Diabetes Details 8: The Damage
Previous diabetes posts are available by clicking the diabetes tag.
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.
June 9, 2010 @ 10:58 am
It sounds like you’ve got pretty good control over it and I can imagine – based on posts on many other things I’ve read – you’ve done some very in-depth research on it.
This may be strange, but one of my biggest fears is that I have diabetes and just don’t know it. Of the fears to have, I feel that’s a weird one.
June 9, 2010 @ 11:07 am
My mom had diabetes. She passed away from cancer, but she still had to watch her diabetes. I forced my dad a few months after my mom’s passing to get tested for it. I knew he was showing the same symptoms that my mom had shown. So, I was right (one of those things when being right sucks). But, because of the 50-60 pounds that he lost in the ensuing years, he was told that he did have it anymore. My brother is diabetic and his wife gets gestational diabetes when she’s pregnant. My wife was borderline gestational with our second child.
I’ve been lucky and eluded this disease. But each time I get my physical, I ask to be tested for diabetes. So I take a semi-proactive approach. Watching Celebrity Apprentice, I was pleased to see Bret Michaels choosing one of the diabetes charities as whom he was playing for (didn’t want him to win, but was glad to see them get some money.)
Anyway, this disease has affected various family members in my life, both blood and non-blood relatives. Many friends, co-workers, and people I stalk–er–follow their career deal with this. Good job at winning the game!
Jim C. Hines
June 9, 2010 @ 11:08 am
Hm … maybe DD9 should be something about the warning signs.
Are there any particular symptoms you’ve noticed that make you worry you might have it?
June 9, 2010 @ 11:11 am
Excellent article, Jim.
Although I’d point out that ketone bodies aren’t actually a toxin; the body produces them as an alternative source of energy in a time of starvation (or pseudostarvation). They’re not wonderful for the body, since they push your pH into the acidic range, especially if enough are produced to overwhelm the body’s natural pH buffering system.
People with DKA tend to be incredibly dehydrated, and have dangerous and touchy electrolyte imbalances. These are the really dangerous parts.
For example, their potassium levels are usually scarily high…even though their total body potassium is actually depleted. So you have to find a way to get their potassium to go back into their cells where it belongs (so their high potassium doesn’t cause heart arrhythmias), IN ADDITION TO replacing their depleted potassium…so their low potassium doesn’t cause heart arrhythmias. Insulin is really good at chasing potassium back into cells. So people with DKA are treated with LOTS of fluids, an insulin drip, and electrolyte replacement (electrolytes are things like sodium and potassium, etc.) coordinated with repeated measurements of their electrolyte levels.
Jim C. Hines
June 9, 2010 @ 11:24 am
Thank you! I appreciate the clarification, and have updated the article to hopefully fix that mistake.
June 9, 2010 @ 11:29 am
Not that I can think of. ><
I don’t think there’s even any history of it in the family.
Warning signs would always be a nice post. Maybe put my mind at ease… or at least give me something to be paranoid about! 😀
June 9, 2010 @ 12:39 pm
Another great post. This disease still confuses the heck out of me every day I can at least say that control seems to be coming faster than understanding. Back in February of this year my A1C was 11.1 and I was told I needed to go on insulin (which we’ve briefly discussed prior). June 1st was my new check and after three months of work my A1C was 7.0. It sometimes amazes me the crazy things our bodies can do. I’m always glad to find posts from people not scared (or at least in digital appearance) to let others know about things like this.
Jim C. Hines
June 9, 2010 @ 2:28 pm
I don’t think it’s a game you can win (at least not with current technology). Kind of like D&D … there’s no clear winning, but you can continue to beat the bad guys back, gain some new experience points, and keep on playing.
I’m glad you were able to get your dad in to get tested. One of the nice things about type 2 diabetes is that it can go into remission with weight loss. (Type 1 doesn’t have that possibility, unfortunately.)
Stay healthy, okay?
Jim C. Hines
June 9, 2010 @ 2:30 pm
11.1 to 7.0 in four months is awesome. 7 is the target ADA recommends diabetics try to hit or beat, isn’t it? Regardless, that’s great work — congrats!
June 9, 2010 @ 5:05 pm
Glad to hear you’re really taking care and keeping it under control, Jim. As someone who’s done the whole sugar-free dieting before, I know how hard it is to try to steer clear of sugar-filled foods in our sugar-obsessed society. But in your case, it’s more than shedding a few pounds that’s on the line… must be tough. =\
I actually had a question about what you said about ketones messing up your pH etc. As I mentioned, I’ve been on low-carb, sugar-free diets like South Beach before and those diets basically work on the principle of putting your body in ketosis and leaving it there. I can see why they wouldn’t mention that ketones flooding your body is dangerous/poisonous in their official literature, but since you mentioned it, I’m a little worried. Can you give me any further details on why ketones are bad for you?
June 9, 2010 @ 5:05 pm
My father was diagnosed with type 1 when he turned 40 (happy birthday) and my father-in-law has had type 1 since he was a kid. For my dad, he was skinny to begin with and got even skinnier. He’s had some other side effects, but nothing too extreme. There was one time he got sick and didn’t tell me right away (I was age 16 or 17 at the time while my mom was out of town) and he almost died.
My father-in-law on the other hand, has had a laundry list of medical problems, pretty much all stemming from diabetes. He’s blind now, has had kidney transplants, takes about 1,000 different pills a day, goes to one doctor or another at least once a week, the list goes on. He takes it all in stride, though, and is one of the most capable people I know. He’s really inspiring that way.
My wife and I are fortunate in that we don’t have diabetes, but we worry that it might rear its ugly head in our children.
Jim C. Hines
June 9, 2010 @ 8:51 pm
I’m not a doctor, so my answer is going to be fairy limited. Breaking down diabetic ketoacidosis (DKA), you’ve got the diabetic part (i.e., caused by the diabetes), the keto- part (ketones), and most importantly, the acidosis part, meaning your body’s chemistry gets pushed too far into the acidic.
The difference between the ketones produced from healthy dieting vs. untreated diabetes? My guess — and it’s a guess only — is that it’s a matter of degree. DKA is extreme. I dropped from about 160 pounds down to 130, and it happened pretty darn quickly.
However, like I said, this is just a guess. I’d strongly advise not taking my word for this, and talking to a doctor or a dietician.
Jim C. Hines
June 9, 2010 @ 8:54 pm
I worry about it with my kids too, but at the same time, I see how far the technology has progressed between my father’s diagnosis and my own. If it keeps up at this rate, by the time one of the kids is diagnosed, I’m guessing the treatment will be to the point where it’s little more than a nuisance. (I’m hoping so, at any rate.)
June 10, 2010 @ 1:25 pm
Lol, okay, I’ve got it, Jim. Thanks for taking a crack at it anyhow. I have the feeling you’re probably right since the name for ketone flooding is different (ketoacidosis) in the diabetes case as opposed to the diet case (ketosis). I did try to find dissenting arguments about South Beach before starting it and didn’t run across anything about increased acidity, etc, so it’s probably cool. Thx!
June 10, 2010 @ 3:00 pm
my boyfriend and my best friend both have diabetes. he has type two and was just recently diagnosed and she has type one. From what I’ve seen type one seems like more stress to deal with but she has the cool pump thing so she can adjust her insulin whenever need be. it’s pretty sweet.
Jim C. Hines
June 10, 2010 @ 3:36 pm
The pump is quite nice. (I’ve been on one for … I don’t even know, at least five years now?) Both types are a pain, but in slightly different ways.