Diabetes

I seemed to have gone through much of my life with no serious health issues. I had the usual complement of broken bones, various colds and infections, and so on, but nothing you would call really serious. But while I was going about my business unaware, something was happening, but I did not recognize it. When a change is gradual, you often don’t notice it.

I was  professor of economics at a local college, and got in the habit of having a drink with me. Usually it would be a diet pop, because it seemed I was always trying to lose weight. But if necessary it would be water. And I needed it. After all, as a professor I was lecturing for as much as an hour, sometimes even longer, and all that talking made me thirsty. And drinking diet pop is not a problem, right? One semester I had a class that was in the Library, and there were signs at the entrance that said you couldn’t bring in any food or drink, but that didn’t apply to me (I thought) since I was faculty. I do remember one of the librarians glaring at me, but what was his problem? I didn’t realize my thirst was getting worse as time went on.

Then one day I was at the computer, and I didn’t feel right. I had trouble describing it, but I called my doctor and said it was kinda-sorta like when you are on a roller coaster, and your stomach has that funny feeling, except I was not on a roller coaster, I was sitting in front of a computer. My doctor said he had no idea what it was about, and that I should go to the emergency room. I did so, and again tried to explain what I was feeling. They did some tests, and were not having much luck diagnosing the problem, when a nurse said “You know, your blood sugar is 300. Maybe that is the problem.”

I had become diabetic.

This began a journey that I am still on, because this is one of those things that when it happens, generally does not go back. More testing confirmed the diagnosis. I was around 50 at the time, so it was not like some people who get the disease as kids and grow up with it. My doctor started me on oral medications to help control the disease, and told me that the key to control was diet and exercise. As it turns out, that is the key to a whole bunch of health issues.

I was not someone who did much exercising on a regular basis. I did on occasion play some volleyball, but not as part of a league. And I did walk the dog pretty regularly. But I was overweight and not in particularly good shape. Possibly that contributed to my getting the disease, but I don’t know if anyone can say that for certain. In any case, my doctor made it clear that I needed to make some changes. For exercise, I looked around and found that the local high school offered Water Aerobics several times a week. That is mostly doing calisthenics while in a pool, and I’ve always enjoyed being in water, so I signed up. I have since added more exercises of various kinds, but it was a start.

On the diet side, my doctor had me focus on reducing fat intake, so I did. I remember talking to my sister about it, and she thought it was odd since diabetes is about sugar, not fat, but I went along with what my doctor said and reduced fat intake. I can remember getting up on a Saturday morning, picking up a couple of donuts, and heading for the pool. I realize now that was a serious mistake, and I have learned that my doctor thinks fat is culprit for most problems. I now allow for that, but overall he is a pretty good doctor, just a bit overboard on this one issue.

What is Diabetes?

First, a disclaimer. I am not a doctor, but I have had the incentive to study up on this. So I think I have it right, but you should always talk to your doctor if you have any concerns. Put another way, you would have to be an idiot to rely on me for medical advice.

Diabetes is a disease of the sugar metabolism. There are two types, called unimaginatively Type I and Type II. I have Type II. What the two kinds have in common is a high level of sugar in the blood, which in turn is due to issues with insulin. Insulin is a hormone produced by the pancreas and has the purpose of taking sugar from the bloodstream and moving it into cells where the sugar can serve as a source of energy. In Type I diabetes what you have is an autoimmune disease where the body mistakenly targets the cells in the pancreas that produce insulin and destroys them. With no cells, you have no insulin, so the blood sugar builds up. In Type II diabetes the insulin is being produced more or less normally, but your cells are much less responsive. So you have both sugar and insulin in your blood, but the sugar builds up. Your body know that too much sugar is bad, so it tries to get rid of it in other ways, such as by having the kidneys remove it and put it in your urine. So you start to pee more, and develop a raging thirst as your body tries to keep up a flow sufficient to remove the excess sugar. That is why I could not go an entire hour without a drink in my hand. This also explains why in the days before more sophisticated testing the main symptom of diabetes was sugar in the urine.

Health Issues

Diabetes can cause serious problems if not controlled. Among the problems are:

  • Retinopathy – The blood vessels in the back of the eye may start to bleed. Initial symptoms may include flashing lights and spots in your vision, cataracts, and glaucoma, and if untreated blindness can result
  • Neuropathy – The nerves in your extremities, particularly legs and feet, become damaged. You may begin to lose sensation there. You could injure yourself and not know it, sores may not heal, and in extreme cases gangrene can lead to amputation.
  • Frequent infections
  • Kidney problems (Nephropathy)

In other words, this is not something to take lightly. Something that can make you go blind or cause you to lose body parts is a serious bummer.

My Experience

As I said, I started on oral medications, began to add exercise, and reduced my fat intake. I got a blood glucose meter, and have taken a reading a every morning (this is called “Fasting Glucose” and it is important) to make sure I am in the right ball park. This meter gives me a reading of my blood glucose in terms of milligrams per deciliter. My doctor also had me go the the local lab every few months for a blood draw (again, a fasting blood test first thing in the morning) which would test for a number of things, but most importantly something called Hemoglobin A1c, or HbA1c, which is a measure of the  average blood glucose over the previous 2-3 months. For daily blood glucose, a normal reading in the morning should be under 100 for a non-diabetic. And the HbA1c normal reading is below 5.7 for a non-diabetic. My numbers were not like that. Most mornings I would be around 140, and when my HbA1c was measured it was around 7-8. Those are not the worst numbers ever, but they aren’t particularly good either. Over time, the levels of my oral medications were raised to keep me from getting any worse, but there were limits. My doctor was hinting that insulin injections were next on the list.

And that is when I read a book that changed my life. It is called Dr. Bernstein’s Diabetes Solution. His approach is based on extensive experimentation, and the essential insight is that you can manage your diabetes though a combination of diet, exercise, and medication, to the point where you are functionally a “normal, non-diabetic” person. And the key I was missing is that I was focused on fat in my diet, when I should have been focused on carbohydrates. I learned that carbohydrates are always turned into sugar in your blood, so minimizing carbohydrates becomes the essential move. At the beginning of 2013 I decided I needed to try this after reading his book. Fortunately we have labeling laws in the US to require prepared foods to list the carbohydrate count, and I could get charts for the unprocessed things like fruits and vegetables. I eliminated all grains and starches from my diet, and went to much higher levels of fruits and vegetables. That means no bread, and no potatoes for this Irishman! No rice, no corn, no oatmeal. You get the idea. I now read labels like a hawk, searching for carbohydrates. I have learned that food manufacturers are very sneaky about putting in sugar in “disguised” forms, such as calling it something like “dextrose” or “maltodextrin”. And I eat a lot of salad. At least one meal a day, sometimes two, is all salad.

And how has it worked? On almost every day my fasting blood sugar is between 70 and 80. And my HbA1c is in the low 5 range, and has never gone above 5.7 (usually it is around 5.3). I have now had 3 different doctors tell me that my blood sugar numbers no longer look like those of a diabetic. To me that means that as long as I continue on the path I am on of diet, exercise, and oral medications, I can go about my business like I don’t have a disease. In 2016 my wife and I went on a bicycling trip in Europe, and in 2017 we went hiking out West in the US in places like the Grand Canyon and Rocky Mountain National Park. So I am in pretty good shape for an older man with diabetes, and I plan to stay that way.

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