Friday, November 14, 2008

Poll: Young people and coping with diabetes

Today I saw this article in the top headlines on Google:

Poll finds that yng diabetes patients have trouble coping

The article is about children and teens with type 1 diabetes, and how well they cope with their condition. Essentially, the poll found that half of young diabetics have "difficulty coping with diabetes," and many suffer from depression as a result.

Interestingly, a common complaint was that teachers and school faculty are not well educated on diabetes, let alone prepared for dealing with diabetic students. Since I have postulated before society's lack of education on diabetes has lead to many misunderstandings about diabetes, I am pretty sure I would agree if I had a diabetic child in school (or if I had become diabetic while I was still in school).

The article also advocates websites, blogs, and discussion boards as support for diabetic children and their parents — as long as they are legitimate resources, which the article defines as those being "monitored by health care professionals." However, I would also go a step further, to say that blogs and websites written by type 1 diabetics who are fairly positive about their diabetes should also be considered legitimate resources. Obviously someone like myself can't give professional medical advice, but I do think that our experiences with diabetes can be helpful to others and should be shared.

The biggest and most important thing that I think I could say to help other young type 1 diabetics cope is: Be proud of who you are. Having type 1 diabetes sets you apart from others, but it's not a difference to be ashamed of. In my opinion, it's a difference that will always encourage you to lead healthier, happier lives than your non-diabetic peers. And when you look at it that way, there's not really that much to be depressed about!

Wednesday, November 5, 2008

A president who will take care of health care

Of course by now you have probably already heard the news: Barack Obama won the election, becoming the nation's first African American president!

Of course, I'm excited for reasons other than his race or the election's historic significance (though those are great reasons to be excited). I'm excited also because diabetics and others with pre-existing conditions can now hope for equal access to quality health care.

Three cheers for Obama!

Monday, November 3, 2008

McCain's health care reform is not reform at all

The other day, this article ran in the Washington Post:

How They Would Change Health Care: McCain

This is an excellent, informative, and well-researched article that demonstrates the shortcomings of McCain's health care reform — the biggest problem being that it's not really reform at all.

The article talks about how McCain has acknowledged that his plan does absolutely nothing for people like us — diabetics and others with pre-existing conditions. His answer? State health care programs should provide care for them.

The article then goes on to show why this is not a good idea. First of all, these state health care programs — set up specifically to insure those the free-market insurance companies won't take — are losing money hand over fist. Turns out it's really expensive to insure just the people who require a lot of prescriptions and doctor's visits. But rather than requiring insurance companies to absorb them into the general population, which they make enough money off of to cover the costs of the "uninsurable" several times over, McCain wants the state governments to continue taking care of it.

Aren't Republicans supposed to be fiscally conservative??!

The article also points out that these programs are not working. They cost so much to maintain that some states are unable to take on any more members:

California's high-risk pool is so strapped that it put a limit on enrollment this year and lowered the maximum it would spend on anyone's treatment. Tennessee's pool has had to eliminate low-income subsidies for new members. Florida's pool has not let in anyone since 1991.

If these programs are already not making it, how are they supposed to be responsible for all of the nation's uninsurable?

Finally, the article points out how dissatisfied people are with these programs. They are expensive and they don't necessarily provide the same quality of health care as people with group plans or individual plans. Isn't the idea of health care reform to fix flaws like this in the system?

In contrast, Obama's health care reform is real reform. He would ensure that everyone had access to decent health care by making it harder (and more distasteful) for employers to skimp on health care, as well as by creating a fall-back plan for those who couldn't get health insurance from their employers.

Obama said in one of the debates that he believed access to health care was a right, not just a responsibility. I think we need someone in office with that attitude, which is why I am voting for change this election — and I hope you will too!

Wednesday, October 22, 2008

High prescription costs pose a threat to diabetics

Last night I noticed this article, which talks about how many people are cutting back on prescription drugs, thanks to money being tighter these days.

This kind of thing is horrifically dangerous to diabetics, and ought to demonstrate why our current health care system is not working. Diabetics who skip insulin can end up in the hospital, as one doctor's patient had in the article. At the very least they'll make themselves miserable (thirsty and having to pee all the time, blurry vision, muscle cramps, etc.), but more significantly they will also set themselves up for health problems over time, particularly if they continue cutting back.

I believe diabetics have a right to expect that they will never have to go without insulin. Insulin is literally our elixir of life — without it, we're as good as dead. I just don't believe we ought to be giving insurance companies, drug companies, and the economy that kind of power over people!

Tuesday, October 21, 2008

Misrepresenting diabetes in Panic Room

I watched Jodie Foster's Panic Room tonight for the first time in several years. Although I love that movie, it annoys me to see diabetes portrayed so inaccurately in the media.

Here are some of the things that bug me:

1) Sarah's insulin dose would not have been set so that her blood sugars dropped overnight. Notice how quickly she goes down during the course of the movie? Well, the body uses insulin even more efficiently while you're sleeping, which means that she would have crashed even faster had she been left in bed. And no doctor (or parent!) is going to set a child's insulin dose that high.

2) When you are stressed, your blood sugar goes up, not down. Remember when Foster tells her daughter not to get herself worked up, because "you know what happens" when she does that? Well, in actuality stress would make her go high, rather than low — but I guess high blood sugar isn't as immediately dangerous (and therefore not as dramatic).

3) The glucose monitoring "watch" didn't work very well, and therefore never came into widespread use. I guess it would make sense that her daddy (who, remember, they said was in pharmaceuticals) could pull some strings and get her one, but why bother when it doesn't work?

I guess though that I also have to give the movie credit for the things it did get right. For example, seizures are a symptom of severe or extended hypoglycemia. Also, I liked the way they made Forest Whitaker's voice sound when he was talking to her — the hollow, almost distant-sounding echo hinted at how surreal it feels to crash.

Like I said, I really like Panic Room, but I think it's important to educate people properly on diabetes and point out where the movie is inaccurate!

Wednesday, October 15, 2008

Another presidential debate on health care reform

Tonight was the third and final presidential debate between Senators Obama and McCain before the election on November 4. As in the second presidential debate, health care reform was a hot-button topic.

Here is a quick rundown of the presidential candidates' plans for health care reform.

Obama's plan:

* Puts an emphasis on enabling research to find cures for diseases such as diabetes and heart disease, and stresses the importance of preventative care to lesson the cost of these preventable diseases (i.e. type 2 diabetes) over the long term.

* Attempts to both control health care costs and extend coverage to the uninsured. If you already have health care, you don't have to change anything, but if you don't have it or can't get on with an employer-sponsored plan, you can buy into the same group plan offered to Federal employees.

* Requires large businesses to either offer their employees health insurance, or pay a "fine" to help fund coverage (i.e. the Federal group plan) for their share of the uninsured. (Small businesses are exempt from this requirement.)

* Makes sure people with pre-existing conditions, such as diabetes, will be able to get health insurance. I am a bit fuzzy on this one, but I believe that he is talking about requiring that the Federal group plan cover people with pre-existing conditions, not that all insurance companies cover people with pre-existing conditions. Either way, it means I can always get health insurance, so I'm happy.

McCain's plan:

* Encourages people to buy their own health insurance by offering them a tax credit of $5,000 for a family or $2,500 for an individual.

* Enables people to buy health insurance across state lines — or, more accurately, encourages insurance companies to set up shop in the states that offer the least restrictions (not necessarily good for us, the people buying the insurance, though it sounds great for the insurance companies).

* Counts employer-sponsored health insurance plans as income, adding as much as $12,000 to your yearly income, and thereby raising your taxes.

One of the criticisms of McCain's plan for health care reform is that it will actually encourage employers to stop offering health insurance as a benefit. Another criticism is that only the young and healthy can actually find health insurance for only $2,500 a year — the rest of us will pay considerably more, if we can find it at all.

Obama's health care plan offers true reform for people like me, who have pre-existing conditions that make finding health insurance difficult, if not impossible. McCain's plan, on the other hand, doesn't reform the industry itself — it just shifts the responsibility of procuring health insurance onto the individual and away from employers.

My argument is that the free-market system is already clearly not working for the health care industry, as insurance companies are putting profit over people's health to such an extreme that both the cost of health care and the numbers of uninsured are steadily rising. So why would we think that giving them even fewer restrictions (i.e. McCain's plan) sounds like a good idea?

Since I am a type 1 diabetic, and health care is a major factor in my life, is it any wonder that I will be voting for the candidate who will do the most to help me and those like me?

Tuesday, October 7, 2008

Health care reform: Obama vs. McCain

The question of health care reform came up during the presidential debate tonight. Since it is something that affects diabetics, I wanted to mention it on my blog.

When asked about his health care plan, Senator Barack Obama, the Democratic presidential candidate, described a plan where people can keep their own employer-sponsored health insurance — but those who aren't currently covered can get the same insurance provided for Federal employees.

Referring to the government-sponsored health insurance, Obama stated, "No one will be excluded for pre-existing conditions, which is a huge problem."

He ain't kidding. If I didn't have health insurance through my husband's employer-sponsored group plan, as a diabetic and a self-employed person I wouldn't be able to get health insurance.

Here, let me say that again, in case you missed it: As a type 1 diabetic, I cannot go out and buy an individual health insurance plan. The only time I can get health insurance is when the insurance company is literally roped into providing it, i.e., via an employer-sponsored group plan. That's because health insurance companies care more about making a profit than taking care of our health.

Because of my own situation, health care reform is one of the political issues I feel the most strongly about. It's not right that diabetics and others with pre-existing conditions can be discriminated against by a bunch of greedy multi-billion dollar companies. Aside from my liberal leanings, this is the biggest reason why I am voting for Obama.

And McCain's plans for health insurance reform? Well, let's just say it's not much of a reform. Sure, he'll give us each $5,000 a year in tax credits and encourage us to go out and buy our own health insurance, but he's not doing anything to ensure that people like me — people with diabetes and other pre-existing conditions — can actually buy health insurance.

In fact, McCain's plan would enable us to cross state lines to buy health insurance. As Obama pointed out, if that happens health insurance companies will all flock to the states with the fewest regulations... making it even harder for people with pre-existing conditions to find coverage.

So not only would I be no better off under McCain's plan, I could actually potentially be worse off.

This is why I am voting for Obama, and why I think you should too. Think about it: I was diagnosed as diabetic at age 22, with no history of it in my family before.

It could happen to you, too. And if it does, wouldn't you rather your health be seen as something that should be taken care of, rather than a liability?

An appointment with my endocrinologist

I recently had an appointment with my endocrinologist at the Barbara Davis Center. Here are, roughly, the results of my appointment:

1. My A1c dropped a little, to 7.1. It's still not as good as I'd like it, but it's significantly better than it was over the summer: In June it was 7.4, and in July, just before I started the study on continuous glucose monitors, it was 7.5.

2. My health insurance company has still not responded to our appeal. About a month and a half ago, my doctor's office sent an appeal to try to get my insurance company to cover the sensors for my CGM. (I got to keep one at the end of the study; more on that later.) They apparently are taking the approach of ignoring me and thereby stalling my efforts to get them to pay for something.

I'll blog about my experiences with the CGMs soon. For now, suffice it to say that if it's this hard for a diabetic to get a potentially life-saving device covered by insurance, than YES, we need some serious health insurance reform!

Monday, September 29, 2008

Another study on continuous glucose monitors

Now that I'm convinced my insurance company should be covering the sensors for a continuous glucose monitor, I'm paying close attention to all the studies that find CGMs are beneficial in some way (and therefore worth the money the insurance company pays to avoid the cost of health complications).

This article reports a study's findings that CGMs reduce the risks of expensive and potentially dangerous complications in diabetic pregnant women. Pregnancies are challenging for diabetics because it is so important for the woman to keep her sugars under super-tight control; high sugars mean bigger babies, and bigger babies mean a higher likelihood of C-section. There are also other complications as a result of poor control during pregnancy, such as babies born with insulin resistance, or babies having hypoglycemic episodes immediately after birth.

Since hubby and I have talked about trying to get pregnant soon, this study's findings are of particular interest to me. I hope I can convince my insurance company to cover the sensors at least before we start trying and while I am pregnant.

Tuesday, September 9, 2008

A study's findings on continuous glucose monitors

I just saw this article last night:

Continuous monitoring devices help adults control diabetes

The article is about a study on continuous glucose monitors, which found that using a CGM helps type 1 diabetics to control their sugar levels better.

Well, duh.

This article reminded me that I need to update my blog on my own experiences with continuous glucose monitors. In the last half of July, I participated in a comparison of two different CGMs at my doctor's office. Basically, I wore both for two weeks, and participated in 3 in-clinic days where my sugars were tested against the readings on both CGMs every 15 minutes — to test the accuracy of each, of course.

I definitely agree with this article — that wearing a CGM helps you maintain tighter control. In fact, my doctor's office and I are currently trying to convince my insurance company of that, too, so perhaps these recent findings will help!

Wednesday, August 27, 2008

Reprogramming cells may offer hope for type 1 diabetics

Just today I saw a headline with some potentially wonderful news for type 1 diabetics: Scientists have learned how to reprogram adult cells.

In the study, scientists actually successfully reprogrammed pancreatic cells in mice, changing regular cells into insulin-producing cells. This is wonderful news for several reasons:

1) It circumvents the stem cell controversy, because it uses existing adult cells
2) It means the potential for a cure for type 1 diabetes that does not involve a transplant
3) It could also mean cures for other diseases

This is a recent discovery, so it's going to take a while before it goes anywhere, or before scientists even know whether it could really cure diabetics. The article estimates that it will be about 5 years before they can begin human testing.

In the meantime, though, I'm quite happy to remain as I am — type 1 diabetic and proud of it!

Monday, July 7, 2008

Treating type 2 diabetes: Diet and exercise "not the reality"

Oh, this kind of thing infuriates me: Tonight I spotted this article calling for more aggressive (read: drug-dependent) methods of treating type 2 diabetes.

The article offers quote from doctors who recommend treating type 2 diabetes as aggressively as possible — that is, by sticking type 2 diabetics with insulin, as well as several oral medications, right away.

The accepted treatment plan for type 2 diabetes right now is to advocate lifestyle changes — such as a healthier diet, increased exercise, and weight loss — and prescribe an oral medication to help resensitize the body to its own insulin. This is because type 2 diabetics don't have a problem with making insulin, but with using it — in fact, usually their bodies make too much insulin in an attempt to compensate for soaring blood sugars. So why you want to go and dump more insulin into these people is beyond me.

An aggravating little tidbit from the article:

DeFronzo acknowledges the benefits of lifestyle changes. "If you could get type 2 patients close to an ideal body weight, my guess is you could control 60% of them with just diet and exercise, no medications," he says.

But because 80% to 90% of diabetes patients are overweight and fail to shed the excess pounds, says DeFronzo, "that's not the reality."

What?! Since when is advocating good health "not the reality"? Personally, I think taking an aggressive drug-dependent approach to treating diabetes is simply going to give overweight, type 2 diabetes-prone people the impression that they don't have to watch their weight, eat healthy food, or exercise. Why should they? There's a pill for that!

Sunday, June 22, 2008

Saluti Cahn discriminated against me because I was diabetic

In my last post, I talked about how forces are at work to strengthen the Americans with Disabilities Act. I also mentioned that I was once discriminated against on the job because of my diabetes, and promised that I'd tell that story in a future post. So here it is:

A few years ago, my employer at the time — Saluti Cahn, a small technical writing firm — tried to refuse to offer me the same health benefits as my non-diabetic coworkers. Since the company didn't have a group health insurance plan, we all had to get individual plans, which we were then reimbursed for. When I was offered the job and this was explained to me, I disclosed that I was diabetic, and that an individual health insurance plan might be expensive or even impossible for me to get. I was offered the job anyway.

As it turned out, I was right. No health insurance company would sell me an individual plan; the only way I was able to find coverage was by getting a conversion plan with the same company that had covered me under my parents' plan while I was in college. It was initially around $560 a month, but Dean Saluti and Marjorie Cahn told me they were going to pay it anyway, because it was the right thing to do.

They seemed to lose their interest in doing the right thing several months later, when I turned 25 and my premium increased to $690 a month. They told me then that they would pay a maximum of $600, leaving me to cover the remaining $90-something a month myself, while my non-diabetic coworkers enjoyed 100 percent reimbursement for their health benefits.

My doctor's office put me in touch with their contact at the American Diabetic Association, who then got me in touch with a lawyer. As I mentioned in my last post, the lawyer sent Dean Saluti a letter saying that he was in violation of Colorado law, and he needed to reimburse me for what I'd paid for out of my own pocket and resume paying my premiums in full. The letter worked, and two weeks later I had a check in hand for the amount I'd paid out-of-pocket (about two months' worth).

However, my experiences with Saluti Cahn threw into sharp relief the problems that I will face my entire life as a diabetic. To prevent employers and health insurance companies from discriminating against diabetics, two things need to happen:

1. Diabetics need to be explicitly included in the Americans with Disabilities Act, and
2. Our nation needs to offer universal health care.

Both of these things are equally important. With only one or the other, you might find diabetics with a job but no health insurance, or with health insurance but no job. I hope that Congress succeeds in passing the ADA Restoration Act, and that in the fall we succeed in electing a president who will ensure that all Americans get health care coverage.

Friday, June 20, 2008

Attempts to improve disability rights law

This story on NPR talks about attempts to revamp disability legislation.

The Americans with Diabilities Act is important to diabetics because it prohibits employers from discriminating against workers with diabetes — theoretically, at least. The story talks about how courts have been splitting hairs over who is disabled enough to qualify for protection under the ADA, which has eliminated protection for many people, such as diabetics.

I feel that this is a very important law, and I'm glad they are trying to improve it. A few years ago, I actually encountered some discrimination because I was diabetic, and quickly discovered that the ADA didn't cover me — the company I worked for was too small.

Luckily, in my case Colorado law stepped in and offered protection where the ADA didn't. The American Diabetic Association hooked me up with a lawyer, who wrote a letter to my boss and got the issue resolved. However, I remember him saying that if writing a letter didn't do the trick, it might not be worth going to court: Courts ruled in favor of diabetics under the ADA only some of the time, and a case with a diabetic had never even been brought to court under Colorado law.

In a later post, I'll explain what happened to me. For right now, suffice it to say that I'm glad to see they are attempting to strengthen the ADA by redefining what qualifies as a disability.

Wednesday, June 18, 2008

Which type of diabetes do you mean?

This morning on Colorado Public Radio, I heard a story about how diabetes and depression often cause one another. They didn't say which type of diabetes they meant, and although I knew they were most likely talking about type 2 diabetes (since the probability of depression causing an autoimmune response is pretty slim), it irritated me that they wouldn't say the words "type 2."

I couldn't find a link to the radio story on NPR, but I did find it on the Washington Post: Diabetes and Depression Go Hand-in-Hand. (Please note that this story does clearly state that they're talking about type 2 diabetics — it was only the NPR radio spot that did not specify which type they meant.)

It really annoys me when the media fails to specify which type of diabetes they're talking about. The two types of diabetes are actually very different — the diseases aren't related at all, even though the end result (too much sugar in the bloodstream) is the same. Type 1 diabetes is the inability to make insulin, because the body's immune system decided to go postal on its pancreas, while type 2 diabetes is the inability to use its own insulin, usually because age or obesity has caused insulin resistance in the body's cells.

In type 2 diabetes, a connection with depression makes sense, because depression typically makes people more sedentary and less willing to exercise, which in turn can exacerbate diabetes. And on the flip side, people who have been diagnosed and are being treated for type 2 diabetes could feasibly be more susceptible to depression, because of the stigma on diabetes in our society.

On the other hand, if the connection were with type 1 diabetes, it would have much more serious genetic and scientific implications. Right now we know that an autoimmune response is what triggers type 1 diabetes — the body's immune system decides to attack the insulin-producing cells of the pancreas, eventually killing enough of the cells that the organ can no longer keep up with the body's insulin needs. The autoimmune gene is hereditary; so far, though, scientists don't know what triggers the autoimmune response. If the study had been on type 1 diabetics, it would have meant that a possible trigger — depression — had been found.

But the study wasn't on type 1 diabetes. It had nothing to do with type 1 diabetes, but because that wasn't clearly stated in the story, some listeners could have drawn the wrong conclusion. So, when you're talking about something — such as depression — being connected to diabetes, you really need to specify which type of diabetes you are talking about, as the connection can have far different connotations for each type!

Sunday, June 15, 2008

Glucagon emergency kit: How-to video

A while back I blogged about the glucagon emergency kit, a treatment for hypoglycemia in diabetics. At the time I tried to find a video on YouTube that would demonstrate how to use it, but discovered there wasn't much information on the subjects — even the written instructions online are rather inadequate.

So I put a Google Alert out on it, and now I'm pleased to be able to show you a video of how to use a glucagon emergency kit. The woman doesn't actually insert the needle, mix the liquid, etc., but she does a pretty good job of imitating those actions on camera.

Friday, June 13, 2008

Recognizing hypoglycemia in others

The Washington Post published this health tip for today on hypoglycemia in diabetics. It's pretty basic, but I think it's interesting that most of the symptoms are ones that the person crashing will feel, rather than symptoms that those around him or her can learn to recognize.

One of the biggest problems with hypoglycemia is that the diabetic doesn't always recognize right away what the problem is. My first symptom is usually a lack of concentration. I have read the same paragraph or page over and over again without understanding it — sometimes staring at it for 10 minutes before realizing what was wrong.

My point is, diabetics don't always know right off the bat when their blood sugar is crashing. Sometimes they stop noticing at all (known as hypoglycemia unawareness). So the people a diabetic spends a lot of time with need to know what it looks like when a person is hypoglycemic.

* Acting "out of it" — My husband says one of the first ways he knows when I'm crashing is that I start acting "out of it" or not as alert. This goes along with the lack of concentration I talked about above — in other words, what I'm feeling also is noticeable in my behavior. I might also say things that don't make much sense, or demonstrate an inability to follow a simple conversation.

* Sudden, unexplainable anger — I've noticed that when I crash, I am much more prone to anger. I've also talked to people who have been around diabetics a lot, particularly diabetics with hypoglycemia unawareness, and often they pick up on the anger before the diabetic actually realizes they are crashing.

* Shaking or unsteadiness — I feel shaky, dizzy, and unsteady when I am crashing, and sometimes actually have a hard time with large and fine motor tasks (I stumble when walking, fumble while opening a bottle, etc.). This is all stuff that an observer should be able to pick up on.

* Pale or sweaty skin — When my blood sugar crashes I usually start feeling inexplicably hot and sweaty. Supposedly pale skin goes along with this. One of the things I do outwardly is to kick the covers off if I crash while sleeping.

If you are with a diabetic who starts showing outward symptoms of hypoglycemia, request nicely but firmly that they check their blood sugar. Sometimes someone who is crashing will actually resist being told to check their sugar, which makes it all the more important that they do it anyway. And of course, if they pass out or are near passing out, call 911 immediately and use their glucagon kit (if they have one on them).

Should type 2 diabetes be treated less aggressively?

The other day I blogged about the findings that hypoglycemia actually increases a type 2 diabetic's risk for heart attack. Since doctors have been operating under the assumption that lowering a type 2 diabetic's blood sugars would lower the risk for heart attack, now there's an article questioning whether the disease should be treated less agressively.

In my opinion, that depends on what your definition of "aggressive treatment" is. Too often, I think type 2 diabetes is treated with drugs — pills to make the body more sensitive to insulin, and sometimes insulin injections to supplement what the body makes on its own. Personally, I think an aggressive treatment for type 2 diabetes should attack the root of the problem: usually obesity, diet, and lack of exercise.

Many cases of type 2 diabetes can be reversed with proper diet and exercise — in other words, by losing weight and eating right. Since I think the chance of heart disease in diabetics is probably linked more to these factors than to high blood sugars, I doubt this kind of approach would make heart attacks more likely. I'm guessing it's the drugs that are causing the lows, which in turn are connected to a greater risk of heart attack.

Of course, not all cases of type 2 diabetes are caused by obesity, diet, and lack of exercise. Some people's bodies develop a resistance to insulin as they age that is unrelated to their lifestyle. However, in light of the epidemic that type 2 diabetes is becoming, I would say a large percentage of the cases are a result of America's couch potato trend.

Wednesday, June 11, 2008

Hypoglycemia connected with heart attack in diabetics

Today USA Today reported that hypoglycemia increases risk of heart attack in diabetics.

Remember my question in another blog post as to whether the risk of heart attack in diabetics affected all diabetics, or just type 2 diabetics? Well, this article says specifically that it applies to type 2 diabetics:

A recent event of hypoglycemia, or extremely low blood sugar, in type 2 diabetics was a major predictor of heart attack, stroke and death, a just-finished study by the Department of Veterans Affairs found.

Also, apparently in February another study found that tightly controlled sugars led to a greater chance of heart attack — perhaps because people with tightly controlled sugars tend to crash more often.

It's funny that this surprises people. I often tell people that the real danger is in my blood sugar going too low, not too high — high blood sugars cause problems over time, but lows can kill right then and there. So it doesn't surprise me that low sugars, not highs, are connected to heart attack.

Really, anyone who has felt the terrible heart-pounding feeling of a bad hypoglycemia episode won't be surprised by this finding.

Monday, June 9, 2008

My doctor's appointment

In my last post I talked about collecting overnight urine samples for my doctor's appointment. My appointment was Friday morning (and partly responsible for a very hectic day).

I always find out at my appointment what my A1c is, as my doctor's office (the Barbara Davis Center) has a little machine that tests it in 6 minutes. It was 7.4, down very slightly from 7.5 at my last appointment.

I had expected that my A1c would be a little high this visit. My brother-in-law and his family moved to Denver at the end of May, so the last month and a half have been kind of crazy and stressful — helping find them a place and preparing for them, and now helping them get settled and still trying to find enough time to get my own work done.

Of course, as my doctor reminded me (gently — he's not a mean doctor), keeping tight control of my diabetes is important, so I need to make sure I remember and/or find time to check my sugars when I am supposed to.

Thursday, June 5, 2008

Collecting overnight urine

I have one of my quarterly visits to the Barbara Davis Center coming up, and as a result I need to collect a couple of samples of my overnight liver for them. My doctor does these tests once a year or so to make sure my kidney is still functioning normally.

I was actually supposed to do this for my last doctor's appointment, but I forgot. Basically, I need to collect all my urine overnight and in the morning in one of those little plastic "hats" they use in the hospital to measure your urine. (For me, this means peeing in the hat just once in the morning, since I don't drink enough fluids to have to get up to pee in the middle of the night.) Then I pour a little bit of the urine into a little vial to take back to the doctor's office with me, and discard the rest.

Since my doctor wants two samples, I need to do this twice.

Kidney failure is a common problem for diabetics, presumably because the kidneys have to work harder in a person with diabetes: Any time the person's blood sugar is over 180, their kidneys kick into overdrive in order to filter out the excess sugar. However, this page about kidney disease claims that it can happen even in diabetics whose sugars are under tight control.

Monday, May 19, 2008

Childhood obesity and type 2 diabetes

Over the weekend, the Washington Post ran the first article in a series about the dangers of childhood obesity. Because part of this epidemic is the rising number of children with type 2 diabetes — a condition that used to only affect older adults — I thought the article deserved a mention in my blog.

The article does a great job of discussing all the ramifications of childhood obesity. Besides the numerous adult diseases appearing in overweight children (high blood pressure, high cholesterol, and of course, type 2 diabetes), being obese during childhood appears to have a lasting impact on an individual's weight. Apparently childhood obesity creates a set point in the child's metabolism, because most overweight children grow up to be overweight adults.

When I was growing up, we rarely had soda, sugary snacks, or fast food. As I got older, and I became more influenced by my peers and by advertising, I remember thinking it was unfair that I didn't get more junk food when all my friends did. But looking back as an adult, I think my mom was exactly right: Soda and fast food appear to be two major contributors in childhood obesity.

While I have my mom to thank for the autoimmune gene (she has hyperthyroidism), I also have her to thank for my normal weight, fast metabolism, and conscientious eating habits. And I will definitely be following her example and restricting my kids' access to soda and fast food when I am a parent!

Friday, May 9, 2008

Horseback riding as a diabetic

One of the biggest challenges I face as a type 1 diabetic is accounting for exercise. I'm not actually terribly active, but I do own a horse and try to ride him several times a week. Even some of the lesser stuff, such as grooming or mucking, can be surprisingly good exercise.

Exercise is challenging for insulin-dependant diabetics because of the risk of hypoglycemia. I have had instances where I am riding my horse or cleaning his stall, and suddenly find myself dizzy and shaky. And sometimes it has even happened later in the day, hours after I've returned from the barn.

Exercise brings on hypoglycemia because of the fact that the insulin is already in my body. Most diabetics take some sort of long-acting insulin that is design to hold their sugars steady over an extended period of time. (The exception is the insulin pump, which delivers short-acting insulin at a steady rate the the diabetic can change as needed — or even stop altogether.)

When a person exercises, his or her body suddenly gets several times more efficient at using insulin. A non-diabetic person's pancreas slows insulin production by about 80 percent while he or she exercises, in order to compensate. But since I take a shot of 24-hour insulin (called Lantus) every evening, I'm stuck with that amount of insulin.

In order to prevent myself from crashing, I need to remember to always eat a snack before I exercise. I've taken to running my blood glucose slightly high before I head to the stables, since I never really know how much the exercise is going to affect me. I can always check my blood sugar again and correct as needed when I return home!

Saturday, May 3, 2008

Bariatric surgery as a cure for type 2 diabetes?

Today I saw the following article on The Washington Post, about bariatric surgery now being used as a cure for type 2 diabetes.

Bariatric surgery basically reduces the size of the stomach — and the length of the intestines. It is used as a "cure" for obesity, because it literally forces the person to eat less at meals — and since it bypasses part of the intestine, fewer calories are absorbed into the person's body.

Recently some doctors have been using it as a cure for type 2 diabetes, too. The surgery is offered as an option for type 2 diabetics who are obese and whose blood glucose levels are way out of control. Patients often find that their sugars become more controllable within days of the surgery.

I can't help but be a little skeptical about this. It seems to me like this makes it far too easy for a type 2 diabetic to say, "Well, losing weight and monitoring my sugars is too much work, so I'll just get surgery to correct the problem for me." Plus, you have to consider that by reducing the size of the digestive tract, you could actually be doing more harm than good — after all, our intestines are the length they are for a reson.

What are your thought on using bariatric surgery as a cure for type 2 diabetes?

Which type of diabetes is worse? Part 2

After blogging about Jay Cutler's diagnosis the other day, I ranted a bit about the assumption that type 1 diabetes is worse. I'd like to add a little more to that rant.

People usually assume type 1 diabetes is worse because it requires insulin injections in order to treat, whereas type 2 only requires oral medications. Shots are associated with hospitals and illness, whereas pills have become commonplace in our society.

I remember talking to a coworker who was type 2 shortly after my diagnosis. When I told her that I was taking insulin, she said mournfully, "Oh, you've got it bad."

This, despite the fact that I had virtually perfect control of my sugars just weeks after my diagnosis — while she started out each day with a blood glucose of about 160, and after only a year of diabetes had already begun to lose sensation in her feet! She was on medication, but since she only checked her blood sugar first thing in the morning, there was no telling how far it climbed during the day.

Which brings me to a final point about why I believe I am better off having type 1 diabetes than type 2: I can control my own treatment. A type 2 diabetic has to get a prescription from a doctor for a medication, take it for several weeks before it starts to take full effect, see the doctor again to have him analyze the results, and have him adjust the pill dosage as necessary. Too weak of a dose will mean high sugars all the time, while too strong of a dose will mean lots of hypoglycemic episodes until the doctor changes the dose.

Compare that to my situation, where all I have to do is check my blood sugar and adjust my insulin dose up or down as needed. Which boat would you rather be in?

Friday, May 2, 2008

Which type of diabetes is worse? Part 1

Last night I blogged about Jay Cutler's diagnosis of type 1 diabetes. The article in the Denver Post reveals a breathtaking mix of scientific fact and popular misunderstandings about diabetes.

Take, for example, the statement that type 1 is "the most serious type of diabetes." Actually, judging from everything I've read and been told by my doctors, I'd actually say that type 1 diabetics actually have it better.

Consider the facts:

* Only 10 percent of all diabetics are type 1. You know those headlines that talk about how diabetes is becoming this epidemic, that more and more people are becoming diabetic all the time? That's type 2 they're talking about. Type 2 is the epidemic.

* Type 1 diabetes is an autoimmune disease, which means my immune system attacked and killed the insulin-producing cells in my pancreas. Compare this to type 2 diabetics, whose condition typically is caused by poor diet, lack of exercise, and obesity. (Not always, mind you, but again -- the epidemic certainly is due to these factors.)

* Type 1 diabetics are typically diagnosed young, many even younger than I was. This usually means that they are more willing to adapt to their condition in order to ensure tight control. Type 2 diabetics, on the other hand, often are unwilling to change their diet or exercise more. They're usually older, so they have had many years to become set in their ways.

All of this begs the question: Which type of diabetes is really worse?

Imagine you have two people with liver problems. One of them has problems that stem from a naturally occurring disease, perhaps a childhood condition. The other is steadily drinking his liver to death, and although his condition is perhaps not as far advanced, it's quickly getting worse — and he shows no signs of letting up. Which one would you consider to be worse off?

Of course, this isn't a perfect analogy, as type 1 and type 2 diabetes are actually dramatically different diseases. As I already mentioned, type 1 diabetes is an autoimmune disease that basically kills off most or all of the insulin-producing cells in the pancreas.

In type 2 diabetes, however, the body actually becomes resistant to its own insulin. It is unable to use the insulin correctly, so it continues to make more and more insulin, which only increases the body's insulin resistance. I believe obesity also contributes to increased insulin resistance.

In any case, my point is that type 1 is usually more treatable, because the patient is generally more willing to manage their diabetes. On the other hand, type 2 diabetics (according to my doctors) tend to be more stubborn and set in their ways, refusing to take the steps that could virtually cure them of their condition.

New type 1 diabetic: Jay Cutler, Denver Broncos quarterback

This story comes from my hometown: Denver Broncos quarterback Jay Cutler was just recently diagnosed with type 1 diabetes. He just turned 25, so he is about 3 years older than I was when I was diagnosed. (I was diagnosed with type 1 diabetes 6 years ago, at the age of 22.)

Apparently they are expecting a lot of public concern, because they keep stressing that he is doing fine with it:

"People need to understand this is very treatable," said a Broncos source. "Jay's going to be fine."

They also were careful to point out that Cutler has been practicing with the rest of the team, and that there has been no move to replace him.

The fact that they even need to say that frustrates me. There are many cases of world-class athletes competing with type 1 diabetes, yet every time they make headlines like it's a brand new situation.

Wednesday, April 30, 2008

Taking insulin for Asian food

I celebrated my birthday over the weekend, and a few days later my husband and I celebrated our one-year anniversary. Both times we visited one of our favorite restaurants, both of which happened to be Asian: a Japanese sushi restaurant (my all-time favorite!) for my birthday, and a Chinese and Thai food restaurant for our anniversary.

Although Asian food is pretty much my favorite cuisine, it is also the most challenging to take insulin for. I treat my diabetes with something known as carb counting, which means that I determine my insulin dose according to what I am eating, rather than determining what I eat according to my insulin dose. My carb-to-insulin ratio is 15:1, meaning that I take one unit of insulin for every 15 grams of carbohydrates I eat.

When I'm eating something with a nutrition label, my insulin dose is pretty easy to determine. Foods without a label — produce, for example, and eating out — are a little more difficult. However, Asian is by far the most difficult to determine.

Sushi is probably the most challenging. Although you wouldn't think there would be many carbs in sushi, since most of it is raw fish, my blood sugars always run ridiculously high afterward — despite my best efforts to guestimate my insulin dose. I think there must be something more than just rice in the sticky rice.

Chinese food is difficult too, primarily because I have no idea what is in the sauces. Also, a nutritionist once told me that they soak the meat in something high carb (corn syrup?) in order to tenderize it. Whatever it is, Chinese food is usually difficult to guestimate an insulin dose for, too.

Usually, my guestimating for Asian food goes something like this: I calculate roughly twice the amount of insulin I would normally expect to take, and then add a couple more units for good measure. Sometimes that turns out to be dead on, but often my blood sugar readings are still in the upper 200s and lower 300s several hours after the meal.

Personally, I think that rather than meaning that I need to deny myself my favorite foods, I actually need more practice with them. I should probably eat sushi and Chinese food on a regular basis, until I get really good at guestimating my insulin doses for those meals!

Monday, April 21, 2008

Nighttime hypoglycemia and hypoglycemia unawareness

Both Friday and Saturday nights this weekend, I woke up crashing at about 3:30 or 4:00 am.

Nighttime hypoglycemia is an issue that many diabetics have to deal with, particularly any diabetic who takes insulin. The problem is that during the middle of the night, there is a period where hormone production stops. Since hormones make insulin less effective, a sudden lack of hormones makes insulin more effective. In a normal body, the pancreas simply produces less insulin, but of course a diabetic taking a 24-hour time-release shot of insulin doesn't have that option.

The end result is that there is a period overnight where diabetics on insulin can crash. To prevent that, I have to go to bed with my blood sugar a little on the high side (ideally about 150). That way, when it drops it won't go too low.

Both instances of nighttime hypoglycemia this weekend were probably caused by too much insulin before bed, or not enough of a snack. Both times, I woke up shaking and drenched in sweat. Hypoglycemic episodes are by far the worst part of being diabetic, in my opinion.

In this case, though, I'm actually kind of glad of it. I hadn't woken up crashing in a long time, and because of a few other indicators, I was worried that I had developed some hypoglycemia unawareness (which is where you don't get the symptoms of crashing, usually because it happens so often that your body stops taking notice).

Not waking up for nighttime hypoglycemia is potentially dangerous, so having woken up crashing twice recently is as much a relief as it is an inconvenience.

Wednesday, April 16, 2008

Why natural sugars are better for diabetics

I mentioned in my last blog post that I was reading a book by Michael Pollan, called In Defense of Food. Since it's a book about food, nutrition, and nutritionism, I found a lot of what it had to say applicable to my type 1 diabetes.

One thing I found particularly interesting was this quote, found on page 112 (emphasis added):

Sugar as it is ordinarily found in nature — in fruits and some vegetables — gives us a slow-release form of energy accompanied by minerals and all sorts of crucial micronutrients we can get nowhere else.

Nutritionists often advise diabetics to opt for naturally occurring sugars, such as fruit, for just this reason: Because of the fiber included in the fruit, the body absorbs the sugars much more slowly, which prevents the rapid peak of blood glucose caused by processed sugars.

(This is also where the Atkins craze got the rather erroneous idea that total carbs - fiber = "actual" carbs. That formula is actually a rather over-simplified way of looking at it, and not quite accurate — the sugars are still there, they just take longer to hit your blood stream. Besides which, you can't duplicate the effect by throwing together processed sugars with a bunch of fiber, like many of the prepackaged Atkins foods do — the lack of processing in the fruit is a significant part of why your body takes longer to absorb the sugar!)

For type 2 diabetics, eating naturally occurring sugars such as fruit is important because it gives your body time to keep up with its insulin needs. For type 1 diabetics, like me, fruit has a slightly different, but rather interesting effect: The delayed absorption into the blood stream changes my insulin needs.

I've found that even though an average-sized apple should typically contain about 30 grams of carbohydrates, 2 units of Humalog will sometimes cause me to dip too low near the end of Humalog's 2- to 3-hour window (Humalog takes between 2 and 3 hours to run its course). I'm guessing that it's because the sugars hit my blood stream so gradually that the insulin ends up being too much.

On the other hand, foods that hit my blood stream more quickly, such as candy bars, sometimes take more insulin than the amount of carbs would indicate.

Although one of the beauties of carb counting is that I can eat whatever I want, whenever I want, it's also good to keep in mind that certain foods foster better overall glucose control.

Tuesday, April 15, 2008

Personal defibrillators?

In case you don't know, an automated external defibrillator (AED) is the thing they shock people with on TV ER shows to restart their heart. (While I'm not a big fan of how medical stuff is portrayed in movies and TV, it seems like the easiest way to explain a defibrillator to someone who doesn't recognize the name.)

Now I guess medical research is looking into the benefits of issuing one to every heart attack survivor. The idea is that someone who has already survived a heart attack might have a better chance of surviving a second one if there is a defibrillator at home.

Since heart disease is a problem among diabetics, I wanted to share the results of the study. Evidently having a defibrillator around isn't much better than having family members around who are trained in CPR. However, if your family doesn't want to learn CPR, or if they suck at it, a defibrillator could increase your chances of survival... if someone is around when you go into cardiac arrest.

This expert quote in the article made me laugh:

"The best way to survive a cardiac arrest is not to have it in the first place," says Arthur Kellermann, of the Emory School of Medicine in Atlanta.

Umm.... Duh. But he follows up with a good point:

"This is accomplished through diet, exercise, non-smoking and access to good medical care for conditions like high blood pressure prior to a heart attack."

In other word, take care of yourself, people!

I still believe that the best treatment for diabetics is to keep their diabetes under good control and live a healthy lifestyle, rather than relying on drugs. However, this study is a good reminder that some form of intervention is necessary in order to avoid a heart attack, because nothing can guarantee your survival once you go down that path!

Thursday, April 10, 2008

Low-fat diets, heart disease, and health

I'm reading a book right now called In Defense of Food. If you haven't heard of it yet, it is kind of the non-nutritionist nutrition book. Michael Pollan's argument is that for the most part, we don't need to dissect the components of food in order to eat a health diet — and that we definitely shouldn't be eating all of the processed food on the market, no matter what nutrients it contains.

One of the things he talks about is how there is some evidence that low-fat diets actually cause weight gain (pg 45). Since obesity is thought to be linked to heart attack, you have to wonder if advising diabetics to eat low-fat diets is really the best course of action.

The book also draws other interesting connections, such as that "many [people] date the current epidemic of obesity and diabetes to the late 1970s, when Americans began bingeing on carbohydrates, ostensibly as a way to avoid the evils of fat."

But by far the most interesting, in my opinion, is this:

Whether the low-fat campaigners should take the credit for [the lower number of heart attack fatalities] is doubtful, however... A ten-year study of heart disease mortality published in the New England Journal of Medicine in 1998 strongly suggests that most of the decline in deaths from heart disease is due not to changes in lifestyle, such as diet, but to improvements in medical care... For while during the period under analysis, heart attack deaths declined substantially, hospital admissions for heart attack did not.

Of course, I am not a scientist or a doctor, but I do know that I personally feel that eating primarily whole, unprocessed foods is far more important than eating low-fat, high-carb, or even than following the food pyramid. My own cholesterol was at its highest when I was eating a lot of processed foods, especially low-fat processed foods.

As Pollan points out in his book In Defense of Food, nutritionism has been wrong before — and disastrously so, such as with the whole trans-fats debacle. This just reinforces my reasons for deciding to not take Lipitor anymore: If you can't trust scientists to report correctly on the connection between dietary fat and heart disease, how do I know they are correctly reporting the connection between type 1 diabetes and heart disease?

I feel In Defense of Food is an important to read, particularly for diabetics. Our "culture of fear" doesn't stop with terrorism — nutritionists and scientists seem determined to make us fear dietary fat every bit as much as an invasion. In Defense of Food provides another look at these issues... and why we shouldn't fear our food.

Tuesday, April 8, 2008

The importance of diabetes self-management

Before I move on, I want to say one last thing about my first endocrinologist.

I mentioned in my post about finding my old medical records that my first endocrinologist used to berate me for adjusting my own insulin dosage.

Here are his notes in my records:


Overall control is much more variable. I have asked Katharine not to very [sic] her Lantus dose. If she is having difficulty she is to let us know.


She has been adjusting her Lantus dose by herself. Her blood sugars have been very irregular since her last visit as a result...

A hemoglobin A1c is significantly improved, however, her blood sugars remain very erratic. I have asked Katharine to not change her Lantus dose. Her Lantus dose should remain relatively stable.

I'm missing the paperwork for the visit that would have fallen between these two, but I'm sure you get the idea. By the time I switched to the Barbara Davis Center, I had come to dread my appointments with my endocrinologist, because I knew I would be harassed and blamed for attempting to control my diabetes on my own.

The thing is, my erratic turned out not to be because I was trying to adjust my own Lantus dose, as my doctor claimed, but because he had failed to tell me Lantus expires 28 days after being opened. I was using the bottle until it was empty, which took about two months — so every other month, my sugars were off the charts.

It was his nutritionist who realized what was going on, and it was she who gave me the subtle encouragement I needed to switch doctors. She saw that I was not happy with my current endocrinologist, and gently suggested that a good doctor-patient personality match is important.

Thanks to that advice, I now have a doctor who is much more supportive of me and my diabetes. He has never criticized me for adjusting my own dosages, and although he has made suggestions in the past, it also seems like he usually agrees with the changes I make to my dosages.

The thing is that being able to adjust one's own insulin dosages is imperative for good control of type 1 diabetes. Despite my doctor's claim that my "Lantus dose should remain relatively stable," my insulin needs are in constant flux, and I need to be able to keep up with them if I want to avoid periods of persistent highs or lows.

For instance, during my menstrual period I almost always require about four units less Lantus, compared with the rest of the month, when I'm on the pill. Stressful periods (such as finals week when I was in school) almost always make my insulin needs go up, and periods when I am more active or eating less than usual almost always make my insulin needs go down.

If I didn't feel confident adjusting my own insulin dosages, I would suffer chronic high sugars or dangerous hypoglycemic episodes every time my metabolism adjusts up or down. This shows that in order to have the best possible control over your diabetes, you literally have to know your body better than your doctor — and be comfortable making executive decisions based on what, in your experience, works or doesn't work. Treating diabetes is a daily thing, not just something your doctor deals with every few months!

Saturday, April 5, 2008

My first endocrinologists and my cholesterol

I know I'm no longer going in the order of the list I made after finding my old medical records, but I'm on a roll here, just thinking of all my beefs with my first endocrinologist.

The issue of my cholesterol is a big one. I finally got off Lipitor last year, after nearly five years on the drug (with a little break here and there, when I wanted to see what my LDL would be without it).

My endocrinologist started harassing me about my cholesterol levels almost right away. He would have put me on Lipitor at my first appointment after being discharged from the hospital, had I not insisted that I wanted to try other methods first. I got off the Depo-Provera (birth control shot) and back onto the pill, because estrogen (which the shot blocks) tends to protect against LDL. I tried eating low-fat and no-fat food, and when my LDL only went up more, I finally acquiesced and allowed my endocrinologist to put me on Lipitor.

(As a side note, I now believe that my higher LDL was a result of eating more processed foods. I now eat more whole fat — whole milk, cheese, etc. — than I used to, yet my LDL is lower. I attribute this partially to the grapefruit juice I'm drinking every day, and partially to the fact that I eat very little processed food anymore.)

Anyway, my endocrinologist started me on Lipitor in January 2003, after my LDL reached the oh-so-scary high of 138. While on Lipitor, my cholesterol was ridiculously low, often running 70 or lower — and I believe I was on the lowest possible dose (10 mg).

A year later, my doctor decided to put me on another cholesterol-reducing medicine, Niaspan. His report reads:

LPa is elevated which places her [at]risk for early coronary disease. I will begin Niapsan 500 mg once daily with supper. This will decrease LPa it [?] levels. She is to take an adult aspirin at the beginning of supper and the Niaspan at the end of supper.

This was the most explanation I ever got — no phone call, and certainly no say in the matter. Back then I was a good little sheep — I mean patient — though, so I got the Niaspan and aspirin and took them without question.

Later that night, I freaked out when I started feeling heat and painful pricking in my ears. Slowly the waves of heating and painful tingling swept through my body. It was one of the most unpleasant and inexplicably painful things I have ever experienced, and not knowing what was causing it was very frightening.

Since the sensation had happened mere hours after I took my first dose of Niaspan, I figured that might be the cause, and started searching the Internet for more information on Niaspan. Thank goodness for the Internet! I was able to verify that the sensation, called "flushing" (a severe understatement), was a side effect of the Niaspan.

I was livid. My doctor hadn't told me anything about Niaspan and its possible side effects. In retrospect, I shouldn't have even taken it without questioning him — and doing my own research — first. Unfortunately, it was another year before I came to my senses and decided to find an endocrinologist with more respect and consideration for his patients — and it wasn't until late 2005 that I finally took charge and told my new doctor that I wanted to stop taking Niaspan.

The Niaspan site offers some information about flushing. Notice how it downplays this side effect. In my experience, flushing was highly painful, rather than just a redness, and it did not lessen after several weeks. The entire time I was on Niaspan, I had to be careful not to drink coffee or sports drinks in the evening, because hot drinks or B vitamins could both trigger a significantly more painful episode. It was a horrible experience, and in my opinion all the stuff about keeping the benefits in mind is BS, because there are better ways to raise HDL and lower "bad" cholesterol than with drugs!

Friday, April 4, 2008

My first endocrinologist and a misdiagnosis of Hashimoto's disease

One of the things I mentioned in my last post, about my first endocrinologist, was a misdiagnosis of Hashimoto's disease.

In retrospect, my doctor seemed way too eager to diagnose me with this disease. Coupled with his eagerness in prescribing medications to me left and right, whether I really needed them or not, it makes me wonder if he got a kickback from the drug companies.

In any case, this is what his report says about my visit and labs from June 2002, literally only a week after my discharge from the hospital:

Hypothyroidism, Chronic Lymphocytic Thyroiditis. TFTs were repeated due to her previous slightly abnormal thyroid functions tests with TSH in the high normal range at 3.91. Laboratories indicate that Katharine has Hashimoto's disease with high antibody levels and is likely to rapidly become hypothyroid. I will send Katharine out a prescription to begin Synthroid 50 mcg daily and follow her thyroid functions regularly to appropriately titrate her thyroid hormone dose. We will further discuss her thyroid disease at her next visit.

My endocrinologist actually called me at work to tell me I had Hashimoto's disease and would become hypothyroid. He said he would be sending out a prescription for me, but he never did. His report on my next visit stated:

Chronic Lymphocytic Thyroiditis. Thyroid functions remain int he normal range indicating that she does not need thyroid hormone replacement yet.

After that it was never mentioned in his reports again, and he never again tested for the antibodies that supposedly indicated I would become hypothyroid. This follow-up statement was the closest I ever got to an admission that he had misdiagnosed me with Hashimoto's disease.

I can remember a technician or a doctor mentioning to me in the hospital that my thyroid levels were a little elevated, but that they thought they would probably normalize now that my sugars would be under better control. My entire system was out of whack when I was in the hospital — just about nothing was in the correct range.

The hospital was right and my endocrinologist was wrong: My thyroid levels have never strayed out of the normal range, and it has been almost six years since my endocrinologist told me I had Hashimoto's disease. When I consider how close I came to taking yet another drug that I didn't need, it makes me shudder. Who knows how long it would have taken me to figure it out and get off of it?

Thursday, April 3, 2008

My first endocrinologist and my diabetes

In the last handful or so of posts, I told the story of my diagnosis and hospitalization. I discussed how ignorance and confusion about diabetes seems to prevail even through the medical industry.

Unfortunately, I didn't experience anything much better from my first endocrinologist.

In the beginning, I though he was great. I credited him with nailing the correct dose of insulin (though after reading my discharge paperwork, the general practitioners had actually pretty much gotten it themselves; all he did was adjust it by a unit).

Within two years, I was totally disillusioned with him. My sugars were out of control, my A1c was the highest it had been since my diagnosis, and he didn't have any clear answers for me.

In fact, my endocrinologist often blamed me for my lack of control. I began to dread my appointments. He was diagnosing and recommending stuff left and right, really bizarre stuff — for instance, he suggested I was type 1 and type 2 and prescribed medication for treating type 2 diabetes, which his dietician thankfully recommended I not take. He also suggested I get on the South Beach diet, which is often used to help type 2 diabetics control their sugars.

Keep in mind that this is someone who is supposed to specialize in conditions like mine.

In the end, the problem turned out to be something extraordinarily simple: My endocrinologist had neglected to tell me that Lantus, my once-a-day insulin, expired 28 days after you opened the bottle. I was using a bottle until it ran out, which took about 2 months. Therefore, every other month my sugars were inexplicably (it seemed) out of control.

This was not the first time I had had a problem with my endocrinologist not properly briefing me on a drug before prescribing it to me. That, coupled with the fact that he never noticed the pattern and figured out what could be causing it (I kept careful records of my sugars, my dosages, etc.), finally pushed me to seek out another doctor.

I switched to the Barbara Davis Center, which is among the top juvenile diabetes clinics in the United States, and it proved to be the best thing for me: I have been happier and in better control of my diabetes ever since. However, before we go there, I have other stories about my first endocrinologist, such as a hasty and incorrect diagnosis of Hashimoto's disease, and the issues surrounding my cholesterol.

Wednesday, April 2, 2008

How diabetes affected my vision

I've been talking lately about finding my old medical records. There's something pretty important that happened to me that the records don't show, so I'll talk about that now.

When I talked about the symptoms of diabetes that I was experiencing before I was diagnosed, I mentioned my blurry vision. This happens when the sugars accumulate in the fluids in the eye. If you think about it, it's kind of like trying to peer through the glaze on a doughnut — ha ha!

It's a pretty well known phenomenon that when someone is diagnosed and their blood glucose is brought down, their vision suddenly improves. What happened to me, though, no one had an answer for. Eventually I came up with my own theory, but I have never been able to confirm it with a doctor.

I have had poor vision since about sixth grade. It's so bad that I can't even read a book or the computer screen without my glasses, without bringing it to within inches of my face. On the third day of my hospitalization, I suddenly realized I was having a hard time seeing through my glasses. I took them off, and was perfectly astonished when I realized I could see better without them!

In fact, my vision was so good that I stopped wearing my glasses entirely. During my follow-up with the family doctor after being released from the hospital, my vision tested at 20/25 — pretty much a miraculous improvement.

At the time, we thought that perhaps I had been developing diabetes for years, and that's why my vision had always been so bad. After several weeks, though, my near-perfect vision started to decline. Eventually, it bottomed out almost right back where it had been.

Why would my vision "fix" itself, and then go right back to being bad? None of my doctors had any answers.

Here is what I finally decided had happened: My sugars had been rising steadily for probably eight months to a year before I was diagnosed (as I remember having an unusual problem with cottonmouth as much as eight months prior to my diagnosis). This entire time, I had been staring through sugar-clouded fluid in my eyes.

Near-sightedness is caused by one's eyeballs having the wrong shape. I think the strain on my eyes during this period was so great that they actually changed shape in order to try to compensate. When my blood sugar was normalized, suddenly they were the correct shape for near-perfect vision. But without the perpetual strain forcing them to keep that shape, they slowly relaxed into their old, near-sighted shape.

Of course, I don't know for sure that this is how it happened, but it's the closest thing to an explanation than I've ever gotten from any doctor.

Tuesday, April 1, 2008

My hospitalization: Surrounded by ineptitude

When I was diagnosed as diabetic, I was sent to the emergency room. I spent the next four nights in the hospital, largely due to the fact that the doctors didn't seem to know what they were doing.

You might thing I'm exaggerating, but I'm not. I went into the hospital with a blood sugar of 515. They got it down to about 80 that first night, but then for the next few days couldn't get it under 250.

I mentioned that I recently found my old medical records. This is what the hospital's discharge summary says:

The patient's course in the hospital was relatively benign, although we had a hard time getting her blood sugars consistently under control for the first few days.

The main cause of this seemed to be a lack of communication. About a half an hour before a meal, someone was always sent to check my blood glucose. Then someone else would bring insulin and give me a shot. And after that, a third person would bring me a meal and put it in front of me. (Sometimes the meal actually came before the shot.) It didn't seem to occur to anyone that if they gave me insulin to correct a high glucose reading, it wouldn't do them any good if they then fed me right away — unless of course they also gave me insulin to counteract the meal.

The report confirms what I've always suspected: They were also way too conservative about how much insulin they gave me.

Lantus was started at 10 units in the morning with a sliding scale of Regular Insulin and through the course of her stay with us, she was switched to Lantus 18 units and Humalog q.a.c. and q.h.s. at 7 units.

(I looked the abbreviations up; q.a.c. stands for the Latin for "before every meal", and q.h.s. means every night.)

Even more interesting, though, is the "Discharge Medications" and "Discharge Instructions" sections:

The patient was discharged with Lantus insulin and Humalog insulin; Lantus 18 units q.p.m. and Humalog 7 units q.a.c. and q.p.m. along with the Lantus, although in separate syringes... The patient is to continue with her diabetic diet.

(I think q.p.m. means, or should have been, q.h.s.)

According to the discharge summary, they put me on a traditional 3-injections-per-day insulin regimen and a restrictive diet, which is so NOT what happened. I was discharged with instructions for carb-counting, which is where you determine your shot according to how many grams of carbohydrates you are eating. My ratio was one unit for every 15 grams of carbs.

So even my discharge report shows the lack of communication that plagued my entire hospital visit.

My hospitalization: MORE misinformation about diabetes

When I was checked into the emergency room with a diagnosis of new onset diabetes, I knew very little about diabetes. I was completely dependent on the hospital staff to educate me.

Which, as it turned out, was a complete mistake.

Here are the various misconceptions that were communicated to me by nurses, dieticians, and doctors:

* That they couldn't tell whether I was type 1 or type 2 diabetic until they completed my blood tests. I never found out about the mysterious blood test that would have determined which type of diabetes I had. However, from what I know now they should have been able to make an educated guess. Not only was I young and skinny, but my family also had a history of autoimmune diseases: My mom has hyperthyroid, or Graves' disease.

* That I would need to eat fewer carbohydrates, and more proteins and fats. This is the OLD way of treating type 1 diabetes. Since heart attack is a major concern among diabetics, the opposite is actually true. Plus, modern insulin allows diabetics to determine their doses by the amount of carbohydrates they are eating, closely mimicking the behavior of the pancreas.

* That I could reuse syringes and lancets numerous times. This misconception is actually kind of dangerous. Modern diabetic supplies have such tiny needles that the tips bend the first time they puncture the skin. After multiple uses, they start causing damage, and injections or finger-pricks become more painful.

I am always frustrated by how little the general public knows about diabetes, but it appalls me that medical staff were this misinformed — not to mention that they were trying to teach me this misinformation! In my next post, I'll also talk about how their misunderstandings of diabetes actually resulted in a lack of appropriate care for me.

Monday, March 31, 2008

My diagnosis: Misinformation about diabetes

Finding out that I was diabetic and checking into the emergency room were all very traumatic for me. What made everything worse was that I didn't know very much about diabetes. I thought my life was over.

I remember my mom talking to me in the hospital during my stay there. She was still reluctant to believe that I was truly diabetic. "Well, you're not fat," she said, speaking of the stereotype that all diabetics (with no differentiation between type 1 and type 2) are overweight.

"You're not a kid, so it can't be juvenile diabetes," was the other line of logic.

My sister made it up to see me on my second full day of hospitalization. I remember her lying in the hospital bed with me, holding me while I cried. "Why did this have to happen to me?" I asked, over and over. "Why me?"

The problem was that I really didn't know much about diabetes, and what I did know sounded pretty bad. My biggest source of information was from The Babysitters' Club, a series of preteen books that I read when I was younger. One of the club's members, Stacey, is a type 1 diabetic. In one of the early books in the series, she gets tired of not being able to eat sweets, and starts sneaking some here and there. Then she wakes up in the hospital, having almost died.

With this as my only basis for comparison, I thought I was never going to be able to eat ice cream again.

My other source was Christopher Pike's Remember Me, in which the protagonist's brother almost dies when he is injected with air. I lived in fear of air bubbles — until an educator at my doctor's office finally told me that air in the syringe can't really kill you. (You'd have to inject a large amount of air directly into a major artery in order for it to have an effect.)

There is a lot of inaccurate information in the media about diabetes, and I think that has a lot to do with why people see it in such pessimistic terms. When I tell people I'm diabetic, sometimes they look at me as if I'm already dead. Other people treat it like it's something shameful.

Even the medical industry seems to be confused about diabetes — which brings me back to my medical records and my hospitalization. I'll talk about that in my next post.

My diagnosis: Checking into the hospital

The night after my doctor's exam, my doctor called me up with the news that I was diabetic. In the blood panel the previous day, my blood glucose had registered at 727.

"You need to go to the emergency room right now," the doctor said. She had already called in to let them know I was coming.

The conversation is a blur in my memory. I know I must have handed the phone over to my mom, who seemed angry. I remember her asking the doctor if I could at least eat dinner first.

The doctor grudgingly said that was okay.

I was in the basement, at the computer, when we received the call, but I don't remember how we got upstairs. I do remember sitting at the bar in the kitchen, completely shell-shocked by the diagnosis. I was crying, on the verge of hysteria.

My mom, meanwhile, still seemed pissed. She went to the phone and called an acquiantance of hers, whose husband and two children were both type 1 diabetic. "My daughter has lost a lot of weight and is going to the bathroom a lot. Does that sound like diabetes to you?" she demanded, almost as soon as her friend picked up the phone.

Of course, this was only upsetting me more. I was pretty much wailing at this point, and my dad told her to get off the phone.

We ate dinner and drove over to the hospital. When we walked into the emergency room, I walked up to the folks at the desk and told them, "I'm diabetic and my blood sugar is over 700."

They just looked at me and asked some question about my symptoms or my sugars, which didn't make sense at the time but that probably would now.

"I don't know," I said. "My doctor just told me to come here."

Evidently those were the magic words. Having a doctor call you in at the ER is like having a backstage pass: I bypassed all the miserable-looking people in the waiting room, and was ushered right into my own room. Before I knew it, they'd had me pee in a cup, drawn blood, hooked me up to an IV, and given me my very first dose of insulin.

I did have to wait for a while after that, but I was constantly being monitored and questioned. I was poked and prodded more times than I could count. I had at least a couple of different med students question me about my symptoms. The doctors even ordered X-rays, though I have no clue what they were looking for.

It wasn't until around midnight — perhaps four hours after my arrival — that I finally got a room of my own.


Sunday, March 30, 2008

My diagnosis: Symptoms of diabetes

In my last post, I mentioned a list of various things that were going through my head since finding my old medical records. Looking over the paperwork on my hospitalization, I discovered some things I didn't know or hadn't realized at the time.

Before I start discussing my list, though, I need to tell you about my diagnosis. I'll split it up into a couple of posts, because it's a long story.

I was diagnosed with new onset diabetes in May of 2002, at the age of 22. I had been losing weight all semester, and when I dipped under 100 pounds around time for finals, I decided to go to the doctor once my exams were over. By the time I went to the doctor, I had lost 20 pounds over a five-month period, and my co-workers had begun to suspect anorexia.

I went to the doctor complaining primarily about the weight loss. I didn't think at the time that anything else was wrong with me, but in fact the symptoms had come on so gradually that I didn't realize. It wouldn't have mattered much if I had, though, because I didn't know anything about the symptoms of diabetes.

In hindsight, these are the symptoms I was experiencing, though I wasn't fully aware of all of them at the time:

* Rapid weight loss, even though I was eating more than I used to
* Extreme thirst
* Having to urinate frequently
* Painful muscle cramps, mainly in my legs in the middle of the night (because I was pissing out all the potassium in my system)
* Blurred vision (from sugar buildup in the fluid in my eyes)
* Lack of energy (sleeping 10+ hours a night, napping frequently, etc.)
* Dizziness (disoriented from extremely high blood sugars)
* Really nasty-smelling farts (no idea why this was, really)

We thought that I might have hyperthyroid, which my mother has, because she had experienced rapid weight loss before she was diagnosed. The doctor did a full blood panel, because we really had no clue what was going on.

That was on a Wednesday. Thursday night around dinnertime, the doctor called me at my parents' house.

"The results came back from your blood tests," she said. "You're diabetic."


Finding my old medical records

I found my old medical records in a file drawer at my parents' house. They include the paperwork from my diagnosis and hospitalization in 2002, plus the records from my doctor's visits in those first couple of years.

I discovered/remembered the following things:

1) Some of the things that happened while I was in the hospital. I had never read through the paperwork, so I found this rather enlightening.

2) A glaring misdiagnosis of Hashimoto's disease from my first endocrinologist. (It's been six years and I've had nothing but normal thyroid function.)

3) Evidently my A1c used to run a little lower than it does now. It then shot up in late 2003/early 2004, which is when I switched to the Barbara Davis Center.

4) My blood sugar was much easier to control when I was on Depo-Provera (an injection form of birth control). When I switched to the pill in an effort to better control my cholesterol, I lost some of my tight control.

5) My old endocrinologist used to berate me for attempting to adjust my nightly Lantus dose on my own. Remembering this made me really mad — I hate it when doctors patronize me or treat me as if I'm incompetent!

6) Evidently my LDL cholesterol didn't run as high as I'd thought — the highest I saw before my endocrinologist put me on Lipitor was 138.

7) It doesn't seem like my doctor had a good reason at all to put me on Niaspan (which I got off of several years ago).

Each of these points deserves some attention, so I'm going to address them individually in a series of future posts.

Friday, March 28, 2008

Glucagon emergency kit

Every diabetic should carry one of these in case of hypoglycemia: a glucagon emergency kit. The one pictured is by Lilly:

Lilly glucagon emergency kit

Lilly glucagon emergency kit

They expire periodically, so make sure you get a new prescription when it's needed.

The problem is that there is a lack of adequate education on how to use one. You won't be the one to use it, so it doesn't help much for just you to know how — if it's needed, you'll probably be unconscious, or at the very least incoherent.

In other words, you need to be sure to educate your family and friends — people who may well be nearby if you have a dangerous low blood sugar episode.

But how do you use these things? It's not like you get a practice run, and Lilly's instructions leave much to be desired. So far, the best instructions I've found is this step-by-step slide show for the Novo Nordisk glucagon kit.

What I'd really like to see is a video of how to use one of these. YouTube would be nice, because then I could embed it in my blog, but there doesn't seem to be one of those. I'll keep looking elsewhere, and let you know if I find anything!

Thursday, March 27, 2008

Saying 'No, thank you' to Lipitor

Yesterday I posted about my lab results, which I had just received from my doctor's office. Today I want to explain why I've decided not to go back on Lipitor unless my LDL goes over 120.

Here are the numbers again:

Triglycerides: 128 (should be below 150)
LDL: 112 ("should" be under 100 for a diabetic, though is more like under 130 for a non-diabetic)
HDL: 77 (should be above 40 — the higher the better)
Total: 215 (should be below 200, though this does not take into account high HDL)
Ratio: 2.8 (should be below 4.5)
CHD risk: less than 0.5 (should be 1 or less)

Compare this to the last time I tried getting off the Lipitor, more than two years ago:

Triglycerides: 95
LDL: 138
HDL: 79
Total: 237
Ratio: 3.0

And although I can't find the records to prove this, I'm pretty sure my LDL was around 150 — and my HDL just barely above 40 — when my first endocrinologist put me on Lipitor, back in 2002.

Do you see what I'm getting at? My LDL has gone down and my HDL has gone up, meaning that I'm healthier than I was before. Is an LDL that is only 12 mg/dL too high worth taking Lipitor — and assuming the risk of liver damage that comes with it?

Personally, I don't think so.

Furthermore, I can't help but wonder about the study (or studies) that decided that all diabetics are automatically at a high risk for heart disease. One of the first things I ever learned upon becoming diabetic is that 80 percent of diabetics die of heart attack.

Yet compare that to some other statistics: Ninety percent of all diabetics are type 2, a form of the disease that is usually (though not always) associated with obesity, poor diet, and lack of exercise.

So when they tell me that I'm at a higher risk for a heart attack simply because I'm diabetic, are they talking about normal-weight, type 1 diabetics — or all diabetics in general? And when the researchers analyzed the data regarding diabetics and heart attack in order to make that generalization, did they control for type of diabetes, weight, diet, and lifestyle?

I'm 5'4" and weigh 123 pounds. I eat an organic, low fat, primarily vegetarian diet. I'm reasonably active. My blood sugar is under good control (my A1c hasn't risen above 7.5 in more than three years, and has lately averaged in the high 6s).

I just don't think I'm in that great danger of heart disease at this point in my life, which is why I've decided to stay off Lipitor as long as my cholesterol stays under 120.

Wednesday, March 26, 2008

My lab results

I just got my lab results back from my last visit to the Barbara Davis Center.

I knew ahead of time what some of the results would be. My doctor called me several days after my visit, sounding concerned: My cholesterol had shot up since my last lab.

I knew this was going to be the case, but I forgot to warn them. I stopped taking Lipitor about 9 months ago, because Michael and I were talking about trying to get pregnant soon after our wedding. Then we kept pushing it back a couple of months at a time, so I never started back up again.

However, I had read somewhere that drinking 8 oz. of grapefruit juice a day has been proven to lower LDL. (This is probably why you are not supposed to have grapefruit while on Lipitor — they don't want it to go too low.) So a glass of grapefruit juice is now a part of my morning routine.

In addition, I think I'm eating much better than I was all the other times I've been tested while off Lipitor. I'm also more active than I used to be: My husband and I walk almost daily, and I spent a lot of time riding and working with my horse.

Although the results rather startled my doctor, I think you can see the effects of my diet and lifestyle changes:

Triglycerides: 128 (range 0-149)
LDL: 112 (range 0-99)
HDL: 77 (range 40-59 — on this one, the higher the better)
Total: 215 (range 100-199)
Ratio: 2.8 (range 0.0-4.4)
CHD risk: less than 0.5 (range 0.0-1.0)

This is up from a LDL of 60 or 70 when I'm taking Lipitor.

I'm actually pretty pleased: Even though my LDL is still above what it should be, it's not by much. In fact, this is officially the first time I've been able to bring my cholesterol down via any method other than drugs. Now that is something to celebrate!

Halle Berry, diabetes, and pregnancy

When I was searching for Halle Berry's quote about diabetes being a gift, I found a lot of celeb gossip that I hadn't been aware of previously: Apparently, she created quite a stir last fall by claiming that she had been cured of type 1 diabetes.

Of course, all of us with type 1 diabetes know that there isn't a cure — yet. Type 1 diabetes is caused when the insulin-producing cells in the pancreas die, which is a permanent problem. Usually this is caused by an auto immune response, where the body's immune system — for whatever reason — decides to attack the pancreas. However, I have also known of people who are technically type 1 diabetics, in that their bodies can't produce their own insulin, but who became that way via other means (i.e. alcoholism, exposure to chemicals used during the Vietnam War, etc.).

A possible cure for type 1 diabetes that is being explored right now is islet cell transplants. The problem with this is that until researchers find a way to stop the auto immune response, the body simply kills the new cells, requiring the procedure to be repeated periodically.

I don't think that Halle Berry's "cure" is from islet cell transplants, as some people have suggested. Rather, I think that it has to do with her pregnancy. I've heard from type 1 diabetic mothers that their insulin needs drop off significantly, and sometimes entirely, while they are pregnant. My old nutritionist, who specialized in working with diabetics, said the same thing.

I'm surprised that the "experts" used for this ABC News article didn't think of this possibility, but I guess this just goes to show how much confusion there still is regarding diabetes.

Berry's baby was born on March 16th. It is my guess that the happy mother will soon find (if she hasn't already) that her blood sugars are rising, despite the diet that "cured" her during her pregnancy. Whether she will publicize her mistake — now that's another matter entirely.