Diabetes is a progressive disease. If you do nothing to manage your glucose levels, complications will eventually occur. Long-term complications can lead to amputations, blindness, renal failure and death.
But the scary thing is that even well-controlled diabetes can continue to progress. I'm currently controlling the disease through diet and exercise alone. There will probably be a day that I need to return to oral medications, perhaps continuing to increase the dosage over time. In the future, I may even need to start an insulin regimen. Being that I'm only 39, I'm hoping to live a long time with diabetes so I've prepared myself to accept this progression as a very possible eventuality. I'm hoping that the better I control my diabetes, the longer I can put these measures off.
Unfortunately, for every two steps forward I make, I sometimes have to take one step back. I've been able to celebrate many successes over the past 10 months as I've tackled my diabetes management aggressively. But that aggressiveness may have also contributed to the setback that I'm currently facing. Tomorrow, I go in for my first laser treatment in an attempt to stop the progression of my retinopathy.
Retinopathy is a vision condition that is unique to diabetes. It is separate from the common "blurred vision" issues that are often a symptom for early diabetes diagnosis. If you've developed retinopathy, there is a good chance that you've had uncontrolled diabetes for many, many years. Excess blood sugars -- and oftentimes high blood pressure -- affect the capillaries in the back of the eyes and create white, cotton-ball like spots. Retinopathy can progress to where the capillaries grow in new directions and bleed in an attempt to carry more oxygen to the eyes.
Being young and relatively healthy, I did not have regular checkups at the doctors like I probably should have. I only went to the doctor if I was ill, which wasn't very often. So instead of preventive medicine, I only received reactive medicine to treat specific issues. So no real chance at catching diabetes early through common blood tests. However, I have been going to an optometrist for many years and getting regular, comprehensive eye exams. My optometrist advertised that he could detect diabetes with these exams, presumably by finding signs of early retinopathy. Unfortunately for me, there wasn't any sign of damage until after I was diagnosed with the disease.
Shortly after diagnosis, I went to the optometrist to see if any damage had been done. I hadn't been having vision issues so there weren't any warning signs. It had been a little over two years since my last dilated eye exam, which had revealed healthy eyes. So my optometrist was shocked to find that I had moderate retinopathy in my left eye and mild retinopathy in my right. He told me that getting my glucose levels under control would help clear my vision up and scheduled an appointment with a retina specialist for me the very next week.
At the retina specialist, I underwent another eye exam. Standard vision test. Numbing of the eye to test for ocular pressure. Dilation so the doctor can see the back of the eyes. And some photographs of the retinas before and after a special dye is injected into the blood stream. These tests, of course, confirmed the retinopathy and I was scheduled for a return visit a few weeks later for treatment.
Before returning to visit the retina specialist, I had a follow up with my endocrinologist who had seen how well I was managing my numbers in such a short time and recommended that I did NOT have the laser procedure at that time. His reasoning was that the retinopathy would clear up with the better control and that by having the procedure to cauterize the leaky vessels in my eyes, that I wouldn't have the opportunity to improve my vision. The retina specialist didn't necessarily agree with that assessment but agreed to give me three more months to see if I could control my glucose numbers and improve the retinopathy on my own.
Since that time, I've had about three additional visits with the retina specialist. And each time, he agreed to prolong the start of the laser treatments -- impressed with my numbers and not seeing any progression of the retinopathy through a dilated exam. A week ago, I went for another visit and he performed another one of the dye photograph sessions to compare the leakage from a year ago and it revealed that the retinopathy has gotten worse and told me that I'll need to go ahead and start the laser procedure.
I was a bit surprised and yet not surprised at the same time. My vision has gotten progressively worse over the year, mostly in my left eye. While I had hoped that everyone was right that it would improve as I worked hard to control my glucose, I could tell that it hadn't. But I was still led to believe by multiple medical personnel that the condition would improve -- or at least not get any worse. So I was surprised when I got the news that it had worsened despite having quickly lowered my A1C.
But apparently that was the problem. What nobody had told me -- perhaps they didn't know -- was that suddenly reaching "normal" glucose levels after having an A1C above a 9 often worsens the condition, not improves it. While good glucose control is something to strive for in the long run, quickly achieving that control in a short time can be detrimental to my eyes' health. I first heard this mentioned on the American Diabetes Association discussion boards long after I had already dropped my numbers and have since confirmed it with some research on the Internet. Who knew?
I wish someone on my medical team had. So now I wait for tomorrow to have a laser procedure that I had tried so hard to avoid in the first place, something I could have started nearly a year ago, and maybe prevented the vision loss that has occurred over that time. I won nothing by waiting and probably actually lost a bit because of it.
Two steps forward, one step back. I do feel like I'm still ahead in my battle against this stupid disease. And I'm hoping that the laser procedures (as in more than one -- apparently this is just the start) will stop the progression and save my eyesight.
I'm not as scared as I was about the procedure when I first heard it might be a possibility. The time I won in the delay let me get to a better place mentally. I'm not really angry that I was lead to believe that good glucose control equaled improved chances of stopping my retinopathy, though I would have been more open to having the procedure done sooner than later if I had known. I've just come to the point where I accept what's going to happen, knowing that the disease progresses sometimes despite good control. I know that I'm doing everything I can to control my diabetes and slow the resulting complications as long as possible.
You win some. You lose some. Tomorrow, I lose a battle. Hopefully, the strategy of accepting that defeat will help me win the war.
Monday, February 27, 2012
Friday, February 24, 2012
Book Report
From stories that I've read and from my own personal experience, when many people are first diagnosed with diabetes, their doctor usually hands them a prescription for metformin and tells them good luck. For anyone who remembers the old TV show The Greatest American Hero, it ain't so much the supersuit that's important as it is the instruction manual. Unfortunately, doctors don't seem to have diabetes instructional manuals on hand at diagnosis.
While waiting at the pharmacy to have the aforementioned metformin prescription filled, I happened upon the Diabetes Health Journal for sale and decided to see what information I might glean from it. It wasn't too bad of a jumping-off point. The book featured a wide variety of topics of interest to diabetics, as well as recipes (which I've included the results of here in previous blog posts) and a handy way to monitor glucose results. I read it from cover to cover to try to learn as much about this disease I now had as possible. While not specifically tailored to Type 2 diabetics, it had enough information about diabetes in general that I felt somewhat better prepared to deal with any issues that might arise than I did when I left the doctor's office.
Much of my continued learning was achieved online -- whether looking up answers for specific issues through a search engine or finding advice and comment in an online forum. On the discussion boards of the American Diabetes Association, I found a number of people advocating a book called The First Year -- Type 2 Diabetes: An Essential Guide for the Newly Diagnosed by Gretchen Becker. I saw that it was available at one of my local libraries and recently checked it out to read.
The book is sort of that missing instruction manual that I wished might have been given to me when I was first diagnosed. Chapters are broken down for each of the first 7 days of diagnosis followed by ones detailing the first weeks through the first month and then monthly through the advertised first year. Each chapter features a "Living Section," which highlights a particular issue that a newly diagnosed diabetic might be experiencing (or feeling) at that particular moment followed by a "Learning Section" that goes into more details about the science of the disease.
What I like most about the book is that it is authored by a "patient-expert," which means that Ms. Becker has walked in my footsteps and understands well how the disease affects people personally rather than just being a clinical study of tests that have been conducted or of outside observations made of diabetics. I hate to suggest that someone couldn't write an equally good book without having experienced the disease first-hand but I think it helps that she has walked in our moccasins, so to speak. Becker's tone, even when dealing with the more in-depth "Learning Section," tends to be somewhat conversational and relatable. It is not a heavy book, thankfully.
Perhaps the hardest thing to in evaluating this book is that I read it over the course of a couple of weeks just after my ninth month of diagnosis. It was not a step-by-step guide for me in the sense that I wasn't reading a chapter a day for the first week and then picking it up at various intervals afterward. But the stuff I knew was great to have as a refresher course and the stuff I didn't know is important to know at any stage of the disease.
There is also somewhat of a chicken-or-the-egg issue going on with the book. Becker had found a lot of support and information from the online diabetes community (even sharing some of their stories throughout) and there are lots of references to things that I've read on the various discussion boards these past 10 months. I'm not sure whether stuff like YMMV (Your Mileage May Vary) came from Becker and has been used by participants of the boards or whether that term and advice were taken from the boards and included in the book. Not that it really matters that much in the grand scheme of things but there are a number of references that can be found in both sources. So much of what I read in the book, I had already read online. Although, that said, there are enough universal thoughts about the disease that I found things that I've alluded to in the book as well and I know Becker didn't get them from me, nor I from her.
I have a much better understanding of diabetes as it relates to me after reading the book. There are a number of things that made me go, "I get it now" or "That makes sense to me." After reading this book and looking at some of my labs, I have a clearer picture of what's going on in my body, with the food that I eat, exercise that I take and how it all relates to one another. For anyone who is looking to take a proactive approach to their diabetes management, this is a good book to read.
I noticed that there is a second, updated version of The First Year available. I'm thinking about buying it and seeing how much has changed. New drugs have been introduced. New ideas and thoughts have emerged from the medical community. And Internet resources that were referenced have grown and changed. Not only am I interested in seeing the updated version for the sake of updates but I also feel like the book is a good one to keep around for reference. If something new pops up or how I approach my diabetes management has to change, it would be good to have this book readily available to see what it might all mean.
Tuesday, February 14, 2012
'My Story' Featured on the American Diabetes Association Newsletter
I got my college degree in journalism. I actually stumbled into it somewhat by accident when attempting to satisfy an English requirement without having to take an English class that I should have already been credited for because of passing the AP test in high school. (How's that for a run-on sentence?) After taking the "101" course, I wound up continuing on to a subsequent course because a classmate wanted to take it but didn't want to do it alone. Shortly after the start of the next semester, she dropped out and I continued on.
That next class was writing for the school paper. My very first assignment -- and my first printed story -- was about our school's newly launched website. The consumer Internet was still in its infancy and the idea of a school of higher education having its own website was apparently big news. Now, years later, I wonder how any of us actually got along before the Internet.
Because of the Internet, you are here reading this blog. Hopefully, that's more of a reward than a punishment. I wouldn't quite consider myself addicted to the Internet but I'm not sure what I would do without it. The Internet has allowed me to gather information from sources all over the world. It has allowed me to keep in touch with old friends and to meet new ones. And the Internet was the ideal place for me to turn to when I was diagnosed with diabetes.
Shortly after my diagnosis, I went looking for as much information about my disease as I could find. I was given so little information by my medical team, it all seemed so overwhelming. One place that I really began investigating was the website for the American Diabetes Association. I eventually found myself on its discussion boards and reading about all of the things that other diabetics did to manage their disease. I decided to quit lurking there and become a full-fledged member around the same time that I launched this blog.
One of the features that they had was a "meet the member" post that was linked from a web-based email newsletter that the ADA sent out. It was a featured poster telling their story of how they discovered they had diabetes and what they do to manage it. It was neat to read about the differing ways that people learned about the disease and themselves in the process. It was also neat to see a picture and know the real name of the people who I had only known as an avatar and a screenname.
After commenting about this on the post of the January member of the month, I was "nominated" by a couple of A Bunch of Pricks readers who thought that I wrote well and had a good story to tell. That "nomination" led to the forum moderator to get in touch with me to see if I would be willing to contribute by doing a "My Story" article of my own. Despite being fairly recently diagnosed, I was assured that others would be interested in reading a different perspective so I drafted a response, had my beautiful wife take a picture of me at the Los Angeles Zoo and sent the whole thing in. The result was being featured in the February eNewsletter of the American Diabetes Association.
If you're still with me, what I'm trying to do in a very long-winded manner is to say, check out the article here and click on through the link to read my full story. Feel free to post any praise or positive comments on the Community boards or here below. Please keep any negative comments to yourself. ;)
In all seriousness, I hope that my story might be inspirational for someone who is using the Internet to search out information about their own diabetes. It's not easy being thrust into this new lifestyle with little information and little connection to others managing the same disease. But the Internet makes it possible to share our stories and not feel as all alone. Hope my story can make someone else feel like I've felt when I found the online community at the ADA.
That next class was writing for the school paper. My very first assignment -- and my first printed story -- was about our school's newly launched website. The consumer Internet was still in its infancy and the idea of a school of higher education having its own website was apparently big news. Now, years later, I wonder how any of us actually got along before the Internet.
Because of the Internet, you are here reading this blog. Hopefully, that's more of a reward than a punishment. I wouldn't quite consider myself addicted to the Internet but I'm not sure what I would do without it. The Internet has allowed me to gather information from sources all over the world. It has allowed me to keep in touch with old friends and to meet new ones. And the Internet was the ideal place for me to turn to when I was diagnosed with diabetes.
Shortly after my diagnosis, I went looking for as much information about my disease as I could find. I was given so little information by my medical team, it all seemed so overwhelming. One place that I really began investigating was the website for the American Diabetes Association. I eventually found myself on its discussion boards and reading about all of the things that other diabetics did to manage their disease. I decided to quit lurking there and become a full-fledged member around the same time that I launched this blog.
One of the features that they had was a "meet the member" post that was linked from a web-based email newsletter that the ADA sent out. It was a featured poster telling their story of how they discovered they had diabetes and what they do to manage it. It was neat to read about the differing ways that people learned about the disease and themselves in the process. It was also neat to see a picture and know the real name of the people who I had only known as an avatar and a screenname.
After commenting about this on the post of the January member of the month, I was "nominated" by a couple of A Bunch of Pricks readers who thought that I wrote well and had a good story to tell. That "nomination" led to the forum moderator to get in touch with me to see if I would be willing to contribute by doing a "My Story" article of my own. Despite being fairly recently diagnosed, I was assured that others would be interested in reading a different perspective so I drafted a response, had my beautiful wife take a picture of me at the Los Angeles Zoo and sent the whole thing in. The result was being featured in the February eNewsletter of the American Diabetes Association.
If you're still with me, what I'm trying to do in a very long-winded manner is to say, check out the article here and click on through the link to read my full story. Feel free to post any praise or positive comments on the Community boards or here below. Please keep any negative comments to yourself. ;)
In all seriousness, I hope that my story might be inspirational for someone who is using the Internet to search out information about their own diabetes. It's not easy being thrust into this new lifestyle with little information and little connection to others managing the same disease. But the Internet makes it possible to share our stories and not feel as all alone. Hope my story can make someone else feel like I've felt when I found the online community at the ADA.
Thursday, February 2, 2012
My Latest A1C Results
Went to my three-month appointment with the endocrinologist today to get the results of my most-recent A1C. I was a bit nervous since it was my first test after attempting to manage my diabetes with diet and exercise alone (as well as having just gone through the eating season of the holidays). But I was pleasantly surprised that it came back at a 5.5 -- just a tenth of a percent higher than the last test!
I also found it interesting that my endo said that I didn't have diabetes anymore. He didn't say I was cured. He didn't say that I had reversed diabetes. But being sensitive to such declarations, I challenged him on it. He clarified his remarks by saying that if I were to take any one of three diagnostic tests for diabetes -- fasting glucose test, random glucose test or A1C -- that my numbers would come back in the normal range. He said that if I were to apply for insurance right now, he would list me as non-diabetic. Splitting hairs or a game of semantics? I don't know but it doesn't affect how I'm going to go about managing the disease going forward.
Anyway, going to keep watching my carbs and exercising daily. I'll find out the results of my next A1C when I follow up with the endo in 6 months time.
I also found it interesting that my endo said that I didn't have diabetes anymore. He didn't say I was cured. He didn't say that I had reversed diabetes. But being sensitive to such declarations, I challenged him on it. He clarified his remarks by saying that if I were to take any one of three diagnostic tests for diabetes -- fasting glucose test, random glucose test or A1C -- that my numbers would come back in the normal range. He said that if I were to apply for insurance right now, he would list me as non-diabetic. Splitting hairs or a game of semantics? I don't know but it doesn't affect how I'm going to go about managing the disease going forward.
Anyway, going to keep watching my carbs and exercising daily. I'll find out the results of my next A1C when I follow up with the endo in 6 months time.
Wednesday, February 1, 2012
Retail Therapy
I hate to admit it but I was envious of the smokers at work.
Not because I wish I could puff on cigarettes too but because I would see them parade past my desk every hour to take a 5 or 10 minute "smoke break" while I stayed in my seat and worked. Six or so breaks a day was at least a half-hour out of the office, which over the course of a year meant that I was working about 2 1/2 weeks more than they were.
I decided that it would be nice to get out from behind my desk a time or two myself but the problem is that I'm not the type of person that just goes off and does "nothing." I had to have a reason to leave the office and do "something." What I wound up doing was walking down the street to the corner convenience store and getting an afternoon snack of a bottle of Coke and a candy bar or two. Do that three or four times a week and I was adding way too many carbs and calories to my diet.
When we moved office buildings a few years back, it got even worse. Instead of getting a nice 20-minute walk in to the corner and back, we had our own cafeteria on the ground floor to visit for the Coke and candy. So instead of getting any exercise to offset the sugary snacks, I was simply taking an elevator down a couple of floors and back each day. Eventually, I decided to stop frequenting the cafeteria and walking across the street to Target where I could walk around and buy my snacks. After the diabetes diagnosis, I would continue my venture across the street but I eliminated the snack portion of the trip.
However, I still needed to do "something" so I started shopping. I've always enjoyed shopping but have never really enjoyed buying. My grandma worked in the mall and I spent about 8 years myself working retail so I'm familiar with the inside of a store. In order to justify the trips to Target -- and to update my wardrobe as I continued to lose weight -- I would buy an item of clothing every now and again.
I like shopping the clearance racks. They often have deals of 30, 50 and 70 percent off the regular price. It started last summer with me needing to get new shorts. Size 34 turned into size 32, then 30, and even a couple of 28s, depending on the cut. I'd need new dress and casual pants, new dress shirts and T-shirts, new nightwear and underwear. I began to notice that as trips to the clothing store replaced trips to the snack shops, it was my own form of retail therapy.
I wouldn't say that I'm addicted to shopping. As I said, I just like to do "something" -- feel like I'm not wasting my time. I wish walking for the sake of walking was enough for me but I do that for my exercise at the end of the evening. Walking isn't "something" during the day. And I'm happy to be doing something that doesn't involve excess carbs and calories.
I've done pretty good on my deals. I rarely pay full price for anything. I either wait for it to go on sale or I buy it on clearance. The clearance rack can be too much of a good thing, though, and I find myself picking up good deals on stuff that I might not need. I've learned lately to really only get something if I really like it rather than buy it because it's cheap. It's a fun diversion.
What makes everything challenging is that as I've lost weight, it gets harder and harder to find items that fit. A lot of retail outlets, if they offer size 30 pants at all, only sell ones with a 30-inch inseam. I need a 32. Likewise, medium-shirts tend to fit my body but the arms can sometimes be too short. The smallest adult belt that Target sells is a medium, which is for a 34-inch waist. I'd prefer a small but there isn't one so I'm on the last hole of the medium and have the excess length tucked around my waist. I actually tried on a boy's extra-large and was surprised that it fit, though I didn't care for the style.
We've since moved office buildings at work again and aren't anywhere near Target anymore. I'm a bit sad about it but I also don't need any more clothes -- at least for this season. Sadly, I'm watching the smokers walk past my desk once again without having any place of my own to venture out to. We are in much more of an business area with restaurants instead of retail outlets all around. I've visited the local convenience store once or twice but only to enjoy a carb-less Diet Dr. Pepper.
I know that I don't need to shove sugary snacks down my mouth to justify doing "something" when I get up from the desk and get out of the office for a bit. And as I get closer to fully fleshing out my wardrobe, I don't need to shop for as much as I once did. The retail therapy was a good way to stop the snacking. And by stopping the snacking, I lost weight and needed to shop retail outlets. But now, I think I'm OK with not doing either. I may still be jealous of the smokers getting up for their hourly breaks but I won't let that convince me to do "something" for the sake of doing something.
Not because I wish I could puff on cigarettes too but because I would see them parade past my desk every hour to take a 5 or 10 minute "smoke break" while I stayed in my seat and worked. Six or so breaks a day was at least a half-hour out of the office, which over the course of a year meant that I was working about 2 1/2 weeks more than they were.
I decided that it would be nice to get out from behind my desk a time or two myself but the problem is that I'm not the type of person that just goes off and does "nothing." I had to have a reason to leave the office and do "something." What I wound up doing was walking down the street to the corner convenience store and getting an afternoon snack of a bottle of Coke and a candy bar or two. Do that three or four times a week and I was adding way too many carbs and calories to my diet.
When we moved office buildings a few years back, it got even worse. Instead of getting a nice 20-minute walk in to the corner and back, we had our own cafeteria on the ground floor to visit for the Coke and candy. So instead of getting any exercise to offset the sugary snacks, I was simply taking an elevator down a couple of floors and back each day. Eventually, I decided to stop frequenting the cafeteria and walking across the street to Target where I could walk around and buy my snacks. After the diabetes diagnosis, I would continue my venture across the street but I eliminated the snack portion of the trip.
However, I still needed to do "something" so I started shopping. I've always enjoyed shopping but have never really enjoyed buying. My grandma worked in the mall and I spent about 8 years myself working retail so I'm familiar with the inside of a store. In order to justify the trips to Target -- and to update my wardrobe as I continued to lose weight -- I would buy an item of clothing every now and again.
I like shopping the clearance racks. They often have deals of 30, 50 and 70 percent off the regular price. It started last summer with me needing to get new shorts. Size 34 turned into size 32, then 30, and even a couple of 28s, depending on the cut. I'd need new dress and casual pants, new dress shirts and T-shirts, new nightwear and underwear. I began to notice that as trips to the clothing store replaced trips to the snack shops, it was my own form of retail therapy.
I wouldn't say that I'm addicted to shopping. As I said, I just like to do "something" -- feel like I'm not wasting my time. I wish walking for the sake of walking was enough for me but I do that for my exercise at the end of the evening. Walking isn't "something" during the day. And I'm happy to be doing something that doesn't involve excess carbs and calories.
I've done pretty good on my deals. I rarely pay full price for anything. I either wait for it to go on sale or I buy it on clearance. The clearance rack can be too much of a good thing, though, and I find myself picking up good deals on stuff that I might not need. I've learned lately to really only get something if I really like it rather than buy it because it's cheap. It's a fun diversion.
What makes everything challenging is that as I've lost weight, it gets harder and harder to find items that fit. A lot of retail outlets, if they offer size 30 pants at all, only sell ones with a 30-inch inseam. I need a 32. Likewise, medium-shirts tend to fit my body but the arms can sometimes be too short. The smallest adult belt that Target sells is a medium, which is for a 34-inch waist. I'd prefer a small but there isn't one so I'm on the last hole of the medium and have the excess length tucked around my waist. I actually tried on a boy's extra-large and was surprised that it fit, though I didn't care for the style.
We've since moved office buildings at work again and aren't anywhere near Target anymore. I'm a bit sad about it but I also don't need any more clothes -- at least for this season. Sadly, I'm watching the smokers walk past my desk once again without having any place of my own to venture out to. We are in much more of an business area with restaurants instead of retail outlets all around. I've visited the local convenience store once or twice but only to enjoy a carb-less Diet Dr. Pepper.
I know that I don't need to shove sugary snacks down my mouth to justify doing "something" when I get up from the desk and get out of the office for a bit. And as I get closer to fully fleshing out my wardrobe, I don't need to shop for as much as I once did. The retail therapy was a good way to stop the snacking. And by stopping the snacking, I lost weight and needed to shop retail outlets. But now, I think I'm OK with not doing either. I may still be jealous of the smokers getting up for their hourly breaks but I won't let that convince me to do "something" for the sake of doing something.
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