M.G. a 32-year-old marketing executive, was diagnosed with juvenile-onset (type 1) diabetes at the age of 3 years. She vividly remembers her mother taking her to the doctor because she had an illness that caused her to feel extremely tired and very thirsty and hungry. She also had a cut on her knee that would not heal and had begun to wet her bed. Her mother had had gestational diabetes during her pregnancy with M.G.; M.G. was described as a "macrosomia" because she weighed 10 lb at birth.
M.G. has managed her disease with meticulous attention to her diet, exercise, preventative health care, regular blood glucose monitoring, and twice-daily injections of regular and NPH insulin, which she rotates among her upper arms, thighs, and abdomen. She continues in a smoking cessation program supported by weekly acupuncture treatments. She maintains good control of her disease in spite of the inconvenience and time it consumes each day. She will be married next summer and would like to start a family. M.G.'s doctor suggested she try an insulin pump to give her more freedom and enhance her quality of life. After intensive training, she has received her pump. It is about the size of a beeper with a thin catheter that she introduces through a needle into her abdominal subcutaneous tissue. She can administer her insulin in a continuous subcutaneous insulin infusion (CSII) and in calculated meal bolus doses. She still has to test her blood for hyperglycemia and hypoglycemia and her urine for ketones when her blood sugar is too high. She hopes one day to have an islet transplantation.
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