ALTURA, Minn. – Eric Hilke is always thinking of his next meal, but not always because he is hungry.
    “Every time I eat, I have to correct my blood sugar,” Hilke said.
    The 29-year-old dairy farmer from Altura has Type 1 diabetes, which he has dealt with since the age of 6. He is one of the 1.25 million Americans who have Type 1 diabetes, according to the American Diabetes Association. The rest of the 30 million Americans who have diabetes have Type 2 diabetes, including Bob Pierce, who dairy farms near Darlington, Wisconsin.
    November is National Diabetes Month, which brings awareness to the disease.
    “Most people don’t know I have diabetes,” Hilke said.
    In Type 1 diabetes, the body does not produce insulin, the hormone that regulates blood sugar. Insulin is needed to breakdown sugar in the bloodstream for energy. People who have Type 1 diabetes must inject or pump insulin into their bodies every day to regulate blood sugar.
    “I am 100 percent insulin dependent,” Hilke said. “It cannot be controlled with diet, exercise and pills. It’s a bit of a struggle to manage.”
    Hilke wears an insulin pump that slowly drips insulin into his body and takes a bolus of insulin every time he eats.
    “You have to compensate and carb count,” Hilke said. “If you’re going to eat 15 grams of carbs, one slice of bread, it will bring you up 100 units on your blood sugar. But if you exercise, or for me milking, feeding calves or doing something on the farm, you might not take any insulin because your body is burning off those carbs and sugar. It’s literally a teeter totter. You have to feed it on one end, but keep it from going the other way.”
    With Type 2 diabetes, the body does not properly use insulin. Initially, the body creates more insulin, but eventually cannot keep up and creates a high blood sugar. Unlike Type 1, Type 2 can be managed with diet, exercise and medication.
Pierce was diagnosed with Type 2 diabetes one year ago at the age of 45. There were several indicators something was not right. Pierce had issues with sensations in his feet. He also drank nearly 5 gallons of water each day.
    “That was my body trying to flush the sugar out of its system,” Pierce said.
    Eating became a constant for Pierce.
    “The last few years, I was eating enough for three people each day,” he said.
He also had extreme fatigue and not only from working hard on the farm.
    “It was constant,” Pierce said. “I could come in from the barn in the morning, sit down and sleep until chores that afternoon. I knew something wasn’t right, but I couldn’t put a finger on it.”
    In October 2018, Pierce decided to do something. Because he knew his symptoms lined up with diabetes, he bought an inexpensive blood sugar monitor from the local drug store.  
    “It wouldn’t even register it was so high,” Pierce said.
    Within 24 hours, Pierce saw a doctor and had a diagnosis of Type 2 diabetes.
Pierce had to immediately change his diet by cutting out sugar and decreasing his carbohydrate intake and also started taking a medication to help his body regulate.
    “In the course of 48 hours, I went from having a little coffee in my morning sugar … to black coffee,” Pierce said. “That was a rude awakening. But now black coffee is good enough.”
    Realistically, Pierce keeps his carbohydrate intake to 50 grams per day; however, he said 20 grams per day is better.
    “One regular slice of bread can have anywhere from 9-16 grams [of carbohydrates] in it,” Pierce said. “When you actually sit down and start reading labels it really scares you.”
    Pierce’s day starts with checking his blood sugar every morning. Before going out to the barn to milk his herd of 38 cows, he has scrambled eggs with cheese along with sausage patties. At noon, his lunch will include something like a turkey and cheese wrap; the wrap has 8 grams of carbohydrates. His dinner and snack before bed are also protein-heavy meals with meat and cheese.
    While Pierce admits he could do a little better to lower his blood sugar, he is now managing it well.
    “I have a lot more energy now,” he said. “Other than the diabetes according to the bloodwork, I’m healthy as a horse.”
    Hilke also has learned how to manage the disease.
    “As a farmer, you get kind of a rhythm and you get used to it,” said Hilke, who milks 115 cows himself.
    He has to check his blood sugar between eight and 10 times each day and estimate on his day’s physical activity so he can think about his meals and compensate his insulin needs.
    “You really have to watch your highs because if you get real high and take a bunch of insulin you’re burnt,” he said. “You get tired. The hard part is trying to have long acting carbs and balancing that with perishable foods. You can’t sit in the house and make food all day.”
    The constant managing can be a struggle.
    “I eat more junk food than I want, but I can’t wait to the next meal to eat,” Hilke said. “If I’m milking and my blood sugar drops to 50 or 40, I have to get something in me quick. So, there are fast acting carbs and long acting carbs.”
    Getting a high or low blood sugar can make him irritable and short tempered along with sleepy.
    “It really drags on you, so keeping it on a balanced level is pretty key,” he said.
    The insulin and equipment to keep Hilke’s body in check is expensive. The insulin pump, which lasts about four years, costs about $20,000. And, insulin is about $100 per bottle.
    “If you don’t have insurance, it’s horribly expensive,” Hilke said.
    Hilke is thankful his wife, Heather, has insurance through her off-farm job as a registered nurse.
    For Pierce, he knows going back to his old habits could cause liver or heart damage; however, he is thankful he is able to manage his diabetes.
    “It’s a change in lifestyle,” he said. “I didn’t expect to ever be diabetic.”