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Front Page » August 24, 2006 » Focus on health » The dilemma of diabetes
Published 2,959 days ago

The dilemma of diabetes


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By RICHARD SHAW
Sun Advocate publisher

Almost everyone knows someone with diabetes.

Almost everyone knows that it has to do with blood sugar.

Almost everyone has heard that there are two types of diabetes, Type I and Type II.

But few people, unless they have it, know the kinds of changes that a life must take when a person is diagnosed with the disease. Those changes are easy to generalize to the layman, but very specific to the person dealing with them.

"I was diagnosed right before my birthday and I remember being mad because I couldn't eat cake," said Liz, a 48 year old office worker in Price who has Type II diabetes. "But as I learned more, it didn't mean I couldn't eat cake, but it did mean I had to change my overall lifestyle."

Step 1: Insert the test strip in the meter.
Step 2: Prick a finger to get a small drop of blood.
Step 3: Contact the blood with the test strip.
Step 4: Read the meter. In this case the 98 is a good reading.

For Kelly, a 26 year old who works in an educational setting in Carbon County, the change was hard to remember, because she was diagnosed with Type I diabetes at the age of five.

"I remember my mother took me to the doctor because I kept having yeast infections," she explained. "And he asked me if I was going to the bathroom a lot and if I was thirsty all the time. But I don't remember too much about the differences in my life until I reached junior high."

For Rose, who was diagnosed with high blood sugar in her 20's and then was told by a doctor that she had Type II diabetes when she was 46 the changes in her life were gradual, and now at 53 she sees a lot of the results of what the disease can do over time.

"For me the dietary changes were a struggle," she said. "It was depressing to have to change so much of what I ate. The regimen for treatment started with one pill. Now I take three big shots of insulin a day. They often hurt and burn."

Different stories; different results; different ages.

There are 20.8 million children and adults in the United States, or 7 percent of the population, who have diabetes. While an estimated 14.6 million have been diagnosed with diabetes, unfortunately, 6.2 million people (or nearly one-third) are unaware that they have the disease.

"I just went in for a checkup because I hadn't had insurance for a few years and I had finally received it at work," said Liz. "It was a total surprise to me. At first when they tested me they thought it might be a screwy thyroid. My blood sugar was through the roof; 550. I didn't have any symptoms at all, I felt fine except that I was tired in the afternoon."

Some people think those that eat lots of sugar will get diabetes. Others believe that only those who are overweight can get it. Still some others, think the disease is something that can be "caught."

But the first two are not necessarily the case and the idea people can be infected with it like a cold is totally incorrect.

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.

When the pills either don't work or the diabetes gets worse, diabetics need to learn to give themselves injections of insulin. Two different types exist, a fast acting and a long lasting. A physician must determine what a diabetic needs for their health. Some diabetics require a regular supply of insulin and doctors then prescribe an insulin pump, which gives a more continuous supply and can be adjusted by the person who is wearing it.

In order to determine whether or not a patient has pre-diabetes or diabetes, health care providers conduct a Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT). Either test can be used to diagnose pre-diabetes or diabetes. The American Diabetes Association recommends the FPG because it is easier, faster, and less expensive to perform.

With the FPG test, a fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes. A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes.

In the OGTT test, a person's blood glucose level is measured after a fast and two hours after drinking a glucose-rich beverage. If the two-hour blood glucose level is between 140 and 199 mg/dl, the person tested has pre-diabetes. If the two-hour blood glucose level is at 200 mg/dl or higher, the person tested has diabetes.

But while these tests show if the disease exists, they still can't show the human experience that is tied to this insidious disease that creeps through the body and can affect everything from the feet to the eyes. It can also affect relationships.

"When I was a kid and I went to parties the parents would treat me differently," said Kelly. "They would say things like 'Gee I don't know if you can eat that sandwich because of your diabetes.' There was almost a stigma attached to the disease. It was very annoying."

Kelly can remember that when her blood sugar got high she got this dry sticky alcohol taste in her mouth. She even gets it at times today.

Kelly also had to eat snacks between meals and some kids, particularly in school, wondered about that. Then came junior high, a tough time in any ones life, but even tougher for a Type I diabetic.

"One day at school I went into insulin shock and had convulsions," she said with a sad voice. "From then all the way until I graduated from high school I got teased about that."

After high school Kelly was like most teenagers rebellious and didn't take care of her diabetes very well.

"I was angry that I had to have this disease," she said. "I chose not to take care of it. But a child with a chronic disease has to grow up; I was ultimately the only one that could be responsible for my health. No one else could tell I was high or low, only me."

Kelly also discovered that diabetics heal slower than other people.

"If most people get a cut on them they heal in a certain amount of time," she said. "If I get a cut it usually takes me twice as long."

But cuts can mean much more than a little longer healing time, particularly in certain parts of the body, including the feet. A cut can lead to much more serious consequences. The feet themselves are a very sensitive area for diabetics.

"My feet are always tingling, like they have pins and needles in," said Rose. "They are very sensitive."

Some of the symtoms of diabetes are extreme thirst, frequent urination, fatigue, shakiness or nausea. The problem is that many people with diabetes either have these symptoms slightly or they have none at all, so they don't know anything is wrong.

For Kelly the same is true; if someone touches her feet she goes through the ceiling.

But there is also much more than just tingling in the feet.

"I have a lot of medications I take besides insulin," stated Rose. "That's because of all the complications that can be related to my diabetes."

The Salt Lake area social worker says she has high blood pressure, which must be controlled because of the problems with her kidneys that resulted from the diabetes.

"All I can say is that anyone who gets diabetes should find a good endocrinologist because they will save your life," she states. "My diabetes has become worse over the last seven years. I began by taking just one pill then a few more and then along with the pills for various things, the insulin. But the medication isn't the total answer either. You need to be as active as possible and eat correctly."

Rose says that all the pills and injections don't make up for the health that is lost to diabetes. The drugs have side affects, so those that can control their situation with diet and exercise should always count on that more than drugs.

Diabetics often have trouble with their eyes, so they need to have them checked by an ophthalmologist regularly. Most diabetics have hemorrhages behind their eyes in the sockets. Only an ophthalmologist can see those.

Problems can also arise with the heart and liver as well. While Type I and II diabetes are well known, there are some rare types of diabetes that attack other organs such as the liver. All diabetics need to worry about organs being affected by their disease however.

For Liz, who was only diagnosed three years ago, life is different. So far she has been able to control the disease with only a couple of pills a day. So far so good.

"My doctor calls me a poster child for diabetes, because I keep my numbers down and the disease hasn't progressed," she said. "My lifestyle hasn't changed that much but no more pints of ice cream eaten in one sitting. The other day I took my daughter to the ice cream shop and she had a bowl, I had a spoonful."

What to eat can be a dilemma, probably one of the biggest in this odd disease. Liz says that you can't ignore the world though.

"My family has to go on living," she says. "It just makes you think about what you are eating. It's not just sugar, but carbohydrates as well. Some people think that if you are eating corn and peas that would be healthy, but for a diabetic both have carbs and sugar. Bread is my biggest downfall; much harder to resist than candy. You just have to be aware of what goes in your body."

For Kelly, life has changed once she started to manage her diabetes.

"I found my husband and that gave me a reason to care about my disease," she said. "Now I count carbs and know how, and care how, to react to what I eat. As you get older diabetes can be more devastating, because your organs get weaker and that is what the disease will go after; the weak points in your system."

Kelly now has an insulin pump which gives her insulin whenever she needs it. She can adjust if for changing needs too. The pump is mounted so that it feeds right into the bloodstream and every once in awhile it must be moved or what diabetics call "moving my site."

Infections are a big problem for diabetics. Even a slight one can be dangerous. And major surgery becomes even more anxious than it is for others because of the chance of infections and blood clots.

But even with the advanced technology, diabetics must be careful, because it is still about taking care of their bodies.

"It's worth it to take care of yourself," says Rose. "If you don't you can face a lot of terrible things like amputation, blindness or heart failure. The right doctor can make all the difference."


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