Diabetes and Me (part 1)

(The original of this was eaten by the broken Blogger/Chrome interaction. You'd think that two Google products might at least be able to co-exist, wouldn't you? Not in our lifetime.)

This post is inspired by melanie who commented on my remark about diabetes control in my Super Bowl Sunday post.

I come from a family of diabetics. My dad was one of six kids, five of whom were or are diabetic. The only one that wasn't a diabetic died rather young so might have been in his later years if he had survived. As a result, I grew up seeing the consequences of both taking care and not taking care of the disease. I watched a beloved aunt die by pieces, losing a toe here, a finger there, a foot, then a leg, an arm, ... until finally there were no more pieces that could be removed and she died. All due to the complications of poorly controlled diabetes. And I watched my dad and mom work hard to keep dad's diabetes under close control. It came as no real surprise to me when I finally failed a glucose tolerance test and joined the diabetic crowd. Given my background, it had always been a matter of time. I decided early on to attempt close control, trying to keep my blood glucose levels as near to non-diabetic levels as I could.

For the uninitiated, blood glucose is measured in two ways today. One is a blood draw test that can determine levels looking back in time for roughly 6 months, called an A1c test. It is the gold standard test since you can't lie and cheat to make it look good. It is reported in % with 6% being the goal (a non-diabetic will have an A1c between 5.5 and 6.0) The other test is the well known finger prick measurement that is immediate and reflects an estimate of the Mean Plasma Glucose (MPG) at that moment. It is measured in units of mg/dL in the US. An A1c of 6% corresponds roughly to 135 mg/dL MPG. A normal non-diabetic will have MPG readings between 90-105 mg/dL. Both tests are needed because an A1c test will not reflect the transient variations of a "brittle" diabetic but the MPG test will.

Each person reacts individually to high or low blood glucose. One of the hazards of poorly controlled diabetes is that the body stops reacting to highs and lows and a person can be in trouble with no sense of danger. Because I have managed pretty good control over the decades, I still have pretty much the same reactions today as I had when I was first diagnosed. I keep that control by a combination of exercise and drugs. Most diabetics will have to adopt an exercise regimen or they will not be able to control their blood glucose levels. And then over the years they will suffer all the complications.

I go through all of the above to get to this point: people don't realize how deeply blood glucose levels and emotional state are connected. I learned early on that my emotional state was tied to my glucose level and not in pleasant ways. Each person reacts differently, but in my case:

• blood glucose 90 to 155 mg/dL - emotions are normal and I feel normal.
• blood glucose greater than 180 mg/dL - I am in a constant state of anger and diffuse rage. I am mad that the chair is holding me up and that the computer has keys and ....
• blood glucose less than 70 mg/dL - everything is sad. I cry because there is an ad on TV and I cry because there isn't an ad on TV, etc.

If my blood glucose drops below 60 mg/dL, things get real interesting real fast. First my body starts shutting down unneeded systems to make sure essential systems like the heart can keep working. For me, color vision processing disappears first. All of a sudden my world is black and white. Then mental acuity goes away as the brain starts shutting down. (The brain is one of the organs that consumes the most energy in a human) Finally, at around 30 mg/dL I pass out. I cannot recommend going through this. Once the mental acuity starts falling off, you cannot act to save yourself even if you dio catch on to what is happening. That is why I always tell people I am a diabetic. If I start acting strangely or if I do have a glucose drop out, the fact that someone knows what is going on may save my life.

Given all of the above, my goal has been to keep the glucose level in the 90-150 range and thus the A1c in the 6% to 6.4% range. I have to admit that I have had my blood glucose drop to the 30mg/dL level only once in my life and that was the result of a drug interaction. On the other hand, when I walk a round at one of the local golf courses and don't eat a snack before starting, I can pretty much count on my color vision disappearing as I walk up the long hill on the 17th hole. Makes putting interesting. {*grin*}

So that's the story. Any questions?