Back to previous post: Duffer’s Drift

Go to Making Light's front page.

Forward to next post: The story’s in the NYPost

Subscribe (via RSS) to this post's comment thread. (What does this mean? Here's a quick introduction.)

November 19, 2005

Sweetness and Light
Posted by Jim Macdonald at 05:03 PM * 133 comments

Sons Save Mom Overseas with Webcam says the headline.

OSLO, Norway (AP) — A Web camera in a Norwegian artist’s living room in California allowed her sons in Norway and the Philippines to see that she had collapsed and call for help, one of the sons said Friday.

“My wife is American and she knew exactly whom to call for help,” he said. “It took five or 10 minutes for the ambulance personnel to arrive.”

He said the family was on the verge of tears when they watched on the Web camera as ambulance personnel assisted their diabetic mother, who is recovering in the Desert Valley Hospital in California.

“I thank that camera and my sons for my life,” Karin Jordal told the Norwegian newspaper Bergens Tidende by telephone from her hospital bed. She has lived in the U.S. and Spain on and off for the past 15 years.

Ole Jordal said low blood sugar caused his mother’s collapse, and that she would be allowed to go home after a few days in the hospital. He said the family set up Web cameras in their homes because of the high cost of staying in touch by telephone when they live so far apart.

So what’s up with diabetes? Let’s start with a quick quiz: Add your point scores for each thing that’s true about you.

  • 2 Always hungry (even after eating)
  • 2 Always tired
  • 2 Unexplained weight loss
  • 2 Sores that don’t heal
  • 2 Erectile dysfunction
  • 2 Family history of diabetes
  • 2 Overweight (waist size > 1/2 height)
  • 3 Numbness/tingling in feet and toes
  • 3 Blurred vision
  • 3 Vaginal infections/itching
  • 4 Frequent urination
  • 4 Crave extra fluids (>7 glasses/day)
  • 10 Blood glucose > 140 mg/dL

Score seven or more = talk to your doctor about diabetes.

A while back, a lady came to the walk-in clinic because she had a persistent sore throat. No biggie. Lots of people have those every winter. There I was, happy young EMT, preparing her and getting her history and vitals and charting them so the doctor could get the story and deal with her rapidly and effectively. As is my wont, I finished up (after getting blood pressure, pulse, respirations, a narrative of his chief complaint and so on) with my standard: “Do you have any other health questions or concerns today?”

Turns out she did: She’d read an article in the Reader’s Digest about diabetes, and she had some of the warning signs.

Which ones?

All of them.

Cool. I said to her, “Tell you what. I can do a finger stick on you right now. It just takes a minute, but I gotta warn you, the finger stick hurts a bit. If it doesn’t show anything, I won’t write it down and you won’t be charged. If it does show something interesting, we’ll tell the doctor. Okay?”

“Okay.”

Woo whee! Her glucose reading was around 500 mg/dL. That’s like five times normal.

Was she happy? She was not. “I came here with a cold and left with diabetes.”

The word “diabetes” comes from the Greek dia, or “through,” and bainein, “to stand with legs asunder.” The word means “one that straddles; a compass or siphon.” The dia is the same dia as in diabolical and diarrhea. (How to tell you’re going to have a bad day in the ER: When you come in, the person who you’re replacing is finishing up some charts and looks up at you and blearily asks “How many ‘r’s in ‘diarrhea’?”)

One of the main symptoms of diabetes (which is one of the top ten, some say top five, diseases in industrialized countries) is drinking a lot of water, and urinating it away. Diabetes mellitus (mellitus is of or pertaining to honey) is so-called because the urine is sweet — and let’s not mention how medieval physicians diagnosed it.

Here’s why the urine is sweet, and why there’s so much urine involved:

Glucose is the basic carbohydrate that provides energy to the body’s cells. But glucose is a big molecule: Too big to pass through the cell membrane of most cells. To pass through the membrane requires a hormone, insulin, to open a tunnel. If that tunnel doesn’t open, the cell starves for energy, the glucose stays in the bloodstream, and the serum glucose level goes up. Normal is 80-120 mg/dL. In diabetics it’s higher. Lots higher.

When the blood has too much glucose the body tries to flush it out, through the kidneys. That requires a lot of water. So that’s why you’re thirsty all the time — the body needs water to flush out the glucose. And that’s why the urine is sweet. The glucose that should have been feeding the cells is going somewhere, and that somewhere is out.

Meanwhile, you’re hungry all the time, since the cells aren’t getting their energy and are yelling “Hey, boss, we’re starving down here!” The muscles start burning protein — that gives you unexpected weight loss, and it also gives you DKA: Diabetic Ketoacidosis. Ketones in the blood — breakdown products of protein. That turns up as a fruity smell in the breath — ketone-breath — and Kussmaul’s Respirations.

Kussmaul breathing is rapid, deep breathing. Y’see, ketones are acidic. Hemoglobin in the red blood cells carries oxygen, but it only works inside of very narrow pH limits. The blood gets too acidic and the oxygen stops being carried. Things get very bad, very fast, right about then. So the body is trying to raise the pH of the blood by dumping carbon dioxide (also acidic) out through the lungs.

By this time you can be staggering like you’re drunk, slurring your words, and otherwise showing signs and symptoms of altered mental status.

The blood is getting thick, like pancake syrup. That thick blood doesn’t move too well through the capillaries. That leads to bad things — poor circulation (often first in the feet, a long way from the heart, fighting gravity, and kept immobile by shoes) yields sores that don’t heal, then necrosis and gangrene, which is treated by amputation (diabetes is the number one cause of non-traumatic amputation in America). Poor capillary circulation in the retinas leads to death of the rods and cones, and blindness (diabetes is the number one cause of non-traumatic blindness in the non-elderly population in America). All the movement of large molecules through the kidneys, combined with poor capillary circulation, tends to burn out the kidneys. Diabetes is the number one reason for kidney failure requiring dialysis in America.

Did I mention that smoking makes all these things worse?

There are two main reasons why the cell membranes might not be passing glucose: One is that the body isn’t producing insulin. The other is that the body is producing insulin, but the cell membranes aren’t reacting properly to it.

That first kind is Type I diabetes, Insulin-Dependent Diabetes Mellitus (IDDM), also called juvenile-onset diabetes because it’s often first observed when the patient is young. The usual cause is an autoimmune reaction, where the body rejects the Islets of Langerhans in the pancreas, and kills them. No more Islets, no more insulin, no more sugar to the cells. Up until 1922, when injectable insulin became available, that meant a death sentence. The disease is usually rapid onset — weeks or months from clinically normal to a full-blown case. Nowadays, IDDM means that you, your glucose test kit, and a hypodermic are going to be close personal friends for life.

Type II diabetes, adult onset, usually comes on over a period of years. Here, the body is producing insulin but the cells are no longer sensitive to it. Usually, you see this in your older folks, particularly sedentary, overweight people. Oftentimes even a modest weight reduction (5 kilos) will be enough to get the cells to start accepting insulin again and start passing that glucose. Type II diabetes can often be controled by diet, exercise, and, if those don’t work, oral medication, or some combination of the three.

I’m not going to go into gestational diabetes — it’s temporary, treatable, and decent prenatal care is going to find it. (Though 20-50% of the women who develop gestational diabetes will go on to develop Type II diabetes in later life, so you might consider it a red flag.)

I’ve talked about muscle and fat cells and such needing insulin to use glucose. Nerve cells — the brain — don’t need insulin. Glucose passes just fine through those cell membranes. But nerve cells need glucose, and they’re highly sensitive to its lack.

While high glucose levels can lead to unconsciousness and death (diabetic coma), what’ll kill you fast is insulin shock. That’s when a person has taken their normal insulin dose, but for some reason doesn’t have their normal glucose levels in their blood. Forgetting breakfast, unusual exercise, a low-grade fever — lots of things can cause that. The glucose level plummets, the nerves starve, the cells die, and it’s lights out.

Fortunately for us EMS types, this is one treatment that’s fast, easy, and magical. You give the person some sugar, they’re better. You have your oral glucose — 15 grams in a little plastic tube that you can squeeze into the person’s mouth (provided they’re conscious enough to be able to guard their airway). It gets absorbed right through the mucous membranes of the cheek and gums. Those little tubes are expensive, so lots of folks, in their personal kits, carry tubes of squeezable cake decoration frosting. It’s pretty much the same stuff. In some EMS systems, if the patient can’t guard his airway, you’re allowed to give rectal glucose. Pop a hard candy right up there — a mucous membrane is a mucous membrane. (Important safety tip: If you want the person to still be your friend afterward, don’t use a Red Hot Fireball cinnamon candy.)

For higher level EMS providers who can start IVs, you have D50 — a 50% dextrose and water solution. These come in 50 mL prefilled syringes. Start your IV, get your blood samples, and push it on in. The patient wakes right up. (It’s wonderful to watch.)

If you can’t establish an IV, paramedic level providers can give intramuscular (IM) shots of glucagon, a hormone that makes the liver dump all its glucose supplies directly into the bloodstream. (The other emergency medical use for glucagon is to relax the esophagus for people who have a bolus of food stuck in there, to allow it to pass into the stomach.) Glucagon’s tricky because you have to mix it up on scene from a powder dissolved in water.

D50 is part of the old Coma Cocktail, the Party Pack. If you come on an unconscious person and don’t have any idea what’s wrong (no baseball bat mark on the skull), no one saw anything, no medic alert bracelet, you whack him up with three things, all in the Might Help Can’t Hurt range: 50 mL of D50, 100 mg of Thiamine (in case alcohol was the problem) and 0.4 mg of Narcan (blocks opiates in case heroin or summat is what put him out).

Suppose the person had high blood sugar, not low blood sugar, and that’s why he’s unconscious? Well, the D50 won’t hurt, since the patient’s blood is already running so sugary that it won’t make a difference.

Anyway, I can neither diagnose nor prescribe. Nothing here is medical advice for your particular situation. Lots of folks recommend screening everyone for diabetes at age 40, again at age 50, and at random afterward.

Do keep a watch out for diabetes in your life, and in the lives of your nearest and dearest. Around 21 million people in America have it. The CDC calls it an epidemic. Stay safe.


Copyright © 2005 by James D. Macdonald

I am not a physician. I can neither diagnose nor prescribe. This post is presented for entertainment purposes only. Nothing here is meant to be advice for your particular condition or situation.

Creative Commons License
Sweetness and Light by James D. Macdonald is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 United States License.

(Attribution URL: http://nielsenhayden.com/makinglight/archives/007011.html)


Index to Medical Posts

Google

Comments on Sweetness and Light:
#1 ::: Cassie Krahe ::: (view all by) ::: November 19, 2005, 05:13 PM:

This is cool. Not in a having-it way, but a knowing-about-it way.
My professors here usually say 'doctors back in the fifties' for diagosing diabetes mellitus. I'm not sure if it's true or if they just think college students don't know the difference between the two eras.

#2 ::: Victor S. ::: (view all by) ::: November 19, 2005, 05:34 PM:

Veering ever so slightly off-topic -- how does thiamine work to counteract alcohol?

#3 ::: Charlie Stross ::: (view all by) ::: November 19, 2005, 05:43 PM:

One point: if you've got these symptoms, go talk to a doctor -- but don't assume that it is diabetes until they've checked your blood glucose. Blood glucose is the gold-standard diagnostic test for diabetes. While diabetes is the commonest reason for having a bunch of these symptoms, they may be the result of some other underlying pathologies, unrelated to one another. If in doubt, see a doctor.

#4 ::: James D. Macdonald ::: (view all by) ::: November 19, 2005, 05:44 PM:

Thiamine doesn't work to counteract alcohol, but alcoholics often have thiamine deficiencies, which also makes it difficult for them to metabolize glucose.

#5 ::: ralph ::: (view all by) ::: November 19, 2005, 06:11 PM:

Note that the last item in your list of points is actually out of date. The fasting blood glucose level that defines diabetes has been redefined in the past couple of years downward to 126 mg/dL.

#6 ::: Carrie ::: (view all by) ::: November 19, 2005, 06:14 PM:

In my EMT class, we were told that one sign of untreated diabetes was an ant problem in the bathroom. The ants are attracted to the glucose in the urine that splashes onto the rim of the toilet. I filed it away as a bit of trivia, because how often do you suppose that actually happens? It never did come up when I was working on the ambulance.

Flash forward to a few years later, in my present job managing apartments. I am in the bathroom of an apartment where two developmentally-disabled middle-aged guys live with their aides, looking at the toilet the aide says is wobbly. "It rocks, it leaks, and what with the ants all over the place in here lately, things are a real mess." "Ants?"

Yes, it turned out that one of the men had developed diabetes since his last check-up (the aide wasn't supposed to disclose this to me, but she wanted to thank me afterward for the weird tip). You never know when this kind of stuff will come in handy.

And Jim, we were allowed to give glucagon at an Basic level. Our county medical director was very aggressive about getting us as highly trained as possible, because the we volunteer EMT-Bs covered rural districts with long transport times. I am normally a lurker here, but I wanted to mention how much I enjoy your posts on these topics.

#7 ::: John M. Ford ::: (view all by) ::: November 19, 2005, 06:40 PM:

Well, the ancient physicians observed that the urine of certain ill persons drew flies (more than, say, an equal quantity of vinegar). And indeed, the word is Greek, because diagnoses go back that far -- about 3500 years, in fact -- though the etiology came long afterward.

But by the Middle Ages, of course, not only had much of the earlier medical knowledge been misfiled, burned, or eaten, uroscopy -- the technical name for "doing odd things with other folks' wee with vaguely medical intent" -- had become practically its own specialty, not to be confused with "urology," which can involve getting a live TV feed from inside your bladder. Technology is swell.

I will note, because this does lead to some confusion, that there are two types of diabetes mellitus, creatively named Type I and Type II. Type I is usually diagnosed in childhood -- it used to be called "juvenile diabetes" -- and is (at least by current understanding) an autoimmune disease in which your body turns nasty on the insulin-producing cells in the pancreas (the beta cells, or islet cells). Eventually almost everyone with Type I completely loses the ability to make insulin, so replacing it is always necessary, by injection or subcutaneous catheter. (Exercise can lower blood sugar without insulin, but not enough to completely replace it.) Beta-cell transplants, which are an actual cure (though you have the problems of any organ transplant) are still experimental, but have had some success, and will likely only get better.

In Type II, "adult-onset" diabetes, insulin production is inadequate, but usually doesn't completely disappear. Most of the symptoms are the same, though ketosis -- the exciting transformation of your blood into paint thinner -- is less common. Also, Type IIs tend to be overweight-to-obese, while Type Is at time of diagnosis are generally underweight. Some Type II patients can get by with dietary control and exercise. Some can take the various oral meds, most of which work by stimulating the beta cells to produce more (so obviously they're useless in Type I). Some people still require insulin, usually in combination with the other therapies.

It is a disease whose therapies and outlook have changed a whole lot in the last few decades. Not very long ago, we didn't have any remotely convenient way of doing blood glucose readings at home, never mind pocket-sized gadgets that would produce a quantitative reading in five seconds. (What you had was urine tests, which were always time-delayed and worthless for checking low sugar.) The variety of insulin mixtures available was much smaller, and they were all of animal origin,* rather than being recombinant human product from trained bugs. Even the needles for injection were a few gauge sizes larger. If you're gonna get it -- and if you have the option, I would recommend that you rent some Ed Wood movies instead -- you now have a pretty decent arsenal to fight it with, and a lot more knowledge of the enemy.

*Made by spinning down pancreases from slaughterhouse cows and pigs. I sometimes wonder if Niven & Pournelle knew this when they let "Dan Forrester" croak so heroically -- and have no doubt whatsoever, fighting hyperglycemia with your bare hands is a wretched way to go. Maybe they didn't think to ask Dan Alderson.

#8 ::: Keith Kisser ::: (view all by) ::: November 19, 2005, 06:44 PM:

Well, I scored a 14 on that quiz. For a few months now, my left eye has been a little blurry. I thought it was just my glasses needing a fine tuning. Perhaps I should see a doctor, now that I have insurrence again...

#9 ::: P J Evans ::: (view all by) ::: November 19, 2005, 06:47 PM:

Dan didn't fight nearly as hard as he should have. (He's the primary reason why the boxes of cold at LASFS had - and probably still have - a rule that Insulin Is Always Private Stock.)

#10 ::: Marilee ::: (view all by) ::: November 19, 2005, 08:06 PM:

You do have to temper the list with your personal knowledge. I scored 12 total from four items, all related to renal disease. We check my blood glucose twice a year and it's always fine.

#11 ::: Stephen Sample ::: (view all by) ::: November 19, 2005, 08:59 PM:

Most of this is quite familiar. My maternal grandmother and great-aunt both had Type I diabetes, and one or the other of them lived in the house next door to my parents' for much of my childhood.

So there were a lot of ambulance visits at odd hours due to insulin shock or diabetic coma--this was in the '70's when the available self-treatments (and glucose measurements) were rather less precise, so it was pretty easy to mis-gauge (or mis-administer) your insulin dose.

A can of Coke was the standard whack-your-blood-glucose-up-a-few-notches method for relatives when one of them was too loopy to think of that herself, but sufficiently coherent to drink it (unfortunately a narrow window). It's harder to match doses, but even if you give too much sugar, it gets you outside the insulin shock domain, and then you have time to get the glucose levels under control. Outside that window, we were definitely looking at an ambulance visit, and possibly a hospital stay for blood work.

Fortunately, the EMTs who had been out before were generally willing to listen when my mom suggested D50 (or rather, to act more quickly on the suggestion). I never heard of any of them trying the hard candy trick, but that's probably not be the sort of treatment you should discuss with a boy of six ;-)

My family has the odd pattern that Type I diabetes hits people in their mid-to-late fifties, which is pretty far from the standard age of onset. So I used to be confused about which form was meant when people talked about juvenile diabetes--I mean, most people with Type II develop it younger than my family develops Type I...

#12 ::: elise ::: (view all by) ::: November 19, 2005, 09:25 PM:

A can of Coke was the standard whack-your-blood-glucose-up-a-few-notches method for relatives when one of them was too loopy to think of that herself, but sufficiently coherent to drink it (unfortunately a narrow window).

Yep, it sure can be narrow.

Around here, the drink of choice is orange juice. Still, anything with sugar will do in a pinch. A person has to be able to drink it, though.

The lowest blood glucose reading I have ever seen in a conscious person is 18. Mind you, this was conscious, not coherent. Fortunately, there was good help at hand.

paramedic level providers can give intermuscular (IM) shots of glucagon

So can significant others who have been trained in doing so, at least in this state. That's why there's always a little red case in my purse. The pep talk from the paramedics helped a lot, and the next time it happened and the glucagon was needed, things went just fine. (I was mostly scared of getting things wrong and making it worse; the pep talk addressed that very well by telling which spots were good choices for IM injections -- outer thigh is good, outer upper arm if outer thigh isn't handy, is what I was told.)

I am glad we have had it when it was needed.

I suppose if the blood glucose test they do on me in a few weeks says I'm part of the happy throng that I will become a person that people follow around with little red cases too. (Blurred vision, increased this and that, lots of family history. Not usually until later in life, though, in my family. That's what I am telling myself.)

It really is amazing to see glucose or orange juice or glucagon work, though. It's so fast, and such a big change.

#13 ::: LeeAnn ::: (view all by) ::: November 19, 2005, 10:02 PM:

Stephan - have your family members been told what possibly contributed to their late development of TypeI? My mother was diagnosed Type I at 51 yrs. She is an adoptee, so we have no family medical history for her. She was misdiagnosed as Type II and treated as such for 1yr. She is now having liver function issues as well as vision changes and numbness in her limbs. She has been on several varieties of insulin, and nothing really controls her blood sugar. I am of course concerned for her, but for myself as well. My father was diagnosed Type 1 40 years ago. Her doctors think that perhaps she was born with an inadequate pancreas and liver- but no one knows.

#14 ::: xeger ::: (view all by) ::: November 19, 2005, 10:34 PM:

I'm not diabetic, but I am hypoglycemic - and the effects of a glass of orange juice with a few tablespoons of sugar in it are amazing.

It's equally amazing to see what happens if you walk to the front of a buffet line in Vegas and explain that you -really- need something with sugar in it to drink -now-.

#15 ::: dargie ::: (view all by) ::: November 19, 2005, 10:50 PM:

I've been a type II for about six years and this is the best and most concise explanation of the disease I've ever read. I'm particularly glad you published the long list of warning signs since the classic ones -- excessive thirst and urination -- didn't begin to apply to me until my glucose was well over 300.

Anyway, thanks for posting.

#16 ::: Catherine McLean ::: (view all by) ::: November 19, 2005, 11:03 PM:

This caught my attention because I work in a diabetes lab, and because a colleague of ours died of insulin shock last week (less rare than people think, sadly).

First, one quick correction on the article - there's quite a lot of research to show that type 1 diabetes actually develops over quite a long period; antibodies indicating the presence of an autoimmune response can be detected months or even years before onset of clinical symptoms. We've actually used this knowledge to screen family members for antibodies so that we can conduct studies in people at-risk for type 1 diabetes who still have relatively normal pancreas function.

To the person who was wondering about type 1 diabetes at 51, look up 'Latent Autoimmune Diabetes in Adults' (LADA) - it's a form of type 1 diabetes where the autoimmune response progresses very slowly, and seems to have some features of type 2 diabetes, such as insulin resistance and obesity. These people often have a small number of the risk genes for type 1 diabetes; the more you have, the earlier you are likely to get it. They also sometimes have T2D genes as well.

Some research by S Fourlanos et al indicates that even in classic type 1 diabetes, insulin resistance is a risk factor - and I believe other researcher are now finding evidence of autoimmunity in people who have had T2D for a long time. So the two diseases may be more closely related than we had thought.

Catherine, not a scientist, but plays one on TV (or rather, is helping administer a clinical trial and has typed up far too many papers on this subject for it not to have sunk in)

#17 ::: will shetterly ::: (view all by) ::: November 19, 2005, 11:12 PM:

Emma came down with Type 1 at the age of 47 or 48. She's 5'11" and was around 140 pounds at the time. Despite that, her doctor was schooled in the days of "juvenile-onset diabetes" and "adult onset diabetes," so it took about a year to get it properly diagnosed. Which had more to do with Emma's research than the doctor's.

Exact factors aren't known, but some people theorize that stress can be a trigger. Emma had broken both elbows some months earlier. One was a simple break; the other was a mess that called for a plate and a lot of physical therapy. We didn't have medical insurance and were deeply in debt. I'm comfortable with the notion that stress can be a trigger.

Emma lost 20 pounds before we quit trying to treat her diabetes as Type 2. Now she uses insulin, Humalog and Lantus, and all seems to be good.

#18 ::: Larry Brennan ::: (view all by) ::: November 19, 2005, 11:43 PM:

Thanks for this Mr. Macdonald. Type 2 diabetes is one of my personal paranoias. My mother died at 62 as a result of badly managed adult onset diabetes, which ultimately led to kidney failure, liver problems and a massive stroke.

Several months ago, I had an unusually high fasting glucose reading (110), which launched me into a bit of a panic and right into the clutches of the medically supervised diet and exercise program heavily subsidized by ReallyBigCorp, Inc. After 4 months of 5 workouts a week and a pretty strict diet, I've lost about 35 pounds (from 240 to 205) and feel a lot better. I can now run for half an hour without feeling like I'm gonna die.

BUT, my fasting glucose last week was still 110. So, it's off to the doctor to see what he says. Dang. Maybe I should be shooting for the 185 that the BMI index says is the max weight for my height. (I somehow don't thing that that would be maintainable, though.)

The thirst point is an interesting one for me. Many years ago, I went on weight watchers and got into the 8+ glasses of water a day habit, which has stuck for the past 15 years. Now, if I fall short of that, I feel thirsty. I discount that as a warning symptom for me, anyway.

I'd really hate to have to manage my diet the way a diabetic does. I'm in NYC for the next 10 days, and I just had dinner at Plataforma with some friends. This was my biggest fall-off-the-diet event, and I planned for it. If I have to start eating like a diabetic, a meal like the one I just ate wouldn't be possible.

My hotel does have a gym, though, and I'll be down there tomorrow running.

#19 ::: James D. Macdonald ::: (view all by) ::: November 19, 2005, 11:44 PM:

I've got one of those little red cases with glucagon right here on my desk. It's for one of my neighbors. If I respond as a neighbor and friend, I can use it. If I respond on the ambulance as an EMT, I can't. Regulations are funny things.

If your Medical Director gives you permission, though, you can do anything. It's his or her license on the line. That's what Medical Control is for in the EMS system.

I'm not a doctor, nor am I a researcher. I'm just a wildnerness EMT who likes to talk about some stuff. (Oh -- if anyone's wondering, my little sea story up there had details changed to preserve patient confidentiality.)

Yo, Keith -- why not chat with a doctor? Rule some stuff out, figure out what the situation is. As Charlie pointed out, all of those signs could have a lot of causes. Only someone who passed medical school and is looking you in the eye can tell you what's actually up. Could be your glasses need fine tuning. Could be a lot of things. It's worth checking.

Speaking of movies (as we were on another thread), in Silly Diabetes Movies we find Con Air, with Nicholas Cage. Who would have suspected that the average junkyard can be assumed include a fully-stocked first aid kit in some random junked truck, and that when you found the first aid kit you could expect it to include a full hypodermic setup?

#20 ::: Paula Kate ::: (view all by) ::: November 20, 2005, 12:06 AM:

I was diagnosed with Type II some years back; recently added glyburide to metformin and we'll do the 3-month blood tests on the new drug combination in a couple of weeks. Stick tests are very encouraging.

pk

#21 ::: Simon ::: (view all by) ::: November 20, 2005, 12:43 AM:

This is interesting, but a little confusing.

In one place you list overweightness as a warning sign of diabetes. In another place you say that diabetes causes unexpected weight loss.

You say that a quick sugar hit is the solution for insulin shock. Yet I have read diabetics saying that candy is deadly to them.

Trying to make sense of all this.

#22 ::: James D. Macdonald ::: (view all by) ::: November 20, 2005, 01:11 AM:

In one place you list overweightness as a warning sign of diabetes.

Often associated with Type II diabetes.

In another place you say that diabetes causes unexpected weight loss.

Often associated with Type I diabetes.

You say that a quick sugar hit is the solution for insulin shock. Yet I have read diabetics saying that candy is deadly to them.

Is in insulin shock: Yes/No. If yes, give sugar. If no, do not.

I'll bet the person who posted that piece over at Monkeys In My Pants carries a roll of Lifesavers in his pocket every day, just in case his blood sugar starts to bottom out.

If the patient is in balance, adding sugar is contraindicated. If the patient is out of balance to the low side, adding sugar is necessary.

#23 ::: Tae ::: (view all by) ::: November 20, 2005, 02:06 AM:

Thiamine given with D50 because of Wernicke-Korsakoff syndrome

#24 ::: Janet Lafler ::: (view all by) ::: November 20, 2005, 02:45 AM:

Another common warning sign of long-standing diabetes is periodontal disease. Dentists diagnose a surprising number of people with diabetes -- or at least refer them for further testing. I know a periodontist who says he identifies two or three likely cases of diabetes a month.

The list of warning signs in your quiz is a little misleading, in that some indicate current high blood sugar and others indicate long-standing vascular damage. Non-healing ulcers, neuropathy, erectile dysfunction, gum disease, etc. are generally due to longterm damage; thirst and unexplained weight loss are immediate signs of hyperglycemia. Blurred vision, oddly, can be either one, depending on whether it's due to diabetic retinopathy (damage to the blood vessels on the retina) or diabetic lens osmosis (a temporary effect of high blood sugar). Having long-term complications before having a diabetes diagnosis is more typical with type 2's, since they can survive longer without being diagnosed or treated -- sometimes decades -- while the vascular damage is accumulating.

Count me as another case of LADA: I was diagnosed with diabetes at age 33. Because of my age and because I was significantly overweight at the time, the assumption from the beginning was that I was type 2. Despite heroic efforts my blood sugar would not come into control with standard type 2 treatments; meanwhile, I lost 80 pounds in 9 months. I knew something was badly wrong after about 5 months, but it took me several more months to convince my doctors. (At one visit when I burst into tears of frustration over my out-of-control blood sugar and frightening weight loss, my doctor wrote me a prescription for tranquilizers; at another, I remember begging her to give me an insulin injection and being refused.) Eventually I got a new dotgor and started on insulin, and lo and behold I responded in such a way that it was clear that I was actually type 1. A C-peptide test later confirmed this. (C-peptide is a byproduct of insulin production, so it's a measure of how much insulin the pancreas is producing.) LADA is unusual, but not really rare, and it's surprising how few doctors, even doctors who treat a lot of diabetic patients, know anything about it.

A few years later, when I had some abnormal thyroid labs, I did some research on Graves' Disease (an autoimmune disease that causes the thyroid gland to become hyperactive), and realized that the "thyroid problems" that my mother and maternal grandmother had had were almost certainly Graves' Disease, even though the name was never mentioned. It turns out that a family history of Graves' is a risk factor for type 1 diabetes, and more generally a family history of any type of autoimmune disease (MS, lupus, rheumatoid arthritis, etc.) is a risk factor for developing any other type. Autoimmune diseases are not all that well understood, and the idea of treating them as a specific class of diseases is pretty recent, so doctors don't always understand the significance of this when taking family histories.

#25 ::: anon ::: (view all by) ::: November 20, 2005, 05:02 AM:

ralph said:

Note that the last item in your list of points is actually out of date. The fasting blood glucose level that defines diabetes has been redefined in the past couple of years downward to 126 mg/dL.

he didn't actually write "fasting blood glucose is >140 mg/dL". when you go into the doctor (or EMT) and get a finger stick, that's NOT fasting blood glucose. fasting means first thing in the morning when you haven't eaten all night. it's pretty common for nondiabetics to have a blood glucose level of 140 mg/dL after eating, or sometimes higher. even if it's higher, something else, other than diabetes, might be wrong. or you might've just visited starbucks and had a frappacino. all that sugar DOES go somewhere you know.

simon said:

In one place you list overweightness as a warning sign of diabetes. In another place you say that diabetes causes unexpected weight loss. You say that a quick sugar hit is the solution for insulin shock. Yet I have read diabetics saying that candy is deadly to them.

simon, being overweight CAN LEAD TO type ii diabetes (not type i) but isn't a warning sign of type ii diabetes. most overweight people don't develop diabetes. but if you are at risk for type ii because of your family history, you should avoid becoming overweight.

i know it's confusing but if an overweight person you know suddenly, inexplicably and rapidly starts losing weight, THAT'S a sign of diabetes. to oversimplify it: STEP 1: you have a tendency toward type ii diabetes; STEP 2: you become overweight; STEP 3: you develop type ii diabetes; STEP 4: you then lose weight rapidly.

type i diabetes is mostly (probably) not caused or triggered by overweightness.

the sugar/insulin thing confuses a lot of people but it's really quite simple: you need insulin to balance your sugar. you need sugar to balance your insulin. the diabetic's life is essentially a non-stop effort to keep the two in perfect balance: not too much insulin, not too much sugar. if you overbalance and have too much insulin, it's called "hypoglycemia" or insulin shock. then you take sugar to correct it. if you overbalance and have too much sugar, it's called "hyperglycemia" or diabetes. then you take insulin to correct it.

janet said:

turns out that a family history of Graves' is a risk factor for type 1 diabetes, and more generally a family history of any type of autoimmune disease (MS, lupus, rheumatoid arthritis, etc.) is a risk factor for developing any other type. Autoimmune diseases are not all that well understood, and the idea of treating them as a specific class of diseases is pretty recent, so doctors don't always understand the significance of this when taking family histories.

i'm a type-1, juvenile onset, and i've also developed hypothyroid (NOT hypERthyroid or hyperactive thyroid) as well as vitiligo. the thyroid and vitiligo are related to the type one diabetes in a fairly simple way: the isles of langerhans, the tissue of the thyroid gland, and the melanocytes (that produce melanin) are all attacked by the immune system and partially or completely destroyed.

#26 ::: Therese Norén ::: (view all by) ::: November 20, 2005, 05:43 AM:

For those using mmol/L (why on Earth are you measuring per dL??), the fasting blood sugar cut-off level for diabetes is 6.1 mmol/dL.

#27 ::: Anna in Cairo ::: (view all by) ::: November 20, 2005, 06:45 AM:

Thanks for this. My husband does a urine test abotu once a year or so because many members of his family including his mom have adult onset. In fact, it is really really common among older adults in Egypt. Really, really, common. I asked an Egyptian doctor about this and he first of all confirmed that my perception was true, said it was because Egyptians have moved from a diet of mostly whole wheat bread to a diet of mostly white rice over the past couple of generations and also that they use a lot of sugar (heavily sugar tea, condition kids to expect that drinks like orange juice, milk, and even Tang(?) be doctored with sugar, etc.) and also that they lead highly stressful lives (crowded, pollution, tension between neighbors, tension driving, many jobs in order to make ends meet, e.g.)

My mother in law has to take an insulin shot daily and at times she gets shaky and someone runs and gets her a glass of sugar water. She also has a variety of other health issues includign weird things like strangely misshapen ingrown fingernails that she sahs doctors have told her is a result of diabetes. (I defer to doctors here. My mother in law does not read and write and it is very possible that she misinterpreted something someone told her.)

#28 ::: Charlie Stross ::: (view all by) ::: November 20, 2005, 06:57 AM:

On the subject of deceptive symptoms, here's a very personal example: over the past few years I found myself getting up to go to the toilet in the middle of the night with increasing frequency. Naturally I was worried about diabetes, so I got myself referred to a urology consultant -- but no, no sign of diabetes. (Or any other cause they could think of -- in 20/20 hindsight they were over-specialized.) Then, eight months ago, I began having palpitations (irregular heartbeat) and went to see my GP in a hurry. It turns out that I have inherited hypertension -- untreated, my blood pressure was 250/150. Now that I'm being treated for it, my blood pressure is down 45% and I'm no longer emulating a broken fire hydrant.

(NB: it's a hereditary condition; men on my mother's side of the family tended to die suddenly between the ages of 45 and 60. It is completely treatable these days if diagnosed before the fatal stroke or heart attack. My elder brother dodged the bullet completely; I got it bad enough to be diagnosed in time. So I'm going to be okay, just as long as I keep taking the pills, for which reason I am very glad I live in the land of the NHS ...)

Anyway, back to the list of symptoms: Pissing like a fountain, check. Fatigue, check. Overweight, check. Crave extra fluids, check. Blurred vision can also be a symptom when your BP is into the malignant hypertension range (where mine was going) -- luckily in my case I didn't have any extra retinopathy.

The moral of this story is that it could be diabetes, or it could be hypertension, or it could be something weird and rare, but the main thing is, don't wait: go and see a doctor and get it diagnosed right now.

#29 ::: KristianB ::: (view all by) ::: November 20, 2005, 07:41 AM:

Sorry to go off-topic, but the post after this one seems to have vanished. Is this a problem on my end, or...?

#30 ::: Leslie Turek ::: (view all by) ::: November 20, 2005, 08:02 AM:

Great article with one of the clearest explanations I've seen about the effects of diabetes and the difference between Type I and Type II.

For the past 6+ years, I've been a subject in the Diabetes Prevention Program, a long-term study to see if Type II can be prevented or delayed. The study followed large numbers of people with "impaired glucose tolerance" (which means that our sugar levels were high, but not yet in the range considered to be diabetes), and divided them into 3 groups. One was a control, one used diet and exercise to lose weight, and one took a common type II diabetes drug.

The study showed that diet and exercise was extremely effective - reducing the incidence of Type II by 58% in they study group. The drug (metformin) was also quite effective, although not quite as good as diet and exercise.

The important point to make is that Type II diabetes comes on in a slow progression, especially if you gain weight as you get older. But you can take steps to keep it at bay. The diet and exercise group in the study lost only an average of 5% of their body weight, yet showed a dramatic reduction in the incidence of diabetes. This is really a situation where your fate is mostly in your own hands.

I join in urging everyone over 40 to get a fasting glucose blood test, especially if you are overweight or have a family history of diabetes.

#31 ::: Leslie Turek ::: (view all by) ::: November 20, 2005, 08:15 AM:

A few words about diabetes blood tests. Anon very correctly points out that the interpretation of test results varies depending on when you have most recently eaten. That's why the more accurate blood test is taken as a fasting test, when you haven't eaten for 12 hours. For a fasting test, the normal range is 70-99 mg/dL, 100-125 is considered impaired glucose tolerance (where you should start thinking about diabetes prevention), and 126+ is considered to be diabetes.

An even more accurate test is the 2-hour glucose test. In this test (which I get once a year as part of the study), they take a fasting measurement, then feed you a measured amount of sugar (in the form of an icky sweet drink), and then wait and measure your glucose exactly 2 hours after getting the drink. This shows how well your body processes the glucose. In this test, normal is 70-139, impaired glucose tolerance is 140-199, and diabetes is 200+.

#32 ::: Steve Glover ::: (view all by) ::: November 20, 2005, 08:53 AM:

Nitpickery
The derivation is more or less right: it's 'dia' plus the verb to straddle (the word for siphon (which always looked Greek to me, anyway) is similar to the word for compass or dividers). It's "diarrhea" that has the word for 'flow' in it (think 'rheology')...

[apologies for the fake email address - every address I've ever used here gets spammed within less than a day]

#33 ::: Ellen Seebacher ::: (view all by) ::: November 20, 2005, 09:47 AM:

I'm a childbirth educator, and while I don't want to get too deeply into the controversy over gestational diabetes, I'll say that many of the supposed cases just ... aren't. As Henci Goer points out in her excellent article Gestational Diabetes: the emperor has no clothes, GD criteria are highly arbitrary, and the management of supposed GD cases often causes more trouble than it prevents. Worth a read.

#34 ::: Jennifer Barber ::: (view all by) ::: November 20, 2005, 10:21 AM:

I'm not diabetic, but I am hypoglycemic - and the effects of a glass of orange juice with a few tablespoons of sugar in it are amazing.

I'm hypoglycemic, too--and unless my blood sugar is really, really low, it doesn't even take anything particularly sugary to cause an obvious effect. The number of times I've had people say, "Wow, you're really feeling better!" when I was in the middle of just an ordinary meal.... This is good, since for the most part I can't stand sweet foods. (Particularly cake. Childhood memories of being force-fed cupcakes because there was nothing else sweet in the house, I suspect.) I do tend to carry hard candy with me, though, especially when I'm travelling.

My boss has come to accept that if I don't get lunch on time, I rapidly become useless. More importantly, she accommodates my eating schedule whenever possible. I consider myself lucky, there.

#35 ::: James D. Macdonald ::: (view all by) ::: November 20, 2005, 11:07 AM:

Thanks, Steve. I'll fix that.

#36 ::: Lin Daniel ::: (view all by) ::: November 20, 2005, 11:59 AM:

I'm not diabetic, but I am hypoglycemic - and the effects of a glass of orange juice with a few tablespoons of sugar in it are amazing.

It's equally amazing to see what happens if you walk to the front of a buffet line in Vegas and explain that you -really- need something with sugar in it to drink -now-.

=====

My husband is hypoglycemic. He must eat on a regular schedule or his blood sugar gets wonky, and his brain follows in short order. A common thread to this thread is that symptoms vary, people vary, treatment varies. Don't ever ever ever feed Jim sugar. He turns manic/depresssive with a four hour cycle, amplitude reducing over a period of days. Yes, days.

Shortly after he was diagnosed and getting used to the diet restrictions, he called me at work, and said in a panic-striken voice, "We're not going out tonight like we'd planned." The voice was the kind of voice one uses when one is making one's only call from the police department, or one is calling from the local hospital emergency room. My heart rate went up, and I asked, "Oh? Why?" "I think I had a donut with sugar on it!"

When I stopped laughing, mostly from relief, he explained he'd eaten what he'd thought was a plain cake donut. The upshot of all of this was the guys he worked with made damned sure there was a plain cake donut in the batch from then on, and that it didn't come in contact with anything else in the box. Jim went manic-normal-depressed-normal-manic over that four-hour cycle for five freakin' days. The amplitude went down, but you could still watch the cycle every four hours.

And Jim's emergency-feed-me thing is beer. It holds his blood sugar level until we can get real food into him. Ask the guys at convention who watched him chug three beers in a row without drunk-symptoms while I ran to the con suite to build him a sandwich.

#37 ::: Dan ::: (view all by) ::: November 20, 2005, 12:22 PM:

Serendipitous article for me. 4 points on the quiz all my life, 11 points if you count the last year, 21 points since three days ago when my doctor ordered a lab for another reason and found a blood glucose level of 217, ugh.

So my doctor told gave me some dietary advice and some glipazide, and instructions on buying and using a home blood glucose meter. Whee, new medical adventure....

#38 ::: Eleanor ::: (view all by) ::: November 20, 2005, 08:15 PM:

Three years ago I could have ticked the boxes for most of those symptoms, but didn't have a clue what they meant. I think it was a visit to Pizza Hut that made my ankles swell up, which finally persuaded me to go to the doctor (perpetual tiredness led to apathy, or I would have gone sooner). I left the surgery with orders to report straight to hospital with DKA. The insulin drip they stuck in my arm as soon as I got there made me feel so much better so rapidly that I almost didn't mind the diagnosis. Yep, type 1 diabetes. I was 24. Once I thought back, I realised I'd been having marked symptoms for at least three months, plus one that isn't on the list - sudden cramp in my feet in the middle of the night.

The tingling fingers and toes aren't necessarily a symptom of neuropathy - I had that, but it cleared up after diagnosis. Sometimes I could feel my fingertips tingle in rhythm with my heartbeat, which was weird.

Thankfully I've never had a hypoglycaemic attack (hypo) that I couldn't recognise and treat by myself before it became serious. If my hands start shaking, or I feel tired at a time of day when I shouldn't, or I start feeling as if the light in the room is too bright, I know what's going on. I carry dextrose tablets or jelly babies wherever I go, plus a muesli bar or two in case I need to eat something more substantial, and a few minutes later I'm usually fine again. I also carry a glucagon kit, but nobody's ever needed to use it.

Jim, are you sure about low-grade fevers causing hypos? In my experience it's the opposite - any illness causes my blood sugar to rise. Someone told me that it's because my liver releases extra glucose to power the extra work my immune system's doing. I add a unit or two to each insulin dose I take until I've recovered, and test more often to check whether I should still be doing it. Last year during a particularly bad cold I was taking extra insulin shots between meals to keep my blood glucose down. But so many diabetes symptoms are idiosyncratic that I wouldn't be surprised to learn I'm in the minority here.

#39 ::: Stuart ::: (view all by) ::: November 20, 2005, 09:02 PM:

I'm another of the Type 2s here. The medical profession lets diabetes progress too far before they diagnose it. Anyone whose blood sugar goes above 100 has impaired glucose tolerence. The EPIC population study in Europe has shown that someone whose blood sugar averages 120 (HgbA1C = 5.5) has more than double the normal risk of a heart attack.

There are metabolic abnormalities that are not on Jim's list that give advance warning of diabetes: high triglycerides, low HDL cholesterol, high blood pressure, high fasting insulin level. I began to manifest some of these 15 years before I developed diabetes. These, along with abdominal fat accumulation, are markers of what Gerald Reaven calls Syndrome X and is now more commonly called metabolic syndrome.

Hypoglycemia is another indication of failure in the control loop that regulates blood sugar. Have your doctor do a fasting insulin test to see how insulin resistant you are.

I kept my A1C in the low fives for five years using a low carb diet and no medications. This spring my doctor changed me to a different Statin (to Crestor from Lipitor) and my blood sugar control went to hell. I skipped all the oral meds and went straight to insulin.

The way to do well as a diabetic is to recognize that your doctor will not die for you if he gives you bad advice or fails to educate you. Learn everything you can. I recommend Dr. Richard K. Bernstein's The Diabetes Solution.

The ADA standards of care will kill you slowly. The limits they set are their response to the poor self care most diabetics give themselves. They feel is not realistic to expect better control.

#40 ::: James D. Macdonald ::: (view all by) ::: November 20, 2005, 10:12 PM:

Jim, are you sure about low-grade fevers causing hypos? In my experience it's the opposite - any illness causes my blood sugar to rise.

You can get a monkey to pass medical school by teaching him to say "It varies." The monkey will graduate in the top half of his class if you can also teach him to say "We see that sometimes."

There are metabolic abnormalities that are not on Jim's list that give advance warning of diabetes...

Sure. There are lots and lots of things. But triglicerides aren't really something you can determine yourself at home. I wondered about putting in the glucose level, because that's something you can't tell without the machine. But the machines are more common, and cheaper, and more accurate these days. Anyone who wants to can probably find someone with a glucose tester and do a fast finger stick on themselves. I was of half a mind to add another couple of points to the quiz: 1 pt for female gender, 1 pt for age 70+. But ... I'm not trying to be exhaustive.

Lots of things have various signs and symptoms. The uncommon symptoms of common diseases are more common than the common symptoms of uncommon diseass.

(Y'all know the difference between signs and symptoms, don't you? A symptom is something only the patient can tell you about -- headache or nausea, for example. A sign is something a third party can determine -- heart rate or blood glucose for other examples.)

Everyone, be good to your body. It's the only one you've got. And you want the EMTs to be able to sleep in, don't you?

#41 ::: Vicki ::: (view all by) ::: November 20, 2005, 10:32 PM:

I am oddly reassured--and Jim, you and your fellow EMTs can sleep in, I hope.

The last time I was at my doctor (for the follow-up manual breast exam after a mammogram) she drew blood for general-purpose testing, since it had been 18 months. She was vaguely irritated that I'd eaten breakfast, but nobody had told me not to, and I hadn't made the appointment for bloodwork. (She was mollified that it was yogurt and fruit, not bacon and eggs.)

When I called for the test results, they just said "it's all fine", but I had them mail me the report. Some of it means nothing to me--I don't offhand know what eosinophils are (since I doubt it actually means people (or things) that like Chinese dawns). Those I could at least google for; there are lots of TLAs that would be harder. But while my triglycerides are a little high, my glucose is quite happy, as are the blood pressure and cholesterol.

#42 ::: James D. Macdonald ::: (view all by) ::: November 20, 2005, 10:46 PM:

Eosinophils? They're a kind of white blood cell. (There isn't just one kind of white cell-- there are several different kinds, each with a special purpose.)

Eosinophils are the kind of white cells that deal with parasites. So a higher eosinophil count might be associated with parasites. You also see high eosinophils associated with some lung diseases. And sometimes you see more eosinophils for no reason at all.

#43 ::: CHip ::: (view all by) ::: November 21, 2005, 12:48 AM:

Usually, you see this in your older folks, particularly sedentary, overweight people. Oftentimes even a modest weight reduction (5 kilos) will be enough to get the cells to start accepting insulin again and start passing that glucose.

Sometimes this works, and sometimes it doesn't (yes, I saw the comment about the monkey); a friend worked her weight down through multiple sizes of clothes, started feeling poorly near her target weight, and was told -"we don't like your blood sugar; lose 10 pounds."- She spent most of the next year in bed, due to the amount of tissue loss (muscle and nerve) that happened before the doctor got serious. As some of the experiences above show, getting the doctor to think (and to react usefully) can sometimes be most of the battle.

But losing weight is often a good idea. (Best if you have a reasonable measure to work toward -- some of the old tables date from Depression-era studies of people who were malnourished, BMI doesn't allow for skeletal build, and Jim's waist/height ratio is a little tight for men -- but it's worth checking where you stand.)There have been a lot of reports that the "epidemic of obesity" is being tailed by a rapid increase in Type II.

#44 ::: Lizzy L ::: (view all by) ::: November 21, 2005, 12:49 AM:

As several folks who post here know, I am the caregiver for my 86 year old mother; she has been a type 1 diabetic for 31 years. She was diagnosed at age 55. (Stephen; I have the feeling such cases are not as rare as once was thought.) They thought she was a type 2, of course, since at that time type 2 meant "adult onset," but she had to go on insulin almost immediately.

I have managed her diabetic care for the last 8 years. Yes, she has doctors, pretty good ones. But most diabetes has to be managed by the person who has it, or in my mother's case, by me and the staff of the assisted living facility in which she resides. (I'm 5 minutes away from her. I am often there 3 or 4 times a day, sometimes for hours...) I am not going to go into specifics, but I will say it's not an easy disease to have, especially for a long time, especially if you come from a family with some very tough genes. (My maternal grandmother had 5 serious heart attacks, and still lived to be 89.)

One week last month I had to call the EMTs 3 different nights to take her to the local hospital. The third night they finally admitted her with a raging kidney infection.

Have I mentioned she's a "brittle" diabetic? Jim (or maybe Janet, hi, Janet) can go into what that means, if he wishes. I'm too tired.

Okay, enough venting. Sorry, sorry all. How interesting, however, to have an intimate and omnipresent topic in my very own personal life show up on one of my favorite web hang-outs.

#45 ::: John M. Ford ::: (view all by) ::: November 21, 2005, 12:53 AM:

The way to do well as a diabetic is to recognize that your doctor will not die for you if he gives you bad advice or fails to educate you. Learn everything you can.

There was only one Great Physician who specfically died for the patients, though a few did highly risky experiments on themselves.

But y'know, there are actually good doctors in the world. I have several, but keeping to the topic, my endocrinologist is intelligent, knowledgeable, and is willing to talk about any aspect of the disorder (not just my variation) -- in fact, he likes it. (It's true that I have a fairly large medical vocabulary, so he doesn't have to translate for me.) If we're going to change something, we talk about it -- by which I mean I have input, not that he tells me what's gonna happen. It took him a while to talk me into the pump, but that was me being skeptical -- I have seen a great many changes in therapy, not all of which proved as good as they looked -- and now I love my hip-mounted R2D2.

He also likes my work (the doctor, not the pump), but maybe I'm just lucky.

In fact, I probably am, and not just for still being above ground. My cardiologist also likes to discuss stuff, and also happens to be one of the top guys in the country for renal-cardiac patients. The transplant clinic wants to fiddle with my drugs, and the nephrologist's approach to this was to have a long discussion about the options and their pros and cons, and then show me where to get the docs online so I could make my own decision (which I will naturally discuss with her).

I'm quite aware that there are also rotten doctors, but fortunately I've only observed the worst ones I've (*mutter*certain male gynecologists*mutter*).

And long ago, I developed the Talk To Nurses mutant ability (a certain amount of Danger Room practice was involved), and if you want a hospital survival trait, this is on the short list.

#46 ::: Tae ::: (view all by) ::: November 21, 2005, 01:41 AM:

You can get a monkey to pass medical school by teaching him to say "It varies." The monkey will graduate in the top half of his class if you can also teach him to say "We see that sometimes."

However, when you hear hoofbeats you think horses - not zebras.

An elevated eosinophil count is most commonly associated with antigen-antibody responses - such as asthma and allergic reactions. Including 'parasites' too high up in the list of differential diagnosis will net you a harsh pimp session and a required presentation on liver flukes.

#47 ::: James D. Macdonald ::: (view all by) ::: November 21, 2005, 01:45 AM:

Including 'parasites' too high up in the list of differential diagnosis will net you a harsh pimp session

Unless you're living in the tropics where microfilarians are a major problem.

#48 ::: Tae ::: (view all by) ::: November 21, 2005, 01:57 AM:

Unless you're living in the tropics where microfilarians are a major problem.

Agreed. Let's just hope Vicki doesn't live in the tropics, or the albuterol MDI she just got isn't going to do spit for her.

#49 ::: James D. Macdonald ::: (view all by) ::: November 21, 2005, 02:07 AM:

My last duty station was in the tropics, where I picked up a lovely case of leptospirosis. Not as much fun as everyone tells you it is.

That isn't the reason I'm permanently deferred from donating blood, but it's certainly more interesting.

#50 ::: Tae ::: (view all by) ::: November 21, 2005, 02:21 AM:

That isn't the reason I'm permanently deferred from donating blood, but it's certainly more interesting.

Uh uh, not gonna touch that. The exclusion criteria can get ... personal.

#52 ::: James D. Macdonald ::: (view all by) ::: November 21, 2005, 02:47 AM:

I spent too much time floating around off the coasts of Europe, eating food brought aboard from European vendors. It worked out to more than two years in Europe, only without the fun of actually spending, y'know, more than two years in Europe. That's why the ARC doesn't love me any more.

I told you the lepto was more interesting.

#53 ::: John M. Ford ::: (view all by) ::: November 21, 2005, 03:09 AM:

Well, I've just got about ten different drugs in my bloodstream at any given time (all prescribed, I assure you), and right after an injury or surgery serious enough to require transfusion is not when you want to get off the bed and mambo. (And I tried that, twice, but it's at least as dull as leptospirosis. Which I make no claims to having had.*)

I spent many years with the ARC, though, helping take it away from other nice people. Attempt to balance the books, I guess.

*One of the Discover Channels has a show about grim survival experiences called "I Shouldn't Be Alive," which causes me to want to put together a show titled "I Shouldn't Be 120/80."

#54 ::: Niall McAuley ::: (view all by) ::: November 21, 2005, 05:45 AM:

>Overweight (waist size > 1/2 height)

Really? I'm not overweight by that measure (72" tall, 32" around the middle) but I am skinny. I would think most adults I know are overweight according to that rule.

#55 ::: Vicki ::: (view all by) ::: November 21, 2005, 09:40 AM:

Clarification: my eosinophil numbers are in the normal range (as printed on this lab report); it's just the most interesting name of the things-I-didn't-recognize.

Thanks for the information, all. And yes, if you hear hoofbeats in New York, California, or Germany, think horses--there are parts of Africa where it's entirely logical to think zebras.

#56 ::: Carrie S. ::: (view all by) ::: November 21, 2005, 09:59 AM:

My boyfriend has had blood sugar issues for most of his life, and when I started dating him three years ago there was a list of things Liam Didn't Eat.

Then his feet started cramping up a lot, and his vision was going weird. He went off to the doctor and had his blood sugar tested. It came out at 586. As another person inquired when told this number, "Is blood still liquid at that point?" Now that they've got him on Avandamet, these problems have cleared right up, thank heavens, and it's a good thing he figured out the problem before permanent damage set in.

Liam's weird, though, in that he starts getting the low-blood-sugar shakes at about 80. And his preferred stopgaps are cheese and milk.

#57 ::: DaveL ::: (view all by) ::: November 21, 2005, 10:25 AM:

Good to see a couple of people note that fasting glucose over 100 is a Warning Sign.

One problem with dealing with both types of diabetes is that the complications (which can be horrific and life-threatening) don't generally happen for a long time. Thus they are psychologically easy to put aside, and worse, there is a financial incentive for insurance companies to not care very much about preventive treatment. I have heard it said many times by people in the industry that since you will be insured by someone else when the complications hit, paying for prevention is wasted money. (I work on a project involving diabetes treatment.)

Another issue is that the general recommendations for "maintenance" glucose level and A1C level (this latter is a protein that essentially is a marker for how much glucose you have processed in the last three months) are set too high to be compatible with long-term complication-free management. The reason is doctors are desperately afraid you will screw up your insulin bolus and die if you actually try to keep it at the best level for long-term health.

Managing diabetes is extremely complicated; it gives one new respect for how well our bodies do the job when everything is working properly.

Eventually there will be closed-loop systems for Type I; there are already continuous-monitoring glucometers available and there are (in development) insulin pumps that could interface to them. However, Type II is another matter.

#58 ::: ajay ::: (view all by) ::: November 21, 2005, 10:42 AM:

Huh. 2 years in Europe (or, rather, nearby) and you are barred from donating blood for life? Why? Are they concerned you might have bioaccumulated high levels of Frenchness? (Hangs around in the fatty tissues, you know, like dioxin.)

I've spent almost my entire life in Europe. Suddenly I am worried.

#59 ::: Cassie ::: (view all by) ::: November 21, 2005, 11:20 AM:

I think it's the quarantine thing-- the UK is full of mad cow, for example. They don't know what you might have picked up over there, but they know we don't have it over here.
I always confuse the screeners because I've been outside the country so much. I usually just pick one of the countries that put me on the malaria deferral list or it takes forever. And two years in Honduras? They *hate* when I bring that up.

#60 ::: Gigi Rose ::: (view all by) ::: November 21, 2005, 11:25 AM:

20-50% of the women who develop gestational diabetes will go on to develop Type II diabetes in later life
I'm relieved to hear your statistic is lower than I believed. I read/heard somewhere that you had a 90% chance to develop type 2 if you had gestational diabetes. I really enjoyed reading this comment even though I feel pretty versed on the subject. I especially liked the line "don’t use a Red Hot Fireball cinnamon candy". LOL!

Xeger said "I'm not diabetic, but I am hypoglycemic - and the effects of a glass of orange juice with a few tablespoons of sugar in it are amazing." and another person mentioned that their hypoglycemia makes them manic. I have been hypoglycemic since I was 12 and I'm 48 now. I keep waiting for the other shoe to fall. My younger brother developed Type 1 diabetes at age 25. To complicate matters I am obese, have hypertension, Rheumatoid Arthritis, and some peculiar allergies. I suspect that our family may have some weird inherited auto-immune thing going on, but no doctor is going to figure this out so we have to live with our symptoms. The main problem I have in controlling my health is that sugar is to me as alcohol is to an alcoholic. I have a very difficult time staying away from it and I greatly abuse it hence the obesity which doesn’t help the other problems one bit.

#61 ::: Vicki ::: (view all by) ::: November 21, 2005, 11:33 AM:

Back to the original post, Jim mentioned Narcan as one of the things the paramedics use if someone is unconscious and they don't know why.

New York City has a relatively new program in which heroin users are being prescribed syringes of Narcan, to be carried in the same way as some people carry epinephrine or glucagon. The syringes are being handed out at the needle exchange programs.

They don't know how many of them are being used--not everyone who has them is comfortable coming back and saying "I think I saved so-and-so's life last week"--but they're confident that some lives are being saved. The next step they're considering is issuing them to city (as in, paid staff) EMS; I was startled, comparing to Jim's post, that our EMS don't already have them in their kits.

#62 ::: Arthur D. Hlavaty ::: (view all by) ::: November 21, 2005, 11:51 AM:

Thanks for the timely information. Last month I was diagnosed with diabetes (significantly lower blood glucose than the woman you tested). I've given up refined sugar (and had recently started walking 20-30 minutes a day) and am negotiating with my body as to further adaptations.

#63 ::: Lizzy L ::: (view all by) ::: November 21, 2005, 12:10 PM:

To all who have recently been diagnosed as diabetic or borderline diabetic, may I recommend exercise? It feels good (endorphins), and handled with common sense it can lower blood sugar and generally help keep your body on an even keel. Don't forget the common sense, though. Keep a candy bar or other sugar source nearby in case you drop low. Lows are more directly dangerous than highs -- they lead to convulsions, loss of consciousness, and death -- but consistent highs also lead to loss of consciousness and they do more sustained damage to organ systems. My mother has been conscious with a low of 29 (I was there, talking to her)and semi-conscious with highs of 680. You don't want to go to either of those extremes, ever.

#64 ::: John M. Ford ::: (view all by) ::: November 21, 2005, 12:13 PM:

Joe Connelly's Bringing Out the Dead has a hilarious EMT story (not in the movie) involving a dose of Narcan, and it would be useful so often that I'm pretty sure they must have it along. It may just be that they're going to add the preloaded injectors to save time and fussing around with loading a syringe. It's not a terribly hard task, but it does require both hands. With a filled syringe one could, if the need required, flip off the guard and shoot.

Many years ago, in the Merck Manual's chapter on Psychiatric Emergencies, there was a discussion of dealing with berserk patients that had some lovely -- and doubtless experientially based -- lines, like "Adequate force should be gathered. In the case of a muscular young male wielding an ax, several policemen may be regarded as indispensable." This was followed by "Administer [a drug to subdue the patient] into the nearest available muscle without undue finesse." Later editions, sadly, lost this paragraph for one that carefully explains that proper restraint and injection procedures must be maintained at all times.

#65 ::: John M. Ford ::: (view all by) ::: November 21, 2005, 12:19 PM:

I have just been reminded (by going over to check the film data) that Bringing Out the Dead was set during the era before the Fire Department took over EMS from the Hospitals Department. So maybe the drug rules changed, though if they did have to stop carrying Narcan, I can't imagine the EMTs were very happy about it.

#66 ::: OG ::: (view all by) ::: November 21, 2005, 01:13 PM:

On the eosinophils: Some doctors don't know what they mean, either. I tried to get an answer for over a month after finally getting a doctor to order a blood panel before I googled it myself. Put together with the symptoms I had been presenting to them for over two years, asthma was blindingly obvious. (Eos count was over 20K, IIRC.)

On exercise: I'm happy for those of you who can jump up and exercise. I can walk into my current doctor and get a lecture about how I must immediately start exercising at least 20 and preferably 60 minutes a day, all in one go, when I'm pleased as punch that I managed to walk from my car to their office door without my cane.

Yes, I'm looking for a new doctor.

Mike: That revised paragraph looks like an anti-lawsuit vaccination to me.

#67 ::: Adam Ek ::: (view all by) ::: November 21, 2005, 01:52 PM:

Thanks for the information. I was just diagnosed with Type II in October. :(

#68 ::: mayakda ::: (view all by) ::: November 21, 2005, 02:33 PM:

The main problem I have in controlling my health is that sugar is to me as alcohol is to an alcoholic.

Yeah, I know that feeling. Two siblings with type 2 (one deceased).
Being on Atkins helps a lot, as well as letting myself indulge in very dark (minimum 72% cacao) chocolate to help from feeling deprived. But when I fall off low-carb wagon it's way too easy to lose control.
The Holiday season is hard. *sighs*

#69 ::: amysue ::: (view all by) ::: November 21, 2005, 04:13 PM:

Great thread with great info. I was lucky, when I had all the symptoms one associates with diabetes I went to my doctor, had her do a fasting glucose and a few other tests and the next morning was unsurprised to here my A1C was 15% and that I would be going directly to insulin. I already had an appointment for that afternoon set up at the Joslin (my SIL heads a dept. there)and I went from someone who "would never stick a needle in myself even if my life depended on it" to "show me where, how and how often". I want to see my kids grow up.

It's been an ongoing learning proces and I am not all that great a diabetic. My A1C's are fine (last one was 6.1% and I expect the next one to be lower), but that's because I use humalog and lantus with a vengeance. I am obese, which means I am insulin resistant but because of other issues don't produce insulin. It makes knowing how big a bolus to take tricky at times.

Except...it wouldn't be if I had the stones and the stamina to radically alter my diet and stick to it. I won't ever be able to say good bye to the needles or insulin (and because of liver problems can't take any orals), but I would be healthier and take far less. If I excercised daily, even a 30 minute brisk walk a day, my numbers would come down. I do my best and try to do better and remind myself that while diabetes isn't my fault I am responsible for my own choices in how to deal with it.

Having said that...to all you pump users, my docs want me to try it and I've been resisting for a year now. I have an aversion to being mated and attached to tubing and a box 24/7 and fear that it will be uncomfortable and unwieldly. Any thoughts?

#70 ::: anon ::: (view all by) ::: November 21, 2005, 04:26 PM:

regarding the question about fever causing low or high blood sugar: i'm surprised that jim didn't immediately affirm eleanor's experience, before going into the snarky commentary about monkeys. eleanor, illness is ALWAYS EXPECTED to raise your blood sugar. this is common and universally known. don't start doubting now! i think what jim was trying to say was that sometimes low grade fevers cause low blood sugar BUT that illness usually raises blood sugar. if HE wasn't trying to say that, I'M saying it now.

regarding docs who won't die for you: excellent point.

for all you new diabetics out there: don't stick with an internist. go find yourself a diabetologist or endocrinologist. insist on it. any doctor who doesn't specialize in diabetes simply will not know the things they need to know. i've been brought to the brink of coma, accused of epilepsy, and told all manner of suable things by internists who did not specialize in diabetes. don't do it to yourself.

on the other hand, don't think that a diabetologist is the answer to all your prayers. you need to do your own research (http://www.diabetes.org/home.jsp), you need to ask lots of questions, you need to ask for OPTIONS, and you need to get your doctor used to being your consultant, not being your decision-maker.

i've seen about 8 diabetologists in six different cities in three different countries and MOST of them want to fix you. that's right, they want to fix you, like most doctors want to fix people, even though they know that diabetes can't be fixed. so they have ONE fix for each problem and you take it or leave it and if you leave it, then you are blocking THEIR WORK and they get pissed off and yell at you.

don't assume that because everyone tells you that your diabetologist is the best in town, that you have to stick with that specialist. find the doctor who will listen TO you and work WITH you and talk WITH you. that's a good doctor, not the one with the best stats. the doc with the best stats is PURSUING good stats, and not helping you live your best life.

on the other side of the coin, pursuing a top-notch a1c is maybe not the best life you can live. it may be the heallthiest, but it may not be the best. you need to put your diabetes in the context of your entire quality of life, and i'm not talking about being able to eat cake, but about being able to stay up late to drink good wine and watch a meteor shower, or to not wear a pump so that you can go surfing or have wild sex in a hot tub, or choosing the simplest (not the complex best) system to work with so that you can travel easily through inner mongolia or volunteer for a year with orphans in soweto. maybe a decade of old age is a worthwhile sacrifice so that you don't have to stay at home, testing your blood sugar ten times a day.

also, type 1s should know that pancreas transplants ARE a viable option, but they're not one that most doctors will bring up to you. there used to be a website dedicated to this (http://www.diabetesportal.com/) but it's closed for now because the person in charge, a 38-year-old former type 1 diabetic who had a successful transplant, has had a baby. here's an article about the substance of her argument for transplantation:
http://www.mendosa.com/insulin_free.htm

and finally, no one ever wants to hear this, but, although there's no conspiracy or anything, diabetics need to be aware that there's no very strong will in the medical community to cure diabetes. diabetes care (not cure) is an exploding industry, and a great deal of research money, especially within the pharmaceutical industry, goes to finding better ways of maintaining diabetes, not curing it. the will to cure is more in the diabetic community, and in organizations like the juvenile diabetes foundation (which focuses on type 1)

just stop and think for a minute about all the doctors, nurses, educators, drug companies, clinics, physical therapists, hospitals, insurance companies, who benefit from diabetic clientele. think how many jobs would be lost if a cure for diabetes was found. think about that when new therapies and treatments come up and your doctor doesn't want to discuss them because they're "too risky". all i'm gonna say.

#71 ::: betsy ::: (view all by) ::: November 21, 2005, 05:31 PM:

carrie s: when my blood sugar gets low enough so that i start shaking, i also go for cheese (or other things containing protein). i will do sugar, but only if i'm really bad off and only to get me to a protein source. for me, my blood sugar seems to bounce back down quickly enough that i just end up with the shakes again pretty quickly.

#72 ::: CHip ::: (view all by) ::: November 21, 2005, 05:57 PM:

It worked out to more than two years in Europe, only without the fun of actually spending, y'know, more than two years in Europe. That's why the ARC doesn't love me any more.

Anyone who has been deferred due to too much overseas time should check the revised standards; sometime last Summer a lot of the numbers were changed, e.g. time in the UK after 1996 doesn't count against the 3-month limit (that's the one I was watching as Interaction was my 6th UK convention), time in Europe is up (5 years?), etc.

#73 ::: Marilee ::: (view all by) ::: November 21, 2005, 06:40 PM:

OG, you sound like we can walk about the same amount -- on land. I can walk and exercise in water.

#74 ::: John M. Ford ::: (view all by) ::: November 21, 2005, 07:07 PM:

Wyth Referrence to Ye Pumps.

With the understanding that this is just my experience; what works is what works for the patient.

First, you aren't permanently mated to the pump. There's a small, soft catheter, a few mm long, that you put in subcutaneously (the introducer needle is immediately removed, so there's no metal in you). This has a socket that connects to the pump with a quick disconnect. So if you want to take a shower, you disconnect the pump, put it on standby, and shower. (There are still plastic neck bags to tuck the pump in while showering, but I've never used one. Being disconnected for fifteen minutes is not a big deal for me, though I can see that for some very brittle folks it might be.)

Apart from this, yes, it is there all the time. In the daytime I wear it on my belt; since we now live in an age where darn near everybody has an electronic device on their belts, this is scarcely noticeable in public. In addition to the basic clip, I've got a neoprene pouch and a black leather model for dress wear.* It does have a length of tubing running to your catheter, which can get untucked and sometimes catches on things, but again, not a huge problem. At night I've got a soft fleece belt with a Velcro pouch, though sometimes I just tuck the pump in a pajama pock You change the catheter a couple of times a week, moving it around just like an injection site. I've only once had a problem with discomfort, and that was apparent as soon as it was installed; I pulled it and put in a new one, which was fine.

My pump has an RF link; it can receive BG data from my meter, which saves entering it manually, though that's not a huge nuisance. It also allows boluses to be set remotely, from a keychain-sized gadget. This means that if you really dislike having the pump showing, you can put it somewhere inside your clothes, and set it from the remote. (Another use of the remote is with small kids or impaired elderly: you lock out the onboard controls and give their boluses from across the room.)

It does take a while to properly tune the pump, and some of it is trial and error, though using the monitor usually makes the errors minor. The basal rate -- the constant trickle of insulin -- can be set to change during the day, and it takes some experimentation to match it to your schedule. On the other hand, once properly set, this means your BG remains relatively constant.

At mealtimes you calculate and deliver a bolus, and this is one of the pump's enormous advantages. You take the mealtime insulin when you're ready to eat; you don't take a slow of slow-acting and then have to cover it on its schedule. And the bolus is based on what you're eating, not what you took four hours ago. If you're having pizza, or something else high-fat (remember, this is not medical advice), you can set the pump to deliver, say, half the dose now and the other half spread out over the next couple of hours, so you're covered as that fat slowly metabolizes. This flexibility is a major improvement (and yes, for a while before changing over I was doing the Lantus/Novolog deal,** with five shots a day. It was better control than the previous two shots of regular/Lente mix, but still not as good, and certainly not as flexible as this.

Again, this is just my experience. But I was resistant too, and I'm not at all sorry I changed. (I don't miss shots, though after over twenty thousand of them they were not really a proble. And five a day, even with the nice portable pen injector, was a bit of a grind.)

*There's a fairly broad aftermarket in pump accessories for gracious living, including satin pouches on lace garters. Not my style, but I'm sure they look really sharp with a slit Mizrahi dress.

**For everyone else: Lantus is a long-acting insulin*** with a very long, very flat action curve; it's similar to the basal rate on the pump, though of course not adjustable. Novolog is an insulin with rapid and short action, which you use to cover meals. My pump is also loaded with Novolog.

***Ooh, nested footnotes. Natural human insulin loses its effect after about four hours. As this won't get you through the day, there are a number of modified insulins that are released more slowly, with various curves of action. A lot of people take one that lasts for 24 hours, with a hypergolic starting slug of unmodified insulin to cover until the long-acting kicks in; for a long while I was doing this twice a day, and before a particular metabolic change (different, long, not very interesting story) that worked pretty well.

#75 ::: John M. Ford ::: (view all by) ::: November 21, 2005, 07:13 PM:

And anon, I am not going to quarrel with any of your observations, but leaving rude phony e-mail addresses is considered very poor form among the regulars here.

#76 ::: amysue ::: (view all by) ::: November 21, 2005, 07:48 PM:

Here's a stupid question:if you sleep in no clothes and don't want to wear a belt then what are your options for placement of the pump?

#77 ::: Lizzy L ::: (view all by) ::: November 21, 2005, 08:08 PM:

About exercise: I am aware that some people find exercise difficult. But as has been posted here, if you can't walk easily on land, maybe you can in water. If you can't walk at all, there are exercise bikes and if they are not appropriate, there are exercises for upper body strength and flexibility and even lower body strength which can be done sitting in a chair. Of course there are people for whom exercise is not possible -- but at the very least, breathing exercises are good for everyone unless you are suffering from lung problems, are in an iron lung, or are in such state of disability that this is all nonsense.

Simply telling people who have never exercised, don't like it, and don't really want to do it to exercise is mostly useless. You have to tell them where to go and whom to talk to, which means you have to KNOW. Most doctors don't.

I was lucky. I fell in love with a particular physical activity when I was 25. In my previous life I weighed 105 lbs, and never did anything more strenuous than picking up a book. I am going to be 60 next birthday and am still doing it. It keeps me reasonably fit and contributes greatly to what sanity I have left.

And I don't, to date, have diabetes. I may yet get it: some of it is inherited, some not. No way to know. At least, if I do get it, I know how to manage it... though I'll miss the ice cream and the beer.

#78 ::: Lizzy L ::: (view all by) ::: November 21, 2005, 08:19 PM:

(Giggle, guffaw, smirk.)
Hey, get your mind out of the gutter...

#79 ::: John M. Ford ::: (view all by) ::: November 21, 2005, 09:01 PM:

amysue: It's not a stupid question -- it's the kind of thing that patients reasonably want to know, but the people who write the literature never think about.

When I stuff the pump in a breast pocket (and occasionally even if it's in the Velcro pouch), it sometimes falls out. This has never been a problem -- lying on top of it is unlikely to cause any damage (though the way I'm built, lying on top of a coconut cream pie might not cause that much damage), and any action that would change a setting or deliver a bolus requires at least two, usually three, button presses (and sometimes a menu access), so it would be pretty hard to mess up the settings (or worse, send a bolus) by rolling on it. (If this became a real problem, the keyboard can be locked out for the night, as I said above.) I suspect the worst thing likely to happen would be for it to fall on the floor, though they're built sturdy. And I suppose a really good yank could pull out the catheter, but the sticky pad that holds it is very strong -- it's supposed to last three days, with showers -- and I've never had that happen. It does tend to wander around the bed when it's loose like that, but you can always follow the tubing.

On the other islet of Langerhans, I can see that this could be troublesome, and it's worth taking into consideration.

#80 ::: Cassie ::: (view all by) ::: November 21, 2005, 09:30 PM:

I went to Costa Rica and Peru a couple years ago; one of the girls on the trip had an insulin pump. It caused a fair amount of trouble getting through airport security, but we expected that. Her general doctors tend not to know what on earth it is. Somewhere in Peru, she and a group of friends went out for the night. Upon getting back to the hotel, she said, "I think my pump's gone."
A streetbrat had stolen it. It took somewhere around a hundred dollars and a lot of arguing, including explaining that it was not a pager and that she needed it, to get it back. Those are some pretty good pickpockets, I guess.

#81 ::: zandperl ::: (view all by) ::: November 22, 2005, 12:45 AM:

Thank you for this good information. My mother has Type II (controlled by injections) and while I knew a bit about what caused it and what the results could be, I didn't understand WHY those results could happen. Now if only I could convince her to exercise. Ever. :(

#82 ::: Paula Helm Murray ::: (view all by) ::: November 22, 2005, 01:25 AM:

a word of advice is needed.
i've got a puzzle (caused by the Queen of Denial, my loving 80-year-old mom)

She told me her doctor advised her that her white count was low. Thanksgiving is going to be okay because my sister, Jim and I are all well right now.

What worries me is that we're ALL going to be there for Christmas, including my niece's three infection-bearing children (even though they're home-schooled, mom tells me they're 'always sick from somethiing.' )

Iis there anything safe (she's hypertensive and takes meds for that, but as far as I know, those and Tylenol are the strongest things she takes daily) that she can take/do to improve her immuity (replying to dragonet@kc.rr.com is okay, not to add to thread)

Thanks in advance for any advice.

#83 ::: Tae ::: (view all by) ::: November 22, 2005, 02:33 AM:

eleanor, illness is ALWAYS EXPECTED to raise your blood sugar. this is common and universally known.

Hypoglycemia commonly occurs in sepsis (overwhelming blood infections), kidney and liver failure. The zebra in the differential would be an insulinoma (insulin-producing tumor).

#84 ::: OG ::: (view all by) ::: November 22, 2005, 06:54 AM:

Marilee, I went from all-day hikes to using a cane to go 50 feet overnight. My allergist thinks I had a form of bronchitis and has some choice things to say about the docs who tried to feed me prozac instead of giving me a referral.

Water exercises are no good for me. The underlying problem is pulmonary, and even the pressure of the water hinders my breathing too much. What progress I've made is thanks to an air walker with a sturdy "hand rest" that I can lean on, but every cold, flu, or round of hay fever sets me back to the beginning again. One step forward, 0.9 steps back.

And exercise is my key. Without it, I can gain weight on 1000 calories a day.

#85 ::: Eleanor ::: (view all by) ::: November 22, 2005, 08:13 AM:

Anyone who's interested in insulin pumps, how to get them and how to live with them should check out insulin-pumpers.org and its British and Canadian sister sites. Excellent sources of diabetes-related information (though skewed towards type 1) even if you don't pump.

anon: Thanks, I knew I wasn't the only one.

Tae: I didn't know that. But for the common cold and the like, I think my experience is normal.

#86 ::: Teresa Nielsen Hayden ::: (view all by) ::: November 22, 2005, 08:49 AM:

Tae: I hope you don't mind my asking, but are you the author of the "Paramedic from Hell" series? If so, thank you -- I enjoyed those immensely.

#87 ::: amysue ::: (view all by) ::: November 22, 2005, 09:15 AM:

John: Thank you for all the pump info. I am not a shy person and yet I feel funny telling my doctor that amoung the many different concerns I have about the pump a few are related to sleep and or sex habits. I'm also a klutz. If there is a way to pull, step on, fall over etc. a given object, I will find that way.
I think that ultimately it will come down to control and what I am comfortable with. I don't mind the 5-6 injections a day. I am not shy about using the needles in public (though occasionally I get asked to not do so). However, the control I have may not be optimal and I need to honestly look at that. The fact is that my children have not once but twice needed to intervene when I've gone low so fast I had no warning. (One time was at the Lowell Folk Festival this past summer and my daughter essentially walked me by the hand to a paramedic and told him I was dabetic and acting funny-he squirted that stuff in my mouth and it really works.) It makes me sad that a 7 and 10 year old are aware of such things and that they worry about me and if the pump will give me better control and lessen the chances of such events than I can suck up inconvienient aspects.

Thanks again for the insight.

#88 ::: Bernadette Bosky ::: (view all by) ::: November 22, 2005, 09:47 AM:

I've been type II diabetic for years now (eight? ten?) and perhaps the most astonishing thing to me about the "diet and exercise" part of diabetic control is how totally different it is, and needs to be, from the weight-loss dieting I yo-yoed on for years. It has to be totally sustainable, a word tossed around much in weight-loss diets but much more the exception than the rule. It has to become a matter of actual habits, not a project. Experience with short-term weight-loss diets will be more a hindrance than a help, she said with epic understatement.

So while diabetics have to be emphatic and tenacious, because real damage is being done, we also have to be really forgiving with ourselves, because putting habits in place is always an annoying and tedious process that must incorporate steps backwards as well as forwards. Also, while nuitrition and exercise are both vital, psych studies show overwhelmingly that it works better to concentrate on building one new habit at a time.

Fortunately, any progress is better than none, and as Charles Fort said, to measure a circle you can begin anywhere. Most books about diabetic control for diabetics have a sane attitude towards habit change that I can only wish I had encountered before I went on my first weight-loss diet.

Another nice thing is that generally speaking, habits that control diabetes also are good for health in general. Everyone would be better off exercising regularly, eating a variety of vegetables every day, etc.; I just have more motivation than many. Which is good, because it sure is a pain in the ass.

#89 ::: Shunra ::: (view all by) ::: November 22, 2005, 10:39 AM:

AmySue, what you wrote is scary. I understand squeamishness about private details - but failure to discuss concerns with a doctor can have horrible side effects.

I urge you (and all the people who feel the same way and don't have the guts to say so in public) to do whatever you need in order to get over the squeamishness. Therapy, role-playing, voodoo dolls, lots of blushing... ANYTHING. Because giving one's doctor full information is the only way some things will get caught, noticed, and treated. Doctors aren't necessarily brilliant, but without full information they can be useless or harmful.

Whatever it takes - it's worth it.

#90 ::: Tae ::: (view all by) ::: November 22, 2005, 11:07 AM:

Tae: I hope you don't mind my asking, but are you the author of the "Paramedic from Hell" series? If so, thank you -- I enjoyed those immensely.

Ah yes, that was me, though I now cringe at my lack of writing and parsing style when I read some of the stuff today.

In my defense, I typed essentially one long paragraph and posted using my trusty Apple //e and my not so trusty dialup connection and hoped that it went through.

Never occurred to me that I could write using a word processor and post in a more lesiurely fashion.

#91 ::: Teresa Nielsen Hayden ::: (view all by) ::: November 22, 2005, 02:21 PM:

AmySue, I've had a semi-disabling case of narcolepsy, and a truly gaudy case of cataplexy, for most of my adult life. One of the most important decisions I ever made was that if someone in an interaction is going to be embarrassed by my narcolepsy, it isn't going to be me. I don't think anyone should have to feel embarrassed about it; but if someone out there thinks differently, it's their embarrassment, not mine.

#92 ::: Daniel Boone ::: (view all by) ::: November 22, 2005, 03:28 PM:

Lizzy L wrote:

To all who have recently been diagnosed as diabetic or borderline diabetic, may I recommend exercise? It feels good (endorphins), and....

Although the exercise advice is good for pragmatic reasons, the "it feels good" bit is infuriating. If that were true, everybody would be doing it, like they are sex. Perhaps it's true for you, Lizzy L, but it's not universally true, and the buried assumption that folks who don't exercise have never tried it and are thus about to discover a new pleasure is ... annoying.

For me, exercise is pain. Not something medically abnormal, just that the sensation of tired muscles is sufficiently akin to pain to be strongly aversive. No matter how hard I exercise, there's never a detectable endorphin response that matches the descriptions; it never starts feeling better, there's never a rush, I never "hit a wall" and start feeling better. Euphoria? It is to laugh. Exercise starts as mild misery and gets swiftly worse from there. The pain (not really pain, but strong unpleasant sensation of muscles stressed past their comfort level) simply gets worse and worse until I stop or cannot move; and then (after I stop) it slowly gets better again. I never wind up feeling better than I did when I started, not until after a good night's sleep anyway. Endorphins schendorfins. All I can say to explain it is, there's a wider metabolic variation in humans than most people suspect.

#93 ::: Vicki ::: (view all by) ::: November 22, 2005, 04:11 PM:

Daniel,

Having been exercising (weights mostly, with as much cardio as I can convince myself to do beforehand) for five years, I am now at the point where I feel better for doing it. Feel better as in, if I'm having a cranky day at work, I go to the gym, and somewhere in there, shoving pieces of metal around, I notice I'm feeling better.

But that's not why I started doing it--it took months, maybe a couple of years, before I reached that point. This doesn't mean you'll ever have that happen--people are different, as you say. (I started because it's good for me, in terms of endurance and other useful things.)

My advice, if you don't find it presumptuous of me to offer any, would be to suggest that you investigate some other form of exercise. I base this on having thought I disliked any exercise other than long walks for most of my life, then happening onto weight stuff because the gym had that and I really didn't like the group exercise "classes". So maybe there's something out there that, even if it doesn't delight you, won't be misery. And to not push yourself to the point of being able to move, in any form of exercise: that's suitable if you're trying to escape a lava flow or other immediate danger, it's not supposed to be part of everyday exercise.

#94 ::: kathryn from Sunnyvale ::: (view all by) ::: November 22, 2005, 05:02 PM:

If you have either form of diabetes you might (well, should) take the supplement benfotiamin (benfothiamine or 5-benzolythiamine-0-monophosphate). If you know someone with diabetes, read the research and then buy it for them: its that important.

Its a form of vitamin B1 that helps stop one type of damage from hyperglycemia. Spiking sugar levels are damaging to the body in part because of the "advanced glycation end-products" (AGEs) that end up in our tissues (1) after the sugar is metabolized, analogous to rust or caramelization. These AGEs in turn are a cause of diabetic neuropathy. Benfotiamine helps prevent AGE damage, which in turn prevents further diabetic neuropathy. One study found it can reverse some damage and pain of d.n.

If you look it up on Pubmed (2) you'll see that benfotiamine's useful effects were first reported by European researchers (in non-British European medical journals, which is perhaps why it didn't get much attention in North America at first). More recently, researchers have found how and why it works, publishing in more famous journals (notably Nature Medicine). The increased attention lead to more companies producing it, so you don't have to import it from Germany.

(1) All people get AGEs, but diabetics have much, much more.

(2) Please look it up on Pubmed or medical journal index of choice first. This isn't just another supplement with interesting anecdotal stories (what a google search alone might suggest, given the shopping sites that result). The peer-reviewed research on what it does and how it works is available.

#95 ::: Lexica ::: (view all by) ::: November 22, 2005, 05:10 PM:

Like Vicki, I've always thought I disliked exercise other than methods of "get me from point A to point B" that also happened to be exercise (like walking and bicycling). Being the last person chosen for the team *every* *flipping* *time* teams got chosen in grammar school didn't help; hearing the team captain say "uh... we'll play one short instead" really didn't help. I've tried gym memberships, I've tried yoga, I've tried Pilates. None of them clicked.

A little over two months ago, however, we got an old exercise videotape off the shelf (Callanetics, released in 1986). For some reason, and I don't know what it is, I'm actually enjoying it. And isn't a matter of enjoying having exercised (you know, like the way banging your head against a brick wall feels so good when you stop), it's that the actual experience of exerting my muscles now feels good to me.

If the exercise you've tried isn't enjoyable to you, try other forms. Maybe I'm a cockeyed optimist, but I believe that for almost anyone, there is *some* form of exercise that will be at least tolerable and possibly even pleasant.

#96 ::: Daniel Boone ::: (view all by) ::: November 22, 2005, 05:31 PM:

Vicki, thanks for the kindly advice; I receive it in the spirit with which it was intended. There are plenty of strategies for accomplishing an unpleasant chore, and frequently I implement some that work.

My point in posting, however, was not so much to bemoan the unpleasantness of the chore, as the challenge the nested assuptions behind that "it's fun, if you'd only try it once you'd enjoy it" post. People who are heavy and sedentary (e.g., me) tend to get touchy when other people assume we've *never even tried* to exercise and thus don't know what a sublime pleasure it is. That comes across as a very patronizing assumption loaded with negative stereotypes. Just how lazy and/or stupid would a person have to be to get to a point in life where overweight is a medical problem, without once ever trying an exercise program? Perhaps I'm lazy and stupid, but I'm a long way from being that lazy and stupid. I grew up poor and did a lot of hard physical labor as a kid; I know what exercise feels like and have hated it since I was a wee skinny little runt. I got fat in puberty *despite* working harder than most modern Americans ever have.

My problem is self-motivation in the face of aversively unpleasant feedback. It was being told that the aversively unpleasant feedback "feels good" that got my dander up.

#97 ::: Marilee ::: (view all by) ::: November 22, 2005, 06:01 PM:

OG, I changed in about three seconds. Of course, I'd already been in the hospital for renal failure for two months and I wouldn't have been hiking during that. My problem with walking (and a lot of other kinds of exercise) is that while I was in the hospital, my blood pressure went up and the doctor ordered a med that was standard protocol back then*. The nurse administered it and my blood pressure dropped so low I didn't get oxygen to my brain for a while. I had a big stroke & coma, and I'm partially paralyzed on the left side and my balance isn't very good. I fall over easily. But in water, the water helps support me, and when I do fall, it doesn't hurt.

*A study was done about six years ago with matched patients and the people who got the med I did had more strokes than the people who got nothing. The treatment was to prevent stroke, and it caused more strokes than doing nothing. They use a different med for that situation now.

#98 ::: James D. Macdonald ::: (view all by) ::: November 22, 2005, 09:55 PM:

Study: Breast-feeding may protect moms from diabetes

CHICAGO, Illinois (AP) -- Breast-feeding is thought to protect babies from developing diabetes. Now research suggests it might even help keep their mothers from getting the disease, too.

A study found that the longer women nursed, the lower their risks of developing diabetes.

The findings are far from conclusive, but the researchers say breast-feeding may change mothers' metabolism in ways that make the possible connection plausible.

These metabolic changes may help keep blood sugar levels stable and make the body more sensitive to the blood sugar-regulating hormone insulin, said Dr. Alison Stuebe, the study's lead author and a researcher at Brigham and Women's Hospital in Boston, Massachusetts.

Story continues at the link.

#99 ::: amysue ::: (view all by) ::: November 22, 2005, 11:06 PM:

Yeah. Honesty with doctors is a good thing and I usually strive for it. But there is a difference between telling a doctor something in order to help with a diagnosis and telling the doctor that one of your concerns about using a pump has to do with your ambitious sex life-though seeing as how I seem to have no trouble writing that on a public blog I should get over myself and raise the question. In any event, right now I am battling some new infection and apparently have bought myself a colonscopy. Yay me. Wasn't exactly what I was hoping the holiday season would bring me...

#100 ::: Lizzy L ::: (view all by) ::: November 22, 2005, 11:38 PM:

Daniel:
Sorry if anything I said sounded patronizing; it was not so intended. Nor did I intend to imply --in fact, I don't think I did imply -- that folks not exercising are stupid or lazy. If you take a look at my post you'll see that I said, I fell in love with a particular activity, and that's still what I do, almost every day. (I also rather like lifting weights.) If someone were to tell me I had to run, or climb, or play a team sport, or throw or catch a ball, or participate in a calisthenics program, or do lots of other stuff I find no pleasure in, I would cheerfully tell them to get stuffed. What I recommend is, find something you like to do with your body, and do it. But if nothing you do with your body feels good, I don't suggest you should do something that hurts for the sake of some mythical chemical rush. (Indeed, it's possible that endorphins cannot be released, or that their release cannot be effective, unless you are doing something you like -- a human being is not a chemical factory, pull this lever, get this chemical. As Screwtape points out, whatever our bodies do affect our souls, and vice versa.)

Maybe bocce ball? :-)

#101 ::: John M. Ford ::: (view all by) ::: November 23, 2005, 03:53 AM:

When I was on the runup to dialysis, the clinic staff (with whom I would also have an extremely good relationship) asked me to watch an instructional video. Normally I don't much care for them -- I'd rather read something with diagrams -- but this one had a fine moment where a woman being interviewed explained that, yeah, though they didn't necessarily ask, people always wanted to know about sex with the catheter* in place, and she went on to say that sometimes the plastic dangly bits flopped around, but it was really irrelevant.

The important thing was that this information was there, up front, before you made the decision to as-it-were have the cable run into your house (which is outpatient surgery, but does kinda commit you for the duration). And y'know something? Sometimes it flopped around, but it was really irrelevant.

*Boring technical explanation which those bored by it years ago can skip: Peritoneal dialysis involves having a length of plastic tube implanted in one's abdomen, which runs through a tunnel made in your flesh through a sort of skin kiri-gami and ends outside. There's eight inches or so of external tubing ending in a valve, and a certain number ot times a day (depending on your exact mode of treatment, which varies) you run a bag of glucose solution into this valve, let it rest in your belly for a number of hours to suck crap from your bloodstream by osmosis (same way your kidneys would, if they were still working), and then drain and dump it. Some people use a machine that does automatic overnight bag swaps, but it's also possible to do it manually, requiring nothing but the bags and a couple of clamps for temporary flow control.

#102 ::: crazysoph ::: (view all by) ::: November 23, 2005, 04:08 AM:

Lizzy and Daniel and Vicki, OG, Marilee, and whoever else commented on exercise -

Thank you for the public service of debating this particular advice. I've encountered and struggled with the same advice, in connection with depression. Being that I'm not overweight (or, am so, but only in the minds of marketers, *g*), "care"-givers seemed too ready to berate me for my resistance to exercise. (A great accusation to have to dodge when already laid low by my own internal weather, but I digress.)

Having found my stride (finally!), I can count my blessings, particularly those circumstances which have been gifts and not products of my own efforts - among them I will count my healthy body; there's still too much blame placed on people who are simply handed a bad deal at the start.

I could try to take some credit for educating myself or encouraging myself to do those positively helpful things but... I'd rather try to figure out how to be helpful to others, rather than laying burdens on them for their situations which often aren't even tangental to my own experiences. I'll keep learning by reading you guys.

Speaking of tangental, this comment started out as a thank you to the community here, and ended... *wan grin*, well, I'll just end it now.

Crazy(and resisting the temptation to shout her fav exercise from the rooftops - that's what LJ is for, girlie-o!)Soph

#103 ::: Elise Matthesen ::: (view all by) ::: November 23, 2005, 04:08 AM:

Ah, those days of dialysis. Call me weird, but I thought that sitting there together, wearing our little masks, while you did an exchange was very domestic and romantic, in a sweetly geeky way.

(One wears a mask because in addition to being a social faux pas to breathe at an uncapped line, which necessarily exists at two points during the exchange, it's also a real bad idea medically.)

#104 ::: OG ::: (view all by) ::: November 23, 2005, 06:23 AM:

Daniel: Exactly. It took years for me to find physical activities I enjoyed, and then they were taken from me one by one. Weightlifting went by the wayside because of tendon problems, yoga ditto, and now I don't even have the lung capacity for short-form tai chi, much less swimming or other in-the-water exercises. The assumption that I'm fat because I sit in front of the television gorging on cheesy poofs is infuriating.

The irony? I'd probably have made more progress in regaining some lung function if I did like television more. Before the last really bad flu bug I caught took me back to zero and left me counting my progress in seconds instead of minutes, I would turn on the television and walk during the commercials. It was a good exertion/rest pace for me, but it eventually led to my associating exercise with brain rot.

What I can't get through to my current doc is that I'm not being stubborn or uncooperative about exercise. (I'll cheerfully admit to both when it comes to the anti-cholesterol drugs she wants to dope me up with. I'm taking enough pills already, thanks, and I'm less than convinced that the benefits are worth the side effects.) I just have to approach exercise as physical therapy and celebrate small advances. A week where I can increase my daily exercise from 30 seconds between rest breaks to 45 seconds between rest breaks is an amazing accomplishment. And the only thing that keeps me going at it is potential quality of life improvement, because I hate aerobic exercise with a passion approaching yours.

I know myself. I know my body. I firmly believe that all the things she's having anxiety attacks about will fall back into place if we can get my lung capacity back from the grave. Instead of working with me to get there, she's throwing pills at me, many of which are counterproductive to my goals.

#105 ::: Michelle K ::: (view all by) ::: November 23, 2005, 08:13 AM:

I'll second crazysoph on the effects of exercise and depression.

I don't feel good when I exercise, in fact, if it weren't for CD walkmen/mp3 players I probably couldn't bring myself to do it. But I find that over the long term exercise has helped control control my depression, and to some small degree, my OCD, and that is well worth all the getting up early.

And it doesn't have to be "strenuous" exercise. I mostly walk (fast) and that works for me just fine.

#106 ::: amysue ::: (view all by) ::: November 23, 2005, 08:44 AM:

I have tried all sorts of exercise and the biggest problem (aside from boredom with many forms) is physical limitations and concurrent pain. Walking is usually what works best, but I sort of hate it and sometimes just cannot physically do it for more than 20-30 minutes. Water exercise I can do for much longer. My most recent goal has simply been to do something for 20-30 minutes each day and build from there if I can.

Teresa: I agree with you and now just ignore folks who seem to think that my taking my insulin is poor manners. I was at a conference in Houston this past week and during a late night song session (oddly it seemed like filking for Jews which kind of scared me, but was infectious fun just the same), amoungst about 3000 people I suddenly realized my lantus was way over due. I drew it up and took it while others danced and sang around me and the guy behind me was horrified and left in a huff. This mostly amused me because it's not like I have some big honkin needle, pull down my pants and stick it in my(insert favorite term here) , it's a teeny, sub-Q injection of less than 30 units and I expose almost no skin when injecting (which takes moments).

Now, I will admit that I am bad about all sorts of things (besides diet) when it comes to diabetes. I reuse my lancets until they hurt and sometimes my needles, I never wipe with alchohol, and have been known to inject through clothing.

The thing about diabetes is it's a 24/7 thing and it never goes away. I can get better control, be healthier and am working toward that and making good strides but the bottom line is (as I think Jim said earlier in this thread) I am best friends with my test kit, syringes and insulins. With out them I will die. I've had this drummed into my head when going on a day trip and forgetting everything, not turning back, and being seriously compromised as a result. That was when I thought I could tip toe away and pretend that diabetes and I never met. Cancer was simpler-take a whole bunch of stuff out of me, burn me and voila! problem solved (well, mostly). Not so much with the problem solving is diabetes, so yeah, I agree that it isn't my problem if others are embarassed by it.

But enough babbling by me on this topic-we have a break in the rain/possible snow scenario and I think the young uns and I will take that walk before we start cooking the curried pumpkin soup for tomorrow's dinner. Happy Thanksgiving all.

#107 ::: jaimito ::: (view all by) ::: November 23, 2005, 11:10 AM:

More than two years in Europe. That's why the ARC doesn't love me any more.

Mad cow? or something we dont know?

#108 ::: Carol ::: (view all by) ::: November 23, 2005, 07:41 PM:

More than two years in Europe. That's why the ARC doesn't love me any more.

My hubby donated today, bringing his total donations to a gallon.

Very proud of him.

#109 ::: anon ::: (view all by) ::: November 24, 2005, 02:55 PM:

daniel and all those who wrote about exercise:

i used to hate exercise when i was a kid, teen and early-twentysomething. it felt just like daniel described. i spent an entire summer on sheer willpower teaching myself how to jog and made it to about 2 miles a day. hated every minute of it. it never got better, never felt good.

i also had congenital low blood pressure, diabetes and hypothyroid, all conditions/diseases that make you lethargic. it's amazing how long it took me to realize that maybe i hated exercise because it really really didn't work well with my body. happy-ish ending: exercise now feels good, probably because i got into worse shape and my blood pressure rose a bit.

to the guy who complained about my "rude" fake email address: i probably shouldn't have chosen a rude address, but i was annoyed that i couldn't post without an address. i personally think i should be able to post anonymously here, since i don't want people emailing me.

#110 ::: Lizzy L ::: (view all by) ::: November 26, 2005, 07:55 PM:

Anon said: i also had congenital low blood pressure, diabetes and hypothyroid, all conditions/diseases that make you lethargic. it's amazing how long it took me to realize that maybe i hated exercise because it really really didn't work well with my body. This post was most helpful to me because I have a dear relative with all these conditions who has never been able to exercise, and I never quite understood why. Now I do. Thank you. I am fortunate, through no particular effort of my own, to have found an exercise I like and to have been given a body that can do it. I try very hard to make no external or internal judgment on anyone else's situation and choices.

#111 ::: Stuart ::: (view all by) ::: November 26, 2005, 09:58 PM:

The amazing thing about this thread is the civil tone that everyone has maintained. I have participated in the Usenet diabetes support newsgroups and they are perpetually infested with trolls and much rudeness. Diabetics tend to have a great deal of emotional investment in their mode of treatment and there is a lot of harrasment of people with different ideas and experiences.

This is particularly ironic since the appear to be a large number of subvarieties of diabetes.

I'm a Type 2 who is not insulin resistant, who excercised a lot, and was only slightly overweight. My native American genes seem to influence my health out of proportion to the percentage they make up of my genome.

There are two attitudes I have found among diabetics that are particularly puzzling to me. The first are those who refuse to deal with their condition. They seem convinced that if they ignore it it will go away. It will, when they die. The second are those who are convinced that their doctor is infallible and if they do what he says and he says everything is fine then they will be alright. These people defend the ADA standard of care as the golden standard for diabetic treament rather than acknowledging that it is the bare minimum you can get by with.

Both of these points of view strike me as ways of whistling past the graveyard rather than dealing agressively with the problem.


Jim,

The reason I point out the lab test results that are precusors to developing diabetes is because with the current mode of diagnosis, half of all diabetics have suffered permanent damage before they are diagnosed. I am displeased to be among that half.

#112 ::: BDan ::: (view all by) ::: November 28, 2005, 12:10 PM:

I've been a Type I diabetic for 16 years, and over that time I've developed some perspective on a lot of these things.

On pumps: Before I got a pump four years ago, I was giving myself around six shots a day, and my blood glucose control was still not so good. In addition, I had had a series of hypoglycemic seizures (all while I was exhausted and asleep, and didn't notice the symptoms, except for the one that I woke up just in time to fall down for, but not soon enough for the glucose I ate to get into my bloodstream). Since I got it, my A1c readings have gone down, I haven't had a single seizure, and it's much more convenient than the shots. I highly recommend it. I normally just sleep with it in the bed next to me, but it also has a soft case and an elastic belt which is reasonably comfortable for sleeping, and very handy for exercising. I also find that it's not a problem to disconnect it for up to an hour, though I usually give myself a small bolus to make up for the basal insulin that I miss[1]. And as for sex, it honestly works fine to just let it sit on the bed then, too, although the elastic belt is another option.

On exercise: I'm one of those people who enjoy exercise, but I'll still note that the really brilliant thing about exercise and diabetes is that exercise increases the effect of insulin. And it doesn't take a lot -- I find that walking a couple of miles every day is enough to significantly improve my control.

On low blood sugar symptoms: One thing I've found that has a major effect is the rate of fall -- if my blood sugar is dropping rapidly I will notice symptoms even when it's within normal range, but if it's only going down slowly I might not notice until it hits 60 mg/dl. I personally generally use SweetTarts (tm) for treatment, since they're cheap, easy to carry, and mostly glucose.

[1] For those who don't know pumps, they deliver a steady stream of insulin, called the basal rate, which takes the place of long-acting insulin, and boluses are then entered for meals.

#113 ::: dichroic ::: (view all by) ::: November 30, 2005, 02:51 PM:

Thank you so, so much. My dad is diabetic, and so my husband and I were discussing diabetes the other day. I knew of most of the symptoms you mention, but not the mechanisms behind them, and it's very helpful to know how it works. (Also, I'll suggest the cake frosting idea to my mom.)

#115 ::: Spotting comment spam (most likely) ::: (view all by) ::: November 23, 2006, 08:39 AM:

#115 with the name given "Political sociology and social discrimination"

Followed by the line "Urban sociology - anti discrimination and social conflicts resolving web blog", which is a link to http://listline.org

#116 ::: David Goldfarb ::: (view all by) ::: December 18, 2006, 11:10 PM:

Seen originally via James Nicoll's LJ: an article about a breakthrough in understanding the causes of diabetes, that seems to hold strong potential for treatment, perhaps even cure.

#117 ::: abi is wondering if this is comment spam ::: (view all by) ::: January 22, 2007, 04:31 PM:

...or merely something truly disconnected from the topic at hand.

Warning - poster's website has banner ads that are VNSFW.

#119 ::: abi ::: (view all by) ::: January 22, 2007, 05:33 PM:

It's worse than that. It's dead, Jim.

#120 ::: naqheel ::: (view all by) ::: January 22, 2007, 11:45 PM:

Dear ladies & Gentlemen, experts,

This is to requesting all of you that my mother is 60 year old and she has daibetics and she has last her full of weight around 40kgs and at the movement her weight might be only 15 to 20 kgs.and she had also kidney stone problem but we had blasted twice through laser, and earlier she was normal weight person before sugar nil problem after it accures she got last weight and she is on bed since 7 years and she can not even stand up from the bed she is lay on bed only and her bathroom deeds will be on bed only. so could any one of you suggest us how could we get her weight up and can walk please. and usualy she suffers from Sugar nil problems and whenever it happends she should take immidiately couple of cups tea so that she would find her suger up. so please i want my mother get well that is how could be possible by the grace of god please.????
and i want to know what should she eat and not to eat suggestion needs.
i would appreciate if you could help us pls.
Thanks for all of you and appreciates your kind advise in advance

have a good day with good health

bye.

naqheel
naqheel@yahoo.com

#121 ::: Tania is not sure if this is spam - opinon please? ::: (view all by) ::: January 23, 2007, 12:10 AM:

Makes my BS sensors go 'whoop whoop whoop' - any thoughts?

#122 ::: kate ::: (view all by) ::: January 23, 2007, 02:31 AM:

I'm pretty sure that's not spam-- for one thing, there's no URLs.

Naqheel-- It really sounds as if it would do your mother a world of good to see a doctor who's a specialist in diabetes. (If, that is, you have the insurance and/or money.) I know it's difficult if she's bed-bound, but there's more going on with her than I feel I can make an informed comment on.

#123 ::: TNH hopes someone with more expertise will take a look at Naqheel's message ::: (view all by) ::: January 23, 2007, 02:39 AM:

Naqheel, you and your mother have my full sympathy. Let me see whether someone who knows more than I do can help you.

#124 ::: James D. Macdonald ::: (view all by) ::: January 23, 2007, 04:27 PM:

Naqheel is posting from India.

I can't diagnose or prescribe, nor would I even attempt to do so over the net if I could.

Naqheel, your mother needs to be seen by a physician. There is nothing more that I can recommend.

My prayers are with you, and with her.

#125 ::: James D. Macdonald ::: (view all by) ::: July 20, 2007, 11:47 AM:

In other news:

WILLIAMS, Ariz. -- A 65-year-old St. Louis man who Amtrak personnel kicked off a train in the middle of a national forest in Williams has been found dehydrated and disoriented two miles from where he was dropped off.

Amtrak officials said train workers followed policy when they put off the train a man they thought was drunk, but the man's family says he was in diabetic shock at the time.

Police said Roosevelt Sims, a factory worker who had just retired last week, was discovered Thursday night walking along the railroad tracks barefoot by Coconino County sheriff's deputies.

Deputies said he was dehydrated and disoriented.

He was rushed to a Flagstaff hospital for emergency treatment, deputies said.

Sims headed to Los Angeles but was asked to leave the train shortly before 10 p.m. Sunday at a railroad crossing five miles outside Williams.

#126 ::: P J Evans ::: (view all by) ::: July 20, 2007, 11:57 AM:

Jim

I certainly hope it results in a change in Amtrak's policy. There is no reason for kicking someone off a train when they have a ticket through, and presumably a seat/compartment to go to. There is absolutely no reason to do it anyplace other than at a station. What would they have said if he'd been found dead?

#127 ::: Xopher ::: (view all by) ::: July 20, 2007, 12:35 PM:

P J 126: Probably that he insisted on leaving the train against their advice.

#128 ::: Leslie in CA ::: (view all by) ::: September 14, 2007, 05:14 PM:

Thanks for this, Jim. My mother had Type II, one of my brothers also has Type II, and my BG's in the danger zone, so I really need to take this seriously.

#129 ::: Mark sees overdone spam ::: (view all by) ::: October 31, 2009, 08:45 AM:

But I'm not getting all exercised about it.

#130 ::: Serge sees SPAM ::: (view all by) ::: January 21, 2011, 01:55 PM:

Esatmos buscando pension la pepa.

#132 ::: Serge ::: (view all by) ::: January 21, 2011, 01:55 PM:

estamos

#133 ::: Juli Thompson sees spam ::: (view all by) ::: February 10, 2011, 10:34 PM:

Or at best, I don't get it

Welcome to Making Light's comment section. The moderators are Avram Grumer, Teresa & Patrick Nielsen Hayden, and Abi Sutherland. Abi is the moderator most frequently onsite. She's also the kindest. Teresa is the theoretician. Are you feeling lucky?

Comments containing more than seven URLs will be held for approval. If you want to comment on a thread that's been closed, please post to the most recent "Open Thread" discussion.

You can subscribe (via RSS) to this particular comment thread. (If this option is baffling, here's a quick introduction.)

Post a comment.
(Real e-mail addresses and URLs only, please.)

HTML Tags:
<strong>Strong</strong> = Strong
<em>Emphasized</em> = Emphasized
<a href="http://www.url.com">Linked text</a> = Linked text

Spelling reference:
Tolkien. Minuscule. Gandhi. Millennium. Delany. Embarrassment. Publishers Weekly. Occurrence. Asimov. Weird. Connoisseur. Accommodate. Hierarchy. Deity. Etiquette. Pharaoh. Teresa. Its. Macdonald. Nielsen Hayden. It's. Fluorosphere. Barack. More here.















(You must preview before posting.)

Dire legal notice
Making Light copyright 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016 by Patrick & Teresa Nielsen Hayden. All rights reserved.