The Princess and the Pancreas: A Fable About Type 1 Diabetes

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By: Maggie Salmon-Leotta

Once upon a time in a land called Sweeten, there lived a beautiful princessnamed Princess Tootsweet. She had long flowing hair, large dark eyes, and a lazypancreas.

"Lazy pancreas? What does that have to do with a lovely princess?" onemight ask.

And one might answer thusly: For some time Princess Tootsweet hadbeen feeling a little too fatigued to enjoy the kingdom's intramural joustingevents. Because she was constantly halting the exhibitions to take a trip to theroyal outhouse, the members of her court would whisper, "Gee, Princess Tootsweetsure does pee a lot."

Princess Tootsweet became so thirsty that the royal water bearers were runningout of royal water to bear. She felt hungry and tired and irritable, and that'swhen she decided it was time to visit her royal doctor, Doctor Langerhans.


"Oh, Doc, I just feel so tired that I can't enjoy the jousting events anymore.I've lost weight, and…." The princess paused. Dr. Langerhans finished, "Andyou're making so many trips to the royal out-house that your subjects arewhispering, 'Gee, Princess Tootsweet sure does pee a lot.'"
 "Yes, precisely.That is why I came to see you."


"Hmmm…." said Doctor Langerhans, "Are you thirsty a lot?"


"Well, yes."
 "Hungry?"
 "I could eat a royal unicorn if I could find one!"
"Irritable?" asked the doctor. 
This really irritated the princess, whoanswered, "Hel-LO, I am the princess of SWEET-EN. I am always sweet. I am NEVERirritable!"


"Not irritable….Okay." Dr. Langerhans looked over his spectacles, "Well, let'sget some blood work done, and we'll get a better idea of what's going on."
 "Blood work, what kind of blood work? I am a princess, and my blood works justfine." 
Dr. Langerhans replied, "Yes, perhaps, but I want to give you a testcalled a fasting plasma glucose test. The results will show whether or not youhave diabetes."


The princess looked dismayed and bewildered. "Diabetes? What are they?"
 Dr.Langerhans also looked dismayed and bewildered. "Not 'They.' It's a disease,singular…"
"Huh?" was the royal reply. "Diabetes is a disease in which thebody does not produce or properly use insulin." "Huh?" again, the royal reply."Let's get the fasting plasma glucose test done," smiled the doctor.
 "Very wellthen," stated the princess with a grand gesture. "Let the bleeding begin!"


"Okay, so what about the lazy pancreas?" you're wondering. Well, I'm gettingthere. Dr. Langerhans received the results of Princess Tootsweet's fastingplasma glucose test. Princess Tootsweet listened as the doctor told her that shehad type 1 diabetes. The doctor explained that her pancreas has stopped makinginsulin and that insulin is needed in the body to deliver energy in the form ofglucose to all the parts of the body. Without insulin, glucose builds up in theblood and can cause all kinds of problems.

Now, Princess Tootsweet was quite upset by this news. She yelled, "I will nottolerate such insolence, such, such, laziness! from any one or any pancreas!Can't I just command my pancreas to work again and make this, what's it called?Insolence… insomnia… instant coffee…?"
"Insulin," answered the doctor. "No,Princess Tootsweet." "What do I do now?" The princess choked back tears. "Thispancreas of mine is lazy, and the intramural jousting exhibition is coming upsoon, and what's going to happen to me? Oh, peppercorns! My life is never goingto be good again!"

Dr. Langerhans understood the princess's frustration and anger. Finding out thatyou have diabetes can be devastating news, be you a princess or a pauper. Princess Tootsweet gathered her crown and scepter quickly, wanting only to beleft alone to try and forget all about this diabetes stuff. Doctor Langerhansstopped her and said, "Princess Tootsweet, you can have a normal life. Withmedicine and the right diet and exercise, with careful monitoring of your bloodglucose levels, and, most importantly, with knowledge of how to manage diabetes,you, Your Royal Highness, can have a wonderful, royal, and groovy life."
 ButPrincess Tootsweet did not want to listen any more.

Princess Tootsweet retired to her chambers. As she paced about, angry and upset,she decided that she did not feel too bad and that perhaps the doctor had made amistake. So she ignored everything the doctor had told her to do. She refused totest her blood sugar – Oww! That thing hurt! She refused to follow a balanceddiet. She refused to believe she had this, this "disease." (She could not evenbring herself to say the word DIABETES.). Then, one day as the princess waswalking in her garden, she felt terribly, horribly sick, sicker than she hadever felt in her life. Suddenly, she collapsed beneath her favorite weepingwillow tree.

Princess Tootsweet woke up in the hospital. Tubes and wires and all sorts ofthings were attached to her in all sorts of odd ways. 
Dr. Langerhans came in tosee the princess. "What happened to me, Doc? And what is up with all these tubesand whatnots going in and out of me?"
 Dr Langerhans replied, "Princess, youhave ketoacidosis." The princess made that scrunched-up face that she alwaysmade when she was confused. "Ketoacidosis? Who are they and what do they wantfrom us? Don't I have a war adviser or something to tell me about these things?Oh, I don't care about invading barbarians with goofy names. They can have thekingdom! I just want to know what happened to me."


Dr. Langerhans explained. "Not 'They.' 'It.' It's a condition, dear Princess.It's what happened to you. You have ketoacidosis." "Oh!" was the royal reply.Dr Langerhans went on to explain what ketoacidosis was and how it is caused. Hetold her that she was being given fluid intravenously (in the vein), along withinsulin, to get her blood to have just the right amount of glucose in it. 
Theprincess could not deny it any more. She slowly came to accept her diagnosis.

While the princess was in the hospital, she learned more about diabetes. Ken RNwas one of Princess Tootsweet's nurses. It was his job to make sure that sheknew how to manage her diabetes when she left the hospital. Ken RN advised theprincess to eat well balanced, healthy meals and to check her blood glucoseregularly. He showed her how to administer insulin, what to do when she got sickwith a cold or flu and was not feeling quite so royal, and where she could getmore information about diabetes. Ken RN made sure that Princess Tootsweet had aclue before she was discharged from the hospital.

After Princess Tootsweet was discharged, she wanted to learn even more aboutdiabetes. So she read books about diabetes, subscribed to Diabetes Healthmagazine, and surfed the web for more information. She learned so much, and sheused all that knowledge to get her diabetes under control. When her diabetes wascontrolled, the princess felt so healthy, so in control, and so groovy that shewas soon considered by all her subjects, and by the royal court as well, to bequite the expert when it came to managing her diabetes.

Yes, indeed, the royal unicorn was spared. The water supply returned to optimumlevels, and the intramural jousting exhibitions resumed. The pancreas, so lazy!stayed on vacation, but none of Princess Tootsweet's subjects or royal courtmembers whispered about her frequent trips to the royal outhouse anymore.Instead they proclaimed, throughout the land of Sweeten and beyond, how smartthe princess was when it came to staying healthy and managing her diabetes. And,of course, they all lived quite happily and healthfully ever after! 


Royal Glossary

Fasting Plasma Glucose Test: This is a blood test to see if you have diabetes.First, you fast (no food!) for about eight hours. Then a little bit of bloodtaken from a small vein and is put into a little test tube. Off it goes to alaboratory, where the amount of glucose in the blood is measured. A person whodoes not have diabetes will have under 100 mg/dl (milligrams of glucose in adeciliter of blood). A person who has diabetes will have 126 mg/dl or more. Thetest is repeated if the number is high, just to make sure that everything wasdone correctly and that the high number is not just a fluke. 


Diabetes: Princess Tootsweet had type 1 diabetes. Type 1 diabetes is caused byan autoimmune disorder, which is a problem with the body's immune system. When apancreas is working the way it should, specialized cells (called beta cells) inthe pancreas make insulin. Insulin is a hormone that allows the body to useenergy from food. In type 1 diabetes, the immune system mistakes beta cells forinvaders and attacks them. After enough beta cells are destroyed, insulin is nolonger produced and symptoms of diabetes appear.

In type two diabetes, the beta cells still produce insulin. However, the otherbody cells do not respond properly to the insulin, or not enough insulin isproduced naturally to meet the needs of the body. Insulin is usually stillpresent in a person with type 2 diabetes, but it does not work as well as itshould. Some people with type 2 can keep it under control by losing weight,changing their diet, and increasing their exercise. Others take one or moremedications, including insulin.

Dr. Langerhans: Dr. Langerhans was a real doctor who discovered the littlegroups of cells in the pancreas that produce insulin and other hormones. Whenhe looked at the groups of cells, he thought they looked like little islands, sohe named them the islets of Langerhans.


Glucose: Generally, glucose starts out as carbohydrates. Carbohydrates are foundin foods like rice, pasta, fruit and bread. The digestive tract breaks down thecarbohydrates into something the body can use for energy: glucose. In the smallintestine, the glucose is absorbed into the bloodstream, and there it meets upwith insulin.

Insulin: Insulin is like the cool knight in shining armor who knows the secretpasswords to all the best castles in the neighborhood. Everyone knows you can'tget into the super-secret castle on Eighth Street without the secret password.Glucose does not have the password, so he pals up with Insulin. Insulin andGlucose together go to the muscle cells and knock on the cells' doors. ThereInsulin says the secret password, and Glucose enters the cells, providing energyto the cells. If Glucose is running around in the blood without Insulin, henever gets in the cells of the muscles because…why? He doesn't have the secretpassword!

Ketoacidosis: Ketoacidosis is a serious complication of diabetes. When Glucoseis not hanging out with Insulin, Glucose does not get into the cells of themuscles to provide energy. So the body starts using fat for energy. When fat isbroken down, some of the little by-products are called ketones. If all thishappens at a very fast rate, the ketones build up in the blood, making the bloodacidic.

Blood loaded down with ketones is like a poison. Why so hungry? Because themuscles are not getting glucose, they "feel" like they are starving. And theyare starving for the energy that glucose gives. Why so thirsty? All that extraglucose in the blood draws water out of the blood like a sponge as it passesthrough parts of the kidneys. If this goes on too long, the body becomesdehydrated. Sometimes the diabetic person starts vomiting, and this causes evenmore dehydration. Severe dehydration can cause a collapse of the whole body,coma and even worse. If you have type 1 diabetes, your body needs insulineveryday, which brings us to…. 


Denial: Sometimes the news can be too horrible, so we just decide it is nottrue. This is a big problem for diabetics and other people who have justreceived bad news. Although you might feel better for a little while by justblocking out the bad news, in the long run the problems get even worse.

Acceptance: If you can accept the bad news, then you can start getting on withmaking your life groovy. It takes work, but a groovy life is worth it: just askPrincess Tootsweet! 


RN: RN stands for Registered Nurse. RNs are specially trained healthcareprofessionals who must go to school, pass rigorous exams, and keep up with newdevelopments. Nursing has traditionally been viewed as a woman's profession, butmore and more men are becoming nurses, attracted by the good pay, flexibility,opportunities for advancement, and their desire to help out their localprincesses and fellow men.

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