Friday, November 23, 2012

Creating Order out of Chaos


In order to get a handle on Diabetes and potential complications; you have to read and learn. A lot!

I've pulled together a lot of useful information here. Hope it helps.  

Discovered the National Diabetes Information Clearing House at:
http://www.diabetes.niddk.nih.gov. This site contains a wealth of information.  There are so many great sites packed with great information such as:  http://www.diabetes.org/  and http://www.diabetesdaily.com.  There are a ton-o-sites out there and so I spent the last couple of days reading.

A summary of the disease (Type 2):
Type-2 diabetes is a lifelong illness, which generally starts in middle age or later part of life, but can start at any age. It has a different cause than Type-1: patients with type-2 diabetes do not respond properly to insulin, the hormone that normally allows the body to convert blood glucose into energy or store it in cells to be used later. The problem in type-2 diabetes is not lack of insulin production; most of these patients produce variable, even normal or high, amounts of insulin.

The first stage in type-2 diabetes is the condition called insulin resistance. Insulin helps glucose to enter cells, where it is used for energy. In patients with insulin resistance, although insulin can attach normally to receptors on liver and muscle cells, certain mechanisms prevent insulin from moving glucose into these cells where it is utilized. As a result body starts making more and more insulin and in the beginning, this amount is usually sufficient to overcome such resistance, but during the later phases of the disease the insulin resistance increases in severity and, blood glucose increases, but at the same time the body is unable to use it properly, and the body’s cells are actually starving for energy. Even with increased amounts of insulin the insulin demands of the body is not met because of the increasing tissue resistance. Because the body does not use insulin properly, blood glucose rises above the safe level. The initial effect at this stage may be an abnormal rise in blood glucose right after a meal (called postprandial hyperglycemia). Type-2 diabetes differs from type-1 diabetes in that type-1 diabetes is always caused by the body's inability to make enough insulin.

Type 2 diabetes is the most common form of diabetes, accounting for 90 - 95% of cases. Eventually, the cycle of elevated glucose further damages beta cells, thereby drastically reducing insulin production and causing full-blown diabetes. This is made evident by fasting hyperglycemia, in which elevated glucose levels are present most of the time.
 
Some Facts:
·       13% of adults have type2 diabetes.  About 25-27 million people in the U.S. have type 2 diabetes. 13 million of those are men. Another 30% have pre-diabetes.
·       Even though millions of Americans have type-2 diabetes, only half of these people are aware that they have diabetes.
·       The death rate in patients with diabetes may be up to 11 times higher than in persons without the disease.
·      The occurrence of diabetes in persons 45 to 64 years of age is 7 percent, but the proportion increases significantly in persons 65 years of age or older.
·        People with diabetes are 2x times more likely to develop serious gum disease.
·      Research has shown that diabetic patients have a shorter life expectancy than non-diabetic individuals and that this excess mortality is largely attributable to cardiovascular causes.
·      Diabetes is known to double the risk of heart attacks and strokes, but the new findings show people with type 2 diabetes are also at greater risk of dying from cancer, infection and mental disorders.
·     Even after accounting for other risk factors such as age, sex, obesity and smoking, the researchers found people with diabetes were at increased risk of death from several common cancers, infections, mental disorders, and liver, digestive, kidney and lung diseases.
·       About 60 per cent of the reduced life expectancy in people with diabetes is attributable to blood vessel diseases – such as heart attacks and strokes. Only a small part of these associations are explained by obesity, blood pressure, or high levels of fat in the blood – conditions which often co-exist with diabetes.
·         Diabetes can cause feelings of isolation. Managing diabetes can cause mounting stresses that sometimes lead to poor self-care and feelings of loss of control. Depression can make it difficult to think; interfering with medication compliance and exercise goals necessary to keep diabetes under control. Diabetes doubles the risk for depression. Depression, in turn, may increase the risk for hyperglycemia and complications of diabetes.

Symptoms I was able to find:
·         Increased thirst
·         Increased hunger (especially after eating)
·         Dry mouth
·         Nausea and occasionally vomiting
·         Frequent urination
·         Extreme unexplained fatigue (weak, tired feeling)
·         Blurred vision
·         Itching of the groin
·         Irritability
·         Numbness or tingling of the hands or feet
·         Wounds that don't heal
·         Frequent infections of the skin, gums or urinary tract

Complications I was able to find:
·   Alzheimer's disease
·   Dehydration
·   Diabetic Ketoacidosis
·   Diminished ability to fight infection
·   Eye damage
·   Foot damage
·   Hearing problems
·   Heart and blood vessel disease
·   Hyperglycemia
·   Hyperosmolar nonketotic diabetic coma
·   Hypoglycemia
·   Kidney damage (nephropathy)
·   Nerve damage (neuropathy)
·   Osteoporosis
·   Poor sleep
·   Skin and mouth conditions
 
What can I do to manage the disease? 
(Note, I’m not a doctor so this stuff is just what I’ve found by reading. Any thresholds listed are for me. You'll need to set your own if these are not applicable to you. )
Alzheimer's disease
o   Control blood Glucose levels
Dehydration
o   Drink 8-10 cups of water every day. This also helps flush out the Glucose.
Diabetic Ketoacidosis
o  
Diminished Ability to Fight Infection
o   Continued and consistent use of multi-vitamins
o   Medications as prescribed by doctor
o   Flu shot annually
o   Pneumonia shot annually
Eye Damage
o   The American Diabetes Association recommends that patients with type 2 diabetes get an initial comprehensive eye exam by an ophthalmologist or optometrist shortly after they are diagnosed with diabetes, and once a year thereafter. The eye exam should include dilation to check for signs of retinal disease (retinopathy).
Foot Damage
o   Thoroughly inspect your feet daily
o   Patients should inspect their feet daily and watch for changes in color or texture, odor, and firm or hardened areas, which may indicate infection and potential ulcers.
o   When washing the feet, the water should be warm (not hot) and the feet and areas between the toes should be thoroughly dried afterward. Check water temperature with the hand or a thermometer before stepping in.
o   Apply moisturizers, but NOT between the toes.
o   Gently use pumice to remove corns and calluses (patients should not use medicated pads or try to shave the corns or calluses themselves).
o   Trim toenails short and file the edges to avoid cutting adjacent toes.
o   Well-fitting footwear is very important.
o   People should be sure the shoe is wide enough. Patients should also avoid high heels, sandals, thongs, and going barefoot. Shoes with a rocker sole reduce pressure under the heel and front of the foot and may be particularly helpful. Custom-molded boots increase the surface area over which foot pressure is distributed. This reduces stress on the ulcers and allows them to heal.
o   Change shoes often during the day.
o   Wear socks, particularly with extra padding (which can be specially purchased).
o   Patients should avoid tight stockings or any clothing that constricts the legs and feet.
o   Consult a specialist in foot care for any problems.
Hearing problems
o   Complete and annual hearing test.
Heart and blood vessels and Nerve Damage(neuropathy)
o   Reduction in weight if necessary and maintenance of doctor prescribed weight
o   Reduce/Manage blood glucose levels
o   Protect the heart and aim for healthy lipid (cholesterol and triglyceride) levels and control of blood pressure.
o   Control blood Glucose levels using exercise, diet, medication, regular testing and countermeasures.
§  Test prior to taking a bite at any meal - Fasting levels 70-130
§  Test 1 hour post-meal and eliminate anything from your diet that causes levels higher than 140.
§  Test 2 hours post-meal and eliminate anything from your diet that causes levels high than 120.
§  Test prior to bedtime and supplement with food if blood glucose level below  .
o   Test HbA1C every three months 
o   Control high blood pressure through exercise, diet, and medication
o   Take an aspirin daily. 
o   Get regular medical checkups (every six months).
Hyperglycemia
o   Control blood Glucose levels using exercise, diet, medication, regular testing and countermeasures.
§  Test prior to taking a bite at any meal - Fasting levels 70-130
§  Test 1 hour post-meal and eliminate anything from your diet that causes levels higher than 140.
§  Test 2 hours post-meal and eliminate anything from your diet that causes levels high than 120.
§  Test prior to bedtime and supplement with food if blood glucose level below  .
o   Test HbA1C every three months
Hypoglycemia
o   Control blood Glucose levels using exercise, diet, medication, regular testing and countermeasures.
§  Test prior to taking a bite at any meal - Fasting levels 70-130
§  Test 1 hour post-meal and eliminate anything from your diet that causes levels higher than 140.
§  Test 2 hours post-meal and eliminate anything from your diet that causes levels high than 120.
§  Test prior to bedtime and supplement with food if blood glucose level below  .
o   Test HbA1C every three months 
Kidney Damage (nephropathy)
o   Drink 8-10 glasses of water per day. This helps flush the system of glucose.
o   The American Diabetes Association recommends that people with diabetes receive an annual microalbuminuria urine test.
o   Patients should also have their blood creatinine tested at least once a year.
Osteoporosis
o  
Poor Sleep
o  
Skin and Mouth Conditions
o   Treatment with doctor prescribed skin lotions
o   Brush teeth in the morning and before bed with a toothpaste specifically formulated for gum health.
o   Bath in a barely warm, not hot bath with about 2 cups (500 ml) of baking soda or some Epsom salts added.
 
Can only hope this might help someone out there who needs the information.

Monday, November 19, 2012

Inescapable Diabetic Weakness and Tiredness


    This morning, I awoke and felt like maybe I should not have. I was extremely tired, weak and achy. I was more tired than I can ever remember being. I had a full night’s sleep and yet my body ached, my brain reeled with depression over this event and I just felt like I never felt before. I was tired in ways I could not have conceived months before this.

    I did an Internet search to look for “tiredness Diabetes” and got a lot of material to read. I read a number of interesting articles, watched some videos and thought about what I’m going to do when I can no longer work due to this disease. My job would be considered as a high stress job. If I am so tired and weak that I can’t think straight, then I’m not going to be effective or successful at my job.  So what options do I have? What are the right options for me? 

 Decided to do two things:
1)      Consult an attorney to determine what options I have to have myself declared “disabled”. That would allow me to get benefits which I’ve been paying into my entire life. I’m not sure what’s possible and will blog about this as things develop.

2)      Consult my doctor. I took three Ibuprofen tablets and felt somewhat better for about two hours. I know I can’t keep doing that every couple of hours for the rest of my life!  I’ll explore what the doctor has to offer and then blog about it as things develop.

If there is anyone out there with some advice about how to deal with this, I’d appreciate hearing from you. Just comment on this post. I’m pretty depressed about this because if I understand what is going on in my body, it can’t get energy out of the food I eat and so I feel tired because it is pulling energy from my muscles and fat stores. So… I almost wish I was fatter!? What happens when I run out of the accumulated energy in my body?  What does the body do then?  My head hurts.

Sunday, November 11, 2012

90 Days with Diabetes


For as long I can remember, I’ve always weighed about two-hundred and fifty pounds and stood six foot two inches tall. My weight has never fluctuated much over the years and I've always eaten fresh food and good food. Annual medical checkups were obligatory and completed without much fanfare or issue. That is until this year…

My annual checkup was pretty much standard fare. They weighed me, hit my knees with a rubber mallet, and so on and so forth. However, this time, near the end, the doctor said “I just want you to know you’re pre-diabetic.”  He said it very mater-of-factly and like it was no big deal. I smiled and said “Okay, thanks for letting me know,” and he didn’t pursue it any further. That was that and the conversation ended. I left with advice that my cholesterol was within normal ranges, my high blood pressure was under control and I was pre-diabetic. As I was leaving, I remember telling myself that I could just cut out on eating the sweets that I treated myself too once in awhile and that should be fine.  Those were really the only sugars I ate.   

True to my word. I did indeed cut out the sweets. I stopped buying any type of pastry, pies, cakes or doughnuts at all. I never really had a sweet tooth and so these little extra indulgences were easy to eliminate. I didn’t really need em’ anyway and never had them that often anyway. I never drank anything but diet soft drinks, never used sugar in my coffee and never chewed anything but sugarless gum.

Looking back; what I didn’t understand, was that the term “pre-diabetic” MEANS something specific within the medical community. It means that you have passed a threshold as far as the glucose in your blood. It means specifically that the glucose level has risen above a pre-defined threshold. The ability of your body to get energy from sugar and deal with glucose in your blood is getting more difficult.  I also understood nearly nothing about "carbs."
 
In addition to my annual medical assessment, I always schedule an annual Optometric visit. A few weeks after my annual medical checkup it was time for the eye examination. This year my “eye doctor” had a new gizmo. It is a device which takes a picture of your inner eye. I thought it was pretty cool and completed the test becasue she said it would help her in her diagnosis. It was an easy test to complete, and did help her, but it really helped me because as an outcome of that test my Optometrist discovered a medical condition and advised me to consult my doctor.
 
A week later, I was again sitting in my doctor’s office… The doctor checked me over, and I took a blood test. Several days later, she shared the results which were that that my H1AC number was above a 7 which means that I was now officially “a diabetic” with Type2.   I was shocked. Just a month earlier the doctor told me I was pre-diabetic and now even though I had cut out sweets, I was a Diabetic!  I was also completely concerned because my Grandmother died from Diabetes. My doctor advised me that she was placing me on a medication called Metformin. I asked if I could just start a diet of some type or eat differently and not take the pill but she said it was important now that I start taking the medication.

That was ninety days ago, in August of 2012, and that was the start of my type 2 diabetes journey. Looking back, I can see now that the symptoms I’d been reporting to my doctor (legs pains and weakness) were actually symptoms that were probably caused by pre-diabetes and yet not one of the doctors I’d seen for the last ten years ever said anything about Diabetes at all.

Having Diabetes means that your cells can no longer effectively use sugar for energy and so your body starts pulling energy from fat stores and muscles. This makes you incredibly tierd and achy all the time. The body must remove the extra sugar (Glucose) in your blood through much more urination. That water loss dries your skin till you itch quite a lot and lastly it also dehydrates you so that your very thirsty.
 
The Kübler-Ross model, commonly known as The Five Stages of Grief, includes denial, anger, bargaining, depression, and acceptance. I never went through any Denial, Anger or Bargaining stages with my Diabetes diagnosis and so I have to alter this model for me. My stages are: Fear, Learning, Commitment, Depression, and Acceptance.  

The Fear stage was that my Grandmother died from Diabetes complications. I never knew the details of what exactly caused her death because I was a kid at the time. My mother told me “It runs in the family;” and now it had me. This causes me great concern.

Learning - Initially I didn’t know anything about Diabetes, and I'm still learning. However, as soon as I had my diagnosis, I started reading everything I could get my hands on related to the disease, its causes, what foods to eat, and not to eat, and so on. I spent eight days away from the office and thinking and reading about this disease. During that time, I designed a diabetic friendly diet for myself which was also healthy for my heart and that would cause me to lose weight.  I’d be happy to send the diet to anyone sending an email request to infinityman@cox.net. I subscribed to a Diabetic Living magazine, bought and read electronic versions of books related to the topic, subscribed to a number of Diabetes related web sites and tried my best to come up to speed with information. I get regular email updates and newsletters. Who knows, they might find a cure!

Commitment – One of the things I had asked my doctor during the meeting where she told me I was Diabetic was if I would need to take insulin or test my blood or anything like that. She advised that I would not need to do any of those things for now except change my diet, take the Metformin, lose weight, &c.  However, being in the Information Technology field I know; the only way to make critical decisions with quality is to have quality data available. The only way to get data about the glucose levels in my blood is to test. So I immediately spent a week or so researching the best testing devices on the market, how to test with accuracy; and then ordered the device, the strips and the lancet device. I learned that it is normal for blood glucose levels to be between 70-130 prior to a meal and two hours after the meal to be as high at 180. It also seems that anything above 144 is considered as “high”.   These are the parameters I am working with and doing everything I can to clearly understand what foods tend to take my glucose levels outside of these thresholds.

Depression – Initially, I really felt like I could beat Diabetes. I could put the disease into remission by doing the right things consistently. What I learned in my reading what that this is not reality. Instead, I learned that my diabetes was coming on for about 10 years. That most people diagnosed as pre-diabetic can only stave off becoming fully diabetic for an average of 2 years. The bottom line is that your body is having a more and more difficult time getting energy from food and effectively dealing with glucose in your blood. This will get progressively worse over time and will be a contributing factor in your death unless a cure is found. This fact must be faced head on and dealt with. It can be a source for depression, but you have to beat that back and accept the disease for what it is.

Acceptance – When all is said and done, one must accept and deal with the fact that you have a disease; through no fault of your own. This is not something you planned and not something you can turn back. It is here, it is real and it has to be managed effectively. Diabetics must:

1)     Watch everything they eat. They must count carbs, watch the nutrition labels and serving sizes and substitute good food items for bad food items. If you screw this up, you stand a good chance of having your feet amputated or other really nasty things (i.e. like eyesight problems, kidney failure) to deal with. It’s not a nice-to-have or something you can follow half-heatedly; but rather a complete necessity for your life and wellbeing. You have to lose weight and get your weight to a level prescribed by the medical professional your working with.  

2)     Watch their hands and feet. Many diabetics experience degrees of neuropathy. This is the tingling and loss of sensation in your hands and feet. Cuts and abrasions and wounds no longer heal as quickly and you don’t even feel them sometimes. There is a huge risk of infection. You must inspect and protect your feet and effectively deal with any wounds. You need to pay attention to this daily and get to the doctor to discuss if there is a wound that is not looking right or healing properly.

3)     Test our blood and record the results. I have two Apps on my smartphone. Each links to a web site so there’s a backup in case anything happens to my phone.

a.     I use the first to record everything I eat. It has a bar scanner and I can scan anything to get exact portions and nutritional information. It tells me how many carbs, calories, fat and other nutritional elements. This way, I can see a clear correlation between what I put in my mouth and my weight and my blood glucose levels.  

b.     The second is an app used to record glucose levels. I test just before meals and two hours after. I test up to six times a day. Sometimes less and sometimes more. I use this data to maintain a spreadsheet of my blood glucose levels; which is useful for discussions with my doctor and for my own understanding of the disease and how it might be progressing. It will get worse over time, so something I eat today that my body can deal with, might not impact my body in the same way in the future. One has to test and record the results in order to be empowered with enough information to make the right decisions.

Ninety days after diagnoses and I now weigh two-hundred and thirty pounds. My goal is 200 which I’ll most likely reach mid-year 2013. Right now, I consume 1500 or fewer calories per day. I’ll keep that up until I reach my goal weight and will then gradually increase the number of calories until I achieve stasis – (I don’t gain or lose weight). There is so much to learn and I'll blog more as I learn and experience more over time.

If you’d like to contact me to discuss or for additional information, send email to infinityman@cox.net.