Thursday, July 15, 2010

Diabetes - it sucks.

I know there are many diseases in the world that are worse. Since Banting and Best discovered insulin (Go Canada!!) it is not a death sentence, but it is still a life sentence, and anyone battling chronic illness knows it can be exhausting and frustrating even when things are going well. And when they are not going well, it seems really unfair how easily the rest of the world (or so we perceive it) has it in their unmedicated, uncomplicated lives.

I also know that compared to many others who share the same disease, I have had a relatively easy time of it. I have type I diabetes - what used to be called juvenile diabetes, because so many with this type are first diagnosed when they are children - which means my pancreas does not produce any insulin. The only way to control it is by taking injections of insulin several times a day. Unlike most, I was not diagnosed until I was 20 years old and able to understand and treat the disease myself, and I was gifted with a childhood free of shots and pain and complications.

I have had two healthy children, without any of the major complications that are so much more prevalent in diabetic pregnancies.

I have now lived almost 15 years with this disease, and so far I have avoided any of the major complications which the disease tends to bring.

But at this point in time, there are therapies and no cures. The complications - including such things as blindness, nerve damage, amputation, heart disease, stroke, kidney failure, etc. - are not to be avoided entirely, but merely postponed. And after 15 years, it feels like I am coming to the end of the carefree invincibility I felt at the beginning of this journey.

I am not entirely blameless, either. When I was first diagnosed, this disease was new, and scary. The doctors gave me the rules for how to manage the disease, and I followed them religiously - because in my mind, if I didn't, I would die. There was a strict schedule - eat this, at this time, and take these shots, at these times. And it worked really well.

But real life does not always allow for clock-regimented meals and shots, so I learned some flexibility - how to adapt if lunch was late, or how to compensate for a slice of birthday cake for a special meal. I needed to learn these things to avoid life-threatening episodes of low blood sugar when food was going to be late, and adjust for uncomfortable but less-dangerous* episodes of high blood sugar if I ate more than the specified amount.

*Notice I said less dangerous, not un-dangerous. High blood sugar will not kill you immediately, but high blood sugar is a cumulative threat that over time will bring about all of the most unpleasant complications of diabetes.

Diabetes is a constant balancing act. When the body does not produce insulin, it cannot break down the sugar you eat to provide the energy your cells need to function. Diabetics take injections of insulin, but it is a guessing game to get the right amount. Too much will mean all of the sugar is used up too quickly. Too little will leave excess sugar behind.

Excess sugar hangs out in the blood, and gets in the way of a lot of important functions. It will slowly destroy small blood vessels, killing off nerves one by one, destroying sensation and in the eyes, sight. It helps out the plaque buildup that leads to heart disease and stroke. And it gets in the way of immune function, making you more susceptible to any germ you come in contact with. Unless it gets very, very high, high blood sugar has very few immediate effects other than increased thirst and urination as your kidneys try to filter and flush out the extra sugar - which, by the way, eventually causes kidney disease, too. If you bring the blood sugar back down, these symptoms disappear. But the effects of high blood sugar add up over time. So a few hours of high blood sugar won't do much. But a few hours day after day, year after year, will eventually add up to irreversible damage to a lot of important body parts.

But if there is too much insulin, then you get immediate bad consequences. Once the sugar has all been used up, there is nothing to power important cells that need constant energy - like your brain. You get shaky, and weak, and then stupid, then quickly lose consciousness and go into a coma. If no one is around, you can die right there. If you are very lucky, someone around you will figure things out and feed you sugar before you lose consciousness, or medical personnel will be available to get you IV sugar, hopefully before the coma is irreversible.

I have had a few episodes get to the stupid stage (not enough brain power left to feed myself sugar) and only a couple got far enough to require medical intervention. It is not an experience I want to repeat (for myself, or the people around me that I scared spitless!), so it should be pretty obvious why I make a lot of effort to stay away from that extreme.

But like I said it is a balancing act. Picture it as a road, with a very narrow but windy path - say, barely as wide as the width of your foot. On one side is a cliff that falls millions of stories to certain death. On the other are some really sharp, nasty rocks covered with dirt and germs and crap. Now walk this blindfolded. Obviously, you want to stay on the path, but if you have to step off, even if the rocks are gonna hurt, it's gotta be better than certain death.

If it was a straight road, it would be easier right? But that's the other fun (hear my sarcasm here) part about diabetes. Besides the fact that it can be very difficult to calculate the amount of sugar (carbohydrates) a given food contains, it's not just a direct relationship between the food you eat and the insulin you need. There are a million other factors that can bump it one way or another, and they are all invisible. More exercise usually lowers the amount of insulin needed. But then occasionally vigorous exercise can cause the body to excrete extra sugar it had stored in the liver. Alcohol? Can make the insulin work better than normal, or might just boost blood sugar because of the extra carbs it usually contains. Stress? Can cause sugar to either raise or lower. Illness? Can also cause problems, but you guessed it - may push the sugars either direction. Hormones? Insulin will work better or worse depending on a woman's time of the month.

It's complicated, and occasionally frustrating, depressing and infuriating. But I have no choice, so I have to keep playing even if the game is rigged.

That's enough of a lesson today class. I've probably bored to tears anyone who stumbled across this post. Anyway, thanks for reading.

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