Diabetes Details 8: The Damage

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My father has had type 1 diabetes for 36 years.  A long time ago, I remember him talking about the disease, saying it was strange to know what would probably kill him.

When your Dad says something like that, it sticks.  When you’re diagnosed with the same disease years later, those words come back again loud and clear.

Of course, these days we’re better off, with five-second glucose tests, insulin pumps, and the first generation of continual glucose monitoring systems (for those with good health coverage and access to such things).  I’ve been able to keep my diabetes under pretty good control for more than a decade.

With the standard disclaimer that I’m not a doctor, I’ve seen what uncontrolled diabetes can do.  I used to play racketball with a man who lost his foot.  My mother donated a kidney to a family friend who was on dialysis.  My father has good control, but has lost a little sensation in the fingertips.

In some ways, I think of diabetes as a video game.  A serious game, but a game nonetheless.  The object is to keep my score (blood sugar) between 70 and 140.  Use food, exercise, and insulin to stay within the bounds (and don’t piss off the diabetes fairy on level six).

When the score dips below 70, I start to get into trouble.  Low blood sugar (hypoglycemia) is an immediate danger.  I sweat and feel shaky.  My brain gets a little fuzzy.  I’ve never been drunk, but I imagine it’s a bit like this, with confusion and loss of coordination, not to mention some mood swings.  If it gets worse, you can have seizures, slip into a coma, and die.

Hypoglycemia can hit fast and hard.  I usually feel when I’m getting low, and can scarf the nearest convenient source of glucose.  (I keep a candy dish on the bedside table.)  But if you go low too often, you can start to lose that awareness, which is both scary and dangerous.

Whereas hypoglycemia hits fast and hard like a barbarian, high blood sugar (hyperglycemia) is the ninja of diabetes.  My blood sugar can creep up to 200 or more without me noticing, because there’s no immediate effect.  But in the long term, the ninja will Mess You Up.

High blood sugar can damage the eyes, kidneys, nerves, heart … it’s nasty.[1. And for some reason, if I'm too high, I start to get pimples.  Damn pimple ninjas.]  Sugar-laden blood cells rip up the tiny blood vessels of the eye.  Nerve damage causes loss of sensation on peripherals, so you might not notice that infected cut on your foot until it spreads.  And diabetics tend to heal slower…

In the meantime, high blood sugar paradoxically means your body isn’t able to use the sugar in your blood, so you begin to rapidly break down fat for energy, releasing toxins into your system. This can lead to a condition called diabetic ketoacidosis.  It’s an effective way to lose weight … if you don’t mind killing yourself.  (I dropped 30 pounds before I was diagnosed.  I don’t want to know how long it took for my system to recover.)

Brief soapbox: I’ve known people who deliberately went off insulin in order to lose weight.  That’s right, we’re so freaking obsessed with weight loss that poisoning killing ourselves is an acceptable way to drop a few pounds.[2. It was pointed out that ketones aren't actually a toxin, but that they mess up the body's pH and cause a number of other nasty side effects.]

High blood sugars don’t generally kill you right away.  If I go to a con and enjoy cheesecake after diner, my sugar might hit 250 a few hours later.  But I test often at cons, allowing me to bring it down pretty quickly. My HBA1C, a long-term average measure of blood sugar, usually comes back around 6.0 (upper normal).  Even though I have the occasional spike, my overall control is pretty darn good.

Perfect control isn’t possible yet, but I don’t plan to let this thing kill me.  Taking care of the disease is a pain in the ass, but it’s far, far better than the alternative.

Comments and questions are welcome, as always.