protect us by destroying foreign bodies that enter the body which could make us sick- such as bacteria or viruses. However, in type 1 diabetes, these cells incorrectly recognize the beta cells of the pancreas as ‘foreign’ and destroy them. This means that the body of a type 1 diabetic is unable to produce insulin to metabolize carbohydrates properly. I now must inject my own insulin for the rest of my life- for each meal- called bolus insulin, and also take a daily injection of basal insulin- which is responsible for keeping my blood sugar levels stable between meals and throughout the day.
A picture of both types of insulin I require to inject myself with daily.
Novorapid is taken when I eat foods containing carbohydrate (on average 1 unit per 15 grams of carbohydrate)
Lantus is taken once a day to keep my fasting glucose levels stable (I take 20 units a day)
This was all such a shock to me I thought that my life and what I could do in my future were going to be taken away from me as I was only 18 and had been diagnosed with a condition I will have for the rest of my life. I was in intensive care for 4 days in the University of Limerick hospital, under 24-hour supervision from a nurse- and had to stay for another 4 days to meet many specialists such as the endocrinology team, diabetic nurses and also dieticians who talked me through how to care for myself. However, this was all so much to take in- balancing my food intake with insulin, checking my blood sugar, dealing with high and low blood sugar levels, exercising, and all of the ins and outs about how type 1 diabetes would change my life.
The first month or two were quite tough, both mentally and physically. The most important things in helping me to live with type 1 diabetes were the acceptance and desire of my family and friends to help me in every way they could. Exercise is also another major component of effectively managing diabetes. It was hard at first to get used to finding the right balance of insulin and food, and when to exercise. However, as it is so important I have made sure to try and fit in exercise every day. To this day my favourites are lifting weights, swimming, cycling or even just a relaxing walk after work.
A healthy blood sugar level, I test my blood sugar levels before each meal (so I know how much insulin to give), 2 hours after each meal (so I can see how well I matched my insulin to my carbohydrate) and also every 20 minutes during exercise.
When I was diagnosed, I thought Diabetes would limit the potential of my life but time and learning how to manage it have showed me that that is not true. Theresa May, the prime minister of the U.K is a type 1 diabetic, as Nick Jonas of the Jonas brothers and also the 2-time Olympic gold medal swimmer Gary Hall. A few days after being diagnosed with type 1 diabetes, my family arranged for me to meet a professional cyclist from Limerick named Stephen Clancy- who also has type 1 diabetes and races with team Novo Nordisk. I learned about how Stephen manages his blood sugar levels during extremely long races which was fascinating. It was also inspiring as it showed me that with determination and dedication, managing my diabetes was something I could achieve.
Since being diagnosed, I have ensured to manage my diabetes as well as possible, but also making sure to pursue my interests such as travelling and getting a good degree so that I can work in the diabetes field in the future.
Picture displaying the prevalence and effects of Type 1 diabetes in the United States (link) (5)
Whilst preparation and planning is an enormous part of managing type 1 diabetes effectively, I have learned that you can’t prepare for everything that life throws at you. Some examples where things have went wrong with regards to my diabetes include- when I was traveling to Canada for 3 months and the airline misplaced my bag containing the majority of my test strips and needles meaning that I had to ration my supplies for around 10 days. Travelling can take more planning with diabetes as I have had my insulin pens ruined by the heat on my trips to Montreal and London due to the high temperatures which lead to high blood sugar levels for a few days. Through these experiences I have learned to always bring spare supplies as you can’t prepare for everything that happens.
Even in day to day life I must be extra prepared in managing my type 1 diabetes- for example eating a breakfast with a similar carbohydrate content as I know how much I need to eat and how it will affect me during my half hour cycle to work- or making sure I have enough test strips and glucose when I am out. Carrying glucose is a necessity- I carry glucose sweets in my pocket with me absolutely everywhere I go in life as I can’t always anticipate when low blood sugar will set in and when I will need sugar to stop me from collapsing or worse. The best way to live with diabetes is to be prepared, learn from your mistakes and not let them get you down, exercise as often as possible but most importantly to look at every day as something that shouldn’t be taken for granted.
My work experience in the NICB
Diabetes is a condition that is increasingly occurring worldwide- as indicated by the World health organisation’s findings that the number of diabetics in the world has almost quadrupled since 1980 (6). At this point in time I have just finished an 8-month work placement from the University of Limerick before returning to my final year of my Bioscience course. Having worked in the NICB from January until August 2018, I have gotten the true experience of what it is like to work in the field of Diabetes research. My experience I have gained from my time here will be a great foundation for my hopes to work in the field of Diabetes research in the future- something that will become increasingly important as more people are diagnosed with Diabetes every day.
Overview of the number of people with diabetes worldwide by the Mediterranean group for the study of diabetes in 2013 (link) (7)
Having diabetes and studying Bioscience at the University of Limerick- I was naturally drawn towards working in the field of diabetes research. I contacted Dr Donal O’ Gorman who has a lot of experience in diabetic research-for example the EU funded DEXLIFE project- (8) as I was interested in an internship. I have just finished my co-op in the NICB, working with the energy and metabolism research group under Dr Donal O’Gorman- which has been an excellent experience between January and August 2018. During my time in the NICB, I have learned a wide variety of lab skills- which were taught to me by my very helpful mentor John Noone, a Ph.D. student under the tutelage of Dr O’ Gorman. The main areas I worked in during my time in the NICB were skeletal muscle proteomic signalling and mitochondrial metabolism. In my in-vitro work, I was responsible for growing and differentiating C2C12 cells which are a musculoskeletal cell line derived from mouse skeletal muscle.
Counting C2C12 cells in the clean room
Proteins were also extracted from these cells during the differentiation process over 5 days and to quantify the upregulation of myosin heavy chain protein-a key component in musculature contraction. My in-vivo work involved the analysis of rat skeletal muscle to assess for in-vivo differences to my in-vitro C2C12 work. John taught me how to homogenize rat muscle by dissecting the rat and breaking down its muscle for example.
The NICB was really an amazing place to receive an introduction into the professional working world- I learned from truly skilled professionals and also made great friends there. I attended many fascinating seminars during my internship such as the 3U annual diabetes conference (review of the event)(9), the Biological Research Society’s annual research day (10) and also many interesting talks by guest speakers from around the world in the NICB. An aspect of work that really helped me to develop my confidence in a group environment was our weekly meetings with the energy and metabolism research group- consisting of Dr O’ Gorman and his Ph.D. students. In these meetings we would talk about the research we did during the week and plan what to do next- this was very helpful for me to participate in a group setting as we can all help- and learn from one another- and enjoy a coffee together after the meeting. The NICB promotes the importance of mixing with fellow workers by hosting coffee mornings, games nights or going for food and drinks with the other staff. During my time in the NICB, I was also assigned a variety of topics to give presentations on such as how skeletal muscle contracts or membrane potentials in the nervous system.
Brushing up on my presentation skills during my time on the NICB
My co-op in the NICB was overall a very positive experience which I thoroughly enjoyed and I would like to thank Dr. O Gorman- John Noone and also everyone who I met throughout my time here for teaching me so much and making me feel so welcome- it has been a pleasure.
My farewell dinner with the members of the EMRG, people present in order from left to right of picture
Enda Murphy (PhD student), Donal O’Gorman (EMRG Principle Investigator), John Noon (PhD student), Ross Heffernan (myself), Rajan Sambhavi Priyadarshini (PhD student), Sam’s parents